Factors associated with dietitian referrals to support long-term care residents advancing towards the end of life.

BACKGROUND: Dietitians are central members of the multidisciplinary long-term care (LTC) healthcare team. The overall aim of this current investigation is to gain a better understanding of dietitian involvement in LTC resident's end-of-life care via referrals. METHODS: Retrospective chart reviews for 164 deceased residents (mean age = 88.3 ± 7.3; 61% female) in 18 LTC homes in Ontario, Canada, identified dietitian referrals and documented eating challenges recorded over 2-week periods at four time points (i.e., 6 months, 3 months, 1 month and 2 weeks) prior to death. Nutrition care plans at the beginning of these time points were also noted. Logistic mixed effects regression models identified time-varying predictors of dietitian referrals. Bivariate tests identified associations between nutrition orders and dietitian referrals that occurred in the last month of life. RESULTS: Nearly three-quarters (73%) of participants had at least one dietitian referral across the four observations. Referrals increased significantly with proximity to death; 45% of residents had a referral documented in the last 2 weeks of life. Dietitian referrals were associated with the number of eating challenges (odds ratio [OR] = 1.42, 95% confidence interval [CI] = 1.27, 1.58). Comfort-focused nutrition care orders were significantly more common when a dietitian was referred (25%) compared with when a dietitian was not referred (12%) in the final month of life (p = 0.04). CONCLUSIONS: Our findings suggest that dietitians are involved in end-of-life and comfort-focused nutrition care initiatives, yet they are not engaged consistently for this purpose. This presents a significant opportunity for dietitians to upskill and champion palliative approaches to nutrition care within the multidisciplinary LTC team.

Assessing knowledge and awareness of Food and Drug Interactions among nutrition sciences students: Implications for education and clinical practice.

BACKGROUND: Chronic diseases and polymedication increase the risk of food-drug interactions (FDIs) among the population, negatively impacting health. Nutritionists, as responsible for dietary planning, have a key role in preventing these events. AIM: To assess the knowledge about FDIs among a sample of Nutrition Sciences Bachelor students. METHODS: A descriptive cross-sectional observational study was conducted, involving 44 students from the 3rd and 4th academic years of different Portuguese universities during the 2023/2024 academic year. Participants completed a self-reported questionnaire, covering general and specific FDIs knowledge, academic background, and perceptions regarding FDIs importance and training adequacy. RESULTS: Results revealed a general lack of FDIs knowledge among participants, particularly in identifying specific interactions and appropriate dietary management. While half of the students reported exposure to a subject dedicated to FDIs, only 18.18% considered the knowledge acquired sufficient. Nearly all participants (93.18%) expressed the need for further training in FDIs during their undergraduate course. Furthermore, none of the participants had received additional training or attended workshops on FDIs. Specifically, participants struggled to identify appropriate dietary choices in conjunction with certain medications. Moreover, only a minority of participants demonstrated awareness of the ideal timing for medication intake relative to food consumption. Despite these knowledge gaps, participants recognized the importance of FDIs knowledge for future clinical practice. CONCLUSION: Bridging these knowledge gaps through targeted educational interventions and interdisciplinary collaboration is essential to ensure future nutrition professionals are equipped to address the complex challenges posed by FDIs in professional practice.

Misinformation and Disinformation in Food Science and Nutrition: Impact on Practice.

Food and nutrition are popular topics in the media and on social media. The ubiquity of social media has created new opportunities for qualified or credentialed experts in the scientific community to connect with clients and the public. It has also created challenges. Health and wellness gurus, or self-proclaimed experts, utilize social media platforms to garner attention through compelling narratives, build audience followings, and influence public opinion by sharing (often) misleading information about food and nutrition. The consequence of this can be the perpetuation of misinformation, which not only undermines a well-functioning democracy but also diminishes support for policies that are science or evidence based. Nutrition practitioners, clinician scientists, researchers, communicators, educators, and food experts need to encourage and model critical thinking (CT) to participate in our world of mass information and mitigate misinformation. These experts can play a vital role in the evaluation of information about food and nutrition against the body of evidence. This article explores the role of CT and ethics of practice in the context of misinformation and disinformation by providing a framework for engaging with clients and offering a checklist for ethical practice.

Many pediatric patients with gastroparesis do not receive dietary education.

