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Sociology of Health & Illness Jun 2022Through an exploration of the origins of dietetics in the West, and specifically in Australia, we problematise the lack of diversity within the profession through the...
Through an exploration of the origins of dietetics in the West, and specifically in Australia, we problematise the lack of diversity within the profession through the lens of intersectionality. Dietetics in Australia continues to be dominated by Australian-born women, and ideologies about dietitians perpetuate narratives of white, young, slim, women. Intersectional approaches to critiquing diversity in dietetics provides a useful framework to extend critical studies of health disparities into disparities in the dietetics professional workforce, which is advanced through structural, political and representational intersectionality guided critique. Through the analysis, a dialog is prompted in order to chart paths forward to find 'how differences will find expression' within the professional group. To do this, dietetics as a profession must reckon with its historical roots and step forward, out of a perceived position of objective neutrality regarding people and diversity, and into a position that can recognise that professional institutions have the power to exclude and marginalise, along with the power to include and transform.
Topics: Australia; Dietetics; Female; Humans; Intersectional Framework; Nutritionists; Racial Groups
PubMed: 35404486
DOI: 10.1111/1467-9566.13471 -
Nutrition & Dietetics: the Journal of... Sep 2020It is the position of Dietitians Australia that clients can receive high-quality and effective dietetic services such as Medical Nutrition Therapy (MNT) delivered via...
It is the position of Dietitians Australia that clients can receive high-quality and effective dietetic services such as Medical Nutrition Therapy (MNT) delivered via telehealth. Outcomes of telehealth-delivered dietetic consultations are comparable to those delivered in-person, without requiring higher levels of additional training nor compromising quality of service provision. Dietitians Australia recommends that policy makers and healthcare funders broaden the recognition for telehealth-delivered dietetic consultations as a responsive and cost-effective alternative or complement to traditional in-person delivery of dietetic services. The successful implementation of telehealth can help to address health and service inequalities, improve access to effective nutrition services, and support people with chronic disease to optimise their diet-related health and well-being, regardless of their location, income or literacy level, thereby addressing current inequities.
Topics: Australia; Dietary Services; Dietetics; Humans; Nutritionists; Telemedicine
PubMed: 32596950
DOI: 10.1111/1747-0080.12619 -
The American Journal of Gastroenterology Jun 2022There is accumulating evidence for the fundamental role of diet in the integrated care of disorders of gut-brain interaction. Food is a complex mixture of components... (Review)
Review
There is accumulating evidence for the fundamental role of diet in the integrated care of disorders of gut-brain interaction. Food is a complex mixture of components with individual, synergistic, and antagonistic effects, compared with the relative purity of a pharmaceutical. Food is also an inherent part of individuals' daily lives, and food choice is strongly tied to food preferences, personal beliefs, cultural and religious practices, and economic status, which can influence its ability to function as a therapeutic intervention. Hence, randomized controlled trials of dietary interventions carry unique methodological complexities that are not applicable to pharmaceutical trials that if disregarded can pose significant risk to trial quality. The challenges of designing and delivering the dietary intervention depend on the type of intervention (i.e., nutrient vs food supplementation or whole-diet intervention). Furthermore, there are multiple modes of delivery of dietary interventions, each with their own advantages (e.g., the high precision of feeding trials and the strong clinical applicability of dietary counseling trials). Randomized placebo-controlled trials of dietary interventions are possible with sufficient attention to their design and methodological nuances. Collaboration with experts in nutrition and dietetics is essential for the planning phase; however, even with expert input, not all challenges can be overcome. Researchers undertaking future dietary trials must be transparent in reporting these challenges and approaches for overcoming them. This review aims to provide guiding principles and recommendations for addressing these challenges to facilitate the conduct and reporting of high-quality trials that inform and improve clinical practice.
Topics: Brain; Diet; Dietetics; Humans; Nutritional Status; Pharmaceutical Preparations
PubMed: 35297784
DOI: 10.14309/ajg.0000000000001732 -
Nutrition & Dietetics: the Journal of... Nov 2022The application of behaviour change science is fundamental to the role of dietitians. This study aimed to describe how behaviour change science is embedded within the...
AIM
The application of behaviour change science is fundamental to the role of dietitians. This study aimed to describe how behaviour change science is embedded within the curricula of accredited/registered dietetics programs in Australia and New Zealand.
METHODS
A descriptive study triangulated quantitative document analysis of curricula content from university websites (Part 1) with qualitative, structured interviews with dietetics academics (Part 2). Part 2 verified and advanced upon information captured in Part 1 and was analysed using thematic content analysis.
