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Hung I, Wischmeyer PE, Kain ZN. Fueling Healing: Tackling Challenges in Integrating Nutrition Screening and Therapy Into Perioperative Care in the United States. Anesth Analg 2024; 139:660-664. [PMID: 38386596 DOI: 10.1213/ane.0000000000006766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Affiliation(s)
- Isaac Hung
- From the Department of Anesthesiology & Perioperative Care, University of California, Irvine, Orange, California
- Center on Stress & Health, Department of Anesthesiology & Perioperative Care, University of California, Irvine, Orange, California
| | - Paul E Wischmeyer
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Zeev N Kain
- From the Department of Anesthesiology & Perioperative Care, University of California, Irvine, Orange, California
- Center on Stress & Health, Department of Anesthesiology & Perioperative Care, University of California, Irvine, Orange, California
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2
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Weston S, Weisbrod V, Duro D. Applications of culinary medicine in the pediatric gastroenterology, hepatology, and nutrition field. J Pediatr Gastroenterol Nutr 2024; 79:453-456. [PMID: 38953165 DOI: 10.1002/jpn3.12308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 07/03/2024]
Abstract
Key points
Culinary medicine can enhance a provider's ability to counsel patients using “food as medicine” to treat disease‐specific areas.
Applying culinary medicine in pediatric gastroenterology is a practical way to empower patients to better manage their condition, minimize gastrointestinal symptoms, and promote a healthier relationship with food.
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Affiliation(s)
- Sharon Weston
- Department of Clinical Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Vanessa Weisbrod
- Department of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
- Celiac Disease Foundation, Woodland Hills, California, USA
| | - Debora Duro
- Pediatric Gastroenterology, Hepatology and Nutrition at Salah Foundation Children Hospital at Broward Health, Fort Lauderdale, Florida, USA
- NOVA Southeastern University, Fort Lauderdale FL and Florida International University (FIU), Miami, Florida, USA
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3
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Lindsay KL, Kennedy J, Kim D, Kalra A, Parekh NK. Development of a Culinary Medicine Curriculum to Support Nutrition Knowledge for Gastroenterology Fellows and Faculty. Nutrients 2024; 16:404. [PMID: 38337688 PMCID: PMC10857341 DOI: 10.3390/nu16030404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Gastroenterologists encounter many nutrition-related disorders in their practice, yet the nutritional needs of patients with chronic gastrointestinal (GI) and liver disease are largely unaddressed by treating physicians, due to suboptimal nutrition education. To address this gap, we developed and piloted a culinary medicine course for a GI fellowship training program. The objective of this study is to describe the development, implementation, and acceptability of the course. A registered dietitian, a chef instructor, and a gastroenterology clinical professor trained in culinary medicine developed the four-class tailored curriculum and delivered the classes remotely. Each class had a theme related to commonly encountered GI disorders and included hands-on meal preparation, a nutrition lecture, and a patient case study discussion. Post-course feedback surveys were disseminated. Twenty-three GI physicians enrolled in the course and the attendance rates in classes 1-4 were 83%, 65%, 61%, and 48%, respectively. Among 15 completed feedback surveys, 80% reported that the class contents were either moderately or extremely useful and all endorsed the curriculum for other gastroenterologists. Future studies of culinary medicine programs tailored to medical specialties should identify strategies to maintain engagement and assess the impact on nutrition knowledge, competencies, and translation of these new skills to clinical practice.
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Affiliation(s)
- Karen L. Lindsay
- Department of Pediatrics, School of Medicine, University of California Irvine, Orange, CA 92686, USA
- Susan Samueli Integrative Health Institute, Susan and Henry Samueli College of Health Sciences, University of California Irvine, Irvine, CA 92617, USA
| | - Jennifer Kennedy
- Division of Gastroenterology, Department of Medicine, School of Medicine, University of California Irvine, Orange, CA 92686, USA
| | - Daniel Kim
- Division of Gastroenterology, Department of Medicine, School of Medicine, University of California Irvine, Orange, CA 92686, USA
| | - Ankush Kalra
- Division of Gastroenterology, Department of Medicine, School of Medicine, University of California Irvine, Orange, CA 92686, USA
| | - Nimisha K. Parekh
- Division of Gastroenterology, Department of Medicine, School of Medicine, University of California Irvine, Orange, CA 92686, USA
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4
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Haines KL, Ohnuma T, Grisel B, Krishnamoorthy V, Raghunathan K, Sulo S, Kerr KW, Besecker B, Cassady BA, Wischmeyer PE. Early enteral nutrition is associated with improved outcomes in critically ill mechanically ventilated medical and surgical patients. Clin Nutr ESPEN 2023; 57:311-317. [PMID: 37739674 DOI: 10.1016/j.clnesp.2023.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND AIMS Data suggest that guidelines for enteral nutrition (EN) initiation are not closely followed in clinical practice. In addition, critically ill mechanically ventilated (MV) patients have varying metabolic needs, which often increase and persist over time, requiring personalized nutrition intervention. While both over- and under-nutrition can impact patient outcomes, recent data suggest that targeted early EN delivery may reduce mortality and improve clinical outcomes. This study examined if early EN improves clinical outcomes and decreases costs in critically ill patients on MV. METHODS Data from a nationwide administrative-financial database between 2018 and 2020 was utilized to identify eligible adult critical care patients. Patients who received EN within 3 days after intubation (early EN) were compared to patients who started EN after 3 days of intubation (late EN). Outcomes of interest included hospital mortality, discharge disposition, hospital and intensive care unit (ICU) length of stay (LOS), MV days, and total cost. After inverse-probability-of-treatment weighting, outcomes were modeled using a nominal logistic regression model for hospital mortality and discharge disposition, a linear regression model for cost, and Cox proportional-hazards model for MV days, hospital and ICU LOS. RESULTS A total of 27,887 adult patients with early MV were identified, of which 16,772 (60.1%) received early EN. Regression analyses showed that the early EN group had lower hospital mortality (OR = 0.88, 95% CI, 0.82 to 0.94), were more likely to be discharged home (OR = 1.47, 95% CI 1.38 to 1.56), had fewer MV days (HR = 1.23, 95% CI, 1.11 to 1.37), shorter hospital LOS (HR = 1.43, 95% CI, 1.33 to 1.54) and ICU LOS (HR = 1.36, 95% CI, 1.27 to 1.46), and lower cost (-$21,226; 95% CI, -$23,605 to -$18,848) compared to the late EN group. CONCLUSIONS Early EN within 3 days of MV initiation in real-world practice demonstrated improved clinical and economic outcomes. These data suggest that early EN is associated with decreased hospital mortality, increased discharge to home, and decreased hospital and ICU LOS, time on MV, and cost compared to delayed initiation of EN; highlighting the importance of early EN to optimize utcomes ando support the recovery of critically ill patients on MV.
