Purpose: To explore what socially just dietetic practice means and how it is enacted in Registered Dietitians' (RDs) day-to-day work. Methods: We used qualitative interpretive description to design this study, for which we interviewed 19 Canadian RDs who engage in what they describe as socially just practice and/or advocacy. Results: Participants felt strongly that socially just practice is a responsibility of all practitioners and is rooted in a broader understanding of social justice. Participants described socially just dietetic practice as multidimensional and intersectional and asserted that it necessitates diverse voices and advocacy. The enactment of socially just practice varied across workplace settings and is shaped by the distinct worldviews, orientations to practice, day-to-day tasks, and demands that characterize different areas of practice, as well as by the attendant knowledge, skills, and experiences of practitioners employed therein. Conclusions: Acting on the commitments, competencies, and calls to action for socially just dietetic practice requires orienting the profession at a fundamental level to a collective and operationalizable vision of socially just dietetic practice and advocacy.
As Canadian registered dietitians with a shared commitment to reimagining how children learn about food and eating, our goal is to support diverse, inclusive, and socially just school nutrition education (SNE). We argue that it is essential to stop focusing SNE on "obesity" prevention and reductionist framings of "healthy eating." Dietitians who are involved in supporting public school educators or curriculum development must reconsider how and what children learn about food, eating, and bodies. To better support students, their families, and their teachers, it is critical to consider the cultural, socio-economic, historical, and structural contexts of school nutrition programming. We must acknowledge the limitations and potential harms of focusing predominantly on behaviour change and instead take a compassionate approach to nutrition education and advocate for social justice. This paper is an invitation to registered dietitians to collectively reflect on how food is taught and learned about in public schools in Canada, specifically considering feeding dynamics, body inclusivity, and food literacy.
Purpose: Malnutrition is common among people with cancer and may be experienced disproportionally if living in rural areas. This study characterizes changes in malnutrition risk and assesses whether living rurally impacts malnutrition risk in people receiving palliative radiation therapy at BC Cancer. Methods: This retrospective study utilized malnutrition screening data from BC Cancer's Early Symptom Indicators for Cancer Care Screening Program, 2019-2022. Malnutrition risk was characterized. Distance between patients' residence and nearest BC Cancer centre was determined; differences in malnutrition risk were assessed based on participant regionality (e.g., urban vs rural). Results: Among 802 total Malnutrition Screening Tool (MST) screens from 402 people, 32.0% were at moderate risk of malnutrition and 7.5% were at high risk. Of those who completed >1 MST screen (n = 145), 68% experienced a change in their malnutrition risk. People living closest (<5 km) and farthest (>160 km) from the nearest cancer centre had the highest mean MST scores of 2.06 and 2.05, respectively. The greatest difference in MST scores (0.52) was between those who lived <5 km and 5-13.5 km from the centre (p = 0.068). Conclusions: Repeat malnutrition risk screening should be implemented in cancer care. Geographical distance to BC Cancer centres did not impact malnutrition risk but should be further investigated.
Food formulation and dietary assessment are essential components of the curricula of undergraduate programs in nutrition, dietetics, and food science. The purpose of this study was to develop a new educational tool using the Canadian Nutrient File (CNF) and Microsoft (MS) Excel, implement the tool in undergraduate coursework, and evaluate its performance through student feedback. The proposed procedure allows students to learn and understand how to calculate key elements in the nutrition facts table and in dietary assessment obtained using a 24-h food recall. The application areas include food, nutrition and dietetic courses, agri-food businesses, food services, nutritional counselling, and research.
Purpose: This study aimed to determine the perception of hospitalized patients towards two educational malnutrition infographics. Methods: A cross-sectional intercept interview was conducted with participants with a nutrition diagnosis of "malnourished" as determined by subjective global assessment. Participants were asked to provide feedback on two different infographics on malnutrition. Results: Nineteen out of 50 (38%) participants consented to participate. Most participants (n = 13/19, 68.4%) had been hospitalized for at least one week. Of the participants, 78.9% (n = 15/19) found the information in both infographics useful. Fifty-eight percent (n = 11/19) said a dietitian had come to see them. Twenty-six percent (n = 5/19) had identified that living alone would be a barrier to eating to meet needs after leaving the hospital, while 26.3% (n = 5/19) identified poor appetite as a challenge. Sixty-three percent (n = 12/19) of participants reported that the words "loss of independence" on infographic 1 stood out to them the most, whereas the words "fuel up to heal up" were noted for infographic 2. Discussion: Participants related to messages that aligned with their health experiences. Participants provided practical tips such as using simpler texts and images in the posters. Future research should examine the effectiveness of infographics in motivating patients to increase their dietary intake.
