Training Of Dietitians Research Articles

Management of eating disorders during pregnancy: A survey of Australian dietitians in clinical practice.

Eating disorders (EDs) are estimated to affect 5.2%-7.5% of pregnant women, equating to 15,800-23,000 births in Australia annually. In pregnancy, an ED increases the risk of complications for both mother and child. Heightened motivation and increased utilisation of healthcare services during pregnancy present an opportunity to identify and commence ED treatment. Dietetic management of EDs differs from nutrition guidelines for pregnancy. This study aimed to assess current practice, confidence and training needs of dietitians to manage EDs in pregnancy. A cross-sectional survey of Australian dietitians with past year exposure to ED and/or antenatal fields was completed using Microsoft Forms between November 2022 and January 2023. One hundred and seventeen responses were analysed. Confidence was less for assessment of a woman with an active ED in pregnancy than a pregnant woman with a history of an ED, pregnancy or an ED alone (p < 0.001). Greater than 5 years of experience as a dietitian, but without recent exposure to the patient population, was associated with increased confidence (p < 0.01). Almost half provided descriptions of treatments and interventions used to treat a pregnant woman with an ED, some of which conflict with ED or antenatal guidelines. Dietitians were more likely to weigh a person with an ED in pregnancy. Most respondents indicated further training (93%) and guidelines (98%) would be helpful. This is the first investigation into the dietetic management of EDs in pregnancy, and it highlights a need for guidelines and training for dietitians.

Muscle ultrasound: a reliable bedside tool for dietitians to monitor muscle mass

Objectives: Monitoring muscle mass (cross-sectional area [CSA]) and quality (echogenicity) using ultrasound may help optimise nutrition support in the critically ill. However, to date, ultrasound imaging has not been included in the undergraduate training of dietitians, who are mostly responsible for the nutrition care of critically ill patients. This study assessed the accuracy and reliability of bedside imaging performed by a dietitian trained according to standardised methodology, followed by blinded analyses. Methods: Two operators (a trainer and dietitian trainee) performed B-mode ultrasonography of the rectus femoris quadriceps muscle. For inter-rater accuracy, imaging was performed independently on 32 subjects by both operators, and for intra-rater reliability both obtained a second image on 15 subjects. A blinded assessor performed analyses (CSA and echogenicity) on all images. In a subset of 11 subjects, a musculoskeletal sonographer repeated all measurements. Inter- and intra-rater reliability were determined by calculating intraclass correlation coefficients (ICC), based on an absolute-agreement, 2-way mixed-effects model. An ICC > 0.75 was classified as good and > 0.90 as excellent. Results: Intra- (ICC = 0.9–0.94) and inter-rater (ICC = 0.85–0.95) reliability of the imaging performed was good to excellent. No statistically significant differences were found between the two operators (mean difference for CSA = 0.18 cm2, 95% CI = −0.38–0.03, p = 0.08; mean difference for echogenicity = 6.88, CI = −0.71–14.78, p = 0.07). Inter-rater reliability for image analyses was excellent (ICC = 0.97–1.0). Conclusion: Bedside ultrasound performed by a dietitian trained according to standardised methodology shows good to excellent reliability and reproducibility. Training dietitians to perform bedside ultrasound may help to monitor muscle mass and quality in the critically ill.

An immersive virtual reality communication skills training for dietitians: A feasibility study

ObjectiveThe training of dietitians emphasizes the development of strong communication skills. Immersive virtual reality (IVR) has been successfully employed for various healthcare scenarios; however, it is yet understudied in dietetics education. Therefore, we conducted a feasibility study to investigate the usefulness of IVR for the purpose of communication skills training. MethodsWe designed a multi-user virtual hospital environment that enabled the training of professional conversations between dietitians and patients. Divided into groups of three, 30 dietetics students participated in a role-play task. Taking a qualitative approach to inquiry, we evaluated how participants assessed the benefits and limitations of the IVR training. ResultsParticipants appreciated the authenticity of the training environment and mentioned various advantages of IVR (e.g., sense of privacy, better focus on conversation) over traditional modes of instruction. On the other side, participants frequently mentioned that the lack of avatars' facial expressions might present an obstacle for effective communication skills training. ConclusionIVR enables authentic communication skills trainings for dietitians. Special consideration should be given to providing ample social cues during training. InnovationThe study demonstrates that the promising results from other healthcare professions regarding the usefulness of IVR training also apply to dietetics.

