The aim of the study was to determine if a 5-week transitions of care (TOC) nutrition intervention, led by a registered dietitian (RD) decreases unplanned hospital readmissions and improves nutrition status among hospitalized patients with malnutrition. A mixed-methods study design was used. Due to the small sample size (n = 21), statistical power was not met, non-parametric statistical tests were used, and the quantitative data was interpreted with caution. The qualitative results shed light on the meager quantitative data. Staff interviews highlighted barriers to implementation of a successful RD-led TOC nutrition intervention. Addressing these barriers in future quantitative research could be informative.

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.

The increasing risk of eating disorders (EDs) in college students experiencing food insecurity (FI) reflects a developing public health crisis. The purpose of this scoping review was to characterize the broad body of emerging research on EDs and maladaptive eating behaviors in college students experiencing FI; identify gaps and inform future research. In sum, this research provides novel evidence of gender differences in both FI severity and internalizing symptoms impacting ED risk. Contradictory evidence on bulimic- and restrictive-spectrum disorders, possibly due to nuances between subjective vs. objective binges, and cognitive restriction (to control weight) vs. other reason restraint, requires further analysis.

Aim/Introduction: Classifying diabetes based on unique characteristics and complications aids in personalized care. Furthermore, it predicts better patients who need intensive treatment. This study aimed to test the clinical utility of Ahlqvist et al. technique of the novel classification of type 2 diabetes (T2D) among resident Ghanaian diabetes patients. Clinical characteristics and different treatments in each subgroup were compared. Materials and Methods: This cross-sectional study consecutively recruited 353 patients with T2D, 18 years and older, from diabetes clinics in four hospitals across the Greater Accra Region of Ghana between March and June 2023. The K-means was used to cluster and analyze the data using five parameters: age at diagnosis, body mass index, glycosylated hemoglobin, homeostatic model assessment 2, to estimate beta-cell function (HOMA2-beta), and insulin resistance (HOMA2-IR). Blood pressure (BP), waist circumference (WC), and lipid profile were included to enhance the clinical utility after the cluster analysis. Results: Four distinct clusters were replicated with varying characteristics: severe insulin-resistant diabetes (SIRD), mild age-related diabetes (MARD), severe insulin-deficient diabetes (SIDD), and mild obesity-related diabetes. The MARD group was the predominant cluster (37%). Medication usage, total cholesterol, systolic BP, and mean WC were significantly different among the clusters (all P value < 0.001). Comparing the two severe forms of T2D (SIRD and SIDD) in this study, participants were more insulin-deficient than insulin-resistant. Conclusions: Four distinct clusters were identified in the Ghanaian population. The risk of diabetic complications, medication treatment, and patient characteristics varied significantly across each cluster.

Background Food insecurity among older adults is influenced by financial, physical and functional barriers that may not be captured by existing screening tools. This study validated the Older Adult Food Insecurity Scale (OAFIS), a multidimensional assessment designed specifically for older adults.Methods 72 community-dwelling older adults (66–87 years) from Florida completed the U.S. Department of Agriculture’s Food Security Survey Module (FSSM) and the 22-item OAFIS. Registered dietitian nutritionists conducted comprehensive assessments to classify food security status. Internal consistency, factor structure and criterion-related validity were evaluated.Results The OAFIS demonstrated good internal consistency (Cronbach’s α=0.77) and identified four domains: mobility/physical limitations, access limitations, financial limitations and bodily function issues. OAFIS scores correlated strongly with dietitian assessments (r=0.69) and moderately with FSSM scores (r=0.57). The FSSM explained only 34% of the variance in dietitian-assigned classifications and was associated with financial and access domains but not mobility or bodily function domains. Brief 8-item and 4-item screeners were also developed.Conclusions The OAFIS provides a valid multidimensional measure of food and nutrition insecurity among older adults, capturing important physical and functional barriers overlooked by traditional screening tools. The instrument may improve identification of at-risk older adults in clinical and community settings.

