搜索结果：Journal of human nutrition and dietetics : the official journal of the British Dietetic Association

Food insecurity, when individuals do not have sufficient access to food, has rapidly increased in high-income countries (HICs) since the 2008 global financial crisis. Women are particularly at risk of experiencing food insecurity, and during pregnancy, this can have detrimental physical and emotional health implications. To synthesise qualitative research exploring pregnant women's experiences of food insecurity in HICs (PROSPERO 2023 CRD42023404774). Systematic review of qualitative literature reporting data on women's experiences of food insecurity. Six databases (MEDLINE, Embase, Web of Science, CINAHL, ASSIA, Scopus) and grey literature sources were searched, followed by forwards and backwards citation chaining for all included studies. Screening of titles, abstracts and full-texts, data extractions and quality appraisals (using the Critical Appraisal Skills Programme (CASP) Qualitative Studies Checklist) were completed in duplicate. Certainty in the evidence was evaluated using GRADE-CERQual. Food-insecure pregnant and postnatal women, in HICs, since the global financial crisis of 2008. Experiences of food insecurity during pregnancy. Thematic synthesis using NVivo14 to code data. Hand-drawn thematic maps were used to group codes into sub-themes and overarching themes. Coding and hand-drawn thematic maps were combined to create a final visual summary of analytical themes. Searches resulted in 32,685 studies, and 32 were included (n = 20 North America, n = 10 Europe, n = 2 Australia). Findings identified three overarching themes: (1) barriers in access to food, (2) impact on physical and mental health, and (3) established individual, informal and statutory coping strategies. Women frequently discussed barriers to accessing fresh fruit and vegetables, resulting in poorer quality diets. Whilst qualitative data extracted precluded any direct pregnancy versus pre-pregnancy comparison, pregnancy appeared to exacerbate the experiences of food insecurity for women. The future arrival of a newborn created additional financial concerns along with worries over nutritional needs. Reliance on others was a recurrent strategy for pregnant women to mitigate the impact of food insecurity. The GRADE CERQual assessment showed moderate to high confidence in all findings. The findings of this qualitative review-the first to focus on experiences of food insecurity during pregnancy across HICs-show that women are experiencing substantial impacts from food insecurity during this critical life course stage. Review findings emphasise the need for co-ordinated screening and interventions that aim to support women to mitigate the impacts of food insecurity and its underlying causes to improve postpartum health and wellbeing.

Registered dietitians (RDs) play a critical role in delivering family-centered care by engaging both fathers and mothers to support children's optimal long-term growth and development. Although fathers use distinct feeding practices and play an important role in shaping children's diet and growth, existing evidence suggests that they may be less engaged in pediatric nutrition care and services than mothers. Given that RDs are uniquely positioned to promote caregiver alignment in feeding practices and strengthen children's dietary and health outcomes, this study aimed to explore Canadian RDs' perceived confidence, facilitators, barriers, and resource needs related to father engagement in pediatric nutrition care and services. A cross-sectional online survey was distributed to RDs across Canada between November 2024 and July 2025. The survey included six 5-point Likert scale items assessing RDs' perceived confidence in engaging fathers in pediatric nutrition care and services, informed by the Connect, Attend, Participate, Enact (CAPE) model of parental engagement, as well as closed-ended questions on resource and training needs. Additionally, open-text questions assessed RDs' perceived facilitators and barriers to father engagement. Quantitative data were analyzed descriptively, while qualitative data were examined using an inductive content analysis approach to identify the major facilitator and barrier themes. A total of 129 RDs (96.9% female; 91.2% white; 69.0% ≥ 6 years of pediatric nutrition experience) participated in this study. While most RDs reported they felt very confident in inviting fathers to appointments (85.3%), encouraging their participation (83.7%), and contribution to care planning work (81.4%), fewer felt confident in retaining fathers in ongoing pediatric nutrition care and services (67.5%). Based on qualitative content analysis of open-text responses, the most commonly reported facilitators to father engagement included fathers' presence and availability (40.4%), interest and openness (35.1%), and high caregiving involvement (23.7%), while the most commonly reported barriers included fathers' absence at appointments (33.3%), limited caregiving roles (33.3%), fathers' limited availability due to work schedule (23.3%), and traditional gender norms undermining father engagement (16.7%). Only 3.1% RDs had received prior training in father-engagement practices. The top three selected resource needs were webinars (92.1%), websites with practice guidelines (66.7%), and self-assessment tools (44.4%). While RDs reported confidence in various aspects of father engagement, few had received formal training in this area. Study findings highlighted opportunities for targeted professional development resources within dietetics to enhance facilitators and address barriers to engaging fathers in pediatric nutrition care and services.

