Academy of Nutrition and Dietetics: Revised 2019 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Nutrition in Integrative and Functional Medicine

Clinical Application of New Possible Biomarkers in the Assessment and Monitoring of Nutritional Status

Nutrition is directly related to human health. It is very critical to determine the nutritional status to prevent or diagnose diseases and create the right treatment plans. The determination of the nutritional status provides an early diagnosis of growth and development retardation such as malnutrition. It also plays a major role in preventing diseases that may be caused by vitamin and mineral deficiencies. It helps in the surveillance of one of the world's most serious health problems, namely “obesity.” Different ways can be used to assess nutritional status. One of the best ways to assess the nutritional and health status is to use biomarkers. A biomarker is a substance whose detection indicates a specific disease state or a response to a therapeutic intervention. Biomarkers are used to detect nutrient consumption and deficiencies as early as possible, enabling early intervention for metabolic problems. Biomarkers also allow the visualization of diseases that a person might develop or potentially have with a sample, such as blood, tissue, and urine, from the person. Health interventions such as nutritional advice will preserve health or promote rapid recovery. In this chapter, the topic of biomarkers related to nutrition and nutrient deficiencies is discussed. The existence of new possible biomarkers is also reviewed.

Tackling Atherosclerosis via Selected Nutrition

The development and pathogenesis of atherosclerosis are significantly influenced by lifestyle, particularly nutrition. The modern level of science and technology development promote personalized nutrition as an efficient preventive measure against atherosclerosis. In this survey, the factors were revealed that contribute to the formation of an individual approach to nutrition: genetic characteristics, the state of the microbiota of the gastrointestinal tract (GIT) and environmental factors (diets, bioactive components, cardioprotectors, etc.). In the course of the work, it was found that in order to analyze the predisposition to atherosclerosis associated with nutrition, genetic features affecting the metabolism of nutrients are significant. The genetic features include the presence of single nucleotide polymorphisms (SNP) of genes and epigenetic factors. The influence of telomere length on the pathogenesis of atherosclerosis and circadian rhythms was also considered. Relatively new is the study of the relationship between chrono-nutrition and the development of metabolic diseases. That is, to obtain the relationship between nutrition and atherosclerosis, a large number of genetic markers should be considered. In this relation, the question arises: “How many genetic features need to be analyzed in order to form a personalized diet for the consumer?” Basically, companies engaged in nutrigenetic research and choosing a diet for the prevention of a number of metabolic diseases use SNP analysis of genes that accounts for lipid metabolism, vitamins, the body’s antioxidant defense system, taste characteristics, etc. There is no set number of genetic markers. The main diets effective against the development of atherosclerosis were considered, and the most popular were the ketogenic, Mediterranean, and DASH-diets. The advantage of these diets is the content of foods with a low amount of carbohydrates, a high amount of vegetables, fruits and berries, as well as foods rich in antioxidants. However, due to the restrictions associated with climatic, geographical, material features, these diets are not available for a number of consumers. The way out is the use of functional products, dietary supplements. In this approach, the promising biologically active substances (BAS) that exhibit anti-atherosclerotic potential are: baicalin, resveratrol, curcumin, quercetin and other plant metabolites. Among the substances, those of animal origin are popular: squalene, coenzyme Q10, omega-3. For the prevention of atherosclerosis through personalized nutrition, it is necessary to analyze the genetic characteristics (SNP) associated with the metabolism of nutrients, to assess the state of the microbiota of the GIT. Based on the data obtained and food preferences, as well as the individual capabilities of the consumer, the optimal diet can be selected. It is topical to exclude nutrients of which their excess consumption stimulates the occurrence and pathogenesis of atherosclerosis and to enrich the diet with functional foods (FF), BAS containing the necessary anti-atherosclerotic, and stimulating microbiota of the GIT nutrients. Personalized nutrition is a topical preventive measure and there are a number of problems hindering the active use of this approach among consumers. The key factors include weak evidence of the influence of a number of genetic features, the high cost of the approach, and difficulties in the interpretation of the results. Eliminating these deficiencies will contribute to the maintenance of a healthy state of the population through nutrition.

Team Approach: Nutritional Assessment and Interventions in Elective Hip and Knee Arthroplasty

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Nutritional assessment is a critical element of routine preoperative assessment and should be approached by an interdisciplinary team that involves the primary care physician, dietitian, and orthopaedist.

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Patients should be stratified on the basis of their nutritional risk, which influences downstream optimization and deficiency reversal.

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The scientific literature indicates that nutritional supplementation affords protection against adverse outcomes and helps functional recovery, even among patients who are not at nutritional risk.

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Published investigations recommend a sufficient preoperative interval (at least 4 weeks) to ensure an adequate nutritional intervention in malnourished patients as opposed to regarding them as nonsurgical candidates.