Food insecurity affects many older Americans due to factors such as financial constraints, transportation access, physical mobility, and bodily functioning. However, the most widely used measure for food insecurity, the USDA Household Food Security Survey Module (FSSM), primarily assesses financial security, overlooking other critical domains. This study aimed to develop and validate a screening tool that captures additional dimensions of food insecurity among older adults. We surveyed 72 older adults (ages 66–87). Each participant met with a registered dietitian nutritionist (RDN), who conducted a comprehensive nutritional assessment and administered both the USDA-FSSM and a newly developed scale based on the World Health Organization’s (WHO) International Classification of Functioning, Disability, and Health. Based on the nutritional assessment, the RDN categorized individuals as food secure, food insecure, or at risk for food insecurity. The FSSM explained only 34% of the variance in dietitian assessments, suggesting it does not fully capture food insecurity in this population. The newly developed scale demonstrated strong internal reliability (Cronbach’s alpha = .77). Factor analysis using Principal Axis Factoring with Oblimin rotation identified four key factors: mobility/physical limitations, access limitations, financial limitations, and bodily function issues. The overall scale score correlated strongly with the dietitian assessment (r = .69) and moderately with the FSSM (r = .51). These findings highlight that food insecurity in older adults extends beyond financial constraints. The newly developed screening tool effectively captures physical and functional challenges that impact food access and consumption, offering a more comprehensive assessment than the FSSM.

Simulation provides an intermediary step in promoting the development of clinical competence and can provide alternative experiential learning opportunities. A nonrandomized, pre-post observational study was conducted to assess the impact of a high-fidelity simulation workshop on dietetics students’ self-efficacy and competence performing the nutrition-focused physical examination, diagnosing malnutrition and micronutrient deficiencies, and dietetics-related procedures. A total of 29 students participated in the workshops. Results indicate that the simulation workshop increased competence ( P < .001) and student self-efficacy ( P < .001) supporting simulation as an important tool for scaffolding skill attainment in dietetics education and can serve as an effective assessment method.

BACKGROUND:Breastfeeding can improve public health and reduce the economic burden associated with illness, hospitalization, and mortality of infants and mothers. Despite the potential for registered dietitian nutritionists (RDNs) to contribute to this area of practice, there are no studies that have analyzed the influence of RDNs on breastfeeding-related health outcomes, such as breastfeeding duration. OBJECTIVE:The Breastfeeding Registry study aims to describe the nutrition care and health-related outcomes of breastfeeding infants receiving care from RDNs. DESIGN:This is a pilot prospective cohort registry study. PARTICIPANTS:Participants are breastfeeding infants receiving care from RDNs as well as RDNs providing care to enrolled infants. DATA COLLECTION:RDNs will provide usual care and document for up to 6 months in an electronic Nutrition Care Process database (the Academy of Nutrition and Dietetics Health Informatics Infrastructure). The validated Nutrition Care Process-Quality Evaluation and Standardization Tool will assess documentation quality. RDNs will document initial and follow-up encounters for infants, aiming to analyze documentation from at least 60 infants. RDNs will be surveyed on site characteristics, individual education, training, and professional experience to account for possible confounding. MAIN OUTCOME MEASURES:The primary health outcome is breastfeeding duration. Secondary outcomes include the frequencies of NCP Terminology documented by NCP step, documentation quality, and rates of nutrition diagnosis resolution and goal attainment. Using the NCP framework, complete NCP cycles that demonstrate improvement in the most prevalent nutrition problems (defined as impactful care plans) will also be presented. ISSUES:Recruitment challenges and large variability in tracked indicators are anticipated, as is common in registry studies. Training and documentation requirements may limit enrollment.