Purpose: The purpose of this study was to explore the perceptions of parents/guardians regarding school food policy (SFP) and food fundraisers in Regina elementary schools. Methods: A 41-item survey was distributed electronically to a school division superintendent to send to their principals to share with parents/guardians. Results: Eighty-four percent (n = 67/80) of respondents that completed the survey were parents/guardians. The majority strongly agreed/agreed that children's nutrition should be a priority for schools (78%; n = 61/80). Thirty-two percent were aware that an SFP existed (32%; n = 22/67), 40% agreed SFP is important (n = 27/67), and 46% (n = 31/67) agreed they could influence SFP. Sixty-five percent (n = 52/80) identified School Community Councils (made up of parents and staff) as the primary fundraising organizers. The majority (68%; n = 52/76) strongly agreed/agreed it is important for fundraisers to support the health of students, staff, and families; however, 57% (n = 45/78) felt it is okay to offer highly processed foods because it only happens occasionally. Fifty-seven percent (n = 45/78) strongly agreed/agreed that non-food and healthy food fundraisers are viable in making as much of a profit as highly processed foods. Conclusions: The results suggest dietitians should engage parents/guardians in SFP and food fundraising to influence health and learning.
Purpose: Malnutrition is an underdiagnosed and undertreated medical condition among hospitalized patients. Validated nutritional care algorithms guide dietitians in identifying malnutrition and elaborating appropriate nutritional care plans for malnourished patients. This study describes how malnutrition was managed in a Canadian hospital that implemented the Integrated Nutrition Pathway for Acute Care (INPAC) algorithm. Methods: Retrospective chart audits were conducted using electronic medical records of all malnourished hospitalized patients admitted to nine acute care units in 2017 and 2019 to describe nutritional care plans during their hospitalization and at discharge. Results: A total of 158 and 122 patients were identified as malnourished in 2017 and 2019, respectively. All malnourished patients (100%) in 2017 and 2019 were provided with a nutritional care plan by a dietitian during their hospitalization. Nutritional discharge planning was more frequent in 2019 (n = 53, 43%), compared to 2017 (n = 46, 29%). The use of oral nutritional supplements (ONS) at mealtime remained the most commonly used nutritional intervention during hospitalization in 2017 (n = 106, 67.1%) and 2019 (n = 81, 66.4%). However, the assistance of a dietetic technician had become as frequently used as ONS at mealtime in 2019 (n = 81, 66.4%). Referring patients to an outpatient clinic represented the most frequently used nutritional intervention during discharge planning in both years (n = 20, 43.5% in 2017 and n = 35, 66.0% in 2019). Conclusions: All malnourished patients received a nutritional care plan during their hospitalization, but only half were provided with a nutrition care plan at discharge. Future studies are needed to assess the impact of nutritional interventions on malnourished patients during hospitalization and at discharge and to clarify the optimal number and types of interventions required to treat malnutrition.
Purpose: Dietitians play a key role in diabetes care. Offering mentorship to increase the capacity of dietitians to provide overall diabetes care may improve outcomes and experiences of people living with diabetes (PWD). The objectives of this study are to assess the perceived need of dietitians for mentorship in diabetes and their preferences for mentorship structure and content. Methods: A 28-question online survey was developed, piloted with 7 dietitians through cognitive interviewing, and disseminated to dietitians in Quebec, Canada. Quantitative data were analyzed descriptively, and survey responses were stratified by years of clinical experience. Results: Of 284 respondents (97% women, mean age 41 ± 10 years), 97% (n = 275) identified a need for mentorship in diabetes. Desire to participate as a mentee, mentor, or both was dependent on years of clinical experience. Formal mentorship was preferred by 41% of respondents, informal by 30%, and 29% preferred a combination of both. The type of mentorship was independent of the years of experience. Finally, 94% believed their confidence levels in providing care for PWD would increase if they participated in mentorship. Conclusion: Mentorship in diabetes was perceived favourably and is believed to increase dietitians' confidence level in caring for PWD and for interprofessional collaboration.
