News from the French Association of Nutritionist - Dietitians (AFDN)
  • The French Association of nutritionist -dietitians (AFDN) has been working since 2017 with the French Clinical Nutrition and Metabolism Society (SFNCM) on the harmonization of standard and therapeutic diets in health facilities, with the aim of:
    Covering patients’ nutritional needs and adapting to them to patients’
    pathophysiological situation as well as the needs of hospitalization.
    Respecting the patient to give the diet its full meaning: nutritional,
    and personal preferences (taking into account the choices, the time of meals...).
    Rationalizing and harmonizing practices related to diet prescriptions.
    Reducing constraints that could lead to restrictions on the provision of
    meals (food choices for food preparations, implications of priced
    meals, consequences of palatability and consumption of dishes).
    After a 2017 report on hospital feeding, the two associations formed a steering group made up of members of AFDN and SFNCM.
    The steering group proposed recommendations based on the results of the 2017 report and data from the literature. These recommendations were submitted to 50 national experts (25 dietitians and 25 medical doctors) who formalized a consensus, according to the Delphi method. 
    This work culminated in 23 recommendations in 2019: 
    1. It is recommended that the food supply includes several choices.
    2. It is recommended that the standard diet meets the recommendations for prevention and health promotion.
    3. Apart from a personalized diet, it is recommended that the standard diet provides a minimum of 2000 kcal /day
    4. It is recommended that the nutritional values (energy, proteins, lipids, carbohydrates) of the food supply are accessible, especially to the prescriber and the dietitian.
    5. It is recommended that any diet should be prescribed at the patient's admission and fitted to the clinical situation.
    6. It is recommended that all types of therapeutic diets should be reassessed during hospitalization and at discharge by the prescriber, and if necessary by a dietitian and / or a nutritionist.
    7. It is recommended not to combine more than 2 restrictive therapeutic foods because of the risk of undernutrition.
    8. It is recommended that meals supplied can be split by offering more than 3 meals a day.
    9. It is recommended that the textures and adaptations be established according to the international IDDSI recommendations/guidelines
    10. In hospital, apart from a specialist nutrition opinion, the prescription of a therapeutic diet aimed at weight loss is not recommended.
    11. It is recommended to adapt protein intake according to the stage of Chronic Kidney Disease and nutritional status.
    12. It is not recommended to prescribe a hypolipidic therapeutic diet  (<35% of the Total Energy Intake), with the exception of primary hypertriglyceridemia major and chylous effusions where a strict restriction of lipids is needed (<30 g per day, excluding medium chain triglycerides) 
    13. The standard diet is suitable for the diabetic patient without excluding foods and desserts containing sucrose.
    14. It is recommended that the standard diet provides a regular supply of carbohydrates with each meal.
    15. It is recommended that the quantities of carbohydrates are known and provided in each dish served.
    16. If a therapeutic low salt diet is indicated, it is recommended not to restrict the salt intake (NaCl) to less than 5g /day (i.e. about 2g of sodium /day), except in the event of severe acute decompensation (for a very short time)
    17. That a diet titled "acid-free and / or spice-free" has no indication (except oral, digestive hypersensitivity or food allergy).
    18. It is recommended not to exclude from the" strict low- fiber " diet (10-14g fiber / d, generally called low in residue or without residue), pulp free fruit juices, potatoes, white bread, milk and milk derivatives.
    19. It is recommended to reserve strict low-fiber diet (10 to 14g / d of fiber) for therapeutic purposes in symptomatic intestinal strictures and for diagnostic purposes in some digestive explorations or for symptomatic purposes. 
    20. On medical prescription, a diet low in fiber (15-20g fiber / day) may have indications in the hospital in regard to digestive symptoms.
    21. It is recommended not to exclude all dairy products as part of lactose intolerance.
    22. Except where celiac disease is medically diagnosed, gluten-free diet is not recommended
    23. For the prevention and management of undernutrition, it is recommended to offer a diet enriched with energy and / or proteins to respond to the undernutrition.
    Ghislain Grodard,