Influence of physician and clinical dietitian on the use of dietary supplements among Polish patients with ulcerative colitis – pilot study / Influencia del médico y dietista clínico sobre el uso de suplementos dietéticos entre pacientes polacos con colitis ulcerosa – estudio piloto

Introduction: Patients with ulcerative colitis are a group of patients who are particularly vulnerable to nutritional deficiencies. Supplementation, prescribed by a physician or clinical dietitian, is therefore important in these patients. Materials and methods: The study was carried out by means of a questionnaire on a group of 106 people diagnosed with colitis and in remission. Results: More than 92% recommended the use of dietary supplements. Vitamin supplements were most common among people with ulcerative colitis (82.7%). The physician as a source of knowledge positively influenced the use of vitamin and mineral supplements (r=0.23, p=0.0213) while dietitians as a source of knowledge showed no significant effect on patients' supplementation choices. Conclusion: In Poland, the physician is the main source of supplementation knowledge than the clinical dietitian. This may be due to the unregulated nature of the dietitian profession in the Polish health care system. . It is therefore necessary to integrate dietitians in Poland into the medical profession, which will allow for better results in the treatment of not only IBD patients.(AU)

Dietitians' practices in dialysis units in Brazil: nutritional assessment and intervention.

INTRODUCTION: The importance of dietitians in dialysis units is indisputable and mandatory in Brazil, but little is known about the practices adopted by these professionals. OBJECTIVE: To know practices adopted in routine nutritional care, focusing on nutritional assessment tools and treatment strategies for people at risk or diagnosed with malnutrition. METHODOLOGY: Electronic questionnaire disseminated on social media and messaging applications. It included questions that covered dietitians' demographic and occupational profile characteristics and of the dialysis unit, use and frequency of nutritional assessment tools, nutritional intervention strategies in cases of risk or diagnosis of malnutrition, prescription and access to oral supplements. RESULTS: Twenty four percent of the Brazilian dialysis units (n = 207) responded electronically. The most used nutritional assessment tools with or without a pre-established frequency were dietary surveys (96%) and Subjective Global Assessment (83%). The strategies in cases of risk or presence of malnutrition used most frequently (almost always/always) were instructions to increase energy and protein intake from foods (97%), and increasing the frequency of visits (88%). The frequency of prescribing commercial supplements with standard and specialized formulas was quite similar. The availability of dietary supplements by the public healthcare system to patients varied between regions. CONCLUSION: Most dietitians use various nutritional assessment tools and intervention strategies in cases of risk or malnutrition; however, the frequency of use of such tools and strategies varied substantially.

Nutritional Considerations of Irish Performance Dietitians and Nutritionists in Concussion Injury Management.

Sport-related concussion incidence has increased in many team-based sports, such as rugby, Gaelic (camogie, hurling, football), and hockey. Concussion disrupts athletes' brain function, causing an "energy crisis" that requires energy and nutrient support to restore function and heal. Performance dietitians and nutritionists play a role in supporting athletes' post-injury nutritional demands. This study aimed to investigate Irish performance dietitians' and nutritionists' knowledge and implementation of nutritional strategies to manage and support athletes' recovery following concussion. In-depth, semi-structured interviews were conducted with seventeen (n = 17) Irish performance dietitians and nutritionists recruited from the Sport and Exercise Nutrition register and other sporting body networks across Ireland. Participants practised or had practised with amateur and/or professional athletes within the last ten years. All interviews and their transcripts were thematically analysed to extract relevant insights. These data provided valuable insights revealing performance dietitians and nutritionists: (1) their awareness of concussion events and (2) their use of nutritional supports for concussion management. Furthermore, the research highlighted their implementation of 'novel nutritional protocols' specifically designed to support and manage athletes' concussion recovery. There was a clear contrast between participants who had an awareness and knowledge of the importance of nutrition for brain recovery after sport-related concussion(s) and those who did not. Participants presenting with a practical understanding mentioned re-emphasising certain foods and supplements they were already recommending to athletes in the event of a concussion. Performance dietitians and nutritionists were keeping up to date with nutrition research on concussions, but limited evidence has prevented them from implementing protocols in practice. Meanwhile, participants mentioned trialling/recommending nutritional protocols, such as carbohydrate reloading, reducing omega-6 intake, and acutely supplementing creatine, omega-3 fish oils high in Docosahexaenoic acid, and probiotics to support brain healing. Performance dietitians' and nutritionists' use of nutrition protocols with athletes following concussion was linked to their knowledge and the limited scientific evidence available. Nutrition implementation, therefore, may be overlooked or implemented with uncertainty, which could negatively affect athletes' recovery following sports-related concussions.

