The concept of a nutritional ecology recognizes nutrition as representing a complex biological system that interacts with both internal factors (i.e., genetics, health, and age) and external factors (i.e., food systems, social determinants of health, and physical environments). The objective of the “Agriculture and Diet: Value Added for Nutrition, Translation, and Adaptation in a Global Ecology” (ADVANTAGE) Project is to employ an ecological approach to understand factors that influence interactions at the nexus of food systems, diet, and health, including the emerging impacts of climate/environmental change (CEC). The ADVANTAGE Project is envisioned to add value to the historical focus on sustainable food systems by emphasizing the role of sustainable nutrition and its ecology. This emphasis will be used in the analyses needed to support the development and promulgation of evidence-informed interventions, guidance, and policy intended to address diet and health in a changing environment. Functionally, ADVANTAGE was designed to identify the extant evidence and gaps that need to be filled to inform these efforts by convening 5 working groups to address the: 1) the implications of CEC on priority diet-related health outcomes; 2) the impact of CEC on dietary patterns and choices; 3) the interactions between CEC and food systems; 4) methodologies/metrics to better understand the intersection of CEC, food systems, nutrition, and health; and 5) frameworks for translating and implementing new evidence and approaches to support context-specific safe and efficacious interventions, dietary guidance, and standards of care. This report presents the justification and conceptual approach underpinning the ADVANTAGE project.

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:Critically ill adults in intensive care unit settings are at high risk of malnutrition, which is linked to poor outcomes. Delivery of optimal nutrition support in this population is challenging due to patient complexity and inconsistent nutrition care recommendations. OBJECTIVE:To provide a comprehensive overview of guidelines and systematic reviews relevant to clinicians managing enteral and parenteral nutrition in critically ill adults and determine whether or not an update to the Academy of Nutrition and Dietetics Nutrition Support Guideline is warranted. 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 January 13, 2025, in MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Database of Systematic Reviews, the Guidelines International Network, and the Guideline Central databases. Included sources were English-language guidelines published in 2015 or after, or systematic reviews published after 2020, on nutrition support for adults (aged 18 years or older) in intensive care units. Data were extracted using standardized templates. Guideline quality was assessed independently by 2 blinded reviewers using the Appraisal of Guidelines for Research & Evaluation II (AGREE II); systematic reviews were appraised using critical domains from A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR2). Results were summarized using charts and maps. RESULTS:Eleven guidelines and 58 systematic reviews were included. Guideline topics included provision of enteral vs parenteral nutrition, timing of initiation, and energy/protein provision. Systematic reviews most often cover energy/protein amounts, delivery rates, and fiber/prebiotics. All guidelines had notable quality issues, often lacking patient input, peer review, or implementation strategies. More than half of the systematic reviews met key AMSTAR2 criteria, although many had methodological concerns. CONCLUSIONS:There are numerous guidelines and systematic reviews on nutrition support interventions for critically ill adults, with substantial variability in quality and scope. A comprehensive, high-quality guideline should be developed through the Grading of Recommendations Assessment, Development and Evaluation approach to Adoption, Adaption, and De novo development (GRADE-ADOLOPMENT) process to leverage current resources. Future systematic reviews of subpopulations are needed to address evidence gaps.

Background: The dietetics workforce is more racially and ethnically homogenous than the diverse profile of the society served and is not demographically representative of the United States (US).Objective:The objective of this scoping review is to address the overarching research question: In adults from racially and ethnically historically marginalized or minoritized groups (Population), what is the availability and characteristics of literature examining barriers and facilitators related to inclusion, diversity, equity, and access, abbreviated as IDEA (Concept) in the nutrition and dietetics profession (Context).Methods:The current study is a scoping review. A search was conducted in MEDLINE, CINAHL,Cochrane CENTRAL, Cochrane Database of Systematic Reviews, Food ScienceSource, SportDiscus, Open Dissertations, PsycINFO, Web of Science Core Collection,and FSTA, as well as hand searches in the Journal of Critical Dietetics and Today’sDietitian. Included articles were written in English and included students and registered dietitian nutritionists (RDNs) in various settings (e.g., high school, university, nutrition practice settings) from the US and Canada. The publications dates were open untilsearch date (June 2023). Articles were independently screened by two authors.Results:A total of 3,924 articles were yielded from the literature search and 138 articles were identified through a hand search. Upon screening, 92 articles were included for data extraction. University settings and students were the most studied setting andpopulation. Articles mostly included qualitative studies, cohort studies, commentaries, and expert opinions. Commonly identified IDEA- related barriers included financial constraints, lack of diverse representation, and racism. Commonly identified IDEA-relatedfacilitators included recruitment to pipeline, mentoring, and cultural awareness/sensitivity.Conclusions:Within the identified articles, there are common barriers and facilitators in advancing IDEA within the profession. However, primary research was lacking and more IDEA-related evidence from robust studies is needed to develop evidence-basedrecommendations to guide the profession.

