Empathy in nutrition and dietetics: a scoping review.

BACKGROUND: Empathy is fundamental to the provision of efficacious patient-centered healthcare. Currently, there is no comprehensive synthesis of peer-reviewed empirical research related to empathy in the nutrition and dietetics profession. Understanding empathy in the context of dietetic care may lead to improved teaching practices that support nutrition and dietetic students and professionals to provide high-quality, empathic, patient-centered care. OBJECTIVE: This scoping review aimed to understand the approaches through which empathy is conceptualized, measured, and taught in the nutrition and dietetics profession. METHODS: Using the PRISMA ScR-Scoping Reviews Statement and Checklist a scoping review process was undertaken. Five databases were searched in February 2023: CINAHL, Embase, Medline, PsycInfo, and Scopus, with no date limits. Eligible studies were English language-based, peer-reviewed, empirical research exploring or measuring empathy as an outcome in primary data stratified to nutrition and dietetics. Extracted qualitative data were synthesized and analysed thematically with an inductive, interpretivist approach applied to conceptualize the interrelationship between empathy and dietetic practice. Quantitative data were extracted and summarized in a table. RESULTS: Twenty-six studies were included in the scoping review. Analysis identified two overarching themes underpinning the current literature on empathy in nutrition and dietetics, that described (i) empathy as a key skill in the application of patient-centered care, which was supported by (ii) approaches to lifelong cultivation of empathy in the nutrition and dietetics profession. A range of tools have measured empathy in nutrition and dietetic students and practitioners with no clear consensus in findings across studies. CONCLUSIONS: This review identified the extent and nature of empathy within nutrition and dietetics, from both professional and patient perspectives, and the vast array of approaches used to teach and quantify empathy in students and professionals. Insights from this review inform the need for future studies. The results of this review suggest that future research include i) exploring implications of empathic dietetic care on patient outcomes and ii) identification of best practice, evidence-based curricula and strategies to support sustainable cultivation and maintenance of empathic care across the career span of nutrition and dietetic professionals.

A systematic review of observational studies exploring the relationship between health and non-weight-centric eating behaviours.

Eating behaviour that does not centralise weight, otherwise known as weight-neutral, is associated with improved physical and psychological health, and greater health promoting behaviours. However, consolidated evidence is lacking. This study aimed to systematically evaluate 'health-centric' eating behaviour reflective of weight-neutral approaches, and their relationship with health (physical and mental) and health promoting behaviours. A systematic search was performed, identifying observational studies with adult populations, ≥1 physical/mental health outcome(s), and ≥1 validated measure(s) of health-centric eating behaviour. Study design, sample characteristics and outcomes were extracted and characterised into four domains. Our search identified 8281 records, with 86 studies, 75 unique datasets, and 78 unique exposures including 94,710 individuals. Eating behaviours included intuitive eating (n = 48), mindful eating (n = 19), and eating competence (n = 11). There were 298 outcomes identified for body composition, size, and physical health (n = 116), mental health and wellbeing (n = 123), health promoting behaviours (n = 51) and other eating behaviour (n = 8). Higher levels of intuitive eating, mindful eating and eating competence were significantly related to a lower BMI, better diet quality and greater physical activity. Higher intuitive and mindful eating were significantly related to lower levels of disordered eating, and depressive symptoms, and greater body image, self-compassion, and mindfulness. Greater eating competence and intuitive eating were significantly related to higher fruit and vegetable intake, and greater eating competence to higher fibre intake and better sleep quality. Our results demonstrate that 'health-centric' eating behaviours are related to a range of favourable health outcomes and engagement in health promoting behaviours. These findings help to enhance our understanding of eating behaviours that do not centre around body weight, providing support for health-centric eating behaviour in healthcare. Future research should focus on intervention studies and more diverse population groups.

