Practice Paper of the Academy of Nutrition and Dietetics Abstract: Nutrition Informatics

As valued members and decision makers of the health care team, registered dietitians and dietetic technicians, registered, practice in a wide variety of settings from corporate wellness to the intensive care unit. Each of these work settings has unique information needs, but all require that dietetics practitioners have immediate access to accurate information. Successful dietetics practice in today's rapidly changing environment requires skills in finding, evaluating, and sharing accurate food and nutrition information. The term informatics is used to describe the science of managing, storing, and communicating information. While not required for informatics practice, use of computers greatly facilitates management of large amounts of information. Health informatics focuses on the application of information science within the health care arena. The field of health informatics includes medical, nursing, pharmacy, dental, public health, and now nutrition informatics. Registered dietitians and dietetic technicians, registered, are now creating nutrition informatics as a new area of dietetics practice. Current use of informatics in health care includes electronic health records, outcomes research, and knowledge acquisition.     

The ADA's research priorities contribute to a bright future for dietetics professionals

The ADA research philosophy is that research is the foundation of the profession, providing the basis for practice, education, and policy (6) and (7). Evidence-based practice and the development of nutrition care guidelines presume that the body of research is adequate and continually addresses key questions related to provision of nutrition care (13). Key characteristics of a viable profession and strategies for success include the continual infusion of ideas and effective use of research in evidence-based practice (5) and (14). Involvement of all the members of the profession is essential to the continued dynamic nature of dietetics. It is necessary to ensure that ADA members, ADA organizational units, and external funding organizations address the most important research. The Research Committee is exploring how to measure progress toward the research priorities and determine how to update the priorities on an ongoing basis to reflect the current research needs of the dietetics profession.ADA Priorities for Research

• Prevention and Treatment of Obesity and Associated Chronic Diseases

• Effective Nutrition and Lifestyle Change Interventions

• Translation of Research into Nutrition Interventions and Programs

• Effective Nutrition Indicators and Outcome Measures

• Dietetics Education and Retention

• Delivery of and Payment for Dietetic Services

• Access to Safe and Secure Food Supply

• Customer Satisfaction

• Nutrients and Gene Expression

(For specific research objectives under each priority area, see full text at www.eatright.org/Public/index_9916.cfm)(2)     

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.     

Advancing practice: Using nutrition information and technology to improve health—the nutrition informatics global challenge

Aims: The unique combination of technology, information and nutrition has been utilised in health care for decades. As technology and effective use of health data evolve, the field of ‘nutrition informatics’ is positioned to advance best practices of nutrition care delivered by registered dietitians and dietetic technicians registered. The present paper reviews the opportunities. Methods: A narrative review was constructed with reference to the literature. Results: Evolution of the use of digital health care in the USA is on an aggressive timeline because of regulations, which provide financial incentives to eligible professionals and hospitals who can prove ‘meaningful use’ of certified health‐care technology. While adoption and use of electronic health records has occurred at the international level for decades, only recently have American adoption rates increased. Health‐care providers are adjusting to rapid cultural changes, which support the interoperability of health data. The dietetics profession must move in tandem with this transition to digital care. This requires implementation and development of nutrition standards, vocabularies and quality measures, which support exchange of pertinent nutrition data critical to patient care and wellbeing. All dietetic professionals need to appreciate the paradigm shift in health care. Conclusions: Dietitians who are involved with informatics will help with this transition through their work with systems implementations, understanding competencies necessary for successful integration of digital nutrition and using electronic nutrition data for research.     

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.     

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.     

Position of The American Dietetic Association: Medical Nutrition Therapy and Pharmacotherapy

It is the position of The American Dietetic Association that medical nutrition therapy and lifestyle counseling are integral components of medical treatment for the management of selected conditions for which pharmacotherapy is indicated. The Association promotes a team approach to care for clients receiving pharmacotherapy and encourages active collaboration among dietetics professionals and other members of the health care team. Numerous chronic medical conditions respond to medical nutrition therapy; however, pharmacotherapy may be needed to achieve control. In some cases, medical nutrition therapy and pharmacotherapy may need to be initiated simultaneously. Medical nutrition therapy is critical to the management of a variety of chronic diseases, is effective in managing disease, and is cost-effective. The use of a coordinated multidisciplinary team effort is critical to the success of medical nutrition therapy and pharmacotherapy. Because medical nutrition therapy with pharmacotherapy is a treatment of long duration that requires monitoring of compliance and effectiveness, it is best accomplished through a team approach. J Am Diet Assoc. 1999;99:227-230.     

Personal digital assistants: Essential tools for preparing dietetics professionals to use new generation information technology

Rapid integration of information technology into health care systems has included the use of highly portable systems-in particular, personal digital assistants (PDAs). With their large built-in memories, fast processors, wireless connectivity, multimedia capacity, and large library of applications, PDAs have been widely adopted by physicians and nurses for patient tracking, disease management, medical references and drug information, enhancing a quality of health care. Many health-related PDA applications are available to both dietetics professionals and clients. Dietetics professionals can effectively use PDAs for client tracking and support, accessing to hospital database or information, and providing better self-monitoring tools to clients. Internship programs for dietetics professionals should include training in the use of PDAs and their dietetics applications, so that new practitioners can stay abreast of this rapidly evolving technology. Several considerations to keep in mind in selecting a PDA and its applications are discussed.     

