Registered Dietitian Nutritionists Research Articles

Pretransplant Malnutrition, Particularly With Muscle Depletion Is Associated With Adverse Outcomes After Kidney Transplantation.

Kidney transplant centers lack consistent diagnostic malnutrition tools. The Academy of Nutrition and Dietetics and American Society of Parenteral Nutrition Adult Malnutrition Criteria (AMC) is the widely accepted and utilized tool by Registered Dietitian Nutritionists (RDNs) to diagnose malnutrition. In this single-center, retrospective observational study, we evaluated the outcomes of prekidney transplant malnutrition based on Academy of Nutrition and Dietetics and American Society of Parenteral Nutrition AMC, as well as the individual components of the AMC, on posttransplant outcomes including length of stay, delayed graft function (DGF), early readmission, cardiovascular events, acute rejection, death-censored graft failure, and death. Bivariable and multivariable logistic regression models were used to assess the association of malnutrition or its components with outcomes of interest. A total of 367 recipients were included, of whom 36 (10%) were malnourished (23 moderately and 13 severely) at pretransplant evaluation. In adjusted models, pretransplant malnutrition was significantly associated with increased risk for early readmission (adjusted odds ratio 2.86; 95% confidence interval: 1.14-7.21; P = 0.03) and with DGF (adjusted odds ratio 8.33; 95% confidence interval: 1.07-64.6; P = 0.04). Muscle depletion was also associated with an increased risk for readmission and with DGF. Fat depletion and reduced functionality in the adjusted model were only associated with increased risk for readmission. Malnutrition could be an important consideration for selecting kidney transplant recipients because it was associated with poor clinical outcomes. A multidisciplinary approach with the involvement of RDNs to outline a nutrition intervention plan may help mitigate some of the poor outcomes.

Evaluation of nutritional literacy among undergraduate nursing students

Background/Objective: It is difficult to describe or quantify the extensiveness and importance of the nurses’ role in direct patient care. Although Registered Dietitian Nutritionists (RDN) are available, it is often the nurse who is tasked with monitoring a patient’s nutritional status and carrying out nutrition interventions to optimize oral intake such as providing meals and oral supplements, as well as administering enteral and parenteral nutrition. Therefore, it is critical that nurses have an understanding of nutrition to promote good health. Although fundamental nursing courses stress the nurse’s role in promoting healthy nutrition as a means to prevent disease and assist patients in sustaining wellness, there is no standardized nursing curriculum enforcing an independent nutrition course within nursing programs.Methods: A quantitative methodology was used to explore the level of nutritional awareness as measured by the Nutritional Literacy Assessment Instrument (NLit) among BSN nursing students in a public, 4-year institution in the Mid-West of the United States. Nutritional literacy, as defined by Gibbs et al., students’ knowledge of food and associated impact on nutrition was evaluated. Results: The data indicated that 70% of participants had completed an undergraduate nutrition course, with the highest performance on the Nutritional Literacy Survey within the understanding of food groups.  Over 80% of respondents were found to have a likelihood of good nutrition literacy. Although no statistical significance was found between a pre-requisite Nutrition course and/or an integrated Nursing Nutrition course and Nutritional Literacy, statistical significance was found when examining student classification (sophomores versus seniors) impact on Nutritional Literacy scores.Conclusions: Promoting the integration of nutrition concepts across a variety of courses within the nursing curriculum will assist the student to utilize clinical judgment in the application and synthesis of nutritional concepts in relation to patient health and wellness.

Development of a bronchopulmonary dysplasia nutrition focused physical examination tool: A modified Delphi study.

The objectives of this study were to identify factors impacting nutrition needs in infants and children with bronchopulmonary dysplasia (BPD). A modified Delphi approach to obtain consensus among pediatric registered dietitian nutritionists (RDNs) was used to create a BPD-specific nutrition focused physical examination (NFPE) tool. RDNs, recruited through pediatric nutrition professional associations, completed a survey rating proposed NFPE components on a Likert scale of 1-5 allowing open-ended responses in a two-round Delphi. Responses were analyzed, deidentified, and results were returned to panelists for in-round feedback. Consensus was defined a priori as 75% agreement for usefulness or relevance ± 1 standard deviation. Six domains (anthropometrics, body composition, development, gastrointestinal, respiratory, and physical signs) and 38 components achieved consensus. Components for an evidence-based tool to enhance nutrition assessment in infants and children with BPD were identified with consensus agreement by an expert panel of 19 pediatric RDNs.

