Nutritionists in industry can play a key role in helping to achieve Health of the Nation targets for nutrition

Nutritionists working in food manufacturing and retailing are potentially in a more powerful position than any other professional group to contribute towards achieving the national targets for nutrition and the reduction of nutrition-related diseases, set out in The Health of the Nation (DoH, 1992) and in Scotland's Health, a Challenge to us All (Scottish Office, 1993). The present paper sets out the details of this argument. First, a review is given of the functions and types of activities carried out by nutritionists in industry. Then a number of key practical ways in which nutritionists, through their activities and functions, can help towards achieving national targets for nutrition and nutrition-related diseases are described. Finally suggestions are made about the knowledge, skills and personal attributes needed by nutritionists who intend making successful careers in industry and who wish, at the same time, to contribute towards improving the health of the nation.     

Nutrition project in a remote Australian aboriginal community.

Much of the ill health of Australian indigenous populations can be attributed to diet-related diseases. This community nutrition project is part of a wider renal screening and prevention program based in the Umoona aboriginal community in Coober Pedy in South Australia's far north. The nutrition project facilitates the capacity of the Umoona aboriginal community to identify and redress nutrition-related issues considered important in improving their overall health status. Project nutritionists developed and implemented a specialized nutrition training program with the Umoona aboriginal health workers. The nutritionists were responsive to requests from community groups to provide nutrition expertise and support in program development. Individual nutrition counseling for adults and children taking part in renal health screening was also provided. The aboriginal health workers reported increased nutritional knowledge and confidence in addressing nutrition-related issues within the community after nutrition training. Individual consultations and partnerships formed with community groups have increased awareness and prompted action to address the importance of nutrition in renal disease and overall health in the Umoona community.     

Nutrition policy in South Korea

Since 1970s, the economic and social development in South Korea, as well as dietary pattern, has undergone various changes. Concerns for the decreased nutrition quality and physical activities among Koreans, especially young population, call for a need of a holistic approach in national food and nutrition policy. The National Health Promotion Act of 1995 included national interventions and programs to deal with nutrition-related chronic diseases and obesity prevention. A nation-wide monitoring system, which includes nutrition and health examination survey, is being built and run by the Ministry of Health and Welfare and its affiliated organizations every three years. The Korea Food and Drug Administration (KFDA) is another key agency undertaking national food and nutrition policies. The KFDA recently promulgated the national strategic plans for improving food safety and nutrition, focusing on children. Nutrition labelling policy for processed food is managed by KFDA and various education programs are developed and disseminated to enhance the awareness of nutrition labelling. The agency also makes standards and regulates foods for special dietary uses and health functional food. The Rural Development Administration (RDA) is responsible for maintaining the food composition database. Finally, the National School Lunch Program is mainly governed by the Ministry of Education and Human Resources Development. The above central government agencies along with regional health centers are making efforts to promote the healthy eating habits in addition to constructing healthy environment by making laws and programs and by research and social marketing.     

Development and promotion of Malaysian Dietary Guidelines

Development and promotion of dietary guidelines is one of the key activities outlined in the National Plan of Action for Nutrition of Malaysia for the prevention of nutrition-related disorders. The first official Malaysian Dietary Guidelines (MDG) was published in 1999 and was thoroughly reviewed and launched on 25 March 2010. The new MDG 2010 is a compilation of science-based nutrition and physical activity recommendations. These guidelines form the basis of consistent and scientifically sound nutrition messages for the public. There are 14 key messages and 55 recommendations, covering the whole range of food and nutrition issues, from importance of consuming a variety of foods to guidance on specific food groups, messages to encourage physical activities, consuming safe food and beverages and making effective use of nutrition information on food labels. The MDG also has an updated food pyramid. Various efforts have been made to ensure that the revised MDG is disseminated to all stakeholders. The Ministry of Health has organised a series of workshops for nutritionists and other health care professionals, and the food industry. In collaboration with other professional bodies and the private sector, the Nutrition Society of Malaysia has been promoting the dissemination and usage of the MDG to the public through a variety of formats and channels. These include the publication of a series of leaflets, educational press articles, educational booklets, as well as through educational activities for children. It is imperative to monitor the usage and evaluation of these dietary messages.     