Distribución de nutricionistas en el sistema de salud peruano: un panorama por niveles de atención

La prestación de servicios para la atención integral de la salud requiere la participación de diversos profesionales con competencias específicas para brindar la mejor atención posible a la población. La inclusión del nutricionista en los diferentes niveles del sistema de salud es crucial para garantizar una atención integral en las diversas etapas de la vida. Una distribución inequitativa de nutricionistas en los niveles de atención puede conducir a una fragmentación de la atención y la pérdida de oportunidades para abordar los problemas relacionados con la alimentación y nutrición. Por ello, se desarrolló un estudio con el objetivo de describir la distribución de nutricionistas en los establecimientos de salud según el nivel de atención, y evaluar el cumplimiento de las recomendaciones de recursos humanos establecidas por la norma técnica de las UPSS de Nutrición y Dietética. Se desarrolló un estudio descriptivo y transversal, mediante el análisis de fuentes secundarias. Se utilizaron los datos de recursos humanos por IPRESS de SUSALUD, del año 2022. Se consideró la Norma técnica de UPSS de Nutrición y Dietética para evaluar el cumplimiento de las recomendaciones de recursos humanos. Entre los principales resultados, se identificó que el 7.93% de los establecimientos de salud del primer nivel de atención tienen al menos un nutricionista. En el segundo nivel de atención, el 96.35% de los establecimientos de salud no cumplen con las recomendaciones de recursos humanos de la norma técnica, y ningún establecimiento del tercer nivel de atención cumplió esta recomendación. La distribución de nutricionistas en los diversos niveles de atención del sistema de salud peruano es desigual. Es necesario mejorar la planificación de recursos humanos en el sistema de salud peruano para garantizar una atención integral de la salud a la población.

The provision of services for comprehensive healthcare requires the involvement of various professionals with specific competencies to provide the best possible care to the population. The inclusion of nutritionists at different levels of the healthcare system is crucial to ensure comprehensive care at various stages of life. An unequal distribution of nutritionists across healthcare levels can lead to fragmented care and missed opportunities to address nutrition-related issues. Therefore, a study was conducted with the aim of describing the distribution of nutritionists in healthcare facilities according to the level of care and evaluating compliance with the human resources recommendations established by the technical standard of Nutrition and Dietetics UPSS. A descriptive and cross-sectional study was conducted using the analysis of secondary sources. Human resources data from SUSALUD for the year 2022 were used. The Technical Standard of UPSS of Nutrition and Dietetics was considered to assess compliance with human resources recommendations. Among the main findings, it was identified that 7.93% of first-level healthcare facilities have at least one nutritionist. In the second level of care, 96.35% of healthcare facilities do not comply with the human resources recommendations of the technical standard, and no third-level healthcare facility met this recommendation. The distribution of nutritionists across various levels of care in the Peruvian healthcare system is unequal. It is necessary to improve human resources planning in the Peruvian healthcare system to ensure comprehensive healthcare for the population..

Nutrition care for older adults with delirium: A scoping review.

AIMS: This scoping review aimed to identify and map the available information on the nutrition care process in older adults with delirium to analyse and summarise key concepts, and gaps, including the barriers and enablers to providing nutrition care for this group. DESIGN: Scoping review. METHODS: This review was conducted in accordance with the JBI methodology for scoping reviews. Published and grey sources in English were considered. DATA SOURCES: Databases searched were CINAHL, Medline, Embase, JBI Evidence-based Practice, Scopus, ProQuest and Google. The initial search was conducted from October 2021 to March 2022 and repeated in October 2023. RESULTS: The database search identified 1561 articles, 186 underwent full-text review and 17 articles were included. The grey literature search identified eight articles. Malnutrition and delirium were identified as mutually reinforcing, and nutrition strategies were included as part of multicomponent interventions for delirium management. There was no mention of barriers or enablers to nutrition care and minimal descriptive or empirical data available to guide nutrition care processes in this group. CONCLUSION: This scoping review revealed a need for further research into nutrition care processes in older patients with delirium, in particular the barriers and enablers, to inform appropriate management strategies in this vulnerable group. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Providing nutrition care for older patients with delirium is important and further practical guidance could help patients, healthcare staff and families. IMPACT: This scoping review yielded instructive data suggesting that delirium is an important risk factor for malnutrition and vice versa, which leads to poor patient and health service outcomes. REPORTING METHOD: This scoping review adhered to relevant EQUATOR guidelines and used the Preferred Reporting Items For Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). PATIENT OF PUBLIC CONTRIBUTION: No patient or public contribution.

Usability and Preliminary Efficacy of an Artificial Intelligence-Driven Platform Supporting Dietary Management in Diabetes: Mixed Methods Study.

