ABSTRACT Introduction Gastroparesis is a complex gastric motility disorder for which diet is recommended as a primary management strategy. Gastroparesis is associated with significant physical and psychological burden, with anxiety and depression commonly reported. Furthermore, gastroparesis overlaps with eating disorders (EDs), complicating management. Clinical guidelines for gastroparesis management acknowledge this overlap and recommend screening for EDs, however little is known about current dietetic practice in managing this intersection. This study aimed to explore dietitians' experiences, practice and confidence in managing adult patients with gastroparesis in the context of EDs. Methods A cross‐sectional online survey of dietitians with experience managing gastroparesis was conducted and distributed via professional networks and social media. The survey explored demographics, dietary strategies, perceived effectiveness, barriers to implementation and mental health support, particularly in relation to EDs. Results A total of 87 surveys were completed. There was wide variation in dietary strategies used; small‐particle diets were the least commonly implemented, while artificial nutrition support was used more frequently and perceived as more effective. Confidence in managing gastroparesis varied, with particularly low confidence in screening for EDs, regardless of years of experience (Mann–Whitney U = 851.4, p = 0.790). Only 20% of respondents screen for EDs more than half the time, and just 8% reported input from a mental health professional in their multidisciplinary teams. Conclusion A variety of dietary strategies are used by dietitians to manage gastroparesis, of which food‐first are perceived as less effective in improving symptoms and nutritional status. Screening for EDs is inconsistent, and access to mental health support is limited. This demonstrates a need for improved dietary management of gastroparesis, better mental health resources and standardised practices to improve patient care.
ABSTRACT Home enteral tube feeding (HETF) faces significant challenges across micro, meso and macro levels of healthcare. Individual and aggregate data generated from a patient‐reported outcome (PROM) or experience measure (PREM) can be used to tackle multilevel healthcare problems. This review sought to comprehensively describe the current landscape of PROMs and PREMs administered to adults receiving HETF and report on relevant psychometric evaluations. A scoping review was conducted sourcing evidence from five bibliographical databases, two clinical trial registries, a comprehensive grey literature search and citation chaining up to January 2025. Eligible studies reported on administration of at least one PROM or PREM to adults receiving HETF. Data was extracted in relation to study characteristics, population attributes, setting and tool details. The search yielded 14,377 unique studies assessed for eligibility, of which 314 reports were included which corresponded to 256 studies. This consisted of 167 publications and clinical trials reporting results, 70 clinical trial registrations without results and 19 reviews and guidelines. The top focus areas of primary studies were cancer (50%), nutrition support (19%) and neurology (19%) and across studies reporting results 45% were conducted in a population where HETF constituted more than 50% of the sample. There were 184 unique instruments (68 disease‐specific, 43 treatment‐specific, 40 symptom‐specific, 33 generic) of which relevant measurement property evaluations in cohorts with HETF patients were conducted for 22 instruments. Reviews and guidelines suggested instruments with limited consideration of their psychometric testing in HETF cohorts. This review provides a comprehensive overview of the range of PROMs and PREMs administered to adults receiving HETF and explores key considerations when selecting or developing an instrument for use in this cohort.
ABSTRACT Introduction Cardiovascular health (CVH) often declines in midlife. Diet during pregnancy, a similarly sensitive period involving physiological changes, may influence long‐term CVH, but few studies have examined this relationship. We examined the associations between diet during pregnancy and CVH in midlife. Methods Participants are 776 women enroled in Project Viva during early pregnancy (1999–2002, mean 32.7 years). Participants completed food frequency questionnaires during the first and second trimesters, from which we calculated three diet scores (higher scores = better diet): Dietary Approaches to Stop Hypertension (DASH), Mediterranean Diet (MD) and Dietary Inflammatory Index (DII × −1). We averaged scores across trimesters and generated internal z ‐scores. At the midlife visit (2017–2021, mean 51.1 y), we assessed CVH using the American Heart Association's Life's Essential 8 (range 0–100; higher scores = better CVH), including behavioural (diet, physical activity, sleep, smoking) and biomedical (BMI, blood pressure, lipids, glucose) subscores. We assessed associations using linear regression adjusted for age, race and ethnicity, nativity, education, parity, marital status and income at enrolment. Results Most participants were non‐Hispanic White (70%) and college graduates (76%). Mean midlife CVH score was 76.3 points. Higher (per 1‐SD) DASH z ‐scores were associated with better overall (β 3.3; 95% CI 2.2–4.3), behavioural (3.5; 2.5–4.4) and biomedical (3.1; 1.5–4.7) CVH scores. Higher MD z ‐scores were associated with better overall CVH (2.4; 1.4–3.4), behavioural (2.6; 1.6–3.5) and biomedical (2.6; 1.0–4.2) scores. Higher DII (× −1) z ‐scores were associated with better overall CVH (2.6; 1.6–3.7), behavioural (2.7; 1.7–3.7) and biomedical (2.5; 0.9–4.1) scores. A better pregnancy diet was associated with higher CVH scores for diet, physical activity and BMI, and both DASH and DII with blood pressure. Conclusions Women who consumed healthier diets during pregnancy had better CVH two decades later. Dietary assessment in pregnancy may identify women at risk for both short‐term and long‐term health problems.