Nutritional ecology: chances of public health services to shape procedures

Nutrition ecology is the science that studies the impacts of human nutrition on the environment, on human health and on social systems. Environmental impacts are usually the result of intensive food production, food transport and food packaging; they include soil contamination and erosion, energy consumption, air contamination and waste disposal. Health impacts of contemporary western eating behavior concern nutrition-related diseases (diabetes, hypertension, gout, overweight etc) and their psychological and social consequences; nutrition ecology aims at a balanced diet and suitable eating behavior to reduce the risks of chronic disease. The social impacts of nutrition concern the effects of feed trade on poor working conditions and poverty, especially in developing countries. The strategies of nutrition ecology agree in many points with those of the agenda 21 and of Consumer Protection. As nutrition-related diseases are increasing further, the public health services in Germany discover nutrition as an important topic in health promotion and prevention. They will contribute remarkably to a sustainable development if they include the strategies of nutrition ecology in their projects.     

Community-based nutrition monitoring.

A community-based nutrition monitoring system is an information system to generate, on a regular basis, an integrated picture of the nutritious condition of a community for local decision-makers. Community-based nutrition monitoring is an extension of international nutrition surveillance and national nutrition monitoring work to the community level where much of the substantive nutrition activity happens. It represents a constructive integration of familiar concepts related to needs assessment, evaluation and program management information systems. The objectives of community-based nutrition monitoring are to provide, in a timely manner, information pertinent to program targeting, funding, priority-setting decisions; to inform and educate decision-makers and enhance the visibility of nutrition-related activities in the community and to provide a vehicle for community-wide nutrition planning. Information about food access, the needs of specific life-cycle or risk groups and chronic disease prevention can all be part of a monitoring system. The specific foci of a system depend on the policy and programming decisions actually or potentially made in the specific community. The monitoring system utilizes multiple simple indicators collected routinely and reported on a regular basis. The development of such a system is a multi-year, inter-agency effort. It presents significant challenges and opportunities to local nutritionists.     

Consensus Report of the Academy of Nutrition and Dietetics: Incorporating Genetic Testing into Nutrition Care

Personalization of nutrition advice is a process already familiar to registered dietitian nutritionists, but it is not yet clear whether incorporating genetic results as an added layer of precision improves nutrition-related outcomes. Therefore, an independent workgroup of experts, supported by the Academy’s Evidence Analysis Center staff, conducted a systematic review to examine the level of evidence measuring the effect of incorporating genetic testing results into nutrition counseling and care, compared to an alternative intervention or control group, on nutrition-related outcomes. This systematic review revealed that only weak quality evidence is available in the scientific literature and observed that this field is still maturing. Therefore, at present, there is insufficient scientific evidence to determine whether there are effects of incorporating genetic testing into nutrition practice. The workgroup prepared this Consensus Report based on this systematic review to provide considerations for the practical application of incorporating genetic testing into the nutrition care process.     

Target Salt 2025: A Global Overview of National Programs to Encourage the Food Industry to Reduce Salt in Foods

Reducing population salt intake has been identified as a priority intervention to reduce non-communicable diseases. Member States of the World Health Organization have agreed to a global target of a 30% reduction in salt intake by 2025. In countries where most salt consumed is from processed foods, programs to engage the food industry to reduce salt in products are being developed. This paper provides a comprehensive overview of national initiatives to encourage the food industry to reduce salt. A systematic review of the literature was supplemented by key informant questionnaires to inform categorization of the initiatives. Fifty nine food industry salt reduction programs were identified. Thirty eight countries had targets for salt levels in foods and nine countries had introduced legislation for some products. South Africa and Argentina have both introduced legislation limiting salt levels across a broad range of foods. Seventeen countries reported reductions in salt levels in foods—the majority in bread. While these trends represent progress, many countries have yet to initiate work in this area, others are at early stages of implementation and further monitoring is required to assess progress towards achieving the global target.     