Knowledge and clinical practice of ASPEN registered dietitian nutritionist members regarding blenderized tube feedings.

Blenderized tube feedings (BTFs) are used by patients/caregivers who report improvements in gastrointestinal tolerance compared with standard commercial feedings. Despite positive outcomes, registered dietitian nutritionists or international equivalents (RDN/Is) hesitate to recommend BTFs. We aimed to determine if an association exists between dietitian characteristics and willingness to recommend BTFs. A BTF-specific survey (N = 157) assessed for validity and reliability was administered to the American Society for Parenteral and Enteral Nutrition (ASPEN) RDN/I members. Binary logistic regression analyses examined the association between age, years of clinical practice, BTF training/education, patient population served, and willingness to recommend BTFs. The response rate was 4.3% of ASPEN RDN/I members. Most respondents were White females with a median age of 39.0 years and 12 years of clinical experience. Although 98.7% of respondents expressed a willingness to support and 73% to recommend BTFs, 60% were not using BTFs in clinical practice. For 94.8% of RDN/Is, the primary reason for BTF use was patient/caregiver requests. After adjustment for age and years of clinical practice, RDN/Is who served pediatric populations (odds ratio [OR] = 4.28; 95% CI, 1.52-12.09) or used three or more professional resources (OR = 2.49; 95% CI, 1.12-5.57), industry-sponsored resources (OR = 3.15; 95% CI, 1.39-7.15), or one or more experiential learning resources (OR = 3.14; 95% CI, 1.38-7.17) were more likely to recommend BTFs whereas those serving adults were less likely to recommend BTFs (OR = 0.33; 95% CI, 0.12-0.95). Pediatric RDN/Is and individuals with BTF-specific education/training were more inclined to recommend BTFs.

Completion of a Nutrition-Focused Physical Exam with hospitalized adults and pediatric patients: Secondary analysis of a prospective cohort study.

Nutrition-Focused Physical Exam (NFPE) feasibility is not well-studied. We describe registered dietitian nutritionist (RDN)-reported NFPE completion for hospitalized adult and pediatric patients overall and by assessment parameters. Trained RDNs systematically conducted NFPEs for hospitalized adult and pediatric patients during the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition Indicators to diagnose Malnutrition multisite cohort study (ClinicalTrials.gov: NCT03928548). RDNs reported their ability to evaluate assessment sites for subcutaneous fat and muscle loss, fluid accumulation, and micronutrient status and to complete handgrip strength (adults and children ≥6 years) and mid-upper arm circumference measurements (children). RDNs noted if they could complete the full NFPE; if not, they noted challenges. We descriptively summarized results and used multilevel logistic regression models to examine relationships between patient characteristics and NFPE completion. RDNs from 39 adult and 29 pediatric US hospitals conducted NFPEs for 327 adults and 214 children aged 1 month to 17.9 years. RDNs reported completing the examination for 44% (n = 145) of adults and 15% (n = 33) of children. They successfully evaluated 25 of 27 and 19 of 26 unique NFPE components in >80% of adults and children, respectively. Common reasons the full NFPE was not completed were limited mobility in adults and patient refusal in children. RDNs had lower odds of completing NFPEs in adults with lower vs higher education levels or higher vs lower nutrition complexity and in younger vs older children. RDNs evaluated NFPE components for a high proportion (>80%) of hospitalized patients.

