The Academy of Nutrition and Dietetics is a 501(c)(6) trade association in the United States. With over 112,000 members, the association claims to be the largest organization of food and nutrition professionals. It has registered dietitian nutritionists (RDNs), nutrition and dietetics technicians registered (NDTRs), and other dietetics professionals as members. Founded in 1917 as the American Dietetic Association, the organization officially changed its name to the Academy of Nutrition and Dietetics in 2012. According to the group's website, about 65% of its members are RDNs, and another 2% are NDTRs. The group's primary activities include providing testimony at hearings, lobbying the United States Congress and other governmental bodies, commenting on proposed regulations, and publishing statements on various topics pertaining to food and nutrition.The association is funded by a number of food multinationals, pharmaceutical companies, and food industry lobbying groups, such as the National Confectioners Association. The Academy has faced controversy regarding corporate influence related to its relationship with the food industry and funding from corporate groups such as McDonald's, Coca-Cola, Mars, and others.
BACKGROUND:This article presents the results of the modified Delphi study conducted by the GLIM Risk of Malnutrition Working Group to develop a consensus-based conceptual definition of "risk of malnutrition," as first step in revising the GLIM screening procedure. METHODS:Focus groups with nutritional care experts and patient/older adult representatives, and a literature exploration informed 46 statements on risk of malnutrition. Malnutrition experts (n = 112) evaluated these statements, using a five-point Likert scale. Statements with ≥75% agreement were accepted; those with ≥75% disagreement and/or neutrality were rejected. Remaining statements were marked "undecided" and re-evaluated in later rounds. RESULTS:In three questionnaire rounds (response rates 63%, 59%, and 54%), 26 statements were ultimately accepted to shape the conceptual definition of "risk of malnutrition". The GLIM Working Group and patient/older adult representatives reviewed the pre-final professional and layperson versions. Risk of malnutrition was defined as: A dynamic state, with or without unintentional weight loss, in which an individual has one or more risk factors, that is, nutrition impact symptoms, and/or disease-related, physical, psychological, social, demographic, and economic risk factors, that may result in malnutrition and may negatively impact clinical outcomes. In the layperson version, sentences were simplified to aid comprehension. CONCLUSION:GLIM has developed the first global (professional and layperson) conceptual definition of risk of malnutrition. This definition will guide future nutritional screening recommendations and a more preventive malnutrition approach. It also implies that screening tools covering "risk of malnutrition" should no longer be validated against signs or the diagnosis of malnutrition.
Background:Registered dietitian nutritionists (RDNs) use the Nutrition Care Process and its Terminology (NCP/T) to generate outcomes and demonstrate the impact of medical nutrition therapy. Despite integration into education in 2009, many RDNs continue to face challenges in its application. Objective:This study aimed to identify barriers and enablers to NCP/T use to better understand how adoption can be improved, and to assess whether qualitative feedback from practicing RDNs aligns with quantitative findings from the 2017 International Nutrition Care Process and Terminology Implementation Survey (INIS). Design:An explanatory sequential mixed-methods approach was used. Quantitative data was from United States based RDNs who participated in the 2017 INIS. The focus group discussion questions were informed by the INIS study and grounded in the Theory of Planned Behavior (13). Zoom technology (14) was used and all the discussions were audio recorded. Only participants and the interviewer were present on the call. Qualitative data from the focus group discussions included RDNs in clinical, community, and academic settings. Semantic thematic analysis was conducted to identify themes related to barriers and enablers to using NCP/T. Participants/setting:INIS study recruitment utilized email lists, e-newsletters, and social media groups; responses from 4,426 active RDNs were analyzed. Focus group inclusion criterion was active RDNs based in the US; 38 RDNs participated in the focus groups. Statistical analyses performed:Cross-tabulation identified correlations between barriers/enablers and characteristics such as years of practice and practice setting (p < 0.05). Results:INIS data showed an association between practice area, years of experience, and NCP/T use (p < 0.001). Enablers included peer support (59% of clinical RDNs, 60.3% of RDNs with 0-5 practice years) and job requirements (52.9% of clinical RDNs, 55.2% of those with 0-5 years). Barriers included limited time (28.9% of clinical RDNs, 29.4% with >16 years) and insufficient education (25% of clinical RDNs, 29.8% with >16 years). Focus groups identified additional enablers, such as integrating NCP/T into Electronic Health Records, and barriers, including eNCPT subscription access. Conclusion:The INIS study and focus groups revealed consistent barriers and enablers, underscoring the need for authoritative state-of-the-art training to address these factors and enhance NCP/T utilization.