Nutrition Care in Bariatric Surgery: An Academy Evidence Analysis Center Systematic Review

Obesity continues to be a major public health crisis, both nationally and globally. Metabolic and bariatric surgery has been proven to be a safe and effective treatment for this multifactorial chronic disease. However, inconsistent and varied results in bariatric nutrition literature have prevented the implementation of standardized guidelines. The purpose of this Evidence Analysis Library systematic review is to provide an evidence-based summary of nutrition-related practices in bariatric surgery. The systematic review methodology of the Academy of Nutrition and Dietetics was applied. A total of 27 research studies were included, analyzed, and assessed for risk of bias by trained evidence analysts. The literature included in the systematic review was published from 2003 to 2015. Evaluation of the literature resulted in the development of five graded conclusion statements. Limited research demonstrates that registered dietitian nutritionists play a role in improving weight loss outcomes after bariatric surgery; further research is needed to understand the role of registered dietitian nutritionists in changing behaviors after bariatric surgery. Bariatric surgery results in significant reductions in resting metabolic rate and postoperative energy intake. There is no significant relationship between macronutrient distribution and postoperative weight loss. The graded conclusion statements provide registered dietitian nutritionists who practice in the field of bariatric nutrition with more insight and evidence that can guide and support their recommendations.     

Block grant nutrition services in Wisconsin: an empirical view

This research applies standard nomenclature and data collection techniques to block grant-funded nutrition services in Wisconsin in 1985 and 1986. We discuss the way public sector nutritionists spent their time and the health conditions of the clients they saw. Analysis reveals both positive and negative factors associated with block grant support of nutrition services. Block grants have afforded some local agencies the needed flexibility to hire nutritionists. Moreover, distributions of clients by demographic characteristics and diagnoses clearly reveal that the nutrition services reached their intended targets, among them several groups that were not likely to have been reached any other way. Especially noteworthy were the limited services provided to the homebound. On the other hand, because the funding was narrowly applied in the case of Maternal and Child Health Block Grants and was of very limited size in the case of Prevention Block Grants, needy groups continue to be missed. These include adolescent and adult males and the developmentally disabled. A final section of our analysis examines the average time spent by nutritionists per client visit. These results are presented in the context of service delivery and diagnostic categories. We conclude that use of block grant funding can add flexibility in meeting the need for nutrition services, but that it is restricted in scope.     

"Achieving Health for All": a framework for nutrition in health promotion.

Achieving Health for All, a document released by Health and Welfare Canada, is a framework for nutrition in health promotion. Specific examples of the nutrition implications of the framework's challenges, mechanisms, and strategies are presented. Opportunities for involvement by individual dietitians/nutritionists as well as for The Canadian Dietetic Association are highlighted.     

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.     

Report on Clinical Nutrition Research Units

The National Institutes of Health support seven Clinical Nutrition Research Units, which are designed to create or strengthen nutrition research, training, and education through coordinated effort, intellectual stimulation, and use of shared resources. Research at the participating institutions focuses on the role of nutrition in cancer, cardiovascular disease, renal disease, digestive diseases, cystic fibrosis, diabetes, and other illnesses. Contributing substantially to the development of this nutrition research base have been Clinical Nutrition Research Unit-supported pilot studies, core laboratories, and new investigators. In the clinical setting, Clinical Nutrition Research Unit Nutritional Support Services assist in the care of patients receiving total parenteral nutrition and those with anorexia nervosa, burns, cancer, and a spectrum of nutrition-related problems. Participation of Clinical Nutrition Research Unit staff in training activities range from undergraduate, graduate, and postgraduate education courses for medical students and other health professionals to continuing education workshops, lecture series, and information programs for professional and lay audiences.     