The mental health of single homeless people in Northampton hostels

Much research evidence about homelessness and health relates to large population centres with correspondingly large homeless populations. Such results may not necessarily apply to small towns such as Northampton. A local need was identified for information relating to health and access to health care for homeless people.Seventy five single, homeless people temporarily residing at open access hostels in Northampton were interviewed.The interviews covered:

• recent accommodation histories

• recent physical health

• mental health

• access to health care

• current social contacts, life style and aspirations

The General Health Questionnaire (GHQ30) was administered to allow assessment of the levels of mental morbidity in the population studied.The results presented here relate to mental health issues. Current mental health problems were reported by 53% of thesample (40 people); of these only 40% (16 people) were receiving treatment. Three people had been admitted to a psychiatric hospital within the past year. Using standard scoring, the GHQ30 identified as cases 72% (44) of the 61 homeless people who completed the GHQ.It was concluded that levels of mental morbidity were higher in the homeless group than would be expected in the general population. This finding, mirrors those of studies in larger population centres.The main form of access to mental health services appeared to be via hospital admission. Any GP treatment offeredwas likely to be medication. There was no mention of Community Psychiatric Nurse involvement in treatment or care.The results may indicate a significant level of umnet need for mental health intervention amongst the local homeless population.     

Dietitians' Perspectives on Teaching Nutrition to Medical Students

Objectives: The provision of nutrition care by health professionals can facilitate improved patient nutrition behaviors. Some education institutions include nutrition in their medical curriculum; however, doctors and medical students continue to lack competence in providing nutrition care. Dietitians are increasingly teaching nutrition to medical students, yet evidence on the topic remains anecdotal. It is important to understand the experiences of these dietitians to support improvements in undergraduate medical nutrition education. The aim of this study was to explore dietitians' perspectives of teaching nutrition to medical students.

Methods: A qualitative study was conducted in collaboration with the Need for Nutrition Education/Innovation Programme (NNEdPro). Twenty-four dietitians who had provided nutrition education to medical students participated in individual semistructured interviews. Participants were from Australia (n = 5), New Zealand (n = 1), the United States (n = 6), Canada (n = 5), the United Kingdom (n = 5), Germany (n = 1), and Finland (n = 1). Data analysis was conducted using a constant comparative approach to thematic analysis.

Results: The dietitians expressed confidence in their ability to teach medical students and believed that they were the most appropriate professionals to administer the education. However, they were not confident that medical students graduate with sufficient nutrition competence and attributed this to poor curriculum planning for nutrition. Dietitians had access to useful resources and tools to support education, with opportunity to contribute further to integration of nutrition throughout medical curricula.

Conclusion: This study suggests that dietitians are likely appropriate nutrition teachers in medical education. However, optimizing dietitians' role requires their further involvement in curriculum planning and development. Including dietitians as members of medical faculty would facilitate their input on nutrition throughout the curriculum, which could enhance the nutrition education of medical students.     

Position of the American Dietetic Association: Oral health and nutrition

It is the position of the American Dietetic Association (ADA) that nutrition is an integral component of oral health. The ADA supports the integration of oral health with nutrition services, education, and research. Collaboration between dietetics and dental professionals is recommended for oral health promotion and disease prevention and intervention. Scientific and epidemiological data suggest a lifelong synergy between nutrition and the integrity of the oral cavity in health and disease. Oral health is an integral part of systemic and nutritional health. Two primary oral infectious diseases are directly influenced by diet and nutrition. Dental caries or tooth decay is modulated by numerous factors, including diet composition and frequency. Periodontal or gum disease is associated with malnutrition. Chronic diseases such as diabetes and cardiovascular disease that are modulated by diet and nutrition intervention have oral sequelae. As we advance in our discoveries of the links between oral and nutrition health, practitioners of both disciplines must learn to provide screening, baseline education, and referral to each other as part of comprehensive client/patient care. The future of dietetics practice requires dietetics professionals to provide medical nutrition therapy (MNT) that incorporates a person's total health needs, including oral health. Inclusion of both didactic and clinical practice concepts that illustrate the role of nutrition in oral health is essential in both dental and dietetic education programs. Collaborative endeavors between dietetics and dentistry in research, education, and delineation of health provider practice roles are needed to ensure comprehensive health care to persons with oral infectious disease and/or oral manifestations of systemic diseases.     