BACKGROUND: Nutrition plays an important role in diabetes self-management. Web-based diabetes care, driven by artificial intelligence (AI), enables more personalized care. OBJECTIVE: This study aimed to examine the usability and preliminary efficacy of a web-based AI-driven nutrition platform to support people with diabetes and their carers in identifying healthy recipes, meal planning, and web-based shopping. METHODS: Diabetes UK signposted people with diabetes and their carers to the platform's study-specific portal through its website, social media, and newsletters. A total of 73 adult participants with prediabetes or diabetes or their carers completed the baseline web-based survey. Of these 73 participants, 23 (32%) completed a web-based survey after 8 weeks of platform use. Web-based semistructured interviews were conducted with platform users (7/23, 30%) who agreed to be followed up and diabetes experts (n=3) who had nutrition and platform knowledge. The intervention consists of a web-based platform that incorporates AI to personalize recipes, meal planning, and shopping list experiences and was made available for 8 weeks. Baseline characteristics, satisfaction, system usability, and diabetes-related and general health indicators were assessed before and after using the platform for 8 weeks. RESULTS: Reductions in weight (mean difference 4.5 kg/m2, 95% CI 1.0-12.0; P=.009; Cliff δ=0.33) and waist size (mean difference 3.9 cm, 95% CI 2.0-6.5; P=.008; Cliff δ=0.48) were found. Most of the participants (151/217, 69.6%) did not regularly use the platform and had low or very low engagement scores. However, the platform was perceived as accessible with no need for additional assistance (11/21, 52%), user-friendly (8/21, 38%), and easy to use (8/21, 38%), regardless of some usability issues. Saving recipes was the most popular feature, with 663 saved recipes. CONCLUSIONS: This study indicated that the usability of the nutrition platform was well perceived by users and their carers. As participants managed their diabetes well, adding an education component would be specifically relevant for people less familiar with the role of diet in diabetes management. To assess the platform's effectiveness in improving diabetes-related health indicators, controlled studies with a larger and more diverse participant sample are recommended.

The True Price of External Health Effects from Food Consumption.

Although global food consumption costs more in terms of impact on human life than money is spent on it, health costs have not been consistently quantified or included in food prices to date. In this paper, a method to determine the external health costs of nutrition and dietetics is developed by employing the cost-of-illness (COI) and true cost accounting (TCA) approaches. This is done exemplarily for the reference country Germany. The results show that 601.50 € per capita and 50.38 billion € in total external health costs are incurred annually due to nutrition. Overall, most costs are accrued through excessive meat consumption (32.56% of costs), deficient whole grain intake (15.42% of costs), and insufficient uptake of legumes (10.19% of costs). Comparing the external health costs with the external environmental costs in Germany, it can be seen that of the total annual costs of around 153.86 billion €, 67.26% originate from environmental impacts and 32.74% from impacts on human life. In order to achieve the 17 Sustainable Development Goals and to increase family as well as public health, there is a need to internalise these external costs into actual food prices.

Distance Education in Nutrition and Dietetics Education over the Past 30 Years: A Narrative Review.

The coronavirus disease 2019 pandemic necessitated the use of distance education, which sparked a technological transformation that was long overdue in higher education. The purpose of this narrative review is two-fold: to summarize the state of knowledge regarding distance education in nutrition and dietetics education over the past 30 years to inform recommendations for future education/research and implications for practice and to determine the influence that distance education has had on the knowledge, skills, and attitudes of both nutrition and dietetics educators and their students. A narrative review of 822 publications yielded 25 that met the search criteria. In the scope of 30 years, the literature shows that attitudes and perceptions of distance education have changed as barriers to online access have diminished and the availability of online nutrition and dietetics courses and Accreditation Council for Education in Nutrition and Dietetics-accredited distance education programs has expanded. However, whereas the limited results are promising, the paucity of large-sample research about the use of distance education in nutrition and dietetics education restricts educators' knowledge of and ability to evaluate the learning outcomes of distance programs and courses. Moreover, differences in how accreditors, government agencies, and institutions define distance education could have significant influence on funding and financial aid benefits for students and research. Recommendations for future research and implications for practice are provided given the relevance and importance of distance education to nutrition and dietetics education.