ABSTRACT Aims This study aimed to explore dietitians' views, experiences, and perceived barriers and enablers to working with people with mental illness in Australian private and public mental health settings, with a focus on clarifying the contribution of private practice dietitians to mental healthcare. Methods A combination of convenience and snowball sampling was used to recruit dietitians who primarily work in private practice or public mental health sectors. Virtual semi‐structured interviews were conducted in two discrete 3–6‐month blocks between 2021 and 2024. A constructivist‐interpretivist approach informed the development of the interview guide, data collection and analysis processes. Semi‐structured interviews explored experiences, facilitators and barriers of private practice dietitians working with people with mental illness. Data were analysed by three authors using reflexive thematic analysis using semantic, inductive coding. Results In total, 14 dietitians completed interviews, comprising 7 working in private practice settings and 7 in public mental health services. Data adequacy was reached with interviews generating 5 main themes and 15 subthemes. Themes included (1) the complex needs of people living with mental illness, (2) access barriers and enablers to private practice dietitian services, (3) gaps in mental health‐specific training and support for dietetics, (4) structural limitations of the private healthcare systems and (5) advantages of integrated care in specialised mental healthcare settings for working with people with mental illness. Conclusions To harness the full potential of private practice dietitians in mental healthcare requires targeted reforms to funding, training and referral systems to ensure equitable, community‐based nutrition support.
ABSTRACT Introduction Dietetic practice is increasingly characterised by complexity arising from chronic disease, food and nutrition insecurity, demographic shifts, and environmental sustainability concerns. Addressing this complexity requires the effective and interprofessionally aligned use of central cognitive strategies. However, despite frequent reference to systems thinking, critical thinking, clinical reasoning, clinical decision‐making, and clinical judgement in health professional education, inconsistent use, and limited shared understanding across professions hinder coherent educational approaches – particularly in dietetic education, where these strategies underpin the Nutrition Care Process (NCP). This article presents an initiative at a Swiss University of Applied Sciences to develop a conceptual pilot model bringing together these five cognitive strategies for Bachelor‐level nutrition and dietetics education, aiming to clarify their relationships, support their use in teaching the NCP and contribute to reflection on a shared interprofessional language. Methods A qualitative case study design with an iterative–inductive reflexive interpretive approach was used to explore shared and profession‐specific understandings of central cognitive strategies within Bachelor‐level nursing, midwifery, physiotherapy, and nutrition and dietetics education. Data were generated through a targeted narrative literature review, consultations with five expert educators across the four professions, and a feedback session with 16 members of the Nutrition and Dietetics Bachelor's educational team. These inputs informed the development of a conceptual pilot model. Results The analysis revealed variation in how the five cognitive strategies are defined, emphasised, and applied across dietetics and other health professions. In response, the Five Cognitive Strategies in Dietetics Education Pilot Model offers an initial shared vocabulary and positions the strategies in relation to the NCP. Conclusions This article introduces a conceptual pilot model addressing fragmented understandings of key cognitive strategies in Bachelor‐level dietetic education. By linking five commonly cited strategies to the NCP, it offers a preliminary framework to support reflection, dialogue, and engagement with complexity in practice. While not intended as a comprehensive or definitive framework, making these strategies explicit may foster a more analytically grounded understanding of professional decision‐making. Further piloting and refinement are needed to assess the model's relevance and educational value.
