Search Results (110)

Background/Objectives: Household food insecurity is a modifiable social determinant of health with important implications for diet quality and health outcomes. Dietitians are well positioned to identify and respond to food insecurity; however, little is known about how this is addressed in routine dietetic practice across Europe. This exploratory study examined food insecurity screening and response practices among dietitians practicing in Europe and examined associated correlates using the Capability, Opportunity, and Motivation Model of Behaviour (COM-B). Methods: An online cross-sectional survey informed by the COM-B framework was distributed through the European Federation of Associations of Dietitians’ institutional communication channels between February and June 2024. Participants were recruited using a voluntary, convenience-based sampling strategy through professional networks and social media dissemination. A total of 148 dietitians practicing in European countries responded. The questionnaire assessed routine food insecurity screening practices, COM-B correlates, perceived barriers, actions taken following identification, and learning needs. Quantitative data were analysed descriptively, and open-ended responses were used illustratively to contextualise reported practices. Results: Food insecurity screening was not systematically embedded in routine dietetic practice, with 11.6% of respondents reporting routine screening and 30.2% not asking about food insecurity. Identification of food insecurity did not consistently translate into follow-up action, and responses were predominantly referral-based rather than involving direct material support. While capability and motivation to address food insecurity were generally high, opportunity-related factors—such as time constraints, limited organisational support, and unclear referral pathways—emerged as the main barriers shaping professional behaviour. Substantial heterogeneity was observed across practice settings. Conclusions: In this sample of dietitians practicing in Europe, food insecurity screening and response were variable and often constrained by organisational and contextual factors. These findings highlight the need for system-level support and practice-oriented training to facilitate the integration of food insecurity into routine dietetic care. Full article

Background: Poor or rapid growth velocity in early childhood can have negative long-term health consequences. Early identification of children at risk of growth problems facilitates timely intervention to change growth trajectories and health parameters, but barriers exist to routine screening in primary care. Methods: Experts from general practice, primary care nursing, pediatrics, dietetics, and academic research convened to develop a practical algorithm to support routine growth screening and intervention in children aged 1 to 5 years in primary care. Results: Using a single initial measurement of weight and height in conjunction with risk factor assessment, the algorithm presented here identifies children at risk of poor or rapid growth velocity and provides guidance for intervention and follow-up frameworks. Conclusions: This tool helps to define children in the community setting who are at risk of poor or rapid growth velocity and supports primary care providers in promoting healthy growth trajectories through timely intervention and continued routine growth monitoring. Full article

Background/Objectives: The Nutrition Care Process (NCP) is a standardized model designed to improve the quality and consistency of nutrition care. However, its implementation remains variable across settings, influenced by factors such as time constraints, training, peer support, and technological infrastructure. This systematic review aims to synthesize the available evidence on barriers and facilitators influencing the implementation of the NCP/NCPT and to explore how different documentation formats may influence its adoption. Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines and included peer-reviewed studies published between 2009 and 2024 in English or Greek. Searches were conducted in MEDLINE, EMBASE, Scopus, CINAHL, and the Cochrane Library. Study quality was assessed using the National Heart, Lung, and Blood Institute (NIH) tool. A total of 11 reports representing eight studies were included, comprising cross-sectional, cohort, qualitative, and pilot designs. Results: The most commonly reported barriers to NCP implementation were lack of training, time constraints, and limited technological infrastructure. Key facilitators included support from national dietetic associations, peer collaboration, and access to electronic health records (EHRs). Electronic formats were more frequently described as supporting improved documentation practices, practitioner confidence, and workflow efficiency, whereas manual approaches were commonly reported as time-consuming and less structured. Conclusions: Digital integration of the NCP may support more consistent documentation practices and improved workflow processes; however, the current evidence is largely observational and heterogeneous. Evidence regarding patient-level outcomes remains limited, and definitive conclusions regarding the comparative effectiveness of implementation formats cannot be drawn. Further high-quality research is needed to evaluate the long-term clinical impact of NCP implementation. Full article

