Position of the Academy of Nutrition and Dietetics: Ethical and Legal Issues in Feeding and Hydration

It is the position of the Academy of Nutrition and Dietetics that individuals have the right to request or refuse nutrition and hydration as medical treatment. Registered dietitians (RDs) should work collaboratively as part of the interprofessional team to make recommendations on providing, withdrawing, or withholding nutrition and hydration in individual cases and serve as active members of institutional ethics committees. RDs have an active role in determining the nutrition and hydration requirements for individuals throughout the life span. When individuals choose to forgo any type of nutrition and hydration (natural or artificial), or when individuals lack decision-making capacity and others must decide whether or not to provide artificial nutrition and hydration, RDs have a professional role in the ethical deliberation around those decisions. Across the life span, there are multiple instances when nutrition and hydration issues create ethical dilemmas. There is strong clinical, ethical, and legal support both for and against the administration of food and water when issues arise regarding what is or is not wanted by the individual and what is or is not warranted by empirical clinical evidence. When a conflict arises, the decision requires ethical deliberation. RDs' understanding of nutrition and hydration within the context of nutritional requirements and cultural, social, psychological, and spiritual needs provide an essential basis for ethical deliberation. RDs, as health care team members, have the responsibility to promote use of advanced directives. RDs promote the rights of the individual and help the health care team implement appropriate therapy. This paper supports the “Practice Paper of the Academy of Nutrition and Dietetics: Ethical and Legal Issues of Feeding and Hydration” published on the Academy website at: www.eatright.org/positions.     

Practice Paper of the Academy of Nutrition and Dietetics: Comprehensive Nutrition Programs and Services in Schools

It is the position of the Academy of Nutrition and Dietetics, School Nutrition Association (SNA), and Society for Nutrition Education and Behavior (SNEB) that comprehensive, integrated nutrition programs in preschool through high school are essential to improve the health, nutritional status, and academic performance of our nation’s children. To maximize impact, the Academy, SNA, and SNEB recommend specific strategies in the following key areas: food and nutrition services available throughout the school campus, nutrition initiatives such as Farm to School and school gardens, wellness policies, nutrition education and promotion, and consideration of roles and responsibilities. This paper supports the joint position paper of the Academy of Nutrition and Dietetics, SNA, and SNEB published in the May 2018 Journal of Academy of Nutrition and Dietetics. In alignment with the joint position paper, this practice paper provides registered dietitian nutritionists and nutrition and dietetics technicians, registered with an overview of current school nutrition services and opportunities for professional careers in school settings. The Academy of Nutrition and Dietetics has several position papers related to youth preschool through adolescence that cover specific nutrition needs in more detail at www.eatright.org.     

Position of the American Dietetic Association: ethical and legal issues in nutrition,hydration, and feeding

It is the position of the American Dietetic Association that the development of clinical and ethical criteria for the nutrition and hydration of persons through the life span should be established by members of the health care team. Registered dietitians should work collaboratively to make nutrition, hydration, and feeding recommendations in individual cases. Registered dietitians have an active role in determining the nutrition and hydration requirements for individuals throughout the life span. When patients choose to forgo artificial nutrition and hydration, or when patients lack decision-making capacity, and others must decide whether or not to provide artificial nutrition and hydration, the registered dietitian has an active and responsible professional role in the ethical deliberation around that decision. There is strong clinical, ethical, and legal support both for and against the administration of food and water when issues arise regarding what is or is not wanted by the patient and what is or is not warranted by empirical clinical evidence. When a conflict arises, the decision to administer or withhold nutrition and hydration requires ethical deliberation. The registered dietitian's understanding of nutrition and hydration within the context of nutritional requirements and cultural, social, psychological, and spiritual needs provides an essential basis for ethical deliberation on issues of nutrition and hydration.     

