Position of the Academy of Nutrition and Dietetics: The Role of Nutrition in Health Promotion and Chronic Disease Prevention


      It is the position of the Academy of Nutrition and Dietetics that primary prevention is the most effective and affordable method to prevent chronic disease, and that dietary intervention positively impacts health outcomes across the life span. Registered dietitians and dietetic technicians, registered are critical members of health care teams and are essential to delivering nutrition-focused preventive services in clinical and community settings, advocating for policy and programmatic initiatives, and leading research in disease prevention and health promotion. Health-promotion and disease-prevention strategies are effective at reducing morbidity and mortality and improving quality of life, and have a significant impact on the leading causes of disease. By applying these principles within a social ecological theoretical framework, positive influence can be applied across the spectrum of engagement: at intrapersonal, interpersonal, institutional, community, and public policy levels. Through the application of efficacious and cost-effective interventions, registered dietitians and dietetic technicians, registered, can positively impact public health as well as health outcomes for the individuals that they counsel. This position paper supports the “Practice Paper of the Academy of Nutrition and Dietetics: The Role of Nutrition in Health Promotion and Chronic Disease Prevention” published on the Academy's website at:
      To read this article in full you will need to make a payment


      1. Practice Paper of the Academy of Nutrition and Dietetics: The role of nutrition in health promotion and disease prevention.
        (Academy of Nutrition and Dietetics website) (Published July 2013. Accessed February 28, 2013)
        • Weintraub W.S.
        • Daniels S.R.
        • Burke L.E.
        • et al.
        Value of primordial and primary prevention for cardiovascular disease.
        Circulation. 2011; 124: 967-990
        • Diabetes Prevention Program Research Group
        Within-trial cost-effectiveness of lifestyle intervention or metformin for the primary prevention of type 2 diabetes.
        Diabetes Care. 2003; 26: 2518-2523
        • Lehnert T.
        • Sonntag D.
        • Konnopka A.
        • Riedel-Heller S.
        • König H.H.
        The long-term cost-effectiveness of obesity prevention interventions: Systematic literature review.
        Obes Rev. 2012; 13: 537-553
        • Loveman E.
        • Frampton G.
        • Shepherd J.
        • et al.
        The clinical effectiveness and cost-effectiveness of long-term weight management schemes for adults: A systematic review.
        Health Technol Assess. 2011; 15: 1-6
        • Appel L.J.
        • Espeland M.A.
        • Easter L.
        • Wilson A.C.
        • Folmar S.
        • Lacy C.R.
        Effects of reduced sodium intake on hypertension control in older individuals: Results from the trial of nonpharmacologic interventions in the elderly (TONE).
        Arch Intern Med. 2001; 161: 685
        • Dehghan M.
        • Mente A.
        • Teo K.K.
        • et al.
        Relationship between healthy diet and risk of cardiovascular disease among patients on drug therapies for secondary prevention/clinical perspective.
        Circulation. 2012; 126: 2705-2712
        • Greaves C.J.
        • Sheppard K.E.
        • Abraham C.
        • et al.
        Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions.
        BMC Public Health. 2011; 11: 119
        • Pi-Sunyer X.
        • Blackburn G.
        • Brancati F.
        • et al.
        Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: One-year results of the Look AHEAD trial.
        Diabetes Care. 2007; 30: 1374
        • Wing R.R.
        • Look AHEAD Research Group
        Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: Four-year results of the Look AHEAD trial.
        Arch Intern Med. 2010; 170: 1566-1575
        • Eilat-Adar S.
        • Eldar M.
        • Goldbourt U.
        Association of intentional changes in body weight with coronary heart disease event rates in overweight subjects who have an additional coronary risk factor.
        Am J Epidemiol. 2005; 161: 352-358
        • Academy of Nutrition and Dietetics Evidence Analysis Library
        What is the evidence to support the cost-effectiveness, cost benefit or economic savings of outpatient MNT services provided by an RD?.
        (Evidence Analysis Library website) (Reviewed December 2007. Accessed January 9, 2013)
        • Academy of Nutrition and Dietetics
        What is the evidence to support effectiveness of nutrition interventions and counseling provided by an RD when part of a healthcare team?.
        (Evidence Analysis Library website) (Reviewed January 2008. Accessed January 9, 2013)
        • Delahanty L.M.
        • Sonnenberg L.M.
        • Hayden D.
        • Nathan D.M.
        Clinical and cost outcomes of medical nutrition therapy for hypercholesterolemia: A controlled trial.
        J Am Diet Assoc. 2001; 101: 1012-1023
        • Holmes A.L.