Support Through Remote Observation and Nutrition Guidance (STRONG), a digital health intervention to reduce malnutrition among pancreatic cancer patients: A study protocol for a pilot randomized controlled trial

BackgroundMalnutrition is a common and distressing condition among pancreatic cancer patients. Fewer than a quarter of pancreatic cancer patients receive medical nutrition therapy (MNT), important for improving nutritional status, weight maintenance, quality of life and survival. System, provider, and patient level barriers limit access to MNT. We propose to examine the feasibility of a 12-week multi-level, digital health intervention designed to expand MNT access among pancreatic cancer patients. MethodsIndividuals with advanced pancreatic cancer starting chemotherapy (N = 80) will be 1:1 randomized to the intervention or usual care. The Support Through Remote Observation and Nutrition Guidance (STRONG) intervention includes system-level (e.g., routine malnutrition and screening), provider-level (e.g., dietitian training and web-based dashboard), and patient-level strategies (e.g., individualized nutrition plan, self-monitoring of dietary intake via Fitbit, ongoing goal monitoring and feedback). Individuals receiving usual care will be referred to dietitians based on their oncologists’ discretion. Study assessments will be completed at baseline, 4-, 8-, 12-, and 16-weeks. ResultsPrimary outcomes will be feasibility (e.g., recruitment, retention, assessment completion) and acceptability. We will collect additional implementation outcomes, such as intervention adherence, perceived usability, and feedback on intervention quality via an exit interview. We will collect preliminary data on outcomes that may be associated with the intervention including malnutrition, quality of life, treatment outcomes, and survival. ConclusionThis study will advance our knowledge on the feasibility of a digital health intervention to reduce malnutrition among individuals with advanced pancreatic cancer. Trial registration: NCT05675059, registered on December 9, 2022.

Current state of dietetic services for inflammatory bowel disease patients in New Zealand: an observational study.

Nutritional therapies for inflammatory bowel disease are increasingly recommended. This study aimed to gain insight from patients, dietitians and gastroenterologists into inflammatory bowel disease dietetic care in New Zealand. Mixed-methods surveys were developed and then distributed online to patients with inflammatory bowel disease and dietitians and gastroenterologists that care for patients with inflammatory bowel disease. Quantitative survey data were analysed using nonparametric statistical tests. Qualitative survey data were analysed using thematic analysis. Responses were received from 406 inflammatory bowel disease patients, 79 dietitians and 40 gastroenterologists. Half of the patients (52%) had seen a dietitian for nutrition advice. Patients more likely to have seen a dietitian were/had: Crohn's disease (p = 0.001), previous bowel surgery (p < 0.001), younger (p < 0.001) or receiving biologic therapy (p = 0.005). Two-thirds (66%) of patients found the dietitian advice at least moderately useful. A common theme from patient comments was that dietitians needed better knowledge of inflammatory bowel disease. Almost all (97%) gastroenterologists reported that their inflammatory bowel disease patients ask about nutrition; 57% reported that there were inadequate dietitians to meet patient needs. Over 50% of dietitians saw inflammatory bowel disease patients infrequently and 39% were not confident that their knowledge of the nutritional management of inflammatory bowel disease was current. Dietitians desired greater links with the inflammatory bowel disease multidisciplinary team. Current inflammatory bowel disease dietetic services in New Zealandare inadequate. Standardised care, increased resourcing, dietitian training in inflammatory bowel disease, and stronger links with the multidisciplinary team are suggested to improve services.