Practice Paper of the Academy of Nutrition and Dietetics Abstract: Oral Health and Nutrition

This paper supports the “Position of the Academy of Nutrition and Dietetics: Oral Health and Nutrition” published in the May 2013 Journal of the Academy of Nutrition and Dietetics. It is the position of the Academy of Nutrition and Dietetics that nutrition is an integral component of oral health. The Academy supports integration of oral health with nutrition services, education, and research. Collaboration between registered dietitian nutritionists (RDNs); dietetic technicians, registered (DTRs); and oral health care professionals is recommended for oral health promotion and disease prevention and intervention. There is a synergistic multidirectional association between diet, nutrition, and oral health. Given that the mouth is the portal of entry into the body, it is essential that RDNs and DTRs include the oral cavity in their assessment for nutritional risk factors and deficiencies. Nutrition assessment is vital to identifying dietary intake and nutritional factors impacting oral health. Conversely, decreased salivary flow, compromised oral integrity, tooth decay, or poor periodontal health can impact an individual's ability to consume an adequate diet. A poor diet can result in limited intake of nutrients crucial to systemic health and well-being. The provision of medical nutrition therapy that incorporates total health, including oral health, is a component of the Standards of Practice for RDNs and DTRs. Inclusion of didactic and clinical practice concepts that illustrate the role of nutrition in oral health is essential in education programs for both professional groups. The multifaceted interactions between diet, nutrition, and oral health in practice, education, and research in both dietetics and dentistry merit the need for collaborative efforts to ensure comprehensive patient care.     

Essential Academy Resources Support Quality and Expand Practice

The Academy of Nutrition and Dietetics (Academy) develops and maintains foundational documents that apply to all registered dietitian nutritionists (RDNs) and nutrition and dietetics technicians, registered (NDTRs): Scope of Practice for the RDN and NDTR; Standards of Practice in Nutrition Care and Standards of Professional Performance for RDNs and NDTRs; and the Academy and the Commission on Dietetic Registration Code of Ethics for the Nutrition and Dietetics Profession. The Quality Management Committee of the Academy has developed resources that assist RDNs and NDTRs in understanding how to work to the fullest extent of their individual scope of practice to increase professional satisfaction, achieve future employment and position goals, and provide safe and reliable services. These resources are the definition of terms list, practice tips and case studies, and scope of practice decision algorithm, which build on Academy foundational documents. They support quality practice by answering questions such as “how can I become more autonomous in my practice” and “how can I use telehealth technology in my practice?” The foundational Academy documents and practice application resources assist all RDNs and NDTRs in recognizing their individual competence and practicing within their scope of practice.     

Position of the American Dietetic Association: Ethical and Legal Issues in Nutrition, Hydration, and Feeding

It is the position of the American Dietetic Association that individuals have the right to request or refuse nutrition and hydration as medical treatment. Registered dietitians (RDs) should work collaboratively to make recommendations on providing, withdrawing, or withholding nutrition and hydration in individual cases and serve as active members of institutional ethics committees. RDs have an active role in determining the nutrition and hydration requirements for individuals throughout the lifespan. When patients choose to forgo any type of nutrition and hydration (natural or artificial) or when patients lack decision-making capacity and others must decide whether or not to provide artificial nutrition and hydration, the RD has an active and responsible professional role in the ethical deliberation around that decision. Across the lifespan, there are multiple instances when providing, withdrawing, or withholding nutrition and hydration creates ethical dilemmas. There is strong clinical, ethical, and legal support both for and against administration of food and water when issues arise regarding what is or is not wanted by the patient and what is or is not warranted by empirical clinical evidence. When a conflict arises, the decision to administer or withhold nutrition and hydration requires ethical deliberation. The RD's understanding of nutrition and hydration within the context of nutritional requirements and cultural, social, psychological, and spiritual needs provides an essential basis for ethical deliberation on issues of nutrition and hydration. The RD, as a member of the health care team, has a responsibility to promote use of advanced directives and to identify the nutritional and hydration needs of each individual patient. The RD promotes the rights of the individual patient and helps the health care team implement appropriate therapy.     