        • Sanderson B.
        • Maisiak R.
        • Brown A.
        • Bittner V.
        Dietitian services are associated with improved patient outcomes and the MEDFICTS Dietary Assessment Questionnaire is a suitable outcome measure in cardiac rehabilitation.
        J Am Diet Assoc. 2005; 105: 1533-1540
      2. American Dietetic Association revised 2008 standards of practice for registered dietitians in nutrition care; standards of professional performance for registered dietitians; standards of practice for dietetic technicians, registered, in nutrition care; and standards of professional performance for dietetic technicians, registered.
        J Am Diet Assoc. 2008; 108: 1538-1542.e9
        • Arena J.
        • Walters P.
        Do you know what a dietetic technician can do?.
        J Am Diet Assoc. 1997; 97: S139-S141
        • Academy of Nutrition and Dietetics
        What is the evidence to support effectiveness of MNT provided by an RD compared with other healthcare professionals who provide nutrition interventions (doctors, nurses, health coaches, etc.)?.
        (Evidence Analysis Library website) (Reviewed January 2008. Accessed January 9, 2013)
      3. Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in US children and adolescents, 2007-2008. JAMA. 2010303(3):242-249.

        • Ogden C.
        • Carroll M.
        • Kit B.
        • Flegal K.
        Prevalence of obesity in the United States, 2009–2010.
        National Center for Health Statistics, Hyattsville, MD2012
        • Guh D.P.
        • Zhang W.
        • Bansback N.
        • Amarsi Z.
        • Birmingham C.L.
        • Anis A.H.
        The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis.
        BMC Public Health. 2009; 9: 88
        • Deckelbaum R.J.
        • Williams C.L.
        Childhood obesity: The health issue.
        Obes Res. 2001; 9: 239S-243S
        • Academy of Nutrition and Dietetics
        Pediatric weight management evidence-based nutrition practice guideline: Executive summary of recommendations.
        (Evidence Analysis Library website) (Accessed January 9, 2013)
        • Finkelstein E.A.
        • Trogdon J.G.
        • Cohen J.W.
        • Dietz W.
        Annual medical spending attributable to obesity: Payer-and service-specific estimates.
        Health Aff (Millwood). 2009; 28: w822-w831
        • Roger V.L.
        • Go A.S.
        • Lloyd-Jones D.M.
        • et al.
        Heart disease and stroke statistics—2012 update: A report from the American Heart Association.
        Circulation. 2012; 125: e2-e220
        • Danaei G.
        • Ding E.L.
        • Mozaffarian D.
        • et al.
        The preventable causes of death in the United States: Comparative risk assessment of dietary, lifestyle, and metabolic risk factors.
        PLoS Med. 2009; 6: e1000058
        • Apovian C.M.
        The causes, prevalence, and treatment of obesity revisited in 2009: What have we learned so far?.
        Am J Clin Nutr. 2010; 91: 277S-279S
        • Finkelstein E.A.
        • Khavjou O.A.
        • Thompson H.
        • et al.
        Obesity and severe obesity forecasts through 2030.
        Am J Prev Med. 2012; 42: 563-570
        • US Preventive Services Task Force
        Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults.
        (Updated 2012. Accessed December 5, 2012)
        • Boyle J.P.
        • Thompson T.J.
        • Gregg E.W.
        • Barker L.E.
        • Williamson D.F.
        Projection of the year 2050 burden of diabetes in the US adult population: Dynamic modeling of incidence, mortality, and prediabetes prevalence.
        Popul Health Metr. 2010; 22: 29
        • Fagot-Campagna A.
        • Pettitt D.J.
        • Engelgau M.M.
        • et al.
        Type 2 diabetes among North American children and adolescents: An epidemiologic review and a public health perspective.
        J Pediatr. 2000; 136: 664-672
        • De Ferranti S.D.
        Epidemiology of paediatric metabolic syndrome and type 2 diabetes mellitus.
        Diab Vasc Dis Res. 2007; 4 (OS): 285-296
        • Nguyen Q.M.
        • Srinivasan S.R.
        • Xu J.H.
        • Chen W.
        • Berenson G.S.
        Changes in risk variables of metabolic syndrome since childhood in pre-diabetic and type 2 diabetic subjects the Bogalusa Heart Study.
        Diabetes Care. 2008; 31: 2044-2049
        • Cowie C.C.
        • Rust K.F.
        • Ford E.S.
        • et al.
        Full accounting of diabetes and pre-diabetes in the US population in 1988–1994 and 2005–2006.
        Diabetes Care. 2009; 32: 287-294
        • Wilson P.W.
