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Davies KP, Gibney ER, O'Sullivan AM. Moving towards more sustainable diets: Is there potential for a personalised approach in practice? J Hum Nutr Diet 2023; 36:2256-2267. [PMID: 37545042 DOI: 10.1111/jhn.13218] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/13/2023] [Indexed: 08/08/2023]
Abstract
Discourse on the relationship between food production, healthy eating and sustainability has become increasingly prominent and controversial in recent years. Research groups often take one perspective when reporting on sustainable diets, and several often neglect considerations for the multiple aspects that make a diet truly sustainable, such as cultural acceptability, differences in nutritional requirements amongst the population and the efficiency of long-term dietary change. Plant-based diets are associated with lower greenhouse gas emissions (GHGEs) and have been linked with better health outcomes, including lower risk of diet-related chronic disease. However, foods associated with higher GHGE, such as lean red meat, fish and dairy, have beneficial nutritional profiles and contribute significantly to micronutrient intakes. Some research has shown that diets associated with lower GHGE can be less nutritionally adequate. Several countries now include sustainability recommendations in dietary guidelines but use vague language such as "increase" or "consume regularly" when referring to plant-based foods. General population-based nutrition advice has poor adherence and does not consider differences in nutritional needs. Although modelling studies show potential to significantly reduce environmental impact with dietary changes, personalising such dietary recommendations has not been studied. Adapting recommendations to the individual through reproducible methods of personalised nutrition has been shown to lead to more favourable and longer-lasting dietary changes compared to population-based nutrition advice. When considering sustainable healthy dietary guidelines, personalised feedback may increase the acceptability, effectiveness and nutritional adequacy of the diet. A personalised approach has the potential for delivering a new structure of more sustainable healthy food-based dietary guidelines. This review evaluates the potential to develop personalised sustainable healthy food-based dietary guidelines and discusses potential implications for policy and practice.
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Affiliation(s)
- Katie P Davies
- UCD Institute of Food and Health, School of Agriculture and Food Science, Dublin, Ireland
| | - Eileen R Gibney
- UCD Institute of Food and Health, School of Agriculture and Food Science, Dublin, Ireland
| | - Aifric M O'Sullivan
- UCD Institute of Food and Health, School of Agriculture and Food Science, Dublin, Ireland
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Keller HH, Laur C, Dhaliwal R, Allard JP, Clermont-Dejean N, Duerksen DR, Elias E, Gramlich L, Lakananurak N, Laporte M. Trends and Novel Research in Hospital Nutrition Care: A Narrative Review of Leading Clinical Nutrition Journals. JPEN J Parenter Enteral Nutr 2020; 45:670-684. [PMID: 33236411 DOI: 10.1002/jpen.2047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/10/2020] [Accepted: 11/16/2020] [Indexed: 01/04/2023]
Abstract
Hospital malnutrition is a longstanding problem that continues to be underrecognized and undertreated. The aim of this narrative review is to summarize novel, solution-focused, recent research or commentary to update providers on the prevention of iatrogenic malnutrition as well as the detection and treatment of hospital malnutrition. A narrative review was completed using the top 11 clinically relevant nutrition journals. Of the 13,850 articles and editorials published in these journals between 2013 and 2019, 511 were related to hospital malnutrition. A duplicate review was used to select (n = 108) and extract key findings from articles and editorials. Key criteria for selection were population of interest (adult hospital patients, no specific diagnostic group), solution-focused, and novel perspectives. Articles were categorized (6 classified in >1 category) as Screening and Assessment (n = 17), Standard (n = 25), Advanced (n = 12) and Specialized Nutrition Care (n = 8), Transitions (n = 15), Multicomponent (n = 21), Education and Empowerment (n = 9), Economic Impact (n = 3), and Guidelines (n = 4) for summarizing. Research advances in screening implementation, standard nutrition care, transitions, and multicomponent interventions provide new strategies to consider for malnutrition prevention (iatrogenic), detection, and care. However, several areas requiring further research were identified. Specifically, larger and more rigorous studies that examine health outcomes and economic analyses are urgently needed.
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Affiliation(s)
- Heather H Keller
- Schlegel-University of Waterloo Research institute for Aging, Waterloo, Ontario, Canada
| | - Celia Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care, and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
| | - Rupinder Dhaliwal
- Canadian Malnutrition Task Force, Canadian Nutrition Society, Ottawa, Ontario, Canada
| | - Johane P Allard
- Department of Medicine, University of Toronto, Toronto General Hospital, University Health Network Toronto, Toronto, Ontario, Canada
| | - Nayima Clermont-Dejean
- Clinical Nutrition, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Donald R Duerksen
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Evan Elias
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leah Gramlich
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Narisorn Lakananurak
- Department of Medicine, University of Alberta, Edmonton, Canada.,Division of Clinical Nutrition, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Manon Laporte
- Department of Clinical Nutrition, Réseau de santé Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada
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Mistiaen P, Van den Heede K. Nutrition Support Teams: A Systematic Review. JPEN J Parenter Enteral Nutr 2020; 44:1004-1020. [PMID: 32181928 DOI: 10.1002/jpen.1811] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND The concept of a nutrition support team (NST) was first introduced at the end of the 20th century in the US and Europe. Expected benefits include reduced (inappropriate) prescription of (par)enteral nutrition; however, to the authors' knowledge, no recent review has assessed the effectiveness of NSTs. Therefore, this systematic review evaluated the effectiveness of NSTs with respect to the prevalence of adult patients receiving (par)enteral nutrition. METHODS Five literature databases were searched and completed by citing searches. Studies on NSTs that were published between 2000 and 2018 in Western countries, applied a comparative design, and contained at least outcome data on the prevalence of (par)enteral nutrition were included. Analyses were mainly descriptive because of high heterogeneity that prevented meta-analyses. RESULTS The 27 included studies mainly originated from the UK and US. Only 1 of the included studies was a randomized trial; the other studies had a pre-post design (n = 17) or compared groups in a nonrandomized way. All but 2 studies were performed in acute care hospitals, and 5 studies focused only on intensive care patients. There was conflicting evidence of whether NSTs lead to reduction or increase in patients starting parenteral nutrition (PN); however, weak evidence suggested that NSTs might lead to an increase in the ratio of enteral nutrition to PN use and might decrease inappropriate PN use. CONCLUSION Although almost all studies concluded in favor of NSTs, the evidence base is weak and insufficient because of a lack of well-designed studies and successful outcomes.
