American Dietetic Association: Standards of Practice and Standards of Professional Performance for Registered Dietitians (Competent, Proficient, and Expert) in Integrative and Functional Medicine

Transforming personalized nutrition practice

The strengths and limitations of current approaches to clinical nutrition practice and their underpinning research are explored in this article. It describes how a personalized nutrition practice approach supported by evidence-based pathophysiological reasoning could direct additional research, which could then transform practice and support food industry developments. Current use of the term "personalized nutrition" is reviewed and a definition is provided. Also explored are current approaches to personalized nutrition practice and evidence-based practice in clinical nutrition. Patient-centered practice, which involves individuals in their healthcare decisions, is currently being provided under the name "personalized." An evidence-based personalized practice approach should include the use of robust, standardized, and validated tools that gather a patient's signs and symptoms, health history, family history, genetics, environment, lifestyle, social life, diet, behavior and other factors that have an impact on physiological processes. It should also gather anthropometric measures as well as functional, diagnostic, and prognostic biomarkers for pathophysiological mechanisms. Such tools would pool n = 1 data into a case-by-case evidence base that uses computational network modelling to predict the efficacy of personalized nutrition interventions. Prediction of the efficacy of interventions should also be validated using, when possible, blinded, randomized, controlled, stratified intervention studies. This model would provide practitioners with data that support evidence-based pathophysiological reasoning. It would enable clinicians to prioritize interventions on the basis of the mechanisms of action of interventions and to ameliorate the mechanisms of pathophysiology, which are a priority for the individual. Interventions then may be applied using a patient-centered practice approach. This would transform evidence-based nutrition practice into a P4 medicine approach that is personalized, preventive, predictive, and participatory. Developing pathophysiological mechanistic understanding also provides new opportunities for stakeholders, including the food industry, researchers, healthcare practitioners, and consumers.

The Potential Contribution of Current Health Care Zeitgeists to the Success of Health and Wellness Coaches

Chronic disease is challenging to treat because treatment often requires lifestyle behavior changes. In recent years the use of health and wellness coaches (HWC) has emerged as a way to support patients making behavioral changes. The use of HWCs has resulted in improved management of chronic disease for many patients. The success of HWCs is often thought to be due to the extended care they provide and the behavioral modification techniques they promote such as goal setting and self-monitoring. This article describes how HWC's conformity to the current health care zeitgeist of personalized, holistic care may be another reason for their success.

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.

Blurred lines: Emerging practice for registered dietitian-nutritionists in integrative and functional nutrition

BACKGROUND

This study explored the health philosophy and practice orientation of RDNs in the United States.

METHODS

A randomly selected group of RDNs were recruited to take an online survey using a reduced version of Integrative Medicine practice (IM-30). Confirmatory factor analysis, analyses of variance, and non-parametric tests were used to investigate the relationships between dietetic professionals' personal health philosophy, lifestyle, and orientation to Integrative Medicine.

RESULTS

Overall construct validity of the IM-26 scale was demonstrated by Cronbach's α with reliabilities ranging from 0.766 to 0.89. Results from chi-square test of goodness-of-fit test (N = 477, χ2 = 228.72, p = 0.123) and RMSEA of 0.016 showed good model fit. IM orientation varied significantly by work setting and certification in one or more CAM therapies.

CONCLUSIONS

The orientation towards Integrative Medicine for a majority of US dietitians is in the awareness and learning phases of adoption.