OBJECTIVE: Study aim was to determine the levels and barriers of the Nutrition Care Process (NCP), a practical method of individualized nutrition support.
METHODS: Delegate of registered dietitians (RDs) from acute-care hospitals answered our nationwide web-based questionnaire (April-June, 2023) to determine the implementation status of screening, assessment, intervention (including planning), and monitoring (components of the NCP).
RESULTS: Of 5,378 institutions contacted, 905 (16.8%) responded. For Screening, 80.0% screened all inpatients: primary personnel in charge were RDs (57.6%); the most used screening tool was Subjective Global Assessment (SGA) (49.2%). For Assessment, 66.1% assessed all inpatients: food intake (93.3%) was most evaluated whereas muscle mass and strength (13.0%, 8.8%) were least evaluated. For Intervention, 43.9% did so within 48h of hospital admission: oral nutritional supplement (92.9%) was the most common RDs intervention and parenteral nutrition (29.9%) was used less. For Monitoring, 18.5% of institutions had monitoring frequency of ≥ 3 times/week whilst 23.0% had monitoring less than once a week for severely malnourished patients. Energy and protein intake (93.7%, 84.3%) were most monitored and lipid intake (30.1%) was less monitored.
CONCLUSIONS: Barriers of NCP included inefficient staffing systems and unsuitable tools in Screening, inaccurate patient targeting and lack of important evaluation items in Assessment, delayed timing and incomplete contents in Intervention, and inadequate fre-quency and lack of important evaluation items in Monitoring. An increase in RDs staffing in acute-care general wards, widespread NCP instruction manuals, and education about the tools and evaluation items utilized in nutritional management are possible solutions.

For artificial intelligence (AI) to support nutrition care, high quality and accuracy of its features within smartphone applications (apps) are essential. This study evaluated popular apps\' features, quality, behaviour change potential, and comparative validity of dietary assessment via manual logging and AI. The top 200 free and paid nutrition-related apps from Australia\'s Apple App and Google Play stores were screened (n = 800). Apps were assessed using MARS (quality) and ABACUS (behaviour change potential). Nutritional outputs from manual food logging and AI-enabled food-image recognition apps were compared with food records for Western, Asian, and Recommended diets. Among 18 apps, Noom scored highest on MARS (mean = 4.44) and ABACUS (21/21). From 16 manual food-logging apps, energy was overestimated for Western (mean: 1040 kJ) but underestimated for Asian (mean: -1520 kJ) diets. MyFitnessPal and Fastic had the highest accuracy (97% and 92%, respectively) out of seven AI-enabled food image recognition apps. Apps with more AI integration demonstrated better functionality, but automatic energy estimations from AI-enabled food image recognition were inaccurate. To enhance the integration of apps into nutrition care, collaborating with dietitians is essential for improving their credibility and comparative validity by expanding food databases. Moreover, training AI models are needed to improve AI-enabled food recognition, especially for mixed dishes and culturally diverse foods.

UNASSIGNED: The prevalence and incidence of cardiovascular diseases significantly increase with age, and it is well-known that nutritional status affects the prognosis and treatment of these diseases. Therefore, evaluating nutritional status is essential for maintaining/regaining health. It is crucial to identify nutritional risk early, prevent and/or treat protein-energy malnutrition, and promote the modification of inappropriate dietary habits.
UNASSIGNED: Nutritional screening represents the first step of access to the Nutrition Care Process (NCP) adopted and managed by the dietitian; this tool must be simple, inexpensive, accessible, accurate, efficient, and validated. A globally accepted standardized definition of malnutrition is necessary, and for this reason, the Global Leadership Initiative on Malnutrition (GLIM) criteria have been recently introduced.The GLIM criteria, after confirming nutritional risk through screening, include both phenotypic and etiological criteria: to diagnose malnutrition, at least one of these must be present.A less commonly performed phenotypic criterion is the assessment of muscle mass, which should be studied as a significant component of sarcopenia.
UNASSIGNED: Greater attention to the identification and treatment of malnutrition would bring benefits to patients and ensure a saving in healthcare expenditure, but for this purpose, an implementation of clinical nutrition services is necessary.