Five-Year Mortality Outcomes for Eating As Treatment (EAT), a Health Behavior Change Intervention to Improve Nutrition in Patients With Head and Neck Cancer: A Stepped-Wedge, Randomized Controlled Trial.

PURPOSE: Malnutrition affects up to 80% of patients with head and neck cancer (HNC) and is associated with higher burden of disease, poorer treatment outcomes, and greater mortality. The Eating As Treatment (EAT) intervention is a behavioral intervention previously demonstrated to be effective in improving nutritional status, depression, and quality of life in patients with HNC. This article examines the effects of the EAT intervention on 5-year mortality among participants. METHODS AND MATERIALS: A multicenter, stepped-wedge, randomized controlled trial was conducted in 5 Australian hospitals. Dietitians were trained to deliver EAT, a combination of motivational interviewing and cognitive behavior therapy strategies, to patients with HNC receiving radiation therapy. Secondary analyses of survival benefit on an intention-to-treat basis were performed. Differences in proportions of 5-year all-cause mortality between the control and EAT intervention arms were analyzed using multivariable logistic regression, and 5-year survival rates were analyzed using Cox proportional hazards regression. Analyses controlled for temporal effects (study duration), hospital site (clustering), and baseline nutritional status differences. RESULTS: Overall, there were 64 deaths in the 5 years after enrollment, 36 (24%) among those assigned to the control condition and 28 (18%) among those assigned to EAT. Logistic regression showed statistically significant reduced odds in favor of EAT (odds ratio, 0.33; 95% CI, 0.11-0.96), with an absolute risk reduction of 17% (95% CI, 0.01-0.33) and a relative risk reduction of 55% (95% CI, 0.22-0.92), resulting in a number needed to treat of 6 (95% CI, 4-13). Survival analysis revealed that risk of death was significantly reduced by the EAT intervention (hazard ratio, 0.39; 0.16-0.96). CONCLUSIONS: Participation in EAT provided a statistically and clinically meaningful survival benefit, likely via improved nutrition during radiation therapy. This survival benefit strengthens the finding of the main trial, showing that a behavioral intervention focused on nutrition could improve HNC outcomes. Replication studies using stepped-wedge designs for implementation into clinical practice may be warranted.

Position of the Academy of Nutrition and Dietetics: Medical Nutrition Therapy Behavioral Interventions Provided by Dietitians for Adults With Overweight or Obesity, 2024.

Providing interventions that facilitate improvement of dietary intake and other health behaviors can improve nutrition-related outcomes in adults with overweight or obesity. Medical nutrition therapy (MNT) behavioral interventions require expertise from registered dietitian nutritionists or international equivalents (dietitians), which no other health care provider can provide for adults with obesity. Current evidence supports the role of MNT behavioral interventions for adults with overweight or obesity as an effective treatment option, when appropriate for and desired by the client. This Academy of Nutrition and Dietetics Position Paper describes potential benefits and concerns regarding dietitian-provided MNT behavioral interventions for adults with overweight and obesity and informs dietitians about implications for practice. This Position Paper is supported by a systematic review examining effectiveness of MNT interventions provided by dietitians and by an evidence-based practice guideline. It is the position of the Academy of Nutrition and Dietetics that MNT behavioral interventions for adults (aged 18 years and older) with overweight or obesity should be a treatment option, when appropriate and desired by the client, to improve cardiometabolic, quality of life, and anthropometric outcomes. Dietitians providing MNT recognize the complex contributors to overweight and obesity, and thus individualize interventions, based on a shared decision-making process, and deliver interventions in an inclusive, compassionate, and client-centered manner. Interventions should include collaboration with an interprofessional team when needed. Dietitians strive to increase health equity and reduce health disparities by advocating and providing opportunities for increased access to effective nutrition care services. This position remains in effect until December 31, 2031.