As health systems globally are facing unprecedented demands, allied health clinicians undertaking advanced practice (AP) roles are increasingly supporting medical professionals, improving health system efficiencies and outcomes. The aim of this mixed methods systematic review was to identify what AP roles dietitians are undertaking and examine how these roles align with the British Dietetic Association (BDA) definition of AP. A systematic review of the literature was conducted on the 22nd August 2025 via MEDLINE, CINAHL and Web of Science with the following inclusion criteria; English language, peer-reviewed journals articles of any date describing dietitians undertaking AP roles as critiqued by the reviewers against the BDA AP capabilities pillars of advanced practice. Papers not published in the English language, conference abstracts, grey literature and studies describing entry level dietitian roles/routine nutrition care were excluded. Risk of bias was evaluated using the Joanna Briggs Institute (JBI) critical appraisal tools, synthesis followed the JBI convergent integrated approach to mixed methods systematic reviews and the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement 2020 (PRISMA 2020) was used to guide reporting. Of the 2209 studies identified by the search strategy, six studies were included in the systematic review. Dates of publication ranged from 1993 to 2014, with papers from the United States of America (n = 5) and the United Kingdom (n = 1). Studies included four original research studies, one Delphi survey and one narrative review. Five specialist area AP roles were identified; inherited metabolic diseases (IMD) dietitian, advanced level specialist practitioner (in paediatric, metabolic, renal specialties) and advanced level practitioners in diabetes and two generalist roles. Key themes were synthesized for each of the BDA AP pillars within the included studies. Despite interest in AP internationally, this systematic review identified only a small number of dietetic roles meeting all BDA AP pillars. Geographical, jurisdictional and dietetic association differences in definitions of AP, along with apparent underreporting in the literature, suggest this review likely understates the depth and breadth of contemporary dietetic AP. High-quality research published by dietitians practicing at an advanced level, clearly stating alignment with AP definitions/frameworks is required to solidify the value of dietetic AP within the global health system. No funding was sought for this review. PROSPERO: Registration Number CRD420251127046 (https://www.crd.york.ac.uk/PROSPERO/view/CRD420251127046).

Family carers have a key role in supporting malnourished older adults; yet, intervention evidence is lacking in the rehabilitation setting. This study aimed to explore the preliminary effects and acceptability of a family-centred, telehealth-enhanced dietary counselling intervention for treating protein-energy malnutrition (PEM) in rural-living older adults transitioning from rehabilitation to home, compared with usual care, in matched patient-carer dyads. A pragmatic, historically controlled, prospective, two-arm non-randomised controlled trial was conducted as a pilot study. Fifteen malnourished older adults admitted to rural rehabilitation units in New South Wales, Australia, and their family carers, were recruited and matched to 15 historical controls. The Patient-Generated Subjective Global Assessment (PG-SGA) was the primary outcome for nutrition status assessed at rehabilitation admission, discharge, and 3 months post-discharge. Quality of life, physical function, length of stay, discharge location, institutionalisation, mortality, carer burden, and service satisfaction were secondary outcomes. The historical control group received usual care. The intervention group received a telehealth-enhanced dietary counselling intervention developed with co-design principles, which engaged the family carer as a partner in the nutrition care team, delivered during the rehabilitation admission and for 3 months post-discharge. The difference in PG-SGA score from baseline to 3 months post-discharge between the two groups was 3.46 (95%CI: -2.07, 9.01; p = 0.238). The intervention group had a higher proportion of patients who were well-nourished at 3 months post-discharge compared to controls (60% vs 13%). At 3 months post-discharge, the intervention group had lower odds of being rated malnourished or with more severe malnutrition (i.e., moderate vs. well-nourished, severe vs. moderate) on the PG-SGA (OR 0.01, 95%CI: 0.00, 0.27; p = 0.005). There was a trend towards the intervention group having reduced odds of being discharged to a location other than home (OR 0.18, 95%CI: 0.03, 1.07; p = 0.06). The intervention was perceived as acceptable to patients and family carers. There were no differences between groups in other outcomes. Compared with usual care, the family-centred telehealth-enhanced dietary counselling intervention for the treatment of PEM in rural-living older adults transitioning from rehabilitation to home demonstrated preliminary efficacy and was acceptable to both patients and family carers. Future research aiming to improve PEM should meaningfully engage family carers as partners in the nutrition care team.