RESULTS
Twenty-five courses from 18 university programs (15 Australia and 3 New Zealand) were synthesised. Fifteen interviews (12 Australia, 3 New Zealand) were conducted. Behaviour change science was taught and assessed at varying levels across all programs. It was taught primarily within lectures or workshops where students apply skills learnt in practical case-based activities, and assessed through small group education planning or demonstrating communication and counselling skills. Five themes were identified from the interviews: (1) behaviour change science should be foundational; (2) integrate and scaffold within curricula; (3) structural limitations within curricula; (4) challenging for students and (5) recommendations for competencies.
CONCLUSION
Behaviour change science is clearly of value to the dietetics profession. Core content appears to be embedded across all university programs; however, the level and depth of the content varied. The knowledge gained from this study provides direction for curricular improvements.
Topics: Humans; Dietetics; New Zealand; Curriculum; Nutritionists; Nutritional Status
PubMed: 34605593
DOI: 10.1111/1747-0080.12704 -
Journal of the Academy of Nutrition and... May 2021
Topics: Dietetics; Fluid Therapy; Humans; Nutrition Therapy
PubMed: 32988795
DOI: 10.1016/j.jand.2020.07.028 -
AMIA ... Annual Symposium Proceedings.... 2015Nutrition care and metabolic control contribute to clinical patient outcomes. Biomedical informatics applications represent a way to potentially improve quality and... (Review)
Review
Nutrition care and metabolic control contribute to clinical patient outcomes. Biomedical informatics applications represent a way to potentially improve quality and efficiency of nutrition management. We performed a systematic literature review to identify clinical decision support and computerized provider order entry systems used to manage nutrition care. Online research databases were searched using a specific set of keywords. Additionally, bibliographies were referenced for supplemental citations. Four independent reviewers selected sixteen studies out of 364 for review. These papers described adult and neonatal nutrition support applications, blood glucose management applications, and other nutrition applications. Overall, results indicated that computerized interventions could contribute to improved patient outcomes and provider performance. Specifically, computer systems in the clinical setting improved nutrient delivery, rates of malnutrition, weight loss, blood glucose values, clinician efficiency, and error rates. In conclusion, further investigation of informatics applications on nutritional and performance outcomes utilizing rigorous study designs is recommended.
Topics: Decision Support Systems, Clinical; Dietetics; Efficiency; Humans; Informatics; Medical Order Entry Systems; Nutrition Assessment; Research Design
PubMed: 26958233
DOI: No ID Found -
Hawai'i Journal of Medicine & Public... Jun 2018The Pacific Island region is geographically the most isolated region in the world representing a diverse population of indigenous peoples, migrated groups and...
The Pacific Island region is geographically the most isolated region in the world representing a diverse population of indigenous peoples, migrated groups and new-comers. Rates of chronic disease are predominately high in populations identified as Pacific Islander. The practice of dietetics, defined as nutrition education for the prevention of disease and medical nutrition therapy for the treatment of chronic diseases, proves challenging with the unique cultural diversity in the region. There is a need to describe dietetics practice, populations served, and needs for resources identified by nutrition-related topic and cultural relevance for Registered Dietitian Nutritionists in the Pacific Island region. An online survey was distributed to all members of the Hawai'i Affiliate of the Academy of Nutrition and Dietetics in 2013-2014. The online survey yielded 104 usable responses. Most participants were female and lived and worked in the Hawaiian Island region. One-third of practicing Registered Dietitian Nutritionists saw >100 patients or clients per month. Most prevalent populations served were identified as Asian and Pacific Islanders. Culturally relevant resources of the highest need were relevant to Asian and Pacific Islander cultures, specifically addressing weight control and diabetes. Dietetics practice in the Pacific Island region is unique given the prevalence of Asians and Pacific Islanders served by Registered Dietitian Nutritionists. Findings will inform the development of new, culturally appropriate online nutrition resources, to enhance dietetics practice in the region. Making these resources available online will be useful for Registered Dietitian Nutritionists and other health care practitioners working in the Pacific Island region.
Topics: Adolescent; Adult; Dietary Services; Dietetics; Female; Hawaii; Humans; Male; Middle Aged; Nutritional Status; Pacific Islands; Rural Health Services; Volunteers
PubMed: 29888116
DOI: No ID Found -
The Cochrane Database of Systematic... Dec 2013Changes in population diet are likely to reduce cardiovascular disease and cancer, but the effect of dietary advice is uncertain. This review is an update of a previous... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Changes in population diet are likely to reduce cardiovascular disease and cancer, but the effect of dietary advice is uncertain. This review is an update of a previous review published in 2007.