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Affiliation(s)
- Krista L Haines
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA; The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Tetsu Ohnuma
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA; Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Braylee Grisel
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Vijay Krishnamoorthy
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA; Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA
| | - Karthik Raghunathan
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA; Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Suela Sulo
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Kirk W Kerr
- Scientific and Medical Affairs, Abbott Nutrition, Columbus, OH, USA.
| | - Beth Besecker
- Scientific and Medical Affairs, Abbott Nutrition, Columbus, OH, USA.
| | - Bridget A Cassady
- Scientific and Medical Affairs, Abbott Nutrition, Columbus, OH, USA.
| | - Paul E Wischmeyer
- Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
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5
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Brennan BR, Beals KA, Burns RD, Chow CJ, Locke AB, Petzold MP, Dvorak TE. Impact of Culinary Medicine Course on Confidence and Competence in Diet and Lifestyle Counseling, Interprofessional Communication, and Health Behaviors and Advocacy. Nutrients 2023; 15:4157. [PMID: 37836442 PMCID: PMC10574678 DOI: 10.3390/nu15194157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Most physicians report inadequate training to provide diet and lifestyle counseling to patients despite its importance to chronic disease prevention and management. To fill the nutrition training gap, elective Culinary Medicine (CM) courses have emerged as an alternative to curriculum reform. We evaluated the impact of an interprofessional CM course for medical and health professional students who experienced the hands-on cooking component in person or a in mixed-mode format (in-person and via Zoom) at the University of Utah from 2019-2023 (n = 84). A factorial ANOVA assessed differences between educational environment and changes between pre- and post-course survey responses related to diet and lifestyle counseling, interprofessional communication, and health behaviors and advocacy. Qualitative comments from post-course surveys were analyzed on a thematic level. Students rated themselves as having greater confidence and competence in diet and lifestyle counseling (p < 0.05) and increased ability to prepare eight healthy meals (p < 0.05). Additionally, a Mann-Whitney two-sample rank-sum test was used to compare data from exit survey responses from medical students who took the CM course (n = 48) and did not take the CM course (n = 297). Medical students who took CM were significantly more likely to agree that they could counsel patients about nutrition (p < 0.05) and physical activity (p < 0.05). CM courses may improve students' confidence to provide diet and lifestyle counseling.
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Affiliation(s)
- Britta Retzlaff Brennan
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84112, USA;
| | - Katherine A. Beals
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84112, USA;
| | - Ryan D. Burns
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT 84112, USA;
| | - Candace J. Chow
- Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, USA;
| | - Amy B. Locke
- Department of Family and Preventative Medicine, University of Utah, Salt Lake City, UT 84112, USA; (A.B.L.); (M.P.P.)
| | - Margaret P. Petzold
- Department of Family and Preventative Medicine, University of Utah, Salt Lake City, UT 84112, USA; (A.B.L.); (M.P.P.)
| | - Theresa E. Dvorak
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84112, USA;
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6
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Ylitalo KR, Janda KM, Clavon R, Raleigh-Yearby S, Kaliszewski C, Rumminger J, Hess B, Walter K, Cox W. Cross-Sector Partnerships for Improved Cooking Skills, Dietary Behaviors, and Belonging: Findings from a Produce Prescription and Cooking Education Pilot Program at a Federally Qualified Health Center. Nutrients 2023; 15:4098. [PMID: 37836383 PMCID: PMC10574603 DOI: 10.3390/nu15194098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/12/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
Participant engagement, psychosocial factors, and dietary behaviors are important components of "Food as Medicine" and cooking education programs. The purpose of this study is to describe a multidisciplinary cooking program at a Federally Qualified Health Center in central Texas. During biannual harvest seasons (2022-2023), patients participated in four or six weekly 1.5 h hands-on cooking classes with shared meals, education, and produce delivery. Pretest-posttest surveys assessed sociodemographic information, health, psychosocial factors, and dietary behaviors; follow-up assessed group cohesion/sense of community in classes. Survey data were described using means and proportions. Across four cohorts, participants (n = 33; mean age: 45 ± 16 years) were 30% Hispanic/Latino, 18% non-Hispanic Black, and 52% non-Hispanic White; on average, participants attended 66% of sessions. Increases in cooking self-efficacy (p < 0.001) and diet-related self-management strategies (p < 0.001) were observed for those with follow-up data (n = 16); further, 44% reported increased vegetable consumption. All participants (100%) reported feeling like a valued member of their cooking group and 94% reported high levels of belonging. In a diverse community health center serving low-income patients, provision of produce and cooking education classes supported strategies to improve diet-related confidence, skills, and behavior. Cross-sector partnership within a health care setting may help patients and physicians prioritize nutrition and food access.
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Affiliation(s)
- Kelly R. Ylitalo
- Department of Public Health, Baylor University, Waco, TX 76798, USA
| | - Kathryn M. Janda
- Department of Public Health, Baylor University, Waco, TX 76798, USA
| | - Reanna Clavon
- Department of Public Health, Baylor University, Waco, TX 76798, USA
| | | | | | | | | | - Katie Walter
- World Hunger Relief Institute, Waco, TX 76705, USA
| | - Wendy Cox
- Waco Family Medicine, Waco, TX 76707, USA
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7
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Jones G, Craigie AM, Zaremba SMM, Jaffee A, Mellor DD. Teaching medical students about nutrition: from basic principles to practical strategies. Frontline Gastroenterol 2023; 14:422-427. [PMID: 37581185 PMCID: PMC10423603 DOI: 10.1136/flgastro-2022-102089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/31/2023] [Indexed: 08/16/2023] Open
Abstract
Poor nutrition is widely recognised as one of the key modifiable risks to health and life, with doctors in an ideal position to recognise when suboptimal nutrition is impacting on their patients' health and provide them with advice and support to create sustainable and achievable diet and lifestyle modifications. However, it has been acknowledged that nutrition training within medical schools is extremely varied, and in many cases inadequate. The Association for Nutrition UK Undergraduate Curriculum in Nutrition for Medical Doctors provides medical schools with guidance on what should be included in the training of all medical students. This paper discusses three key ways in which medical schools can support the implementation of nutrition into their teaching; incorporating nutrition within the core medical curriculum teaching, the use of subject specific experts to support and deliver nutrition training, and the inclusion of nutrition within formal assessment so as to reinforce and cement learnings into practical, applicable actions and advice.