The Good Food for Learning Population Health Intervention Research Project piloted a universal school lunch program in select Saskatoon elementary schools. Digital photography-assisted weighing (DPAW) was used to conduct plate waste audits to determine student food consumption. DPAW is a novel method, thought to be too labour-intensive to be used in schools. The purpose of the study was to determine the practicalities of using DPAW plate waste audits in elementary schools from research assistants' (RAs') viewpoint. Semi-structured, 30-45-minute virtual interviews were conducted with former RAs and research supervisors involved in data collection during the 2021 and 2023 phases of the Good Food for Learning Project. Ultimately, 11 of 16 prospective participants were interviewed. A hybrid approach of deductive and inductive data coding was used for thematic analysis. We found that although most of the RAs wanted to improve in-person training and coordination with school staff, most reported that they would recommend this method to other researchers carrying out studies under similar settings. This study shows that RAs support the feasibility of DPAW plate waste audits in elementary schools, though some challenges need to be addressed to improve implementation.
Purpose: Dysphagia, common among adult patients in acute care settings, is associated with various complications. This study aimed to identify significant predictors of adverse health outcomes in hospitalized patients with dysphagia. Methods: A consulting committee meeting preceded a retrospective chart review involving 420 adult patients (mean age 72 years, 55% male) hospitalized at CHU de Québec-Université Laval, who underwent an interdisciplinary dysphagia assessment. Multivariate logistic and linear regression analyses were conducted to examine relationships between potential predictors and outcomes (in-hospital mortality and pneumonia), with age and sex as covariates. Results: The consulting committee agreed that most predictors of adverse health outcomes, identified through the research team's clinical experience and existing literature, were both important and applicable to clinical practice. Stroke, head and neck cancer, all types of malnutrition, and unauthorized food intake were the most significant predictors of mortality (P < 0.04, for all). Intellectual disability, chronic obstructive pulmonary disease, gastroesophageal reflux, and severe malnutrition were the most significant predictors of pneumonia (P ≤ 0.02, for all). Conclusion: This study highlights the importance of addressing malnutrition as a significant modifiable risk factor for mortality and pneumonia among hospitalized patients with dysphagia. These findings underscore the need to manage high-risk patients with dysphagia effectively.
A rapid assessment was conducted, including a literature review and key informant interviews, to explore optimal staffing levels and factors influencing staffing decisions across public health jurisdictions in Canada, including strategic plans and priorities. The literature review found no current guidance to plan for future public health dietitian workforce needs. An outdated staffing benchmark (1 full-time equivalent [FTE] per 50,000 population) is still referenced in some sources. Twenty-nine individuals from 25 jurisdictions across nine provinces participated via interviews or email. Eleven jurisdictions had public health nutrition-related strategic plans, with common priorities. Staffing numbers from 21 jurisdictions ranged from 1 FTE per 32,000 to 1 FTE per 316,000. Additional staffing challenges that surfaced included lost positions due to attrition or transitions to other roles, insufficient staff for programme needs, increased complexity and inconsistencies in public health dietitian roles and responsibilities across jurisdictions. There is an urgent need for updated workforce planning approaches for public health nutrition practice in Canada. Public health dietitians, leaders, and academics must collaborate to recognize and address this need.
Purpose: To assess nutritional quality of foods promoted in Canadian grocery flyers including level of processing, and whether adherence to dietary guidance varied by year, region, store type (regular or discount), or location in the flyer. Methods: Observational study; national sample of weekly digitized flyers (n = 53 flyers; n = 8,790 promoted foods and beverages) were collected from Canada’s largest market-share national grocer, from 2014, 2017, and 2021. Flyer food items were extracted and coded manually into food groups and categories. Nutritional quality of promoted items was analyzed by three nutrient profiling systems including NOVA level of processing and Canada’s Food Guide (CFG). Logistic regression models were used to examine odds of flyer foods aligning with dietary guidance. Results: Mean food items per flyer were 106 (SD = 66.4) in 2014; 174 (SD = 106.2) in 2017; and 215 (SD = 49.8) in 2021. Baked products (11%), non-alcoholic beverages (10.7%) and milk/dairy (10.2%) comprised the largest proportions of flyers. Least healthy/ultra-processed foods were most frequently advertised (CFG: 58.5%; NOVA: 51.2%); but followed by the most healthy/un/minimally processed (CFG: 33.6%: NOVA: 27.8%). Across geographic regions, odds of CFG alignment were similar, and no different in discount versus regular banners. Food items on the flyer cover page had consistently higher odds of CFG alignment. Conclusion: Consistent with past research, flyer foods frequently did not align with dietary guidance.
