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Research is essential to further advance our understanding of the role of nutrition and dietetics in maintenance and improvement of health. Research is also essential for nutrition and dietetics practitioners to create and provide evidence-based interventions, including medical nutrition therapy provided by registered dietitian nutritionists. Given this critical role of research, the Academy of Nutrition and Dietetics (Academy) has a variety of resources to assist its members in accessing, understanding, participating in, conducting, and disseminating nutrition research. These resources are comprehensive and include opportunities to participate in research (eg, Nutrition Research Network and Data Science Center), tools to aggregate practice data (Nutrition Care Process and Terminology and the Academy of Nutrition and Dietetics Informatics Infrastructure), funding opportunities to support primary research (eg, Academy Foundation), resources to understand the latest research informing evidence-based practice (eg, Evidence Analysis Center), and avenues for sharing research findings (eg, Foodamp; Nutrition Conferenceamp; Expo™). The aim of this article is to encourage Academy members to get involved in research by describing Academy-based research resources and opportunities to contribute to nutrition and dietetics research, as well as describe specific examples of research conducted at the Academy. The information presented can serve as a framework to guide members in engaging in research through the Academy.

Background While obesity presents specific acute and long-term risks to the pregnant woman and her offspring, the effects of bariatric surgery on pregnancy outcomes are undetermined. Objective A systematic review was performed according to the Academy of Nutrition and Dietetics Evidence Analysis Library process to determine the effects of bariatric surgery on both maternal and infant health outcomes of pregnancy. Design A comprehensive literature search of PubMed was conducted to identify studies published from years 2000 to 2015 that examined the health effects of pregnancy after bariatric surgery. Experimental studies and observational studies with a control group were included. Main outcome measures Outcomes of interest were gestational weight gain, maternal complications (ie, gestational diabetes, pre-eclampsia, eclampsia, hypertension, and postpartum hemorrhage), miscarriage and/or stillbirth, cesarean section, birth weight in grams, birth weight in categories (ie, macrosomia, low birth weight, small for gestational age, and large for gestational age), gestational age and preterm birth, infant illness and complications (ie, perinatal death, admission to neonatal intensive care unit, neonatal illness, and congenital malformation rates), and Apgar scores. Results Thirteen of 246 studies were included. Compared to body mass index–matched controls without surgery, bariatric surgery before pregnancy reduced infant birth weight in grams, with no effect on total maternal gestational weight gain or Apgar scores. Surgery did not increase risk of adverse outcomes, such as miscarriage and/or stillbirth, preterm birth, or infant complications. Effects of surgery on maternal complications, infant birth weight categories, and surgical delivery rates were inconsistent. Conclusions Bariatric surgery is a successful treatment of maternal obesity, but certain surgery-specific risks may exist. More data are needed to determine clinical guidelines. The long-term effects of surgery on pregnancy outcomes are unknown.

Background Dietitians in countries across the world have been implementing the Nutrition Care Process (NCP) and Terminology (NCPT) during the past decade. The implementation process has been evaluated in specific countries and in smaller international studies; however, no large international study comparing implementation between countries has been completed. Objective The aim of this study was to describe and compare the level of NCP/NCPT implementation across 10 countries. Methods A previously tested web-based survey was completed in 2017 by 6,719 dietitians across 10 countries. Participants were recruited through e-mail lists, e-newsletters, and social media groups for dietitians. Nondietitians were excluded through screening questions and targeted dissemination channels. Main outcome measures and statistical analysis The main outcome of interest was the level of implementation of each of the four NCP steps. Differences in implementation between the NCP (process) and NCPT (terminology) were also measured. Differences between groups were assessed using Kruskal-Wallis test and Mann-Whitney U test. Multiple linear regression was used to assess relationships between the main outcomes and respondent demographic information. Results Australia, New Zealand, and the United States had higher implementation rates compared with other countries surveyed. Awareness of the NCP was high in most countries (>90%) but lower in Greece (50%). All countries had a higher implementation level of the NCP (process) compared with the NCPT (terminology). Dietitians working with inpatients reported the highest implementation levels while those working in public health reported the lowest. Conclusions Dietitians in countries with more experience in NCP/NCPT implementation and a clear implementation strategy had higher levels of implementation. To achieve a successful NCP/NCPT implementation among dietitians, there is a need to promote the value of a standardized dietetic language together with the more easily implemented process. There is also a need to promote NCP/NCPT for all areas of practice, and develop strategic plans for implementation of the NCP and NCPT.