Análisis cualitativo de los perfiles de egreso en procesos de aseguramiento de la calidad de carreras de Nutrición y Dietética en Chile

Antecedentes: La evaluación de los perfiles de egreso es uno de los aspectos centrales en la acreditación de carreras en Chile, por cuanto su formulación y aplicación en los procesos formativos influyen en sus niveles de pertinencia y calidad. Objetivo: Evidenciar las fortalezas y debilidades del diseño y aplicación de los perfiles de egreso de las carreras de Nutrición y Dietética en Chile, a partir de los resultados de sus procesos de acreditación. Materiales y métodos: Estudio transversal, descriptivo, cualitativo. Se identificaron, en las resoluciones de acreditación entre los años 2004 y 2016, las fortalezas y debilidades de los perfiles de egreso y las contradicciones entre lo declarado y lo ejecutado por los programas. Las carreras se ordenaron en dos grupos según el tiempo de acreditación: i) de dos a cuatro años y ii) de 5 o más años. Usando el software Atlas.ti 7.0 se determinaron los patrones y diferencias conceptuales en los juicios evaluativos de los perfiles de egreso. Resultados: Existe una alta variabilidad entre carreras en los contenidos y aplicación de los perfiles de egreso. Ella se asocia a las capacidades instaladas en las instituciones y a los tiempos de acreditación de la carrera. Existen carreras con déficit en el cumplimiento de competencias, conocimientos y habilidades. Conclusiones: Los contenidos y aplicación de perfiles de egreso son muy heterogéneos y su aplicación se asocia al tiempo de acreditación de la carrera. Es necesario limitar la alta dependencia a la demanda y estimular mayores compromisos institucionales.

Background: Assessment of the graduate profiles is one of the key aspects of program accreditation in Chile, therefore, their development and application in training processes have an impact on their relevance and quality. Objective: To demonstrate the strengths and weaknesses of the design and application of graduate profiles of Nutrition and Dietetics degree programs in Chile, on the basis of the outcomes of their accreditation processes. Materials and methods: Cross-sectional, descriptive, qualitative study. Strengths and weaknesses of graduate profiles, and inconsistencies between what was stated and what was actually implemented in the programs were identified in the accreditation resolutions issued between 2004 and 2016. Degree programs were classified in two groups, according to accreditation years: i) two to four years, and ii) five or more years The Atlas.ti 7.0 software was used to determine patterns and conceptual differences in the evaluative judgement of graduate profiles. Results: There was a high variability in the content and application of graduate profiles between degree programs. This was associated with the institutions' installed capacities and with accreditation years awarded to the program. Some programs were not compliant with the required competencies, knowledge and skills. Conclusions: The content and application of graduate profiles are highly heterogeneous, and its application is associated to accreditation years of the program. It is necessary to limit high dependency on demand to encourage stronger institutional commitments.

The corporate capture of the nutrition profession in the USA: the case of the Academy of Nutrition and Dietetics.

OBJECTIVE: The involvement of unhealthy commodity corporations in health policy and research has been identified as an important commercial determinant contributing to the rise of non-communicable diseases. In the USA, health professional associations have been subject to corporate influence. This study explores the interactions between corporations and the Academy of Nutrition and Dietetics (AND), and their implications for the profession in the USA and globally. DESIGN: We conducted an inductive analysis of documents (2014-2020) obtained through freedom of information requests, to assess key AND actors' dealings with food, pharmaceutical and agribusiness corporations. We also triangulated this information with publicly available data. SETTING: The USA. PARTICIPANTS: Not applicable. RESULTS: The AND, AND Foundation (ANDF) and its key leaders have ongoing interactions with corporations. These include AND's leaders holding key positions in multinational food, pharmaceutical or agribusiness corporations, and AND accepting corporate financial contributions. We found the AND has invested funds in corporations such as Nestlé, PepsiCo and pharmaceutical companies, has discussed internal policies to fit industry needs and has had public positions favouring corporations. CONCLUSION: The documents reveal a symbiotic relationship between the AND, its Foundation and corporations. Corporations assist the AND and ANDF with financial contributions. AND acts as a pro-industry voice in some policy venues, and with public positions that clash with AND's mission to improve health globally.

What is the level of nutrition care provided to older adults attending emergency departments? A scoping review protocol.

