Perspective: Key considerations when developing and publishing dietary interventions for human clinical trials.

A key guiding principle in the 2020-2025 Dietary Guidelines for Americans emphasizes the need for individuals to choose eating habits that allows for personal, cultural, and traditional preferences while establishing a high-quality diet. This concept becomes a daunting task given the need to reduce the consumption of foods higher in saturated fat, sodium, and/or added sugar - which are typically found in familiar, highly palatable foods most-often liked and consumed in the United States. Similarly, in nutrition intervention studies, adherence to healthier dietary patterns is typically low as a result of many factors, including reduced taste, flavor, and familiarity to the study foods. Increasing evidence illustrates the promising role of herbs and spices to maintain acceptability of healthier food options for nutrition interventions. This perspective paper was informed by a Satellite Session presented at the American Society for Nutrition's annual meeting, Nutrition 2023, entitled, "Developing Culturally Appropriate Recipes for Human Clinical Trials," which explored several proposed 'best practice' guidelines when developing nutrition interventions to improve dietary adherence and acceptability within clinical trials. The session also highlighted a need to include sufficient detail concerning the types and amounts of specific foods included within nutrition interventions in combination with preparation methods and study recipes, including herbs and spices, to improve intervention reproducibility and translatability for future research, dietary guidelines, and clinical practice.

How might enhanced interprofessional collaboration between primary care physicians and registered dietitian nutritionists impact clinical outcomes related to obesity and associated illnesses? A commentary.

The unsettling worldwide prevalence of obesity and obesity-related illnesses seems to be well-understood. What seems to be lacking, however, is a strategy of how best to fix the issue. Meagre nutrition content in medical school curricula may contribute to limited primary care physician (PCP) knowledge of the role nutrition has in health ailments and the understanding of a registered dietitian nutritionist (RDN) scope of practice. In USA, RDN are health care practitioners specialised in nutrition and who are experts in treating obesity and obesity-related illnesses. An increased RDN involvement in patient care has been shown to promote improvements in nutrition-related clinical outcomes. Therefore, enhanced collaboration between PCP and RDN has the potential to ameliorate the obesity epidemic. Tactics to promote collaboration may include enhancing nutrition education in medical school and providing nutrition-focussed continuing education for practicing physicians. The seriousness of the obesity epidemic underscores the need for interprofessional collaboration between PCP and allied health professionals who are uniquely trained to address obesity and obesity-related illnesses.

Sex at every size: A content analysis of weight inclusivity in sexual functioning research.

Sexual functioning research has been slow to address sizeism within its volumes. Much of the sexual health science has adopted a weight normative model rather than a weight inclusive model. The purpose of this study was to, through systematic literature review, describe the sexual functioning research landscape with respect to weight inclusivity. The review included three databases (Google Scholar, Medline and Ebsco) between 2010 and 2020. Each article was double coded for weight inclusivity and sexual functioning. Sixty-seven articles met the criteria and were included in analysis. The articles, overall, only endorsed weight inclusive tenets 16 % of the time. Articles were most weight inclusive when discussing sexual satisfaction (22.5 %). Meanwhile, when discussing sexual arousal, the articles were the least weight inclusive (16.7 %). These findings suggest there is needs to be greater education and intention for sex educators, therapists, and clinicians, to explore and enhance body positivity and sexual health.

Association of fruit and vegetable color with incident diabetes and cardiometabolic risk biomarkers in the United States Hispanic/Latino population.

BACKGROUND: Color groups of fruits and vegetables (FV) are part of a healthy diet, but evidence for an association with cardiometabolic outcomes is inconsistent. OBJECTIVE: To examine the association between intake of FV of different colors with incident diabetes and cardiometabolic risk biomarkers among U.S. Hispanics/Latinos. SUBJECTS/METHODS: We used data from 9206 adults ages 18-74 years who were free of diabetes at baseline (2008-2011) and had follow-up data at visit 2 (2014-2017) in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a multicenter, prospective cohort study of self-identified Hispanics/Latinos. Dietary intake was assessed using two 24 h recalls at baseline. FV were categorized into five color groups: green, white, yellow/orange, red/purple, and uncategorized. Diabetes was defined based on laboratory measures and self-reported antihyperglycemic medication. We used survey logistic regression models to evaluate the association between FV color groups and incident diabetes and survey linear regression models to evaluate the association of FV color groups with cardiometabolic risk biomarkers at visit 2. RESULTS: During ~6 years of follow-up, 970 incident cases of diabetes were documented. The red/purple FV color group was the least consumed (0.21 servings/day), whereas white FV were the most consumed (0.92 servings/day). For each serving of total FV intake, body mass index (BMI) was lower by 0.24% (p = 0.03) and insulin by 0.69% (p = 0.03). For each serving of red/purple FV intake, HDL was 1.59% higher (p = 0.04). For each serving of white FV intake (with potato), post-OGTT was 0.83% lower (p = 0.04) and triglycerides 1.43% lower (p = 0.04). There was no association between FV intake and incident diabetes. CONCLUSIONS: Specific FV colors were associated with cardiometabolic benefits though the associations were of relatively small magnitudes. Dietary recommendations could consider varying colors of FV intake, especially white and red/purple color groups, for a healthy diet.