Background: Artificial intelligence (AI) is increasingly being integrated into healthcare, with applications ranging from predictive analytics to clinical decision support. In clinical nutrition, AI tools offer opportunities to improve workflow efficiency, enhance dietary assessment, and personalize nutrition care. Despite growing interest, little is known about registered dietitian nutritionists’ (RDNs) perceptions of AI in clinical practice. The aim of the present study was to assess RDNs’ attitudes toward AI use within a large healthcare system, along with their perceived barriers in this regard. Methods: A cross-sectional survey was developed through expert review and distributed electronically via REDCap to RDNs across Mayo Clinic’s academic campuses and affiliated health system sites. The 23-item survey included Likert-scale items addressing AI’s potential utilization within clinical care, perceived benefits and risks, and readiness for adoption. Responses were summarized using descriptive statistics. Factor analysis identified underlying constructs related to AI attitudes. Differences stratified by age and years of experience were evaluated using ANOVA. Results: Of the 185 RDNs invited, 64 (35%) responded. Two factors emerged: optimism regarding AI usage (Cronbach’s α = 0.94) and skepticism about implementation (α = 0.76). The overall mean ± SD score for optimism was 0.1 ± 0.6 (neutral), while skepticism averaged 1.0 ± 0.6 (moderate). Skepticism differed by years of experience (p = 0.012), with the lowest levels observed among RDNs with ≥21 years of practice. No significant differences were observed across age groups. Discussion: RDNs demonstrated neutral attitudes toward AI use but expressed concerns about accuracy, training, and implementation challenges. Addressing these concerns through education and structured implementation strategies may facilitate successful adoption of AI in dietetic practice. Full article

Background/Objectives: The growing integration of Artificial Intelligence (AI) and chatbots in health professional education offers innovative methods to enhance learning and clinical preparedness. This study aimed to evaluate the educational impact and perceptions in university students of Human Nutrition and Dietetics, regarding the utility, usability, and design of the E+DIEting_Lab chatbot platform when implemented in clinical nutrition training. Methods: The platform was piloted from December 2023 to April 2025 involving 475 students from multiple European universities. While all 475 students completed the initial survey, 305 finished the follow-up evaluation, representing a 36% attrition rate. Participants completed surveys before and after interacting with the chatbots, assessing prior experience, knowledge, skills, and attitudes. Data were analyzed using descriptive statistics and independent samples t-tests to compare pre- and post-intervention perceptions. Results: A total of 475 university students completed the initial survey and 305 the final evaluation. Most university students were females (75.4%), with representation from six languages and diverse institutions. Students reported clear perceived learning gains: 79.7% reported updated practical skills in clinical dietetics and communication were improved, 90% felt that new digital tools improved classroom practice, and 73.9% reported enhanced interpersonal skills. Self-rated competence in using chatbots as learning tools increased significantly, with mean knowledge scores rising from 2.32 to 2.66 and skills from 2.39 to 2.79 on a 0–5 Likert scale (p < 0.001 for both). Perceived effectiveness and usefulness of chatbots as self-learning tools remained positive but showed a small decline after use (effectiveness from 3.63 to 3.42; usefulness from 3.63 to 3.45), suggesting that hands-on experience refined, but did not diminish, students’ overall favorable views of the platform. Conclusions: The implementation and pilot evaluation of the E+DIEting_Lab self-learning virtual patient chatbot platform demonstrate that structured digital simulation tools can significantly improve perceived clinical nutrition competences. These findings support chatbot adoption in dietetics curricula and inform future digital education innovations. Full article

Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is now the most prevalent chronic liver disorder among children and adolescents, mirroring the rise in pediatric obesity. The Mediterranean diet (MD) has demonstrated anti-inflammatory, antioxidant, and beneficial effects on different health outcomes across different life stages. The MD’s effect has been explored in adult MASLD, but there is limited information on the pediatric population. However, evidence on pediatric MASLD should be explored given its rising prevalence. Therefore, the aim of this review is to collect human studies assessing the effect of MD interventions on pediatric MASLD, focusing on key pathophysiological mechanisms. It also examines other interventions, including specific energy/macronutrient prescriptions, nutrition education or counseling, and physical activity components. Methods: A comprehensive search of PubMed, Scopus, and Web of Science was conducted using terms related to the Mediterranean diet, nutrition education, physical activity, pediatrics, and MASLD/NAFLD. Pre-determined inclusion and exclusion criteria were used to collect eligible studies to be included in the review. Study quality was assessed using the Academy of Nutrition and Dietetics Quality Criteria Checklist. Screening, data extraction, and appraisal were performed independently, with discrepancies resolved through discussion, and the findings were synthesized qualitatively. Results: This review synthesizes findings from eight human studies evaluating the impact of the MD, alone or integrated with structured exercise and nutrition education, on pediatric MASLD. Interventions consistently demonstrated reductions in hepatic steatosis, liver stiffness, and fibrosis markers, alongside improvements in inflammatory cytokines, oxidative stress defenses, and liver enzymes. The MD also enhanced lipid and glycemic profiles, lowering triglycerides, total cholesterol, and insulin resistance indices. Nutrition education and family-centered approaches improved adherence, while structured, enjoyable physical activity enhanced outcomes and long-term sustainability. Conclusions: Collectively, the MD, particularly when combined with exercise and tailored education, offers a safe, effective, and comprehensive lifestyle intervention for pediatric MASLD. Nonetheless, current evidence remains limited by small sample sizes, heterogeneity in protocols, and short follow-ups. Larger, multicenter randomized trials with standardized designs are needed to establish best practices and long-term efficacy. Full article

Background: Foundational learning spaces in South Africa, designed to nurture growth and development, continue to grapple with malnutrition, a persistent barrier to the health, cognitive potential, and wellbeing of preschool-aged children, amidst a nutrition transition. Aim: This study assessed dietary diversity, nutritional status, and their associations among children aged 2–5 years attending funded Early Learning Centres (ELCs) in Johannesburg (Region C). Methods: Using systematic random sampling across 33 nutrition-funded ELCs in Region C, we assessed the nutritional status of children aged 2–5 years with WHO Anthro software (z-score cut-offs for undernutrition: stunting, underweight, thinness; overnutrition: overweight, obesity). Dietary diversity scores (DDSs) were derived from a 24 h recall of 16 food groups, classified by primary nutrient contributions (some groups spanning multiple classes), and categorized as low (≤8) or normal (≥9). Associations between DDS and nutritional indicators were analyzed using Poisson regression to estimate adjusted prevalence ratios (aPRs). Results: Despite structured feeding practices, all ELCs reported inadequate nutritional funding, prompting calls for dietitian support. While 27% sourced groceries from wholesalers, most relied on supermarkets and spaza shops; all had cooking infrastructure, but only 12% had food gardens, and 88% expressed interest in establishing them to improve dietary diversity. The mean DDS was 9.47 (±1.07), and 83% of children had a normal DDS (≥9), with common consumption of cereals (100%), vitamin A-rich vegetables (100%), oils (100%), and leafy greens (96%), but limited intake of protein-rich foods like eggs (7%), legumes (19%), and fish (37%). A dual burden of malnutrition was observed: 31% of children were stunted and 30% were overweight or obese. Multivariable analysis showed that boys had significantly lower odds of stunting compared to girls (aPR = 0.38; 95%CI: 0.01–0.74), while younger age (aPR = 0.61; 95%CI: 0.37–0.85) and low DDS (aPR = −0.15; 95%CI: −0.29–−0.06) were independently associated with increased risk of stunting. Age was positively associated with underweight (aPR = 1.27; 95%CI: 0.58–1.96), and thinness was strongly associated with boys (aPR = 17.00; 95%CI: 15.12–18.74), with a marginal association with age. Conclusions: Integrated nutrition strategies are critical to addressing the dual burden of stunting and being overweight in urban ELCs. Strengthening funding, professional dietetic support, and promoting food gardens can enhance dietary diversity and child health outcomes. Full article