BACKGROUND:Carbohydrate (CHO) restriction has regained attention as a dietary approach for weight management and cardiometabolic health, though evidence supporting its effectiveness remains controversial, particularly regarding degree of restriction. OBJECTIVE:Examine effects of CHO-restricted versus higher CHO dietary approaches on weight- and cardiometabolic-related outcomes in adults with overweight or obesity without other established disease. METHODS:Searches of MEDLINE, CINAHL, and Cochrane databases identified relevant randomized controlled trials (RCTs) published from 2010-2025. Primary outcomes were anthropometric outcomes (body weight, BMI, waist circumference, fat and lean body mass) and glycemic outcomes (fasting blood glucose, HbA1c). Meta-analyses were conducted using random-effects models for an outcome of interest. Heterogeneity was assessed using I2, evidence certainty using the GRADE methodology, and publication bias was assessed using Begg and Egger's statistic and by generating funnel plots. RESULTS:Twenty-three RCTs, represented in 28 articles, were included. Degree of CHO restriction varied across studies, with self-reported intake often less restrictive than prescribed levels. CHO restriction resulted in modest but significant reductions in body weight (Mean difference (MD): -1.32kg, 95% CI: -2.03, -0.61), waist circumference (MD: -0.89 cm, 95% CI: -1.44, -0.34), and fat mass (standardized mean difference (SMD): -0.29, 95% CI: -0.48, -0.10) compared to higher CHO diets. CHO restriction reduced fasting blood glucose (MD: -0.08mmol/L, 95% CI: -0.17, 0.00), HbA1c (MD: -0.16%, 95% CI: -0.28, -0.04), triglycerides (MD: -0.17mmol/L, 95% CI: -0.26, -0.08), and systolic blood pressure (MD: -4.86mmHg, 95% CI: -6.60, -3.11). CONCLUSIONS:CHO restriction (<45% total daily energy intake) likely provides modest benefits for weight management and certain cardiometabolic risk factors in adults with overweight or obesity.
BACKGROUND:Predictive equations are commonly used to estimate energy needs in hospitalized patients. Accurate estimations help prevent under- or overfeeding, both linked to adverse health outcomes. OBJECTIVE:This scoping review aimed to summarize evidence evaluating the validity of predictive equations compared to indirect calorimetry in hospitalized adults and compare outcomes of nutrition support guided by predictive equations versus indirect calorimetry. METHODS:The Academy of Nutrition and Dietetics' Evidence Analysis Center conducted a scoping review following methodologies adapted from Arksey and O'Malley, Levac and colleagues, and the Joanna Briggs Institute. A comprehensive search was performed on December 4, 2024, in MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Cochrane CENTRAL, and the Cochrane Database of Systematic Reviews. Included studies evaluated predictive energy equations or their use in guiding nutrition support in hospitalized adults (aged 18 years or older), were published in English after 1996, and appeared in peer-reviewed journals. Two reviewers independently screened and extracted data using a standardized template. Findings were synthesized by population and equation type and presented in tables, figures, and heat maps. RESULTS:The review included 152 studies assessing the validity of predictive equations and 9 studies evaluating their use in guiding nutrition support. Most were prospective cohort studies involving critically ill, mechanically ventilated patients. More than 65 predictive equations were identified; Harris-Benedict, Mifflin-St Jeor, and weight-based equations were most frequently evaluated. CONCLUSIONS:There is substantial evidence on the validity of predictive equations for estimating energy needs in critically ill, hospitalized adults, and limited evidence on their role in guiding nutrition support. Targeted systematic reviews and subpopulation analyses are needed. Existing reviews on burns, obesity, and weight-based equations can inform practice. Further research should address disease-specific accuracy, cost-effectiveness, and clinical outcomes.
BACKGROUND AND AIMS:Within the original GLIM procedure (2019), the step on nutritional screening was not further elaborated. A new GLIM Risk of Malnutrition Working Group has recently developed a consensus-based conceptual definition of "risk of malnutrition." The present study aimed to operationalize this definition. METHODS:This study consisted of: (1) a literature search to identify risk factors for malnutrition, and (2) a two-round online modified Delphi study. International professional experts (n = 113) in the field of malnutrition were invited to rate the importance of identified risk factors using a 9-point Likert scale. In questionnaire round 1, risk factors were rated "critically important" if ≥70% of the participants rated them 7-9, or "not important" if >30% rated them 1-3. The remaining risk factors were categorized as "undecided." In questionnaire round 2, undecided risk factors were classified as "critically important" or "important, but not critical," based on the same threshold. RESULTS:The literature search revealed 64 risk factors that were included in the Delphi questionnaires. Of 113 invited experts, 57 responded to Delphi Round 1, and 46 responded to Delphi Round 2. Twenty-nine risk factors (from the overarching risk categories unintentional weight loss, nutrition impact symptoms, disease-related factors, physical factors, psychological factors, decreased food intake, food assimilation, and poor diet) were deemed "critically important," 10 "important, but not critical," and 19 "substantially important." CONCLUSION:In this study, we identified which risk factors are considered critical to operationalize "risk of malnutrition." Screening for risk of malnutrition should take these relevant risk factors into account.
