Integrating nutrition and culinary medicine into preclinical medical training.

BACKGROUND: Poor nutrition is a leading cause of preventable death, but is inconsistently taught in medical education and inadequately discussed in medical care. To overcome this problem, we developed a hybrid nutrition team-based learning/culinary medicine approach to integrate practical nutrition knowledge and basic cooking skills into the training of future health professionals. METHODS: Nutrition was integrated into the systems-based courses at a college of osteopathic medicine, complemented by culinary medicine sessions based on the Health meets Food curriculum (HmF; culinarymedicine.org). Students participated in the program for one year and two cohorts of students were included in this analysis. Outcomes were measured via online food frequency questionnaire (FFQ, Vioscreen, Viocare, Inc) and surveys administered via Qualtrics online survey software. Diet quality was measured using the Healthy Eating Index (HEI)-2015. Data were analyzed using SAS 9.4. RESULTS: One hundred and ninety-five first year students completed a baseline FFQ (97.5% response rate). Mean age of students was 26 years, 47% were female (n = 92/195). The average BMI of participants was 24.8 kg/m2 (range 17-45.4) and the majority of participants reported being active. Seventy-five students (38%) completed an end of year FFQ. Diet quality was poor among students at baseline (n = 195; 67.59 (SD 10.54)) and improved slightly but significantly at the end of year 1 (n = 75, 69.63 (SD: 12.42), p = 0.04). The survey was administered to the second cohort only; 63 students responded (53% response rate). Talking to patients about nutrition was seen as more relevant to future practice among respondents than talking to patients about safe sex, weight, tobacco, alcohol, other substance abuse and domestic violence. CONCLUSIONS: This study evaluated the nutrition and culinary medicine curriculum at a new college of osteopathic medicine. Students rated the program highly and attendance was excellent, even though not required. Student diet quality did not decline over the first year of medical school. Students rated talking to patients about nutrition as highly relevant, providing encouragement that they will do so in future practice. We believe our work shows that nutrition can be integrated into the training of future physicians and that it may pay dividends, particularly with the increasing awareness of the importance of preventive care.

Dietetic research involvement is associated with the European region where a dietitian is working and their highest degree qualification.

BACKGROUND: Research is the foundation of the dietetic profession and of evidence-based guidelines/practice. The present study aimed to examine the level of research involvement among dietitians in Europe. METHODS: A cross-sectional study was conducted among dietitians across Europe using the validated Research Involvement Questionnaire (RIQ), which assigns participants to four levels of research involvement. The survey link was distributed through various channels; for example, National Dietetic Association (NDA) members of European Federation of the Associations of Dietitians (EFAD), the EFAD eNewsletter, national newsletters, etc. Data were analysed with SPSS, using descriptive statistics, statistical tests and ordinal logistic regression analysis with the level of research involvement as the dependent variable. RESULTS: In total, 257 European dietitians completed the survey (84.6% female). Most participants held a Master's degree (46.1%), followed by a Bachelor's degree (27.3%) or Doctorate (25.7%). One-third of participants were involved at level 3 or 4 (leading research, leadership in research), whereas most were involved at level 1 (evidence-based practice) or 2 (collaboration in research). The multivariate regression analysis showed that dietitians' research involvement was higher in dietitians with a Doctorate and in Northern/Southern Europe compared to Eastern/Western Europe. CONCLUSIONS: Dietitians have low levels of research involvement in practice even when highly qualified. Interventions to motivate dietitians to be more involved in research projects are important, as well as interventions to facilitate dietitians' research activities. This would inform the discipline's evidence base, strengthen the professional status of dietitians and increase their reputation within the healthcare sector.

Integrating the sustainable development goals into health professions' curricula: using the nominal group technique to guide their contextualisation.

BACKGROUND: To embed the Sustainable Development Goals in health profession education, educators must contextualise them to their profession and geographical region. This study used the nominal group technique to contextualise the SDGs for Australian nutrition and dietetics tertiary education programs by determining the specific knowledge, skills, and values required for graduating dietitians to practise sustainably. METHODS: In 2022, 23 experts in food and sustainability attended a group session that employed the nominal group technique to discuss the Sustainable Development Goals knowledge, skills, and values Australian dietetic students should develop. After the group session, participants ranked the Sustainable Development Goals according to their perceived level of importance for student dietitians. These data were analysed using multi-methods, including a summation of the rankings, directed qualitative content analysis and reflexive thematic analysis. RESULTS: The three highest-priority Sustainable Development Goals identified were (1) Zero Hunger, (2) Good Health and Well-Being, and (3) Responsible Consumption and Production, which were then considered with the qualitative findings. The main categories that were generated from the content analysis reflected the broad knowledge, skills, and values student dietitians should develop. The preliminary codes provided specific details for each of the main categories. The thematic analysis generated two additional themes: the importance of Indigenous ways of knowing, being and doing, and authentic experiential learning activities. CONCLUSIONS: The method employed for this study provides a useful framework for health professions to contextualise the Sustainable Development Goals to their profession and geographical region. For this study, the ranking process and the qualitative data analysis enabled the Sustainable Development Goals to be reframed in a way that would be meaningful for dietetic educators and students and demonstrate the interrelatedness of the goals. The direct qualitative content analysis and reflexive thematic analysis identified the knowledge, skills, and values student dietitians should develop.