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Affiliation(s)
| | - Angela M Craigie
- Centre for Public Health Nutrition Research, University of Dundee School of Medicine, Dundee, UK
| | - Suzanne M M Zaremba
- Centre for Public Health Nutrition Research, University of Dundee School of Medicine, Dundee, UK
| | - Ally Jaffee
- Luton and Dunstable Hospital NHS Foundation Trust, Luton, UK
| | - Duane D Mellor
- Aston Medical School, Aston University, Birmingham, UK
- Centre for Health and Society, Aston University, Birmingham, UK
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8
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Plotnikoff GA, Dobberstein L, Raatz S. Nutritional Assessment of the Symptomatic Patient on a Plant-Based Diet: Seven Key Questions. Nutrients 2023; 15:1387. [PMID: 36986117 PMCID: PMC10056340 DOI: 10.3390/nu15061387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/01/2023] [Accepted: 03/10/2023] [Indexed: 03/15/2023] Open
Abstract
Plant-based diets, both vegan and vegetarian, which emphasize grains, vegetables, fruits, legumes, nuts, and seeds are increasingly popular for health as well as financial, ethical, and religious reasons. The medical literature clearly demonstrates that whole food plant-based diets can be both nutritionally sufficient and medically beneficial. However, any person on an intentionally restrictive, but poorly-designed diet may predispose themselves to clinically-relevant nutritional deficiencies. For persons on a poorly-designed plant-based diet, deficiencies are possible in both macronutrients (protein, essential fatty acids) and micronutrients (vitamin B12, iron, calcium, zinc, and vitamin D). Practitioner evaluation of symptomatic patients on a plant-based diet requires special consideration of seven key nutrient concerns for plant-based diets. This article translates these concerns into seven practical questions that all practitioners can introduce into their patient assessments and clinical reasoning. Ideally, persons on plant-based diets should be able to answer these seven questions. Each serves as a heuristic prompt for both clinician and patient attentiveness to a complete diet. As such, these seven questions support increased patient nutrition knowledge and practitioner capacity to counsel, refer, and appropriately focus clinical resources.
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Affiliation(s)
| | | | - Susan Raatz
- Department of Food Science and Nutrition, University of Minnesota, Minneapolis, MN 55455, USA
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9
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Kouritzin T, Spence JC, Lee K. Food Intake and Food Selection Following Physical Relocation: A Scoping Review. Public Health Rev 2023; 44:1605516. [PMID: 36817863 PMCID: PMC9928753 DOI: 10.3389/phrs.2023.1605516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
Objectives: To synthesize the current available evidence on the changes in food intake and food selection after physical relocation in non-refugee populations. Methods: The inclusion criteria were studies with a measurement of food selection and/or food intake in non-refugee populations where physical relocation had occurred with self-reported or objective assessment of the neighbourhood physical environment before and after relocation. Databases searched included MEDLINE, EMBASE, CINAHL and SCOPUS from 1946 to August 2022. Results: A total of four articles met the inclusion criteria. Overall, these studies gave longitudinal (n = 2) and cross-sectional (n = 2) evidence to suggest that moving to an urban neighbourhood with more convenience stores, cafés and restaurants around the home was associated with an increase in unhealthy food intake in adult populations. Additional factors such as income, vehicle access, cost, availability and perceptions of the local food environment played a role in shaping food selection and food intake. Conclusion: Four internal migration studies were found. The limited evidence base calls for more research. Future studies should include children and apply appropriate research designs to account for neighbourhood self-selection and concurrent life events. International migration studies should include assessment of neighbourhood physical environments pre- and post-relocation.
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Affiliation(s)
- Trevor Kouritzin
- Division of Preventive Medicine, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada,*Correspondence: Trevor Kouritzin,
| | - John C. Spence
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Karen Lee
- Division of Preventive Medicine, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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10
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Stoutenberg M, Lewis LK, Jones RM, Portacio F, Vidot DC, Kornfeld J. Assessing the current and desired levels of training and applied experiences in chronic disease prevention of students during medical school. BMC MEDICAL EDUCATION 2023; 23:54. [PMID: 36690998 PMCID: PMC9872306 DOI: 10.1186/s12909-023-04044-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/19/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Chronic diseases account for approximately 70% of deaths in the U.S. annually. Though physicians are uniquely positioned to provide behavior change counseling for chronic disease prevention, they often lack the necessary training and self-efficacy. This study examined medical student interest in receiving chronic disease prevention training as a formal part of their education as part of an effort to enhance their ability to provide guidance to patients in the future. METHODS A 23-question, online survey was sent to all undergraduate medical students enrolled in a large medical education program. The survey assessed medical student interest in receiving training related to chronic disease prevention. Survey topics included student awareness of primary prevention programs, perceived importance of receiving training and applied experience in chronic disease prevention, and preferences for how and when to receive this training. RESULTS Of 793 eligible medical students, 432 completed the survey (54.5%). Overall, 92.4% of students reported receiving formal training in physical activity, public health, nutrition, obesity, smoking cessation, and chronic diseases was of "very high" or "high" importance. Despite this level of importance, students most frequently reported receiving no or 1-5 h of formal training in a number of topics, including physical activity (35.4% and 47.0%, respectively) and nutrition (16.9% and 56.3%, respectively). The level of importance given to public health training was significantly greater across degree type (p = 0.0001) and future specialty (p = 0.03) for MD/MPH students and those interested in primary care, respectively. CONCLUSIONS While medical students perceive chronic disease prevention as an important topic, most reported receiving little to no formal training. To address the growing prevalence of chronic disease across our society, programs schools should place greater emphasis on integrating training in physical activity, nutrition, and obesity-related content into the medical education curriculum.
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Affiliation(s)
- Mark Stoutenberg
- Department of Kinesiology, College of Public Health, Temple University, 237 Pearson Hall, 1800 North Broad Street, Philadelphia, PA, USA.
- Department of Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA.
| | - Lauren K Lewis
- Department of Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Resa M Jones
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA, USA
- Fox Chase Cancer Center, Temple Health, Philadelphia, PA, USA
| | - Francia Portacio
- Department of Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA
- Combined Degree and Physician Scholars Program Office, University of Pennsylvania, Philadelphia, PA, USA
| | - Denise C Vidot
- Department of Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Julie Kornfeld
- Department of Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA
- School of Public Health, Columbia University, New York, NY, USA
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11
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Qubty L, Hicks-Roof K. How might enhanced interprofessional collaboration between primary care physicians and registered dietitian nutritionists impact clinical outcomes related to obesity and associated illnesses? A commentary. Public Health Nutr 2022; 26:1-4. [PMID: 36458843 PMCID: PMC9989699 DOI: 10.1017/s1368980022002518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/10/2022] [Accepted: 11/22/2022] [Indexed: 12/04/2022]
Abstract
The unsettling worldwide prevalence of obesity and obesity-related illnesses seems to be well-understood. What seems to be lacking, however, is a strategy of how best to fix the issue. Meagre nutrition content in medical school curricula may contribute to limited primary care physician (PCP) knowledge of the role nutrition has in health ailments and the understanding of a registered dietitian nutritionist (RDN) scope of practice. In USA, RDN are health care practitioners specialised in nutrition and who are experts in treating obesity and obesity-related illnesses. An increased RDN involvement in patient care has been shown to promote improvements in nutrition-related clinical outcomes. Therefore, enhanced collaboration between PCP and RDN has the potential to ameliorate the obesity epidemic. Tactics to promote collaboration may include enhancing nutrition education in medical school and providing nutrition-focussed continuing education for practicing physicians. The seriousness of the obesity epidemic underscores the need for interprofessional collaboration between PCP and allied health professionals who are uniquely trained to address obesity and obesity-related illnesses.