The Assessment of Nutrition Knowledge in ROTC Cadets

Introduction: The purpose of this study was to measure the nutrition knowledge of Army ROTC cadets before and after the implementation of nutrition education sessions presented by a registered dietitian nutritionist (RDN), while observing the effectiveness of nutrition intervention on this population.Methods: Army ROTC cadets (n=33; 19+1 years old) from a southeastern university participated in a 9-week study in which they completed a nutrition knowledge survey pre- and post- implementation of six nutrition education sessions. General nutrition knowledge (GNK) and sports nutrition knowledge (SNK) were measured via the Abridged Nutrition for Sport Knowledge Questionnaire (ANSKQ).Results: General, sports, and total nutrition knowledge (TNK) improved significantly between pre-survey and post-survey scores (p < .001; p < .01; p < .001, respectively). Independent samples t-test showed large t-score values (GNK t = -3.559; SNK t = -2.794; TNK t = -3.776), indicating a strong difference between the three groups. Army ROTC cadet ANSKQ scores significantly improved GNK from adequate to good, SNK from poor to adequate, and TNK from poor to adequate.Conclusions: The results of this study indicate nutrition knowledge is poor in ROTC cadets, but may improve from nutrition education interventions presented by an RDN.

Use of an Escape Room to Enhance Nutrition Care Process Skills and Self-efficacy

Application of the Nutrition Care Process (NCP) is a fundamental concept for students preparing to become registered dietitian nutritionists (RDNs). Adequate practice, within pedagogical methods designed to mimic actual dietetics practice scenarios as realistically as possible, is necessary to increase student NCP skill proficiency and confidence. This study assessed the impact of a virtual escape room experience compared with a traditional case study on both NCP skills and confidence in a senior didactic program in dietetics for undergraduate students. Results indicate that the escape room experience improved both NCP documentation (P < .001) and student self-efficacy (P < .001).

Treatment of functional bowel disorders in an integrative medicine clinic resulting in improved digestive tract symptoms.

Functional bowel disorders (FBDs), including irritable bowel syndrome (IBS) and others, are conditions without a physically identifiable etiology that, as a result, are difficult to treat. Alternatives to traditional medical interventions are needed because IBS patients require more of physician time and higher healthcare spending. The goal of this study was to determine the efficacy of alternative lifestyle interventions for patients with FBDs seen in an integrative medicine (IM) clinic at an academic medical center. We performed a retrospective chart review to determine whether patients with FBDs had improvement in symptoms following predominantly nutrition-based IM interventions that included recommendations for dietary supplements and elimination diets. We measured symptoms before and after intervention (average time between measurements 8.75 months) using a medical symptoms questionnaire (MSQ) commonly used to quantify symptom change in IM clinics. Digestive tract symptoms, as measured by the MSQ, improved significantly in patients (n = 57) with FBDs following IM intervention. The MSQ Digestive Tract subtotal for FBD patients decreased from 10.2 (SD, 5.4) to 7.2 (SD, 5.2) (P < 0.001) after IM intervention. Patients in an IM clinic had improved digestive tract symptoms scores following IM intervention. Because nutrition-based interventions were the primary intervention recommended by IM providers, primary care physicians and gastroenterologists may wish to consider referring FBD patients to registered dietitian-nutritionists (RDNs) skilled in implementing elimination diets.

COLLABORATION IN CARING FOR OLDER ADULTS WITH DEMENTIA LIVING IN LONG-TERM CARE FACILITIES

Abstract Current evidence calls for an interdisciplinary, team approach to caring for older adults with dementia. Registered dietitian nutritionists (RDNs) are interdisciplinary team members who play an important role in nutrition and dementia care. Our study explored how RDNs collaborate with licensed healthcare providers and direct care staff to provide nutrition care for older adults with dementia living in long-term care (LTC) facilities. RDNs who work with residents with dementia in the U.S. (n = 18) were recruited to participate in one of five focus groups, where they described the various disciplines they collaborate with. Focus groups were led by a trained moderator using a semi-structured interview guide, transcribed verbatim, and audited by the research team for accuracy. Transcripts underwent descriptive content analyses using NVivo© software. Descriptive content analyses revealed the following diverse groups who work collaboratively with RDNs: 1) nursing staff, 2) foodservice staff, 3) therapists, 4) physicians, and 5) other non-clinical staff, including activities staff and nursing home administrators. Additionally, RDNs reported they worked closely with residents’ family members and resident members of the food committee. In conclusion, in LTC settings, RDNs collaborate with various groups, encompassing clinical, non-clinical, and even residents/family to care for older adults with dementia. However, collaboration is not limited to clinical staff. To provide optimal nutrition care for older adults with dementia, it is important to recognize the value of collaborating with both clinical and non-clinical stakeholders to meet resident needs.