Background Malnutrition is common in adults with hematologic malignancies and can negatively impact treatment outcomes. Objective This systematic review evaluated the association between nutrition support interventions compared to alternative or usual care, and primary outcomes (nutritional status, anthropometric measures, length of stay, readmissions, quality of life) and secondary outcomes (survival, mucositis, graft-vs-host disease, delayed engraftment, inflammation, cost, and calorie or protein intake), in adults with hematologic malignancies. Methods MEDLINE, CINAHL, Cochrane CENTRAL, Food Science Source, and SPORTDiscus databases were searched for controlled trials and observational studies published in English in peer-reviewed journals from January 2000 – July 2024. Risk of bias (RoB) was assessed using Cochrane’s RoB 2 tool for randomized controlled trials (RCTs), RoB in Non-randomized Studies of Interventions (ROBINS-I) for non-RCTs, RoB in Non-randomized Studies of Exposures (ROBINS-E) for observational studies. Meta-analyses used a maximum likelihood random-effects model, and heterogeneity was quantified using I2. Certainty of evidence for primary outcomes was evaluated using the Grading of Recommendations, Assessment, and Evaluation (GRADE) method. Results Twenty-one articles (11 RCTs, 9 cohorts, 1 non-RCT) representing 2,122 participants were included. RoB was low (2 studies), some concerns/moderate (11 studies), and high (8 studies). Meta-analysis indicated a decrease in length of stay for enteral nutrition over parenteral nutrition, and no effect on length of stay for glutamine-enriched nutrition support; however, evidence was very low certainty. Individualized nutrition support interventions including calculation of estimated needs demonstrated benefit in decreasing weight loss. Overall, the association between nutrition support interventions and nutritional status, weight, readmissions, quality of life, and secondary outcomes was uncertain (very low certainty). Conclusion No single nutrition support intervention emerged as superior for all outcomes of interest, though current best practices were supported. Certainty of evidence was very low for primary outcomes, and heterogeneity limited conclusions for secondary outcomes. Further high-quality research is needed.

The emergence of incretin-based therapies, specifically glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and glucose-dependent insulinotropic polypeptide (GIP), as a new class of obesity medications, is dramatically changing obesity care. Use of these medications, known categorically as anti-obesity medications, as part of comprehensive obesity management is associated with significantly greater weight loss and health benefits than found with earlier-generation obesity medications. The outcomes reported from medication trials were often achieved in conjunction with lifestyle counseling sessions by a registered dietitian nutritionist (RDN) or other qualified health care professional. Research demonstrates that evidence-based obesity care should incorporate lifestyle interventions. Counseling by an RDN, paired with incretin-based therapies, can play a critical role in supporting adherence to the medication regimen, preventing and managing adverse effects, supporting adequate nutrient intake, and establishing lifestyle behaviors for long-term weight and health management. To date, minimal research has been reported on the impact of incretin-based therapies on food and nutrient intake. Until that research is conducted, RDNs and other health care professionals can apply knowledge and experience from clients who have undergone other intensive treatments. This article provides considerations for lifestyle interventions, with a focus on medical nutrition therapy provided by RDNs for adults prescribed incretin-based therapies. RDNs have the education and training to provide medical nutrition therapy for people with overweight or obesity, as well as lifestyle counseling on physical activity, stress management, sleep hygiene, goal setting, and other behaviors associated with positive health outcomes. RDNs have a critical role in the integration of incretin-based therapies into obesity management.

