Therapeutic carbohydrate restriction pre-COVID pandemic: assessing registered dietitians' knowledge, use and perceived barriers in Canada.

BACKGROUND/OBJECTIVES: Evidence supports therapeutic carbohydrate restriction (TCR) for managing appropriate patients with chronic illness, but little is known about TCR prescribing among dietitians. This study evaluated dietitians' knowledge, information use and needs for TCR in Canada.

METHODS

Registered dietitians (RDs) were recruited (n = 274) from January to December 2020 to collect semi-structured data using an online needs assessment survey (French and English). Descriptive and inferential statistics were used to describe and assess which nine RD practice characteristics predicted TCR prescription in clinical practice.

RESULTS

Respondents were located in all provinces and territories in Canada, with few international responses in the sample (3.5%). We found statistically significant differences between RDs who have prescribed TCR or not in four practice characteristics studied: level of knowledge (p < 0.001), reviewing literature (p = 0.02), clinician referrals (p < 0.001) or personal experience (p < 0.001). Multivariable models showed that the odds of prescribing TCR was associated with intermediate/expert knowledge (OR 5.92 [95% CI: 2.26-17.77]), clinician's referral (OR 3.22 [1.73-6.14]) and personal experience, whether a former user (OR 2.24 [1.09-4.72]) or a current user of TCR (OR 9.09 [2.70-42.09]), compared to no knowledge, no referral or no experience.

CONCLUSION

There is a strong link between the use, or lack, of TCR in clinical practice among RDs and their knowledge level, personal experience and clinician referrals/support. Scope exists to develop novel educational tools and resources on scientific evidence for TCR, and increase multidisciplinary teams, so as to better support RDs in Canada to safely implement TCR in appropriate patients with chronic illness.