CONTEXT:The provision of Medical Nutrition Therapy (MNT) is recommended as a component of best practice care for the management of diabetes. OBJECTIVES:The objectives of this umbrella review were to: (1) Describe the characteristics of the reviews identified and included in the review, (2) identify re-occurring (in ≥3 reviews) themes related to barriers and facilitators for healthcare professionals providing and patients living with diabetes receiving MNT for diabetes management, and (3) map these identified factors to the Capacity, Opportunity, Motivation-Behavior Wheel (COM-B) model and the Theoretical Domains Framework (TDF). The COM-B model assumes an individual's behavior change is dependent on 3 elements: capability, opportunity, and motivation. The TDF identifies 14 behavior change factors that are influenced by the 3 elements of the COM-B model. DATA SOURCES:A search of the literature was conducted using 4 databases for reviews published from inception to July 2023. Reviews that met the following criteria were included in the review: Sample: adults living with diabetes, GPs, clinicians or dietitians; Phenomena of interest: MNT; Design: Systematic reviews, reviews of reviews, meta-analyses; Evaluation: Perceived barriers and facilitators for providing or receiving MNT in primary care; Research type: quantitative, qualitative, or mixed-methods research. DATA EXTRACTION:Two independent reviewers completed the data extraction. Identified barriers and facilitators were mapped to the COM-B model and TDF. DATA ANALYSIS:Of 294 articles that were identified from the literature search strategy, 7 reviews were included. Most reviews (5 of 7) had ≥90% of the included studies from high-income countries. The patient "barrier" themes identified were time constraints and negative interactions with healthcare professionals, while the "facilitator" theme included positive interactions with the health service and providers. For healthcare professionals, the "barrier" themes identified were time constraints, limited resources, and miscommunication, while "facilitator" themes were having confidence in providing dietary advice and involving patients in clinical decisions. CONCLUSION:To improve the provision of MNT for adults with diabetes, interventions are required that target the TDF domain: Environment Context and Resources. Ensuring that patients understand what is provided from dietetic services and that they receive a referral to consult with a dietitian will be important for supporting the provision of MNT in clinical practice. These review findings are only relevant in the context of high-income countries, and further research is needed in low- and middle-income countries. UMBRELLA REVIEW REGISTRATION:OSF Preregistration.  https://osf.io/hm7qp.

INTRODUCTION:With the growing use of GLP-1/GIP receptor agonist medications, their impact on dietary intake and quality remains unclear. This systematic review examined how randomized controlled trials (RCT) prescribing liraglutide, semaglutide, or tirzepatide assessed and reported dietary intake and quality as outcome measures, alongside weight loss and/or glycemic control, and identified gaps in the use and methodological quality of dietary assessment methods. METHODS:Medline, Embase, Cochrane, Scopus, and CINAHL were systematically searched between January 2008-January 2025 (adults) and January 2014-January 2025 (children/adolescents). The review was registered with the Open Science Framework (DOI: 10.17605/OSF.IO/XPNGY). RESULTS:Forty-three articles from 41 unique RCTs, comprising 50,690 participants (n = 688 children/adolescents, n = 50,002 adults) were included. Except for two studies targeting adults (one published and one unpublished data from an included study), this review found no other studies that assessed or reported dietary intake or changes in diet. Both reported a reduction in the total energy intake and altered macronutrient distribution in the medication plus diet group, although one was not significantly different from medication alone. Quality of assessment methods used was categorized as "poor" and "acceptable," respectively. These results highlight a critical gap in the literature. CONCLUSION:Only 2/41 studies (≈5%) reported or assessed dietary intake or evaluated diet changes secondary to GLP-1/GIP RA medication use. This review highlights a major gap in the evidence requiring urgent attention. More high-quality research, using validated dietary assessment methods as outcome measures in RCTs is needed to understand how these medications impact diet and diet quality, nutrient intake, and chronic disease risk.

BackgroundPeople with intellectual disability have diverse needs and experience higher rates of diet-related chronic disease such as type 2 diabetes compared to people without disability. However, they are infrequently included in development and implementation of interventions to address diet-related chronic disease. The present study describes the process to plan, develop and refine the Food and Lifestyle Information Program (FLIP) culinary nutrition intervention for adults with mild-to-moderate intellectual disability.MethodsThe project was initiated by a disability service provider and was guided by the Cook-Ed (TM) model and inclusive research principles. Initially the disability service provider and academic research team members co-designed pre-program consultation and pilot studies, and draft program resources. Pre-program consultation explored paid disability support worker (n = 10) perceptions of cooking and food skills, nutrition priorities and optimal program format, which guided further program drafting. Program resources and pilot study design were further developed and refined with co-researchers with lived experience of intellectual disability who attended a pre-pilot and then pilot study sessions as remunerated co-facilitators.ResultsKey characteristics of the FLIP intervention arising from pre-program consultation included providing cooking task instruction in small steps, enabling participant choice in program activities, promoting an inclusive and social atmosphere, and providing paper-based resources.ConclusionsFLIP intervention co-design was enabled through ongoing input from the disability service provider and people with lived experience of intellectual disability. Evaluation of FLIP feasibility, acceptability and preliminary effectiveness to improve diet-related health is underway. People with intellectual disability often miss out on mainstream health promotion because it is not tailored to their needs. The present study describes the development and refinement of a culinary nutrition intervention with, and for, adults with mild-to-moderate intellectual disability. Considerations for culinary nutrition education for adults with intellectual disability are presented. image An academic research team, disability service provider and people with lived experience of intellectual disability co-designed a culinary nutrition intervention for adults with mild-to-moderate intellectual disability Key considerations for culinary nutrition programs for people with intellectual disability include providing small group practical instruction, paper-based Easy Read recipes, providing choice and creating a social and inclusive atmosphere