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Affiliation(s)
- Leah Qubty
- Department of Applied Health Sciences, Bethel University, St. Paul, MN, USA
| | - Kristen Hicks-Roof
- Department of Nutrition & Dietetics, Brooks College of Health, University of North Florida, Jacksonville, FL32224, USA
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12
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Jones G, Macaninch E, Mellor D, Spiro A, Martyn K, Butler T, Johnson A, Moore JB. Putting nutrition education on the table: development of a curriculum to meet future doctors' needs. BMJ Nutr Prev Health 2022; 5:208-216. [PMID: 36619326 PMCID: PMC9813613 DOI: 10.1136/bmjnph-2022-000510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 06/28/2022] [Indexed: 01/11/2023] Open
Abstract
COVID-19 has further exacerbated trends of widening health inequalities in the UK. Shockingly, the number of years of life lived in general good health differs by over 18 years between the most and least deprived areas of England. Poor diets and obesity are established major risk factors for chronic cardiometabolic diseases and cancer, as well as severe COVID-19. For doctors to provide the best care to their patients, there is an urgent need to improve nutrition education in undergraduate medical school training. With this imperative, the Association for Nutrition established the Inter-Professional Working Group on Medical Education (AfN IPG) to develop a new, modern undergraduate nutrition curriculum for medical doctors. The AfN IPG brought together expertise from nutrition, dietetic and medical professionals, representing the National Health Service, royal colleges, medical schools and universities, government public health departments, learned societies, medical students and nutrition educators. The curriculum was developed with the key objective of being implementable through integration with the current undergraduate training of medical doctors. Through an iterative and transparent consultative process, 13 key nutritional competencies, to be achieved through mastery of 11 graduation fundamentals, were established. The curriculum to facilitate the achievement of these key competencies is divided into eight topic areas, each underpinned by a learning objective statement and teaching points detailing the knowledge and skills development required. The teaching points can be achieved through clinical teaching and a combination of facilitated learning activities and practical skills acquisition. Therefore, the nutrition curriculum enables mastery of these nutritional competencies in a way that will complement and strengthen medical students' achievement of the General Medical Council Outcomes for Graduates. As nutrition is an integrative science, the AfN IPG recommends the curriculum is incorporated into initial undergraduate medical studies before specialist training. This will enable our future doctors to recognise how nutrition is related to multiple aspects of their training, from physiological systems to patient-centred care, and acquire a broad, inclusive understanding of health and disease. In addition, it will facilitate medical schools to embed nutrition learning opportunities within the core medical training, without the need to add in a large number of new components to an already crowded programme or with additional burden to teaching staff. The undergraduate nutrition curriculum for medical doctors is designed to support medical schools to create future doctors who will understand and recognise the role of nutrition in health. Moreover, it will equip front-line staff to feel empowered to raise nutrition-related issues with their patients as a fundamental part of enhanced care and to appropriately refer on for nutrition support with a registered nutritionist (RNutr)/registered associate nutritionist (ANutr) or a registered dietitian (RD) where this is likely to be beneficial.
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Affiliation(s)
| | - Elaine Macaninch
- Education and Research in Medical Education (ERimNN), Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Duane Mellor
- Aston Medical School, Aston University, Birmingham, UK
| | | | - Kathy Martyn
- Education and Research in Medical Education (ERimNN), School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | - Thomas Butler
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
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13
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Visioli F, Bodereau V, van der Kamp M, Clegg M, Guo J, Del Castillo MD, Gilcrease W, Hollywood A, Iriondo-DeHond A, Mills C, Sciascia S, van Zutphen T, Visser E, Willett WC. Educating health care professionals on the importance of proper diets. An online course on nutrition, health, and sustainability. Int J Food Sci Nutr 2022; 73:1091-1095. [PMID: 36146949 DOI: 10.1080/09637486.2022.2123908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The majority of university curricula for health professionals does not incorporate courses on human nutrition and its links with human and planetary health. This primarily applies to medical and pharmacy students, who have important counselling roles and are at the forefront of public health. To address this important issue, EIT Food recently launched an online course on nutrition, health, and sustainability. Learners were able to provide feedback on the course through an end-of-course survey and social interaction on the FutureLearn platform. The course was very well attended worldwide and received positive feedback from learners. A total of 3,858 students enrolled in the program, from >20 countries. Learners reported inadequate training on nutrition in their own curriculum and indicated they would use key insights from the course to inform their own practice. This report provides insights from the course, which could be used as guidance for future initiatives.