Academy of Nutrition and Dietetics: Revised 2017 Scope of Practice for the Nutrition and Dietetics Technician,Registered

The Academy of Nutrition and Dietetics (Academy) is the world’s largest organization of food and nutrition professionals and the association that represents credentialed nutrition and dietetics practitioners—nutrition and dietetics technicians, registered (NDTRs) and registered dietitian nutritionists (RDNs). An NDTR’s scope of practice in nutrition and dietetics has flexible boundaries to capture the depth and breadth of the individual's practice. The NDTR’s practice expands with advances in many areas, including nutrition, food production, food safety, food systems management, health care, public health, community health, and information and communication technology. The Revised 2017 Scope of Practice for the NDTR reflects the position of the Academy on the essential role of the NDTR in the management and delivery of food and nutrition services. The scope of practice for the NDTR is composed of education and credentialing, practice resources, Academy Standards of Practice and Standards of Professional Performance, codes of ethics, accreditation standards, state and federal regulations, national guidelines, and organizational policy and procedures. The Revised 2017 Scope of Practice for the NDTR is used in conjunction with the Revised 2017 Standards of Practice in Nutrition Care and the Standards of Professional Performance for NDTRs. The Standards of Practice address activities related to direct patient and client care. The Standards of Professional Performance address behaviors related to the technical role of NDTRs. These standards reflect the minimum competent level of nutrition and dietetics practice and professional performance for NDTRs. A companion document addresses the scope of practice for the RDN.     

Academy of Nutrition and Dietetics: Revised 2017 Scope of Practice for the Registered Dietitian Nutritionist

The Academy of Nutrition and Dietetics (Academy) is the world’s largest organization of food and nutrition professionals and the association that represents credentialed nutrition and dietetics practitioners—registered dietitian nutritionists (RDNs) and nutrition and dietetics technicians, registered (NDTRs). RDNs integrate research, professional development, and practice to stimulate innovation and discovery; collaborate to solve the greatest food and nutrition challenges now and in the future; focus on systemswide impact across the food, wellness, and health sectors; have a global impact in eliminating all forms of malnutrition; and amplify the contribution of nutrition and dietetics practitioners and expand workforce capacity and capability. The Revised 2017 Scope of Practice for the RDN reflects the position of the Academy on the essential role of the RDN in the direction and delivery of food and nutrition services. The scope of practice for the RDN is composed of education and credentialing, practice resources, Academy Standards of Practice and Professional Performance, codes of ethics, accreditation standards, state and federal regulations, national guidelines, and organizational policy and procedures. The Revised 2017 Scope of Practice for the RDN is used in conjunction with the Revised 2017 Standards of Practice (SOP) in Nutrition Care and the Standards of Professional Performance (SOPP) for RDNs. The SOP address activities related to direct patient and client care. The SOPP address behaviors related to the professional role of RDNs. These standards reflect the minimum competent level of nutrition and dietetics practice and professional performance for RDNs. A companion document addresses the scope of practice for the NDTR.     

Position of the Academy of Nutrition and Dietetics: Nutrition Informatics

It is the position of the Academy of Nutrition and Dietetics that nutrition informatics is a rapidly evolving area of practice for registered dietitian nutritionists and nutrition and dietetic technicians, registered; and that the knowledge and skills inherent to nutrition informatics permeate all areas of the dietetics profession. Further, nutrition and dietetics practitioners must continually learn and update their informatics knowledge and skills to remain at the forefront of nutrition practice. Nutrition informatics is the intersection of information, nutrition, and technology. However, informatics is not just using technology to do work. The essence of nutrition informatics is to manage nutrition data in combination with standards, processes, and technology to improve knowledge and practice that ultimately lead to improved quality of health care and work efficiency. Registered dietitian nutritionists and nutrition and dietetic technicians, registered, are already experts in using evidence to practice in all areas of nutrition and dietetics. To remain at the forefront of technological innovation, the profession must actively participate in the development of standards, processes, and technologies for providing nutrition care.     

Research at the Academy of Nutrition and Dietetics: What,How, and Why?

