Journal of the Academy of Nutrition and Dietetics最新文献

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.

It is the position of the Academy of Nutrition and Dietetics that, in adults, appropriately planned vegetarian and vegan dietary patterns can be nutritionally adequate and can offer long-term health benefits such as improving several health outcomes associated with cardiometabolic diseases. Vegetarian dietary patterns exclude meat, poultry, and seafood, and vegan dietary patterns exclude all foods of animal origin. Registered dietitian nutritionists (RDNs) and nutrition and dietetics technicians, registered (NDTRs) play a pivotal role in providing meal-planning strategies and evidence-based nutrition information to clients currently following vegetarian or vegan dietary patterns or who may benefit from and express interest in following vegetarian or vegan dietary patterns. RDNs and NDTRs can work with their clients to create tailored, lifestyle-oriented, nutritionally balanced, and culturally suitable vegetarian and vegan dietary patterns that optimize health benefits while reducing concerns about nutrient inadequacies. Adults follow vegetarian and vegan dietary patterns for various reasons. The aim of this position paper is to inform health care practitioners, including RDNs and NDTRs, about the evidence-based benefits and potential concerns of following vegetarian and vegan dietary patterns for different populations of nonpregnant, nonlactating adults. This position paper is supported by current evidence, including several systematic reviews. As leaders in evidence-based nutrition care, RDNs and NDTRs should aim to support the development and facilitation of vegetarian and vegan dietary patterns and access to nutrient-dense plant-based meals. Promoting a nutrient-balanced vegetarian dietary pattern on both individual and community scales may be an effective tool for preventing and managing many diet-related conditions. This position was approved in January 2025 and will remain in effect until December 31, 2032.

Background: Evaluation of public health nutrition interventions designed to increase fruit and vegetable intake (FVI) is critical to understanding and improving these projects. Challenges with self-reported dietary intake data and feasibility of biochemical assessments in community-based settings have led to use of skin carotenoid measurements as an alternative measure of FVI.

Objective: Understand how the Veggie Meter, a tool for measuring skin carotenoids, is applied and adapted for use in community-based settings to measure FVI.

Design: This mixed-methods study applied a convergent parallel design. Quantitative data were collected via an online survey. Qualitative semi-structured interviews were conducted with individuals who had experience collecting Veggie Meter data in community-based settings.

Participants/setting: Fourteen individuals with experience collecting data with the Veggie Meter in a community-based setting enrolled. Fourteen surveys were collected via Qualtrics and 10 audio-recorded interviews were conducted via Zoom from March through July 2023.

Analysis: Descriptive statistics were calculated for survey results. A constructivist approach was applied to the qualitative interview data.

Results: Fourteen individuals completed the survey, and of those individuals, ten also completed an interview. Three main themes were identified to describe application and adaption of the Veggie Meter in community-based settings: (1) balancing protocol adherence with contextual adaptation in Veggie Meter usage, (2) implementation and operation of the Veggie Meter in community-based settings, and (3) strategies for maximizing participant engagement with the Veggie Meter.

Conclusions: Use of the Veggie Meter for data collection in community-based necessitated adaptation of standard protocols to meet varied needs of the environments, communities, and participants where evaluation of public health nutrition interventions occurred.

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: Latina breast cancer (BC) survivors experience health disparities. Effective lifestyle interventions are sparse.

Objective: This trial tested the effectiveness of a culturally-tailored diet and physical activity (PA) intervention in Latina BC survivors.

Design: Using a 2x2 factorial design, women were randomized to receive: 1) 4 weekly in-person group sessions, 2) 11 months of eHealth communications, 3) in-person sessions and eHealth, or 4) control. Follow-up data were collected at months 6 and 12.

Participants/setting: Eligibility criteria were self-identification as Latina, post-treatment for early-stage BC, and consuming <5 daily servings of fruits and vegetables (F/V) and/or engaging in <150 minutes/week of moderate-to-vigorous PA (MVPA). A total 167 women from New York City were enrolled from July 2016 to October 2018 with 93.4% retention at 12-month follow-up (n=156).

Intervention: All participants received a Fitbit and one 1:1 health coaching session. In-person group sessions included nutrition and PA education, cooking classes, fitness classes or grocery store visit, and social activities. The eHealth communications included motivational text messaging, emailed newsletters, and study website access. Activities were conducted in Spanish and English.

Main outcome measures: Primary outcomes were 12-month change in F/V servings/day and energy density of food. Secondary outcomes were 12-month change in MVPA and anthropometry.

Statistical analysis: Outcomes comparing intervention arms with the control were examined using generalized estimating equations.

Results: At baseline (n=167), mean age was 56.7 years; 82.3% had overweight/obesity. At month 12, daily F/V intake for women in the in-person sessions increased by 10% and decreased by 44% for women in the control, a +96% group difference (p=0.01); no other between-group differences were observed. At month 12, women in the control had a 53% increase in minutes/week of MVPA while women in the in-person plus eHealth group had a 34% decrease, a -57% group difference (p=0.01); no other between-group differences were noted. No changes in energy density or weight between groups were observed.

Conclusion: Women randomized to the in-person ¡Mi Vida Saludable! classes modestly increased F/V intake at 12 months relative to control. Those receiving eHealth communication did not have diet, MVPA, or weight change. More research is needed to understand how to support Latina BC survivors make sustained diet and PA changes.

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 healthcare 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 semi-structured 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 impact of dietetic care on CVD 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 healthcare 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 Practitioners (GPs).

Conclusions: Consultation with dietitians working in rural areas can offer valuable insight into rural dietetic 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.