Background/objectives: The nutrition care process (NCP) is an evidence-based practice framework used in Medical Nutrition Therapy for the prevention, treatment, and management of non-communicable chronic health conditions. This review aimed to explore available artificial intelligence (AI)-integrated technologies across the NCP in dietetic primary care, their uses, and their impacts on the NCP and patient outcomes. Method: Six databases were searched: MEDLINE, Embase, PsycINFO, Scopus, IEEE, and ACM digital library. Eligible studies were published between January 2007 and August 2024 and included human adult studies, AI-integrated technologies in the dietetic primary care setting, and patient-related outcomes. Extracted details focused on participant characteristics, dietitian involvement, and the type of AI system and its application in the NCP. Results: Ninety-seven studies were included. Three different AI systems (image or audio recognition, chatbots, and recommendation systems) were found. These were implemented in web-based or smartphone applications, wearable sensor systems, smart utensils, and software. Most AI-integrated technologies could be incorporated into one or more NCP stages. Seventy-nine studies reported user- or patient-related outcomes, with mixed findings, but all highlighted efficiencies of using AI. Higher patient engagement was observed with Chatbots. Seventeen studies raised concerns encompassing ethics and patient safety. Conclusions: AI systems show promise as a clinical support tool across most stages of the NCP. Whilst they have varying degrees of accuracy, AI demonstrates potential in improving efficiency, supporting personalised nutrition, and enhancing chronic disease management outcomes. Integrating AI education into dietetic training and professional development will be essential to ensure safe and effective use in practice. Full article

The pine nut, the seed of the stone pine, is highly valued in local cuisine and dietetics for its nutritional qualities. These nuts still come from forest stands, which results in their limited and irregular presence on the market. Domesticating the species through orchard management practices could increase its production. In this context, two irrigation schedules were tested in a grafted stone pine orchard that was planted in 2009 and has been under drip irrigation since 2011. Water needs were calculated weekly using the water balance method (ETc-P). The treatments considered were as follows: T₁, irrigation from April to the end of summer; T₂, irrigation from April to the end of June; and T₀, rainfed as the control. Monitoring of the pines, considering vegetative and reproductive responses, was carried out from 2015 (7th leaf) to 2023. T₁ and T₂ increased primary and secondary growth and resulted in higher strobili production compared to T₀. The tree’s ability to sustain the reproductive load was enhanced under irrigation versus rainfed treatment. The longest irrigation schedule increased productivity. However, when the environmental cost of supplying twice as much water in the Mediterranean region—an annual average of 900 m³ ha⁻¹ (T₂) versus 1900 m³ ha⁻¹ (T₁)—is considered, the overall assessment changes. The irregularity of stone pine mating was not prevented by a regular water supply, but it was mitigated, promoting sustainable production. Full article

Emotional regulation plays a central role in shaping eating behaviors and body image, though few studies have examined this relationship in students of food sciences. A total of 297 undergraduates from Human Nutrition and Dietetics and Food Science and Technology completed surveys on health, body image, and eating behaviors, along with the Difficulties in Emotion Regulation Scale (DERS). Exploratory factor analysis (EFA) identified four perception dimensions. Pearson correlations and multiple linear regression assessed their relationships with emotional regulation. EFA revealed four factors: (1) health perception, (2) body image and related emotions, (3) weight and diet control, and (4) individual responsibility for diet. No differences emerged by sex or degree. Correlations indicated that three factors were significantly associated with DERS scores, particularly body image and emotions. Multiple regression showed that body image and emotions and weight and diet control significantly predicted emotional regulation, while health perception and individual responsibility were not significant. These findings highlight the role of emotional regulation in shaping perceptions of health and eating, underscoring its relevance in the education of future food professionals. Training food professionals should integrate emotional competencies to support healthier self-perceptions and practices. Full article

