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PubMed2004

Position of the American Dietetic Association: Functional foods.

It is the position of the American Dietetic Association that functional foods, including whole foods and fortified, enriched, or enhanced foods, have a potentially beneficial effect on health when consumed as part of a varied diet on a regular basis, at effective levels. The Association supports research to define further the health benefits and risks of individual functional foods and their physiologically active components. Dietetics professionals will continue to work with the food industry, the government, the scientific community, and the media to ensure that the public has accurate information regarding this emerging area of food and nutrition science. Knowledge of the role of physiologically active food components, from both phytochemicals and zoochemicals, has changed the role of diet in health. Functional foods have evolved as food and nutrition science has advanced beyond the treatment of deficiency syndromes to reduction of disease risk. This position reviews the definition of functional foods, their regulation, and the scientific evidence supporting this emerging area of food and nutrition. Foods can no longer be evaluated only in terms of macronutrient and micronutrient content alone. Analyzing the content of other physiologically active components and evaluating their role in health promotion will be necessary. The availability of health-promoting functional foods in the US diet has the potential to help ensure a healthier population. However, each functional food should be evaluated on the basis of scientific evidence to ensure appropriate integration into a varied diet.

Dietetics↗

PubMed2004

Nutrition education: a survey of practices and perceptions in undergraduate dietetics education.

Electronic mail messages linked to an online survey were sent to 281 directors of didactic and coordinated programs in dietetics to investigate coverage of nutrition education in undergraduate curriculua, perceived importance of topics, and perceived trends. Descriptive statistics and content analysis were performed on responses from 117 programs. Programs addressed nutrition education through a variety of methods and materials. Fifty-three percent (n=62) offered a course dedicated to nutrition education. The most common teaching methods were didactic (88%) and experiential learning (87%). Most of the topics investigated, including those addressed by the Commission on Accreditation for Dietetics Education Accreditation Manual, were viewed as important, very important, or essential. Perceived trends included increased use of technology, theories/models, client-centered education, cultural awareness, and behavior change. Eighty-eight percent of respondents indicated satisfaction with nutrition education curriculum strategies. Dissatisfaction was associated with inadequate time and resources, need for course improvement, and lack of control over experiences. Results may aid in curriculum development.

Accreditation↗

PubMed2006

Position of the American Dietetic Association: child and adolescent food and nutrition programs.

It is the position of the American Dietetic Association that all children and adolescents, regardless of age, sex, socioeconomic status, racial diversity, ethnic diversity, linguistic diversity, or health status, should have access to food and nutrition programs that ensure the availability of a safe and adequate food supply that promotes optimal physical, cognitive, social, and emotional growth and development. Appropriate food and nutrition programs include food assistance and meal programs, nutrition education initiatives, and nutrition screening and assessment followed by appropriate nutrition intervention and anticipatory guidance to promote optimal nutrition status. Food and nutrition programs create a safety net that ensures that children and adolescents at risk for poor nutritional intakes have access to a safe, adequate, and nutritious food supply and nutrition screening, assessment, and intervention. It is important that continued funding be provided for these programs, which consistently have been shown to have a positive impact on child and adolescent health and well-being. Food and nutrition programs serve as a means to prevent or reduce hunger and food insecurity, but also as a vehicle for nutrition education and promotion of physical activity designed to prevent or reduce overweight and prevent chronic disease. It is the role of the registered dietitian to support adequate and sustained funding for food and nutrition programs, universal health care reimbursement for nutrition services, and the use of research and surveillance programs to evaluate and improve these programs. In addition, the registered dietitian and dietetic technician, registered, are responsible for serving as a nutrition resource to all groups and individuals providing services to children and adolescents, acting as an advocate for the establishment of child-care, school, and community settings conducive to the development of good nutrition habits.

Adolescent↗

PubMed2000

Position of the American Dietetic Association: local support for nutrition integrity in schools.