Understanding nutrition students' knowledge, perceived barriers and their views on the future role of nutritionists regarding sustainable diets.

Nutrition professionals are important stakeholders in sustainable food systems with skills to promote the connection between health, food production, environment, culture and economics. Higher education institutions are increasingly recognising the importance of teaching about sustainability, yet there exists a gap in the literature detailing the awareness of sustainability issues by nutrition students. This study aimed to ascertain the level of knowledge of sustainable diets (SDs), the perceived barriers to their adoption in their own diets, students' experience of university-based teaching about SDs and their views on the future role of the nutrition profession in relation to SD amongst nutrition students on Association for Nutrition (AfN)-accredited degrees. The study assessed environmental and sustainable food literacy (SFL) through an online questionnaire and explored the issues in more detail in virtual or face-to-face interviews in 2019. Quantitative data were analysed using descriptive statistics (Kruskal-Wallis, Jonckheere-Terpstra, independent t-test, Spearman, Pearson Correlations). Qualitative data were analysed using the Braun and Clark (2006) six-step approach to thematic analysis. The questionnaire responses (n = 51) represented 17 AfN-accredited undergraduate courses (35% of AfN-accredited universities in 2019). The majority (76%) of students had received an introduction, partaken in a module or received teaching on SDs throughout their whole degree. Students were predominantly environmentally literate, yet had a fragmented understanding of SDs, focusing on the environmental aspects of SDs. There was no correlation between SFL and reported sustainability content of university courses, highlighting a need for more effective teaching on sustainability topics. Additionally, no relationship between self-reported diet intake and SFL was found. Students identified a lack of knowledge and education as barriers preventing them from adopting sustainable practices in the present and future. To integrate sustainability into their future practice more consistently and effectively, nutrition students require more structured, holistic sustainability education and knowledge.

The effectiveness of medical nutrition therapy provided by a dietitian in adults with prediabetes: a systematic review and meta-analysis.

BACKGROUND: A total of 374 million adults worldwide are living with prediabetes, 70% of whom will develop type 2 diabetes mellitus (T2DM) in their lifetime. Medical nutrition therapy (MNT) provided by a dietitian, such as that found in lifestyle interventions, has the potential to improve glycemic control and prevent progression to T2DM. OBJECTIVES: The objective of this systematic review was to examine the effectiveness of MNT provided by a dietitian, compared with standard care, on glycemic, cardiometabolic, and anthropometric outcomes in adults with prediabetes. METHODS: Searches were conducted for randomized controlled trials (RCTs) published between 1995 and 2022 using electronic databases MEDLINE, CINHAL, and Cochrane Central. The risk of bias was assessed using version 2 of the Cochrane risk-of-bias tool for RCTs. Meta-analyses were conducted using a random-effects model. The certainty of evidence was assessed for each outcome using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method, and a summary of findings table was created using the GRADEpro Guideline Development Tool. RESULTS: Thirteen RCTs were included in the analysis, showcasing a variety of MNT interventions delivered by dietitians. Intervention durations ranged from 3 to 24 mo. Compared with standard care, MNT improved hemoglobin A1c (HbA1c) (mean difference [95% confidence interval]: -0.30% [-0.49, -0.12]) and fasting blood glucose (FBG) (-4.97 mg/dL [-6.24, -3.71]). Statistically significant improvements were found in anthropometrics (weight, body mass index, and waist circumference), cholesterol (total, high-, and low-density lipoproteins), and blood pressure (systolic and diastolic). No significant effect was found on T2DM or triglycerides. The certainty of evidence was moderate for FBG and low for HbA1c and incidence of T2DM. CONCLUSIONS: In adults with prediabetes, MNT was effective in improving glycemic outcomes, anthropometrics, blood pressure, and most lipid levels. However, most studies had a risk of bias because of the randomization process or deviations from intended interventions. MNT plays a key role in improving cardiometabolic risk factors in adults with prediabetes. TRIAL REGISTRATION NUMBER: This study was registered with the registration ID #351421, available from https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=351421.