COMPREHENSIVE MALNUTRITION ASSESSMENT IMPROVES HEALTH OUTCOMES AMONG HOMEBOUND OLDER ADULTS

Abstract Approximately 30 percent of older adults are malnourished upon hospital admission while others develop malnutrition during hospitalization and subsequent discharge. High hospital readmission rates are associated with malnutrition. Malnutrition is common among older adults discharged to home and receiving home delivered meals. However, there is limited research on the appropriate malnutrition care for this population. The aim of this study was to investigate the effectiveness of a novel social determinants of health (SDOH)-based comprehensive malnutrition assessment (CMA) on malnutrition treatment and functionality. A pilot study of 46 participants recruited from northern Utah Area Agencies on Aging Nutrition Programs was conducted. The SDOH-CMA was performed during home visitations by a registered dietitian nutritionists for both the intervention and control groups over a six-month period. Logistic regression was then conducted to compare the effect of the SDOH-based CMA on malnutrition as assessed by the Nutrition-Focused Physical Exam (NFPE) between intervention and control groups. Odds ratios (OR) with p values were reported. At baseline, 91.4% of participants were white, 54% were female, 76% were unmarried, 67% lived below the federal poverty level, 61% lived alone, 51% received home health, 51% had anxiety, 33% had PHQ-2 screened depression, 22% were unable to cook, and 13% were unable to shop. The intervention group had significant improvements in the NFPE (OR=10.1, p=.02), calorie intake (OR= 19.6, p=.02), protein intake (OR=36.7, p =.007) and the Timed Up and Go test (OR=7.7, p=.05) than the control group. The intervention was significantly effective in improving nutritional status and functionality.

Saturated Fat Intake and the Prevention and Management of Cardiovascular Disease in Adults: An Academy of Nutrition and Dietetics Evidence-Based Nutrition Practice Guideline.

Cardiovascular disease (CVD) is the leading cause of death in the United States and globally and is largely attributable to atherosclerosis. Evidence indicates that multiple dietary components contribute to the complex causes of CVD and associated events and mortality. Public health authorities and scientific organizations have recommended reduced saturated fatty acid (SFA) intake for decades to promote cardiovascular health, which is linked to favorable impacts on established and emerging atherosclerotic CVD risk factors. Recently, a debate has emerged about whether SFA intake should be reduced for CVD prevention, which has contributed to confusion among health care professionals, including registered dietitian nutritionists (RDNs), and the general public, and necessitates the critical evaluation of the evidence. The objective of this evidence-based nutrition practice guideline is to provide health care and public health professionals, particularly RDNs, with evidence-based recommendations on how to address SFA intake in adults within an individualized healthy dietary pattern. Moderate evidence supports the reduction of SFA intake for CVD event reduction, low- to moderate-certainty evidence supports prioritization of replacement of SFAs with polyunsaturated fatty acids, and low-certainty evidence supports focusing on reducing the total amount of SFA rather than specific food sources of SFA. Guideline implementation should include consideration of individual preferences; principles of inclusion, diversity, equity, and access; and potential nutritional deficiencies that may occur with reduced SFA intake. Future research is needed to address gaps that were identified and provide high-quality evidence to support stronger future recommendations based on the relationship between SFA and CVD.

Comparison of virtual vs face-to-face medical nutrition therapy in patients with hyperlipidemia

Since the COVID-19 pandemic, utilization of telemedicine visits has increased. The outcomes of virtual compared to face-to-face (F2F) visits for treating hyperlipidemia are uncharacterized. This observational study compared pre- to post-visit change in lipid markers between 41 virtual and 151 F2F visits with a registered dietitian nutritionist at the University of Michigan Preventive Cardiology program from 3/31/2019–9/31/2022. Total cholesterol (TC), high-density lipoprotein (HDL), and triglycerides (TG) were collected pre- and post-visit with a median 33 days between collections. Low-density lipoprotein (LDL-C) was calculated using the Sampson equation. We used paired T-tests to evaluate mean change in lipid markers for each visit type between pre and post timepoints, and linear regression to compare virtual to F2F visits. There was a significant decrease in TC, LDL-C, and non-HDL-C for both visit types. There was no significant difference in mean change in lipid markers between virtual and F2F visits. Telehealth is a promising strategy for increasing access to medical nutrition therapy.