Plant-based milks have been increasing in popularity amongst Australian consumers, concurrent with a decrease in cow's milk consumption. Given the key role of cow's milk in Australian diets, it is necessary to understand the motivations behind this consumer behaviour and investigate the nutritional implications associated with this shift in dietary choice. Adults, including both omnivores and purposefully targeted vegan individuals, were recruited via social media to complete an online survey and two 24-h dietary recalls using the online Intake24 dietary assessment programme. The survey explored milk type choice and participant perceptions of the health and environmental impact of plant-based milks. Respondents were divided into groups based on whether they reported to consume or not consume dairy products in the survey. Survey and dietary intake data were then compared between these two groups. Of the 217 survey responses received (n&#x2009;=&#x2009;74 dairy and n&#x2009;=&#x2009;143 non-dairy consumers), soy, almond and oat plant-based milks were the most popular choices. The primary drivers behind milk type choice were animal rights, self-reported adverse health symptoms and environmental concerns. Additionally, non-dairy consumers were more likely to perceive these products as healthier and better for the environment than cow's milk. Dietary intake data identified that overall non-dairy consumers had significantly lower intakes of saturated fat, iodine and vitamin B12 (14.9 vs. 21.9&#x2009;g/day; p&#x2009;=&#x2009;0.001, 70.8 vs. 128.8&#x2009;&#x3bc;g/day; p&#x2009;<&#x2009;0.001 and 0.9 vs. 3.0&#x2009;&#x3bc;g/day; p&#x2009;<&#x2009;0.001, respectively) and higher amounts of dietary fibre (27.2 vs. 21.3&#x2009;g/day; p&#x2009;=&#x2009;0.008) compared to dairy consumers. This study provides novel insights into the motivations to consume, and perceptions of the healthfulness, plant-based milk in Australia and identified that non-dairy consumers may be at increased risk of iodine and vitamin B12 deficiency.

This qualitative systematic review explored how entrustment is understood, experienced and enacted within pre-registration practice-based learning (PBL) across international healthcare education, with a specific focus on implications for the UK dietetic profession. Fifteen qualitative and mixed methods studies were synthesised using thematic synthesis, identifying how entrustment shapes learner participation, supervision, and capability development. The review found that entrustment functions as a 'credible developmental space' that enables learners to engage in authentic workplace activities with supported autonomy, while also revealing how workplace pressures and local contextual factors influence entrustment decisions. Feedback emerged as the central mechanism through which learners make sense of supervision levels, understand expectations, and professionally develop; without high quality dialogic feedback, entrustment risks becoming a procedural rather than educational process. Entrustment was shown to be inherently relational and co-constructed, shaped by trust, supervisor familiarity, contextual constraints, perceived risk, and the quality of supervisory relationships. These findings challenge overly technical or checklist based interpretations of entrustment and highlight the need for assessment approaches that prioritise narrative feedback, shared sensemaking and contextual awareness. For UK dietetics, an entrustment informed approach offers a defensible, capability-aligned way to structure PBL across diverse settings, particularly as the profession implements a national common assessment tool. A proportionate, light touch approach, using a small number of meaningful EPA aligned tasks supported by succinct narrative feedback, may enhance developmental value without increasing burdens on practice educators. Entrustment has the potential to strengthen fairness, consistency, and capability development in dietetic PBL when implemented in a relational, context sensitive manner. These insights have relevance globally, providing a conceptual foundation for international dietetics and wider health professions to strengthen supervision and assessment in diverse PBL contexts.

There is a lack of detailed polyphenol intake data collected at the national level, both in Australia and globally. Hence, the aim of this study was to estimate the intake of total polyphenols, polyphenol classes, and polyphenol subclasses in a nationally representative sample of Australians across the lifespan. Polyphenol intake was estimated from secondary analyses of two 24-h dietary recalls collected as part of the 2011-12 National Nutrition and Physical Activity Survey component of the Australian Health Survey (N&#x2009;=&#x2009;7735) using an Australian-specific polyphenol database. Polyphenol content data were previously incorporated into this database using Phenol-Explorer. Intake of total polyphenols, polyphenol classes, and polyphenol subclasses was reported and compared by sex and age using median regression models, both before and after adjusting for energy intake. The estimated total polyphenol intake of Australians aged 2+ years [mean (SD) age: 40.9 (22.7) years] was median (IQR) 479.07 (529.81) mg/day when unadjusted for energy intake and 253.18 (276.29) mg per 1000&#x2009;kcal/day when adjusted. The most consumed polyphenol class was flavonoids, providing 64.5% and 55.6% of total polyphenols before and after adjusting for energy intake. Among major food groups, the top contributor to total polyphenols was non-alcoholic beverages, primarily consisting of tea, coffee, and coffee substitutes. This study offers an Australian-wide comprehensive description of polyphenol intake. By addressing key gaps in the literature, this study contributes to the limited global and Australian research on polyphenol intake. Further, this study includes findings that align with other population-wide polyphenol intake studies from Europe, the United States, and the United Kingdom that have also reported tea and coffee as primary sources of polyphenols.