Ketogenic Diet as a Possible Non-pharmacological Therapy in Main Endocrine Diseases of the Female Reproductive System: A Practical Guide for Nutritionists.

PURPOSEOF REVIEW: This narrative review explored the role of ketogenic diets (KDs) in improving fertility outcomes, low-grade inflammation, body weight, visceral adipose tissue, and its potential use in certain types of cancer, through its favorable actions on mitochondrial function, reactive oxygen species generation, chronic inflammation, and tumor growth inhibition. RECENT FINDINGS  : Nutrition is crucial to maintain the female reproductive system's health. Evidence on the association between diet and female reproductive system has greatly expanded over the last decade, leading to the identification of specific diet therapy, particularly KDs. KDs has been proved to be an effective weight-loss tool. To date, KDs is being increasingly used in the treatment of many diseases, such as obesity, type 2 diabetes mellitus. KDs is a dietary intervention capable of ameliorating the inflammatory state and oxidative stress through several mechanisms. Due to the increasing use of KDs beyond obesity, this literature review will provide the latest scientific evidence of its possible use in common disorders of the female endocrine-reproductive tract, and a practical guide to its use in these patients.

Medical Nutrition Therapy Provided by Dietitians is Effective and Saves Healthcare Costs in the Management of Adults with Dyslipidemia.

PURPOSE OF REVIEW: Referral to nutrition care providers in the USA such as registered dietitian nutritionists (RDNs) for medical nutrition therapy (MNT) remains low. We summarize research on the effectiveness of MNT provided by dietitians versus usual care in the management of adults with dyslipidemia. Improvements in lipids/lipoproteins were examined. If reported, blood pressure (BP), fasting blood glucose (FBG) glycated hemoglobin (A1c), body mass index (BMI), and cost outcomes were also examined. RECENT FINDINGS: The synthesis of three systematic reviews included thirty randomized controlled trials. Multiple MNT visits (3-6) provided by dietitians, compared with usual care, resulted in significant improvements in total cholesterol (mean range: - 4.64 to - 20.84 mg/dl), low-density lipoprotein cholesterol (mean range: - 1.55 to - 11.56 mg/dl), triglycerides (mean range: - 15.9 to - 32.55 mg/dl), SBP (mean range: - 4.7 to - 8.76 mm Hg), BMI (mean: - 0.4 kg/m2), and A1c (- 0.38%). Cost savings from MNT were attributed to a decrease in medication costs and improved quality of life years (QALY). Multiple MNT visits provided by dietitians compared with usual care improved lipids/lipoproteins, BP, A1c, weight status, and QALY with significant cost savings in adults with dyslipidemia and justify a universal nutrition policy for equitable access to MNT.

A survey of Canadian dairy nutritionists to assess current trace element formulation practices.

