Dietary Counselling Interventions in Malnutrition Research: Achieving an International Consensus on Best Practices Using an Amended Delphi Process

Abstract

Introduction

The evidence for the use of dietary counselling interventions in the management of malnutrition is inconsistent. Lack of consistency limits the ability to compare studies, impacting research, clinical practice and policy development.

Aims

To establish an international consensus on minimum requirements for dietary counselling interventions used for the prevention and management of malnutrition in adults in a clinical research context.

Methods

An international expert panel with seven members was formed. An amended Delphi study was conducted with 37 initial consensus statements generated from a targeted search of the literature. The agreement was assessed across two Delphi rounds and two online meetings. The full consensus was defined as the assignment of a score of 5 (strongly agree). A preliminary external validation was conducted with clinical and/or research dietetic professionals when delegates at the International Congress of Dietetics (ICD) 2021 voted during an online meeting on agreement with statements relating to patient assessment and delivery of a dietary counselling intervention.

Results

Consensus was achieved for 27 statements across four themes, with justifications and commentary. Minimum requirements included eight statements for ‘nutritional assessment’ (theme 1), seven for ‘nutritional intervention content’ (theme 2), five for ‘nutritional intervention delivery’ (theme 3) and seven for ‘monitoring and follow-up’ (theme 4). The ICD delegates voted on elements of assessment (77 of 140 delegates in agreement) and delivery of the intervention (37 of 101 delegates in agreement), demonstrating that consensus on these aspects of nutritional support interventions was low to moderate in this delegate sample.

Conclusions

Consensus was achieved by an international group of experts to define the minimum essential factors for delivering dietary counselling interventions for the management of malnutrition in a research context; however, further external validation is required. The minimum requirements have the potential to influence research, clinical practice and policy development.