It is the position of The American Dietetic Association that the school and community have a shared responsibility to provide all students with access to high-quality foods and nutrition services as an integral part of the total education program. Educational goals, including the nutrition goals of the National School Lunch Program and the School Breakfast Program, should be supported and extended through school district policies that create an overall school environment with learning experiences that enable students to develop lifelong, healthful eating habits. Local school policy, developed through a collaborative process that responds to community needs and priorities, should include the integration of the school nutrition program with education. Nutrition integrity policy provides a framework for the integration and coordination of all aspects of the school nutrition program. Nutrition integrity is defined as "a guaranteed level of performance that ensures that all foods available and consumed by children in schools are consistent with the Recommended Dietary Allowances and the Dietary Guidelines for Americans, and contribute to the development of lifelong, healthy eating habits." Achieving nutrition integrity means taking a comprehensive approach to program planning, management, operations, and integration of nutrition into the total education program of the school. The community is a valuable resource for this effort. Collaboration between key school- and community-based constituents, including children and other stakeholders, will result in the most effective and relevant plans for local school nutrition programs. However, competing and profit-making food and beverage sales may create a conflicting environment and can contradict lessons taught in health and nutrition education. This position provides direction for the dietetics profession for addressing this issue along with providing a suggested action plan for local schools and their communities.

Child↗

PubMed2000

Position of the American Dietetic Association: nutrition, aging, and the continuum of care.

Scientific evidence increasingly supports that good nutrition is essential to the health, self-sufficiency, and quality of life of older adults. With the population of the United States living longer than ever before, the older adult population will be more diverse and heterogeneous in the 21st century. The oldest-old and minority populations will grow more quickly than the young-old and non-Hispanic white populations, respectively. For the current 34 million adults 65 years of age and older living in the United States, there are about 12 million caregivers who provide formal or informal care. A broad array of culturally appropriate food and nutrition services, physical activities, and health and supportive care customized to accommodate the variations within this expanding population of older adults is needed. With changes and lack of coordination in health care and social-support systems, dietetics professionals need to be proactive and collaborate with aging-services and other health care professionals to improve policies, interventions, and programs that service older adults throughout the continuum of care to ensure nutritional well-being and quality of life. The American Dietetic Association supports both the provision of comprehensive food and nutrition services and the continuation and expansion of research to identify the most effective food and nutrition interventions for older adults over the continuum of care.

Aged↗

PubMed2000

Minority recruitment and retention in dietetics: issues and interventions.

To better understand the reasons why minorities and males are underrepresented among registered dietitians (RDs) and dietetic technicians, registered, (DTRs) and to develop focuses for intervention, the investigators performed a telephone survey of newly credentialed RDs and DTRs and directors of RD and DTR education programs. Using lists of students recruited by the American Dietetic Association for participation in the survey, the investigators interviewed 83 RDs and DTRs and 20 education program directors. RDs and DTRs attributed minority underrepresentation primarily to the field's lack of visibility and underrepresentation of men to the traditional association with women. Education program directors attributed minority underrepresentation to educational disadvantages, particularly in scientific subjects. Findings from this study support program-level interventions such as increasing program flexibility, initiating outreach to K-12 schools and lower-division college students, providing tutoring in a nondemeaning atmosphere, and visibly expressing commitment to minority representation. More fundamental changes in the profession itself appear necessary for large-scale increases in minority representation. These include increasing internship opportunities; raising the profession's level of remuneration, prestige, and independence; increasing scholarship support; and advertising nationally through channels capable of reaching minorities.

Black or African American↗

PubMed2001

Position of the American Dietetic Association: the impact of fluoride on health.

Fluoride is an important element for mineralization of body tissues. The use of topical and systemic fluoride for oral health has resulted in major reductions in dental caries and its associated disability. Fluoridation of public water supplies has been endorsed by over 90 professional health organizations as the most effective dental public health measure in existence. Still, about half of the US population fails to receive the maximum benefits possible from community water fluoridation and the use of fluoride products. Fluoride also plays a role in bone health. The role of high doses of fluoride for prevention of osteoporosis is undergoing active study and is considered experimental at this point. Dietetics professionals should routinely monitor and promote the use of systemic and topical fluorides, especially in children and adolescents. The American Dietetic Association strongly reaffirms its endorsement of the use of systemic and topical fluorides, including water fluoridation, at appropriate levels of intake, as an important public health measure. However, clients should be cautioned that experimental use of high intakes of fluoride should be avoided unless they are participating in clinical trials.

Administration, Topical↗

PubMed2001

Program directors' opinions in regard to Didactic Program in Dietetics graduates' failure to secure placement in Supervised Practice Programs.