Nutrition is a cornerstone of public health, yet the unique nutrition needs and considerations of lesbian, gay, bisexual, transgender, and others (LGBT+) communities remain largely invisible in the field of dietetics. These populations face disproportionate burdens of obesity, eating disorders, body dysmorphia, metabolic risks, and food insecurity, often driven by stigma, minority stress, and structural inequities. This narrative review aimed to synthesize current evidence on nutrition-related disparities among LGBT+ populations and identify opportunities for dietitians to advance equity in care. A comprehensive search of PubMed, Scopus, and Web of Science was conducted for studies addressing diet quality, obesity, eating disorders, food insecurity, and metabolic health in sexual and gender minorities. Evidence indicates clear subgroup differences: lesbian and bisexual women are more likely to experience obesity and food insecurity; gay and bisexual men report lower BMI but greater body image concerns and disordered eating; transgender individuals face nutritional challenges linked to gender-affirming therapy and high rates of food insecurity; and people living with HIV encounter additional metabolic risks associated with treatment. Despite these findings, LGBT+ health remains rarely reflected in dietary guidelines or professional training. Embedding inclusivity into dietetic education and clinical encounters, adopting culturally competent and structurally aware practices, and tailoring interventions to subgroup-specific needs are key priorities. Inclusive, equity-driven, and person-centered nutrition care is essential to closing health gaps for LGBT+ populations and ensuring that every patient receives guidance that affirms their identity and lived experience. Full article

Background/Objectives: Artificial intelligence (AI) has emerged as a transformative force in healthcare, with nutrition and dietetics becoming key areas of application. AI technologies are being employed to enhance dietary assessment, personalize nutrition plans, manage chronic diseases, deliver virtual coaching, and support public health nutrition. This review aims to critically synthesize the current literature on AI applications in nutrition, identify research gaps, and outline directions for future development. Methods: A systematic literature search was conducted across PubMed, Scopus, Web of Science, and Google Scholar for peer-reviewed publications from January 2020 to July 2025. The search included studies involving AI applications in nutrition, dietetics, or public health nutrition. Articles were screened based on predefined inclusion and exclusion criteria. Thematic analysis grouped findings into six categories: dietary assessment, personalized nutrition and chronic disease management, generative AI and conversational agents, global/public health nutrition, sensory science and food innovation, and ethical and professional considerations. Results: AI-driven systems show strong potential for improving dietary tracking accuracy, generating personalized diet recommendations, and supporting disease-specific nutrition management. Chatbots and large language models (LLMs) are increasingly used for education and support. Despite this progress, challenges remain regarding model transparency, ethical use of health data, limited generalizability across diverse populations, and underrepresentation of low-resource settings. Conclusions: AI offers promising solutions to modern nutritional challenges. However, responsible development, ethical oversight, and inclusive validation across populations are essential to ensure equitable and safe integration into clinical and public health practice. Full article

Obesity is closely associated with appetite dysregulation, influenced by behavioral, hormonal, and neurological factors. The Council on Nutrition Appetite Questionnaire (CNAQ) is a validated tool, translated into Arabic, but its application in weight-loss interventions remains underexplored. This secondary cross-sectional analysis evaluated whether the Arabic CNAQ can differentiate appetite levels after a 6-month telenutrition weight-loss intervention supported by telemonitoring and health coaching, and whether appetite is associated with weight-loss outcomes. A total of 36 participants were assessed: the intervention group (n = 21), who completed the program, and the control group (n = 15), who received no continuous support. Appetite was measured using the CNAQ after 6 months. Independent-samples t-tests and Mann–Whitney U tests were applied to compare appetite scores, while Chi-square tests were used for appetite categories. Results showed mean CNAQ scores of 27.87 (SD = 2.64) for the control group and 26.86 (SD = 4.46) for the intervention group (p = 0.402). Most participants reported moderate appetite (93.3% control; 76.2% intervention), with no significant between-group differences (p = 0.367). Although differences were not statistically significant, the findings demonstrate the feasibility of using the Arabic CNAQ in telehealth weight management. Larger studies with repeated measures are needed to confirm its utility in clinical and dietetic practice. Full article

