The document provides information on evidence-based guidelines in nutrition practice. It discusses: - The process of developing evidence-based nutrition practice guidelines which are disease/condition-specific recommendations derived from systematic reviews of scientific evidence. - Key elements of the guidelines include explanations of scope, interventions considered, major recommendations and corresponding strength of evidence ratings. - The ADA evidence-based nutrition practice guidelines for diabetes are published online. They are similar to guidelines from the American Diabetes Association but developed using a different method. - Evidence-based guidelines are designed to assist in appropriate nutrition care decisions for specific diseases/conditions based on analysis of relevant research studies.

1. EVIDENCE BASED GUIDELINES
IN NUTRIITON PRACTICE

2. • Evidence-Based Nutrition Practice Guidelines are a series of guiding
statements and treatment algorithms developed using a systematic
process for identifying, analyzing and synthesizing scientific evidence.

3. • In the 1990s, the American Dietetic Association (ADA) began
developing nutrition practice guidelines for registered dietitians (RDs)
and evaluating how their use affected clinical outcomes. Clinical trials
and outcomes research report that diabetes medical nutrition
therapy, delivered using a variety of nutrition interventions and
multiple encounters, is effective in improving glycemic and other
metabolic outcomes.

4. • The process of developing nutrition practice guidelines has evolved
into evidence-based nutrition practice guidelines, which are
disease/condition-specific recommendations and toolkits.
• An expert work group identified important clinical questions related
to diabetes nutrition therapy.
• Research studies were analyzed and evidence summaries and
conclusion statements written and graded for strength of research
design.
• Based on the research conclusions, evidence-based nutrition
recommendations and guidelines for adults with type 1 and type 2
diabetes were formulated.

5. • The ADA evidence-based nutrition practice guidelines for diabetes are
published in the Web-based evidence analysis library.
• The recommendations are similar to those of the American Diabetes
Association, although developed using a different method.
• To define the RD's professional practice, the ADA has published the
Scope of Dietetics Practice Framework, the Standards of Practice and
Standards of Professional Performance, and specialized standards for
the RD in diabetes nutrition care. The latter defines the knowledge,
skills, and competencies required by RDs to provide diabetes care at
the generalist, specialist, and advanced practice level.

6. • Evidence-based guidelines are designed to assist in decisions about
appropriate nutrition care for specific disease states or conditions in typical
settings.
• Key elements of each guideline consist of an explanation of the scope,
interventions and practices considered, summary of major recommendations
and the corresponding rating of evidence strength, including areas of
agreement and disagreement.

7. Is the Eatwell guide evidence-based?
• The Eatwell Guide has been developed from
evidence based nutrition advice, and is
designed in a pictorial form to help the
communication of a healthy balanced diet
to consumers.

9. Who monitors the accuracy of National Food
Guide
• USDA and HHS have evolved the process to update the Dietary
Guidelines over time, in step with advancements in nutrition science,
public health, and best practices in scientific review and guidance
development. Each edition of the Dietary Guidelines builds on the
one that came before it

10. Are the dietary Guidelines is evidence based?
• The Dietary Guidelines is based on scientific evidence on health-
promoting diets in people who represent the general U.S. population,
including those who are healthy, those at risk for diet-related
diseases, and those living with these diseases.

11. Why evidence based nutrition is so important
• Evidence-based practice is an approach to health care wherein
credentialed nutrition and dietetics practitioners use the best
available evidence to make decisions for patients/clients, customers,
individuals, groups, or populations. knowledge of disease
mechanisms, and pathophysiology.

12. Where can I find a dietary evidence based
nutrition?
• eatright.org This site was designed for nutrition professionals and the
public as well. It's all evidence based, which means that there is a
substantial body of research supporting the advice offered.

13. • sportsnutritionsociety.org The International Society of Sports
Nutrition site offers a library of researched articles that are evidence
based.
• It’s very thorough; a board of certified professionals reviews the
content. This is a particularly good site if you are researching a
supplement.
• We know there is a lot of interest in supplements, but it’s important
to remember that supplements aren’t regulated. We tell our patients
to talk with a physician before trying any supplement—even one they
buy over the counter. Just because a supplement makes a claim
doesn’t mean that the claim is supported by research.

14. Why evidence based nutrition information
important?
• The main reason evidence based nutrition is so important is to make
sure recommendations are true. Without research, it is impossible to
know if, and how much, a particular food, nutrient or eating pattern is
beneficial.