Persistent food insecurity and diet-related chronic disease in North Carolina underscore the need for systems-based approaches in nutrition and dietetics. Small- and medium-scale farms face barriers to consistent markets, while food-insecure households encounter limited access to fresh, culturally relevant foods. Programs that integrate local food production with community-based distribution can simultaneously address agricultural, nutrition and health system challenges, while fostering community resilience through new connections and partnerships. This study evaluates the 2024 Local Food Purchasing Agreement (LFPA)-funded FarmsSHARE program through a systems-based lens, examining cross-level impacts on farm viability, organizational capacity, food and nutrition security and dietary health outcomes. A mixed-methods evaluation engaged four stakeholder groups, farmers, food hubs, community-based organizations (CBOs) and program recipients, using statewide surveys (n&#x2009;=&#x2009;322) and 14 focus groups (n&#x2009;=&#x2009;105). The evaluation was guided by the High Level Panel of Experts (HLPE) conceptual framework for food systems and the Socio-Ecological Model to capture interactions across supply chains, food environments, food and nutrition security and perceived dietary health outcomes. Quantitative data were analyzed using descriptive statistics and ANOVA, while qualitative transcripts were inductively coded and thematically analyzed to identify emergent system-level outcomes. Within the 2024 LFPA-funded FarmsSHARE season, it generated multi-level impacts: (1) increased farm revenue and market stability, including $2.95 million in direct payments to 312 small- and mid-size farms; (2) strengthened organizational infrastructure, with food hubs and CBOs expanding staffing, cold storage and distribution capacity; (3) improved food access and utilization, with 92% of recipients reporting increased access to healthy foods and 95% using all or most of the items provided; and (4) measurable health benefits, including enhanced dietary quality and improved management of chronic conditions such as diabetes and hypertension. Additionally, FarmsSHARE facilitated new community partnerships and cross-sector connections, supporting a more resilient, community-centred approach to health and food security. The evaluation demonstrates that systems-based, multi-level interventions can strengthen local food systems while enhancing nutrition security and supporting perceived improvements in dietary quality and health outcomes among participants. These findings highlight local food as a critical component of food and nutrition security and suggest the need for further research examining objective health indicators, including clinical biomarkers. Registered Dietitian Nutritionists (RDNs) play a critical role as systems-level practitioners, bridging agriculture, community and health systems to design, implement and sustain complex interventions. Scaling and sustaining similar programs require cross-sector collaboration, stable funding mechanisms and integration of local food initiatives into broader health and policy frameworks.

Systems-based practice is crucial for health professionals. Our study aimed to explore systems-based practice within health professions competency standards in Australia, Canada and the United Kingdom. We employed conceptual content analysis to review the extent to which systems-based practice is articulated within competency standards documents across 14 different health professions. Systems-based practice key word searches were undertaken across 38 documents, with frequency of terms counted and compared across professions and countries. The text surrounding the key word was analysed and categorised based on a systems-based practice framework into either knowledge (structural competencies), skills (structural action) or attitudes (social responsibility). Categories across professions were summarised and synthesised across professions for each of knowledge, skills and attitudes. The most common terms used across the professions and countries were 'quality' and 'system' with most phrases surrounding quality related to safe and effective patient care with only some references to improving care or quality improvement. Text surrounding the term 'system' mainly referred to health professions being able to navigate the systems in which they interact to provide care, with some standards describing competencies to affect systems that affect health, including bias, determinants of health, and access to care. The competency statements mostly focused on knowledge and skills with only some attitudinal capabilities described across the standards. All professions included systems-based practice competencies with some emphasising health system practice (paramedicine, midwifery, medicine, paramedicine, pharmacy, podiatry, radiography) and others including broader social systems (dietetics, nursing, physiotherapy, psychology, sonography, speech pathology, social work). Systems-based practice is as a key competency for health professionals across Australia, Canada and the United Kingdom with a focus on health care systems and limited focus on competencies that challenge broader systems and prepare graduates to address the determinants of health.