        • Meigs J.B.
        • Sullivan L.
        • Fox C.S.
        • Nathan D.M.
        • D'Agostino Sr, R.B.
        Prediction of incident diabetes mellitus in middle-aged adults: The Framingham Offspring Study.
        Arch Intern Med. 2007; 167: 1068-1074
        • Psaltopoulou T.
        • Ilias I.
        • Alevizaki M.
        The role of diet and lifestyle in primary, secondary, and tertiary diabetes prevention: A review of meta-analyses.
        Rev Diabet Stud. 2010; 7: 26-35
        • Gillies C.L.
        • Abrams K.R.
        • Lambert P.C.
        • et al.
        Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: Systematic review and meta-analysis.
        BMJ. 2007; 334: 299
        • Jemal A.
        • Siegal R.
        • Xu J.
        • Ward E.
        Cancer statistics, 2010.
        CA Cancer J Clin. 2010; 60: 277-300
        • National Cancer Institute
        Cancer trends progress report—2011/2012 Update.
        (Accessed October 15, 2012)
        • Prentice R.L.
        • Thomson C.A.
        • Caan B.
        • et al.
        Low-fat dietary pattern and cancer incidence in the women's health initiative dietary modification randomized controlled trial.
        J Natl Cancer Inst. 2007; 99: 1534-1543
        • Prentice R.L.
        • Caan B.
        • Chlebowski R.T.
        • et al.
        Low-fat dietary pattern and risk of invasive breast cancer.
        JAMA. 2006; 295: 629-642
        • Robitaille J.
        • Yoon P.W.
        • Moore C.A.
        • et al.
        Prevalence, family history, and prevention of reported osteoporosis in US women.
        Am J Prev Med. 2008; 35: 47-54
        • Rizzoli R.
        • Bianchi M.L.
        • Garabedian M.
        • McKay H.A.
        • Moreno L.A.
        Maximizing bone mineral mass gain during growth for the prevention of fractures in the adolescents and the elderly.
        Bone. 2010; 46: 294-305
        • Prentice A.
        Diet, nutrition and the prevention of osteoporosis.
        Public Health Nutr. 2004; 7: 227-244
        • Kaye E.K.
        Bone health and oral health.
        J Am Dent Assoc. 2007; 138: 616-619
      4. (CS)
        • Cohen L.
        Beyond brochures—The imperative for primary prevention.
        in: Cohen L. Chavez V. Cehimi S. Prevention Is Primary. John Wiley & Sons, San Francisco, CA2007: 3-24
        • Kumanyika S.K.
        • Obarzanek E.
        • Stettler N.
        • et al.
        Population-based prevention of obesity: The need for comprehensive promotion of healthful eating, physical activity, and energy balance: A scientific statement from American Heart Association Council on Epidemiology and Prevention, Interdisciplinary Committee for Prevention (formerly the Expert Panel on Population and Prevention Science).
        Circulation. 2008; 118: 428-464
        • Beaulac J.
        • Kristjansson E.
        • Cummins S.
        A systematic review of food deserts, 1966-2007.
        Prev Chronic Dis. 2009; 6: A105
        • Larson N.I.
        • Story M.T.
        • Nelson M.C.
        Neighborhood environments: Disparities in access to healthy foods in the US.
        Am J Prev Med. 2009; 36: 74-81.e10
        • Krishnan S.
        • Coogan P.F.
        • Boggs D.A.
        • Rosenberg L.
        • Palmer J.R.
        Consumption of restaurant foods and incidence of type 2 diabetes in African American women.
        Am J Clin Nutr. 2010; 91: 465-471
        • Fleischhacker S.E.
        • Evenson K.R.
        • Rodriguez D.A.
        • Ammerman A.S.
        A systematic review of fast food access studies.
        Obes Rev. 2011; 12: e460-e471
        • Duffey K.J.
        • Gordon-Larsen P.
        • Steffen L.M.
        • Jacobs Jr, D.R.
        • Popkin B.M.
        Regular consumption from fast food establishments relative to other restaurants is differentially associated with metabolic outcomes in young adults.
        J Nutr. 2009; 139: 2113-2118
        • Franzini L.
        • Caughy M.
        • Spears W.
        • Fernandez Esquer M.E.
        Neighborhood economic conditions, social processes, and self-rated health in low-income neighborhoods in Texas: A multilevel latent variables model.
        Soc Sci Med. 2005; 61: 1135-1150
        • Chamberlain L.J.
        • Wang Y.
        • Robinson T.N.
        Does children's screen time predict requests for advertised products?.
