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Robinson J, Nitschke E, Tovar A, Mattar L, Gottesman K, Hamlett P, Rozga M. Nutrition and Physical Activity Interventions Provided by Nutrition and Exercise Practitioners for the General Population: An Evidence-Based Practice Guideline From the Academy of Nutrition and Dietetics and American Council on Exercise. J Acad Nutr Diet 2023; 123:1215-1237.e5. [PMID: 37061182 DOI: 10.1016/j.jand.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/10/2023] [Indexed: 04/17/2023]
Abstract
A nutritious diet and adequate physical activity vitally contribute to disease prevention, but most adults do not meet population-based dietary and physical activity recommendations. Qualified nutrition and exercise practitioners can address challenges to adopting healthy lifestyle behaviors by providing consistent, individualized, and evidence-based education and programming within their professional scopes of practice to improve client outcomes. The objective of this evidence-based practice guideline is to inform practice decisions for nutrition and exercise practitioners providing nutrition and physical activity interventions for adults who are healthy or have cardiometabolic risk factors, but no diagnosed disease. Evidence from a systematic review was translated to practice recommendations using an evidence-to-decision framework by an interdisciplinary team of nutrition and exercise practitioners and researchers. This evidence-based practice guideline does not provide specific dietary or physical activity recommendations but rather informs nutrition and exercise practitioners how they may utilize existing guidelines for the general population to individualize programming for a range of clients. This evidence-based practice guideline provides widely applicable recommendation statements and a detailed framework to help practitioners implement the recommendations into practice. Common barriers and facilitators encountered when delivering nutrition and physical activity interventions, such as adherence to professional scopes of practice; methods to support behavior change; and methods to support inclusion, diversity, equity, and access, are discussed. Nutrition and exercise practitioners can consistently provide individualized, practical, and evidence-based interventions by seeking to understand their clients' needs, circumstances, and values and by co-creating interventions with the client and their allied health team.
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Affiliation(s)
- Justin Robinson
- Kinesiology Department, Point Loma Nazarene University, San Diego, California
| | - Erin Nitschke
- Department of Exercise Science, Laramie County Community College, Cheyenne, Wyoming
| | | | - Lama Mattar
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Lebanon
| | - Kimberly Gottesman
- Department of Nutrition and Food Science, California State University Los Angeles, Los Angeles, California
| | - Peggy Hamlett
- Department of Kinesiology, Washington State University Pullman, Washington
| | - Mary Rozga
- Evidence Analysis Center, Academy of Nutrition and Dietetics, Chicago, Illinois.
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Lin P, Hillstrom K, Gottesman K, Jia Y, Kuo T, Robles B. Financial and Other Life Stressors, Psychological Distress, and Food and Beverage Consumption among Students Attending a Large California State University during the COVID-19 Pandemic. Int J Environ Res Public Health 2023; 20:3668. [PMID: 36834363 PMCID: PMC9965632 DOI: 10.3390/ijerph20043668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
The novel coronavirus disease 2019 (COVID-19) pandemic abruptly disrupted the daily lives and health of college students across the United States. This study investigated several stressors (e.g., financial strain/uncertainty), psychological distress, and dietary behaviors among college students attending a large state university during the pandemic. A cross-sectional online survey was administered to students from the California State University, Los Angeles between April and May 2021 (final analytic sample n = 736). Differences in gender and race/ethnicity were examined using chi-square, t-test, and one-way ANOVA tests. Paired t-tests were performed to compare variables before and during the pandemic. Negative binomial regression models examined the associations between various stressors, psychological distress, and three key dietary outcomes. Descriptive results showed that the consumption of fruits and vegetables, fast food, and sugary beverages, along with psychological distress, all increased during the pandemic. Significant differences in fruit and vegetable and fast food consumption by gender and race/ethnicity were also observed. In the regression models, several stressors, including financial strain and psychological distress, were associated with unfavorable food and beverage consumption, thereby suggesting that college students may need more support in mitigating these stressors so they do not manifest as poor dietary behaviors. Poor diet quality is associated with poor physical health outcomes such as premature development of type 2 diabetes or hypertension.
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Affiliation(s)
- Paulina Lin
- Department of Epidemiology, UCLA Fielding School of Public Health, P.O. Box 951722, Los Angeles, CA 90095, USA
| | - Kathryn Hillstrom
- Department of Nutrition and Food Science, California State University, Los Angeles, 5151 State University Drive, Los Angeles, CA 90032, USA
| | - Kimberly Gottesman
- Department of Nutrition and Food Science, California State University, Los Angeles, 5151 State University Drive, Los Angeles, CA 90032, USA
| | - Yuane Jia
- School of Health Professions, Rutgers Biomedical and Health Sciences, 65 Bergen St., Newark, NJ 07101, USA
| | - Tony Kuo
- Department of Epidemiology, UCLA Fielding School of Public Health, P.O. Box 951722, Los Angeles, CA 90095, USA
- Department of Family Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Blvd, Suite 1800, Los Angeles, CA 90024, USA
- Population Health Program, UCLA Clinical and Translational Science Institute, 10833 Le Conte Ave., BE-144 CHS, Los Angeles, CA 90095, USA
| | - Brenda Robles
- Research Group on Statistics, Econometrics, and Health (GRECS), University of Girona, Carrer de la Universitat de Girona 10, Campus de Montilivi, 17003 Girona, Spain
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Nitschke E, Gottesman K, Hamlett P, Mattar L, Robinson J, Tovar A, Rozga M. Impact of Nutrition and Physical Activity Interventions Provided by Nutrition and Exercise Practitioners for the Adult General Population: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14091729. [PMID: 35565696 PMCID: PMC9103154 DOI: 10.3390/nu14091729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 12/18/2022] Open
Abstract
Healthy dietary intake and physical activity reduce the risk of non-communicable diseases. This systematic review and meta-analysis aimed to examine the effect of interventions including both nutrition and physical activity provided by nutrition and exercise practitioners for adults in the general population (those without diagnosed disease). The MEDLINE, CINAHL, Cochrane Central, Cochrane Database of Systematic Reviews and SportDiscus databases were searched for randomized controlled trials (RCTs) published from 2010 until April 2021. Outcomes included physical activity, fruit and vegetable intake, waist circumference, percent weight loss, quality of life (QoL) and adverse events. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods were used to synthesize and grade evidence. Meta-analyses were stratified according to participant health status. The database search identified 11,205 articles, and 31 RCTs were included. Interventions increased physical activity amount [standardized mean difference (SMD) (95% CI): 0.25 (0.08, 0.43)] (low certainty evidence); increased vegetable intake [SMD (95% CI): 0.14 (0.05, 0.23)] (moderate certainty evidence); reduced waist circumference [MD (95% CI): −2.16 cm (−2.96, −1.36)] (high certainty evidence); and increased likelihood of achieving 5% weight loss for adults with overweight and obesity [relative risk (95% CI): 2.37 (1.76, 3.19)] (high certainty evidence). Very low and low certainty evidence described little-to-no effect on QoL or adverse events. Nutrition and exercise practitioners play key roles in facilitating positive lifestyle behaviors to reduce cardiometabolic disease risk in adults.