BACKGROUND: Gastroparesis is delayed gastric emptying in the absence of obstruction; dietary modifications are first-line treatment. However, we do not know the factors related to provision of dietary recommendations. METHODS: We sought to determine how often pediatric patients with gastroparesis receive dietary education (from a gastroenterology provider vs dietitian), the recommendations given, and factors related to these outcomes. We performed a retrospective chart review of children 2- to 18-years-old managed by pediatric gastroenterology providers at our institution. Patient demographics and clinical data, dietary advice given (if any), and dietitian consultation (if any), practice location, and prokinetic use were captured. An adjusted binomial regression model identified factors associated with dietary education provision, dietitian consultation, and diet(s) recommended. RESULTS: Of 161 patients who met criteria, 98 (60.8%) received dietary education and 42 (26.1%) met with a dietitian. The most common recommendation by gastroenterology providers and dietitians was diet composition adjustment (26.5% and 47.6%, respectively). Patients with nausea/vomiting were less likely to receive dietary education or be recommended to adjust diet composition. Patients with weight loss/failure to thrive were more likely to receive dietitian support. Patients seen in the community vs medical center outpatient setting were more likely to be recommended a low-fat diet. CONCLUSIONS: Only a little over half of children with gastroparesis receive dietary education and use of a dietitian's expertise is much less frequent. Symptoms and clinical setting appear related to what, where, and by whom guidance is provided.

Insights from dietitians providing individualised dietetic care to people living with disabilities: A single site exploration in the community.

BACKGROUND: The present study aims to share insights and lessons learnt by dietitians providing individualised care to people living with disabilities in the community. This is important to build the evidence to inform dietetic best practice standards. METHODS: The study involved a cross-sectional data audit of dietitian reports for clients living with a disability seen at a metropolitan dietitian clinic in South Australia. Content analysis of the reports was conducted. Initial coding occurred deductively followed by inductive qualitative content analysis. RESULTS: Thirty-one participants consented to have their dietitian reports included in the study. Intellectual disabilities made up the majority (48%) of disabilities reported in the sample. Nutrition diagnoses predominantly related to energy imbalances (54%). Barriers to dietary change included a reliance on others and limitations in the disability support system. Kitchen skills and cooking were the most often employed nutrition strategy suggested by dietitians. Following dietetic intervention, improvements were seen in the types of foods people with a disability consumed along with changes to their body weight. Dietitians reported the importance of effective communication with the care team and providing engaging methods to instigate dietary behaviour change. CONCLUSIONS: The present study highlights that there are opportunities to build on individualised dietetic care provided to people living with disabilities. These opportunities include addressing excess energy consumption, fostering collaborations with other health providers and understanding how to better work with carers. Further research is required to understand how to progress these opportunities forward and to understand the generalisability of the findings.

A situational analysis of registered dietitians' participation in network marketing.

BACKGROUND: Registered dietitians (RDs) are allied health professionals with advanced training in nutrition and food science. To practice, RDs must maintain registration with the regulatory body in their jurisdiction. METHODS: We conducted a situational analysis to better understand: (i) RDs participation as independent sales consultants (ISCs) for network marketing companies and (ii) the role of regulatory bodies in overseeing network marketing participation among RDs. We conducted semi-structured interviews with individuals who had, within the past 5 years, concurrently been an RD and an ISC, and with three representatives of non-RD regulatory bodies in the province of Ontario. Other sources of discursive data included relevant articles published in academic journals and in the mainstream media, documentary series and circulating memes. RESULTS: Our results are depicted in three maps (ordered situational, arenas and positional). Overall, much of what was highlighted in the reviewed articles and expressed in the analytic maps about network marketing remained unsaid in RD interviews (n = 8). CONCLUSIONS: RDs who participate in network marketing were often able to achieve a level of personal fulfilment that appeared unattainable through their professional work alone. However, the stigma of network marketing participation appeared to diminish the benefits of ISC work. Consistent, clear guidelines from RD regulatory bodies are desired by RD/ISCs.

Investigating the Role of Nutrition in Enhancing Immunity During the COVID-19 Pandemic: Twitter Text-Mining Analysis.