AbstractBackgroundAn Australia wide cross‐sectional online survey examined facilitators and barriers of health and education professionals to providing culinary nutrition (CN) and culinary medicine (CM) education and behaviour change support in usual practice, in addition to identifying continuing professional development (CPD) needs in this domain.MethodsSurvey items included socio‐demographic characteristics, cooking and food skills confidence, nutrition knowledge (PKB‐7), fruit and vegetable intake (FAVVA) and CPD needs. Data were summarised descriptively.ResultsOf 277 participants, 65% were likely/somewhat likely to participate in CN CPD. Mean (SD) cooking and food skill confidence scores were 73 (17.5) and 107.2 (24), out of 98 and 147, respectively. Mean PKB‐7 score was 3.7 (1.4), out of 7. Mean FAVVA score was 98 (29), out of 190.ConclusionsGaps in knowledge and limited time were the greatest modifiable barriers to providing CM/CN education and behaviour change support in practice. Health and education professionals are interested in CPD conducted by dietitians and culinary professionals to enhance their knowledge of CM/CN and behaviour change support.

BACKGROUND:Poor diet, including inadequate vegetable intake, is a leading risk factor for noncommunicable disease. Culinary and nutrition education provided to trainee and practising health and education professionals is an emerging strategy to promote improved dietary intake, including vegetable consumption. We evaluated the impact and feasibility of an online culinary medicine and nutrition (CM/CN) short course for health, education and vegetable industry professionals. The course aimed to improve participants' skills and confidence to prepare vegetables, knowledge of evidence-based nutrition information and recommendations for improving vegetable consumption and diet quality. METHODS:A pre-post study consisting of two separate groups participating in two course rounds recruited practising professionals (n = 30) working in health; community, adult and/or culinary education; and the vegetable industry. Evaluation assessed diet quality, vegetable consumption barriers, cooking and food skill confidence, nutrition knowledge and process measures. RESULTS:Seventeen participants (68%) completed the programme. Pre- to postintervention statistically significant increases in vegetables (M 1.3, SD 2.2), fruit (M 1.6, SD 3.1), and breads and cereal (M 1.1, SD 1.7) intakes were observed. Statistically significant increases and large effect sizes for mean food skill confidence scores (M 8.9, SD 15.4, Cohen's d 0.56) and nutrition knowledge scores (M 6.2, SD 15.4, Cohen's d 0.83) were also observed pre- to postintervention. CONCLUSIONS:The short online course was feasible and improved diet quality, food skill confidence and nutrition knowledge. Online CM/CN education for practising professionals represents a promising area of research. Future research involving a larger study sample and a more rigorous study design such as a randomised control trial is warranted.

Culinary education programs are generally designed to improve participants’ food and cooking skills, with or without consideration to influencing diet quality or health. No published methods exist to guide food and cooking skills’ content priorities within culinary education programs that target improved diet quality and health. To address this gap, an international team of cooking and nutrition education experts developed the Cooking Education (Cook-EdTM) matrix. International food-based dietary guidelines were reviewed to determine common food groups. A six-section matrix was drafted including skill focus points for: (1) Kitchen safety, (2) Food safety, (3) General food skills, (4) Food group specific food skills, (5) General cooking skills, (6) Food group specific cooking skills. A modified e-Delphi method with three consultation rounds was used to reach consensus on the Cook-EdTM matrix structure, skill focus points included, and their order. The final Cook-EdTM matrix includes 117 skill focus points. The matrix guides program providers in selecting the most suitable skills to consider for their programs to improve dietary and health outcomes, while considering available resources, participant needs, and sustainable nutrition principles. Users can adapt the Cook-EdTM matrix to regional food-based dietary guidelines and food cultures.