Position of the American Dietetic Association: food and nutrition misinformation

It is the position of the American Dietetic Association that food and nutrition misinformation can have harmful effects on the health and economic status of consumers. It is the role of nationally credentialed dietetics professionals to advocate for and promote sound, science-based nutrition information to the public, function as primary nutrition educators to health professionals, and actively counter and correct food and nutrition misinformation. The federal government has recognized the strong link between nutrition and health in recent years. Consumers are taking greater responsibility for self-care and are hungry for food and nutrition information, creating opportunities for nutrition misinformation, health fraud, and quackery to flourish. The media are consumers' leading source of nutrition information, but news reports rarely provide enough context for consumers to interpret the advice given. Promoters turn preliminary findings into sales pitches with baseless claims, often for the sole purpose of economic gain. Effective nutrition communication is consumer focused and presented with sufficient context to allow consumers to weigh the information and determine whether it applies to his or her unique needs. Nationally credentialed dietetics professionals are best prepared to communicate sound advice and scientific advances about nutrition. These dietetics professionals have a responsibility to take an active role in providing accurate, easily understood food and nutrition information, interpreting emerging research for media and consumers and encouraging consumers to look for credentialed dietetics professionals as nutrition experts.     

Longitudinal and horizontal integration of nutrition science into medical school curricula

The overall goal of our Nutrition Academic Award (NAA) medical nutrition program at Mercer University School of Medicine is to develop, implement and evaluate a medical education curriculum in nutrition and other aspects of cardiovascular disease (CVD) prevention and patient management with emphasis on the training of primary care physicians for medically underserved populations. The curriculum is 1) vertically integrated throughout all 4 y of undergraduate medical education, including basic science, clinical skills, community science and clinical clerkships as well as residency training; 2) horizontally integrated to include allied healthcare training in dietetics, nursing, exercise physiology and public health; and 3) designed as transportable modules adaptable to the curricula of other medical schools. The specific aims of our program are 1) to enhance our existing basic science problem-based Biomedical Problems Program with respect to CVD prevention through development of additional curriculum in nutrition/diet/exercise and at-risk subpopulations; 2) to integrate into our Clinical Skills Program objectives for medical history taking, conducting patient exams, diet/lifestyle counseling and referrals to appropriate allied healthcare professionals that are specific to CVD prevention; 3) to enhance CVD components in the Community Science population-based medicine curriculum, stressing the health-field concept model, community needs assessment, evidence-based medicine and primary care issues in rural and medically underserved populations; 4) to enhance the CVD prevention and patient management component in existing 3rd- and 4th-y clinical clerkships with respect to nutrition/diet/exercise and socioeconomic issues, behavior modification and networking with allied health professionals; and 5) to integrate a nutrition/behavior change component into Graduate Residency Training in CVD prevention.     

The medical records professionals' view of the electronic medical record

The migration of Kaiser-Permanente (KP), a large managed care organization, to the management of health care information in a paperless environment is presented from the viewpoint of Health Information Management (HIM) professionals. The author conducted an informal survey of these professionals and presents a synopsis of their recommendations in the context of KP's efforts to develop an enterprise Electronic Medical Record. Their consensus is that physicians are primarily information managers and that successful health care organizations will be those who most effectively manage their information.     

Position of the American Dietetic Association: oral health and nutrition

It is the position of the American Dietetic Association that nutrition is an integral component of oral health. The American Dietetic Association supports the integration of oral health with nutrition services, education, and research. Collaboration between dietetics and dental professionals is recommended for oral health promotion and disease prevention and intervention. Scientific and epidemiological data suggest a lifelong synergy between nutrition and the integrity of the oral cavity in health and disease. Oral health and nutrition have a synergistic bidirectional relationship. Oral infectious diseases, as well as acute, chronic, and terminal systemic diseases with oral manifestations, impact the functional ability to eat as well as diet and nutrition status. Likewise, nutrition and diet may affect the development and integrity of the oral cavity as well as the progression of oral diseases. As we advance in our discoveries of the links between oral and nutrition health, practitioners of both disciplines must learn to provide screening, baseline education, and referral to each other as part of comprehensive client/patient care. Dietetics practice requires registered dietitians to provide medical nutrition therapy that incorporates a person's total health needs, including oral health. Inclusion of both didactic and clinical practice concepts that illustrate the role of nutrition in oral health is essential in both dental and dietetic education programs. Collaborative endeavors between dietetics and dentistry in research, education, and delineation of health provider 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.     

Nutrition Care Process and Model: ADA adopts road map to quality care and outcomes management

Just as maps are reissued when new roads are built and rivers change course, this Nutrition Care Process and Model reflects recent changes in the nutrition and health care environment. It provides dietetics professionals with the updated “road map” to follow the best path for high-quality patient/client/group-centered nutrition care.     

Identifying the educational needs of aspiring sports nutritionists

Many dietetics professionals express interest in becoming sports nutritionists without full awareness of the complexity of this specialty area of dietetics—in terms of both the medical nutrition therapy involved and the business savvy required. Aspiring sports nutritionists need education in nutrition throughout the life cycle, medical nutrition therapy, nutrition therapy for management of eating disorders exercise science, business basics, and communication skills. Work experience is also important to develop confidence and skills. This is often gained while the dietitian is employed in another aspect of dietetics practice. J Am Diet Assoc. 2000;100:1522-1524.