Research is essential to further advance our understanding of the role of nutrition and dietetics in maintenance and improvement of health. Research is also essential for nutrition and dietetics practitioners to create and provide evidence-based interventions, including medical nutrition therapy provided by registered dietitian nutritionists. Given this critical role of research, the Academy of Nutrition and Dietetics (Academy) has a variety of resources to assist its members in accessing, understanding, participating in, conducting, and disseminating nutrition research. These resources are comprehensive and include opportunities to participate in research (eg, Nutrition Research Network and Data Science Center), tools to aggregate practice data (Nutrition Care Process and Terminology and the Academy of Nutrition and Dietetics Informatics Infrastructure), funding opportunities to support primary research (eg, Academy Foundation), resources to understand the latest research informing evidence-based practice (eg, Evidence Analysis Center), and avenues for sharing research findings (eg, Food & Nutrition Conference & Expo?). The aim of this article is to encourage Academy members to get involved in research by describing Academy-based research resources and opportunities to contribute to nutrition and dietetics research, as well as describe specific examples of research conducted at the Academy. The information presented can serve as a framework to guide members in engaging in research through the Academy.     

Practice Paper of the Academy of Nutrition and Dietetics Abstract: The Role of Nutrition in Health Promotion and Chronic Disease Prevention

Food intake, lifestyle behaviors, and obesity are linked to the development of chronic diseases such as type 2 diabetes, certain cancers, and cardiovascular diseases. It is recognized that physical and social environment influences individuals' behaviors, and some population subgroups such as racial/ethnic minorities and individuals with low socioeconomic status or limited literacy or language abilities seem to be especially vulnerable to disparities in disease risk factors, disease prevalence, or health outcomes. Certain life cycle phases appear to be especially important for health promotion and disease prevention as the development of chronic diseases can take several decades. Such complex health issues often require system-wide, multifactorial, and multidisciplinary solutions. Social ecological models, with approaches spanning from individual level to macro policy level, can provide registered dietitians (RDs) and dietetic technicians, registered (DTRs) with a comprehensive framework to promote health and to prevent chronic diseases. Furthermore, the Nutrition Care Process can be utilized in carrying out the health promotion and disease prevention efforts. RDs and DTRs have the training and requisite skills to be leaders and active members of multidisciplinary teams to promote health and prevent chronic diseases across the life span. The position of the Academy of Nutrition and Dietetics states that primary prevention is the most effective, affordable method to prevent chronic disease, and that dietary intervention positively impacts health outcomes across the life span. RDs and DTRs are critical members of health care teams and are essential to delivering nutrition-focused preventive services in clinical and community settings, advocating for policy and programmatic initiatives, and leading research in disease prevention and health promotion. In concordance with the Academy's position, this practice paper provides an overview of practice examples, effective program components, and a comprehensive range of health promotion and chronic disease prevention strategies for RDs and DTRs. This paper supports the “Position of the Academy of Nutrition and Dietetics: The Role of Nutrition in Health Promotion and Chronic Disease Prevention” published in the July 2013 Journal of the Academy of Nutrition and Dietetics.     

Medical Nutrition Therapy in Adults with Chronic Kidney Disease: Integrating Evidence and Consensus into Practice for the Generalist Registered Dietitian Nutritionist

Chronic kidney disease is classified in stages 1 to 5 by the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative depending on the level of renal function by glomerular filtration rate and, more recently, using further categorization depending on the level of glomerular filtration rate and albuminuria by the Kidney Disease Improving Global Outcomes initiative. Registered dietitian nutritionists can be reimbursed for medical nutrition therapy in chronic kidney disease stages 3 to 4 for specific clients under Center for Medicare and Medicaid Services coverage. This predialysis medical nutrition therapy counseling has been shown to both potentially delay progression to stage 5 (renal replacement therapy) and decrease first-year mortality after initiation of hemodialysis. The Joint Standards Task Force of the American Dietetic Association (now the Academy of Nutrition and Dietetics), the Renal Nutrition Dietetic Practice Group, and the National Kidney Foundation Council on Renal Nutrition collaboratively published 2009 Standards of Practice and Standards of Professional Performance for generalist, specialty, and advanced practice registered dietitian nutritionists in nephrology care. The purpose of this article is to provide an update on current recommendations for screening, diagnosis, and treatment of adults with chronic kidney disease for application in clinical practice for the generalist registered dietitian nutritionist using the evidence-based library of the Academy of Nutrition and Dietetics, published clinical practice guidelines (ie, National Kidney Foundation Council on Renal Nutrition, Renal Nutrition Dietetic Practice Group, Kidney Disease Outcomes Quality Initiative, and Kidney Disease Improving Global Outcomes), the Nutrition Care Process model, and peer-reviewed literature.     