Introduction: Nutrition status among older adults is an important factor in health and clinical outcomes but malnutrition goes unrecognised in routine health care.  Older adults often present to emergency departments (ED) and are subsequently discharged without hospital admission.  Discharge is a transitionary time of care when nutritional vulnerability could be mitigated with the instigation of targeted nutrition care pathways. This protocol outlines a scoping review to identify the level of nutrition care provided to older adults attending emergency departments. Methods: This scoping review will be conducted using the framework proposed by the Joanna Briggs Institute. The Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR) will be used to guide the reporting. Two researchers will search electronic databases (Medline, CINAHL Complete, EMBASE, Cochrane Library and Scopus), grey literature sources (DART-Europe E-theses portal, Open Grey, and Trip Medical database) and website searches (Google, Google Scholar, Pubmed, NICE and LENUS) to identify appropriate data for inclusion within the last 10 years. Key information will be categorised and classified to generate a table charting the level of nutrition and dietetic care initiated for older adults in the ED according to the Nutrition Care Process Model. A narrative synthesis will be conducted. Conclusions: This scoping review will be used to inform a foundational concept of nutrition care in an ED setting and allow the future examination of nutrition care pathways, practice, policy, and research within models of integrated care for older persons.

The Impostor Phenomenon in the Nutrition and Dietetics Profession: An Online Cross-Sectional Survey.

The impostor phenomenon (IP) (also known as impostor syndrome) describes high-achieving individuals who, despite their objective successes, fail to internalize their accomplishments and have persistent self-doubt and fear of being exposed as a fraud or impostor. This study aimed to assess the prevalence and predictors of IP within a sample of nutrition and dietetics students and practitioners. An online cross-sectional survey was conducted and utilized a non-random, convenience sampling approach. A total of 1015 students, dietetic interns, and currently practicing and retired registered dietitian nutritionists and nutrition and dietetic technicians registered provided complete responses. IP was assessed with the Clance Impostor Phenomenon Scale (CIPS). Self-reported job satisfaction and well-being were assessed using validated scales. Average CIPS score was 66.0 ± 16.3 (range 22−99), and higher scores indicate more frequent or severe IP experiences. Frequent or intense IP was reported by 64% of survey respondents (n = 655). Older age, greater educational attainment and professional level, and membership in Academy of Nutrition and Dietetics groups were associated with lower IP scores. Greater social media use was associated with higher IP scores. Job satisfaction and overall well-being were inversely correlated with IP (p < 0.001). Findings suggest that IP experiences were common among a majority of nutrition and dietetics students and practitioners surveyed. Additional research and development of preventative strategies and interventions is needed.

Integrating a New Dietetic Care Process in a Health Information System: A System and Process Analysis and Assessment.

Managing routinely collected data in health care and public health is important for evaluation of interventions and answering research questions using "real life" and "big data". In addition to the technical requirements of information systems, both standardized terminology and standardized processes are needed. The aim of this project was to analyse and assess the integration of standardized terminology and document templates for a dietetic care process (DCP) into the health information system (HIS) in a hospital in Austria. Using an action research approach, the DCP was analysed through four expert interviews and the integration into the HIS through two expert interviews with observations. Key strengths and weaknesses for the main criteria ("integration of the ICF catalogue", "adaption of the document templates", "adaption of the DCP", and the "adaption of the user authorizations") were presented and proposals for improvement given. The system and process integration of the DCP is possible, and the document templates can be adapted with the software currently in use. Although an increase in resources and finances required is to be expected initially, the integration of a standardized dietetic terminology in combination with a standardized process is likely to improve the quality of care and support outcomes management and research.

Prevalence and impact of malnutrition on length of stay, readmission, and discharge destination.

BACKGROUND: Studies indicate one in three hospitalized patients are malnourished on admission; however, the documented malnutrition rate in acute care hospitals is often lower. This study measured prevalence of malnutrition on admission and correlated the relationship among malnutrition status, length of stay (LOS), discharge disposition, and readmission rate. METHODS: A prospective observational cohort study was performed across nine tertiary care hospitals in Houston, Texas. Registered dietitians screened patients aged ≥18 years within 24 h of admission for two consecutive days per hospital. Malnourished patients were diagnosed using a modified version of the 2012 Consensus Statement from the Academy of Nutrition and Dietetics (AND)/American Society for Parenteral and Enteral Nutrition (ASPEN). Data collected included demographics, LOS, discharge disposition, and 30-day readmission status. RESULTS: In 416 patients, 31.7% were malnourished on admission. Malnourished patients were significantly older (67.8 vs 57.6 years; P < 0.001) and had a lower body mass index (26.2 vs 32.4; P < 0.001) than nonmalnourished patients. Malnourished patients had higher odds of having a LOS of ≥3 days (2.38 [95% CI, 1.45 to 3.88]; P < 0.001) and higher odds of readmitting within 30 days (2.28 [95% CI, 1.26 to 4.12]; P < 0.006) when compared with nonmalnourished patients. There were no significantly different clinical outcomes between moderately and severely malnourished groups. CONCLUSION: The study successfully utilized the modified AND-ASPEN criteria to show that approximately one in three patients presented with malnutrition on admission. Malnourished patients were more likely to have a longer LOS and more likely to be readmitted within 30 days.

