Consistency and Accuracy of Artificial Intelligence for Providing Nutritional Information.

This cross-sectional study analyzes the accuracy of nutrition information from artificial intelligence (AI) in comparison with a nutritionist.

Barriers and Opportunities for Clinical Nutritionists in 13 Latin American Countries: A Qualitative Study.

A clinical nutritionist (CN) is a university-educated professional trained to perform preventive and recovery functions in the health of patients. The actions of these professionals, both worldwide and in Latin America, may face barriers and opportunities that require careful identification and examination. The main objective of this study is to identify the most important barriers and opportunities for the clinical nutritionist in 13 Latin American countries. A qualitative study was carried out; the initial phase involved conducting in-depth individual interviews with 89 informants, experienced CNs from 13 Latin American countries. After calculating the mean and standard deviation, we ranked the top 10 most frequently reported barriers by assigning a score ranging from 1 to 10. Additionally, 3 opportunities were identified with a lower score from 1 to 3. Means and standard deviation were calculated to sort the responses. Results: the most important barrier was the absence of public policies that regulate and/or monitor compliance with the staffing of CNs according to the number of hospital beds, while the most important opportunity was the advances in technology such as software, body analysis equipment and other tools used in Nutritional Care. The identified barriers can interfere with the professional performance of CNs and, moreover, make it difficult to monitor the good nutritional status of patients. It is recommended to consider the barriers identified in this study, as well as the opportunities, with a view to improving the quality of hospital services with an adequate supply of nutritionists.

NUQUEST-NUtrition QUality Evaluation Strengthening Tools: development of tools for the evaluation of risk of bias in nutrition studies.

BACKGROUND: Dietary exposure assessments are a critical issue in evaluating human nutrition studies; however, nutrition-specific criteria are not consistently included in existing bias assessment tools. OBJECTIVES: Our objective was to develop a set of risk of bias (RoB) tools that integrated nutrition-specific criteria into validated generic assessment tools to address RoB issues, including those specific to dietary exposure assessment. METHODS: The Nutrition QUality Evaluation Strengthening Tools (NUQUEST) development and validation process included 8 steps. The first steps identified 1) a development strategy; 2) generic assessment tools with demonstrated validity; and 3) nutrition-specific appraisal issues. This was followed by 4) generation of nutrition-specific items and 5) development of guidance to aid users of NUQUEST. The final steps used established ratings of selected studies and feedback from independent raters to 6) assess reliability and validity; 7) assess formatting and usability; and 8) finalize NUQUEST. RESULTS: NUQUEST is based on the Scottish Intercollegiate Guidelines Network checklists for randomized controlled trials, cohort studies, and case-control studies. Using a purposive sample of 45 studies representing the 3 study designs, interrater reliability was high (Cohen's κ: 0.73; 95% CI: 0.52, 0.93) across all tools and at least moderate for individual tools (range: 0.57-1.00). The use of a worksheet improved usability and consistency of overall interrater agreement across all study designs (40% without worksheet, 80%-100% with worksheet). When compared to published ratings, NUQUEST ratings for evaluated studies demonstrated high concurrent validity (93% perfect or near-perfect agreement). Where there was disagreement, the nutrition-specific component was a contributing factor in discerning exposure methodological issues. CONCLUSIONS: NUQUEST integrates nutrition-specific criteria with generic criteria from assessment tools with demonstrated reliability and validity. NUQUEST represents a consistent and transparent approach for evaluating RoB issues related to dietary exposure assessment commonly encountered in human nutrition studies.

Content Validation of a Chrononutrition Questionnaire for the General and Shift Work Populations: A Delphi Study.