Extending the scope of dietetic practice in a regional setting: Dietitians credentialed to insert and manage nasogastric tubes

To describe the process of credentialing and implementing dietitian insertion of nasogastric tubes (NGTs) in a regional setting in Australia, and report on patient outcomes, timeliness and safety of insertion, and staff acceptance. An observational, mixed-methods study of service and patient outcomes was undertaken during the 2 years (2018-2020) following the implementation of dietitian credentialling for the insertion and management of NGTs. Data relating to the insertion of NGTs by credentialled dietitians were collected prospectively. A staff survey was circulated during and after the data collection period. Data has been reported descriptively. The model of care was successfully implemented with two dietitians credentialed to insert NGTs. There were 38 unique occasions of NGT insertions for 31 individual patients. Eighty-seven percent (n=33) of cases were inpatients. NGT insertion was successfully performed by the dietitian 82% of the time (n=31). No medical complications relating to NGT insertion were reported following a dietitian inserted NGT, with the exception of one incidence of mild epistaxis. The average insertion time was 25.5min (14.1), the average number of insertion attempts by a dietitian was 1.7 (1.27) and on one occasion more than one x-ray was required. This study supports the recommendations of Dietitians Australia that this model of care is viable as an extended scope of practice model of care for dietetic departments across Australia. This evaluation adds to the evidence base for extended scope of practice and informs future directions for the service and training of dietitians.

Commentary: When applying dietary therapies for gastrointestinal conditions, family values, culture, and social challenges matter.

Some gastrointestinal conditions now have diet as a cornerstone to therapy. Three examples include the low-fermentable, oligosaccharide, disaccharide, monosaccharide, and polyol diet for irritable bowel syndrome, a gluten-free diet for celiac disease, and a hypoallergenic diet for eosinophilic esophagitis. All have been shown to be effective in Western or highly industrialized countries. However, these gastrointestinal conditions occur worldwide. Less is known regarding the effectiveness of dietary therapies in cultures and regions of dense religious and traditional practices where food is a central focus. This includes South Asia, the Mediterranean region, Africa, the Middle East, South America, and within Indigenous communities. Hence, there is a need to reproduce dietary intervention studies within cultures of dense traditional dietary practices to understand the applicability and acceptability of dietary therapy to establish generalizability. Furthermore, there is a need for nutrition experts to have a deep understanding of various cultural cuisines, practices, values, and customs. To achieve this, increasing the diversity of students in the sciences and having a diverse workforce of nutrition experts and health professionals that reflects the patient population will allow for more personalized care. In addition, there are social challenges, including a lack of medical insurance coverage, the cost of dietary interventions, and inconsistent nutrition messaging. Although there are many cultural considerations and social challenges to implementing effective dietary interventions around the world, these barriers are addressable through research methodologies that address culture and society challenges, and enhanced training of dietitians.

PS-P14-3: EFFORTS OF “S-1 GRAND PRIX”, A DELICIOUS LESS SALT RECIPE CONTEST AIMED AT PREVENTING CARDIOVASCULAR DISEASES

Purpose: As the average salt intake of Japanese people is as high as 10 gram per day, it is necessary to reduce the salt intake for the prevention and treatment of cardiovascular diseases. We held a less salt recipe contest to promote delicious less salt recipes among society and examined the potentiality of “deliciously less salt meals”. Method: National Cerebral and Cardiovascular Center (NCVC) held the “The 5th S-1 Grand Prix”, a contest to develop delicious and less salt bento recipes on a nationwide scale. The contest named after its goal of reducing the salt intake by 1 gram in each meal. Under the theme of a delicious and attractive less salt bento meeting to the nutritional value standards (such as less than 2 gram of salt equivalent per meal), NCVC called for the bento recipe ideas from the 10th of May to 26th of July 2021. All the applied recipes are evaluated and tasted by NCVC contest board members, then the best one was decided for a “Grand-Prix” award. Contest was held on-line due to the COVID-19, the video presentation made by the applicants were evaluated for the final selection. Result: A total of 67 teams (25 teams in the general category, 15 teams in the student category, 27 teams in the disaster nutrition category) were applied to this contest. We encouraged governments, hospitals, dietitian training schools, and convention-related companies and organizations nationwide to apply the contest. Compared to the 4th tournament, the number of applicants were increased by 16 teams. More than half of the applicants were from “educational institutions such as universities”. Although the 5th tournament was held online, we were able to hold a recipe contest in a new format, such as using applicants’ video presentation for the final selection. Discussion: In the disaster nutrition category, many recipes for the delicious, preserved foods and cooking methods under the disaster were gathered, so that these less salt recipes can be widely adopted in the disaster foods. Through this attempt, we created an opportunity to make a delicious less salt meals, and motivated participants to cook “deliciously less salt meals”. In the future, more people will participate in this contest in order to get them to participate, we will consider the conditions of the recipe and the recruitment method.