It is the position of the Academy of Nutrition and Dietetics that all individuals with nutrition-related health conditions or risk factors should have access to medical nutrition therapy (MNT) provided by a registered dietitian nutritionist (RDN). MNT provided by RDNs is effective in improving health outcomes for many chronic conditions that are leading drivers of morbidity, mortality, and health care costs in the United States. Widespread access to MNT using an individualized, client-centered, and evidence-based approach has the potential to improve population health, reduce health disparities, and reduce health care costs associated with nutrition-related health conditions. This Academy of Nutrition and Dietetics position paper summarizes recent evidence from systematic reviews on the effectiveness of MNT provided by an RDN for the prevention and treatment of nutrition-related health conditions. A total of 25 systematic reviews published between 2017 and 2024 were summarized and assessed for certainty of evidence. Systematic reviews with high or moderate certainty of evidence demonstrate that MNT is likely effective in improving a range of health outcomes in adults with pre-diabetes, type 1 diabetes, type 2 diabetes, obesity, pre-hypertension, hypertension, dyslipidemia, chronic kidney disease, head and neck cancer, and chronic obstructive pulmonary disease compared with no MNT or standard care. Barriers exist to accessing MNT, including inadequate staffing of RDNs in some areas, a lack of provider referrals to an RDN for MNT, and a lack of payer coverage and reimbursement. This position was approved in September 2025 and will remain in effect until December 31, 2032.

Food as Medicine (FAM) interventions are emerging as an effective approach to addressing nutrition security and chronic disease among patients with nutrition-related disease or risk factors. FAM programs are food-based interventions provided simultaneously with medical nutrition therapy that reaffirm the role food and nutrition play in health outcomes. The Academy of Nutrition and Dietetics (Academy) is taking bold steps to promote registered dietitian nutritionists (RDNs) as a requisite of rigorous FAM programming capable of transforming health and improving well-being. The Academy's 2025-2030 Strategic Plan aims to establish RDNs as leaders in providing evidence-based nutrition care and positions the discipline to expand partnerships that increase awareness of, and access to, RDNs and medical nutrition therapy. In addition, the Academy's FAM Strategic Roadmap identifies actions for the Academy, in alignment with the Strategic Plan, that highlight and support the FAM programs and policies inclusive of RDNs. The objectives of this article are to summarize evidence of RDN roles in FAM programs, highlight consistent messaging for RDNs to elevate inclusion of the profession in the design and delivery of FAM programs to achieve optimal health outcomes, and introduce the Academy's Strategic Roadmap for FAM programs in support of its overarching Strategic Plan.

BACKGROUND:Malnutrition is common in adults with hematologic malignancies and can negatively influence treatment outcomes. OBJECTIVE:This systematic review evaluated the association between nutrition support interventions compared with alternative or usual care, and primary outcomes (nutritional status, anthropometric measures, length of stay, readmissions, and quality of life) and secondary outcomes (survival, mucositis, graft-vs-host disease, delayed engraftment, inflammation, cost, and calorie or protein intake), in adults with hematologic malignancies. METHODS:MEDLINE, CINAHL, Cochrane CENTRAL, Food Science Source, and SPORTDiscus databases were searched for controlled trials and observational studies published in English in peer-reviewed journals from January 2000 to July 2024. Risk of bias (RoB) was assessed using the Cochrane RoB 2 tool for randomized controlled trials (RCTs), RoB in Non-randomized Studies of Interventions for non-RCTs, and RoB in Nonrandomized Studies of Exposures for observational studies. Meta-analyses used a maximum likelihood random-effects model, and heterogeneity was quantified using I2. Certainty of evidence for primary outcomes was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation method. RESULTS:Twenty-one articles (11 RCTs, 9 cohorts, 1 non-RCT) representing 2122 participants were included. RoB was low (2 studies), some concerns/moderate (11 studies), and high (8 studies). Meta-analysis indicated a decrease in length of stay for enteral nutrition over parenteral nutrition, and no effect on length of stay for glutamine-enriched nutrition support; however, evidence was of very low certainty. Individualized nutrition support interventions, including the calculation of estimated needs, demonstrated benefit in decreasing weight loss. Overall, the association between nutrition support interventions and nutritional status, weight, readmissions, quality of life, and secondary outcomes was uncertain (very low certainty). CONCLUSIONS:No single nutrition support intervention emerged as superior for all outcomes of interest, although current best practices were supported. Certainty of evidence was very low for primary outcomes, and heterogeneity limited conclusions for secondary outcomes. Further high-quality research is needed.