Unusual meal timing has been associated with a higher prevalence of chronic disease. Those at greater risk include shift workers and evening chronotypes. This study aimed to validate the content of a Chrononutrition Questionnaire for shift and non-shift workers to identify temporal patterns of eating in relation to chronotype. Content validity was determined using a Delphi study of three rounds. Experts rated the relevance of, and provided feedback on, 46 items across seven outcomes: meal regularity, times of first eating occasion, last eating occasion, largest meal, main meals/snacks, wake, and sleep, which were edited in response. Items with greater than 70% consensus of relevance were accepted. Rounds one, two, and three had 28, 26, and 24 experts, respectively. Across three rounds, no outcomes were irrelevant, but seven were merged into three for ease of usage, and two sections were added for experts to rate and comment on. In the final round, all but one of 29 items achieved greater than 70% consensus of relevance with no further changes. The Chrononutrition Questionnaire was deemed relevant to experts in circadian biology and chrononutrition, and could represent a convenient tool to assess temporal patterns of eating in relation to chronotype in future studies.

Roles and competencies in the nutritional domain for the management of the metabolic diseases and in the hospital setting: A position paper of the Italian College of Academic Nutritionists, MED-49 (ICAN-49).

Epidemiological evidence has confirmed the potential causal relationship between specific dietary factors and non-communicable diseases. However, currently nutrition was shown to be insufficiently integrated into medical education, regardless of the country. Without an adequate nutrition education, it is reasonable to assume that future physicians, as well as other health care professionals, will be not able to provide the highest quality care to patients in preventing and treating non-communicable diseases. Furthermore, the insufficient availability of physicians with specializations in nutrition has posed the basis for the development of non-medical careers in the field of nutrition. The present document was drafting by the Italian College of Academic Nutritionists, MED-49 (ICAN-49), with the aim to provide an overview on the nutritional competency standards covered by several health care professionals (Physicians Clinical Nutrition Specialists, Clinical Dietitians, Professional Clinical Nutrition Specialists, etc) for the prevention of diseases and/or support of pharmacological therapies. The aim of the ICAN 49 is to suggest a major shift in practice opportunities and roles for many nutritionists, especially for the management of the metabolic diseases, and promote a paradigm change: a clinical and educational leadership role for Physician Clinical Nutrition Specialists in the hospital setting.

Errors in the implementation, analysis, and reporting of randomization within obesity and nutrition research: a guide to their avoidance.

Randomization is an important tool used to establish causal inferences in studies designed to further our understanding of questions related to obesity and nutrition. To take advantage of the inferences afforded by randomization, scientific standards must be upheld during the planning, execution, analysis, and reporting of such studies. We discuss ten errors in randomized experiments from real-world examples from the literature and outline best practices for their avoidance. These ten errors include: representing nonrandom allocation as random, failing to adequately conceal allocation, not accounting for changing allocation ratios, replacing subjects in nonrandom ways, failing to account for non-independence, drawing inferences by comparing statistical significance from within-group comparisons instead of between-groups, pooling data and breaking the randomized design, failing to account for missing data, failing to report sufficient information to understand study methods, and failing to frame the causal question as testing the randomized assignment per se. We hope that these examples will aid researchers, reviewers, journal editors, and other readers to endeavor to a high standard of scientific rigor in randomized experiments within obesity and nutrition research.

Aplicabilidad de la innovación en la nutrición clínica / Applicability of innovation in clinical nutrition