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Affiliation(s)
- Francesco Visioli
- Department of Molecular Medicine, University of Padova, Padova, Italy.,IMDEA-Food, Madrid, Spain
| | | | | | - Miriam Clegg
- Institute for Food, Nutrition and Health and Department of Food and Nutritional Sciences, University of Reading, Whiteknights, UK
| | - Jing Guo
- Institute for Food, Nutrition and Health, University of Reading, School of Food Science and Nutrition, Faculty of Environment, University of Leeds, Leeds, UK
| | - Maria Dolores Del Castillo
- Food Bioscience Group, Department of Bioactivity and Food Analysis, Instituto de Investigación en Ciencias de la Alimentación (CIAL) (CSIC-UAM), Madrid, Spain
| | - Winston Gilcrease
- UNESCO Chair for Sustainable Development and Territory Management, University of Turin, Turin, Italy
| | | | - Amaia Iriondo-DeHond
- Food Bioscience Group, Department of Bioactivity and Food Analysis, Instituto de Investigación en Ciencias de la Alimentación (CIAL) (CSIC-UAM), Madrid, Spain
| | - Charlotte Mills
- Hugh Sinclair Unit of Human Nutrition, School of Chemistry, Food and Pharmacy, University of Reading, Reading, UK
| | - Savino Sciascia
- Savino Sciascia, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Tim van Zutphen
- Department of Sustainable Health, Faculty Campus Fryslân, University of Groningen, Leeuwarden, The Netherlands.,Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Edith Visser
- Department of Sustainable Health, Faculty Campus Fryslân, University of Groningen, Leeuwarden, The Netherlands
| | - Walter C Willett
- Departments of Epidemiology and Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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14
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Jones G, Macaninch E, Mellor DD, Spiro A, Martyn K, Butler T, Johnson A, Moore JB. Putting nutrition education on the table: development of a curriculum to meet future doctors' needs. Br J Nutr 2022; 129:1-9. [PMID: 36089804 PMCID: PMC9991850 DOI: 10.1017/s0007114522001635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/11/2022] [Accepted: 05/16/2022] [Indexed: 11/06/2022]
Abstract
COVID-19 has further exacerbated trends of widening health inequalities in the UK. Shockingly, the number of years of life lived in general good health differs by over 18 years between the most and least deprived areas of England. Poor diets and obesity are established major risk factors for chronic cardiometabolic diseases and cancer, as well as severe COVID-19. For doctors to provide the best care to their patients, there is an urgent need to improve nutrition education in undergraduate medical school training.With this imperative, the Association for Nutrition established an Interprofessional Working Group on Medical Education (AfN IPG) to develop a new, modern undergraduate nutrition curriculum for medical doctors. The AfN IPG brought together expertise from nutrition, dietetic and medical professionals, representing the National Health Service (NHS), royal colleges, medical schools and universities, government public health departments, learned societies, medical students, and nutrition educators. The curriculum was developed with the key objective of being implementable through integration with the current undergraduate training of medical doctors.Through an iterative and transparent consultative process, thirteen key nutritional competencies, to be achieved through mastery of eleven graduation fundamentals, were established. The curriculum to facilitate the achievement of these key competencies is divided into eight topic areas, each underpinned by a learning objective statement and teaching points detailing the knowledge and skills development required. The teaching points can be achieved through clinical teaching and a combination of facilitated learning activities and practical skill acquisition. Therefore, the nutrition curriculum enables mastery of these nutritional competencies in a way that will complement and strengthen medical students' achievement of the General Medical Council (GMC) Outcome for Graduates.As nutrition is an integrative science, the AfN IPG recommends that the curriculum is incorporated into initial undergraduate medical studies before specialist training. This will enable our future doctors to recognise how nutrition is related to multiple aspects of their training, from physiological systems to patient-centred care, and acquire a broad, inclusive understanding of health and disease. In addition, it will facilitate medical schools to embed nutrition learning opportunities within the core medical training, without the need to add in a large number of new components to an already crowded programme or with additional burden for teaching staff.The undergraduate nutrition curriculum for medical doctors is designed to support medical schools to create future doctors who will understand and recognise the role of nutrition in health. Moreover, it will equip frontline staff to feel empowered to raise nutrition-related issues with their patients as a fundamental part of enhanced care and to appropriately refer on for nutrition support with a registered associate nutritionist/registered nutritionist (ANutr/RNutr) or registered dietitian (RD) where this is likely to be beneficial.
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Affiliation(s)
| | - Elaine Macaninch
- Education and Research in Medical Education (ERimNN) Brighton and Sussex Medical School, Brighton, UK
- NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
| | | | | | - Kathy Martyn
- NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
- Education and Research in Medical Education (ERimNN), School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | - Thomas Butler
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | | | - J. Bernadette Moore
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
- The Nutrition Society, London, UK
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15
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Selected Organizational and Managerial Aspects of Health and Nutrition Education of Various Types of Consumers of Spa Treatment Services in Poland. Nutrients 2022; 14:nu14112337. [PMID: 35684136 PMCID: PMC9183019 DOI: 10.3390/nu14112337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/29/2022] [Accepted: 06/01/2022] [Indexed: 02/04/2023] Open
Abstract
Consumer education, including nutrition education, understood as a process based on scientific principles, is becoming a very effective element in influencing the health of the population in the modern world. This work is based on direct research carried out in 2016–2018 in the form of a questionnaire interview among patients—consumers of educational services in spa treatment facilities. The research sample was N = 1000 (600 people were tested with the use of PAPI (Paper and Pencil Interview), and 400 people with the use of CAWI (Computer-Assisted Web Interview)) and concerned a representative group of spa patients in Poland. In addition, as a supplement, a direct survey was conducted in the form of a Computer-Assisted Telephone Interview with managers of spa treatment facilities (N = 50). Consumers of spa treatment services differ from each other, and types can be distinguished based on their professional activity status and the type of entity that pays for their stay in the spa, and, using cluster analysis, the status of professional activity in relation to their education level. The nutritional education system is based on highly specialized medical personnel. At the same time, it does not use the available assessment tools based on proven monitoring and evaluation indicators. Health education, which also includes nutritional education, apart from disease prevention, is the basic tool for health promotion in spa treatment conditions, enabling the introduction of a permanent change in the patients’ lifestyles, the additional advantages of which are low costs and relatively high efficiency. In the course of the study, several useful patient profiles were also distinguished, thanks to which it is possible to select dedicated educational methods for selected groups of recipients.
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16
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Morton KF, Pantalos DC, Ziegler C, Patel PD. A Place for Plant-Based Nutrition in US Medical School Curriculum: A Survey-Based Study. Am J Lifestyle Med 2022; 16:271-283. [PMID: 35706597 PMCID: PMC9189581 DOI: 10.1177/1559827620988677] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Purpose. To evaluate medical students' and family medicine residents' perceptions of their current degree of nutrition training in general and regarding a whole-foods, plant-based (WFPB) diet. Methods. An original survey instrument was administered to medical students and family medicine residents. Quantitative and qualitative data were collected to evaluate perceptions of nutrition education in medical training, a WFPB diet, and ideas for nutrition-focused curricular reform. Results. Of the 668 trainees surveyed, 200 responded (response rate = 30%). Of these, 22% agreed that they received sufficient nutrition education in medical school and 41% agreed that a WFPB diet should be a focus. Respondents with personal experiences with a plant-based diet were more willing to recommend it to future patients. Common ideas for curricular reform were instruction on a WFPB diet along with other healthy dietary patterns, patient counseling, a dedicated nutrition course, and electives. Conclusions. Nutrition education in US medical training needs improvement to address the growing burden of obesity-related chronic disease. Proper nutrition and lifestyle modification should therefore play a larger role in the education of future physicians. A focus on plant-predominant diets, such as the WFPB diet, may be an acceptable and effective addition to current medical school curriculum, and deserves further study.