Development of an Undergraduate Dietetics and Preceptor Training Program: A Malawi-US partnership

Participants will be able to describe at least two barriers and opportunities in developing dietitian training infrastructure in an underserved country, like Malawi.

Oral Health in Relation to Nutrition a Literature Review

Purpose: This review deals with complex relationship among diet, nutrition and their implications on oral health and this review also reveals the oral diseases are associated with considerable pain, anxiety and impaired social functioning. Search method: An electronic search was done in the google website, PubMed, and google scholar. Articles from 1993 to 2017 were included in the review. Summery and Conclusions: Mouth being a reflecting mirror of general health often helps in early diagnosis of many diseases and disturbances. Like any other system of our body, In this way nutrition and oral health are mutually dependent and hence an extensive understanding of this inter relationship is essential for healthy life the customary allowance of food and drink taken by any person per day varies from nutrition, which involves the metabolic processes and utilization of nutrients in the food. Malnutrition affects the oral health and a poor oral health in turn, may lead to malnutrition. Malnutrition may alter the homeostasis, which can lead to disease progression of the oral cavity, reduce the resistance to the microbial biofilm and reduce the capacity of tissue healing. A poor diet was significantly associated with increased odds of oral disease. Dietary advice for the prevention of oral diseases has to be a part of routine patient education practices. Inconsistencies in dietary advice may be linked to inadequate training of professionals. Literature suggests that the nutrition training of dentists and oral health training of dietitians and nutritionists is limited. Keywords: Dietary, dental caries, Malnutrition, Oral manifestations and nutrient deficiency

Evaluation and Practice of an Online Overseas Program in a Registered Dietitian Training University

Evaluation and Practice of an Online Overseas Program in a Registered Dietitian Training University

A191 PERSISTENT BENEFIT OF DIETITIAN-LED GLUTEN-FREE DIET EDUCATION AT CD DIAGNOSIS ON DIETARY ADHERENCE IN CHILDREN AND ADULTS WITH TYPE 1 DIABETES AND CELIAC DISEASE

BackgroundCeliac disease (CD) is a common autoimmune comorbidity of type 1 diabetes (T1D) with a gluten-free diet (GFD) being the current gold standard treatment for this condition. Adherence to a GFD can be impacted by several factors including dietetic counselling, yet little is known about the impact of clinic-based interventions on long-term GFD adherence in this population.AimsTo prospectively evaluate the impact of a dietitian-led GFD education intervention on adherence to a GFD in children and adults with T1D and CD over a 3-year period.MethodsA cohort of N=62 pediatric and adult subjects who screened seropositive for CD as part of the CD-DIET clinical trial were followed over a 3-year period post-CD diagnosis and assessed on the basis of the GFD education regimen they received at initial CD diagnosis. This included 3 groups: 1) intensive dietitian training (IDT = 5 dietitian visits over 1 year while following GFD), 2) single dietitian training (SDT = 1 GFD training session after 1 year of following GCD) and 3) no dietitian training (NDT) at CD diagnosis. Annual visits included serologic testing of TTG-IgA titres, anthropometric assessments and the completion of questionnaires evaluating diet and adherence to a GFD. Data was analysed longitudinally using linear mixed effects and generalized estimating equations (GEE) regression modeling adjusting for the fixed effects of age, sex, duration of diabetes and time.ResultsAt baseline, participants who received IDT (n=15), SDT (n=16) and NDT (n=31) represented 24.2%, 25.8%, and 50.0% of the cohort, respectively. Over the 3-year study period, participants in the IDT group had the greatest odds of self-reporting being a GFD, with odds 4.3 (95%CI: 1.1 to 16.4; P=0.033) and 9.5 (95%CI: 2.7 to 33.7; P<0.001) greater than the SDT and NDT groups, respectively. The assessment of daily gluten intakes less than 10mg, as recommended for a GFD, revealed a lack of differences between the IDT and SDT groups. In contrast, the NDT group had significantly lower odds of meeting this threshold relative to those who received IDT (OR=0.2; 95%CI: 0.04 to 0.56; P=0.004). No longitudinal differences in TTG-IgA levels were seen between groups over the 3-year period.ConclusionsIn diabetes patients greater contact with a dietitian at CD diagnosis was associated with higher levels of GFD adherence over time, which was not reflected in follow-up Serologic evaluation. These findings highlight the importance of nutritional support in patients with both diabetes and celiac disease at the time of CD diagnosis. In addition, following TTG-IgA alone does not fully inform dietary compliance to a GFD.Diet teaching stratification Diet assignmentFunding AgenciesJuvenile Diabetes Research Foundation / PSI

