Journal of the Academy of Nutrition and Dietetics最新文献

Background: Complementary feeding is a critical period for meeting an infant's nutritional needs and creating healthy eating habits. Baby-led weaning (BLW) is a newer complementary feeding approach that encourages infants to feed themselves finger foods from the start of solid food introduction.

Objective: This scoping review aimed to explore the extent and nature of the available evidence describing the advantages, disadvantages, and safety of BLW compared with traditional approaches to complementary feeding.

Methods: PubMed, Scopus, CINAHL, and Web of Science databases were searched for eligible studies. Peer-reviewed studies published in English up until July 05, 2024, that evaluated infants who were exposed to BLW, traditional weaning, or a mixed approach at the start of complementary feeding were included. Screening and data extraction and analysis were independently conducted by 2 authors.

Results: Sixty-three studies and 80 reports were reported in this scoping review, including 19 reports from 5 randomized control trials, 45 cross-sectional studies, 8 reports from 5 longitudinal cohort studies, and 8 qualitative studies. Most studies were conducted in the United Kingdom (n = 27). The most common methods used to measure outcomes in the reported studies included self-reported questionnaires and 24-hour dietary recalls. The evidence was organized into the following outcome categories: food and nutrient intake; eating behavior; growth and obesity risk; developmental milestones; choking risk; parental characteristics, knowledge, attitudes, and experiences; and health care professionals' knowledge, attitudes, and recommendations.

Conclusions: Findings from this scoping review suggest a need for stronger study designs that apply objective assessments to measure infant feeding and a clear definition of BLW that can be used across future research.

Background: A common, underrecognized symptom in cancer is early satiety (ES), which is classified as an orphan symptom. No systematic or scoping review focusing on ES has been published previously.

Objective: This scoping review aimed to detail the available evidence and knowledge gaps surrounding ES in individuals with cancer.

Methods: Five databases (Cochrane, EBSCOhost, Embase, PubMed, and Web of Science) were searched from inception until August 9, 2023. Inclusion criteria were original data on ES in cancer, human studies, peer-reviewed, and full text in English. Extracted data included characteristics, tools used, and results on ES.

Results: Seventy-eight reports were included. All but 1 was quantitative. A quarter used validated tools to screen for ES. Where a description of ES was given (n = 40), 20 were unique. Median prevalence in mixed cancer cohorts was 44%. ES was the most common symptom postesophagectomy. ES was associated with cachexia, malnutrition, lower handgrip strength, lower quality of life, and reduced survival in cancer compared with those without ES. No clear pathophysiology was identified. No 2 studies investigated the same intervention, and none investigated nonpharmacologic interventions. Healthcare professionals reported lacking knowledge regarding the identification and management of ES. It was therefore among the least treated symptoms in practice.

Conclusions: ES is a highly prevalent symptom, with multiple potentially negative associations with health. Despite this, there are large knowledge deficits in identification practices, influence, pathophysiology, and appropriate treatment because no specific pathophysiology or treatment was identified. Future work should form a consensus definition, investigate pathophysiology, and trial both pharmaceutical and nonpharmaceutical interventions.

Background: Consultation with rural dietitians can inform the development of rural telehealth medical nutrition therapy (MNT) interventions and contribute to their effectiveness.

Objective: This study aimed to explore dietitians' experiences and perceptions delivering in-person and telehealth MNT in rural primary health care settings in New South Wales (NSW), Australia, to inform the development of a rural-based telehealth MNT intervention for cardiovascular disease (CVD) risk reduction.

Design: Qualitative study design whereby semistructured interviews were conducted between March and April 2021. Interview topic areas included experiences and perceptions of working in rural areas, delivering telehealth consultations, key factors for successful dietetic consults, the influence of dietetics care on cardiovascular disease prevention, relationships with other health professionals, and the importance of continuity of care.

Participants and setting: Dietitians in rural NSW, Australia, who held Accredited Practising Dietitian (APD) status or qualified for APD status were eligible to be interviewed.

Data interpretation: Interview data were interpreted thematically. Actionable items were developed through iterative discussion and applied to a rural telehealth MNT intervention design.