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Affiliation(s)
- Kara F. Morton
- Department of Undergraduate Medical Education,
University of Louisville School of Medicine, Louisville, Kentucky
| | - Diana C. Pantalos
- Department of Pediatrics, University of
Louisville, Louisville, Kentucky
| | - Craig Ziegler
- University of Louisville Office of Undergraduate
Medical Education, Louisville, Kentucky
| | - Pradip D. Patel
- Department of Pediatrics, University of
Louisville, Louisville, Kentucky
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17
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Cepni AB, Crumbley C, Nadeem S, Ledoux TA, Johnston CA. Incorporating Nutrition Counseling into Lifestyle Medicine. Am J Lifestyle Med 2022; 16:291-294. [PMID: 35706592 PMCID: PMC9189585 DOI: 10.1177/15598276221077224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Despite considerable evidence that plant-based diets can significantly improve health, medical professionals seldom discuss this with their patients. This issue might occur due to minimal training received in medical education, lack of time, and low self-efficacy for counseling patients about diet. Nutrition and lifestyle change should be considered a core competency for all physicians and health professionals looking for cost-effective ways to improve patient health outcomes and reduce nutrition-related chronic diseases. Strategies for health professionals to acquire nutrition counseling skills in medical training and clinical practices are discussed.
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Affiliation(s)
- Aliye B. Cepni
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - Christine Crumbley
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - Saad Nadeem
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - Tracey A. Ledoux
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - Craig A. Johnston
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
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18
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Morton KF, Pantalos DC, Ziegler C, Patel PD. Whole-Foods, Plant-Based Diet Perceptions of Medical Trainees Compared to Their Patients: A Cross-Sectional Pilot Study. Am J Lifestyle Med 2022; 16:318-333. [PMID: 35706594 PMCID: PMC9189575 DOI: 10.1177/15598276211041551] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Purpose: To evaluate medical trainees' and patients' perceptions of the utility of a whole-foods, plant-based (WFPB) diet for chronic disease management. Methods: A cross-sectional study using two original survey tools was implemented. Quantitative and qualitative data were collected from trainees and patients to evaluate perceived motivations and barriers to WFPB diet implementation. Results: Two hundred trainees and 52 patients responded to the surveys. Nearly half (48%) of patients were willing to try a WFPB diet, expressing a desire for additional information and help with its practical application. Over half (53%) of trainees were willing to recommend a WFPB diet to patients but expressed concern about its acceptability and feasibility. Patients perceived significantly more barriers related to personal enjoyment of animal products while trainees perceived more socioeconomic barriers. Conclusion: Poor diet has been identified as the United States' leading risk factor for mortality from chronic diseases. Plant-predominant diets, such as a WFPB diet, are associated with improved health outcomes and may be an acceptable solution for many patients. WFPB dietary modification could be pursued with a motivational interviewing approach that targets patients' individual goals. Medical providers should address their own assumptions regarding the dietary changes their patients are willing to make.
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Affiliation(s)
- Kara F. Morton
- Department of Undergraduate Medical Education, University of Louisville School of
Medicine, Louisville, KY, USA, (KFM, CZ); Department of Pediatrics, University of Louisville School of
Medicine, Louisville, KY, USA, (DCP. PDP)
| | - Diana C. Pantalos
- Department of Undergraduate Medical Education, University of Louisville School of
Medicine, Louisville, KY, USA, (KFM, CZ); Department of Pediatrics, University of Louisville School of
Medicine, Louisville, KY, USA, (DCP. PDP)
| | - Craig Ziegler
- Department of Undergraduate Medical Education, University of Louisville School of
Medicine, Louisville, KY, USA, (KFM, CZ); Department of Pediatrics, University of Louisville School of
Medicine, Louisville, KY, USA, (DCP. PDP)
| | - Pradip D. Patel
- Department of Undergraduate Medical Education, University of Louisville School of
Medicine, Louisville, KY, USA, (KFM, CZ); Department of Pediatrics, University of Louisville School of
Medicine, Louisville, KY, USA, (DCP. PDP)
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19
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Plant-Based Dietary Patterns for Human and Planetary Health. Nutrients 2022; 14:nu14081614. [PMID: 35458176 PMCID: PMC9024616 DOI: 10.3390/nu14081614] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 12/24/2022] Open
Abstract
The coronavirus pandemic has acted as a reset on global economies, providing us with the opportunity to build back greener and ensure global warming does not surpass 1.5 °C. It is time for developed nations to commit to red meat reduction targets and shift to plant-based dietary patterns. Transitioning to plant-based diets (PBDs) has the potential to reduce diet-related land use by 76%, diet-related greenhouse gas emissions by 49%, eutrophication by 49%, and green and blue water use by 21% and 14%, respectively, whilst garnering substantial health co-benefits. An extensive body of data from prospective cohort studies and controlled trials supports the implementation of PBDs for obesity and chronic disease prevention. The consumption of diets high in fruits, vegetables, legumes, whole grains, nuts, fish, and unsaturated vegetable oils, and low in animal products, refined grains, and added sugars are associated with a lower risk of all-cause mortality. Meat appreciation, health concerns, convenience, and expense are prominent barriers to PBDs. Strategic policy action is required to overcome these barriers and promote the implementation of healthy and sustainable PBDs.
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20
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Jakše B. Placing a Well-Designed Vegan Diet for Slovenes. Nutrients 2021; 13:4545. [PMID: 34960098 PMCID: PMC8706043 DOI: 10.3390/nu13124545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 02/06/2023] Open
Abstract
Interest in vegan diets has increased globally as well as in Slovenia. The quantity of new scientific data requires a thorough synthesis of new findings and considerations about the current reserved position of the vegan diet in Slovenia. There is frequently confusion about the benefits of vegetarian diets that are often uncritically passed on to vegan diets and vice versa. This narrative review aims to serve as a framework for a well-designed vegan diet. We present advice on how to maximize the benefits and minimize the risks associated with the vegan diet and lifestyle. We highlight the proper terminology, present the health effects of a vegan diet and emphasize the nutrients of concern. In addition, we provide guidance for implementing a well-designed vegan diet in daily life. We conducted a PubMed search, up to November 2021, for studies on key nutrients (proteins, vitamin B12, vitamin D, omega-3 long chain polyunsaturated fatty acids (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)), calcium, iron, zinc, iodine and selenium) in vegan diets. Given the limited amount of scientific evidence, we focus primarily on the general adult population. A well-designed vegan diet that includes a wide variety of plant foods and supplementation of vitamin B12, vitamin D in the winter months and potentially EPA/DHA is safe and nutritionally adequate. It has the potential to maintain and/or to improve health. For physically active adult populations, athletes or individuals with fast-paced lifestyles, there is room for further appropriate supplementation of a conventional vegan diet according to individuals' health status, needs and goals without compromising their health. A healthy vegan lifestyle, as included in government guidelines for a healthy lifestyle, includes regular physical activity, avoidance of smoking, restriction of alcohol and appropriate sleep hygiene.