BACKGROUND: The COVID-19 pandemic has brought to the spotlight the critical role played by a balanced and healthy diet in bolstering the human immune system. There is burgeoning interest in nutrition-related information on social media platforms like Twitter. There is a critical need to assess and understand public opinion, attitudes, and sentiments toward nutrition-related information shared on Twitter. OBJECTIVE: This study uses text mining to analyze nutrition-related messages on Twitter to identify and analyze how the general public perceives various food groups and diets for improving immunity to the SARS-CoV-2 virus. METHODS: We gathered 71,178 nutrition-related tweets that were posted between January 01, 2020, and September 30, 2020. The Correlated Explanation text mining algorithm was used to identify frequently discussed topics that users mentioned as contributing to immunity building against SARS-CoV-2. We assessed the relative importance of these topics and performed a sentiment analysis. We also qualitatively examined the tweets to gain a closer understanding of nutrition-related topics and food groups. RESULTS: Text-mining yielded 10 topics that users discussed frequently on Twitter, viz proteins, whole grains, fruits, vegetables, dairy-related, spices and herbs, fluids, supplements, avoidable foods, and specialty diets. Supplements were the most frequently discussed topic (23,913/71,178, 33.6%) with a higher proportion (20,935/23,913, 87.75%) exhibiting a positive sentiment with a score of 0.41. Consuming fluids (17,685/71,178, 24.85%) and fruits (14,807/71,178, 20.80%) were the second and third most frequent topics with favorable, positive sentiments. Spices and herbs (8719/71,178, 12.25%) and avoidable foods (8619/71,178, 12.11%) were also frequently discussed. Negative sentiments were observed for a higher proportion of avoidable foods (7627/8619, 84.31%) with a sentiment score of -0.39. CONCLUSIONS: This study identified 10 important food groups and associated sentiments that users discussed as a means to improve immunity. Our findings can help dieticians and nutritionists to frame appropriate interventions and diet programs.

Symptom management needs of patients with irritable bowel syndrome and concurrent anxiety and/or depression: A qualitative study.

AIMS: To understand the experiences and needs of symptom management among individuals with irritable bowel syndrome and concurrent symptoms of anxiety and/or depression. DESIGN: This study used a qualitative descriptive research design. METHODS: Individuals with a diagnosis of irritable bowel syndrome and concurrent symptoms of anxiety and/or depression participated were recruited through an online ResearchMatch and a listserv. Semi-structured interviews focused on symptoms and experiences with symptom management interventions conducted from June to August 2020. Interviews were transcribed and data were analysed based on thematic analysis. RESULTS: Twelve individuals participated in this study; all reported current irritable bowel syndrome and anxiety/depression symptoms. The data analysis cumulated with three themes related to symptom management: (a) irritable bowel syndrome negatively impacts physical and mental well-being; (b) a trial and error approach to symptom management; and (c) challenges with healthcare professionals supporting symptom management including negative interactions with healthcare professionals and lack of nutritional expertize and support. CONCLUSION: There is a need for individualized approaches which consider patients' current symptoms of anxiety and depression, previous experiences with the trial-and-error process and consideration for intervention delivery methods. IMPACT: There is a limited qualitative research focusing on the experiences of individuals with irritable bowel syndrome and concurrent symptoms of anxiety and/or depression. This research highlights the need for individualized approaches to enhance symptom management that acknowledges patients' psychological state and past negative experiences with providers and prior dietary regimens.

The feasibility and acceptability of a dementia care training program for registered dietitian nutritionists.

There is a need for more Registered Dietitian Nutritionists (RDNs) trained to provide nutritional care to older adults with dementia who experience mealtime difficulties. The purpose of this single-arm, pre/post pilot study was to adapt a generalized dementia care curriculum to the learning needs of RDNs who work with individuals with dementia and to determine the feasibility and acceptability of the adapted program. Using an existing evidence-based dementia care curriculum, the research team identified learning objectives and content pertinent to the scope of RDNs. The adapted program was piloted with RDNs who work with older adults with dementia. Twenty-five RDNs registered for the training while 80% (20) attended the training and completed the post-training survey. All participants agreed that the module met the learning needs of RDNs who work with older adults with dementia, the two-hour workshop was a good use of their time, and the experience and skills gained would be useful in their work as an RDN. Implementation costs totaled $1,310. Based on the post-training feedback, the adapted program was deemed feasible and acceptable by RDN participants, who also expressed interest in using the module to train other caregivers on providing mealtime assistance to older adults with dementia.

Physical Activity Counselling and Exercise Prescription Practices among Dietitians Across Nova Scotia.

