Registered Dietitian Nutritionists' Perceptions of the Relationship Between Food and Peace in the United States Food System: A Qualitative Study.

BACKGROUND: In the United States, persistent food insecurity alongside social and health disparities limit peace in the food system. A peacebuilding approach offers a potential paradigm shift integrating food in the context of peace to foster right and just relationships with self, others, and the Earth for sustainable, resilient, and equitable food systems. OBJECTIVE: This qualitative study sought to explore registered dietitian nutritionists' (RDNs) perceptions of the relationship between food and peace and to identify implications of food as grounds for peacebuilding, using a Food Peace Framework in the field of nutrition and dietetics. DESIGN: Virtual, semistructured individual interviews elicited the perceptions and understandings of a purposive sample of RDNs working within the US food system. PARTICIPANTS/SETTING: Twenty-two purposively sampled RDNs of differing races, ethnicities, ages, places of employment, years of work experience, and diverse geographic locations across the United States were interviewed from October 2021 to January 2022. ANALYSIS: Qualitative grounded theory iterative coding was performed in three phases: initial, focused, and theoretical coding. Thematic coding analysis with NVivo (version 12.0) was used to organize and interpret data. RESULTS: Four themes on the perceptions of peace within the US food system emerged, including (1) barriers to peace; (2) conflict in the US food system; (3) values in systems; and (4) new understandings of peacebuilding in the US food system. Four themes of implications of the Food Peace Framework emerged, including implications for (1) education and research communities; (2) nutrition counseling and health care settings; (3) local organizations and programs; and (4) policy. CONCLUSIONS: This initial study revealed a gap in RDNs' current understandings of peacebuilding in the context of food and acknowledged the need for future research. The Food Peace Framework could offer a comprehensive and inclusive model with the potential to initiate conversations that could address root causes of economic despair, social injustices, and political oppression in food systems.

Predicted vs measured energy expenditure in critically ill, underweight patients.

A retrospective analysis was conducted to compare 4 energy-prediction equations against measured resting energy expenditure (MREE) determined via indirect calorimetry. Data from a heterogeneous group of 42 critically ill, severely underweight (59.50 +/- 17.30 kg; 77.1 +/- 9.7% ideal body weight [IBW]) male patients were assessed. The Hamwi formula was used to determine IBW. The Harris-Benedict (HB) equation was calculated for patients <90% IBW using both current body weight (CBW) and IBW. Energy needs were also estimated with an Ireton-Jones formula for all mechanically ventilated patients (n = 37). For patients <85% IBW (n = 31), an adjusted body weight was determined ([CBW + IBW]/2) and used in the HB formula. The HB formula using the IBW, CBW, and adjusted body weight was significantly different (p < .05) than MREE. The Ireton-Jones equation was not significantly different (p > .05) from MREE but tended to overestimate energy needs (109.3% +/- 16.8% MREE). Conversely, using the CBW or IBW in the HB underestimated the patient's energy needs; 77.0% +/- 11.6% MREE and 90.9 +/- 16.1% MREE, respectively. For patients <85% IBW, use of the adjusted body weight in the HB represented 84.2% +/- 13.9% MREE. The average caloric need was 31.2 +/- 6.0 kcal/kg CBW. Indirect calorimetry remains the best method of determining a patient's energy needs. Until a large prospective trial is conducted, a combination of prediction equations tempered with clinical judgment and monitoring the appropriateness of the nutrition prescription remains the best approach to quality patient care.