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Affiliation(s)
- Boštjan Jakše
- Department of Food Science, Biotechnical Faculty, University of Ljubljana, SI-1000 Ljubljana, Slovenia
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21
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Leggett LK, Ahmed K, Vanier C, Sadik A. A Suggested Strategy to Integrate an Elective on Clinical Nutrition with Culinary Medicine. MEDICAL SCIENCE EDUCATOR 2021; 31:1591-1600. [PMID: 34603833 PMCID: PMC8446146 DOI: 10.1007/s40670-021-01346-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 06/02/2023]
Abstract
Time allocated to nutrition education in the medical school curriculum stands in contrast to high mortality rates attributable to poor diet in patients. Counseling patients on nutrition-related diseases is a critical skill for physicians, particularly those entering primary care. The crowded medical school curriculum has made adding hours of nutrition instruction difficult. This study evaluates the attitudes of undergraduate medical students at a single institution regarding the need for and relevance of nutrition education and reports on organization of and students' responses to a short experimental elective. Student attitudes regarding nutrition in medicine and a proposed nutrition elective were surveyed. Results helped formulate a short experimental elective. A two-session experimental course was completed, after which the participants were surveyed. Students agreed or strongly agreed with statements regarding the importance of nutrition in clinical practice. Greater than 60% of students surveyed in each class were interested in the proposed elective. All participants found the elective with culinary medicine sessions at least moderately useful to their needs as future healthcare providers. The majority of participants (more than 93%) reported being likely to both take and recommend the elective should it be offered in the future. Medical students consider nutrition an essential aspect of a patient encounter, but do not feel prepared to counsel future patients on dietary changes for management and/or prevention of nutrition linked diseases. There is strong student support for creating an elective in clinical nutrition with culinary medicine sessions to address the gap in their education and improve their confidence. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-021-01346-3.
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Affiliation(s)
- Lindsey K. Leggett
- College of Osteopathic Medicine, Touro University Nevada, Henderson, NV USA
| | - Kareem Ahmed
- College of Osteopathic Medicine, Touro University Nevada, Henderson, NV USA
| | - Cheryl Vanier
- College of Osteopathic Medicine, Touro University Nevada, Henderson, NV USA
| | - Amina Sadik
- College of Osteopathic Medicine, Touro University Nevada, Henderson, NV USA
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22
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Meta-analysis and machine learning-augmented mixed effects cohort analysis of improved diets among 5847 medical trainees, providers and patients. Public Health Nutr 2021; 25:281-289. [PMID: 34176552 PMCID: PMC8883775 DOI: 10.1017/s1368980021002809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: We sought to produce the first meta-analysis (of medical trainee competency improvement in nutrition counseling) informing the first cohort study of patient diet improvement through medical trainees and providers counseling patients on nutrition. Design: (Part A) A systematic review and meta-analysis informing (Part B) the intervention analysed in the world’s largest prospective multi-centre cohort study on hands-on cooking and nutrition education for medical trainees, providers and patients. Settings: (A) Medical educational institutions. (B) Teaching kitchens. Participants: (A) Medical trainees. (B) Trainees, providers and patients. Results: (A) Of the 212 citations identified (n 1698 trainees), eleven studies met inclusion criteria. The overall effect size was 9·80 (95 % CI (7·15, 12·45) and 95 % CI (6·87, 13·85); P < 0·001), comparable with the machine learning (ML)-augmented results. The number needed to treat for the top performing high-quality study was 12. (B) The hands-on cooking and nutrition education curriculum from the top performing study were applied for medical trainees and providers who subsequently taught patients in the same curriculum (n 5847). The intervention compared with standard medical care and education alone significantly increased the odds of superior diets (high/medium v. low Mediterranean diet adherence) for residents/fellows most (OR 10·79, 95 % CI (4·94, 23·58); P < 0·001) followed by students (OR 9·62, 95 % CI (5·92, 15·63); P < 0·001), providers (OR 5·19, 95 % CI (3·23, 8·32), P < 0·001) and patients (OR 2·48, 95 % CI (1·38, 4·45); P = 0·002), results consistent with those from ML. Conclusions: The current study suggests that medical trainees and providers can improve patients’ diets with nutrition counseling in a manner that is clinically and cost effective and may simultaneously advance societal equity.
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23
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Shilts MK, Diaz Rios LK, Panarella KH, Styne DM, Lanoue LL, Drake CM, Ontai L, Townsend MS. Feasibility of Colocating a Nutrition Education Program into a Medical Clinic Setting to Facilitate Pediatric Obesity Prevention. J Prim Care Community Health 2021; 12:21501327211009695. [PMID: 33845676 PMCID: PMC8047825 DOI: 10.1177/21501327211009695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: Within a medical clinic environment, pediatric obesity prevention education for families faces challenges. Existing long-term government-funded nutrition education programs have the expertise and staff to deliver. The purpose is to determine feasibility of colocating the Expanded Food and Nutrition Education Program (EFNEP) into a medical clinic setting to support pediatric obesity prevention. Methods: Physicians from a large university teaching and research hospital (n = 73) and 4 small Medicaid-serving community clinics (n = 18) in the same geographic area in northern California were recruited and trained in the patient-referral protocol for a primary prevention intervention provided by EFNEP. The 8-week intervention deployed in the medical clinics, included general nutrition, physical activity and parenting topics anchored with guided goal setting and motivational modeling. Referral, enrollment, and attendance data were collected for 2 years. Parent and physician feasibility surveys, parent interviews and parent risk assessment tools were administered. Paired-sample t-test analysis was conducted. Results: Twenty intervention series with parents of patients (n = 106) were conducted at 5 clinics. Physicians (n = 92) generated 686 referrals. Every 6 referrals generated 1 enrolled parent. Physicians (91%, n = 34) reported the intervention as useful to families. Parents (n = 82) reported improved child behaviors for sleep, screen time, physical activity, and food and beverage offerings (P < .0001) and at family mealtime (P < .001). Focus group interviews (n = 26) with 65 participants indicated that parents (97%) reacted positively to participating in the intervention with about a third indicating the classes were relevant to their needs. Conclusion: The intervention is a feasible strategy for the 5 medical clinics. Physicians referred and parents enrolled in the intervention with both physicians and parents indicating positive benefits. Feasibility is contingent upon physician awareness of the intervention and motivation to refer patients and additional EFNEP and clinic staff time to enroll and keep parents engaged.