15. • The Evidence-Based Nutrition Practice Guidelines are derived from
completed Evidence Analysis Library systematic reviews.
• The Academy workgroup that guides the systematic reviews also
develops the disease-specific guideline.

16. What is evidence based in dietetics
• The Academy of Nutrition and Dietetics defines evidence-based
dietetics practice as “the process of asking questions, systematically
finding research evidence, and assessing its validity, applicability and
importance to food and nutrition practice decisions” in light of the
client's or patient's values

17. • The Academy of Nutrition and Dietetics' Evidence Analysis Library®
launched in 2004.
• The Evidence Analysis Library (EAL) is a synthesis of the best, most relevant
nutritional research on important dietetic practice questions housed
within an accessible, online, user-friendly website.
• This online resource is a growing series of systematic reviews and
evidence-based nutrition practice guidelines for registered dietitian
nutritionists and other members of the health care team. Projects are
developed by Academy members and the EAL relies on volunteers to help
conduct evidence analysis projects. Learn more about volunteering for the
EAL.

18. • Features of the Evidence Analysis Library:
• Users can view the list of topics from the Projects tab. They projects are
listed in alphabetical order. The left navigation bar for each project has the
most current information at the top. The user can see as much – or as little
– information posted by expanding each section.
• Each systematic review includes a conclusion statement that summarizes
the collected research; a grade that indicates the quality and extent of the
support evidence for each conclusion statement; an evidence summary
that describes the major findings; tables summarizing the study findings;
worksheets that provide detailed information for each study and a quality
rating for each study.
• Evidence-based recommendations consists of a series of guiding
statements to assist the registered dietitian nutritionist in decisions about
appropriate care for specific disease states or conditions. Key elements of
each guideline include an explanation of the scope, interventions and
practices considered, summary of major recommendations and the
corresponding rating of evidence strength, including areas of agreement
and disagreement.

19. Why Use the Evidence Analysis Library?
• Sifting through the vast amounts of literature: Individual practitioners would find
it very difficult to keep up with amount of health care research that is continually
published. Evidence-based resources narrow down this literature so practitioners
can make clinically sound decisions and recommendations more efficiently.
• Quick access to answers: Patients, clients and other stakeholders have many
nutrition questions. Synthesized evidence-based resources help practitioners
respond to those questions quickly and easily.
• Faster implementation of research findings: Evidence-based practice resources
bring together information across disciplines and fields and identify new ways to
apply research findings to patient care, cutting down the lag time from “bench-
to-bedside.” Improved practice quality and effectiveness: As more practitioners
incorporate evidence-based guidelines and methods, the standard of care
improves and the quality and effectiveness of practice increases.

20. Why evidence based practice is important to
dietitians?
• Dietitians use the evidence base to ensure their practice is well
informed, safe and effective.

21. What are the government nutritional
guidelines?
• The Eatwell Guide
• Eat at least 5 portions of a variety of fruit and vegetables a day. ...
• Base meals on potatoes, bread, rice, pasta or other starchy
carbohydrates. ...
• Have some dairy or dairy alternatives (such as soya drinks and
yoghurts) ...
• Eat some beans, pulses, fish, eggs, meat and other protein.

22. The Philosophy of Evidence-Based Principles
and Practice in Nutrition
• The practice of evidence-based nutrition involves using the best
available nutrition evidence, together with clinical experience, to
conscientiously work with patients’ values and preferences to help
them prevent (sometimes), resolve (sometimes), or cope with (often)
problems related to their physical, mental, and social health.

23. • The EBN approach necessitates seeking out and understanding clinical
research evidence regarding the role of nutrition in health care
problems.
• For those involved in making health care decisions, EBN encompasses
creating implementation strategies, often among a team of
multidisciplinary clinicians using a shared decision-making framework
grounded in the patient's values

24. • At the core of EBN is a care and respect for patients, for whom it will be a
disservice if clinicians provide advice that neglects or misinterprets
research findings.
• Effective practitioners of EBN strive for a clear and comprehensive
understanding of the evidence underlying their clinical care, and work with
each patient to ensure that chosen interventions are in the patient’s best
interest.

25. 3 fundamental principles of evidence-based
practice as applied to the field of clinical nutrition.
• First, optimal clinical decision making requires awareness of the best
available evidence, which ideally will come from unbiased systematic
summaries of that evidence.
• Second, evidence-based nutrition provides guidance on how to decide
which evidence is more or less trustworthy—that is, how certain can we be
of our patients’ prognosis, diagnosis, or of our therapeutic options?
• Third, evidence alone is never sufficient to make a clinical decision.
Decision makers must always trade off the benefits with the risks, burden,
and costs associated with alternative management strategies, and, in so
doing, consider their patients’ unique predicament, including their values
and preferences.