The purpose of this study was to identify current practices and perceptions around trace element feeding for dairy cows through a Canadian dairy nutritionist survey. An online survey with 23 questions was used to collect data from Canadian dairy nutritionists with the help of professional associations and social media. The survey was active from November 2021 to April 2022. The first 7 questions collected descriptive information on respondents, and the subsequent 16 questions focused on trace element feeding. A total of 92 participants from all over Canada filled out the survey, and about 26% of Canadian herds and cows were represented by these respondents. The participants had diverse views on the importance of diet formulations for trace elements to optimize cow health and productivity, with perceptions varying from very important to not important. In comparison, macronutrients and selenium were consistently rated as very important by between 58% and 74% of respondents. Software reference values were used by 54%, 72%, and 73% of participants to estimate trace element concentrations of forages, cereals, and protein sources, respectively, highlighting the importance of regularly updating the feed library of the software. More than 60% of nutritionists participating in this study had intentionally formulated diets above trace element software recommendations, considered mineral interactions occurring in the rumen, and used a trace element source known for its better bioavailability (e.g., organic, chelate) when they formulated diets. Herds with more than 80 cows were more likely to be given trace element supplements known for their greater bioavailability. The most used supplement with enhanced bioavailability was selenium. In addition, different trace element feeding strategies pertaining to different stages of lactation and breeds were reported. This finding can be explained by the absence of clear recommendations on trace element feeding by breed. The participants who adjusted trace element feeding according to the stages of lactation considered the transition period as the most challenging period, and they identified the need for a source of trace element known for its greater bioavailability for this period. Further research should aim to identify environmental risk of trace element overfeeding using the One Health approach. Moreover, strategies to avoid trace element overfeeding should be evaluated.

Nutrition-Related N-of-1 Studies Warrant Further Research to Provide Evidence for Dietitians to Practice Personalized (Precision) Medical Nutrition Therapy: A Systematic Review.

N-of-1 trials provide a higher level of evidence than randomized controlled trials for determining which treatment works best for an individual, and the design readily accommodates testing of personalized nutrition. The aim of this systematic review was to synthesize nutrition-related studies using an N-of-1 design. The inclusion criterion was adult participants; the intervention/exposure was any nutrient, food, beverage, or dietary pattern; the comparators were baseline values, a control condition untreated or placebo, or an alternate treatment, alongside any outcomes such as changes in diet, body weight, biochemical outcomes, symptoms, quality of life, or a disease outcome resulting from differences in nutritional conditions. The information sources used were Medline, Embase, Scopus, Cochrane Central, and PsychInfo. The quality of study reporting was assessed using the Consort Extension for N-of-1 trials (CENT) statement or the STrengthening Reporting of OBservational Studies in Epidemiology (STROBE) guidelines, as appropriate. From 211 articles screened, a total of 7 studies were included and were conducted in 5 countries with a total of 83 participants. The conditions studied included prediabetes, diabetes, irritable bowel syndrome, weight management, and investigation of the effect of diet in healthy people. The quality of reporting was mostly adequate, and dietary assessment quality varied from poor to good. The evidence base is small, but served to illustrate the main characteristics of N-of-1 study designs and considerations for moving research forward in the era of personalized medical nutrition therapy.

Canadian Registered Dietitians' Utilization of the 2018 Diabetes Canada Nutrition Therapy Clinical Practice Guidelines: A Cross-sectional Study.

OBJECTIVES: Our aim in this work was to ascertain Canadian registered dietitians' (RDs) use of the 2018 Diabetes Canada nutrition therapy (NT) recommendations and to identify the degree of agreement with facilitator-to-use statements. METHODS: A national 28-item anonymous cross-sectional survey of RDs who counsel people with diabetes was conducted. RESULTS: Three hundred sixty RDs responded to the survey, but some questions had fewer responses. Mean age of respondents was 36.8±10.1 years and 51.3% were certified diabetes educators (CDEs). Energy/macronutrient recommendations used most were regular timing/spacing of meals (85%), 30 to 50 g/day dietary fibre intake (71%), and maintaining a low glycemic index (65%). Mediterranean and Dietary Approaches to Stop Hypertension (DASH) dietary patterns had similar utilization rates as macronutrient distribution ranges, at 50% to 60%. Specific food recommendations were used most often, with the emphasis on fruits/vegetables and whole grains at 92% and 86%, respectively. Of the special considerations for people on insulin, regular meals/meal spacing was the recommendation used most often (88%). The statements "I trust the content …" and "I understand the scientific basis …" of the NT chapter were the internal facilitators most agreed with, at 86% each. The least agreed upon external facilitators were "my workplace encourages me to use the NT chapter," at 54%, and "I learned about the NT chapter in my formal education," at 44%. CDEs had significantly higher agreement on 12 of the 21 facilitator statements compared with non-CDEs. CONCLUSIONS: Canadian RDs are utilizing the NT guidelines, including the new dietary patterns. Simple, easy-to-implement recommendations, such as specific foods and timing/spacing of meals, were used most frequently. Opportunities for increased use could include encouraging dietetic training programs and worksites to promote utilization of CPGs in practice.