La industria de la salud ha experimentado una gran innovación y lo seguirá haciendo en los próximos años. El término innovación viene de "fuera a dentro" impulsado por la necesidad de que el conocimiento y la investigación se traduzcan realmente en mejoras efectivas (de ahí la secuencia desde la investigación y desarrollo hacia la innovación: I+D+i); pero también viene de "abajo hacia arriba" como una pulsión de la organización sanitaria (basada, como pocas otras, en el conocimiento como activo fundamental) para dar salida a su creatividad y su capacidad de encontrar nuevas soluciones a viejos y nuevos problemas. El sistema sanitario actual debe avanzar en el desarrollo de una filosofía de cuidados más global e integrada que permita hacer frente a las consecuencias derivadas del envejecimiento y el aumento de las enfermedades crónicas y de la dependencia, que suponen un aumento de la demanda de atención. A medio-largo plazo se deberá potenciar una lógica de cuidados basada en las características individuales desde la perspectiva molecular, lo que se conoce como medicina 5P (personalizada, preventiva, predictiva, participativa y poblacional), igualmente denominada personalizada, un paradigma que ya ha iniciado su entrada, lenta y desigual, en los sistemas sanitarios. Y deberá adaptarse además a una sociedad con personas más informadas y participativas en la gestión de su propia salud, que de manera creciente utilizan tecnologías cuya velocidad de desarrollo crece exponencialmente. Teniendo en cuentas estas características y objetivos, en este artículo buscamos definir los rasgos fundamentales de la intersección entre innovación y nutrición clínica

The health industry has experienced great innovation and will continue to do so in the coming years. The term innovation comes from "outside to inside" driven by the need for knowledge and research to truly translate into effective improvements (hence the sequence from Research and Development to Innovation: R+D+I); but it also comes from "bottom up" as a drive of the health organization (based, as few others, on knowledge as a fundamental asset) to give way to their creativity and their ability to find new solutions to old and new problems. The current health system must advance in the development of a more global and integrated philosophy of care, which allows dealing with the consequences of aging and the increase in chronic diseases and dependence, which represent an increase in the demand for care. In the mediumlong term, a care logic based on individual characteristics from the molecular perspective should be promoted, which is known as 5P medicine (personalized, preventive, predictive, participatory and population), also called personalized medicine, a paradigm that has already initiated its entry, slow and uneven, in health systems. And it must also adapt to a society with more informed and participatory people in the management of their own health, which increasingly use technologies whose development speed grows exponentially. Taking into account these characteristics and objectives, in this article we seek to define the fundamental features of the intersection between innovation and clinical nutrition

[Pillars for excellence in nutrition units - research]. / Pilares para la excelencia en las uidades de nutrición: la investigación.

INTRODUCTION: Research in clinical nutrition and dietetics consists of "carrying out intellectual and experimental activities in a systematic way with the purpose of increasing knowledge on this topic." The biomedical research carried out in clinical nutrition and dietetics units (UNCyDs) must be clinical-translational, which is understood as the fastest way to ensure that new scientific knowledge is transferred not only to clinical research but also to clinical practice. When UNCyDs conduct research, regardless of type and extent, they achieve higher quality standards in the health care they provide to their users. Clinical practice and scientific research are activities that constitute a continuous, indissoluble action. For this reason, both those responsible for health management and nutrition units and all their members have an obligation to promote research. In this article, a brief historical review of the birth of clinical nutrition as a scientific discipline is made, the legislation that supports biomedical research is briefly mentioned, the main keys to promote research in UNCyD are proposed, and finally orientation is offered on the main funding for biomedical research programs, and how to transfer and disseminate results.

INTRODUCCIÓN: Investigar en nutrición clínica y dietética consiste en "realizar actividades intelectuales y experimentales de modo sistemático con el propósito de aumentar los conocimientos de esta materia". La investigación biomédica que se realiza en las unidades de nutrición clínica y dietética (UNCyD) debe ser clínico-traslacional, entendida como la forma más rápida de conseguir que los nuevos conocimientos científicos se transfieran no solamente a la investigación clínica sino también a la práctica asistencial. Cuando las UNCyD realizan investigación, independientemente del tipo y la extensión, alcanzan mayores cotas de calidad en la atención sanitaria que prestan a sus usuarios. La práctica clínica y la investigación científica son actividades que constituyen una acción continuada e indisoluble. Por ello, tanto los responsables de las gerencias sanitarias como los de las unidades de nutrición y todos sus miembros tienen la obligación de fomentar la investigación. En el artículo se realiza un breve repaso histórico del nacimiento de la nutrición clínica como disciplina científica, se nombra someramente la legislación que sustenta la investigación biomédica, se proponen las principales claves para potenciar la investigación en las UNCyD y, por último, se orienta sobre las principales vías de financiación y sobre cómo realizar la transferencia y difusión de los resultados.