The purpose of this study was to assess the perceptions and practices around physical activity counselling and exercise prescription of dietitians in Nova Scotia. Dietitians (n = 95) across Nova Scotia completed an online self-reflection survey regarding their current physical activity and exercise (PAE) practices. Most (51%; n = 48) reported no previous PAE educational training. Dietitians infrequently prescribed exercise to their patients (16% ± 26% of appointments) or provided PAE referrals (17% ± 24%). Dietitians reported moderate confidence (57% ± 21%) performing PAE counselling and included PAE-related content in half of patient appointments (52% ± 31%). Almost all respondents (95%) identified interest in further PAE education or training. Open-ended responses also demonstrated the need for community-based exercise programs (28% of providers) and qualified exercise professionals to refer to (25%). Overall, dietitians report rarely providing patients with written exercise prescriptions or referrals to other professionals for PAE content but do frequently include PAE in patient appointments. Dietitians in Nova Scotia are well positioned to promote PAE, but more educational training and improved referral systems to qualified exercise professionals or community exercise programs is strongly desired. Exercise professionals and dietitians should concurrently advocate for these changes and collaborate to help more patients lead physically active lifestyles.

Sharing the 'weight' of obesity management in primary care: integration of registered dietitian nutritionists to provide intensive behavioural therapy for obesity for Medicare patients.

BACKGROUND: Clinical provision of intensive behavioral therapy for obesity (IBTO) has been a reimbursable treatment for obesity since 2012. However, gaps remain in the literature regarding its impact on patient outcomes. OBJECTIVES: The primary objective of this study was to examine the integration of registered dietitian nutritionist provided IBTO into a primary care setting and evaluate clinic outcomes for Medicare Part B beneficiaries. A secondary objective was to examine intensity of IBTO (quantity of IBTO visits) versus clinical outcomes and influence of socioeconomic factors. METHODS: A case-control retrospective chart review was conducted at a rural, Academic Family Medicine Clinic in Eastern North Carolina for patients seen between 1 January 2016 and 1 January 2019. In order to be included in the treatment group, patients had to be female, white or black race, have Medicare insurance and a body mass index ≥ 30 kg/m2. RESULTS: Mixed model analysis showed statistically significant improvements in clinical outcomes from IBTO treatment. Weight decreased by nearly 3 pounds, while body mass index was half a point lower. A1C was 0.1 units lower for IBTO patients, and they took prescription medication and average of 6 days less than the control group. Minorities and older respondents experienced smaller, all else constant, and annual fixed effects suggest that differentials widen over time. CONCLUSIONS: Registered dietitian nutritionist (RDN) provision of IBTO has demonstrated benefit in improving clinical outcomes including weight, A1C, and reduced medication duration (use) as demonstrated by the IBTO treatment group versus control. IBTO intensity was not predictive of success, and its impact was reduced with older and African American patients. IBTO is beneficial and can be delivered within the primary care setting by a RDN.

Family medicine physicians' report strong support, barriers and preferences for Registered Dietitian Nutritionist care in the primary care setting.

BACKGROUND: Previous studies have examined barriers (e.g. time) for Family Medicine Providers (FMPs) to provide nutrition and lifestyle counseling, however, to date no studies have examined access or interest to Registered Dietitian Nutritionist (RDN) care for patients. OBJECTIVE: The objective of this study was to explore FMP access, referral practices, barriers and preferences for RDN care. METHODS: A cross-sectional online survey, with content and face validation was conducted with Family Medicine Departments within large academic health care systems in the Southeastern United States. The main variables of interest included: FMP access, interest, current referrals and referral preferences for RDN care, barriers to referrals and overall perceptions regarding RDN care. Descriptive analysis of close-ended responses was performed with SPSS 26.0. Open-ended responses were analysed using inductive content analysis. RESULTS: Over half of the respondents (n = 151) did not have an RDN on-site (64%) yet were highly interested in integrating an RDN (94.9%), with reported preferences for full-time on-site, part-time on-site or off-site RDN care (49.1%, 39.5% and 11.4% respectively). The greatest reported barriers to RDN referrals were perceived cost for the patient (64.47%) and uncertainty how to find a local RDN (48.6%). The most consistent theme reported in the open-ended responses were concerns regarding reimbursement, e.g. 'Insurance does not cover all of the ways I would like to use an RDN'. CONCLUSIONS: FMPs report interest and value in RDN services despite multiple perceived barriers accessing RDNs care. Opportunities exist for interprofessional collaboration between dietetic and FMP professional groups to address barriers.