Dietary modification is a crucial component of chronic kidney disease (CKD) management, but the complexity of renal diets leads to significant adherence challenges. Understanding the patient's perspective is vital for developing effective, patient-centred interventions that improve adherence and health outcomes. This scoping review aimed to map the available evidence on the reported preferences of patients with CKD regarding nutrition-related health outcomes, and to identify the perceived barriers and facilitators that hinder or support the achievement of these outcomes. Studies were included if they involved adult patients with CKD and explored their perspectives on nutrition-related outcomes, barriers, or facilitators to dietary management. Qualitative, quantitative, and mixed-methods studies published in English were eligible. A systematic search was conducted in June 2025 across four electronic databases (MEDLINE, CINAHL, Embase, and Cochrane Database of Systematic Reviews), supplemented by hand-searching reference lists of included articles. Data were extracted independently using a custom data extraction tool. The identified barriers and facilitators were thematically mapped and categorised according to the World Health Organization Multidimensional Adherence Model (WHO-MAM). Four studies met the inclusion criteria. A primary finding was the lack of evidence directly addressing patients' preferred nutrition-related health outcomes. However, preferences could be inferred; patients value reassurance, emotional support, and receiving practical, individualised, and culturally relevant advice. Perceived barriers included: (A) unhelpful, paternalistic communication from healthcare teams; (B) patient factors like feeling overwhelmed and confused; (C) socioeconomic factors such as conflicting cultural norms and social pressures; and (D) therapy-related factors like generic, non-culturally specific advice. Key facilitators included: (A) helpful, empathetic, and collaborative communication styles; (B) patient factors like self-monitoring and psychosocial support; (C) socioeconomic factors such as leveraging cultural health beliefs; and (D) therapy-related factors like health literacy-sensitive materials and dietitian support. There is a significant gap in the literature regarding the nutrition-related health outcomes that CKD patients prioritise. The findings highlight that the patient-healthcare provider relationship is a pivotal factor influencing adherence. Clinical practice should shift towards a more patient-centred, collaborative, and culturally sensitive model of care. Future research should use qualitative methods to directly investigate patient preferences to inform the co-design of effective dietary interventions.

Enjoying food is related to the taste, smell and texture of food, ambience during meals, presentation of the meals, and freedom to choose meals. A decrease in food enjoyment can lead to decreased food intake, undesired weight loss, and reduced quality of life. Cancer and cancer treatment can induce symptoms that affect food enjoyment. To optimise food enjoyment and intake, insight in the experiences and preferences of hospitalised patients with cancer is essential. This qualitative study aimed to explore the perspectives of patients with cancer on the experience of food and drinks, ambience during meals, timing of the meals, and the freedom to choose one's own meals, during hospital admission. In hospitalised patients with cancer treated with systemic therapy, 12 semi-structured interviews were performed. Nutritional status was subjectively assessed, and taste and smell objectively to characterise the study population. Thematic analysis was used to identify key themes. Three selective codes emerged: (1) the quality of hospital food and drinks, (2) the presentation of hospital food and drinks, and (3) meeting patients' preferences. Patients described hospital food, and in particular main meals, as bland, overcooked, and repetitive. Autonomy in meal choices and flexibility in portion sizes were appreciated but inconsistently facilitated. Ambiance was moderately important, with suggestions for communal dining areas. Presentation issues, including plastic odours and inconsistent meal temperatures, were mentioned. Patients valued personalised options such as additional seasonings or sauces. The eating experience of hospitalised cancer patients is shaped by various factors including quality of food, its presentation, and the ability to cater to individual preferences. By addressing these aspects and implementing a patient-centred food service, care could be optimised in oncology wards.