Practical guidelines and apps for improvement of guideline implementation.

The European Society for Clinical Nutrition and Metabolism (ESPEN) presents a new series of "practical guidelines" based on previously published scientific guidelines. A first example of such a Practical Guideline has been completed and published recently (ESPEN practical guideline: Clinical Nutrition in inflammatory bowel disease), other will follow soon. The practical guidelines are generated by shortening and restructuring of the Scientific guidelines and by presenting the content using flow charts for a fast navigation through the content. The practical guidelines serve as templates for IT-based versions for the smartphone, tablet and PC, for lay versions and for translations into different languages. These efforts are part of a new guideline dissemination and implementation program ESPEN launched in 2018 also with support by the United European Gastroenterology society. First results are presented.

What Will It Take to Build an Expert Group of Nutrigenomic Practitioners?

BACKGROUND: The past two decades have seen exponential growth in the number of genetic testing companies, but only a small percentage of these tests are being sold through health care professionals (HCPs). As each new genetic testing company appears, it is becoming more difficult for the practitioner and consumer to evaluate the credibility of the claims being made and the value of the tests being offered. SUMMARY: HCPs appear to have minimal nutrigenomics knowledge and little confidence in choosing and interpreting nutrigenetic tests. To remedy this, HCPs need access to credible education, professional support, networking, career development, mentorship, and a regulated testing environment. This will enable them to evaluate the credibility of genetic tests and testing companies, provide genetic results in context, and apply appropriate clinical translation. Key Message: In order to establish an expert group of nutrigenomic practitioners, collaboration is required between educational institutions, professional organizations, and genetic testing companies. This will provide the necessary support, skills, and knowledge to ensure that the best value is extracted from nutrigenetic tests in an ethical and responsible manner.

A peer evaluation training results in high-quality feedback, as measured over time in nutritional sciences graduate students.

Peer evaluation skills are not typically taught to students, yet they are expected to provide high-quality feedback to their peers. Gameful learning, a pedagogy supporting student-driven learning, can further reinforce the development of peer evaluation skills, if students are motivated to improve upon them. To better understand the effects of a peer evaluation training on the quality of student-generated peer evaluations, we scored peer evaluations from two cohorts taking a graduate-level nutritional sciences class using gameful learning pedagogy. The intervention group completed a peer evaluation training before engaging in peer reviews, while the control group did not. The training included two readings, a video, and reflection questions. The peer evaluations submitted by both the intervention and control groups were assessed on a validated rubric. The peer evaluation training had a positive effect on the quality of the submitted peer evaluations. The intervention group had a 10.8% higher score on its first submitted peer evaluation compared with controls (P = 0.003). The intervention group improved the quality of its future submissions by a further 8.9%, whereas the controls did not continue to improve substantially (P < 0.001). Overall, peer review training enhanced the quality of peer evaluations and allowed students to develop professional skills that they can utilize in any biomedical profession. Our results highlight the importance of peer evaluation training in combination with repeated practice and student-driven learning brought forth by gameful learning pedagogy in improving the quality of evaluations and developing professional skills.

Validity and Reliability of Pediatric Nutrition Screening Tools for Hospital, Outpatient, and Community Settings: A 2018 Evidence Analysis Center Systematic Review.