High turnover in clinical dietetics: a qualitative analysis.

BACKGROUND: Relationships between dietitians and other healthcare providers can impact the degree to which patient care is collaborative; inefficient communication can lead to suboptimal care. It takes time for multidisciplinary team members to build collaborative, trusting relationships. For this reason, frequent dietitian turnover is of concern. Consequences include fewer referrals to clinical dietetic services and limited provider continuity. The characteristics of clinical dietetic jobs associated with high turnover have not been identified. We predicted that managers would identify disease prestige as having an impact. In this study, we aimed to explore: 1) characteristics of clinical dietetic jobs associated with the highest turnover, and 2) consequences of high turnover on patients and managers of clinical dietitians. METHODS: Research assistants conducted semi-structured interviews with ten managers of clinical dietitians in the Canadian public healthcare system. We employed a constant comparative approach to thematic analysis. We classified themes related to turnover as either avoidable or unavoidable. RESULTS: Sub-themes under avoidable turnover included lack of manager support, growth opportunities, burnout/workload, tension/conflict and hours of work. Sub-themes under unavoidable turnover included life-stage/life-events and geography. We also identified themes related to consequences of turnover, including: burnout/workload, client/patient impact, tension/conflict, cost and gap-specific. As predicted, prestige was perceived as playing a role in triggering dietitian turnover. Managers observed high turnover resulting in low provider continuity and limiting patient access to dietitians. CONCLUSIONS: Managers of publicly-employed dietitians identified many factors as contributing to high turnover. Future prospective research, incorporating the objective measure of turnover and multi-method analysis of work characteristics and work setting, would be of value in the identification of characteristics of clinical dietetic jobs associated with high turnover and the consequences of high turnover on patients and managers of these staff.

Antenatal models of care for women with gestational diabetes mellitus: Vignettes from an international meeting.

BACKGROUND: Gestational diabetes (GDM) is one of the commonest pregnancy complications and is placing an increasing burden on diabetes and obstetric resources. AIMS: To describe different antenatal models of care that have developed to address the increasing proportion of pregnancies complicated by GDM. MATERIALS AND METHODS: Narrative review with thematic analysis from 15 volunteer antenatal diabetes in pregnancy services from Australia and New Zealand identified through a national diabetes organisation. Main outcomes were approaches to patient education, medical nutrition therapy (MNT), ongoing management and escalation of therapy for women with GDM. RESULTS: All clinics provided at least one group education and one MNT session within 1-2 weeks of GDM diagnosis. Women from culturally and linguistically diverse communities usually required 1:1 education. Ongoing management of women with GDM was through either all women being seen in the GDM clinic, a step-up approach (ongoing management by the primary antenatal team with diabetes team referral if self-blood glucose monitoring (SBGM) or insulin therapy dosage criteria are reached) or step-down approach (ongoing management by the diabetes team with step-down to the primary antenatal team if SBGM criteria are reached). Telehealth was used to reduce the burden of clinic attendance, particularly in rural areas. CONCLUSIONS: Increasing numbers, earlier diagnoses, the need to provide care to women in rural, remote areas, and cultural/language differences, have generated a range of different antenatal models of care, allowed better workload accommodation and probably reduced costs. Randomised controlled trials of different models of care, with associated health economic analyses, are urgently needed.

The role of allied healthcare professionals in head and neck cancer surveillance: A systematic review.

OBJECTIVES: The roles of Allied Health Care Professionals (AHPs) in Head and Neck Cancer (HNC) are wide ranging but not clearly defined. Inter-regional variability in practice results from a lack of standardisation in approaches to the Multidisciplinary Team (MDT) make-up and structure. Traditionally, the follow-up of HNC patients is clinician led with multiple scheduled follow-up appointments. The increasing population of HNC patients provides logistical, monetary and efficiency challenges. This systematic review presents the roles of the multiple AHP sub-groups in HNC with the aim of presenting how their differing skill sets can be integrated to modernise our approach in follow-up. DESIGN: We searched MEDLINE, Embase, the Cochrane Library, NIHR Dissemination Centre, The Kings Fund Library, Clinical Evidence, National Health Service Evidence and the National Institute of Clinical Excellence to identify multiple subgroups of AHPs (Dentists, Speech and Language Therapists, Dieticians, Physiotherapists, Psychologists, Clinical Nurse Specialists) and evidence of their role in HNC follow-up. Evidence not directly relating to HNC follow-up was excluded. SETTING AND PARTICIPANTS: This Systematic Review was undertaken online by the Integrate (UK ENT Trainee National Collaborative) Head and Neck Subcommittee. MAIN OUTCOME MEASURES: Most evidence was of low-quality, and the broad nature of the protocol provided a wide variety of study models. Two authors screened the articles for relevance to the topic before final analysis. RESULTS: The main role identified was improvement in Quality of Life and symptom control rather than detecting recurrence. We also demonstrate that it is possible to stratify HNC follow-up patients using their received treatment modality and Distress Thermometers to identify groups who will require more intensive AHP input. CONCLUSIONS: HNC follow-up covers a broad group of patients with differing needs. As such, a blanket approach to this phase of treatment is likely to be less effective than a patient-led model where the group of AHPs are employed on a needs basis rather than at set time points. This will likely lead to greater patient satisfaction, earlier detection of recurrence and efficiency savings.