This study investigated program directors' perspectives on Didactic Program in Dietetics graduates' inability to secure positions in Supervised Practice Programs. The sample included all 229 program directors listed in the Directory of Dietetics Programs 1997-98. Directors contacted by electronic mail or fax completed a 4-part survey instrument including 3 Likert scale sections exploring the effects of the situation and strategies suggested to lessen them. The fourth part reported current practices. Response rate was 56%. Graduates' failure to secure Supervised Practice Program positions was found to be a significant or somewhat significant problem regardless of program size or affiliation. Strategies to increase the likelihood of Supervised Practice Program acceptance included work experience, application coaching, graduate coursework, and reapplication. We found that program directors have a high level of concern about their graduates' futures and are frustrated by their limited ability to improve the situation. Helping graduates who do not secure Supervised Practice Program assignments identify career options is essential.

Career Choice↗

PubMed2001

Position of the American Dietetic Association: breaking the barriers to breastfeeding.

It is the position of the American Dietetic Association (ADA) that broad-based efforts are needed to break the barriers to breastfeeding initiation and duration. Exclusive breastfeeding for 6 months and breastfeeding with complementary foods for at least 12 months is the ideal feeding pattern for infants. Increases in initiation and duration are needed to realize the health, nutritional, immunological, psychological, economical, and environmental benefits of breastfeeding. Breastfeeding initiation rates have increased, but cultural barriers to breastfeeding, especially against breastfeeding for 6 months and longer, still exist. Gaps in rates of breastfeeding based on age, race, and socioeconomic status remain. Children benefit from the biologically unique properties of human milk including protection from illness with resulting economic benefits. Mother's benefits include reduced rates of premenopausal breast and ovarian cancers. Appropriate lactation management is a critical component of successful breastfeeding for healthy women. Lactation support and management is even more important in women and children with special needs caused by physical or developmental disability, disease, or limited resources. Dietetics professionals have a responsibility to support breastfeeding through appropriate education and training, advocacy, and legislative action; through collaboration with other professional groups; and through research to eliminate the barriers to breastfeeding.

Attitude↗

PubMed2002

Position of the American Dietetic Association: total diet approach to communicating food and nutrition information.

It is the position of the American Dietetic Association that all foods can fit into a healthful eating style. The ADA strives to communicate healthful eating messages to the public that emphasize the total diet, or overall pattern of food eaten, rather than any one food or meal. If consumed in moderation with appropriate portion size and combined with regular physical activity, all foods can fit into a healthful diet. Public policies that support the total diet approach include Reference Dietary Intakes, Food Guide Pyramid, Dietary Guidelines for Americans, Nutrition Labeling and Healthy People 2010. The value of a food should be determined within the context of the total diet because classifying foods as "good" or "bad" may foster unhealthy eating behaviors. Eating practices are influenced by taste and food preferences, concerns about nutrition and weight control, physiology, lifestyle, environment, and food product safety. To increase the effectiveness of nutrition education in promoting sensible food choices, dietetics professionals plan communications and educational programs that utilize theories and models related to human behavior. Communication campaigns/programs should implement an active, behaviorally focused approach within the larger context of food choices. Nutrition confusion can be reduced by emphasizing moderation, appropriate portion size, balance and adequacy of the total diet over time, the importance of obtaining nutrients from foods, and physical activity.

Advertising↗

PubMed2002

Position of the American Dietetic Association: nutrition services in managed care.

It is the position of the American Dietetic Association that medical nutrition therapy is an essential component of disease management and healthcare provided by managed care organizations, and that such care must be provided by qualified nutrition professionals. Compared with traditional fee-for-service reimbursement systems, managed care presents new opportunities for dietetics professionals. Until recently, the lack of billing infrastructure has handicapped nutrition providers who wish to bill for their services and has made it difficult to track the outcomes of nutrition care. With the publication of current procedure terminology codes for medical nutrition therapy (MNT) and the implementation of MNT benefits in Medicare part B for diabetes and nondialysis kidney disease, commercial payers, including managed care organizations (MCOs) are likely to implement or expand their coverage of MNT. A large body of evidence supports the efficacy and cost-effectiveness of MNT coverage within managed care plans. This evidence includes cost analyses of conditions treated by MNT, and clinical trial data confirming the efficacy of MNT in improving patient outcomes. MNT is also an important part of national standards of care for many chronic disease conditions. Based on evidence supporting the role of MNT in improving patient outcomes, the Institute of Medicine (IOM) recommended that MNT services be reimbursed by Medicare when patients are referred by a physician. Provision of appropriate MNT can also help MCOs meet accreditation and quality standards established by entities such as the National Committee for Quality Assurance and the Joint Commission for the Accreditation of Health Care Organizations. Much of the work required to secure a place for MNT in MCOs will be done at the practitioner level, by nutrition professionals themselves. Registered dietitians must market MNT to their customers in managed care by addressing the needs of each player. By emphasizing the importance of MNT and other cost-effective forms of preventive care and disease management, MCOs will be well positioned to improve population health at modest cost.