A common consequence of Parkinson's disease (PD) is constipation. Beyond its deleterious effect on the quality of life in affected persons, constipation is associated with gut microbiota dysbiosis and microbial-generated inflammatory metabolites, which may further disease progression. Management strategies are needed, and diet, specifically higher fiber dietary patterns or fiber supplements, may be recommended. However, therapeutic effectiveness and potential health benefits have been underexplored, and risks may be unappreciated. This perspective addresses whether high-fiber diets and fiber supplements to support laxation are efficacious, safe, and generally feasible for people with PD. Diverse sources of fiber from plant-based dietary patterns may be particularly critical for balancing microbiota and the microbial production of beneficial vs. inflammatory metabolites, although adherence to such dietary patterns may be challenging. Supplemental fiber may be needed to manage constipation symptoms. However, the potential safety issues related to fiber supplementation, such as appetite suppression, unintentional weight loss, and risk of malnutrition in the context of neurodegeneration, must also be considered. Slow colonic transit time and defecatory disorders of PD may be best managed with high intakes of bran or hull fibers resistant to microbial fermentation, which will significantly increase stool bulking. However, clinical trials are needed to confirm efficacy and dose-response.
Purpose: Dietitians (RDs) are well-positioned to drive food system transformation by supporting dietary patterns sourced from sustainable food systems (SFS). This research aims to identify how RDs conceptualize sustainability, describe SFS activities, define success, and determine the knowledge and skills required to practice in this area. Methods: A convenience sample of Canadian RDs completed a crosssectional survey with open-and close-ended questions. Quantitative data were analyzed using descriptive statistics. Qualitative responses were thematically analyzed. Practice activities were mapped using the Socioecological Framework (SEF). Results: A diverse sample (n = 92) reported using common SFS definitions, frameworks, or other documents. Practice activities were reported on all levels of the SEF. Dietitians reported successes; however, the vagueness or responses suggested it may be too early to quantify these. Dietitians reported needing foundational and practice area-specific knowledge and skills and practical examples to support SFS in practice. Conclusions: Canadian RDs in this study demonstrated significant work in SFS using skills they developed to practice in other areas of dietetics. There is an opportunity to expand impact by sharing existing resources, developing new supports that include Indigenous perspectives and systems thinking, evolving RD roles, increasing macro-level strategies, and identifying success indicators to monitor impact.
LGBTQ+ inclusion in dietetics education is essential to fostering culturally safe and structurally responsive learning environments. Drawing on auto-theory informed by poststructuralism, I reflect on a piece of student feedback that described the LGBTQ+ content in my course as excessive and suggested that such excess denied discussion about other historically excluded groups. This feedback illustrates how cis-heteronormative assumptions shape expectations about what counts as appropriate, balanced, or necessary content in professional education. Using the queer expression "No T, no shade, no pink lemonade," I explore how power, discourse, and affect emerge in moments of discomfort and curricular critique. I consider how such moments offer opportunities for reflexivity and deeper attention to the norms that shape belonging, visibility, and legitimacy in professional training. This paper contributes to ongoing efforts to embed cultural safety into dietetics curricula in ways that are reflexive, relational, and justice-oriented.
Purpose: An exploratory longitudinal cohort study to assess scientific literacy (SL) skill development (both practical and self-perceived capabilities) in the Master of Applied Nutrition program. Methods: Students (n = 22) completed an optional online survey at the start and end of the combined coursework and practicum training portion of the program. Practical SL skills were assessed using the validated Test of Scientific Literacy Skills. Results: Both practical and perceived SL capabilities increased during the program with the largest increases in the ability to draw conclusions based on quantitative data and to read and interpret graphical data. Critical assessment of scientific literature validity was an identified training gap. Conclusion: SL skills are necessary for evidence-based dietetic practice and are critical skills that are acquired in the program; however, targeted approaches to minimize training gaps are required.