Boosting Whole-Grain Utilization in the Consumer Market: A Case Study of the Oldways Whole Grains Council's Stamped Product Database.

Whole grains are a vital part of a healthy diet, yet there are insufficient data on the whole-grain content of commercial food products. The purpose of this research is to examine the long-term change in (1) measured whole grains in food products, (2) Whole Grain Stamp usage and (3) the prominence of whole-grain ingredients and product categories, across the United States and Latin America. These changes were quantified by analyzing the Oldways Whole Grains Council's (WGC) Stamped Product Database from 2007 to 2020. Mean whole grains increased 36-76%, from 19 grams to 25.8 grams per serving in the U.S. and 18.1 grams to 31.9 grams per serving in Latin America. Whole Grain Stamp usage worldwide has increased from 250 products in 2005 to more than 13,000 products in 2020. These findings suggest that manufacturers are increasing the percentage of the grain that is whole in their products and developing more whole-grain products for consumers, thus providing an opportunity for consumers to meet national-level whole-grain recommendations.

A Mentoring Program Builds the Bridge with Nutrition Students and Healthcare Professionals.

Mentoring is an effective strategy to help train and guide emerging professionals to be successful in their careers and to stay abreast as evidence-based recommendations are continuously evolving. Experiential learning opportunities can help students to gain knowledge and improve skillsets. The RD Mentorship Program was established to enhance professional development and knowledge by connecting nutrition students (NS) and registered dietitians (RD). This program used social exchange theory and Kolb's experiential learning theory to evaluate the impact. RD (n=238) and NS (n=302) across Texas and Florida participated in a 1-year, project-based mentoring program from 2016 to 2020. This program collected qualitative and quantitative data in this pre-post program design. While the sheer number of participants over the three academic years was a strength of the program, there were also some valuable lessons learned. Most participants rated their experience as satisfied to highly satisfied (6.7-8.7/10). Five key themes emerged from program evaluation: mutuality, opportunity, career development, diversity and inclusion and barrier. Mentorship, both virtually and in-person, can offer unique "hands-on" learning opportunities that bridge the gap between students and healthcare practitioners. The RD Mentorship Program models how mentorships can successfully be applied in diverse health professions.

Covid-19 Impacts on Florida's Healthcare Professionals.

This study described how COVID-19 impacted employment, telehealth usage, and interprofessional collaboration. A cross-sectional survey was deployed in June 2020 to healthcare professionals in Florida. Job status was uniquely separated by profession, with more nurses and medical doctors reported having no effect, and more mental health counselors transitioned to telehealth. Over a third of rehabilitation providers reported being furloughed. Over forty percent of providers had no training in telehealth, yet 33.1% reported an increase in usage. Interprofessional interactions are lower across professions during the pandemic, compared with before. This study shows the need for additional training on telehealth and interprofessional collaboration.

Nutrition education for providers is limited: it is time for increased education to boost interprofessional collaboration!

Nutrition plays a major role in the overall health, longevity, and quality of life of each person, from infancy to elderly. Education and training for most health-care providers to deliver nutrition care to patients have been inadequate and on the decline in the past several decades. This gap needs to be addressed by increasing the knowledge, confidence, and abilities of health-care professionals to deliver nutrition care and work as an interprofessional team for patients. Having a registered dietitian nutritionist as part of the interprofessional team can lead to better-coordinated care, using nutrition at the forefront. We describe the issues with a disparity in online nutrition-focused continuing professional development (CPD) and propose an avenue and strategy to use CPD to deliver nutrition education and training to providers, ultimately to boost interprofessional collaboration.

Beyond the clinical walls: registered dietitian nutritionists providing medical nutrition therapy in the home setting.