Cost-Benefit Analysis↗

PubMed2002

Position of the American Dietetic Association: domestic food and nutrition security.

In 2000, over 10% of United States (US) households, including more than 33 million people, experienced food insecurity. Food insecurity negatively affects the dietary intake and nutritional status of adults leading to poor health and increased risk for the development of chronic diseases. Food insecurity also negatively affects children's health, psychological and cognitive functioning, and their academic achievement. It is the position of the American Dietetic Association that systematic and sustained action is needed to bring an end to domestic food insecurity and hunger and to achieve food and nutrition security for all in the US. Immediate and long-range interventions, including adequate funding for and increased utilization of food and nutrition assistance programs, the inclusion of food and nutrition education in all programs providing food and nutrition assistance, and innovative programs to promote and support the economic self-sufficiency of individuals and families, are key to ending domestic food insecurity. Dietetics professionals can play a key role in ending food insecurity not only through competent and collaborative practice, but also through advocacy efforts at the local, state, regional, and national levels.

Dietetics↗

PubMed2003

A preceptor focus group approach to evaluation of a dietetic internship.

Geographical dispersion of preceptors within dietetic internship programs creates educational challenges. Iowa State University's dietetic internship utilizes preceptors from more than 90 facilities statewide. Three preceptor focus groups were conducted to identify strengths and areas needing improvement in the internship, including preceptor and intern needs and expectations. Of the more than 90 preceptors representing medical nutrition therapy, foodservice management, and community nutrition, 36 were contacted and 18 preceptors participated, resulting in 5 to 7 participants per focus group. Emerging themes included effective feedback; preceptor networking; and communication between internship program/faculty, interns, and preceptors. Geographic isolation and minimal use of Internet-based resources may contribute to these themes. Whereas the majority of preceptors had access to the Internet, only 7 (38%) had accessed the Internet-based resources provided by the program. Preceptor suggestions can provide new perspectives for enhancing the learning environment. Regional workshops and e-mail list-serves can help facilitate communication and networking among preceptors.

Communication↗

PubMed1995

Automating clinical dietetics documentation.

A review of commonly used charting formats discussed in the dietetics literature revealed that the subjective, objective assessment and planning (SOAP) approach is most frequently used by dietitians. Formats reported in the nursing literature were charting by exception (CBE); problem, intervention, evaluation (PIE); and focus/data, action, response (Focus/DAR). The strengths and weaknesses of the charting styles as they apply to the needs of clinical dietetic specialists were reviewed. We then decided to test in house the Focus/DAR format by assessing chart entries for adherence to style, brevity, and physician response. Dietitians pilot tested all the methods, but found them time consuming to use. The consensus was that SOAP could be adapted to the documentation needs of the individual situation and required little additional staff training. Often because of time limitations, a narrative summary was most appropriate. Chart entry length was reduced as much as 200% when staff were given brief clinical communication as a goal, and a further reduction when line limits were imposed. The physician response was positive, with recommendations followed in 50% of charts, compared with 34% in a previous audit. A nutrition documentation system was developed by the researchers by reviewing medical chart structure, documentation standards, methods of risk identification, and terminology for clinical documentation style. The resulting system affected the decision making of physicians, who could now scan notes more quickly and implement nutrition recommendations in a more timely fashion.

Diet Records↗

PubMed1995

Position of the American Dietetic Association: food and nutrition misinformation.

Food and nutrition experts, including ADA members, need to take an active role in helping consumers recognize misinformation. The challenge of dealing with food and nutrition misinformation is long-standing and persistent. However, qualified dietetics professionals, in partnership with other members of the health-care team, educators, and representatives of the food industry, can be a forceful voice against food and nutrition misinformation. Qualified dietetics professionals can positively shape the food choices of Americans by collaborating with the media to communicate balanced nutrition information to consumers and to counter misinformation; writing letters to the editors of newspapers and magazines to counter inaccurate and biased articles; calling television and radio shows that interview nutrition extremists and purveyors of misinformation to express their professional concerns; directing the news media and consumers to responsible sources of nutrition information; encouraging researchers to present their results with a balanced perspective; collaborating with the food industry to provide reliable nutrition information; and cooperating with other practitioners to expose emerging misinformation, misbeliefs, frauds, and quackery before they are widely accepted.