        Arch Pediatr Adolesc Med. 2006; 160: 363-368
        • Rideout V.J.
        • Foehr U.
        • Roberts D.
        Generation M2: Media in the lives of 8- to 18-year-olds.
        (Published January 2010. Accessed April 12, 2013)
        • te Velde S.
        • van Nassau F.
        • Uijtdewilligen L.
        • et al.
        Energy balance-related behaviours associated with overweight and obesity in preschool children: A systematic review of prospective studies.
        Obes Rev. 2012; 13: 56-74
        • Tremblay M.S.
        • LeBlanc A.G.
        • Kho M.E.
        • et al.
        Systematic review of sedentary behaviour and health indicators in school-aged children and youth.
        Int J Behav Nutr Phys Act. 2011; 8: 98
        • Chinapaw M.
        • Proper K.
        • Brug J.
        • Van Mechelen W.
        • Singh A.
        Relationship between young peoples' sedentary behaviour and biomedical health indicators: A systematic review of prospective studies.
        Obes Rev. 2011; 12: e621-e632
        • National Prevention Council
        National Prevention Strategy.
        (Office of the Surgeon General website) (Published June 2011. Accessed April 12, 2013)
        • Sallis J.F.
        • Owen N.
        • Fisher E.B.
        Ecological models of health behavior.
        in: Glanz K. Rimer B. Viswanath K. Health Behavior and Health Education: Theory, Research, and Practice.4th ed. Jossey-Bass, San Francisco, CA2008: 465-486
        • McLeroy K.R.
        • Bibeau D.
        • Steckler A.
        • Glanz K.
        An ecological perspective on health promotion programs.
        Health Educ Q. 1988; 15: 351-377
        • US Department of Health and Human Services
        (Accessed May 15, 2012)
        • US Department of Agriculture, US Department of Health and Human Services
        Dietary Guidelines for Americans, 2010.
        7th ed. US Government Printing Office, Washington, DC2010
        • US Preventive Services Task Force
        Guide to Clinical Preventive Services, 2012.
        (AHRQ Publication No. 12-05154 Agency for Healthcare Research and Quality website) (Published October 2012. Accessed January 9, 2013)
        • Community Preventive Services Task Force
        The Guide to Community Preventive Services.
        (Updated April 4, 2013. Accessed January 9, 2013)
        • Wolf A.M.
        • Siadaty M.
        • Yaeger B.
        • et al.
        Effects of lifestyle intervention on health care costs: Improving Control with Activity and Nutrition (ICAN).
        J Am Diet Assoc. 2007; 107: 1365-1373
        • Herman W.
        • Brandle M.
        • Zhang P.
        • et al.
        The Diabetes Prevention Program Research Group: Costs associated with the primary prevention of type 2 diabetes mellitus in the Diabetes Prevention Program.
        Diabetes Care. 2003; 26: 36-47
        • Sikand G.
        • Kashyap M.L.
        • Wong N.D.
        • Hsu J.C.
        Dietitian intervention improves lipid values and saves medication costs in men with combined hyperlipidemia and a history of niacin noncompliance.
        J Am Diet Assoc. 2000; 100: 218-224
        • Bós A.M.
        • Howard B.V.
        • Beresford S.A.A.
        • et al.
        Cost-effectiveness analysis of a low-fat diet in the prevention of breast and ovarian cancer.
        J Am Diet Assoc. 2011; 111: 56-66
        • US Department of Health and Human Services
        HHS action plan to reduce racial and ethnic health disparities: A nation free of disparities in health and health care.
        (Accessed April 12, 2013)
        • Johnson-Askew W.L.
        • Gordon L.
        • Sockalingam S.
        Practice paper of the American Dietetic Association: Addressing racial and ethnic health disparities.
        J Am Diet Assoc. 2011; 111: 446-456
        • Kurian A.K.
        • Cardarelli K.M.
        Racial and ethnic differences in cardiovascular disease risk factors: A systematic review.
        Ethn Dis. 2007; 17: 143-152
        • Flores G.
        • Committee on Pediatric Research
        Technical report—Racial and ethnic disparities in the health and health care of children.
        Pediatrics. 2010; 125: e979-e1020
        • Argeseanu Cunningham S.
        • Ruben J.D.
        • Narayan K.M.
        Health of foreign-born people in the United States: A review.
        Health Place. 2008; 14: 623-635
        • Fitzgerald N.
        Acculturation, socioeconomic status, and health among Hispanics.
        NAPA Bulletin. 2010; 34: 28-46
        • Lopez-Quintero C.
        • Berry E.M.
        • Neumark Y.
