BRIEF RESEARCH REPORT article
Front. Nutr.
Sec. Clinical Nutrition
This article is part of the Research TopicInnovative Approaches to Nutrition Counseling in Pediatric Dietetics - Guidelines, Practices, and Future DirectionsView all 12 articles
Higher Quality Nutrition Care Process Documentation Predicts Nutrition Diagnosis Improvement in the Academy of Nutrition and Dietetics Breastfeeding Registry Study
Provisionally accepted
Allison Gaubert1
Julie M Long2Lindsay Woodcock2
Lauri Wright3
Casey Colin4
Hanadi Hamadi4
Constantina Papoutsakis2*- 1Nicholls State University, Thibodaux, Louisiana, United States
- 2Academy of Nutrition and Dietetics, Chicago, United States
- 3University of South Florida, Tampa, Florida, United States
- 4University of North Florida, Jacksonville, Florida, United States
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Registered dietitian nutritionists (RDNs) provide medical nutrition therapy (MNT) to improve health outcomes, but impact on exclusive breastfeeding remains underexplored. The Breastfeeding Registry Study examines the influence of MNT provided to breastfeeding infants. This study describes nutrition care patterns, documentation quality, nutrition diagnosis improvement, goal attainment, and outcomes predictors. Methods: This prospective, observational study included breastfeeding infants (n=92) from July 2020 to June 2024 using the Academy of Nutrition and Dietetics Health Informatics Infrastructure. The outcome was breastfeeding duration. Frequencies of Nutrition Care Process (NCP) terminology, impactful care plans, and diagnosis improvement were assessed. Documentation quality was evaluated using the NCP Quality Evaluation and Standardization Tool (NCP-QUEST). Mixed-effects logistic regression identified predictors of outcomes. Duration of any breastfeeding averaged 34.2±7.5 (mean±SD) days (n=10), although documentation of this indicator was poor. The most frequent etiology was breastfeeding difficulty (18%). Common intervention categories were Food and/or Nutrient Delivery (46%) and Coordination of Nutrition Care (43%). At reassessment, 68% of diagnoses improved, with the highest rates for breastfeeding difficulty (55%), predicted breastfeeding difficulty (83%), inadequate vitamin D intake (83%), and underweight (83%). NCP-QUEST score (OR = 1.58, 95% CI [1.02, 2.45] p = 0.042) and frequency of visits (OR = 1.77, 95% CI [0.34, 0.9.33] p = 0.049) predicted diagnosis improvement. Higher-quality documentation and more visits were associated with improvements in nutrition diagnoses. This is the first known study to describe care plans that improved prevalent lactation-related nutrition problems and proposes standards for documenting breastfeeding care data in alignment with global recommendations.
Keywords: lactation1, Breastfeeding2, registered dietitian nutritionist3, nutrition care process4, nutrition care process terminology5, informatics6, medical nutrition therapy7, public health nutrition8
Received: 21 May 2025; Accepted: 27 Oct 2025.
Copyright: © 2025 Gaubert, Long, Woodcock, Wright, Colin, Hamadi and Papoutsakis. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Constantina Papoutsakis, cpapoutsakis@eatright.org
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