BACKGROUND:Culinary medicine (CM) or culinary nutrition (CN) education provided to professionals with the capacity to influence behaviour change is an emerging strategy to promote diet quality and reduce the burden of diet related chronic disease in adults. The purpose of this scoping review was to synthesise current research describing CM/CN education provided to or by health, education and culinary professionals, or students of these disciplines. METHODS:Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) was used. Eleven electronic databases were searched in March 2019. Included studies were: (i) nutrition, health or lifestyle programs with a CM/CN component; (ii) study participants or programs facilitated by people working or training in health, community and/or adult education, or culinary roles where facilitator training was described; (iii) reported in the English language; and (iv) published from 2003. RESULTS:In total, 33 studies were included. Nineteen studies delivered programs to general population groups and were facilitated by health professionals and/or health university students. Fourteen studies delivered CM/CN training to health professionals or students. Studies reported changes in participants' culinary skill and nutrition knowledge (n = 18), changes in dietary intake (n = 13), attitudes and behaviour change in healthy eating and cooking (n = 4), and competency in nutrition counselling and knowledge (n = 7). CONCLUSIONS:Further research examining the effectiveness of CM/CN programs, and that describes optimal content, format and timing of the programs, is needed. Research evaluating the impact of training in CM/CN to education and culinary professionals on healthy cooking behaviours of their patients/clients is warranted.

Introduction: Quantifying Home Cooking EnviRonments has applications in nutrition epidemiology, health promotion, and nutrition interventions. This study aimed to develop a tool to quantify household cooking environments and establish its content validity, face validity, and inter-rater agreement. Methods: The Home Cooking EnviRonment and equipment Inventory observation form (Home-CookERI™) was developed as a 24-question (91-item) online survey. Items included domestic spaces and resources for storage, disposal, preparation, and cooking of food or non-alcoholic beverages. Home-CookERITM was piloted to assess content validity, face validity, and usability with six Australian experts (i.e., dietitians, nutrition researchers, chefs, a food technology teacher, and a kitchen designer) and 13 laypersons. Pilot participants provided feedback in a 10 min telephone interview. Home-CookERI™ was modified to an 89-item survey in line with the pilot findings. Inter-rater agreement was examined between two trained raters in 33 unique Australian households. Raters were required to observe each item before recording a response. Home occupants were instructed to only assist with locating items if asked. Raters were blinded to each other’s responses. Inter-rater agreement was calculated by Cohen’s Kappa coefficient (κ) for each item. To optimize κ, similar items were grouped together reducing the number of items to 81. Results: Home-CookERITM had excellent content and face validity with responding participants; all 24 questions were both clear and relevant (X2 (1, n = 19; 19.0, p = 0.392)). Inter-rater agreement for the modified 81-item Home-CookERI™ was almost-perfect to perfect for 46% of kitchen items (n = 37 items, κ = 0.81–1), moderate to substantial for 28% (n = 23, κ = 0.51–0.8), slight to fair for 15% (n = 12, κ = 0.01–0.5), and chance or worse for 11% of items (n = 9, κ ≤ 0.0). Home-CookERITM was further optimized by reduction to a 77-item version, which is now available to researchers. Conclusion: Home-CookERI™ is a comprehensive tool for quantifying Australian household cooking environments. It has excellent face and content validity and moderate to perfect inter-rater agreement for almost three-quarters of included kitchen items. To expand Home-CookERI™ applications, a home occupant self-completion version is planned for validation.

Domestic cooking education programs are typically designed to improve an individual's food and cooking skills, although not necessarily diet quality. Currently, there are no comprehensive models to guide the planning, implementation and evaluation of domestic cooking education programs that focus on improving diet and health. Our aim was to address this through development of the Cooking Education ("Cook-EdTM") model, using the PRECEDE-PROCEED model as the underlying Cook-EdTM framework. A review of the food and cooking skills education literature informed the content of the Cook-EdTM model. Cook-EdTM was critiqued by experts in consumer behaviour, cooking and nutrition education research and education until consensus on model content and format was reached. Cook-EdTM leads cooking program developers through eight distinct stages, engaging key stakeholders in a co-design process from the outset to tailor programs to address the need of individuals and inform the development of program content, program delivery, and evaluation. A Cook-EdTM scenario applied in practice is described. The proposed Cook-EdTM model has potential to be adapted for use in domestic cooking education programs delivered in clinical, community, school or research settings. Further research will establish Cook-EdTM's utility in enhancing program development and in improving food and cooking skills, dietary patterns and health outcomes.

Aim: Very low-energy diets are a weight loss strategy that utilises severe and controlled energy restriction to induce rapid weight loss. This review aimed to evaluate their use in terms of efficacy and safety, and to identify for whom they may be effective for weight loss. Methods: English-language papers examining the use of very low-energy diets for weight loss in adults with a body mass index 30kg/m2 and published between March 2003 and March 2010 were retrieved from health and medical databases. Results: Eight randomised control trials, two cohort and six pre-post studies were eligible for inclusion and were assessed for methodological quality and had data extracted. The greatest initial weight loss was -22kg, after 16weeks of a very low energy diet. Greatest weight loss after follow up was -13.1 +/- 8.0kg and 9.1 +/- 9.7kg (7.7 +/- 8.1%) after 1 and 2years, respectively. Studies comparing the effects in males versus females yielded conflicting results. Very low-energy diets are effective for producing short-term weight loss. However not all initial weight loss is maintained long term. Conclusion: Future studies using very low-energy diets should conduct more rigorous analyses of dietary adherence and physical activity and should be required to document side effects experienced in order to identify how and for whom they are effective in facilitating long-term weight loss in adults.