Position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior: Food and Nutrition Programs for Community-Residing Older Adults

Given the increasing number and diversity of older adults and the transformation of health care services in the United States, it is the position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior that all older adults should have access to evidence-based food and nutrition programs that ensure the availability of safe and adequate food to promote optimal nutrition, health, functionality, and quality of life. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, in partnership with other practitioners and nutrition educators, should be actively involved in programs that provide coordinated services between the community and health care systems that include regular monitoring and evaluation of programming outcomes. The rapidly growing older population, increased demand for integrated continuous support systems, and rising cost of health care underscore the need for these programs. Programs must include food assistance and meal programs, nutritional screening and assessment, nutrition education, medical nutrition therapy, monitoring, evaluation, and documentation of evidence-based outcomes. Coordination with long-term care services and support systems is necessary to allow older adults to remain in their homes; improve or maintain their health and manage chronic disease; better navigate transitions of care; and reduce avoidable hospital, acute, or long-term care facility admissions. Funding of these programs requires evidence of their effectiveness, especially regarding health, functionality, and health care–related outcomes of interest to individuals, caregivers, payers, and policy makers. Targeting of food and nutrition programs involves addressing unmet needs for services, particularly among those at high risk for poor nutrition. Registered dietitian nutritionists and nutrition and dietetics technicians, registered must increase programmatic efforts to measure outcomes to evaluate community-based food and nutrition services.Position StatementIt is the position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior that older adults should have access to evidence-based food and nutrition programs that ensure the availability of safe and adequate food to promote optimal nutrition, health, functionality, and quality of life. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, in partnership with other practitioners and nutrition educators, should be actively involved in programs that provide coordinated services between the community and health care systems that include regular monitoring and evaluation of programming outcomes. The rapidly growing older population, increased demand for integrated continuous support systems, and rising cost of health care underscore the need for these programs.     

Practice Paper of the Academy of Nutrition and Dietetics Abstract: Nutrition and Lifestyle for a Healthy Pregnancy Outcome

It is the position of the Academy of Nutrition and Dietetics that women of childbearing age should adopt a lifestyle optimizing health and reducing risk of birth defects, suboptimal fetal development, and chronic health problems in both mother and child. Components leading to healthy pregnancy outcome include healthy pre-pregnancy weight, appropriate weight gain and physical activity during pregnancy, consumption of a wide variety of foods, appropriate vitamin and mineral supplementation, avoidance of alcohol and other harmful substances, and safe food handling. Nutrition assessment needs to encompass changes in anthropometric, biochemical, and clinical indicators throughout pregnancy. Pregnant women should gain weight according to the 2009 Institute of Medicine Guidelines. Energy needs are no higher than the Estimated Energy Requirement for nonpregnant women until the second trimester; thereafter, the extra energy need per day is 340 kcal and 452 kcal in the second and third trimesters, respectively. Using the 2010 Dietary Guidelines for Americans, registered dietitian nutritionists and dietetics technicians, registered, can help pregnant women select a food plan based on age, physical activity, trimester, weight gain, and other considerations. Women are encouraged to participate in at least 150 minutes of moderate-intensity aerobic activity spread throughout the week or 30 minutes of moderately intense exercise on most days of the week. When good food choices are made, food consumption to meet extra energy needs and the increased absorption and efficiency of nutrient utilization that occurs in pregnancy are generally adequate to meet most nutrient needs. However, vitamin and mineral supplementation may be important in vulnerable cases including food insecurity; alcohol, tobacco, or other substance dependency; anemia; strict vegetarian (vegan) diet; or poor eating habits. Multiple strategies are needed to support healthy lifestyles for all women, from preconception through the postpartum period. This practice paper supports the Academy of Nutrition and Dietetics’ position paper “Nutrition and Lifestyle for a Healthy Pregnancy Outcome” published in the July 2014 Journal of the Academy of Nutrition and Dietetics.     