The availability and cost of gluten-free (GF) products in grocery stores and online have increased in recent years, but less is known about availability and cost of GF menu items in restaurants, as well as whether methods are being implemented to limit cross-contact (CC) of GF with gluten-containing menu items. The purpose of this study was to assess the reported availability, additional cost and use of methods to limit cross-contact (CC) of GF items in restaurants in Winnipeg, Canada. Restaurant staff were asked over the telephone if they served GF items, if there was an additional cost for these items and if they used methods to limit gluten CC. Chi-squared (X2) tests were used to test for differences in the proportion of restaurants reporting serving GF items, charging extra and using methods to limit CC based on service type, locality, and ethnic cuisine type. A p-value of <&#x2009;0.05 was considered significant. Of the 548 restaurants surveyed, 69% reported offering GF items. A higher proportion of full-service restaurants (73%) reported offering GF foods compared to quick-service restaurants (55%). A lower proportion of full-service restaurants that served GF foods reported a surcharge (22%) compared to quick-service restaurants (48%). Similarly, a lower proportion of full-service restaurants that served GF foods reported using methods to limit CC (79%) compared to quick-service restaurants that served GF foods (90%). A higher proportion of chain restaurants reported GF menu options (78%), additional charge for GF foods (41%) and using methods to limit CC (89%) compared to local restaurants (67%, 22%, 78%, respectively). The type of cuisine significantly affected the proportion of restaurants reporting GF item availability, surcharges and whether methods were used to limit CC. Availability of GF foods, cost and use of procedures to limit gluten CC vary based on type of service, locality, and cuisine served.

The imperative for food system transformation is well known, yet to date there has been minimal emphasis on the blue food system [foods sourced from marine and freshwater environments]. Generally, a food systems approach should shift away from linear and move towards more systems thinking to embrace complexity. This paper focuses on a local social innovation project (Plymouth Fish Finger (PFF)) which has pioneered localising the blue food system. This study aimed to elicit how the (policy and practice) system around the PFF can be appraised to optimise social innovation practices for (blue) food system transformation. Expert elicitation combined with group model building (GMB) to co-create and validate a 'Causal Loop Diagram' (CLD) to visually understand the policy and practice implication and needs of the PFF initiative. Purposive sampling to recruit a range (n&#x2009;=&#x2009;14 total) of experts representing the different parts of the system. Two 'mapping' workshops (one face-to-face, one online) facilitated elicitation of expert input into the process to enable establishment of a final synthesised systems map for critique and validation. Hand-created maps evolved into a validated CLD, containing 49 elements connected by 130 causal links and 5 feedback loops. These loops revealed how demand generation, supply chain capacity, economic viability, trust and product consistency, and infrastructural constraints, reinforce or balance system performance. Six themes emerged: (i) demand generation, (ii) supply chain constraints, (iii) economic viability, (iv) social innovation and trust, (v) nutritional guidance and (vi) unintended consequences. The CLD also enabled interventions to be pinpointed within a system to inform policy/practice actions for change. We illustrate how systems thinking and expert elicitation approaches have successfully encouraged dynamic dialogue to support the identification of future policy and practice interventions. This demonstrates how social innovation projects can be championed and their powerful potential for catalysing (blue) food system transformation better realised.

Research paradigms in nutrition and dietetics research have remained largely hegemonic and reductionistic, leading to interventions that inadequately address complex real-world challenges, such as diet-related chronic diseases. These paradigms have placed emphasis on individual-level interventions that insufficiently account for the evolving individual, environmental, sociocultural and political contexts that shape dietary behaviour and related health outcomes. Viewing topics and problems through a complex systems lens reveals that health and behaviours are influenced by multiple, context-dependent factors that interact and evolve over time. Achieving meaningful improvements in health outcomes therefore requires cross-disciplinary collaboration to build a more complete understanding of a problem and identify the factors and interrelationships driving systemic behaviour over time. The continuing emergence and application of systems science methods highlight the value in reconsidering the application of a complex systems approach to complement traditional research paradigms within nutrition and dietetics research. This paper provides an overview of the opportunities that systems science offers the nutrition and dietetics community and describes how its principles and methods have been used in research, including example areas for future application. Three commonly utilised system science approaches are explored: agent-based modelling, system dynamics, and network analysis. While translating system insights into practice is necessary for achieving real-world change, this paper focuses on practical entry points for getting started in keeping with the aims of this special issue on advancing systems-based practice in nutrition and dietetics. By continuing to embrace systems thinking, the nutrition and dietetics research workforce can strengthen its capacity to understand complexity, design coordinated actions and drive transformative, sustainable improvements in population nutrition-related health.

