ABSTRACT
Background
As health systems globally are facing unprecedented demands, allied health clinicians undertaking advanced practice (AP) roles are increasingly supporting medical professionals, improving health system efficiencies and outcomes. The aim of this mixed methods systematic review was to identify what AP roles dietitians are undertaking and examine how these roles align with the British Dietetic Association (BDA) definition of AP.
Methods
A systematic review of the literature was conducted on the 22nd August 2025 via MEDLINE, CINAHL and Web of Science with the following inclusion criteria; English language, peer-reviewed journals articles of any date describing dietitians undertaking AP roles as critiqued by the reviewers against the BDA AP capabilities pillars of advanced practice. Papers not published in the English language, conference abstracts, grey literature and studies describing entry level dietitian roles/routine nutrition care were excluded. Risk of bias was evaluated using the Joanna Briggs Institute (JBI) critical appraisal tools, synthesis followed the JBI convergent integrated approach to mixed methods systematic reviews and the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement 2020 (PRISMA 2020) was used to guide reporting.
Results
Of the 2209 studies identified by the search strategy, six studies were included in the systematic review. Dates of publication ranged from 1993 to 2014, with papers from the United States of America (n = 5) and the United Kingdom (n = 1). Studies included four original research studies, one Delphi survey and one narrative review. Five specialist area AP roles were identified; inherited metabolic diseases (IMD) dietitian, advanced level specialist practitioner (in paediatric, metabolic, renal specialties) and advanced level practitioners in diabetes and two generalist roles. Key themes were synthesized for each of the BDA AP pillars within the included studies.
Discussion
Despite interest in AP internationally, this systematic review identified only a small number of dietetic roles meeting all BDA AP pillars. Geographical, jurisdictional and dietetic association differences in definitions of AP, along with apparent underreporting in the literature, suggest this review likely understates the depth and breadth of contemporary dietetic AP. High-quality research published by dietitians practicing at an advanced level, clearly stating alignment with AP definitions/frameworks is required to solidify the value of dietetic AP within the global health system.
Other
No funding was sought for this review.
Trial Registration: PROSPERO: Registration Number CRD420251127046 (https://www.crd.york.ac.uk/PROSPERO/view/CRD420251127046).
Journal of Human Nutrition and Dietetics, Volume 39, Issue 3, June 2026. Read More