26. • Practicing EBN requires clinicians to understand how uncertainty
about clinical research evidence intersects with an individual patient’s
predicament and preferences regarding the balance of nutrition and
susceptibility to diseases related to nutrition. Herein, we outline how
EBN proposes to achieve these goals and, in so doing, define the
nature of EBN.

27. • Historically, the question “What is the best evidence?” was answered
with hierarchies of evidence based on study design.
• The most prominent is the hierarchy related to evidence that
supports therapeutic interventions
• Issues of diagnosis or prognosis require different hierarchies. For
studies of the accuracy of diagnostic tests, the top of the hierarchy
includes studies that enroll patients about whom clinicians have
diagnostic uncertainty and that undertake a blind comparison
between the candidate test and a reference standard.

28. • For prognosis, prospective observational studies that accurately
document exposures and objective outcomes, ideally with blind
outcome assessment, and follow up all patients during relevant
periods would sit atop the hierarchy.
• For example, hospitalists are often interested in predictors of
prognosis, such as malnutrition on mortality in elderly patients after
hospital discharge.

33. legal mandates related to nutrition and diet
therapy in the Philippines
• Republic Act 8172 (1995)
• is to protect and promote the health of the people, to maintain an
effective food regulatory system and to provide the entire population
especially women and children with proper nutrition.
• President Rodrigo Duterte signed Republic Act 11148 last November
29. The law seeks to scale up the national and local health and
nutrition programs through a strengthened integrated strategy for
maternal, neonatal, child health and nutrition in the first 1,000 days
of life.

34. • Nutrition Act of the Philippines
• Presidential Decreee No. 491 (June 25, 1974), or the “Nutrition Act of
the Philippines”, created the National Nutrition Council (NNC) under
the Office of the President as the policy-making and coordinating
body for nutrition.

35. • mandated the Integration of Nutrition Education in the school curriculum
• Executive Order 51: Milk Code
• Presidential Decree No. 491 – Creating National Nutrition Council of the
Philippines
• Republic Act 11148: An act scaling up the national and local health and
nutrition programs through a strengthened integrated strategy for
maternal, neonatal, child health and nutrition in the first one thousand
(1,000) days of Life

36. • Republic Act 10862 - An act regulating the practice of Nutrition and
Dietetics in thePhilippines5. Republic Act 10611: Food Safety Act
of2013
• Food Safety Awareness Week is a yearly campaign in the Philippines
aimed at the importance of safe and clean food. The week-long
celebration falls every October and was proclaimed on August 1999
by virtue of Proclamation No. 160, signed by President Joseph Estrada

37. • Food Safety is the assurance/guarantee that food will not cause harm
to the consumers when it is prepared and/or eaten according to its
intended use
• Food and Water-borne Diseases is a group of illness caused by any
infectious (bacteria, viruses and parasites) and non-infectious agents
(chemical, animal and plant toxins).

38. • Republic Act 10028 (2009) An act on the Expanded Breastfeeding
Promotion Act was signed to support, protect and encourage women
whoarebreastfeeding working moms.
• Republic Act 9711: Food and DrugAdministration
• Republic Act 8976: Food FortificationAct of 2000

39. • The National Food Fortification Day is observed annually on
November 7,pursuant to Executive Order 382, which recognizes the
persistence of micro-nutrient deficiencies as a public health problem
that has affected a significant proportion of the population, resulting i

40. • The key agencies in the program:
• the Department of Health(DOH),responsible for the
implementationand monitoring of the law; the NationalNutrition
Councilthat serves as thepolicy-making body, particularly relative
todetermining what food vehicles should befortified and with what
nutrients
• Department of Trade and Industry, which assists manufacturers in
upgrading their technologies by providingfinancial

41. • A. Food and drugs Administration(FDA)
•the Food and Drug Administration of the Phil. Formerly called the
Bureau of Foods and Drugs was created under the DOH to license,
monitor, and regulate the flow of food, drugs, cosmetics, medical
devices, and house hold hazardous wastes in the Phil.

42. • B. Health Insurance Portability and Accountability Act (HIPAA) •is
a Unites States legislation that provides data privacy and security
provisions for safeguarding medical information.