OBJECTIVES
To assess the effects of providing dietary advice to achieve sustained dietary changes or improved cardiovascular risk profile among healthy adults.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials, the Database of Abstracts of Reviews of Effects (DARE) and the HTA database on The Cochrane Library (Issue 4, 2010). We searched MEDLINE (Ovid) (1950 to week 2 October 2010) and EMBASE (Ovid) (1980 to Week 42 2010). Additional searches were done on CAB Health (1972 to December 1999), CVRCT registry (2000), CCT (2000) and SIGLE (1980 to 2000). Dissertation abstracts and reference lists of articles were checked and researchers were contacted.
SELECTION CRITERIA
Randomised studies with no more than 20% loss to follow-up, lasting at least three months and involving healthy adults comparing dietary advice with no advice or minimal advice. Trials involving children, trials to reduce weight or those involving supplementation were excluded.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trial quality and extracted data. Study authors were contacted for additional information.
MAIN RESULTS
Forty-four trials with 52 intervention arms (comparisons) comparing dietary advice with no advice were included in the review; 18,175 participants or clusters were randomised. Twenty-nine of the 44 included trials were conducted in the USA. Dietary advice reduced total serum cholesterol by 0.15 mmol/L (95% CI 0.06 to 0.23) and LDL cholesterol by 0.16 mmol/L (95% CI 0.08 to 0.24) after 3 to 24 months. Mean HDL cholesterol levels and triglyceride levels were unchanged. Dietary advice reduced blood pressure by 2.61 mm Hg systolic (95% CI 1.31 to 3.91) and 1.45 mm Hg diastolic (95% CI 0.68 to 2.22) and 24-hour urinary sodium excretion by 40.9 mmol (95% CI 25.3 to 56.5) after 3 to 36 months but there was heterogeneity between trials for the latter outcome. Three trials reported plasma antioxidants, where small increases were seen in lutein and β-cryptoxanthin, but there was heterogeneity in the trial effects. Self-reported dietary intake may be subject to reporting bias, and there was significant heterogeneity in all the following analyses. Compared to no advice, dietary advice increased fruit and vegetable intake by 1.18 servings/day (95% CI 0.65 to 1.71). Dietary fibre intake increased with advice by 6.5 g/day (95% CI 2.2 to 10.82), while total dietary fat as a percentage of total energy intake fell by 4.48% (95% CI 2.47 to 6.48) with dietary advice, and saturated fat intake fell by 2.39% (95% CI 1.4 to 3.37).Two trials analysed incident cardiovascular disease (CVD) events (TOHP I/II). Follow-up was 77% complete at 10 to 15 years after the end of the intervention period and estimates of event rates lacked precision but suggested that sodium restriction advice probably led to a reduction in cardiovascular events (combined fatal plus non-fatal events) plus revascularisation (TOHP I hazards ratio (HR) 0.59, 95% CI 0.33 to 1.08; TOHP II HR 0.81, 95% CI 0.59 to 1.12).
AUTHORS' CONCLUSIONS
Dietary advice appears to be effective in bringing about modest beneficial changes in diet and cardiovascular risk factors over approximately 12 months, but longer-term effects are not known.
Topics: Adult; Blood Pressure; Cardiovascular Diseases; Cholesterol; Diet; Diet, Fat-Restricted; Diet, Sodium-Restricted; Dietetics; Humans; Randomized Controlled Trials as Topic
PubMed: 24318424
DOI: 10.1002/14651858.CD002128.pub5 -
The Cochrane Database of Systematic... Mar 2013Changes in population diet are likely to reduce cardiovascular disease and cancer, but the effect of dietary advice is uncertain. This review is an update of a previous... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Changes in population diet are likely to reduce cardiovascular disease and cancer, but the effect of dietary advice is uncertain. This review is an update of a previous review published in 2007.
OBJECTIVES
To assess the effects of providing dietary advice to achieve sustained dietary changes or improved cardiovascular risk profile among healthy adults.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials, the Database of Abstracts of Reviews of Effects (DARE) and the HTA database on The Cochrane Library (Issue 4, 2010). We searched MEDLINE (Ovid) (1950 to week 2 October 2010) and EMBASE (Ovid) (1980 to Week 42 2010). Additional searches were done on CAB Health (1972 to December 1999), CVRCT registry (2000), CCT (2000) and SIGLE (1980 to 2000). Dissertation abstracts and reference lists of articles were checked and researchers were contacted.