“Because I don’t come from the culture:” Examining dietitian’s experience promoting healthy dietary behaviors among Hispanic Caribbean clients in New York City

Dietitians are key in addressing existing diet-related health inequities, yet, research is lacking concerning how dietitians’ experiences working within culturally diverse communities. Addressing this gap, we interviewed fifteen dietitians working with Hispanic Caribbean (HC) communities in New York City, an understudied community with high incidence of diet-related conditions, to assess the best practices and experienced barriers when working with these communities. The best practices identified included building rapport, incorporating cultural values, and addressing food access. However, the interviews revealed important barriers that prevented successful implementation of these best practices. These included personal factors (language, food culture knowledge, food preferences), lack of culturally-relevant resources, cultural challenges that prevented engaging clients in participatory decision making, and institution-related constraints (time scarcity and funding). The findings underscore the need for improved training for dietitians to be better equipped to work with communities with different cultural and economic backgrounds from their own, for more culturally-relevant resources and funding to address underlying causes of diet-related health disparities in minority populations, and for increased diversity in the profession. Furthermore, our focus on Hispanic Caribbean communities expands existing research promoting cultural competence in the profession, presenting experiences working in with this large segment of the Hispanic community in the United States.

Dietetic Management of Adults with Phenylketonuria (PKU) in the UK: A Care Consensus Document.

There is an increasing number of adults and elderly patients with phenylketonuria (PKU) who are either early, late treated, or untreated. The principal treatment is a phenylalanine-restricted diet. There is no established UK training for dietitians who work with adults within the specialty of Inherited Metabolic Disorders (IMDs), including PKU. To address this, a group of experienced dietitians specializing in IMDs created a standard operating procedure (SOP) on the dietetic management of adults with PKU to promote equity of care in IMD dietetic services and to support service provision across the UK. The group met virtually over a period of 12 months until they reached 100% consensus on the SOP content. Areas of limited evidence included optimal blood phenylalanine reporting times to patients, protein requirements in older adults, management of weight and obesity, and management of disordered eating and eating disorders. The SOP does not include guidance on maternal PKU management. The SOP can be used as a tool for training dietitians new to the specialty and to raise the standard of education and care for patients with PKU in the UK.

State of Education and Factors Related to Healthy Food Environment in Registered Dietitians and Dietitian Training Schools

State of Education and Factors Related to Healthy Food Environment in Registered Dietitians and Dietitian Training Schools

Knowledge of Halal Foods by University Students Enrolled in a Dietitian Training Course in Japan

ABSTRACT The number of visitors to Japan, particularly from Islamic regions, has increased in recent years. It can be inferred that the increased opportunities for Muslims to visit and reside in Japan may require dietitians and nutritionists to respond to the demand for halal foods. Hence, this study investigated the knowledge of halal foods among 82 university students enrolled in a training course for registered dietitians. Overall, 15% of the students answered that they could explain halal foods, and 52% answered that they “did not know about halal foods at all.” However, 92% responded that as aspiring dietitians, they needed an opportunity to learn about halal foods. Furthermore, these students also felt that knowledge regarding halal foods was necessary, and with the increasing number of Muslim visitors to Japan, it seems necessary to actively establish an opportunity to learn about halal foods through registered dietitian training courses in the future.

Awareness and Attitudes of Student Dietitians in Lebanon, UK and USA towards Food Safety.