Applying Contemporary Machine Learning Approaches to Nutrition Care Real-World Evidence: Findings From the National Quality Improvement Data Set

Using real-world data from the Academy of Nutrition and Dietetics Health Informatics Infrastructure, we use state-of-the-art clustering techniques to identify 2 phenotypes characterizing the episodes of nutrition care observed in the National Quality Improvement (NQI) registry data set. The 2 phenotypes identified from recorded Nutrition Care Process data in the NQI exhibit a strong correspondence with the clinical expertise of registered dietitian nutritionists. For one of these phenotypes, it was possible to implement state-of-the-art classification techniques to predict the nutrition problem-resolution status of an episode of care. Prediction results show that the assessment of nutrition history, number of recorded visits in the episode, and use of nutrition counseling interventions were significantly and positively correlated with problem resolution. Meanwhile, evaluations of nutrition history that were not within the desired ranges were significantly and negatively correlated with problem resolution. Finally, we assess the usefulness of the current NQI data set and data model for supporting the application of contemporary machine learning methods to the data set. We also suggest ways of enhancing the NQI since registered dietitian nutritionists are encouraged to continue to contribute patient cases in this and other registry nutrition studies.     

Functional foods: delivering information to the oncology nurse

Recent research suggests a beneficial role of nutrition as possible supportive therapy for cancer patients. A national survey of oncology nurses has shown that nutrition-related issues are an important subject discussed during nurse-patient meetings. The authors applied the activation theory of information exposure to oncology nurses in regard to nutrition information. Findings suggest that oncology nurses who consider nutrition important at a personal level tend to discuss nutrition more with patients and to seek more information about nutrition and cancer. Personal rather than professional motives appear to be triggers for the information search. Implications for health care communication professionals are discussed.     

Urban health educators' perspectives and practices regarding school nutrition education policies

Although nutrition-related health education policies exist at national, state and local levels, the degree to which those policies affect the everyday practices of health education teachers who are charged with executing them in schools is often unclear. The purpose of this study was to examine the nutrition-related health education policy matrix that affected one urban school district, the health education teachers' awareness of those policies, the impact of nutrition policies on teachers' instruction and challenges teachers perceived in executing comprehensive nutrition education. The study used interpretive ethnography to examine the educational contexts and perspectives of 27 health educators from 24 middle schools in one urban district in the Midwestern United States. Data were collected through school observations, interviews with key personnel and document collection. We found that a network of nutrition-related education policies governed health education teachers' instruction, but that teachers were uniformly unaware of those policies. Without institutional coherence and clear directives, health education teachers taught little nutrition content, primarily due to poor training, professional development, instructional resources and administrative accountability. The results are discussed in light of the enormous challenges in many urban schools and the need for nutrition education professional development.     

Assessment of nutrition education needs among a sample of elderly Chinese in an urban area

As Malaysia is moving towards a rapidly developing economy, its elderly population is also expected to increase not only in numbers and proportion but also in their life expectancies. This demographic shift from a relatively young population to one that includes an increasing number of old and very old age group presents a real challenge to nutritionists and health professionals. The challenge is to maintain a healthy and vigorous elderly population who can lead fulfilling and independent lives. Health promotion and disease prevention efforts, including nutrition education, targeted towards this group can contribute important elements in meeting the challenge. The objective of the study was to assess the nutrition education needs of a sample of elderly Chinese in an urban area. The sample consisted of 34 males and 36 females, whose age ranged from 55 to 86 years. They were generally affluent and well-educated with a mean income of RM101 1.86 and 8.0 years of formal education. A self-administered questionnaire which requires 20 to 30 minutes to complete was used to collect the information. The results of the nutrition knowledge assessment indicated that the typical respondent correctly identified 16 of the 22 nutrition knowledge statements. A majority (91.4%) of the respondents recognized the fact that tomato, dark green leafy vegetables, and orange juice are good sources of vitamin C, while the statement on vitamin supplementation was correctly answered by only 15.7% of the respondents. The mean nutrition knowledge score was 26.14 with a range of between 18 and 36. The t-test indicated a significant difference (t=3.63, p_0.05) between males and females in their nutrition knowledge scores, with the males having higher mean scores. Although only 8.6% of the respondents reported they had participated before in a nutrition education programme, a majority of them believed that nutrition education can improve the nutritional and health status of the elderly. A majority (80%) of the respondents mentioned newspaper articles as their source of nutrition information, while only 8.6% indicated the dietitian as their source of information. However, the doctor was identified as a more creditable and reliable source of information by a majority.