Position of the Academy of Nutrition and Dietetics: Individualized Nutrition Approaches for Older Adults: Long-Term Care,Post-Acute Care,and Other Settings

It is the position of the Academy of Nutrition and Dietetics that the quality of life and nutritional status of older adults in long-term care, post-acute care, and other settings can be enhanced by individualized nutrition approaches. The Academy advocates that as part of the interprofessional team, registered dietitian nutritionists assess, evaluate, and recommend appropriate nutrition interventions according to each individual’s medical condition, desires, and rights to make health care choices. Nutrition and dietetic technicians, registered assist registered dietitian nutritionists in the implementation of individualized nutrition care, including the use of least restrictive diets. Health care practitioners must assess risks vs benefits of therapeutic diets, especially for frail older adults. Food is an essential component of quality of life; an unpalatable or unacceptable diet can lead to poor food and fluid intake, resulting in malnutrition and related negative health effects. Including older individuals in decisions about food can increase the desire to eat and improve quality of life.     

Using Academy Standards of Excellence in Nutrition and Dietetics for Organization Self-Assessment and Quality Improvement

Standards of Excellence in Nutrition and Dietetics for an Organization is a self-assessment tool to measure and evaluate an organization's program, services, and initiatives that identify and distinguish the Registered Dietitian Nutritionist (RDN) brand as the professional expert in food and nutrition. The Standards of Excellence will serve as a road map to recognize RDNs as leaders and collaborators. Standards of Excellence criteria apply to all practice segments of nutrition and dietetics: health care, education and research, business and industry, and community nutrition and public health. Given the membership's call to action to be recognized for their professional expertise, the Academy of Nutrition and Dietetics Quality Management Committee developed four Standards of Excellence in Nutrition and Dietetics for Organizations: Quality of Leadership, Quality of Organization, Quality of Practice, and Quality of Outcomes. Within each standard, specific indicators provide strategies for an organization to demonstrate excellence. The Academy will develop a self-evaluation scoring tool to assist the organization in applying and implementing one or more of the strategies in the Standards of Excellence indicators. The organization can use the self-assessment tool to establish itself as a Center of Excellence in Nutrition and Dietetics. The role examples illustrate initiatives RDNs and organizations can take to identify themselves as a Center of Excellence in Nutrition and Dietetics. Achieving the Excellence level is an important collaborative initiative between nutrition and dietetics organizations and the Academy to provide increased autonomy, supportive management, respect within peers and community, opportunities for professional development, support for further education, and compensation for the RDN. For purposes of the Standards, “organization” means workplace or practice setting.     

Academy of Nutrition and Dietetics and National Kidney Foundation: Revised 2014 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent,Proficient, and Expert) in Nephrology Nutrition

Compelling evidence indicates that the incidence of chronic kidney disease (CKD) is increasing because of an aging population and a higher prevalence of cardiovascular disease, diabetes, and hypertension. Nutrition management of patients with CKD requires early disease recognition, appropriate interpretation of the markers and stages of CKD, and collaboration with other health care practitioners. Better management of CKD can slow its progression, prevent metabolic complications, and reduce cardiovascular related outcomes. Caring for patients with CKD necessitates specialized knowledge and skills to meet the challenges associated with this growing epidemic. The Academy of Nutrition and Dietetics Renal Dietitians Practice Group and the National Kidney Foundation Council on Renal Nutrition, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, have updated the 2009 Standards of Practice in Nutrition Care and Standards of Professional Performance as a tool for registered dietitian nutritionists working in nephrology nutrition to assess their current skill levels and to identify areas for additional professional development in this practice area. The Standards of Practice apply to the care of patients/clients with kidney disease. The Standards of Professional Performance consist of six domains of professionalism, including: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Within each standard, specific indicators provide measurable action statements that illustrate how nephrology nutrition principles can be applied to practice. The indicators describe three skill levels (ie, competent, proficient, and expert) for registered dietitian nutritionists working in nephrology nutrition.     