Cost and accessibility of empiric food elimination diets for treatment of eosinophilic oesophagitis.

AIM: This study aimed to investigate and compare the cost, affordability, and accessibility of three elimination diet approaches for the treatment of patients with eosinophilic esophagitis: the two-, four- and six-food elimination diets and with comparison to a standard diet. METHODS: An evidence-based modelling process was undertaken for costing and accessibility, including the development of three hypothetical reference families; four food baskets were modified from an established benchmark for each diet. Baskets were costed across eastern Melbourne, Australia. Affordability was modelled using two incomes: the equivalised disposable household income and welfare payments for reference families. Affordability was defined as <30% of the median weekly household income and food stress defined as >25% of a median weekly household income. RESULTS: All elimination diets were significantly more expensive than a standard diet and may be unaffordable for those receiving welfare. Prices significantly increased as the number of food allergens eliminated increased. Most items for a two-food elimination diet were available at major supermarkets; however, items for nutritionally complete four- and six-food elimination diets required a visit to a second store. CONCLUSION: A step-up approach, commencing with a two-food elimination diet, instead of starting with a six-food elimination diet, may alleviate affordability barriers for most family types, which may enhance compliance. Clinicians should consider family type, financial situation, as well as accessibility of allergen-free foods in the patient's residential area when deciding on the most appropriate dietary or therapeutic treatment approach for eosinophilic oesophagitis.

Status of nutritional literacy in adolescents in the semi-rural area in Turkey and related factors.

OBJECTIVE: To determine the status of nutritional literacy and its affecting factors among the adolescents who are in the 9th grade in Çivril, in Denizli province, in Turkey. DESIGN: This is a cross-sectional study that determines the sociodemographic characteristics, nutritional habits, nutritional behaviour, nutritional literacy status of adolescents and affecting factors. SETTING: Denizli, Turkey. PARTICIPANTS: We included 523 adolescents in ninth grade in this study. RESULTS: Half (49·7 %) of the participants were female; 47 %, in normal BMI; and 68·1 %, non-smokers. The mean (sd) Adolescent Nutrition Literacy Scale score was 67·6 (sd 7·9). Nutrition literacy status was related to mothers' education level (P 0·021); health perceptions (P 0·008); positive body perception (P 0·032); unhealthy food consumption status (P 0·017); information barriers (undecided about effort for information gathering (P 0·026), undecided about the difficulty of understanding information (P 0·042) and thinking it is difficult to understand (P 0·003)), trust in nutrition, diet information sources (nutrition and diet expert, dietitian trusting (according to others) (P 0·001), nutrition and diet expert, dietitian neutral to trust (compared with others) (P 0·011) and trust in textbooks (P 0·023)). CONCLUSIONS: The level of nutrition literacy status of participants was moderate. It is important to carry out interventions to increase the education level of women, positive body perceptions and general health perceptions of adolescents and to remove information barriers related to nutrition.

Análisis cualitativo de los procesos regulatorios de la calidad en los programas de Nutrición y Dietética en Chile

RESUMEN Introducción. El objetivo de este estudio es establecer patrones positivos y negativos de los resultados de los procesos de acreditación de las carreras. Asimismo, identificar desde una perspectiva cualitativa, variables relevantes y relaciones entre los criterios usados en su evaluación. Materiales y métodos. El estudio es transversal, descriptivo y cualitativo. Se analizaron veinte resoluciones de acreditación de las carreras de Nutrición y Dietética en Chile, emitidas entre los años 2004 y 2016 por la Comisión Nacional de Acreditación mediante el software ATLAS ti. Se consideraron las tres dimensiones; Propósitos e Institucionalidad; Condiciones de Operación y Resultados; y Capacidad de Autorregulación para establecer una matriz de relaciones con la identificación de patrones positivos y negativos entre criterios. Resultados. Se evidencian fuertes diferencias entre las carreras. Las relaciones positivas y negativas entre los códigos de los criterios perfil de egreso y plan de estudio indican que solo algunas de ellas proveen una formación adecuada. Del mismo modo, las relaciones entre la calificación del cuerpo docente y la investigación revelan casos de docentes sin niveles suficientes. Otros aspectos deficitarios son el nivel con que ingresan los estudiantes y el uso efectivo de diagnósticos y autoevaluaciones. Conclusiones. El estudio provee información relevante para la toma de decisiones y procesos de retroalimentación orientados al urgente mejoramiento y aseguramiento de la calidad de carreras, en particular de sus planes de estudio, calificación de docentes y efectividad de los procesos de aseguramiento de la calidad, dada la creciente importancia de estos profesionales en la salud pública.