43. • Two main purposes : a.to provide continuous health insurance
coverage for workers who lose or change their job b.to reduce the
administrative burden and cost of healthcare by standardizing the
electronic transmission of administrative and financial transactions.
• this information can be held in any form, including digital, paper
or oral
• • it is otherwise known as PHI ( personal health information)
under the privacy rule.

44. • C. National Nutrition Council
• •is an agency of the Phil. Government under the DOH
responsible for creating a conducive policy environment for
national and local nutrition planning, implementation, monitoring
and evaluation and surveillance using state-of the art technology
and approaches

45. • C. National Nutrition Council
• is an agency of the Phil. Government under the DOH
responsible for creating a conducive policy environment for
national and local nutrition planning, implementation, monitoring
and evaluation and surveillance using state-of the art technology
and approaches

46. ETHICO- MORAL PRINCIPLES RELATED TO
CULTURAL AND SPIRITUALPREFERENCES:
• A. Nutritional Genomics
• Genome – is the complete set of genetic information in an
organization Nutritional genomics – also known as NUTRIGENOMICS
is a science studying the relationship between human genome,
nutritionand health help explain the different individual responses
people have when they aregiven the same nutritional treatment the
influence of diet on health depends on an individual’s genetic make-
up.

47. • B. Nutritional support and end of life decision making
• Nutrition support – does not reverse or cure a disease or injury; it is
and adjunctive therapy that enables a patient to meet nutrient needs
during curative or palliative therapy
• Palliative care – an approach that improves the quality of life of patients
andtheir families facing the problem associated with life-threatening
illness,through the prevention and relief of suffering by means of
early identification and impeccable assessment and treatment of pain and
otherproblems, physical, psychosocial and spiritual
• 1. end of life care
• if an individual who have an illness that cannot be cured, palliative
caremakes a person as comfortable as possible by managing the pain and
otherdistressing symptoms

48. • Hospice care – focus on comfort and quality of life rather than cure ; begins
after treatment of the disease is stopped and when it is clear that
the person is not going to survive the illness
• End of life decision making
• the fundamental principle that underlies all nursing practice is respect forthe
inherent dignity of all individuals
• patients have the moral and legal right to determine what will be done withand to
their own person
c. to refuse a particular treatment through the informed consent process
they have the right to :
1. when the patient lacks decisional capacity, the surrogate makes decisions as the
patient would base on the patient’s previously expressed wishes and known values
2. advance directives allows adults with decisional capacity to surrogate decision-
makers who can accept or refuse treatments on the patients’ behalf, should the
patient lose capacity, or if the patient chooses not to participate in decision-
making.

49. • C. Social, political and economic issues and concerns affecting
nutrition care
• Health and nutrition economics: diet costs are associated with
diet quality
• 1.The WHO asserts that the global food price crisis threatens public health
and jeopardizes the health of the most disadvantaged groups such as
women, children and elderly and low income families.
• 2.Economic factors play a crucial role and could affect personal nutrition
status and health. Economic decision factors such as: food price and
income do influence people’s food choices.

50. • 3.Food costs are a barrier for low-income families to healthier food
choices and studies indicate that diet costs are associated with
dietary quality and also food safety.
• 4.Rising food processes are having severe impacts on population
health and nutritional status. People who change their diet pattern
for economic reasons may develop a range of unintentionally related
disorder and diseases from so called over-nutrition to or with under-
nutrition even within the one house hold. This is likely to increase
with growing food insecurity.

51. • 5.Collaborative, cross-disciplinary nutritional economic research
should play a greater role in the prevention and management of food
crises.

52. • Cultural Aspects of Dietary Planning
• Food is influenced by many factors
• For most people food is cultural not nutritional

53. CREATE A MEAL PLAN THRU A PLATE OR
PINGGANG PINOY/SAMPLE MEAL PLAN

54. INCLUDE IN MEAL PLAN
• SAMPLE FOR DIABETIC DIET
• Carbohydrates In Diabetic Diet Meal Plans
• Protein in Diabetic Diet Meal Plans
• Fats in Diabetic Diet Meal Plans

55. CALCULATE THE FOOD EXCHANGE LIST
• MAKE A BUDGET WITH CORRESPONDING PRICE LIST GOOD FOR THE
BUDGET GIVEN
MENU INGREDIENTS FEL PRICE
TINOLANGMANOK
1WHOLECHICKEN
2PCSCHICKENBROT
……
…..
TOTAL