BACKGROUD/OBJECTIVES: Registered dietitian nutritionists (RDN) are providers of medical nutrition therapy (MNT) to address health and chronic disease. Traditionally, RDNs have provided care in healthcare facilities including hospitals and private care facilities. The purpose of this study was to determine how RDN individualized MNT in the home impacted nutrition, physical activity, and food security. SUBJECTS/METHODS: This is a secondary data analysis. The mean age of the participants (n = 1,007) was 51.6 years old with a mean body mass index (BMI) of 34.1 kg/m2. Individualized MNT visits were delivered by an RDN in the home setting from January to December 2019. Participants were referred by healthcare professionals or self-referred. Participants had MNT benefits covered by their health insurance plan (43.3% Medicaid; 39.8% private insurance; 7.9% Medicare, 9% other). Health outcomes related to nutrition care were measured. Outcomes included self-reported consumption of nutrition factors and physical activity. Our secondary outcome focused on food security. The changes in weight, BMI, physical activity, and nutrition factors were analyzed by a linear regression model or linear mixed model, adjusting for age, sex, baseline value, and number of appointments. Food security was summarized in a 2 by 2 contingency table. RESULTS: Baseline values had significantly negative impacts for all changes and number of appointments was significant in the changes for weight and BMI. Increases in physical activity were significant for both female and male participants, 10.4 and 12.6 minutes per day, respectively, while the changes in weight and BMI were not. Regarding dietary factors, the consumption total servings per day of vegetables (0.13) and water (3.35) significantly increased, while the consumption of total servings of whole grain (-0.27), fruit (-0.32), dairy (-0.80) and fish (-0.81) significantly decreased. About 24% (of overall population) and 45% (of Medicaid population) reported improvements in food security. CONCLUSIONS: This study found that home visits were a useful setting for MNT delivered by RDNs. There is a strong need for individualized counseling to meet the participants' needs and personal goals.

Older and Wiser? The Need to Reexamine the Impact of Health Professionals Age and Experience on Competency-Based Practices.

INTRODUCTION: Delivery of healthcare services makes up a complex system and it requires providers to be competent and to be able to integrate each of the institute of medicine's (IOM) 5 core competencies into practice. However, healthcare providers are challenged with the task to be able to understand and apply the IOM core competencies into practice. OBJECTIVE: The purpose of the study was to examine the factors that influence health professional's likelihood of accomplishing the IOM core competencies. METHODS: A cross-sectional study design was used to administer a validated online survey to health providers. This survey was distributed to physicians, nursing professionals, specialists, and allied healthcare professionals. The final sample included 3,940 participants who completed the survey. RESULTS: The study findings show that younger health professionals more consistently practice daily competencies than their older counterparts, especially in the use of evidence-based practice, informatics, and working in interdisciplinary teams. Less experienced health professionals more consistently applied quality improvement methods but less consistently used evidence-based practice compared to their more experienced counterparts. CONCLUSION: There is a need to understand how health professionals' age and experience impact their engagement with IOM's core competencies. This study highlights the need for educational resources on the competencies to be tailored to health providers' age and experience.

Dietary and behavior changes following RDN-led corporate wellness counseling: A secondary analysis.

BACKGROUND: Worksite wellness programs have the ability to activate health promotion and stimulate behavior change. OBJECTIVE: To measure longitudinal associations between visits with a Registered Dietitian Nutritionist (RDN), as part of worksite wellness programs, on dietary and lifestyle behavior changes. METHODS: The study sample included 1,123 employees with 77 different worksite wellness programs across the United States from March to December 2017. Hierarchical linear modeling was used to evaluate the associations of RDN visits with behavior changes. RESULTS: The mean BMI at baseline was 33.48, indicating over half of all employees are considered obese. Employees who attended more than one visit showed an increase in whole grain consumption and corresponding weight loss (t-ratio = 2.41, p = 0.02). Age played a significant factor in the rise of systolic blood pressure; employees who attended more visits showed an increase in whole grain consumption and corresponding blood pressure (t-ratio = -2.11, p = 0.04). CONCLUSIONS: RDNs as part of worksite wellness programs, can contribute to improvements in lifestyle behavior changes. These data highlight the need for nutrition intervention at the workplace. Research on nutrition-focused worksite wellness programs is needed to assess the long-term health outcomes related to dietary and lifestyle behavior changes.

Development of a Sustainable Mentorship Program: Registered Dietitian Nutritionists Mentoring Undergraduate Dietetics Students.

Formal mentoring programs for dietetics students are limited, a critical gap in student application of learning. The educational program evaluated in this study was a structured project-based mentorship program between registered dietitian nutritionists (RDNs) and students in a didactic program in dietetics (DPD). There were 57 participants in our two-semester program, launched between a large university and a local dietetic association. The program resulted in high satisfaction ratings and strong interest in participating in the future program due to a reported increase in knowledge of concepts in the dietetics field from mentors and mentees involved. This program model has the ability to be adapted for launch at other DPD programs around the country to provide students with valuable hands-on experience in the field.