Nutritional Characteristics of Menus in State Prisons.

Nutrition-related health disparities plague prisons in the United States. Unregulated and inadequate prison menus may contribute to noncommunicable chronic health conditions in this vulnerable population. The purpose of this research was to assess nutrition offerings provided by prison menus. Researchers requested the most current version of all master menus and associated nutrition analyses for gendered and age-centric (pediatric vs geriatric) menus. Menu and nutrient data were extracted and entered into a spreadsheet for analysis. Prisons serve gendered or nongendered menus to the general population, and 52.9% of prisons offer nongendered menus where males and females receive the same meals. This approach provides excess calories and saturated fat to females. Sodium was served in excess to both males and females. Fruit and vegetable servings on all gendered menus fell short of recommendations. The average prison menu inappropriately offers calories, sodium, and fruit and vegetable servings in a one-size-fits-all menu development method without considering gender, age, and physical activity. Interpretation and application of Dietary Guidelines for Americans are inconsistent. Nutrition guidelines recommending appropriate nutrients and food groups should be developed and available to corrections systems and dietitians. Current prison menu development practices yield inappropriate nutrition for prison populations.

REGISTERED DIETITIAN NUTRITIONISTS' ATTITUDES OF INTERPROFESSIONAL HEALTH CARE TEAMS: A CROSS-SECTIONAL SURVEY.

BACKGROUND: Registered Dietitian Nutritionists (RDNs) are important members of interprofessional (IP) healthcare teams; yet, there is limited research of RDN perspectives of IP teams. OBJECTIVE: To examine associations between the characteristics of RDNs and their attitudes of team-based care (TBC). DESIGN: A cross-sectional electronic Qualtrics survey encompassing demographic questions, the Attitudes Toward Interdisciplinary Healthcare Teams scale (ATIHCT), and additional interprofessional-related items was distributed to RDNs in January 2020. PARTICIPANTS/SETTING: 5,018 RDNs from various regions/specialties in the United States were recruited primarily via direct email from a random list of RDNs obtained through the Commission on Dietetic Registration. The final sample was n = 616; 12.3% of RDNs; 88.1% of RDNs who initiated the survey. MAIN OUTCOME MEASURES: ATIHCT subscale scores, which measure attitudes regarding (1) efficiency of TBC; (2) service quality of TBC. STATISTICAL ANALYSES PERFORMED: Multiple linear regression modeled area of specialty, time with RDN credential, location, gender, frequency of TBC, and how valued the RDN perceived themselves to be as independent variables, with ATIHCT subscales as outcome variables. Data were subjected to confirmatory factor analysis to determine appropriate use of the ATIHCT in the sample. RESULTS: Food service (ß = -1.48, p = 0.004) and sports nutrition RDNs (ß = -2.58, p = 0.014) had lower scores for attitudes regarding efficiency of TBC (subscale 1) than clinical RDNs. Greater perceived value of the RDN was associated with higher scores for attitudes regarding efficiency (ß = 0.66, p < .001). Greater perceived value of the RDN (ß = 0.13, p = 0.03) was associated with higher scores for attitudes regarding service quality of TBC (subscale 2). CONCLUSIONS: Specialty and perceived RDN value are associated with more favorable IP attitudes among RDNs. To support positive attitudes regarding IP collaboration, efforts should be honed to foster appreciation and clarity of the RDN's role in TBC.

Culinary Medicine and Teaching Kitchens: Dietitians Leading Innovative Nutrition Training for Physicians.