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Affiliation(s)
- Erin Nitschke
- Department of Exercise Science, Laramie County Community College, 1400 E College Drive, Cheyenne, WY 82007, USA;
| | - Kimberly Gottesman
- Department of Kinesiology, Nutrition and Food Science, California State University Los Angeles, 5151 South University Drive, Los Angeles, CA 90032, USA;
| | - Peggy Hamlett
- Department of Movement Sciences, University of Idaho, 875 Perimeter Drive, Moscow, ID 83844, USA;
| | - Lama Mattar
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut 10150, Lebanon;
| | - Justin Robinson
- Kinesiology Department, Point Loma Nazarene University, 3900 Lomaland Dr, San Diego, CA 92106, USA;
| | - Ashley Tovar
- Gilead Sciences, 333 Lakeside Dr, Foster City, CA 94404, USA;
| | - Mary Rozga
- Evidence Analysis Center, Academy of Nutrition and Dietetics, 120 S Riverside Plaza, Suite 2190, Chicago, IL 60606, USA
- Correspondence: ; Tel.: +1-(312)-899-1758
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Burslem R, Gottesman K, Newkirk M, Ziegler J. Energy requirements for critically ill patients with COVID-19. Nutr Clin Pract 2022; 37:594-604. [PMID: 35315122 PMCID: PMC9088341 DOI: 10.1002/ncp.10852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/14/2022] [Accepted: 02/19/2022] [Indexed: 11/08/2022] Open
Abstract
Early reports suggested that predictive equations significantly underestimate the energy requirements of critically ill patients with coronavirus disease 2019 (COVID-19) based on the results of indirect calorimetry (IC) measurements. IC is the gold standard for measuring energy expenditure in critically ill patients. However, IC is not available in many institutions. If predictive equations significantly underestimate energy requirements in severe COVID-19, this increases the risk of underfeeding and malnutrition, which is associated with poorer clinical outcomes. As such, the purpose of this narrative review is to summarize and synthesize evidence comparing measured resting energy expenditure via IC with predicted resting energy expenditure determined via commonly used predictive equations in adult critically ill patients with COVID-19. Five articles met the inclusion criteria for this review. Their results suggest that many critically ill patients with COVID-19 are in a hypermetabolic state, which is underestimated by commonly used predictive equations in the intensive care unit (ICU) setting. In nonobese patients, energy expenditure appears to progressively increase over the course of ICU admission, peaking at week 3. The metabolic response pattern in patients with obesity is unclear because of conflicting findings. Based on limited evidence published thus far, the most accurate predictive equations appear to be the Penn State equations; however, they still had poor individual accuracy overall, which increases the risk of underfeeding or overfeeding and, as such, renders the equations an unsuitable alternative to IC.
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Affiliation(s)
- Ryan Burslem
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, NJ, USA
| | - Kimberly Gottesman
- Department of Clinical and Preventive Nutrition Sciences, Rutgers University, Newark, NJ, USA
| | - Melanie Newkirk
- Department of Clinical and Preventive Nutrition Sciences, Rutgers University, Newark, NJ, USA
| | - Jane Ziegler
- Department of Clinical and Preventive Nutrition Sciences, Clinical Nutrition Program, Rutgers University, Newark, NJ, USA
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Gottesman K, Rawal S, Parrott J, Radler D, Byham-Gray L, Touger-Decker R. Changes in Cardiometabolic Risk Factors and in Physical Activity in Worksite Wellness Participants. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.06.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Anderson D, Keteyian SJ, Roble A, Gottesman K, Rubin J, Ehrman JK. Comparison of Bariatric Surgery and Weight Management with Very Low Calorie Diet. Med Sci Sports Exerc 2006. [DOI: 10.1249/00005768-200605001-02800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Zatoński W, Gałczyński M, Gottesman K, Przewoźniak K, Sierzputowska E. [Tobacco smoking among physicians in Poland. Preliminary report on the study conducted in 1986]. Pneumonol Pol 1987; 55:352-6. [PMID: 3697308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Zatoński W, Gottesman K, Przewoźniak K. [Smoking and malignant neoplasm mortality in Poland]. Pneumonol Pol 1987; 55:357-61. [PMID: 3697309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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