BACKGROUND:Malnutrition is associated with increased morbidities and mortality. OBJECTIVE:The aim of this systematic review and meta-analysis was to evaluate the effect of medical nutrition therapy (MNT) provided by a registered dietitian nutritionist or international equivalent compared with no MNT on nutritional status and health outcomes (eg, mortality, length of stay, readmissions, quality of life, weight, physical function, and cost-effectiveness) in adults with protein-energy malnutrition. METHODS:MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central, Food Science Sources, and SPORTDiscus databases were searched for observational and controlled trials published in English in peer-reviewed journals from 2000 to September 2024. Risk of bias was assessed using Cochrane Risk of Bias tools for randomized controlled trials (RCTs) and observational studies. Meta-analyses were conducted using the DerSimonian-Laird random-effects model. Certainty of evidence (COE) was assessed using the Grading of Recommendations, Assessment, and Evaluation method. RESULTS:Fifteen articles representing 11 studies (9 RCTs, 1 non-RCT, and 1 retrospective cohort) with 86 740 participants were included. Risk of bias for included studies were low (1 study), some concerns (7 studies), and high (3 studies). MNT may decrease length of stay, increase weight (inpatient), and improve quality of life (inpatient) (low COE). In adults with protein-energy malnutrition, the effect of MNT on nutritional status, calorie and protein intake, body mass index (BMI), handgrip strength, and cost-effectiveness is uncertain. The effect of MNT on mortality was uncertain in outpatient settings and conflicted in inpatient settings, with no effect in pooled RCTs (low COE) and reduced mortality in an observational study (moderate COE). Its effect on readmissions was also uncertain in an RCT but may reduce readmissions according to an observational study (moderate COE). CONCLUSIONS:MNT may improve some outcomes (eg, length of stay, hospital readmissions, weight, and quality of life) in inpatients with protein-energy malnutrition, but evidence is uncertain for most outcomes (eg, nutritional status, mortality, weight, handgrip strength, and quality of life) in outpatient settings and requires more research.

Despite evidence that nutrition can play a substantial role in curbing the burden of chronic disease, findings reported in the nutrition literature have been plagued with debate and uncertainty, including questions about the confidence we can place in evidence from observational studies, the validity of dietary intake data, and the applicability of randomised trials to real-world patients or members of the public. Structured nutrition users’ guides (NUGs) to evaluate common research study designs (ie, randomised trials, cohort studies, systematic reviews and clinical practice guidelines) addressing nutrition questions will help clinicians and their patients, as well as health service workers and policy-makers, use the evidence to make more informed decisions on disease management and prevention. In addition, NUGs will provide comprehensive teaching materials for nutrition trainees on how to appraise, interpret and apply the research evidence.We hereby introduce a series of structured NUGs for the literature on nutrients, foods and dietary patterns and programmes. Each article will address three key components when assessing different study designs used to assess nutrition interventions or exposures, including (1) assessing the methodological quality of the study, (2) interpreting study results (magnitude and precision of treatment or exposure effects for outcomes of benefit and harm) and (3) applying the results to unique patient or population scenarios based on their health-related values and preferences related to the potential benefits, harms, convenience and cost of an intervention.This series of articles will serve to empower clinicians, health service workers and health policy-makers to better understand the validity, interpretability and applicability of the nutrition literature, while also helping practitioners and their clients make more evidence-based, value-sensitive and preference-sensitive nutrition decisions.

BACKGROUND:A total of 374 million adults worldwide are living with prediabetes, 70% of whom will develop type 2 diabetes mellitus (T2DM) in their lifetime. Medical nutrition therapy (MNT) provided by a dietitian, such as that found in lifestyle interventions, has the potential to improve glycemic control and prevent progression to T2DM.OBJECTIVES:The objective of this systematic review was to examine the effectiveness of MNT provided by a dietitian, compared with standard care, on glycemic, cardiometabolic, and anthropometric outcomes in adults with prediabetes.METHODS:Searches were conducted for randomized controlled trials (RCTs) published between 1995 and 2022 using electronic databases MEDLINE, CINHAL, and Cochrane Central. The risk of bias was assessed using version 2 of the Cochrane risk-of-bias tool for RCTs. Meta-analyses were conducted using a random-effects model. The certainty of evidence was assessed for each outcome using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method, and a summary of findings table was created using the GRADEpro Guideline Development Tool.RESULTS:Thirteen RCTs were included in the analysis, showcasing a variety of MNT interventions delivered by dietitians. Intervention durations ranged from 3 to 24 mo. Compared with standard care, MNT improved hemoglobin A1c (HbA1c) (mean difference [95% confidence interval]: -0.30% [-0.49, -0.12]) and fasting blood glucose (FBG) (-4.97 mg/dL [-6.24, -3.71]). Statistically significant improvements were found in anthropometrics (weight, body mass index, and waist circumference), cholesterol (total, high-, and low-density lipoproteins), and blood pressure (systolic and diastolic). No significant effect was found on T2DM or triglycerides. The certainty of evidence was moderate for FBG and low for HbA1c and incidence of T2DM.CONCLUSIONS:In adults with prediabetes, MNT was effective in improving glycemic outcomes, anthropometrics, blood pressure, and most lipid levels. However, most studies had a risk of bias because of the randomization process or deviations from intended interventions. MNT plays a key role in improving cardiometabolic risk factors in adults with prediabetes.TRIAL REGISTRATION NUMBER:This study was registered with the registration ID #351421, available from https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=351421.