The objective of this evaluation was to determine the impact of a pop-up Teaching Kitchen (TK) at a national cardiovascular conference. The 60-minute session was hosted in a hotel conference room and led by two registered dietitians. Participants prepared 12 recipes, enjoyed a family-style meal, and explored nutrition behaviour change strategies for patients. Using Likert-scaled and open-ended questions, pre-/post-online surveys assessed change in perceived nutrition counselling skills, attitudes, and confidence; post-survey also assessed effectiveness of session components and further training needs. Pre-survey response was 72% (18/25). Twenty-one participants attended the event (14 pre-registrants, six from waitlist, and five drop-ins); 81% completed the post-survey. Positive shifts were reported in nutrition competence, particularly attitudes towards using recipes in nutrition counselling, and increased skills and confidence discussing eating on a budget and SMART (Specific, Measurable, Achievable, Relevant, and Time-Bound) goal setting with patients. Components of the TK session that enhanced nutrition competence were key patient messages and the shared meal. Preparing and eating together in a hands-on format was most enjoyable. Promoting healthy eating behaviours requires understanding the complexity of individual and societal food literacy. With high physician interest, dietitians are well positioned to deliver culinary medicine interventions and support physicians' confidence in health promotion and chronic disease prevention and management.

Exploring Dietitians' Perspectives Toward Current Practices and Services in Relation to Irritable Bowel Syndrome Management in Clinical Settings Across the United Kingdom: A Qualitative Study.

BACKGROUND: Irritable bowel syndrome (IBS) is a chronic and relapsing gastrointestinal condition that negatively impacts quality of life. Dietary triggers are common and dietary management is central to the IBS treatment pathway, and dietitians are the main education providers for patients. OBJECTIVE: The aim of this study was to explore dietitians' perspectives on current practices and services in relation to IBS management in clinical settings across the United Kingdom. DESIGN: Qualitative semi-structured interviews were undertaken from May to October 2021 via videoconferencing software. Eligible participants were dietitians specializing in gastroenterology and working in National Health Service (NHS) Trusts in the United Kingdom. Interviews were audio recorded and transcribed following intelligent transcription. Template analysis guided by naïve realism and its underlying epistemological assumptions was used. PARTICIPANTS/SETTING: Dietitians (N = 13) working in various NHS Trusts across the United Kingdom with at least 1 year of clinical experience in IBS management were included. QUALITATIVE DATA ANALYSIS: Template analysis, a form of thematic analysis with hierarchical coding, was used to explore dietitians' perspectives of IBS practices. RESULTS: Participating dietitians were mostly female (92.3%), of White race (84.6%), working in various NHS Trusts across the United Kingdom, and had more than 5 years of clinical experience (69.2%). The following 3 main themes emerged: 1) dietetics services as part of IBS referral pathways; 2) practices in relation to dietetics services; and 3) patients' expectations and feelings. Each main theme had subthemes to facilitate the description and interpretation of data. The increasing number of IBS referrals to dietitians and the need for accurate and timely IBS diagnosis and specialist dietitians were reported, along with the use of digital innovation to facilitate practice and access to dietetic care. The use of internet as a source of (mis)information by patients and the limited time available for educating patients were identified as potential barriers to dietetic practice. Dietitians follow a patient-centered approach to dietary counseling and recognize the negative implications of perceived IBS-related stigma by patients on their feelings and treatment expectations. CONCLUSIONS: The study identified areas and practices that can facilitate access to dietetic services and patient-centered care in IBS management, as outlined in UK-based guidelines.

Knowledge Gaps in Gluten-Free Diet Awareness among Patients and Healthcare Professionals: A Call for Enhanced Nutritional Education.

Diet is the only treatment for celiac disease (CeD), and good adherence to a gluten-free diet (GFD) is the only way to ensure complete remission and to prevent complications. Limited education about the disease and a GFD is an attributing factor to inadequate adherence. Thus, our aim was to assess the current knowledge about a GFD and the clinical monitoring of adherence to the diet among CeD people and HCPs. Specific questionnaires were designed and distributed to assess the knowledge of CeD people (Q1 questionnaire) (n = 2437) and to analyze the follow-up of the disease from the perspective of patients (Q2 questionnaire) (n = 1294) and HCPs (Q3 questionnaire) (n = 346). Two-thirds of HCPs specialized in pediatric care, while one-third did so in adult care. In CeD people, general questions regarding food classification and cross-contamination are well understood. When patients have doubts, 51.4% reported using the Internet and social networks. Thus, it is crucial that resources like social media are reliable and provide valuable information. Q3 revealed the lack of time to follow up the diet after diagnosis (48% of HCPs allocate < 15 min), the interest in further training, and the need for a professional specialized in diets within the healthcare system. In conclusion, it is essential to enhance nutritional education to increase awareness of a GFD.