Results: All dietitians recruited (N = 9) participated in an interview. Key themes interpreted from the data included building trusting therapeutic relationships, using telehealth as a nuanced tool, and valuing each health care team member. Actionable items developed from these themes included recruiting rural-based dietitians for service delivery, training dietitians in online rapport-building skills and telehealth software, providing a flexible telehealth service, and ensuring the service facilitates optimal communication with general practitioner (GP) physicians.

Conclusions: Consultation with dietitians working in rural areas can offer valuable insight into rural dietetics practice and inform the development of rural telehealth MNT interventions. Future research investigating telehealth MNT interventions could consider using the actionable items developed in this research study. Researchers and service designers may also consider consultation with local practitioners to inform place-based solutions for their own telehealth interventions.

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.

Background: Indirect calorimetry (IC) is the gold standard method for measuring energy expenditure to calculate an individual's nutritional requirements. However, literature is limited on its use in adults with eating disorders who are hospitalized due to medical instability and undergoing refeeding.

Objective: The objective of this scoping review is to map the evidence regarding the use of IC for adults with eating disorders hospitalized due to medical instability.

Methods: PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library were searched on April 18, 2024, to identify studies published in English reporting the use of IC in adult patients with eating disorders who are hospitalized and undergoing refeeding. There were no restrictions on publication date, and all eating disorder types were accepted. Article screening was conducted in 2 stages, and identified studies were independently screened by 2 reviewers to identify studies that met the inclusion criteria. Data extracted included study and population characteristics, eating disorder diagnosis, nutrition regimen, and IC protocol.

Results: Searches yielded 641 articles for screening, with 19 studies included in the final review. There were 624 patients with eating disorders, all diagnosed with anorexia nervosa, with a body mass index range of 9.6 to 15.4 kg/m². Before IC measurements, patients fasted for ≥10 to 12 hours, and no adverse events regarding fasting were reported. Timelines of IC measurements during refeeding were variable, and it remains unclear what the most efficacious time to perform IC is if used to guide nutrition provision. Reporting on co-occurring mental health diagnoses and complexities and considerations when using IC in patients with eating disorders was scarce.

Conclusions: There is a paucity of literature regarding practical considerations of using IC in adult patients hospitalized with eating disorders. Further research is required to inform the useful, sensitive, and robust use of IC in the target cohort.

Background: Updates to the meal pattern requirements for the Child and Adult Care Food Program (CACFP) took effect in 2017. The updates were designed to align CACFP meals and snacks with the Dietary Guidelines for Americans and represented the first major revision of the CACFP meal patterns since the Program's inception in 1968.

Objective: To examine changes in the nutritional quality of CACFP meals and snacks served to children ages 3 to 5 in early child care programs before and after the updated meal patterns were implemented.

Design: The USDA's Study of Nutrition and Activity in Child Care Settings (SNACS-I) collected data in program year 2016-2017, and SNACS-II collected data in program year 2022-2023 from nationally representative samples of CACFP programs and the children they served. Both studies used a menu survey to collect detailed descriptions and recipes for all foods and beverages served in CACFP meals and snacks during a one-week period, and onsite measurements of reference portions to estimate portion sizes for the foods and beverages served.

Participants: /setting: The analysis included data from 664 early child care programs in SNACS-I and 759 early child care programs in SNACS-II.

Outcome measures: Mean Healthy Eating Index (HEI)-2015 scores were calculated for all CACFP meals and snacks served combined, in addition to separate HEI-2015 scores for breakfast, lunch, morning snack, and afternoon snack.

Statistical analysis: Differences in the mean HEI-2015 scores between the two time periods were estimated and two-tailed Welch's t-tests were conducted to test for statistical significance.

Results: After the meal pattern updates, mean total HEI-2015 scores significantly improved for CACFP breakfasts by 6.1 points (p < 0.001), lunches by 5.5 points (p < 0.001), afternoon snacks by 4.7 points (p < 0.05), and all meals and snacks combined by 5.1 points (p < 0.001).

Conclusions: This analysis demonstrates that CACFP meals and snacks served in early child care programs were more consistent with the Dietary Guidelines for Americans after updated CACFP meal pattern requirements were implemented in 2017. This work underscores the importance of updating meal pattern requirements for nutrition assistance programs such as the CACFP to ensure meals provided to children are aligned with the latest Dietary Guidelines for Americans.