Standards of Excellence in Nutrition and Dietetics Organization Criteria: An Update

The Center of Excellence in Nutrition and Dietetics Award utilizes the Standards of Excellence (SoE) to identify and recognize organizations with exemplary leadership, outcomes, organization, and practice within the realm of nutrition and dietetics. Organizations with this designation continuously highlight and celebrate the work and expertise of the Registered Dietitian Nutritionist (RDN) and Nutrition and Dietetic Technician, Registered (NDTR) as the nutrition experts. This Award utilizes four domains in categorizing the SoE: Quality in Organization, Quality in Practice, Quality in Outcomes, and Quality in Leadership. Because these criteria can be applied broadly to a variety of practice areas, credentialed nutrition and dietetics practitioners across the care spectrum can actively participate in achieving this designation. The nature of the SoE is detail-oriented, allowing organizations and their leadership to determine opportunities for improvement and formulate action plans and long-term strategic plans to ensure excellence is at the forefront of all they do. Organizations that receive this award will have a competitive edge in recruiting and retaining credentialed nutrition and dietetics practitioners to the organization, and generate valuable metrics including benchmark data, best practices, and quality outcomes in their organizations. As this Award gains prestige and popularity, organizations will actively work to achieve and maintain this designation.

Harnessing the benefits of the Nutrition Care Process Quality Evaluation and Standardization Tool: a national auditing initiative to improve quality of documentation.

The Nutrition Care Process Quality Standardization and Evaluation Tool (NCP QUEST) is a validated audit instrument assessing the quality of NCP documentation by Registered Dietitians Nutritionists (RDNs). The present quality improvement project describes change in documentation quality as measured by NCP QUEST and word count of notes after a monthly national digital training provided to Veteran Affairs (VA) RDNs. The training and adoption of NCP QUEST was voluntary. Facilities were recruited among those that had participated during the design and validation study of NCP QUEST. The NCP QUEST score was calculated and the word count was determined for 52 documentation notes (28 from NCP QUEST non-user facilities and 24 from NCP QUEST user facilities) before and after training. The mean pre-training NCP QUEST score for notes from NCP QUEST non-user facilities was 13.71 and 13.88 for NCP QUEST user facilities. The mean post training total NCP QUEST score for non-user facilities was 14.00 and 17.65 for user facilities, with no improvement for the non-user facilities (P=0.69). A significant improvement was identified for the NCP QUEST user facilities (P≤0.001). All facilities experienced a significant reduction in the word count of assessment notes (P=0.04). Use of the electronic NCP terminology website increased 123-fold and was sustained after the training. NCP QUEST users reported that the audit tool is useful. The NCP QUEST should be at the center of RDNs' training and more strategic effort is needed to engage practitioners in the optimal application of the NCP.

Validation of the Rapid Prime Diet Quality Score Screener (rPDQS), A Brief Dietary Assessment Tool With Simple Traffic Light Scoring.

Dietary pattern is a determinant of chronic disease, but nonregistered dietitian nutritionist (non-RDN) clinicians rarely assess diet because of barriers such as time constraints and lack of valid, brief diet quality assessment tools. The study aimed to evaluate the relative validity of a brief diet quality screener using both a numeric scoring system and a simple traffic light scoring system. A cross-sectional study was conducted using the CloudResearch online platform to compare participants' responses to the 13-item rapid Prime Diet Quality Score screener (rPDQS) and the Automated Self-Administered 24-hour (ASA24) Dietary Assessment Tool. The study was conducted in July and August 2021 and included 482 adults ≥18 years of age or older sampled to be representative of the US population. All participants completed the rPDQS and an ASA24; of these, 190 completed a second ASA24 and rPDQS. Responses to rPDQS items were coded using both traffic light (eg, green= healthiest intake, red= least healthy intake) and numeric (eg, consume < 1 time a week, consume ≥ 2 times per day) scoring methods and were compared with food group equivalents and Healthy Eating Index-2015 (HEI-2015) scores estimated from ASA24s. Deattenuated Pearson correlation coefficients were calculated to account for within-person variation in 24-hour diet recalls. Overall, 49% of participants were female, 62% were ≥35 years, and 66% were non-Hispanic White, 13% non-Hispanic Black, 16% Hispanic/Latino, and 5% Asian. For both food groups to encourage (eg, vegetables, whole grains) and to consume in moderation (eg, processed meats, sweets), there were statistically significant associations with intakes assessed by rPDQS, using both traffic light and numeric scoring methods. Total rPDQS scores correlated with the HEI-2015, r= 0.75 (95% confidence interval [CI]= 0.65, 0.82). The rPDQS is a valid, brief diet quality screener that identifies clinically relevant patterns of food intake. Future research is needed to test whether the simple traffic light scoring system is an effective tool that can help non-RDN clinicians provide brief dietary counseling or make referrals to registered dietitian nutritionists, as needed.