Documentation is essential for communicating care between credentialed nutrition and dietetics practitioners and other health care providers. A validated tool that can evaluate quality documentation of the Nutrition Care Process (NCP) encounter, including progress on outcomes is lacking. The aim of the NCP Quality Evaluation and Standardization Tool (QUEST) validation study is to revise an existing NCP audit tool and evaluate it when used within US Veterans Affairs in all clinical care settings. Six registered dietitian nutritionists revised an existing NCP audit tool. The revised tool (NCP-QUEST) was analyzed for clarity, relevance, and reliability. Eighty-five documentation notes (44 initial, 41 reassessment) were received from eight volunteer Veterans Affairs sites. Five of six registered dietitian nutritionists participated in the interrater reliability testing blinded to each other's ratings; and two registered dietitian nutritionists participated in intrarater reliability reviewing the same notes 6 weeks later blinded to the original ratings. Results showed moderate levels of agreement in interrater reliability (Krippendorff’s α = .62 for all items, .66 for total score, and .52 for quality category rating). Intrarater reliability was excellent for all items (α = .86 to .87 for all items; .91 to .94 for total score and.74 to .89 for quality category rating). The NCP-QUEST has high content validity (Content Validity Index = 0.78 for item level, and 0.9 for scale level) after two cycles of content validity review. The tool can facilitate critical thinking, improved linking of NCP chains, and is a necessary foundation for quality data collection and outcomes management. The NCP-QUEST tool can improve accuracy and confidence in charting.

More evidence regarding registered dietitian nutritionist implementation of evidence-based nutrition practice guidelines (EBNPGs) is needed. We assessed the utility of an automated informatics tool to evaluate congruence of documented nutrition care with 13 individual recommendations in the diabetes mellitus (DM) EBNPG and with the guideline overall. A concurrent validation study was conducted using Nutrition Care Process Terminology documentation entered in the Academy of Nutrition and Dietetics Health Informatics Infrastructure by registered dietitian nutritionists caring for patients with DM. A 15% subset (n = 115) of the 790 patient encounters recorded were selected randomly, and the documented care was evaluated using the automated DM Expected Care Plan (ECP) Analyzer and expert audit. Recommendation-level congruence, as determined by each method, was compared using Cohen’s κ analysis, and the accuracy, sensitivity, and specificity of the DM ECP Analyzer for assessing overall guideline-level congruence was calculated with expert audits as the “gold standard.” For recommendation-level congruence, the DM ECP Analyzer identified more instances of recommendation implementation in the patient encounters, and classified more encounters as including partial or full recommendation implementation for 10 of the 13 recommendations, compared with the expert audit. There was slight to fair agreement between the DM ECP and the expert audit for most individual recommendations, with a mean ± standard deviation level of agreement of κ = .17 ± .19 across all eligible recommendations. At the guideline level, the DM Analyzer had high accuracy (98.3%) and sensitivity (99.1%) and low specificity (0%; no true negatives detected). The DM ECP Analyzer is acceptable for conducting automated audits of nutrition documentation to assess congruence of documented care with recommendations for evidence-based care. Future changes to the EBNPG, Nutrition Care Process Terminology, Academy of Nutrition and Dietetics Health Informatics Infrastructure, and the DM ECP Analyzer could potentially improve recommendation-level performance. The DM ECP Analyzer can be modified for other EBNPGs to facilitate automated assessment of guideline implementation.