SELECTION CRITERIA
Randomised studies with no more than 20% loss to follow-up, lasting at least three months and involving healthy adults comparing dietary advice with no advice or minimal advice. Trials involving children, trials to reduce weight or those involving supplementation were excluded.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trial quality and extracted data. Study authors were contacted for additional information.
MAIN RESULTS
Forty-four trials with 52 intervention arms (comparisons) comparing dietary advice with no advice were included in the review; 18,175 participants or clusters were randomised. Twenty-nine of the 44 included trials were conducted in the USA. Dietary advice reduced total serum cholesterol by 0.15 mmol/L (95% CI 0.06 to 0.23) and LDL cholesterol by 0.16 mmol/L (95% CI 0.08 to 0.24) after 3 to 24 months. Mean HDL cholesterol levels and triglyceride levels were unchanged. Dietary advice reduced blood pressure by 2.61 mm Hg systolic (95% CI 1.31 to 3.91) and 1.45 mm Hg diastolic (95% CI 0.68 to 2.22) and 24-hour urinary sodium excretion by 40.9 mmol (95% CI 25.3 to 56.5) after 3 to 36 months but there was heterogeneity between trials for the latter outcome. Three trials reported plasma antioxidants, where small increases were seen in lutein and β-cryptoxanthin, but there was heterogeneity in the trial effects. Self-reported dietary intake may be subject to reporting bias, and there was significant heterogeneity in all the following analyses. Compared to no advice, dietary advice increased fruit and vegetable intake by 1.18 servings/day (95% CI 0.65 to 1.71). Dietary fibre intake increased with advice by 6.5 g/day (95% CI 2.2 to 10.82), while total dietary fat as a percentage of total energy intake fell by 4.48% (95% CI 2.47 to 6.48) with dietary advice, and saturated fat intake fell by 2.39% (95% CI 1.4 to 3.37).Two trials analysed incident cardiovascular disease (CVD) events (TOHP I/II). Follow-up was 77% complete at 10 to 15 years after the end of the intervention period and estimates of event rates lacked precision but suggested that sodium restriction advice probably led to a reduction in cardiovascular events (combined fatal plus non-fatal events) plus revascularisation (TOHP I hazards ratio (HR) 0.59, 95% CI 0.33 to 1.08; TOHP II HR 0.81, 95% CI 0.59 to 1.12).
AUTHORS' CONCLUSIONS
Dietary advice appears to be effective in bringing about modest beneficial changes in diet and cardiovascular risk factors over approximately 12 months, but longer-term effects are not known.
Topics: Adult; Blood Pressure; Cardiovascular Diseases; Cholesterol; Diet; Diet, Fat-Restricted; Diet, Sodium-Restricted; Dietetics; Humans; Randomized Controlled Trials as Topic
PubMed: 23543514
DOI: 10.1002/14651858.CD002128.pub4 -
Journal of Nutritional Science and... 2015This author (A.I.) has witnessed the introduction of the Nutrition Care Process (NCP) and its subsequent adjustment over 10 y of her career in an acute and critical... (Review)
Review
This author (A.I.) has witnessed the introduction of the Nutrition Care Process (NCP) and its subsequent adjustment over 10 y of her career in an acute and critical setting. A.I. observed that the NCP went through several revisions to better suit the actual clinical practices and the NCP was gradually incorporated into everyday work and accepted in a clinical setting. The NCP helped ensure that all practicing registered dietitians (RDs, RDNs) have up-to-date skill sets. The NCP is a systematic problem-solving tool with four distinct and interrelated steps that help RDs to improve critical thinking and address practice-related problems so that RDs can more effectively intervene and evaluate. In summary, RDs using the NCP are producing consistent and easy-to-read documentation of clinical practices that benefit other healthcare members. The intention to provide diagnosis-oriented assessment and to treat nutrition problems with intervention plans opens up opportunities for communication within healthcare teams and clients. The best practice requires interactive and ongoing communication with healthcare teams and clients. The NCP has resulted in improved productivity as the RDs are writing diagnosis- focused documentation with specific plans for intervention. In addition, analysis of common problems and nutrition diagnoses resolution rates appear to be in process in some facilities and may further promote RD roles in practice settings. In conclusion, the NCP is an effective tool to provide improved nutrition care.
Topics: Dietetics; Humans; Nutritional Status; Nutritionists
PubMed: 26598881
DOI: 10.3177/jnsv.61.S41