Work of nutritionists from the Family Health Support Center in the state of Paraíba, Brazil / Atuação de nutricionistas de Núcleo de Apoio à Saúde da Família no estado da Paraíba, Brasil

INTRODUCTION: Nutritional care in Primary Health Care is essential to face the problems of food and nutrition of the Brazilian population. OBJECTIVE: To compare the performance patterns of nutritionists who are members of the Family Health Support Center in the state of Paraíba, according to training in Primary Health Care. METHODS: A cross-sectional study was conducted with 34 nutritionists linked to the Family Health Support Center in the State of Paraíba. Information on demographic characteristics, professional qualification, labor specificities, knowledge, and use of essential bibliography for work in Primary Health Care, development of food and nutrition actions, and job satisfaction were collected. RESULTS: There were deficiencies in the knowledge and use of some technical documents in the area, as well as in the development of actions related to food and nutrition surveillance (completion of SISVAN-Web/e-SUS forms/sheets and interpretation of nutritional reports), vitamin A, and iron supplementation programs and care provision (monitoring of the growth and food guidance) to beneficiaries of the Bolsa Familia Program, especially among professionals without training in Primary Health Care. CONCLUSION: Nutritionists act on the actions of the food and nutrition programmatic agenda in Primary Health Care. The use of SISVAN-Web or e-SUS, activities linked to micronutrient supplementation programs, and the care provided to beneficiaries of the Bolsa Família Program were the least developed actions, particularly in the absence of training to work in Primary Health Care.

INTRODUÇÃO: O cuidado nutricional na Atenção Primária à Saúde é essencial para enfrentar os problemas de alimentação e nutrição da população brasileira. OBJETIVO: Comparar os padrões de atuação de nutricionistas integrantes de Núcleo de Apoio à Saúde da Família no Estado da Paraíba conforme a realização de treinamentos em Atenção Primária à Saúde. MÉTODOS: Estudo transversal, realizado com 34 nutricionistas vinculados aos Núcleo de Apoio à Saúde da Família no Estado da Paraíba. Foram coletadas informações sobre características demográficas, qualificação profissional, particularidades trabalhistas, conhecimento e utilização de bibliografia essencial para o trabalho na Atenção Primária à Saúde, desenvolvimento de ações de alimentação e nutrição, e satisfação com o trabalho. RESULTADOS: Houve deficiências no conhecimento e utilização de alguns documentos técnicos da área, bem como no desenvolvimento de ações relacionadas à vigilância alimentar e nutricional (preenchimento de formulários/fichas do SISVAN-Web/e-SUS e interpretação de relatórios nutricionais), aos programas de suplementação de vitamina A e ferro e à prestação de cuidados (acompanhamento do crescimento e orientação alimentar) a beneficiários do Programa Bolsa Família, principalmente entre os profissionais sem treinamento em Atenção Primária à Saúde. CONCLUSÃO: Os nutricionistas atuam em ações da agenda programática de alimentação e nutrição na Atenção Primária à Saúde. O uso do SISVAN-Web ou e-SUS, atividades vinculadas aos programas de suplementação com micronutrientes e a atenção prestada a beneficiários do Programa Bolsa Família foram as ações menos desenvolvidas, particularmente na ausência de capacitação para trabalhar na Atenção Primária à Saúde.