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Vanherle K, Werkman AM, Baete E, Barkmeijer A, Kolm A, Gast C, Ramminger S, Höld E, Kohlenberg-Müller K, Ohlrich-Hahn S, Walters ME, Wewerka-Kreimel D, Adam M, Valentini L. Proposed standard model and consistent terminology for monitoring and outcome evaluation in different dietetic care settings: Results from the EU-sponsored IMPECD project. Clin Nutr 2018; 37:2206-2216. [PMID: 30274899 DOI: 10.1016/j.clnu.2018.08.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 08/10/2018] [Accepted: 08/31/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS Dietetic interventions contribute to certain health objectives and other outcomes, but are mostly part of a multimodal and multidisciplinary approach what makes evaluating the actual effects of dietitians' involvement rather complex. Although monitoring and outcome evaluation (M&OE) can provide routine data to prove the effectiveness of dietetic interventions, this has not been established yet in different dietetic settings. METHODS A comprehensive framework for M&OE in dietetics was developed by dietetic experts from five European higher education institutes for dietetics in the course of the EU sponsored project "Improvement of Education and Competences in Dietetics (IMPECD)". RESULTS Firstly, clear definitions on M&OE are proposed to facilitate the use of consistent terminology, with a specific emphasis on the term "impact" covering macro-level outcomes such as cost-effectiveness. Secondly, the Dietetic Care Process (DCP) was merged into a logic model to demonstrate the position of M&OE in relation to intervention planning and implementation, in both group and individual settings. Thirdly, selecting the appropriate indicators is indispensable to monitor and evaluate outcomes, and requires a high level of dietitians' critical reasoning. A categorized overview of indicators is provided to support this process. Lastly, the consortium developed a checklist to give dietitians a handle on what elements could be included in their M&OE plan and trigger them to perform M&OE in practice. CONCLUSIONS Innovative M&OE models may help dietitians to demonstrate their effectiveness in improving clinical outcomes and justify their role in health care.
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Affiliation(s)
- K Vanherle
- Artesis Plantijn University College Antwerp, Department of Science and Technology, Nutrition and Dietetics Programme, Kronenburgstraat 47, 2000, Antwerp, Belgium.
| | - A M Werkman
- Hanzehogeschool Groningen, School of Health Care Studies, Nutrition and Dietetics Programme, Petrus Driessenstraat 3, NL 9714 CA, Groningen, the Netherlands
| | - E Baete
- Artesis Plantijn University College Antwerp, Department of Science and Technology, Nutrition and Dietetics Programme, Kronenburgstraat 47, 2000, Antwerp, Belgium
| | - A Barkmeijer
- Hanzehogeschool Groningen, School of Health Care Studies, Nutrition and Dietetics Programme, Petrus Driessenstraat 3, NL 9714 CA, Groningen, the Netherlands
| | - A Kolm
- University of Applied Sciences St. Pölten, Department of Health Sciences, Dietetics Programme, Matthias Corvinus-Straße 15, 3100, St. Pölten, Austria
| | - C Gast
- Fulda University of Applied Sciences, Department of Nutritional, Food and Consumer Sciences, Leipziger Straße 123, 36037, Fulda, Germany
| | - S Ramminger
- University of Applied Sciences Neubrandenburg, Section of Dietetics, Dept. of Agriculture and Food Sciences, Brodaer Str 2, 17033, Neubrandenburg, Germany
| | - E Höld
- University of Applied Sciences St. Pölten, Department of Health Sciences, Dietetics Programme, Matthias Corvinus-Straße 15, 3100, St. Pölten, Austria
| | - K Kohlenberg-Müller
- Fulda University of Applied Sciences, Department of Nutritional, Food and Consumer Sciences, Leipziger Straße 123, 36037, Fulda, Germany
| | - S Ohlrich-Hahn
- University of Applied Sciences Neubrandenburg, Section of Dietetics, Dept. of Agriculture and Food Sciences, Brodaer Str 2, 17033, Neubrandenburg, Germany
| | - M E Walters
- Hanzehogeschool Groningen, School of Health Care Studies, Nutrition and Dietetics Programme, Petrus Driessenstraat 3, NL 9714 CA, Groningen, the Netherlands
| | - D Wewerka-Kreimel
- University of Applied Sciences St. Pölten, Department of Health Sciences, Dietetics Programme, Matthias Corvinus-Straße 15, 3100, St. Pölten, Austria
| | - M Adam
- Artesis Plantijn University College Antwerp, Department of Science and Technology, Nutrition and Dietetics Programme, Kronenburgstraat 47, 2000, Antwerp, Belgium
| | - L Valentini
- University of Applied Sciences Neubrandenburg, Section of Dietetics, Dept. of Agriculture and Food Sciences, Brodaer Str 2, 17033, Neubrandenburg, Germany
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