Allied health professionals such as dietitians can play a critical role in providing food safety advice to vulnerable consumers. To maximize food-related health and wellbeing, food needs to be safe and nutritious; consequently, food safety is referred to in international curricula for the training of dietitians. The purpose of this study was to explore the awareness and attitudes of student dietitians from three international institutions towards food safety. A total of 207 student dietitians participated in the study from Columbus, OH, USA (n = 99), Cardiff, Wales, UK (n = 78) and Beirut, Lebanon (n = 30). Completion of the study established that the students in three dietetic training programs lacked awareness of key food safety concepts. Close to half (43%) were not familiar with Campylobacter, with the USA students being significantly less knowledgeable (p < 0.001) with 58% being unaware of the pathogen. Understanding of safe handling of leftovers was the lowest for the students in all institutions; only 46% described appropriate reheating practices, with significantly lower (p < 0.001) understanding in Lebanon (28%). The students reported a good understanding of vulnerable populations and perceived food safety to be important for these groups. However, the knowledge of certain high-risk foods was lacking. For instance, 69% of students thought that fresh squeezed juices and smoothies made with raw fruits and vegetables were safe for vulnerable patients, with the UK students being the least familiar with this risk (16%). This is the first study of its kind to take an international perspective of student dietitian food safety awareness and attitudes; the findings are important to dietetic food safety educators and recommendations are made to further explore the interpretation of food safety requirements in international dietetic curricula. Future studies should extend student dietetic research to address attitudes, self-efficacy and the overall readiness to deliver food safety advice to the patients and the community.

Dietary Habits of an Ambulatory Diabetic Population at the University Hospital of Conakry, Guinea

Background: A healthy diet is essential for optimal diabetes management. However, dietary habits vary from one region to another, making it challenging to standardize practices. Objective: To describe the diet habits of patients living with diabetes in Guinea. Methods: We conducted a dietary habits survey among 102 patients living with diabetes followed-up at the University Hospital of Conakry in Guinea between January and March 2012. Data were collected by individual interview on the basis of a three-item questionnaire: diabetes data, diet mode, and food composition. Results: In total, 85% of patients were consuming 3 meals daily; 13.7% had a collation and 25% had snacking habits. The meal was individual in 82.4% and collective in 17.6% of patients. The main foods consumed daily were: rice (93.1%), fish (93.1%), palm oil (91.1%), bread (87.2%). Foods consumed regularly (2 to 3 times a week) were: meat (49%), eggs (23.5%), dairy products (34.3%), fruit (43.1%), vegetables (40.2%) and peanut oil (21.5%). The food bans reported were: regular sugar (100%), sodas (62.7%), peanuts (84.3%) and sweetened fruits (55.8%). Conclusion: Combining dietary recommendations and dietary habits is essential for appropriate management of diabetic patients. The assessment of local food glycemic indexes and the training of dietitians remains a challenge in our context.

Effect of lifestyle and stress on health food use among students in a registered dietitian training program

Effect of lifestyle and stress on health food use among students in a registered dietitian training program

Factors that affect dietitians and registered dietitians' learning about dental caries and periodontal disease

Objectives The present study examined factors that affect learning about dental caries and periodontal disease before or after graduation or completion of training for dietitians and registered dietitians.Methods A questionnaire survey was conducted with members of the Aomori Prefectural Dietetic Association between October and November 2019, and 276 participants were included in the analysis. A multiple logistic regression analysis was performed to assess the characteristics associated with learning about dental caries and periodontal disease; odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. The following independent variables were assessed: age (<30, 30-39, 40-49, 50-59, or ≥60 years), license (dietitian or registered dietitian), and occupational field (medical institution [nutrition management or food service], administrative agency, nursing care insurance facility, school-related work, training instructor in training facility for dietitians and registered dietitians, or other).Results The multiple logistic regression analysis showed that dietitians and registered dietitians who had learned about dental caries and periodontal disease during training tended to be below the age of 40 years and have a registered dietitian license (dental caries: OR=2.79, 95% CI=1.08-7.24; periodontal disease: OR=6.51, 95% CI=1.71-24.84). Furthermore, dietitians and registered dietitians who had learned about dental caries and periodontal disease after graduation or training completion tended to be over the age of 40, have studied at a training facility (dental caries: OR=3.21, 95% CI=1.65-6.27; periodontal disease: OR=3.06, 95% CI=1.32-7.12), and be employed in the field of school-related work (dental caries: OR=4.23, 95% CI=1.03-17.27; periodontal disease: OR=5.56, 95% CI=1.15-26.98).Conclusions To facilitate increased cooperation among practitioners in the fields of nutrition and dental health, necessary opportunities for learning about dental caries and periodontal disease alongside experts should be provided to those who do not have a registered dietitian license and have not studied at training facilities.