Using real-world data from the Academy of Nutrition and Dietetics Health Informatics Infrastructure, we use state-of-the-art clustering techniques to identify 2 phenotypes characterizing the episodes of nutrition care observed in the National Quality Improvement (NQI) registry data set. The 2 phenotypes identified from recorded Nutrition Care Process data in the NQI exhibit a strong correspondence with the clinical expertise of registered dietitian nutritionists. For one of these phenotypes, it was possible to implement state-of-the-art classification techniques to predict the nutrition problem-resolution status of an episode of care. Prediction results show that the assessment of nutrition history, number of recorded visits in the episode, and use of nutrition counseling interventions were significantly and positively correlated with problem resolution. Meanwhile, evaluations of nutrition history that were not within the desired ranges were significantly and negatively correlated with problem resolution. Finally, we assess the usefulness of the current NQI data set and data model for supporting the application of contemporary machine learning methods to the data set. We also suggest ways of enhancing the NQI since registered dietitian nutritionists are encouraged to continue to contribute patient cases in this and other registry nutrition studies.

Limited research exists to evaluate nutrition guideline impact on clinical practice and patient health outcomes. In this study we investigate (1) the impact of guideline training on the implementation of the diabetes prevention Evidence-Based Nutrition Practice Guideline (EBNPG), and (2) the relationship between EBNPG congruence and resulting health outcomes in patients with prediabetes. We conducted an implementation study in which registered dietitian nutritionists (RDNs) provided nutrition care with 3-month follow-up to 102 pre-diabetes patients before and after a professional training on the implementation of the Diabetes Prevention EBNPG. Using the RDNs' Nutrition Care Process (NCP) documentation, we measured percent guideline congruence and health outcomes (body weight, waist circumference, fasting glucose, glycosylated hemoglobin), and modeled health outcomes. Guideline congruence improved after training by 4.3% (P0.05). However, no significant associations were observed between guideline training, or guideline congruence and health outcomes. Our model showed a reduction in waist circumference (2.1 ± 0.92 cm; P = 0.023), and body weight (-1.78 ± 0.55 kg; P = 0.001) throughout the course of the study. Training of nutrition professionals improved congruence to EBNPG for Diabetes Prevention. Nevertheless, improved guideline congruence did not impact related health outcomes. Standard care including nutrition intervention resulted in body weight and waist circumference reductions. Future research needs to further address the impact of evidence-based guidelines on outcomes in all areas of practice.

Provision of nutrition care is vital to the health and well-being of any patient who enters the health care system, whether in the ambulatory, inpatient, or long-term care setting. Interdisciplinary professionals—nurses, physicians, advanced practice providers, pharmacists, and dietitians—identify and treat nutrition problems or clinical conditions in each of these health care settings. The documentation of nutrition care in a structured format from screening and assessment to discharge allows communication of the nutrition treatment plans. The goal of this document is to provide recommendations to clinicians for working with an organization’s Information Systems department to create tools for documentation of nutrition care in the electronic health record. These recommendations can also serve as guidance for health care organizations choosing and implementing health care software.