BACKGROUND: Nutrition screening tools are used to identify risk of malnutrition or change in risk of malnutrition. However, it is unclear which tools have demonstrated high validity, reliability, and agreement. OBJECTIVE: Our aim was to conduct a systematic review of valid and reliable pediatric nutrition screening tools for identifying malnutrition risk (under- or overnutrition), and to determine whether there are differences in validity and reliability according to users of the tools. METHODS: A literature search using Medline, Embase, and CINAHL databases was conducted to identify relevant research published between 1995 and May 2017 examining validity and reliability of nutrition screening tools in the pediatric population. A multidisciplinary workgroup developed eligibility criteria, data were extracted and summarized, risk of bias was assessed, and evidence strength was graded, according to a standard process. RESULTS: Twenty-nine studies met inclusion criteria. Thirteen pediatric nutrition screening tools designed for various settings were included in the review (seven inpatient/hospital, three outpatient or specialty setting, and three community). The most frequently examined tools were the Screening Tool for the Assessment of Malnutrition in Pediatrics, Screening Tool for Risk on Nutritional Status and Growth (13 studies each), and Paediatric Yorkhill Malnutrition Score (nine studies). No tools demonstrated high validity. Reliability and agreement were reported infrequently. CONCLUSIONS: Nutrition screening tools with good/strong or fair evidence and moderate validity included the Screening Tool for the Assessment of Malnutrition in Pediatrics, Screening Tool for Risk on Nutritional Status and Growth, and Paediatric Yorkhill Malnutrition Score in the inpatient setting and Nutrition Risk Screening Tool for Children and Adolescents with Cystic Fibrosis in the specialty setting. No tools in the community setting met these criteria. While differences in validity and reliability measures among tool users were found, the significance of these findings is unclear. Limitations included few studies examining each tool, heterogeneity between studies examining a common tool, and lack of tools that included currently recommended indicators to identify pediatric malnutrition.

Benchmarking the research track record and level of appointment of Australian dietetic academics.

AIMS: Research involvement is fundamental to the practice of dietetics. The present study aims to benchmark the research track record of Australian dietetic academics, and to provide insight into how research productivity informs the level of appointment of academics across the career pathway. METHODS: Australian dietetic faculty websites and corresponding Scopus database profiles were used to support a bibliographic analysis of Australian dietetic academics' research track record. Current research productivity in relation to academic attributes, level of appointment, and institutional characteristics were explored. RESULTS: In Australia, dietetic academic level of appointment is logarithmically related to number of publications and relatively consistent across regions and university networks. CONCLUSIONS: Benchmarking provides universities with guidance regarding the performance to expect from academics at each academic level as well as feedback regarding recruitment and promotion practices. The present study provides an important benchmark for Australian dietetic academics and offers implications for individual academics and university management.

An Ontology to Standardize Research Output of Nutritional Epidemiology: From Paper-Based Standards to Linked Content.

BACKGROUND: The use of linked data in the Semantic Web is a promising approach to add value to nutrition research. An ontology, which defines the logical relationships between well-defined taxonomic terms, enables linking and harmonizing research output. To enable the description of domain-specific output in nutritional epidemiology, we propose the Ontology for Nutritional Epidemiology (ONE) according to authoritative guidance for nutritional epidemiology. METHODS: Firstly, a scoping review was conducted to identify existing ontology terms for reuse in ONE. Secondly, existing data standards and reporting guidelines for nutritional epidemiology were converted into an ontology. The terms used in the standards were summarized and listed separately in a taxonomic hierarchy. Thirdly, the ontologies of the nutritional epidemiologic standards, reporting guidelines, and the core concepts were gathered in ONE. Three case studies were included to illustrate potential applications: (i) annotation of existing manuscripts and data, (ii) ontology-based inference, and (iii) estimation of reporting completeness in a sample of nine manuscripts. RESULTS: Ontologies for "food and nutrition" (n = 37), "disease and specific population" (n = 100), "data description" (n = 21), "research description" (n = 35), and "supplementary (meta) data description" (n = 44) were reviewed and listed. ONE consists of 339 classes: 79 new classes to describe data and 24 new classes to describe the content of manuscripts. CONCLUSION: ONE is a resource to automate data integration, searching, and browsing, and can be used to assess reporting completeness in nutritional epidemiology.