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Medical Nutrition Therapy to Patients Screened for Food Insecurity

June 22, 2020
Author: Children’s National Medical Center

Center for Quality Improvement and Innovation (CQII)


Integration of medical nutrition therapy in routine HIV care via screening of patients for food insecurity and delivery of cooking classes and healthy groceries to those needing food assistance.

Change Ideas

  • Screened patients for food insecurity through a two-question verbal survey
  • Nutrition assistance was provided to those expressing food insecurity via community resources (i.e., food bank), grocery gift card vouchers, grocery bags, etc.
  • Held cooking classes, which taught nutrition principles lead by registered dietitian, and were open to patients, their parents, and their siblings
  • Distributed healthy produce with recipes, $8 worth of fresh fruits and vegetables in bags at each visit, chosen weekly by registered dietitian at local grocery store


The Academy of Nutrition and Dietetics supports integration of medical nutrition therapy (MNT) into routine care for people with HIV (PWH). MNT is an approach that has been found to improve the effectiveness of antiretroviral therapy (ART).1 MNT (with or without oral nutritional supplementation) has also shown to improve outcomes related to energy intake among PWH.2,3 Medical nutrition therapy was provided by Children’s National Medical Center to youth ages 13-24 years with food insecurity through cooking classes and distribution of healthy produce bags. Screening for food insecurity was carried out using the American Academy of Pediatrics Vital Signs survey, consisting of two questions, which was administered verbally in a conversational style by Registered Dietitian at clinic visits for each patient to assess if food insecurity existed among them. Between August 2018 and August 2019, 54 out of the 206 patients screened (26%) were found to be positive for food insecurity. Responses were documented in patient EMR. Additionally, nutrition assistance was provided to those expressing food insecurity via community resources (i.e. food bank), grocery gift card vouchers, and grocery bags. From September 2018 to August 2019, cooking classes were held 1-2 times per month. Produce distribution began in July 2018, which included $8 worth of fruits and vegetables per visit, along with recipes. The produce was chosen weekly by the Registered Dietitian based on seasonality and price. Viral suppression among youth increased from 68.3% (125/183) to 71.5% (118/165) during this intervention.

1 Spada C, Treitinger A, Reis M, Masokawa IY, Verdi JC, Luiz MC et al. An evaluation of antiretroviral therapy associated with alphatocopherol supplementation in HIV-infected patients. Clinical Chemistry and Laboratory Medicine. 2002. 40:456-459.

2 Rabeneck L, Palmer A, Knowles JB, Seidehamel RJ, Harris CL, Merkel KL et al. A randomized controlled trial evaluating nutrition counseling with or without oral supplementation in malnourished HIV-infected patients. Journal of the American Dietetic Association. 1998. 98(4):434-8.

3 Schwenk A, Steuck H, Kremer G. Oral supplements as adjunctive treatment to nutritional counseling in malnourished HIV-infected patients: randomized controlled trial. Clinical Nutrition. 1999. 18(6):371-4.

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