BACKGROUND: Food as medicine (FAM) interventions have been associated with improved health outcomes. However, there is limited FAM evidence in food retail settings.
OBJECTIVE: The objective was to evaluate the feasibility of a registered dietitian nutritionist-led FAM program that aims to detect changes in participants\' nutrition problems and related nutrition and health outcomes, as documented by the Nutrition Care Process framework.
METHODS: The study was a descriptive feasibility nutrition intervention cohort analysis.
UNASSIGNED: A convenience sample of online food shoppers were enrolled in collaboration with a food retail chain (n = 39 participants completed the intervention and were included in primary analyses).
METHODS: Participants received nutrition care for 6 months either in person or via telehealth. The FAM intervention included tailored nutrition care that integrated software-generated meal plans and food shopping lists to support online food shopping.
METHODS: Progress of nutrition problems and diet quality (assessed via the Picture your Plate survey) were measured. Measurements included changes in anthropometric and biochemical parameters, blood pressure, and quality of life (assessed via the Centers for Disease Control and Prevention\'s Health Related Quality of Life-14 survey).
METHODS: Mann-Whitney U test, Pearson\'s χ2, and Wilcoxon signed-rank tests were used to detect differences.
RESULTS: The most prevalent nutrition problems demonstrated improvement rates as follows: excessive energy intake, 81% (n = 21 of 26); excessive carbohydrate intake, 88% (n = 7 of 8); and obesity, 100% (n = 5 of 5). Exposure to the FAM intervention improved dietary quality, quality of life, body weight, waist circumference, and systolic pressure.
CONCLUSIONS: FAM interventions can be carried out by in-store registered dietitian nutritionists in the supermarket setting. This feasibility study highlighted the need and opportunity for larger studies in which registered dietitian nutritionist-led FAM interventions, in collaboration with food retailers, may improve people\'s nutrition and health.

UNASSIGNED: To describe nutrition care documentation patterns and investigate predictors of nutrition diagnosis resolution.
UNASSIGNED: This is a secondary data analysis of a 2-year pragmatic, quasi-experimental study conducted in outpatient clinics where nutrition care was provided to adults with diabetes Type 1 or 2 from May 2017 to June 2019 (n = 564 patients). The main outcome measures were frequency of standardized Nutrition Care Process (NCP) terms, NCP links, nutrition diagnosis resolution and predictors of nutrition diagnosis resolution. Predictors of diagnosis resolution were identified using a multivariable logistic regression model.
UNASSIGNED: The most prevalent resolved diagnoses were excessive carbohydrate intake (32%), undesirable food choices (21%) and excessive energy intake (13%). The top etiology was food and nutrition related knowledge deficit (57%) and interventions were drawn mainly from the Nutrition Education domain (64%). One hundred forty-six patient cases (26%) had at least one follow-up visit and 26% of those with a follow-up (n = 38) had a resolved diagnosis. The presence of the evidence-diagnosis NCP link in documentation predicted diagnosis resolution (OR = 2.80, 95% CI 1.30-6.02; p = 0.008).
UNASSIGNED: Most diagnoses were caused by patients\' lack of knowledge and respective interventions focused on nutrition education. Odds of diagnosis resolution improved when the signs and symptoms of the diagnosis were documented during assessment (evidence-diagnosis NCP link). Training dietitians on NCP links may be important to resolve nutrition diagnoses. Presented findings are hypothesis generating.