Assessing Impact of Nutrition Care by Registered Dietitian Nutritionists on Patient Medical and Treatment Outcomes in Outpatient Cancer Clinics: A Cohort Feasibility Study.

More information is needed about the impact of outpatient nutrition care from a registered dietitian nutritionist (RDN) on patient outcomes. This study aimed to assess the feasibility of a cohort study design to evaluate impact of RDN nutrition care on patient outcomes, describe clinic malnutrition screening practices, and estimate statistical parameters for a larger study. Seventy-seven patients with lung, esophageal, colon, rectal, or pancreatic cancer from six facilities were included (41 received RDN care and 36 did not). RDN nutrition care was prospectively documented for six months and documented emergency room visits, unplanned hospitalizations and treatment changes were retrospectively abstracted from medical records. Most facilities used the Malnutrition Screening Tool (MST) to determine malnutrition risk. Patients receiving RDN care had, on average, five, half hour visits and had more severe disease and higher initial malnutrition risk, although this varied across sites. Documented medical and treatment outcomes were relatively rare and similar between groups. Estimated sample size requirements varied from 113 to 5856, depending on tumor type and outcome, and intracluster correlation coefficients (ICCs) ranged from 0 to 0.47. Overall, the methods used in this study are feasible but an interventional or implementation design might be advantageous for a larger study.

Medical Nutrition Therapy Interventions Provided by Dietitians for Adult Overweight and Obesity Management: An Academy of Nutrition and Dietetics Evidence-Based Practice Guideline.

Overweight and obesity affect most adults living in the United States and are causally linked to several adverse health outcomes. Registered dietitian nutritionists or international equivalents (dietitians) collaborate with each client and other health care professionals to meet client-centered goals, informed by the best available evidence, and translated through a lens of clinical expertise and client circumstances and preferences. Since the last iteration of the Academy of Nutrition and Dietetics guideline on adult weight management in 2014, considerable research has been conducted and circumstances confronting dietitians have evolved. Thus, updated guidance is needed. The objective of this evidence-based practice guideline is to provide recommendations for dietitians who deliver medical nutrition therapy behavioral interventions for adults (18 years and older) with overweight and obesity to improve cardiometabolic outcomes, quality of life, and weight outcomes, when appropriate for and desired by the client. Recommendations in this guideline highlight the importance of considering complex contributors to overweight and obesity and individualizing interventions to client-centered goals based on specific needs and preferences and shared decision making. The described recommendations have the potential to increase access to care and decrease costs through utilization of telehealth and group counseling as effective delivery methods, and to address other barriers to overweight and obesity management interventions. It is essential for dietitians to collaborate with clients and interprofessional health care teams to provide high-quality medical nutrition therapy interventions using the nutrition care process to promote attainment of client-centered outcomes for adults with overweight or obesity.

Examining dietitians' knowledge, skills and attitudes regarding working with older adults in residential aged care facilities and home care services: An integrative review.

BACKGROUND: The Australian 2021 Royal Commission identified that the dietetic workforce needs to grow in size and capacity to support nutrition care in older adults. However, little is known about dietitians' knowledge, skills and attitudes (KSA) regarding working with older adults in residential aged care facilities (RACFs) or their homes. This review describes dietitians' KSA regarding older adults in RACFs and home care services. METHODS: A systematic literature search was conducted in August 2021 to identify studies examining any aspect of dietitians or student dietitians' KSA working in RACFs and home care services. No restrictions were applied to methodological design, language, location or publication year. Studies were assessed for quality using the Johanna Briggs Institute Quality Appraisal Tools. Study findings were analysed thematically using meta-synthesis. RESULTS: All 17 studies that met the inclusion criteria explored dietitians' attitudes towards their role, three studies examined perceived knowledge, although no studies objectively explored dietitians' skill levels. Five themes were developed inductively: (1) recognising their contribution as dietitians; (2) lacking clarity about the boundaries of their role; (3) all team members have a role to play in nutrition care; (4) assumptions and biases about working with older people; and (5) needing to build capacity in the workforce. DISCUSSION: Dietitians have mixed attitudes about working in RACFs and home care services. Future directions include evaluating dietitians' role in RACFs, reviewing education and training and practical opportunities for student dietitians, and assessing the impact of more dietitian support on an older person's dietary intake and nutrition.