Consumer Advocacy↗

PubMed1995

Academic measures available in sophomore year can predict application and admission to dietetic supervised practice programs.

The purpose of the study was to determine whether college grade point average (GPA) and application and admission to supervised practice programs could be predicted from measures available in the sophomore year. The sample consisted of 193 graduates of a didactic program in a research university in class years 1986 to 1993. Variables tested included GPA in required dietetics program courses, SAT scores, high school class rank, and age. prediction equations were developed using data from class years 1986 to 1992 and tested on subjects in class year 1993. Subjects who applied to and were admitted to supervised practice programs had significantly higher GPAs. In class years 1986 to 1992, GPAs and SAT math scores of sophomores explained 88% of the variance in the college GPA, whereas the sophomore GPA for professional courses correctly classified 63% of applicants and 73% of admitted subjects. Using these prediction equations for the class of 1993, college GPA of subjects was accurately predicted and 84% of applicants and 75% of admitted subjects were correctly classified. The results of this study provide valuable information for didactic program directors to counsel students into or out of a dietetics program, and could decrease the number of graduates who do not complete registration requirements.

Adult↗

PubMed1995

Eating disorders: current nutrition therapy and perceived needs in dietetics education and research.

OBJECTIVE: Research was conducted to obtain a profile of nutrition therapy currently in practice for patients with anorexia nervosa, bulimia nervosa, and anorexia/bulimia (mixed diagnosis) and to identify the areas of dietetics education and research regarding eating disorders that need more attention. DESIGN: A cross-sectional correlational survey was conducted by mailing a questionnaire composed of open- and closed-ended questions to US dietitians who work with patients who have eating disorders. SAMPLE: Of 199 dietitians selected from a list of 495 representing all geographic areas of the United States, 117 responded. The list was obtained from a national referral network for eating disorders. STATISTICAL ANALYSIS: chi 2 Analysis was completed on all closed-ended answers. Pearson's correlation coefficient with a value of P < .05 was considered significant. RESULTS: Nutrition therapy administered varied among dietitians treating inpatients, outpatients, and both. Three community groups were identified as most important to reach for prevention of eating disorders: junior high school students, coaches, and parents. Crucial areas of research were perceived by 94 dietitians to be comparative effectiveness of techniques of medical nutrition therapy (n = 55) and of techniques of prevention (n = 26) and increased understanding of etiology in relation to identification of high-risk groups and prevention (n = 21). Dietitians desired further information on multiple topics related to eating disorders. APPLICATION: Medical nutrition therapy for eating disorders is a specialization that requires education and training beyond the minimum required for dietetic registration. Some of the techniques required are unique to this specialization due, in part, to the psychological nature of the disorders. All dietitians, however, must be able to recognize and refer patients with eating disorders; these skills must be included in basic undergraduate programs and internships. This study supports the need for more research concerning the outcomes of nutrition therapy and the effectiveness of prevention programs.

Anorexia Nervosa↗

PubMed1995

Standards of practice for gerontological nutritionists: a mandate for action. The American Dietetic Association.

Dietitians who had been members of the Gerontological Nutritionists dietetic practice group for more than 2 years were sent a questionnaire to determine demographics of members and to ascertain their level of agreement and compliance with 26 suggested criteria and supporting documentation for standards of practice. Standards of practice for gerontological nutritionists were based on the six Standards of Practice of The American Dietetic Association. Of the 1,571 questionnaires mailed, 415 were returned. Data were analyzed using the StatPac Gold statistical analysis package. All correlation analyses were positive with correlation coefficients in the range of 0.0 to 1.0. Correlation coefficients and mean scores were highest for the standards related to maintaining credentials and adhering to a code of ethics. Compliance was weakest for standards related to conducting research to justify reimbursement for nutrition services (correlation of 0.22) and advocating public policies to ensure quality nutrition care and dissemination of information (correlation of 0.25). Results indicate that to comply with the standards of practice, members need to be proactive in showing efficacy and cost-effectiveness of medical nutrition therapy; conduct, document, and apply outcome research to practice; and advocate public policies affecting older people.

Aged↗