Background Given the high rates of vitamin D deficiency among pregnant women and possible effects on offspring health, a systematic review on this topic was conducted to help inform future practice guidelines. Objective To evaluate associations between maternal vitamin D supplementation, maternal 25-hydroxyvitamin D (25(OH)D) concentrations, and health outcomes. Methods A PubMed literature search was conducted to identify studies that examined the health effects of vitamin D supplementation during pregnancy on maternal and infant health outcomes published from 2000 to 2016. Among 976 identified publications, 20 randomized clinical trials met the inclusion criteria. The initial search was extended to include five studies published between July 2016 and September 2018. Main outcome measures Maternal and infant 25(OH)D concentrations, gestational diabetes, preeclampsia or gestational hypertension, cesarean section, maternal parathyroid hormone and calcium concentrations, and infant gestational age, birth weight, and birth length. Statistical analyses Mean differences, odds ratios, and 95% CIs were calculated, only for the initial search, using separate random-effects meta-analyses for each outcome. Results Evidence was good or strong that maternal vitamin D supplementation significantly increased maternal (13 studies, n=18, mean difference, 14.1 ng/mL [35.2 nmol/L]; 95% CI=9.6-18.6 ng/mL [24.0-46.4 nmol/L]) and infant (nine studies, n=12; 9.7, 5.2, 14.2 ng/mL [24.2, 12.9, 35.5 nmol/L]) 25(OH)D concentrations, although heterogeneity was significant (I2=95.9% and I2=97.4, respectively, P Conclusions Results show vitamin D supplementation during pregnancy improves maternal and infant 25(OH)D concentrations and may play a role in maternal insulin resistance and fetal growth. To further inform practice and policies on the amount of vitamin D, which supports a healthy pregnancy, high quality dose-response randomized clinical trials, which assess pregnancy-specific 25(OH)D thresholds, and appropriately powered clinical outcomes are needed.

Background The Nutrition Care Process (NCP) and NCP Terminology (NCPT) is a systematic framework for critical thinking, decision making, and communication for dietetics practitioners worldwide, aiming to improve quality and patient safety in nutrition care. Although dietetics practitioners in several countries have implemented the NCP/NCPT during recent years, to date there is no globally validated instrument for the evaluation of NCP/NCPT implementation that is available in different languages and applicable across cultures and countries. Objective The aim of this study was to develop and test a survey instrument in several languages to capture information at different stages of NCP/NCPT implementation across countries and cultures. Setting In this collaboration between dietetics practitioners and researchers from 10 countries, an International NCP/NCPT Implementation Survey tool was developed and tested in a multistep process, building on the experiences from previous surveys. The tool was translated from English into six other languages. It includes four modules and describes demographic information, NCP/NCPT implementation, and related attitudes and knowledge. Methods The survey was reviewed by 42 experts across 10 countries to assess content validity and clarity. After this, 30 dietetics practitioners participated in cognitive interviews while completing the survey. A pilot study was performed with 210 participants, of whom 40 completed the survey twice within a 2- to 3-week interval. Results Scale content validity index average was 0.98 and question clarity index was 0.8 to 1.0. Cognitive interviews and comments from experts led to further clarifications of the survey. The repeated pilot test resulted in Krippendorff's α=.75. Subsequently, refinements of the survey were made based on comments submitted by the pilot survey participants. Conclusions The International NCP/NCPT Implementation Survey tool demonstrated excellent content validity and high test–retest reliability in seven different languages and across an international context. This tool will be valuable in future research and evaluation of implementation strategies.

In the late 20th century, plant breeders began using molecular biology techniques such as recombinant DNA, also known as genetic engineering, along with traditional cross-breeding. Ten plant and one animal food have been approved for commercialization in the United States. Today, foods and ingredients from genetically engineered (GE) crops are present throughout the food supply, which has led to varying levels of acceptance. Much discussion exists among consumers and health professionals about the believability of statements made regarding benefits or risks of GE foods. The aim of this systematic review was to examine the evidence on the association of consumption of GE foods and ingredients derived from them on human health, specifically allergenicity, food safety, pesticide consumption, nutrient adequacy, inflammation, and antibiotic resistance. An expert panel conducted a systematic review on advanced technology in food production. The 30 developed questions focused on effects of human consumption of GE foods and the effects of human consumption of foods containing pesticide residues on human health. Primary research published from 1994 to 2014 were identified using PubMed and Agricultural Online Access databases. Additional studies were identified by searching references of review articles. Twenty-one studies met the inclusion criteria. Relevant research addressed five of 30 questions. Four questions focused on food allergenicity, the fifth on nutrient adequacy, and all received a Grade III (limited/weak) rating. No human studies addressed 25 questions on the consumption of foods produced using genetic engineering technologies on gene translocation, cancer, food safety, phenotype expression, inflammation and inflammatory markers, or antibiotic resistance. These questions received a Grade V (grade not assignable). Evidence from human studies did not reveal an association between adverse health effects and consumption of foods produced using genetic engineering technologies. Although the number of available human studies is small, they support that there are no clear adverse health effects-as they relate to allergenicity and nutrient adequacy-associated with consumption of GE foods. The present systematic review is aligned with a recent report by the National Academy of Sciences that included human and animal research.