ABSTRACT Introduction. The objective of this study is to establish positive and negative patterns based on the results of accreditation processes of degree programs. Similarly, its aim is to identify, from a qualitative perspective, relevant variables and relationships among the criteria used in their evaluation. Materials and methods. This is a cross-sectional, descriptive and qualitative study. Twenty accreditation resolutions of Chilean Nutrition and Dietetics degree programs were analyzed using the software ATLAS ti. Resolutions were issued between 2004 and 2016 by the National Accreditation Commission. Three dimensions were considered in order to establish a matrix of relationships associated with the identification of positive and negative patterns among criteria: Purpose and Institutionalism; Operating Conditions and Results; and Self-Regulatory Ability. Results. Major differences were found among the degree programs. Positive and negative relationships between criteria codes, graduate profile and curriculum, indicate that only some degree programs provide an appropriate training. In the same way, the relationship between the teaching staff qualification and research work revealed cases of teachers who were not sufficiently qualified. Other weak aspects were the level of knowledge that students have when they enter university and the effective use of diagnostics and self-assessment tests. Conclusions. This study provides relevant information for decision making and feedback processes oriented at the urgent improvement and quality assurance of degree programs, particularly of curricula, teaching staff qualifications, and effectiveness of the quality assurance processes, given the increasing importance of nutrition professionals in the public health area.

Stakeholders' perceptions of the nutrition and dietetics needs and the requisite professional competencies in Uganda: a cross-sectional mixed methods study.

BACKGROUND: Effective implementation of nutrition and dietetics interventions necessitates professionals in these fields to possess the requisite competencies for health systems performance. This study explored the stakeholders' perceptions of the community nutrition and dietetics needs, the nature of work done by graduates of the Bachelor's degree in Human Nutrition/Human Nutrition and Dietetics (HN/HND), and the competencies required of Nutrition and Dietetics professionals in Uganda. METHODS: A cross-sectional mixed methods design was used. Respondents included 132 graduates of the Bachelor's degrees in HN/HND obtained from the Makerere and Kyambogo Universities in 2005-2016; 14 academic staff that train HN/HND in the two universities; and 11 HN/HND work/internship supervisors. Data from the graduates was collected through an email-based survey; data from other participants was through face to face interviews using researcher administered questionnaires. RESULTS: Most HN/HND respondents (84.8%) obtained their Bachelor's degrees from Kyambogo University; 61.4% graduated in 2013-2016. Most (64.3%) academic staff respondents were females and the majority (57.1%) had doctorate training. All stakeholders viewed communities as facing a variety of nutrition and dietetics challenges cutting across different Sustainable Development Goals. The nutrition and dietetics interventions requested for, provided, and considered a priority for communities were both nutrition-specific and nutrition-sensitive. Work done by HN/HND graduates encompassed seven main competency domains; the dominant being organizational leadership and management; management of nutrition-related disease conditions; nutrition and health promotion; research; and advocacy, communication, and awareness creation. CONCLUSIONS: This study shows that nutrition and dietetics challenges in Uganda are multiple and multifaceted; HN/HND graduates are employed in different sectors, provide nutrition-specific and sensitive services in a multisectoral environment, and are expected to possess a variety of knowledge and skills. However, graduates have knowledge and skills gaps in some of the areas they are expected to exhibit competency. We recommend using these findings as a basis for obtaining stakeholder consensus on the key competencies that should be exhibited by all HN/HND graduates in Uganda; developing a HN/HND competency-based education model and a national HN/HND training and practice standard; and undertaking further research to understand the quality and relevancy of HN/HND curricula to Uganda's job market requirements.

High impact nutrition and dietetics journals' use of publication procedures to increase research transparency.