For employers, investing in workplace wellbeing programmes is considered in the context of potential cost-savings related to employee absenteeism, productivity, recruitment, retention, and company reputation. This review evaluated the effectiveness of workplace interventions with a dietary component on organisational outcomes. This systematic review was registered in the International Prospective Register of Systematic Reviews (CRD42023454673). Six databases (Medline, Embase, Cochrane Library, Web of Science, APA PsycINFO, Business Source Complete) were searched for studies from 1990 to September 2023. Studies were screened in duplicate and included if they were a randomised controlled trial (RCT) or quasi-experimental (QE) design, conducted in a workplace setting in a high-income country, the intervention included a dietary component, and they reported organisational-related outcomes. A synthesis without meta-analysis was conducted and risk of bias was determined using study design specific Joanna Briggs Institute critical appraisal tools. From 29,418 articles retrieved, 168 met the inclusion criteria. Most studies (68.4%) used a QE design and 76% were conducted in North America. Provision of educational materials (62.5%) and group nutritional education (56.0%) were the most frequently reported nutritional intervention components. Most studies (91.7%) combined nutrition with another lifestyle component, mainly physical activity (82.0%). From the studies 407 measurements were evaluated across 50 organisational outcomes. The most frequently reported outcome was absenteeism (87 studies) with most (75.9%) showing no significant intervention effect. Healthcare costs were evaluated in 65 (38.6%) studies with 41.5% indicating positive effects. Return on Investment (ROI) was evaluated in 28 (16.6%) studies and had the largest proportion, 89.3% reporting a positive effect (range of ROI negative 3.9 to positive 15.6). Overall non-RCTs were classified having 'moderate' risk of bias and most RCTs being at 'high' risk of bias mainly due to lack of blinding, cluster design and incomplete follow up. Workplace health and wellbeing programmes with a nutritional component may have a beneficial impact on healthcare costs; however, the evidence is heterogenous and largely based on interventions in the USA. This review identifies the need for improved reporting of interventions and outcomes in evaluations to assess organisational benefits.

Behaviour change techniques (BCTs) are key components of interventions designed to improve health behaviours including eating and drinking. The Behaviour Change Technique Taxonomy v1 (BCTTv1) identifies 93 distinct BCTs. To effectively support practitioners and researchers in nutrition and dietetics, practical examples of these are essential. The aims of this study were to develop examples that illustrate the 93 BCTs in the BCTTv1, focusing on clinical nutrition (CN) and public health nutrition (PHN), and use a Delphi technique to achieve a consensus on their applicability and usefulness. Examples of BCTs, described in the BCTTv1, were drafted for CN and PHN. Experts were invited to evaluate them using a 0-5 score and provide comments. Following an initial assessment round, the examples were revised in response to feedback, and a second round of evaluations was conducted. BCTs achieving a mean score of &#x2265;&#x2009;4.0 were considered to have reached consensus. Fourteen experts from eight countries participated, including researchers, teachers, and practitioners. After round 1 (R1), consensus was reached in 77 CN examples and 60 PHN examples. After round 2 (R2), average scores significantly increased (CN median [range] R1 4.42 [3.33-4.92], R2 4.73 [3.72-5.00], p&#x2009;<&#x2009;0.0001; PHN: mean [SD] 4.09 [0.34], 4.46 [0.29], p&#x2009;<&#x2009;0.0001) and consensus was reached in 85 CN and 84 PHN examples. Consensus on the applicability and usefulness of 85 and 84 BCT examples was reached for CN and PHN, respectively. These examples provide a foundation for practitioners and researchers to use when designing and implementing behaviour change interventions.