        Limited English proficiency is a barrier to receipt of advice about physical activity and diet among Hispanics with chronic diseases in the united states.
        J Am Diet Assoc. 2010; 110: S62-S67
        • Lara M.
        • Gamboa C.
        • Kahramanian M.I.
        • Morales L.S.
        • Bautista D.E.
        Acculturation and Latino health in the United States: A review of the literature and its sociopolitical context.
        Annu Rev Public Health. 2005; 26: 367-397
        • Braveman P.A.
        • Cubbin C.
        • Egerter S.
        • Williams D.R.
        • Pamuk E.
        Socioeconomic disparities in health in the United States: What the patterns tell us.
        Am J Public Health. 2010; 100: S186-S196
        • Galobardes B.
        • Smith G.D.
        • Lynch J.W.
        Systematic review of the influence of childhood socioeconomic circumstances on risk for cardiovascular disease in adulthood.
        Ann Epidemiol. 2006; 16: 91-104
        • Escarce J.J.
        Racial and ethnic disparities in access to and quality of health care.
        (Robert Wood Johnson Foundation website) (Published September 2007. Accessed April 12, 2013)
        • Morris A.M.
        • Rhoads K.F.
        • Stain S.C.
        • Birkmeyer J.D.
        Understanding racial disparities in cancer treatment and outcomes.
        J Am Coll Surg. 2010; 211: 105-113
        • Nord M.
        • Andrews M.
        • Carlson S.
        Household Food Security in the United States, 2008, ERR-83.
        (Economic Research Service website) (Published November 2009. Accessed April 12, 2013)
        • Troy L.M.
        • Miller E.A.
        • Olson S.
        Hunger and obesity: Understanding a food insecurity paradigm.
        Institute of Medicine, The National Academies Press, Washington, DC2011
        • Fitzgerald N.
        • Hromi-Fiedler A.
        • Segura-Perez S.
        • Perex-Escamilla R.
        Food insecurity is related to increased risk of type 2 diabetes among Latinas.
        Ethn Dis. 2011; 21: 328-334
        • Thompson J.N.
        Fetal nutrition and adult hypertension, diabetes, obesity, and coronary artery disease.
        Neonatal Netw. 2007; 26: 235-240
        • Armitage J.A.
        • Poston L.
        • Taylor P.D.
        Developmental origins of obesity and the metabolic syndrome: The role of maternal obesity.
        Front Horm Res. 2008; 36: 73-84
        • Bellamy L.
        • Casas J.P.
        • Hingorani A.D.
        • Williams D.
        Type 2 diabetes mellitus after gestational diabetes: A systematic review and meta-analysis.
        Lancet. 2009; 373: 1773-1779
        • Collins J.L.
        • Lehnherr J.
        • Posner S.F.
        • Toomey K.E.
        Ties that bind: Maternal and child health and chronic disease prevention at the Centers for Disease Control and Prevention.
        Prev Chronic Dis. 2009; 6: A01
        • Stuebe A.M.
        • Rich-Edwards J.W.
        • Willett W.C.
        • Manson J.E.
        • Michels K.B.
        Duration of lactation and incidence of type 2 diabetes.
        JAMA. 2005; 294: 2601-2610
        • Juonala M.
        • Magnussen C.G.
        • Venn A.
        • et al.
        Influence of age on associations between childhood risk factors and carotid intima-media thickness in adulthood: The Cardiovascular Risk in Young Finns Study, the Childhood Determinants of Adult Health Study, the Bogalusa Heart Study, and the Muscatine Study for the International Childhood Cardiovascular Cohort (i3C) Consortium.
        Circulation. 2010; 122: 2514-2520
        • American Dietetic Association
        Position of the American Dietetic Association: Individual-, family-, school-, and community-based interventions for pediatric overweight.
        J Am Diet Assoc. 2006; 106: 925-945
        • Eaton D.
        • Kann L.
        • Kinchen S.
        • et al.
        Youth Risk Behavior Surveillance—United States, 2011.
        MMWR Surveill Summ. 2012; 61: 1-162
        • Gregg E.W.
        • Cheng Y.J.
        • Cadwell B.L.
        • et al.
        Secular trends in cardiovascular disease risk factors according to body mass index in US adults.
        JAMA. 2005; 293: 1868-1874
        • Bernstein M.
        • Munoz N.
        Position of the Academy of Nutrition and Dietetics: Food and nutrition for older adults: Promoting health and wellness.
        J Acad Nutr Diet. 2012; 112: 1255-1277
        • US Department of Health and Human Services
        2008 Physical Activity Guidelines for Americans.
        (Accessed May 15, 2012)