Sports nutritionists' perspectives on enablers and barriers to nutritional adherence in high performance sport: A qualitative analysis informed by the COM-B model and theoretical domains framework.

Athlete adherence to nutritional guidance is critical for optimal health and performance, yet little is known about the barriers and enablers to athletes' dietary behaviours within high-performance sport. To advance understanding, we applied a theoretical lens derived from the Capability, Opportunity, Motivation - Behaviour (COM-B) model and the Theoretical Domains Framework (TDF) to explore the qualitative accounts of sports nutritionists. Five focus groups comprising sports nutritionists working in Olympic and Paralympic sport (n = 14), professional sport (n = 6), or both (n = 6) were undertaken. Thematic analysis was conducted and the interpretations of the findings were guided by COM-B and the TDF. To achieve nutritional adherence, the behavioural analysis identified the need to intervene across all three COM-B components and at least five associated TDF domains (e.g., decision-making processes, reinforcement, social influences, behavioural regulation and environmental context and resource). For the first time, the findings illustrate the complex interplay of the training setting with the capabilities, opportunities, and motivation of the practitioners, athletes and coaches. By applying established behavioural science theories to sports nutrition, the foundations for the development of targeted and multifaceted behavioural interventions addressing athlete dietary adherence in high-performance sport have been laid.

Oral Health Knowledge and Practices of WIC Staff at Florida WIC Program.

This study was conducted to assess the oral health knowledge, practices and confidence of staff in the Special Supplemental Nutrition Program for Women, Infant and Children (WIC) by administering an anonymous self-completed survey to 39 WIC Clinic staff in Northern Florida. The survey instrument was a 28-item questionnaire adapted from previous validated surveys and covered questions on oral health knowledge, confidence and general practices related to oral health. Survey data were analyzed by descriptive statistics. The majority of WIC staff is knowledgeable about the role of the caregiver in cleaning the child's teeth and the role of bottle use in dental caries. Only 7 (25 %) of total 28 WIC staff indicated that fluoridated toothpaste could be used for children younger than 2 years of age. Only 18 (64 %) agreed that the cariogenic bacteria could be transmitted from mother to child. Nutritionists reported greater confidence compared to others in oral health tasks. Only 6 (67 %) of the nutritionists reported to counsel caregivers on the importance of regular tooth brushing. Only 4 (44 %) nutritionists reported to refer WIC clients to dental care. These results indicate that WIC staff has a limited knowledge on the age recommendations for the fluoride toothpaste use and on the transmission of the cariogenic bacteria. Many do not provide oral health counseling to caregivers. WIC staff with more education is more likely to discuss oral health issues. WIC staff is in need for oral health training and education to provide oral health counseling for at risk WIC population.

Qualitative analysis of the contributions of nutritionists to the development of an online instrument for monitoring the food intake of schoolchildren.

BACKGROUND: The Consumo Alimentar e Atividade Fisica de Escolares (CAAFE) questionnaire is an online research tool that has been developed to enable the self-report of physical activity and diet by Brazilian schoolchildren aged 7-10 years. Formative research was conducted with nutritionists during the development of the web-based questionnaire. The suggestions and insights obtained were used to design a tool to monitor schoolchildren's food consumption based on the concept of healthy and unhealthy food indicators. The present study aimed to report the focus group discussions conducted with nutritionists concerning the CAAFE questionnaire. METHODS: Focus group discussions were conducted using a semi-structured questionnaire, and these were then analysed thematically. RESULTS: Twenty-four nutritionists participated (four focus groups; average per group: six people); the majority (n = 22) had experience with 7-10-year-old children. Four themes emerged: (i) healthy and unhealthy food indicators; (ii) suggestions for the online instrument; (iii) potential applications; and (iv) challenges for its construction. CONCLUSIONS: Comments made by nutritionists enabled the construction of an instrument that is able to answer questions related to food consumption in schools and at home.