OBJECTIVE: This study aimed to explore dietitians\' perceptions of their current practice for identifying and managing malnutrition/frailty in the community, to fill an evidence gap.
METHODS: This mixed-methods study involved an online survey distributed to dietitians practising in Australia and New Zealand, and semi-structured interviews with a subset of survey participants. The 34-item survey and interviews explored dietitians\' practices for identifying/managing malnutrition and frailty, focusing on the community setting. Survey data were analysed descriptively and some simple association tests were conducted using statistical software. Interview data were analysed thematically.
RESULTS: Of the 186 survey respondents, 18 also participated in an interview. Screening and assessment for malnutrition varied in the community and occurred rarely for frailty. Dietitians reported practising person-centred care by involving clients/carers/family in setting goals and selecting nutrition interventions. Key barriers to providing nutrition care to community-dwelling adults included a lack of awareness/understanding of nutrition by clients and other health professionals (leading to them not participating in or valuing nutrition care), lack of time and resources in the community, and client access to foods/supplements. Enablers included engaging family members/carers and coordinating with other health professionals in nutrition care planning.
CONCLUSIONS: Reported practices for identifying malnutrition and frailty vary in the community, suggesting guidance may be needed for health professionals in this setting. Dietitians reported using person-centred care with malnourished and frail clients but encountered barriers in community settings. Engaging family members/carers and multidisciplinary colleagues may help overcome some of these barriers.

BACKGROUND: The documentation of goals and outcomes of nutrition care in Electronic Health Records is insufficient making further exploration of this of particular interest. Identifying common features in documentation practice among Scandinavian dietitians might provide information that can support improvement in this area.
OBJECTIVE: To explore the associations between clinical dietitians\' self-reported documentation of patients\' goals and outcomes and demographic factors, self-reported implementation of the systematic framework the Nutrition Care Process 4th step (NCP) and its associated terminology, and factors associated with the workplace.
METHODS: Data from a cross-sectional study based on a previously tested web-based survey (INIS) disseminated in 2017 to dietitians in Scandinavia (n = 494) was used. Respondents were recruited through e-mail lists, e-newsletters and social media groups for dietitians. Associations between countries regarding the reported documentation of goals and outcomes, implementation levels of the NCP 4th step, demographic information and factors associated with the workplace were measured through Chi-square test. Associations between dependent- and independent variables were measured through logistic regression analysis.
RESULTS: Clinically practicing dietitians (n = 347) working in Scandinavia, Sweden (n = 249), Norway (n = 60), Denmark (n = 38), who had completed dietetic education participated. The reported documentation of goals and outcomes from nutrition intervention was highly associated with the reported implementation of NCP 4th step terminology (OR = 5.26; p = 0.009, OR = 3.56; p = 0.003), support from the workplace (OR = 4.0, p < 0.001, OR = 8.89, p < 0.001) and area of practice (OR = 2.02, p = 0.017). Years since completed dietetic training and educational level did not have any significant associations with documentation practice regarding goals and outcomes.
CONCLUSIONS: Findings highlight strong associations between the implementation of the NCP 4th step terminology and the documentation of goals and outcomes. Strategies to support dietitians in using standardized terminology and the development of tools for comprehensive documentation of evaluation of goals and outcome are required.

Entrustable professional activities (EPAs) describe key workplace activities and are increasingly being used for student work-based assessment. An EPA-based work-based assessment tool offers potential to increase understanding of dietetics student skill development and opportunity for standardised work-based student assessment.
To determine construct validity and educational impact of an EPA work-based assessment tool for dietetics placement students in clinical settings.
Using a time series design, supervisor and student self-assessment data collected from an EPA-based assessment tool from three cohorts of dietetics students and supervisors from 2017-2019 was analyzed.
Dietetics students (n = 145) from an accredited dietetic training program in Australia and affiliated metropolitan and rural hospitals.
Construct validity was determined through analysis of supervisor evaluation of student performance against EPAs over time. Educational impact was determined through comparing student performance across EPAs to predicted milestones to identify areas of least entrustment.
Student performance over time and differences between student self-assessment and supervisor assessment for each EPA were investigated using Wilcoxon signed-rank tests and linear mixed-model analysis. Descriptive statistics summarised student performance against each EPA.
Performance significantly increased over time in 35 out of 37 EPAs. Significant differences between supervisor and student self-assessment were evident in 9 out of 37 EPAs. Dietetics student performance varied across EPAs with 88.2% of students achieving entrustment for nutrition management EPAs compared with 100% for professionalism EPAs.
The tool\'s construct validity was established. EPAs identified areas of Nutrition Care Process skills development requiring additional support. Data collected by the tool can inform teaching.