The globalised industrial food system is one of the main drivers of global environmental change. As such, there is an increasingly greater number of food-based dietary guidelines, and a shift towards food-system based dietary guidelines, with components of environmental sustainability and other aspects of food systems. In Chile and globally, there is a lack of comprehensive recommendations for integrating food-based dietary guidelines into local food systems, with distinct climates, infrastructure, and groups of Indigenous Peoples. We used a transdisciplinary, participatory food systems approach across five climatically, agriculturally, and culturally distinct regions (Metropolitan, Arica and Parinacota, Coquimbo, La Araucan&#xed;a, Los Lagos) to explore the complexities of implementing the new Chilean Dietary Guidelines, collaborating across disciplines (e.g., anthropology, nutrition, agriculture, health) and related sectors (small-scale producers, small-scale vendors/retailers, consumers). In each region, we conducted a project launch event, local food system mapping workshop, telephone surveys and one participatory group model building workshop (n&#x2009;=&#x2009;30-34/region) to identify barriers and facilitators, and the relationships between them, to sustainable food systems. Across regions, local food systems definitions were developed. Five regional causal loop diagrams were constructed, from which a consolidated causal loop diagram was synthesised. From the 143 food systems drivers and factors were identified, 14 overarching themes critical to understanding local food systems emerged: (1) Food and nutrition policies, (2) School food programmes, (3) Sustainable food systems, (4) Local production and access, (5) Labour supply, (6) Climate change, (7) Fresh flavour quality, (8) Fast-paced lifestyle, (9) National recognition of ancestral and traditional food culture, (10) Home cooking perception, (11) Cost-convenience trade-off, (12) Imported foods, (13) Household food culture, and (14) Ancestral and traditional food knowledge. These themes reflect a strong awareness amongst diverse local food system actors in Chile of the links between territory, climate, food, and environmental sustainability. A transdisciplinary approach to understanding local food systems is essential for strengthening sustainable food systems that mitigate climate change, with participatory methods ensuring that public health policies align with territorial and intercultural realities. Identifying leverage points within local communities, based on their experiences and proposed solutions, is critical for supporting the culturally and contextually relevant implementation of food-based dietary guidelines, ensuring policies are both effective and equitable in addressing food system challenges amidst the climate crisis.

Malnutrition is a significant health burden that negatively impacts health outcomes and resources. It disproportionately affects rural communities where access to healthcare facilities, highly trained practitioners, and resources are already limited, and malnutrition is unfortunately underdiagnosed. Nutrition-focused Physical Exam (NFPE) is a critical component of the nutrition care process (NCP) used for identifying malnutrition in patients. Training was provided to rural nutrition preceptors of a coordinated program (CP) in dietetics using didactic and hands-on simulation training to reinforce learning, with additional guidance on how to assess student competency while performing a NFPE using the interactive Nutrition Specific Physical Exam Competency Tool (INSPECT) available to educators. The invitation to participate in the NFPE training was shared with nutrition professionals who were actively serving as preceptors to the CP in dietetics at a University that serves rural communities. Participants were recruited by invitation through email and social media. The training included an informative presentation on malnutrition, NFPEs, and the INSPECT tool. Demonstration was provided, then participants were put into groups of three: one participant filled the role as the patient, one as a student completing the NFPE, and one as the preceptor evaluating the student. Each group practiced NFPEs while simultaneously utilizing INSPECT to practice evaluating student competency. Pre- and post-intervention surveys were collected anonymously to measure changes in self-efficacy of NFPEs, malnutrition diagnoses, and changes in self-efficacy for evaluating student competence while performing NFPEs. Seventeen rural preceptors participated in the training. Simulation-based group learning was effective at improving preceptors' self-efficacy in using NFPEs and in evaluating student competency; Cohen's d was >&#x2009;1.0 while p was <&#x2009;0.05 for all items. Participants reported they would make changes to their current practice by implementing or increasing their use of NFPEs when completing nutrition assessments. Simulation training significantly increased the self-efficacy of preceptors working with dietetic students completing NFPEs during supervised practice. Expanding this training could significantly impact malnutrition diagnosis in rural communities.

Contemporary food systems contribute to climate change and influence food security, diet quality, equity and regional resilience. Addressing these interconnected challenges requires coordinated, place-based actions across the entire food system, with dietitians and nutrition professionals increasingly recognised as key system actors. To describe a dietitian-led, systems-thinking approach used to inform the development of a regional food strategy in New South Wales, Australia and to identify opportunities for dietitians and nutrition professionals in food system change across health, equity and environmental sustainability domains. Using a socioecological model of health promotion and a collective impact methodology, a 2-year evidence-building and co-design programme of work was undertaken. Mixed methods were used across Ottawa Charter action areas: Building Healthy Public Policy; Creating a Supportive Environment; Developing Personal Skills; and Strengthening Community Action. Activities included diet affordability analysis, food environment and production mapping, community surveys, social network analysis, pilot skills-building initiatives and cross-sector stakeholder engagement. The programme generated a coordinated regional evidence base on food security, food environments and local food systems, which informed the establishment and governance structure of a cross-sector Food Futures Taskforce and the co-design of a regional Food Charter and Action Plan with defined priorities and responsibilities. Findings highlight the central role of dietitians as knowledge translators, equity advocates and facilitators of systems change. This case study demonstrates how dietitians can operationalise systems thinking to catalyse regional food system governance and transformation. The approach offers a transferable model for integrating research, policy and practice to advance healthy, equitable and sustainable food systems.