Currently in Myanmar, the term “ nutrition” has become popular but few people understand the profession of Nutrition and Dietetics which can be traced back to Grecian writings by Plato, Homer and Hippocrates.Florence Nightingale understood the importance of diet in the care of the wounded during war time. Dietitians first served in the Spanish American War (1898) and the first professional organization (American Dietetic Association) was formed in 1917 by visionary Army nurses. The goal was to provide adequate food and proper meals for soldiers and provide diet therapy for the sick and wounded in hospitals and outpatient clinics.
With subsequent World Wars, the importance of the Dietetic/Nutrition profession became recognized by doctors and role of the profession expanded in the medical care of patients. The profession has been recognized for over a hundred years and dietitians have served as multidisciplinary team members for over fifty years. Although dietetics started in the US and followed by England, the profession is recognized in over 42 countries and the recognition is growing in many other countries. The largest organization is the Academy of Nutrition and Dietetics with over 100,000 health professional members.
Nutrition is the “study of nutrients of food, how the body uses nutrients and the relationship between diet, health and disease”. Dietetics is the study of human nutrition and regulation of diet based on the medical conditions and individual needs. The terms “nutritionists and dietitians” are related but very different. All dietitians are nutritionists but not all nutritionists are dietitians. In many countries like the United States and England, dietitians oversee the role of nutritionists.Anyone can call himself/herself a “nutritionist” although some countries protect the term through registration/licensure and require a specificeducational curriculum and training. Registration/licensure will need to be developed in Myanmar to further prevent confusion about the term “nutritionists”.
On the other hand, registered dietitians are regulated healthcare professionals licensed to “assess, diagnose and treat nutritional problems by participating, managing and directing programs and services to identify and evaluate individuals for nutritional risk, providing medical nutrition therapy and nutrition education, counseling, care coordination and management to address prevention and treatment of acute and chronic conditions” in conjunction with physician consultation and interdisciplinary health care team approach to promote person-centered care integrated with patient goals “ (1).
Medical nutrition therapy is a therapeutic tool and method to treating medical conditions and symptoms, using specially designed diets for disease conditions and monitored by doctors and registered dietitian/ nutritionist. This nutritional therapy adjusts the patients’ diet changes with the quantity, quality and method of nutrient intake. Medical nutrition therapy uses food intake to prevent malnutrition and improve medical conditions and minimize medical complications by improving the nutritional status of patients.
Why is nutrition important?
Malnutrition is a general term to describe any imbalance in nutrition: undernutrition, overnutrition or inadequate intake of certain nutrients.
In the Community/public health sector, the 2017 Global Nutrition Report (2) includes these statistics:
2 billion people lack micronutrients like iron and Vitamin A
155 million children are stunted
52 million children are wasted
2 billion adults are overweight/obese
41 million children are overweigh
88 % of the 193 countries have serious burden (2 or 3 malnutrition indicators)
Therefore, despite technologic and economic advances in the world, malnutrition remains a huge problem with both undernutrition and overnutrition presenting increased risks for other diseasesand complicated factors in medical care treatment. The global epidemic of obesity/overweight accelerates the development of non-communicable diseases. Childhood obesity rates are rapidly increasing in both developed and developing countries. Unfortunately, this disease presents long-term health risks complicated by social, psycho-emotional damage for the children.
Malnutrition in hospitalized patients is well documented in Western countries with 30-55 % of hospitalized patients reported as being malnourished. Hospitalized and patients with acute/chronic diseases and disorders are at nutrition risk because malnutrition causes: depressed immune system, impaired wound healing, muscle wasting, longer hospital stay, higher treatment costs and increased mortality rates. Malnutrition can develop as a result of: inadequate dietary intake; disease states causing increased nutrient requirements; complications from underlying disease which causes decreased nutrient absorption or excessive losses(3) The factors that promote malnutrition include: inability to eat/swallow, inadequate food intake, decreased sensory taste/smell losses and medical/drug treatment which affects food intake.