Purpose: The growing interest in digital health applications (apps) in dietetic practice prompted the current study aimed to describe app use among Registered Dietitians (RDs) in Alberta. Methods: A cross-sectional web-based survey was developed, drafted in REDCap, and tested with RDs. The College of Dietitians of Alberta distributed it to all registered members via email list. RDs registered with the College were eligible to participate. Responses were analyzed using descriptive statistics and single level structural coding of open-ended responses. Results: Of the 290 RDs who partially or fully completed the survey, 74.5% used and 84.9% recommend apps to patients in their practice. Barriers to use include patient technological self-efficacy and uncertainty about which apps to recommend. RDs desire guidance and support from professional organizations in selecting and using apps, highlighting the need for evidence-based evaluation criteria for apps. RDs emphasized the need for user-friendly, evidence-based, secure apps tailored to specific nutrition management needs. Conclusions: RDs in Alberta are using and recommending apps in their practice despite limited evidence regarding their effectiveness in improving health outcomes. Collaborative efforts among RDs, app developers, and health organizations are essential to address current limitations and advance the use of apps in dietetic practice.
Conventional food systems lead to environmental degradation and nutrient deficiencies, contributing to poor health. Conceptualizing dietetic practice by practice areas limits how dietitians (RDs) see the relevance of food systems to practice and potential actions to contribute to more healthy, sustainable food systems. RDs are well-positioned to promote sustainable food systems (SFS) because they work across the food system landscape: Food Production, Economic, Political, Consumer Demand, and Health Systems. In this article, we invite RDs to view SFS activities through a systems lens, bringing more awareness to their impact. This includes identifying leverage points - actions that have a larger impact than their immediate outcome - and unintended negative consequences of recommendations. We discuss findings from a scoping review that included 11 peer-reviewed and 16 grey literature articles and chart practice activities, tools and recommendations according to practice area and the food system landscape. Findings demonstrate there are several existing activities and areas for further growth. Framing practice activities across the food system landscape, facilitates understanding of the interconnected nature of the food system to get to the root cause of problems. As a self-determining profession, dietitians determine the degree of influence they have in supporting the transition to sustainable dietary patterns.
Purpose: To investigate the knowledge, attitudes, practices, and perceptions of Canadian dietitians regarding supporting individuals with intellectual and developmental disabilities (IDDs) in their practice. Methods: A 25-question cross-sectional online survey was developed by the research team, reviewed by experts, mounted on Research Electronic Data Capture (REDCap), and advertised to dietitians across Canada. Recruitment took place via email, social media, and e-newsletters. The survey was open in January–February 2024. Closed-ended responses were analyzed using descriptive statistics, and open-ended responses were analyzed using conventional content analysis. Results: In total, 136 respondents met inclusion criteria; 80% reported they have supported patients/clients with IDD in their role as a dietitian, and 96% agreed dietitians can positively influence the health outcomes of people with IDD. Over 50% of respondents did not feel they had access to appropriate client/caregiver resources, nearly 75% of respondents denied receiving dietetic training in the nutrition care of patients/clients with IDD. Most respondents (∼70%) were interested in learning more about supporting people with IDD as dietitians. Conclusions: Many respondents reported a gap in education, skills, and resources in this area. These findings can be used to improve dietetic training and inform future strategies to help reduce the shortcomings in health care experienced by people with IDD.
Purpose: There have been many changes to both academic and practical aspects of dietetic education in Canada since 1993. This study sought to document and explore major changes. Methods: Key informants (n = 22) identified through purposeful sampling completed semi-structured interviews, using a draft timeline based on a literature review. Recordings were transcribed, coded, and analyzed thematically using a social ecologic framework. Results: Five main themes emerged: (i) challenges with the traditional dietetic education model; (ii) emergence of champions for change; (iii) barriers and facilitators for change; (iv) shift towards integration; and (v) increasing access for diverse populations. The interviews supported that changes had been driven by a need to increase access to dietitians and to improve the capacity and sustainability of dietetic education. Conclusions: The past thirty years have been marked by changes in the organization and delivery of dietetic education in Canada, mainly through collaborations of university programs with health system and community partners. Overall, dietetic education programs have increased their capacity and sustainability. By doing so, they have improved access and better positioned the profession to meet the needs of diverse populations. These findings provide context for dietitians, educators, and students to prepare for future development of the profession.