Virtual Reality (VR) simulations provide immersive, realistic educational experiences that are increasingly used to enhance teaching and learning in nursing and medicine; however, use in dietetics lags. To fill this gap, four Nutrition Counselor VR simulations were developed collaboratively with the goal of building confidence in dietetic students’ nutrition counseling skills. After formative testing, pilot testing, and refinements, simulations were field tested with 34 dietetic students (91% women; age 25.67 ± 3.79 SD years; 68% White) from four supervised practice programs using a standard protocol administered by trained researchers (N = 5). Students completed a pre-survey, one VR simulation (≥2 times w/varying outcomes), and a post-survey. Online pre- and post-surveys examined changes in nutrition counseling skills, knowledge and self-efficacy, and comfort in using nutrition counseling skills. Paired t-tests revealed significant (p < 0.05) mean differences in nutrition counseling skill self-efficacy (medium effect size, d = 0.46) and comfort in using nutrition counseling skills (large effect size, d = 0.96) between the pre- and post-survey. At post-survey, >75% agreed the simulations helped build their nutrition assessment skills (79%) and counseling skills (88%) and prepared them to work with real patients (97%). Findings suggest the Nutrition Counselor VR simulations provided a realistic and safe learning environment that may be a valuable learning tool for dietetic students. Full article

Background/Objectives: Children with Down syndrome (DS) present unique and multifaceted nutritional challenges arising from genetic, metabolic, and developmental factors. Despite growing interest in the health of individuals with DS, dedicated nutritional guidelines tailored to their specific needs remain lacking. This narrative review aims to summarize current scientific evidence on nutritional status, challenges, and therapeutic strategies in children with DS, with an emphasis on clinical implications and practical recommendations for healthcare professionals. Methods: A literature search was conducted across four databases (PubMed, Scopus, Web of Science, and Google Scholar) for English-language publications from 1993 to June 2025. Thirty-five peer-reviewed articles were included, comprising original studies, narrative reviews, and expert guidelines (e.g., the American Academy of Pediatrics [AAP], the European Society for Paediatric Gastroenterology, Hepatology and Nutrition [ESPGHAN], and the European Federation of Associations of Dietitians [EFAD]). The selection process followed the PRISMA protocol. Studies were categorized according to key themes: energy requirements, comorbidities, feeding difficulties, nutrient needs, and therapeutic interventions. Results: Children with DS typically exhibit lower basal metabolic rates and altered body composition (i.e., higher fat mass and reduced lean mass), which increase their risk of both obesity and nutrient deficiencies. Common comorbidities—such as hypothyroidism, celiac disease, and gastrointestinal or immune disorders—further complicate dietary management. Feeding difficulties, including sucking/swallowing impairments, food selectivity, neophobia, and delayed independence in eating, are prevalent and significantly affect diet quality. Key nutrients of concern include protein, omega-3 fatty acids, fiber, vitamins B12 and D, iron, and antioxidants. Although no official nutrition guidelines currently exist for this population, existing recommendations from pediatric and dietetic organizations provide partial guidance that can be adapted to clinical practice. Conclusions: There is an urgent need to develop evidence-based, population-specific dietary guidelines for children with Down syndrome. Clinical nutrition care should be individualized, multidisciplinary, and proactive, integrating regular assessments of growth, feeding abilities, and biochemical markers. Dietitians must play a central role in both early intervention and long-term management. Further research, particularly interventional studies, is essential to optimize dietary strategies and improve health outcomes in this vulnerable population. Full article