Academy of Nutrition and Dietetics: Revised 2020 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Eating Disorders

Eating disorders (ED) are complex mental illnesses and are not a result of personal choice. Full recovery from an ED is possible. The severity and inherent lethality of an ED is undisputed, and the role of the registered dietitian nutritionist (RDN) is essential. Clinical symptomology presents at varying developmental milestones and is perpetuated through a sociocultural evaluation of beauty and drive for ascetic idealism. ED are globally prevalent in 4.4% of the population aged 5 to 17 years, yet affect individuals across the entire lifespan, including all cultures and genders. The Behavioral Health Nutrition Dietetic Practice Group, along with the Academy of Nutrition and Dietetics Quality Management Committee, revised the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for RDNs in Eating Disorders. Including the RDN in ED treatment is vital for all levels of care. The RDN must be perceptive to negative symptoms indicative of psychological triggers when exploring food belief systems, patterns of disinhibition, and nutrition misinformation with clients. Through a conscious awareness of medical, psychological, and behavioral strategies, the implementation of the SOP and SOPP supports a dynamic and holistic view of ED treatment by the RDN. The SOP and SOPP are complementary resources for RDNs and are intended to be used as self-evaluation tools for assuring competent practice in ED and for determining potential education, training, supervision, and mentorship needs for advancement to a higher practice level in a variety of settings.

Functional Voice Assessment and Therapy Methods Supported by Telepractice, VoiceEvalU8, and Estill Voice Training

Functional assessment and therapy methods are necessary for a client-centered approach that addresses the client's vocal needs across all environments. The purpose of this article is to present the approach with the intent to encourage discussion and implementation among educators, clinicians, researchers, and students. The functional approach is defined and its importance is described within the context of the World Health Organization's International Classification of Functioning, Disability, and Health with support provided by synchronous and asynchronous telepractice, the VoiceEvalU8 app, server, and web portal, and a framework that defines voice qualities (e.g., resonance, twang, loud, and others) by the anatomy and physiology of the voice production system (i.e., Estill Figures for Voice). Case scenarios are presented to highlight application of the functional voice approach.

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.

Effect of Incorporating Genetic Testing Results into Nutrition Counseling and Care on Health Outcomes: An Evidence Analysis Center Systematic Review-Part II

In recent years, literature examining implementation of nutritional genomics into clinical practice has increased, including publication of several randomized controlled trials (RCTs). This systematic review addressed the following question: In children and adults, what is the effect of incorporating results of genetic testing into nutrition counseling and care compared with an alternative intervention or control group, on nutrition-related health outcomes? A literature search of MEDLINE, Embase, PsycINFO, CINAHL, and other databases was conducted for peer-reviewed RCTs published from January 2008 until December 2018. An international workgroup consisting of registered dietitian nutritionists, systematic review methodologists, and evidence analysts screened and reviewed articles, summarized data, conducted meta-analyses, and graded conclusion statements. The second in a two-part series, this article specifically summarizes evidence from RCTs that examined health outcomes (ie, quality of life, disease incidence and prevention of disease progression, or mortality), intermediate health outcomes (ie, anthropometric measures, body composition, or relevant laboratory measures routinely collected in practice), and adverse events as reported by study authors. Analysis of 11 articles from nine RCTs resulted in 16 graded conclusion statements. Among participants with nonalcoholic fatty liver disease, a diet tailored to genotype resulted in a greater reduction of percent body fat compared with a customary diet for nonalcoholic fatty liver disease. However, meta-analyses for the outcomes of total cholesterol, low-density lipoprotein cholesterol, body mass index, and weight yielded null results. Heterogeneity between studies and low certainty of evidence precluded development of strong conclusions about the incorporation of genetic information into nutrition practice. Although there are still relatively few well-designed RCTs to inform integration of genetic information into the Nutrition Care Process, the field of nutritional genomics is evolving rapidly, and gaps in the literature identified by this systematic review can inform future studies.

Advancements in Personalized Nutrition Technologies: Guiding Principles for Registered Dietitian Nutritionists

Individualized nutrition counseling and care is a cornerstone of practice for registered dietitian nutritionists (RDNs). The term personalized nutrition (PN) refers to "individual-specific information founded in evidence-based science to promote dietary behavior change that may result in measurable health benefits." PN technologies, which include the "omics" approaches, may offer the potential to improve specificity of nutrition care through assessment of molecular-level data, such as genes or the microbiome, in order to determine the course for nutrition intervention. These technologies are evolving rapidly, and for many RDNs, it is unclear whether, when, or how these technologies should be incorporated into the nutrition care process. In order to provide guidance in these developing PN fields, International Life Sciences Institute North America convened a multidisciplinary panel to develop guiding principles for PN approaches. The objective of this article is to inform RDN practice decisions related to the implementation of PN technologies by examining the alignment of proposed PN guiding principles with the Code of Ethics for the Nutrition and Dietetics Profession, as well as Scope and Standards of Practice. Guiding principles are described as they apply to each stage of the nutrition care process and include identifying potential beneficiaries, communicating effects transparently, and protecting individual privacy. Guiding principles for PN augment standard guidance for RDNs to pose relevant questions, raise potential concerns, and guide evaluation of supporting evidence for specific PN technologies. RDNs have a responsibility to think critically about the application of PN technologies, including appropriateness and potential effectiveness, for the individual served.