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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: The Nutrition Care Process (NCP) is a systematic method used by dietitians to provide high-quality nutrition care resulting in good patient outcomes. This study aimed to assess the NCP implementation and use of NCP Terminologies (NCPT) among hospital dietitians in the Philippines. Specifically, the study aimed at assessing the knowledge, perception, and practices on NCP and use of NCPT and correlate them with the dietitians\' education, and professional and employment profile; and explain the barriers and facilitators of the practice of NCP and use of NCPT among hospital dietitians in the Philippines.
UNASSIGNED: The knowledge, perception, and practices (KPP) on NCP and NCPT of the dietitians employed in the Philippine Department of Health\'s licensed level 3 hospitals were determined using a validated questionnaire. Significant factors associated with the KPP were also determined. The barriers and facilitators of the practice of NCP and NCPT were determined using focus group discussion and key informant interviews of chief clinical dietitians and hospital administrators, respectively.
UNASSIGNED: The study revealed that majority of the participants had a high level of knowledge on NCP and NCPT, positively perceived its implementation, and more than half of them implement NCP and NCPT in the hospitals. The participants\' knowledge on NCP and NCPT was significantly associated with research involvement and active membership in a professional organization. While the practice of NCP and NCPT was significantly associated with having NCP-related trainings, frequency of trainings, and active membership in a professional organization. The barriers to NCP implementation were insufficient resources; lack of orientation, trainings, and support; organizational and administrative constraints; pandemic constraints; insufficient time; and lack of confidence to conduct NCP. While the facilitators of implementation were collaboration, dedication, and commitment of the healthcare team; institutionalization of NCP laws and policies; budget allocation for NCP-related activities; monitoring and consistency of NCP implementation; and work schedule.
UNASSIGNED: The findings suggest that the implementation of NCP and NCPT in the Philippines needs further support from the institution, professional organizations, and policy makers by developing strategies to cope with the barriers, and strengthen the facilitators and factors associated with practice.

The level of NCP implementation varies across countries due to differences identified in major components of health systems such as infrastructures, legislation, training, and cultural diversities. Dietitians in Greece receive sufficient training in the implementation of the NCP as part of their main studies; however, the level of awareness and adoption of the NCP model is still quite low, with limited information on the potential barriers. The primary aim of this study was to gain a deeper understanding of the perspectives of Greek dietitians on the NCP and the use of digital tools. An online survey was created and distributed through the platform \"SurveyMonkey version 4.1.1\". The overall structure of the questionnaire was modeled according to the validated NCP/NCPT INIS Tool. A total of 279 subjects were included in this study, and 192 were aware of the NCP tool. The most important challenges for the implementation of the NCP included communication with other healthcare professionals (68.2%), provision of appropriate care (33.9%), and insufficient access to continuous education (29.2%). Of the 192 participants who knew the NCP, 81.3% reported using digital applications for the collection and assessment of health data, while 18.8% indicated that they did not utilize such tools. No relationship was found between the use of digital applications by dietitians, NCP knowledge, and demographic characteristics. Our findings highlight the need for targeted educational interventions and appropriate application of standardized protocols by Greek dietitians in daily practice. National Dietetic Associations should provide sufficient guidance on digital tool utilization in facilitating patient data management and enhancing NCP implementation.

The presence and impact of malnutrition in adult hospitalized patients has been well documented by a significant body of literature. However, current malnutrition care practices often vary widely and frequently lack standardization. The Global Malnutrition Composite Score (GMCS), the first nutrition-related electronic clinical quality measure, is intended to evaluate the quality of malnutrition care provided to inpatient adults. This measure aims to aid in standardizing malnutrition care through performance measurement. The four components of the measure (nutrition screening, nutrition assessment, malnutrition diagnosis, and nutrition care plans) follow the well-established Nutrition Care Process and encourage the use of standardized terminology. Facilities with high-performance scores on the GMCS are likely to experience improved outcomes associated with high-quality malnutrition care.

In healthcare, weight is often equated to and used as a marker for health. In examining nutrition and health status, there are many more effective markers independent of weight. In this article, we review practical and emerging clinical applications of technologies and tools used to collect non-weight-related data in nutrition assessment, monitoring, and evaluation in the outpatient setting. The aim is to provide clinicians with new ideas about various types of data to evaluate and track in nutrition care.

BACKGROUND: The nutrition care process (NCP) is a four-step systematic approach to guide dietitians in providing high-quality nutrition care. It fosters critical thinking and enhances the consistency of dietitians\' documentation. Following international recommendations, University Training Hospital of Fribourg (HFR) implemented it in 2013. This study aimed to evaluate the quality of NCP documentation in electronic patient records (EPRs) and to determine the nutrition problems dietitians most often identified while documenting their actions.
METHODS: The audit was performed on 92 EPRs using the Diet-NCP-Audit, which was translated into French for this study.
RESULTS: The documentation quality was assessed as high in 62% of the EPRs, and nutrition diagnoses were mostly documented. In half of the EPRs, nutrition assessment (step 1 of the NCP) was inconsistent with nutrition diagnosis (step 2). Dietitians often used the same nutrition problems: out of the 73 nutrition problems defined in NCP terminology, only 4 (5%) represented 58% of the 189 problems identified in the EPR audit.
CONCLUSIONS: EPRs were mostly assessed as high quality. However, the entire process requires improved consistency. The poorly documented link between the NCP steps and the restricted choices of nutrition problems dietitians identified should be addressed because they could reveal that dietitians have not fully adopted critical thinking, which the NCP stresses.