The benefits of providing adequate nutritional care include: long term health and wellness, prevention of malnutrition and deficiency states; faster recovery; improvement of medical care outcomes; shorter hospital; decreased health care costs and decreased morbidity and mortality rates.
How do Dietitians/Nutritionist provide international standard nutritional care?
They follow the Nutrition Care Process, a “systematic problem solving method” which utilizes critical –thinking skills for making evidence-based decisions regarding nutrition-related problems, disorders and diseases so that nutrition care is consistent, safe, and of high quality. The Nutrition Care Process on patientsincludes four processes :
- Nutritional Assessment : verification, recording,verification of relevant data for the patient’s nutritional status ( weight, height, body mass index, triceps skinfold, mid-arm upper circumference, direct and indirect calorimetry, waist-hip measurements, biochemical and diagnosis results and dietary information regarding intake, eating patterns, environmental/behavioral parameters related to diet/nutrient intake). This assessment evaluates objective and subjective data related to the patient’s food intake, lifestyle and medical history for the assessment of nutritional status
- Nutrition Diagnosis : identifies and labels nutrition problem that nutrition professional must treat independently (different from medical diagnosis).Domains include : intake, clinical, behavioral, knowledge
- Nutrition Intervention : resolve/improve the patient’s nutritional problem by implementing strategies to change nutritional intake, knowledge, behavior or environmental factors that impact diet or refer to other supportive services. Develop therapeutic diets and meals plans to help patients/families set goals to improve nutrition-related conditions/diseases. Educate on all aspects of food related to disease conditions.
- Nutrition Monitoring/ Evaluation – determine if goals/objectives have been met; monitor, measure and evaluate nutrition care and status.
Registered Dietitians/nutritionists must be trained: to provide patient-centered care with counseling skills which utilize motivational interviewing methods; to think critically in the care of patients; to have nutrition/food knowledge and communicative and collaborative skills to work with multidisciplinary team members; to practice the profession in an evidenced-based mannerand to conduct themselves with ethical standards according to the Code of Ethics.
Education and training of Registered /licensed Dietitians/Nutritionists
The training requires a four-year Bachelor’s degree with clinical training of 500 hours for ASEAN countries and up to 9 month programs in Western countries and most hold advanced degrees. Dietitians/nutritionists can practice in many settings:hospital in-patient and out-patient care settings, schools, public health sector, old-age institutions, academia, private practice, research, food service, management and food technology fields.
Clinical nutrition is a recognized health profession has become very specialized in many areas: enteral/parenteral, oncology, renal, pediatric, maternal/infant, geriatric, transplantation, cardiovascular, sports nutrition, weight management, wellness/health industry, bariatric medicine, trauma/intensive and neonatal care. Dietitians practice their specialties mostly in the clinical settings.
Dietetics/Nutrition in Myanmar
The Science and Technology Institute Myanmar University (STIMU) has led the country by establishing a Master’s of Nutrition and Dietetics Program in conjunction with University of Bedfordshire (UK) program and collaboration with Mahidol University, Thailand. I am proud to introduce the first batch of Nutritionists/ Dietitians who will graduate in November 2018 and be able to apply to be Registered Nutritionist (UK) after 3 years of appropriate employment/work history.We are just a little behind but are on our way to providing excellent nutritional care for the people of Myanmar.
The students are standing and Faculty are sitting. Dr. ChoMarLwin is Program Director and is 5th from the left.
References
Academy of Nutrition and Dietetics Quality Management Committee and Scope of Practice Subcommittee of the Quality Management Committee. Academy of Nutrition and Dietetics: Scope of Practice for the Registered Dietitian. J. Acad.Nutr. Diet. 2013. 113 (6 suppl 2):S17
Who Global Nutrition Report (2017)
Barker, L.S. et.al. Prevalance , Incidence and Impact on Patients and the Health Care system. Int. J. Environ.Res.Public Health.2011 Feb; 8(2): 514-527
Thelma Tun-Thein, MS, RDN, IBCLC, RLC