Do some patients receive unnecessary parenteral nutrition after pancreatoduodenectomy? Results from an international multicentre study.

Backgrounds/Aims: After pancreatoduodenectomy (PD), an early oral diet is recommended; however, the postoperative nutritional management of PD patients is known to be highly variable, with some centers still routinely providing parenteral nutrition (PN). Some patients who receive PN experience clinically significant complications, underscoring its judicious use. Using a large cohort, this study aimed to determine the proportion of PD patients who received postoperative nutritional support (NS), describe the nature of this support, and investigate whether receiving PN correlated with adverse perioperative outcomes. Methods: Data were extracted from the Recurrence After Whipple's study, a retrospective multicenter study of PD outcomes. Results: In total, 1,323 patients (89%) had data on their postoperative NS status available. Of these, 45% received postoperative NS, which was "enteral only," "parenteral only," and "enteral and parenteral" in 44%, 35%, and 21% of cases, respectively. Body mass index < 18.5 kg/m2 (p = 0.03), absence of preoperative biliary stenting (p = 0.009), and serum albumin < 36 g/L (p = 0.009) all correlated with receiving postoperative NS. Among those who did not develop a serious postoperative complication, i.e., those who had a relatively uneventful recovery, 20% received PN. Conclusions: A considerable number of patients who had an uneventful recovery received PN. PN is not without risk, and should be reserved for those who are unable to take an oral diet. PD patients should undergo pre- and postoperative assessment by nutrition professionals to ensure they are managed appropriately, and to optimize perioperative outcomes.

Medical nutrition therapy provided by a dietitian improves outcomes in adults with prehypertension or hypertension: a systematic review and meta-analysis.

BACKGROUND: Hypertension is an important risk factor for cardiovascular disease (CVD). Interventions with dietitians can help modify dietary intake and reduce hypertension risk. OBJECTIVES: We aimed to examine the following research question: In adults with prehypertension or hypertension, what is the effect of medical nutrition therapy (MNT) provided by a dietitian on blood pressure (BP), CVD risk and events, and anthropometrics compared with standard care or no intervention? METHODS: MEDLINE, CINAHL, and Cochrane Central databases were searched for randomized controlled trials (RCTs) published in peer-reviewed journals from 1985-2022. Risk of bias was assessed using version 2 of the Cochrane tool for RCTs. Meta-analyses were conducted using the DerSimonian-Laird random-effects model. Certainty of evidence (COE) was assessed for each outcome using the Grading of Recommendations, Assessment and Evaluation method. RESULTS: Forty articles representing 31 RCTs were included and analyzed. MNT provided by a dietitian may reduce systolic [mean difference (MD): -3.63 mmHg; 95% confidence interval (CI): -4.35, -2.91 mmHg] and diastolic (MD: -2.02 mmHg; 95% CI: -2.56, -1.49 mmHg) BP (P < 0.001) and body weight (MD: -1.84 kg; 95% CI: -2.72, -0.96 kg; P < 0.001) and improve antihypertensive medication usage, relative risk of stroke (MD: 0.34; 95% CI: 0.14, 0.81; P = 0.02), and CVD risk score [standardized mean difference (SMD): -0.20; 95% CI: -0.30, -0.09; P < 0.001] compared with control participants, and COE was moderate. Additionally, MNT may reduce arterial stiffness (SMD: -0.45; 95% CI: -0.71, -0.19; P = 0.008) and waist circumference (SMD: -1.18 cm; 95% CI: -2.00, -0.36; P = 0.04), and COE was low. There was no significant difference in risk of myocardial infarction between groups. Dietitian interventions reduced BP and related cardiovascular outcomes for adults with prehypertension or hypertension. CONCLUSIONS: Dietitians play a critical role in improving cardiometabolic risk factors for adults with elevated BP; thus, improved payment for and access to MNT services has the potential to significantly impact public health. This review was registered at PROSPERO as CRD42022351693.