A dietitian or dieticianThe spelling with "c" is listed first in UK dictionaries, for example Oxford, Longman, and Collins. The American English versions of Oxford and Collins list the spelling with "t" first. is an expert in identifying and treating disease-related malnutrition and in conducting medical nutrition therapy, for example designing an enteral tube feeding regimen or mitigating the effects of cancer cachexia. Many dietitians work in hospitals and usually see specific patients where a nutritional assessment and intervention has been requested by a doctor or nurse, for example if a patient has lost their ability to swallow or requires artificial nutrition due to intestinal failure. Dietitians are regulated healthcare professionals licensed to assess, diagnose, and treat such problems. In the United Kingdom, dietitian is a 'protected title', meaning identifying oneself as a dietitian without appropriate education and registration is prohibited by law.
A registered dietitian (RD) (UK/USA) or registered dietitian nutritionist (RDN) (USA) meets all of a set of special academic and professional requirements, including the completion of a bachelor's and/or master's degree in nutrition and dietetics (or equivalent). One or more internships (USA) or clinical placements (UK) must also be completed. These may be allocated and monitored by the university as part of the structured degree programme (UK) or may be applied for separately (USA).
Roughly half of all RD(N)s hold graduate degrees and many have certifications in specialized fields such as nutrition support, sports, paediatrics, renal, oncological, food-allergy, or gerontological nutrition. Although assessment priorities differ depending on the specialist area, a patient's medical and surgical history, biochemistry, diet history, eating and exercise habits usually form the basis of assessment. The RD(N) negotiates a treatment plan with the patient which may include prescriptions, and follow-up visits often focus on maintenance and monitoring progress.
Most RDs work in the treatment and prevention of disease (administering medical nutrition therapy, as part of medical teams), often in hospitals, health-maintenance organizations, private practices, or other health-care facilities. In addition, many registered dietitians work in community and public-health settings, and/or in academia and research. A growing number of dietitians work in the food industry, medical corporations, journalism, sports nutrition, corporate wellness programs, and other non-traditional dietetics settings.
The spellings "dietitian" and "dietician" As explained by the American Heritage and Merriam-Webster's dictionaries, the cause of the confusion is that the spelling with "-tian" is an irregular alteration of the ending "-cian". These and other American dictionaries also list the spelling with "c" but list the spelling with "t" first because this spelling is more common in the United States. Nevertheless, the American publisher McGraw-Hill exclusively uses the spelling with "c" in the 2003 edition of the McGraw-Hill Dictionary of Scientific & Technical Terms and the 2002 edition of the McGraw-Hill Concise Dictionary of Modern Medicine.
The spelling with "t" is the one preferred by the profession itself internationally, but the spelling with "c" is used often enough in texts not written by members of the profession to be considered a valid variant by both American and British dictionaries. In fact, British dictionaries list the spelling with "c" first and list the spelling with "t" as a variant. American dictionaries list the spelling with "t" first and the spelling with "c" as a variant.
As explained in a 2010 newsletter of the International Confederation of Dietetic Associations:
ILO has however also issued new documents using the spelling "dietician".
World Health Organization classification Dietitians supervise the preparation and service of food, develop modified diets, participate in research, and educate individuals and groups on good nutritional habits.World Health Organization. Classifying health workers. Geneva, World Health Organization, 2010.U.S. Bureau of Labor Statistics: Occupational Outlook Handbook, 2010–11 Edition. — Dietitians and Nutritionists. Accessed 11 March 2011. The goals of dietitians are to provide medical nutritional intervention, and to obtain, safely prepare, serve and advise on flavorsome, attractive, and nutritious food for patients, groups and communities. Dietary modification to address medical issues involving dietary intake is a major part of dietetics (the study of nutrition as it relates to health). For example, working in consultation with physicians and other health care providers, a dietitian may provide specific artificial nutritional needs to patients unable to consume food normally. Professional dietitians may also provide specialist services such as in diabetes, obesity, oncology, osteoporosis, pediatrics, renal disease, and micronutrient research.DIETS Thematic Network for Dietetics. Improving the nutrition of Europe through a fully evidenced based profession of dietetics. Accessed 11 March 2011.Misner B. 2006. "Food Alone May Not Provide Sufficient Micronutrients for Preventing Deficiency." Int Soc Sports Nutr; 3(1): 51–55. Accessed 14 March 2011.National Health Service: Careers in detail – Dietitian. Accessed 1 April 2011.