BACKGROUND: The rigor and integrity of the published research in nutrition studies has come into serious question in recent years. Concerns focus on the use of flexible data analysis practices and selective reporting and the failure of peer review journals to identify and correct these practices. In response, it has been proposed that journals employ editorial procedures designed to improve the transparency of published research. OBJECTIVE: The present study examines the adoption of editorial procedures designed to improve the reporting of empirical studies in the field of nutrition and dietetics research. DESIGN: The instructions for authors of 43 journals included in Quartiles 1 and 2 of the Clarivate Analytics' 2018 Journal Citation Report category Nutrition and Dietetics were reviewed. For journals that published original research, conflict of interest disclosure, recommendation of reporting guidelines, registration of clinical trials, registration of other types of studies, encouraging data sharing, and use of the Registered Reports were assessed. For journals that only published reviews, all of the procedures except clinical trial registration were assessed. RESULTS: Thirty-three journals published original research and 10 published only reviews. Conflict of interest disclosure was required by all 33 original research journals. Use of guidelines, trial registration and encouragement of data sharing were mentioned by 30, 27 and 25 journals, respectively. Registration of other studies was required by eight and none offered Registered Reports as a publication option at the time of the review. All 10 review journals required conflict of interest disclosure, four recommended data sharing and three the use of guidelines. None mentioned the other two procedures. CONCLUSIONS: While nutrition journals have adopted a number of procedures designed to improve the reporting of research findings, their limited effects likely result from the mechanisms through which they influence analytic flexibility and selective reporting and the extent to which they are properly implemented and enforced by journals.

Protein delivery in intermittent and continuous enteral nutrition with a protein-rich formula in critically ill patients-a protocol for the prospective randomized controlled proof-of-concept Protein Bolus Nutrition (Pro BoNo) study.

BACKGROUND: Critically ill patients rapidly develop muscle wasting resulting in sarcopenia, long-term disability and higher mortality. Bolus nutrition (30-60 min period), whilst having a similar incidence of aspiration as continuous feeding, seems to provide metabolic benefits through increased muscle protein synthesis due to higher leucine peaks. To date, clinical evidence on achievement of nutritional goals and influence of bolus nutrition on skeletal muscle metabolism in ICU patients is lacking. The aim of the Pro BoNo study (Protein Bolus Nutrition) is to compare intermittent and continuous enteral feeding with a specific high-protein formula. We hypothesise that target quantity of protein is reached earlier (within 36 h) by an intermittent feeding protocol with a favourable influence on muscle protein synthesis. METHODS: Pro BoNo is a prospective randomised controlled study aiming to compare the impact of intermittent and continuous enteral feeding on preventing muscle wasting in 60 critically ill patients recruited during the first 48 h after ICU admission. The primary outcome measure is the time until the daily protein target (≥ 1.5 g protein/kg bodyweight/24 h) is achieved. Secondary outcome measures include tolerance of enteral feeding and evolution of glucose, urea and IGF-1. Ultrasound and muscle biopsy of the quadriceps will be performed. DISCUSSION: The Basel Pro BoNo study aims to collect innovative data on the effect of intermittent enteral feeding of critically ill patients on muscle wasting. TRIAL REGISTRATION: ClinicalTrials.gov NCT03587870 . Registered on July 16, 2018. Swiss National Clinical Trials Portal SNCTP000003234. Last updated on July 24, 2019.

¿Qué pasa con la formación de nutricionistas en Chile? / What happening with nutritionist training in Chile?

RESUMEN El propósito de este artículo es analizar la evolución de las carreras y programas de Nutrición y Dietética en Chile. Se verifica un incremento sostenido de la oferta formativa, particularmente en los últimos veinte años, asociado a procesos de mercantilización de la Educación Superior. El aseguramiento de la calidad ha operado a través de la acreditación voluntaria y sus resultados son congruentes con el contexto nacional. La creciente importancia de la alimentación y nutrición en la salud pública del país exige formular cambios en la formación en Nutrición y Dietética, para lo cual se plantean diversas recomendaciones para lograr mayores niveles de pertinencia y el mejoramiento continuo de la calidad.

ABSTRACT The purpose of this article is to analyze the evolution of Nutrition and Dietetics degree programs and majors in Chile. This research demonstrated a sustained increase in the number of training programs, particularly during the last twenty years, due to the process of commodification of higher education. Quality assurance has been implemented by voluntary accreditation, which has shown results consistent with the national context. The growing importance given to food and nutrition in the national public health scenario requires changes in Nutrition and Dietetics academic programs. To this end, different recommendations are made in order to achieve improved relevance standards and continuous quality improvement.