Background: Malnutrition affects about 61% of patients with gastrointestinal (GI) cancers, yet timely, dietitian-led care is often delayed or uneven across settings.

Objective: To identify Registered Dietitians' (RDs) perceived barriers to timely nutrition support in GI oncology within a multi-site academic health system.

Design: Qualitative descriptive study using semi-structured interviews, supplemented by a brief survey to characterize participants and practice context.

Participants: /Setting: Seven RDs practicing across inpatient and outpatient services at a main campus and satellite sites (all non-Hispanic White women; median age 45 years, IQR 37-52 years).

Main outcome measures: Perceived barriers to timely nutrition support; theme salience by clinician characteristics (years in practice, GI caseload, number of facilities).

Analyses performed: Inductive thematic analysis by two coders with iterative codebook refinement and consensus; descriptive summaries of survey items; joint display mapping participant attributes to theme salience (0 = not mentioned, 1 = mentioned, 2 = strongly emphasized) and a salience-weighted score (the sum of the five theme ratings; range: 0-10).

Results: Five barriers emerged: Access, Referral Timing, Coordination, Workforce Constraints, and Emotional Burden. Theme salience peaked among clinicians covering two or more facilities (mean salience-weighted score 9.5/10). In the joint display (years in practice, GI caseload, and the number of facilities), Access, Coordination, and Workforce appeared across all subgroups. All RDs endorsed a multidisciplinary team focused on non-medical barriers.

Conclusions: System-level obstacles, particularly access limitations, coordination gaps, and staffing constraints, delay timely nutrition support in GI oncology, with multi-site coverage intensifying these challenges. Findings highlight actionable leverage points for implementation, including standardized early referral triggers, structured cross-setting handoffs, streamlined resource navigation, and workforce supports. In response, a preoperative nutrition handout paired with an automatic RD referral at the surgical preoperative visit was initiated at the study institution. Prospective studies should assess impacts on nutritional status, treatment tolerance, and patient-reported outcomes.

Background: High diet quality may reduce health disparities and prevent co-morbidities among cancer survivors.

Objective: The aims of this study were to describe the diet quality among cancer survivors from a nationally representative sample using the Healthy Eating Index (HEI)-2020, and to determine the association between sociodemographic characteristics and health behaviors and HEI-2020 by race and ethnicity.

Design: This was a secondary analysis of the cross-sectional U.S. National Health and Nutrition Examination Survey (NHANES) 2011 - 2020.

Participants/setting: This study included 1,841 cancer survivors, 20 years and older.

Main outcome measures: Diet quality was measured using HEI-2020 calculated from the average of two 24-hr dietary recalls.

Statistical analyses: Weighted Rao-Scott chi-square tests were employed to test associations between sociodemographic and health behavior variables with race and ethnicity. HEI component scores were also compared between race and ethnicity using Sidak adjusted Wald tests. Multivariate linear regression was utilized to investigate the association between sociodemographic and health-related characteristics with total HEI-2020 scores overall and stratified by race and ethnicity.

Results: The mean HEI-2020 score among cancer survivors was 60.8 (se 0.6). There were no statistically significant differences between mean HEI-2020 scores by race and ethnicity (Hispanic/Mexican American (Hisp/MA): (62.1, se 0.8), Non-Hispanic White (NHW; 60.8, se 0.6), Non-Hispanic Black (NHB; 60.0, se 1.1). For individual components, total protein foods and total vegetables had the highest mean scores, and refined grains and added sugars had the lowest mean scores. Significant associations were found between HEI-2020 scores and age and alcohol status among NHW adults; age, nativity, and BMI in NHB adults; and sex, age, education, poverty income ratio, and physical activity in Hisp/MA adults.

Conclusion: Study findings indicated low diet quality among adult cancer survivors, with significant group differences and associations observed between several sociodemographic and health-related characteristics and race and ethnicity. Further research is needed to better understand factors associated with diet quality unique to different racial and ethnic groups to inform more tailored interventions and dietary guidance to support positive, long-term health outcomes.