Different professional terms are used in different countries and employment settings, for example, clinical dietitian, community dietitian, dietetic educator, food-service dietitian, registered dietitian, public health dietitian, therapeutic dietitian, or research dietitian.Statistics Canada: National Occupational Classification 2006 — D032 Dietitians and Nutritionists. Accessed 11 March 2011. In many countries, only people who have specified educational credentials and other professional requirements can call themselves "dietitians"—the title is legally protected. The term "nutritionist" is also widely used; however, the terms "dietitian" and "nutritionist" should not be considered interchangeable—the training, regulation and scope of practice of the two professional titles can be very different across individuals and jurisdictions.
In many countries, the majority of dietitians are clinical or therapeutic dietitians, such as the case of the United States, the United Kingdom, and much of Africa. In other countries they are mostly foodservice dietitians, such as in Japan and many European countries.Hwalla N, Koleilat M. 'Dietetic practice: the past, present and future.' Eastern Mediterranean Health Journal, 2004, 10(6):716–730 http://www.emro.who.int/Publications/EMHJ/1006/index.htm
Dietitians in practice
Clinical dietitians Clinical dietitians work in hospitals, outpatient clinics, nursing care facilities and other health care facilities to provide nutrition therapy to patients with a variety of health conditions, and provide dietary consultations to patients and their families. They confer with other health care professionals to review patients' medical charts and develop individual plans to meet nutritional requirements. Some clinical dietitians will also create or deliver outpatient or public education programs in health and nutrition. Clinical dietitians may provide specialized services in areas of nourishment and diets, tube feedings (called enteral nutrition), and intravenous feedings (called parenteral nutrition) such as total parenteral nutrition (TPN) or peripheral parenteral nutrition (PPN). They work as a team with the physicians, physician assistants, physical therapists, occupational therapists, recreational therapists, pharmacists, speech therapists, social workers, nurses, dietetic technicians, psychologists and other specialists to provide care to patients. Some clinical dietitians have dual responsibilities with patient nutrition therapy and in food service or research (described below).
Community dietitians Community dietitians work with wellness programs, public health agencies, home care agencies, and health maintenance organizations. These dietitians apply and distribute knowledge about food and nutrition to individuals and groups of specific categories, life-styles and geographic areas in order to promote health. They often focus on the needs of the elderly, children, or other individuals with special needs or limited access to healthy food. Some community dietitians conduct home visits for patients who are too physically ill to attend consultations in health facilities in order to provide care and instruction on grocery shopping and food preparation.
Foodservice dietitians Foodservice dietitians or managers are responsible for large-scale food planning and service. They coordinate, assess and plan foodservice processes in health care facilities, school food-service programs, prisons, restaurants, and company cafeterias.Alberta Employment and Immigration: "Alberta Occupational Profiles – Dietitian". Accessed 1 April 2011. These dietitians may perform audits of their departments to ensure quality control and food safety standards, and launch new menus and various programs within their institution to meet health and nutritional requirements. They train and supervise other food service workers such as kitchen staff, delivery staff, and dietary assistants or aides.
Gerontological dietitians Gerontological dietitians are specialists in nutrition and aging. They work in nursing homes, community-based aged care agencies, government agencies in aging policy, and in higher education in the field of gerontology (the study of aging).
Neonatal dietitians Neonatal dietitians provide individualized medical nutrition therapy for critically ill premature newborns. They are considered a part of the Neonatal Intensive Care Unit's medical team. The neonatal dietitian performs clinical assessment of patients, designs nutrition protocols and quality improvement initiatives with the medical team, develops enteral and parenteral regimens, helps establish and promote lactation/breastfeeding guidelines and often oversees the management of infection prevention in the handling, storage, and delivery of nutritional products.
Pediatric dietitians Pediatric dietitians provide nutrition and health advice for infants, children, and adolescents. They focus on early nutritional needs, and often work closely with doctors, school health services, clinics, hospitals and government agencies, in developing and implementing treatment plans for children with eating disorders, food allergies, or any condition where a child's diet factors into the equation, such as childhood obesity.PediatricDietician.net . Accessed 14 March 2011.
Research dietitians Research dietitians may focus on social sciences or health services research, for example, investigate the impact of health policies or behaviour change, or evaluate program effectiveness. They may survey food-service systems management in order to guide quality improvement. Some research dietitians study the biochemical aspects of nutrient interaction within the body.de Jong N et al. 'Functional Biochemical and Nutrient Indices in Frail Elderly People Are Partly Affected by Dietary Supplements but Not by Exercise.' Journal of Nutrition 1999;129:2028–2036. In universities, they also may have teaching responsibilities. Some clinical dietitians' roles involve research in addition to their patients care workload.
Administrative dietitians