Plant-based dietary patterns, including vegetarian and vegan dietary patterns, may help to manage type 2 diabetes (T2DM) by contributing to maintenance of a healthy body weight, improved glycemic control, and reduced risk of diabetes complications. Several diabetes clinical practice guidelines support the use of vegetarian dietary patterns, but there has not been a recently updated systematic review (SR) of evidence from randomized controlled trials (RCTs) to examine efficacy. The primary objective of this SR was to examine the effect of vegetarian dietary patterns compared with nonvegetarian dietary patterns in adults with T2DM. MEDLINE, CINAHL, Cochrane CENTRAL Database of Controlled Trials, Food Science Source, and SportsDiscus databases were searched for RCTs published from 1998 to May 2023. Two independent reviewers extracted data and assessed risk of bias using the Cochrane RoB 2 tool. Data were pooled using a DerSimonian-Laird random-effects model and expressed as mean differences (MDs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the I2 statistic, and certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Full texts of 66 articles were reviewed, and 7 RCTs (n = 770 participants) were included in this SR. Vegetarian dietary patterns likely reduce hemoglobin A1c [MD (95% CI): -0.40% (-0.59, -0.21)] and body mass index [MD (95% CI): -0.96 kg/m2 (-1.58, -0.34)] (moderate certainty evidence); may allow for reduced diabetes medication (in 2 of 3 included studies) (low certainty); and may improve metabolic clearance of glucose (insulin sensitivity) [MD (95% CI): 10% (1.86, 18.14)] (very low certainty), compared with nonvegetarian dietary patterns. There were no effects of vegetarian dietary patterns on fasting blood glucose, fasting insulin, or low-density lipoprotein cholesterol concentrations. These findings support the inclusion of vegetarian or vegan dietary patterns as options in nutrition care plans for adults with T2DM. PROSPERO REGISTRATION: CRD42023396453.

Background: Diet significantly influences the risk of developing cardiovascular disease (CVD), the leading cause of death in the United States. As vegetarian dietary patterns are increasingly being included within clinical practice guidelines, there is a need to review the most recent evidence regarding if and how these dietary patterns mitigate CVD risk. Objective: This umbrella review of systematic reviews compared the relationships between vegetarian, vegan and non-vegetarian dietary patterns and CVD health outcomes and risk factors among presumably healthy adults (≥18 years) in the general population. Methods: MEDLINE, CINAHL, Cochrane Databases of Systematic Reviews, Food Science Source and SportsDiscus databases were searched for systematic reviews (SRs) published from 2018 until March 2024. Eligible SRs and meta-analyses examined relationships between vegetarian or vegan diets and CVD risk factors and disease outcomes compared to non-vegetarian diets. SRs were screened in duplicate, and SR quality was assessed with AMSTAR2. The overall certainty of evidence (COE) was evaluated using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) method. Results: There were 758 articles identified in the databases’ search and 21 SRs met inclusion criteria. SRs targeting the general population had primarily observational evidence. Vegetarian, including vegan, dietary patterns were associated with reduced risk for CVD incidence [Relative Risk: 0.85 (0.79, 0.92)] and CVD mortality [Hazard Ratio: 0.92 (0.85, 0.99)] compared to non-vegetarian diets. Vegan dietary patterns were associated with reductions in CVD risk factors including blood pressure [systolic mean difference (95 % CI): -2.56 mmHg (-4.66, -0.445)], low-density lipoprotein cholesterol [-0.49 mmol/l (-0.62, -0.36)], and body mass index [-1.72 kg/m2 (-2.30, -1.16)] compared to non-vegetarian dietary patterns, as well as c-reactive protein concentrations in a novel meta-analysis [-0.55 mg/l (-1.07, -0.03)]. Conclusion: Practitioners can consider recommending vegetarian dietary patterns to reduce cardiometabolic risk factors and risk of CVD incidence and mortality.