Nutrition Information on TikTok: A Qualitative Exploration of Posts from Registered Dietitian Nutritionists (RDN) and non-RDNs

Registered Dietitian-Nutritionists (RDN) are using TikTok to promote their services and public nutrition knowledge. However, their viewer’s engagement and comments have yet to be explored. A descriptive qualitative study was conducted to identify the difference in posts by RDNs and non-RDNs. For one month, the engagement on posts from 4 creators (n=2 RDNs and n=2 non-RDNs) was recorded. The number of positive and negative comments and common comment topics were identified. Four post categories were identified: preparing meals, consuming nutritious food/meals, nutrition/diet tips, and indirectly nutrition related. Likes were the most common form of engagement. Most comments were positive (70%). The creators with more followers received more negative comments (27%) than those with less followers (6%). RDNs received more comments asking for nutrition advice (n&gt;44) than non-RDNs (n&lt;13). RDNs posted more about preparing meals and nutrition/diet tips while non-RDNs posted more about consuming nutritious food/meals and indirectly nutrition related. Informing RDNs of the usefulness of TikTok and of the expectations of their audience is important as the use of social media in health care is increasing. Thus, further research is important to ensure that we can inform RDNs on the best social media practices.

Systematic Review of the Frequency of Registered Dietitian-Nutritionist Intervention in the Primary Care Setting for Diabetes Self-Management Education for Patients with Type II Diabetes.

The purpose of this systematic review is to discuss the ideal frequency of Registered Dietitian-Nutritionist (RDN) contact required to improve glycemic control in patients with type 2 diabetes in the primary care setting. Researchers completed a literature search between April 1 and June 30, 2020. Researchers identified 184 studies and included seven studies for full-text analysis. Eligible studies were required to occur in a primary care setting, use A1C as an outcome measure, and use some form of education or contact with an RDN. Study quality was assessed using the NIH Study Quality Assessment Tool. Compared to the usual care group of each study, increased contact with an RDN improved A1C lowering regardless of frequency (round-the-clock, monthly, biannually). The largest decreases occurred in the round-the-clockand quarterly touch groups. Studies varied in modality (inperson, telehealth, etc.) and type of intervention. The participants had A1Cs between 8.07% and 10.25% before intervention. With RDN contact of any frequency between provider visits and participants saw A1Cs decreased between 0.66% and 2.2%. Greater glycemic control in patients with type 2 diabetes in the primary care environment is linked to more frequent RDN contact than that advised by the American Diabetes Association Standards of Care.

Registered Dietitian Nutritionists Taking the Lead in Teaching Kitchens.

Registered Dietitian Nutritionists Taking the Lead in Teaching Kitchens.

Burnout and Turnover Among Program Directors in ACEND-accredited Registered Dietitian Nutritionist Programs: A 2-year Follow-up Study

Burnout and Turnover Among Program Directors in ACEND-accredited Registered Dietitian Nutritionist Programs: A 2-year Follow-up Study

Telenutrition Group Programs for Cancer Survivors Improve Access to Oncology Registered Dietitian Nutritionists’ (RDNs) Expertise

Telenutrition Group Programs for Cancer Survivors Improve Access to Oncology Registered Dietitian Nutritionists’ (RDNs) Expertise