Lymphatic filariasis (LF) is a mosquito-borne neglected tropical disease that causes disfiguring of the affected extremities, often leading to permanent disability and stigma. Described as a disease of poverty, the impact of socioeconomic indicators such as nutrition on LF remains largely unexplored. This cross-sectional study investigates nutritional predictors implicated in the progression of LF using machine learning methods in the Ahanta West Municipality, Ghana. There were 109 participants with a mean age of 50.72±13.8, and three-quarters being females. Only 14 (12.8%) each had comorbidities or LF-related wounds. Nutrition risk assessment showed 70.7% of participants were either malnourished or at risk of being malnourished. The prevalence of anemia was 84.0%. Dietary assessment indicates marked macro- and micronutrient intake with 98.2% protein, 75.2% fat, and 73.4% carbohydrate inadequacies. There were inadequate intakes of minerals: Calcium (100%), Potassium (91.7%) and Zinc (91.7%); and vitamins: Vitamin B12 (81.7%), Vitamin C (75.2%), Niacin (70.6%), and Vitamin B6 (68.8%). The decision tree and random forest models show vitamins C and K and blood pressure as the most important predictors of LF progression. Other predictors include body mass index, anemia, folate, and age. These findings suggest that maintaining healthy blood pressure and adequate intake of vitamins C and K may slow LF progression. This highlights the importance of nutritional intervention and underscores the need for integrated approaches that address nutritional deficiencies and LF management strategies.

IntroductionRegistered dietitian nutritionists (RDNs) provide medical nutrition therapy (MNT) to improve public health outcomes, yet RDNs impact on breastfeeding outcomes remains underexplored. The Breastfeeding Registry Study addresses this gap by examining MNT provided to breastfeeding infants. This study describes Nutrition Care Process (NCP) documentation patterns, evaluates documentation quality, and reports nutrition diagnosis improvement, goal attainment, and outcomes predictors.MethodsThis prospective, observational study included documentation from breastfeeding infants (n = 92) from July 2020 to June 2024 using the Academy of Nutrition and Dietetics Health Informatics Infrastructure. The primary outcome was breastfeeding duration. Frequencies of documented NCP terminology, impactful care plans, and nutrition diagnosis improvement were assessed. Documentation quality was evaluated using the NCP Quality Evaluation and Standardization Tool (NCP-QUEST). Mixed-effects logistic regression was used to identify predictors of improved outcomes.ResultsDuration of any breastfeeding averaged 34.2 ± 7.5 (mean ± SD) days (n = 10), although documentation of this indicator was poor. The most frequent etiology was breastfeeding difficulty (18%). Common intervention categories were Food and/or Nutrient Delivery (46%) and Coordination of Nutrition Care (43%). At reassessment, 68% of diagnoses improved, with the highest rates for breastfeeding difficulty (55%), predicted breastfeeding difficulty (83%), inadequate vitamin D intake (83%), and underweight (83%). NCP-QUEST score (OR = 1.58, 95% CI [1.02, 2.45] p = 0.042) and frequency of registered dietitian visits (OR = 1.77, 95% CI [0.34, 0.9.33] p = 0.049) predicted diagnosis improvement.DiscussionHigher-quality documentation and more RDN visits were associated with improvements in breastfeeding infants' nutrition diagnoses. This is the first known study to describe comprehensive care plans delivered by RDNs that improved prevalent lactation-related nutrition problems and to propose standards for documenting breastfeeding care data in alignment with global breastfeeding standards.

In 2013, the Accreditation Council for Education in Nutrition and Dietetics (ACEND), Commission on Dietetic Registration (CDR), Council on Future Practice (CFP), Education Committee of the Board of Directors and the Nutrition and Dietetic Educators and Preceptors (NDEP, then a dietetic practice group) collectively decided that a graduate degree would be a new standard for entry into the profession.

Hydration plays a crucial role in maintaining health and physiological functions, yet dehydration contributes to morbidity in chronic diseases. Despite the importance of hydration management, research indicates that healthcare professionals, including dietitians, lack sufficient training and confidence in this area. This study aimed to assess the impact of an educational workshop on dietitians' and dietetic students' self-efficacy, knowledge, and assessment skills related to hydration and electrolyte management. A non-randomized, pre-post observational study was conducted among 191 dietitians and dietetic students attending a half-day continuing education program in Ghana. Participants completed pre- and post-surveys assessing self-efficacy, knowledge, and assessment skills. The Wilcoxon signed-rank test was used to evaluate changes in scores. Data were analyzed using IBM SPSS Statistics Version 29, with significance set at p < 0.05. Out of 191 participants, 141 completed both pre- and post-surveys. Significant improvements were observed in self-efficacy (hydration: Z = 8.64, p < 0.001; electrolytes: Z = 8.66, p < 0.001), assessment skills (Z = 7.57, p < 0.001), and knowledge (Z = 7.45, p < 0.001). Both dietitians and students showed similar improvements across all variables. The workshop significantly enhanced participants' confidence, knowledge, and assessment skills in hydration and electrolyte management, addressing critical gaps in their professional training. The findings underscore the need for ongoing, interprofessional education in hydration care. Targeted educational interventions can effectively improve healthcare professionals’ abilities to manage hydration, with implications for better patient care outcomes. Further research is needed to expand these findings across diverse settings.