Asthma and overweight/obesity prevalence are both increasing worldwide. Overweight/obesity has been suggested as a risk factor for developing asthma. The aim of this review is to present and evaluate recent publications that help answer the question: "Is increased body weight (at least overweight status) related to asthma in children?" A systematic review of epidemiologic literature was carried out using the MEDLINE database. Epidemiologic studies on young human subjects (ie, infants, children, and adolescents), published in English during the period 2006-2011 were included. A comprehensive literature search yielded 434 studies for further consideration. Forty-eight studies fulfilled the review's eligibility criteria. Two researchers applied the MOOSE Guidelines for Meta-Analysis and Systematic Reviews of Observational Studies on all identified studies. Current evidence supports a weak yet significant association between high body weight and asthma. New information indicates that central obesity in children increases asthma risk. Also, the link between high body weight and asthma may be stronger in nonallergic asthma. There are mixed results about the importance of sex. Although the nature of the association between overweight/obese status and asthma remains unclear, prospective studies point that high body weight precedes asthma symptoms. These data add weight to the importance of preventing and treating a high body weight against asthma outcomes. Available research in children has not studied adequately the influence of weight change (either gain or loss) on asthma symptoms, an area of clinical importance. Beyond energy control, the role of diet as a possible inflammatory stimulus warrants further investigation. Limited data seem to favor the promotion of breastfeeding in attenuating the overweight/obesity–asthma relationship. Finally, future research should include weight intervention studies assessing various measures of body fat in relation to well-defined asthma outcomes.

The International NCP (Nutrition Care Process) Implementation Survey (INIS): Preliminary Data from Greek Dietitians-Nutritionists

Hypertension (HTN) or high blood pressure (BP) is among the most prevalent forms of cardiovascular disease and occurs in approximately one of every three adults in the United States. The purpose of this Evidence Analysis Library (EAL) guideline is to provide an evidence-based summary of nutrition therapy for the management of HTN in adults aged 18 years or older. Implementation of this guideline aims to promote evidence-based practice decisions by registered dietitian nutritionists (RDNs), and other collaborating health professionals to decrease or manage HTN in adults while enhancing patient quality of life and taking into account individual preferences. The systematic review and guideline development methodology of the Academy of Nutrition and Dietetics were applied. A total of 70 research studies were included, analyzed, and rated for quality by trained evidence analysts (literature review dates ranged between 2004 and 2015). Evaluation and synthesis of related evidence resulted in the development of nine recommendations. To reduce BP in adults with HTN, there is strong evidence to recommend provision of medical nutrition therapy by an RDN, adoption of the Dietary Approaches to Stop Hypertension dietary pattern, calcium supplementation, physical activity as a component of a healthy lifestyle, reduction in dietary sodium intake, and reduction of alcohol consumption in heavy drinkers. Increased intake of dietary potassium and calcium as well as supplementation with potassium and magnesium for lowering BP are also recommended (fair evidence). Finally, recommendations related to lowering BP were formulated on vitamin D, magnesium, and the putative role of alcohol consumption in moderate drinkers (weak evidence). In conclusion, the present evidence-based nutrition practice guideline describes the most current recommendations on the dietary management of HTN in adults intended to support the practice of RDNs and other health professionals.