BACKGROUND: Personalized diet counselling, as part of lifestyle change programs for cardiometabolic risk conditions (combinations of prediabetes or type 2 diabetes, hypertension, dyslipidemia and high waist circumference) has been shown to reduce progression to type 2 diabetes overall. To identify key process of care measures that could be linked to changes in diet, we undertook a secondary analysis of a Canadian pre-post study of lifestyle treatment of metabolic syndrome (MetS). Diet counselling process measures were documented and association with diet quality changes after 3 months were assessed. Results of the primary study showed 19% reversal of MetS after 1 year.
METHODS: Registered dietitians (RDs) reported on contact time, specific food behaviour goals (FBG), behaviour change techniques (BCT; adapted from the Michie CALO-RE taxonomy) and teaching resources at each contact. Diet quality was measured by 2005 Canadian Healthy Eating Index (HEI-C) and assessed for possible associations with individual BCT and FBG.
RESULTS: Food behaviour goals associated with improved HEI-C at 3 months were: poultry more than red meat, increased plant protein, increased fish, increased olive oil, increased fruits and vegetables, eating breakfast, increased milk and alternatives, healthier fats, healthier snacks and increased nuts, with an adverse association noted for more use (> 2 times/ 3 months) of the balanced meal concept (F test; p < 0.001). Of 16 BCT, goal setting accounted for 15% of all BCT recorded, yet more goal setting (> 3 times/3 months) was associated with poorer HEI-C at 3 months (F test; p = 0.007). Only self-monitoring, feedback on performance and focus on past success were associated with improved HEI-C.
CONCLUSIONS: These results identify key aspects of process that impact diet quality. Documentation of both FBG and BCT is highly relevant in diet counselling and a summary diet quality score is a promising target for assessing short-term counselling success.

BACKGROUND: Nutrition care plays a significant role in the prevention and treatment of malnutrition, although the challenge to establish the precise impact of a nutrition intervention on patient outcomes remains. Malnutrition can be associated with diverse underlying diseases and an increased risk of complications, which increases the difficulty of monitoring and evaluating the nutrition intervention. The aim is to gain an understanding of dietitians\' reflections concerning nutrition care outcomes of interventions in patients at risk of malnutrition.
METHODS: Six semi-structured audio-recorded focus group discussions with registered dietitians from primary healthcare and hospitals (n = 29) in Sweden were held at the dietitians\' place of work or at the University. Focus group transcripts were analysed thematically to reveal patterns in the data and identify themes and subthemes.
RESULTS: The dietitians described an approach to nutrition monitoring and evaluation of patients at risk of malnutrition that was categorised into three themes: (i) quantitative explicit outcomes, based on objective measures and described as rigorous; (ii) quantitative estimated outcomes, based on estimates and described as less rigorous and (iii) qualitative implicit outcomes, based on patients\' subjective perceptions and experiences of their health and described as difficult to measure.
CONCLUSIONS: Findings indicate the need for new strategies to promote systematic and comprehensive nutrition monitoring and evaluation.

This 12-month prospective randomized cluster trial of 20 dietitians in India compared usual care (UC) and evidence-based nutrition practice guideline (EBNPG) care for patients with type 2 diabetes mellitus. Baseline, 6-month, and 12-month data from 238 patients were analyzed. EBNPG implementation was evaluated using the Ottawa Model for Knowledge Transfer. EBNPG and UC groups achieved significant hemoglobin A1C improvements. EBNPG-treated participants were significantly more likely to meet low-density lipoprotein, high-density lipoprotein, and triglyceride goals at 6 or 12 months. Dietitian dropout, implementation barriers, and undetermined EBNPG intervention fidelity are limitations. Future research should assess barriers/supports and degree of EBNPG use.