{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T14:13:36Z","timestamp":1788790416683,"version":"build-2803163510"},"reference-count":32,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T00:00:00Z","timestamp":1762041600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T00:00:00Z","timestamp":1762041600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aspenjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nut in Clin Prac"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Persons living with amyotrophic lateral sclerosis (PALS) are at high risk for malnutrition because of disease\u2010related factors such as dysphagia, self\u2010feeding difficulty, and hypermetabolism. Nutrition interventions, including enteral nutrition (EN) initiation after gastrostomy tube (G\u2010tube) placement, are integral to care but can introduce challenges, such as refeeding syndrome. This qualitative analysis explores how registered dietitians (RDs) at US\u2010based outpatient amyotrophic lateral sclerosis (ALS) clinics assess malnutrition, facilitate discussions around G\u2010tube placement, and mitigate refeeding syndrome risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Six focus groups were conducted with 22 RDs from US ALS clinics. Audio files were transcribed verbatim, and data analyzed by deductive thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>RDs reported widespread use of the Academy of Nutrition and Dietetics\/American Society for Parenteral and Enteral Nutrition indicators for diagnosing malnutrition, with some using the Global Leadership Initiative on Malnutrition criteria. However, RDs described limitations in using these tools for PALS, particularly in differentiating disease\u2010related from malnutrition\u2010related muscle loss. When discussing G\u2010tube placement, RDs described themselves as key informants in multidisciplinary teams, with timing of counseling typically based on symptoms and clinical progression. For refeeding syndrome, most clinics lacked formal protocols, although RDs used preventative practices, including slow initiation and advancement of EN and proactive communication with the care team.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ALS RDs play a critical and multifaceted role in managing nutrition\u2010related ALS care. There is a need for ALS\u2010specific malnutrition criteria and standard protocols to manage refeeding syndrome in the outpatient setting. RDs\u2019 involvement in G\u2010tube discussions underscores their role in supporting patients in medical decision\u2010making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ncp.70069","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T02:04:24Z","timestamp":1762135464000},"page":"589-597","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Medical nutrition therapy for ALS: Dietitians' approaches to diagnosing malnutrition, facilitating feeding tube discussions, and mitigating refeeding syndrome risk"],"prefix":"10.1002","volume":"41","author":[{"given":"Stephanie","family":"Dobak","sequence":"first","affiliation":[{"name":"Jefferson Weinberg ALS Center Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith","family":"Pearson","sequence":"additional","affiliation":[{"name":"Department of Nutrition Sciences The University of Alabama at Birmingham Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebekah","family":"McGuire","sequence":"additional","affiliation":[{"name":"Department of Human Nutrition The University of Alabama Tuscaloosa Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy C.","family":"Ellis","sequence":"additional","affiliation":[{"name":"Department of Human Nutrition The University of Alabama Tuscaloosa Alabama 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