The Impact of RDNs on Non-Communicable Diseases: Proceedings from The State of Food and Nutrition Series Forum

In the United States, nutrition-related morbidities are rising steadily at rates corresponding to increasing overweight and obesity in the population. Such morbidities take huge tolls on personal health and impose high costs on health care systems. In 2019, the Academy of Nutrition and Dietetics (Academy) and the Academy of Nutrition and Dietetics Foundation (Academy Foundation) embarked on a new project titled “The State of Food and Nutrition Series” to demonstrate the value of nutrition interventions led by registered dietitian nutritionists for individuals with the following 3 high-priority non-communicable diseases that affect many in the United States and globally: type 2 diabetes mellitus, chronic kidney disease, and hypertension. Poor nutritional status contributes to disease onset and progression in these non-communicable diseases, and appropriate medical nutrition therapy can prevent or delay worsening and ameliorate poor health outcomes. However, many people who have these conditions do not have access to an registered dietitian nutritionist, and consequently do not receive the nutrition care they need. On February 19-20, 2020 in Arlington, VA, as the first stage in The State of Food and Nutrition Series, the Academy and the Academy Foundation gathered health care policymakers, clinicians, and researchers from across the country for the State of Food and Nutrition Series Forum, where Academy leaders sought input to build a comprehensive research strategy that will quantify the impact of patient access to registered dietitian nutritionist–led nutrition interventions for type 2 diabetes mellitus, chronic kidney disease, and hypertension. This article summarizes the findings of that forum.     

Position of the Academy of Nutrition and Dietetics: Oral Health and Nutrition

It is the position of the Academy of Nutrition and Dietetics that nutrition is an integral component of oral health. The Academy supports integration of oral health with nutrition services, education, and research. Collaboration between dietetics practitioners and oral health care professionals is recommended for oral health promotion and disease prevention and intervention. Scientific and epidemiological data suggest a lifelong synergy between diet, nutrition, and integrity of the oral cavity in health and disease. Oral health and nutrition have a multifaceted relationship. Oral infectious diseases, as well as acute, chronic, and systemic diseases with oral manifestations, impact an individual's functional ability to eat and their nutrition status. Likewise, nutrition and diet can affect the development and integrity of the oral cavity and progression of oral diseases. As knowledge of the link between oral and nutrition health increases, dietetics practitioners and oral health care professionals must learn to provide screening, education, and referrals as part of comprehensive client/patient care. The provision of medical nutrition therapy, including oral and overall health, is incorporated into the Standards of Practice for registered dietitians and dietetic technicians, registered. Inclusion of didactic and clinical practice concepts that illustrate the role of nutrition in oral health is essential in education programs for both professional groups. Collaborative endeavors between dietetics, dentistry, medicine, and allied health professionals in research, education, and delineation of practice roles are needed to ensure comprehensive health care. The multifaceted interactions between diet, nutrition, and oral health in practice, education, and research in both dietetics and dentistry merit continued, detailed delineation.     

Position of the Academy of Nutrition and Dietetics: The Role of Medical Nutrition Therapy and Registered Dietitian Nutritionists in the Prevention and Treatment of Prediabetes and Type 2 Diabetes

It is the position of the Academy of Nutrition and Dietetics that for adults with prediabetes or type 2 diabetes, medical nutrition therapy (MNT) provided by registered dietitian nutritionists (RDNs) is effective in improving medical outcomes and quality of life, and is cost-effective. MNT provided by RDNs is also successful and essential to preventing progression of prediabetes and obesity to type 2 diabetes. It is essential that MNT provided by RDNs be integrated into health care systems and public health programs and be adequately reimbursed. The Academy’s evidence-based nutrition practice guidelines for the prevention of diabetes and the management of diabetes document strong evidence supporting the clinical effectiveness of MNT provided by RDNs. Cost-effectiveness has also been documented. The nutrition practice guidelines recommend that as part of evidence-based health care, providers caring for individuals with prediabetes or type 2 diabetes should be referred to an RDN for individualized MNT upon diagnosis and at regular intervals throughout the lifespan as part of their treatment regimen. Standards of care for three levels of diabetes practice have been published by the Diabetes Care and Education Practice Group. RDNs are also qualified to provide additional services beyond MNT in diabetes care and management. Unfortunately, barriers to accessing RDN services exist. Reimbursement for services is essential. Major medical and health organizations have provided support for the essential role of MNT and RDNs for the prevention and treatment of type 2 diabetes.