ObjectiveThis scoping review explores the broad body of peer-reviewed research measuring food insecurity in post-secondary students in the U.S. to identify trends and gaps to inform future research.MethodsThree search engines (PubMed, Web of Science, and CINHAL Full Text) were systematically searched for articles reporting on food security status in U.S. college students.ResultsOne-hundred and sixty studies met inclusion criteria. Emerging high-risk student characteristics include gender non-conforming (GNC) and non-binary, financial independence in college, and pregnant and parenting students. Emerging correlates include lack of transportation, anxiety, and eating disorders.ConclusionsPrevalence data can be used by colleges to advocate for services and programs. Additional multi-institutional cohort, longitudinal and qualitative studies are needed to identify timely interventions and effective solutions. A new "rights-based" approach to food security solutions that includes nutrition and food literacy for all students is needed.

A healthy diet cannot cure all, but the power of nutrition has been underutilized in our current health care system. Whether you call it "Food Is Medicine" or "Food As Medicine," this is a movement whose time has come.

Background: Persons living with dementia and informal caregivers are at a higher risk for malnutrition. Most caregivers are not experts at identifying nutritional complications of dementia. Therefore, we aimed to identify nutrition knowledge and challenges related to feeding and caring for persons with dementia to develop a meaningful intervention. Methods: A mixed-methods approach was used. Eight focus groups were conducted with caregivers of persons living with dementia (n = 28) and healthcare professionals (n = 23). Data was analysed using NVivo software. A questionnaire was administered to identify nutritional challenges. A modified food frequency questionnaire assessed food patterns of caregivers and persons with dementia. Results were compared to Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) dietary guidelines. Data were analysed using SPSS software. Results: Four major themes emerged: forgetting to eat, developing food aversions, strong preferences for sweets and weight changes. Findings revealed common strategies used to improve nutrition intake included cueing, supplements and quiet eating environment. Caregivers were impacted by stress leading to poorer food choices and exhaustion. Recommendations for a caregiver program made by participants included education, resources and support. Findings from the food frequencies questionnaire survey showed most participants had a lower dietary diversity compared to the MIND diet guidelines. Conclusions: With both groups being more prone to malnutrition, this research shows that participants were less likely to obtain adequate nutrition for brain health. Additionally, caregivers are dealing with nutrition issues themselves and their person living with dementia. The findings support the need for registered dietitians to provide tailored nutrition interventions for these families.

We assessed store-level food availability, quality, variety, depth of stock, and cost at small Supplemental Nutrition Assistance Program (SNAP)-authorized retailers and compared stocking patterns to proposed United States Department of Agriculture criteria. Food environment observations were conducted at 82 retailers from June to December 2019 in Pinellas County, Florida, and descriptively analyzed. Less than one-third of retailers stocked frozen fruit, fresh or frozen vegetables, tortillas, whole-wheat bread, low-fat milk, fresh or frozen meat, fish or meat alternatives, dried beans, or healthier frozen meals. Twenty-two and 26% had at least seven SNAP-eligible varieties of fruits and vegetables and protein products, respectively.

Particularly in 2024, we are advocating for 2 significant initiatives that will shape the future of our profession: the Medical Nutrition Therapy Act and a potential new interstate professional licensure compact for registered dietitian nutritionists (RDN). See the boxes in this article for more details on each of these high-priority issues.