Clinical and nutritional management of very-low-calorie ketogenic diet (VLCKD) in patients with psoriasis and obesity: a practical guide for the nutritionist.

Psoriasis is an immune-mediated inflammatory skin disease associated with multiple comorbidities. Considered one of the most common inflammatory skin diseases among the general population, it not only affects the skin, but also negatively impacts other organs and joints. In addition, psoriasis has been associated with several chronic cardio-metabolic diseases such as obesity, which would seem to be (i) a risk factor for the onset of psoriasis and (ii) a worsening factor of the severity of the disease. Weight loss appears to improve severity in overweight patients. Recently proposed as an obesity management nutritional strategy, the very-low-calorie ketogenic diet (VLCKD) has demonstrated significant effects in reducing inflammatory processes. In the current review, we describe the evidence available on psoriasis and VLCKD, and provide a practical guide to the prescription of VLCKD in the different phases, evaluation and management of possible adverse events, and the importance of physical activity as a lifestyle modification to reduce psoriasis and associated comorbidities. Randomized control trials are, however, necessary to determine the most effective VLCKD protocol for patients with obesity and psoriasis, optimal protocol duration, composition of micronutrients and macronutrients, choice of special supplements, and management of carbohydrate reintroduction.

EASO and EFAD Position Statement on Medical Nutrition Therapy for the Management of Overweight and Obesity in Children and Adolescents.

INTRODUCTION: This position statement on medical nutrition therapy in the management of overweight or obesity in children and adolescents was prepared by an expert committee convened by the European Association for the Study of Obesity (EASO) and developed in collaboration with the European Federation of the Associations of Dietitians (EFAD). METHODS: It is based on the best evidence available from systematic reviews of randomized controlled trials on child and adolescent overweight and obesity treatment and other relevant peer-reviewed literature. RESULTS: Multicomponent behavioural interventions are generally considered to be the gold standard treatment for children and adolescents living with obesity. The evidence presented in this position statement confirms that dietary interventions can effectively improve adiposity-related outcomes. Dietary strategies should focus on the reduction of total energy intake through promotion of food-based guidelines that target modification of usual eating patterns and behaviours. These should target increasing intakes of nutrient-rich foods with a lower energy density, specifically vegetables and fruits, and a reduction in intakes of energy-dense nutrient-poor foods and beverages. In addition, higher intensity, longer duration treatments, delivered by interventionists with specialized dietetic-related skills and co-designed with families, are associated with greater treatment effects. DISCUSSION: Such interventions should be resourced adequately so that they can be implemented in a range of settings and in different formats, including digital or online delivery, to enhance accessibility.

Coffee consumption, health benefits and side effects: a narrative review and update for dietitians and nutritionists.

Coffee is one of the most popular beverages worldwide; however, its impact on health outcomes and adverse effects is not fully understood. The current review aims to establish an update about the benefits of coffee consumption on health outcomes highlighting its side effects, and finally coming up with an attempt to provide some recommendations on its doses. A literature review using the PubMed/Medline database was carried out and the data were summarized by applying a narrative approach using the available evidence based on the literature. The main findings were the following: first, coffee may contribute to the prevention of inflammatory and oxidative stress-related diseases, such as obesity, metabolic syndrome and type 2 diabetes; second, coffee consumption seems to be associated with a lower incidence of several types of cancer and with a reduction in the risk of all-cause mortality; finally, the consumption of up to 400 mg/day (1-4 cups per day) of caffeine is safe. However, the time gap between coffee consumption and some drugs should be taken into account in order to avoid interaction. However, most of the data were based on cross-sectional or/and observational studies highlighting an association of coffee intake and health outcomes; thus, randomized controlled studies are needed in order to identify a causality link.