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Affiliation(s)
- Mical K Shilts
- California State University, Sacramento, Sacramento, CA, USA
| | | | | | - Dennis M Styne
- University of California, Davis Medical Center, Sacramento, CA, USA
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24
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Are We Neglecting Nutrition in UK Medical Training? A Quantitative Analysis of Nutrition-Related Education in Postgraduate Medical Training Curriculums. Nutrients 2021; 13:nu13030957. [PMID: 33809505 PMCID: PMC8000414 DOI: 10.3390/nu13030957] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/10/2021] [Indexed: 12/28/2022] Open
Abstract
Suboptimal nutrition is a major cause of morbidity and mortality in the United Kingdom (UK). Although patients cite physicians as trusted information sources on diet and weight loss, studies suggest that the management of nutrition-related disorders is hindered by insufficient medical education and training. Objectives of this study were to: (1) Quantify nutrition-related learning objectives (NLOs) in UK postgraduate medical training curriculums and assess variation across specialties; (2) assess inclusion of nutrition-related modules; (3) assess the extent to which NLOs are knowledge-, skill-, or behaviour-based, and in which Good Medical Practice (GMP) Domain(s) they fall. 43 current postgraduate curriculums, approved by the General Medical Council (GMC) and representing a spectrum of patient-facing training pathways in the UK, were included. NLOs were identified using four keywords: 'nutrition', 'diet', 'obesity', and 'lifestyle'. Where a keyword was used in a titled section followed by a number of objectives, this was designated as a 'module'. Where possible, NLOs were coded with the information to address objective 3. A median of 15 NLOs (mean 24) were identified per curriculum. Eleven specialties (25.6%) had five or less NLOs identified, including General Practice. Surgical curriculums had a higher number of NLOs compared with medical (median 30 and 8.5, respectively), as well as a higher inclusion rate of nutrition-related modules (100% of curriculums versus 34.4%, respectively). 52.9% of NLOs were knowledge-based, 34.9% skill-based, and 12.2% behaviour-based. The most common GMP Domain assigned to NLOs was Domain 1: Knowledge, Skills and Performance (53.0%), followed by Domain 2: Safety and Quality (20.6%), 3: Communication, Partnership and Teamwork (18.7%), and 4: Maintaining Trust (7.7%). This study demonstrates considerable variability in the number of nutrition-related learning objectives in UK postgraduate medical training. As insufficient nutrition education and training may underlie inadequate doctor-patient discussions, the results of this analysis suggest a need for further evaluation of nutrition-related competencies in postgraduate training.
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25
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Magallanes E, Sen A, Siler M, Albin J. Nutrition from the kitchen: culinary medicine impacts students' counseling confidence. BMC MEDICAL EDUCATION 2021; 21:88. [PMID: 33541352 PMCID: PMC7863372 DOI: 10.1186/s12909-021-02512-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/26/2021] [Indexed: 06/02/2023]
Abstract
BACKGROUND Although a poor diet is the number one risk factor for early death in the United States and globally, physicians receive little to no training in dietary interventions and lack confidence counseling patients about lifestyle modifications. Innovative, interprofessional strategies to address these gaps include the emergence of culinary medicine, a hands-on approach to teaching the role of food in health outcomes. We sought to assess the impact of a culinary medicine elective on counseling confidence, awareness of an evidence-based approach to nutrition, and understanding of the role of interprofessional teamwork in dietary lifestyle change among medical students at one undergraduate medical school. METHODS We administered pre- and post-course surveys to two cohorts of medical students (n = 64 at pre-test and n = 60 at post-test) participating in a culinary medicine enrichment elective. Chi-square analysis was used to assess the relationship between participation in the course and a positive response to each survey item. RESULTS Compared with the baseline, students participating in culinary medicine were more likely to feel confident discussing nutrition with patients (29% vs 92%; p < 0.001), to feel familiar with the Mediterranean diet (54% vs. 97%; p < 0.001), and to understand the role of dietitians in patient care (37% vs. 93%; p < 0.001). CONCLUSIONS Culinary medicine shows promise as an impactful educational strategy among first-year medical students for increasing counseling confidence, promoting familiarity with evidence-based nutrition interventions, and augmenting understanding of the role of interprofessional engagement to address lifestyle-related disease.
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Affiliation(s)
- Emily Magallanes
- UT Southwestern School of Medicine, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Ahana Sen
- Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Milette Siler
- Moncrief Cancer Institute at UT Southwestern, 400 W. Magnolia Ave, Fort Worth, TX, 76104, USA
| | - Jaclyn Albin
- Departments of Pediatrics and Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
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Aravind Gandhi P, Venkatesh U, Tiwari P, Kishore J. An initiative to improve nutritional education among medical students. Med J Armed Forces India 2021; 77:S190-S194. [PMID: 33612952 DOI: 10.1016/j.mjafi.2020.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 12/12/2020] [Indexed: 10/22/2022] Open
Abstract
Background India faces a double burden of Malnutrition-undernutrition and overnutrition. In the medical institutes of India, there are no practice-based teaching methods to instill a greater understanding of the concepts of nutrition and healthy cooking. Hence, we have focused on an initiative named "Diet Demonstration" (DD) that is being practiced in the Department of Community Medicine at a government medical college in New Delhi. Methods Diet Demonstration is conducted in batches of 30-40 students. This specific exercise was conducted in May 2018. A batch of 35 MBBS students was subdivided into five groups, with 7 students/group. Each group was given a scenario/person with certain health conditions. They formulated a 24-h balanced dietary plan for nutrients and devised a food menu according to the scenario provided to them. The groups procured the raw materials from local markets, prepared the food according to their menu in the home/hostel kitchens. The cooked foods, alongside the equivalent raw materials used for cooking the respective foods, were presented and explained by each group in front of the whole batch and the faculty of the department. Results majority of the students opined that it had helped them in understanding nutrition in a better way, practice healthy cooking methods, and to learn the associated practical difficulties while planning and cooking a balanced diet. Conclusion Diet Demonstration can be an innovative, cost effective way of inculcating nutrition knowledge and healthy cooking practices among the budding doctors, which needs replicability and feasibility studies in other settings.
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Affiliation(s)
- P Aravind Gandhi
- Junior Resident (Community Medicine), Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - U Venkatesh
- Senior Resident (Community Medicine), Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Poornima Tiwari
- Professor, (Community Medicine), Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Jugal Kishore
- Director Professor & Head (Community Medicine), Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
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Amakye WK, Bozovic S, Faraque A, Yao M, Ren J. Nutrition education in medical school: the case of international medical students in China. BMJ Nutr Prev Health 2020; 3:308-319. [PMID: 33521542 PMCID: PMC7841843 DOI: 10.1136/bmjnph-2020-000117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/20/2020] [Accepted: 11/10/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess the knowledge on country-specific nutrition situation, perceptions of the nutrition curricula and factors influencing capacity to offer nutrition guidance among medical students studying internationally in China compared with their home-country counterparts. DESIGN Cross-sectional study. SETTINGS China, Ghana, India and Montenegro. PARTICIPANTS International medical students in China and medical students studying in their home countries of Ghana, India and Montenegro. MAIN MEASURE An online semistructured questionnaire was administered using WeChat for international students and Microsoft Forms for home-country medical students to assess students' perceived knowledge and significance of nutrition, knowledge of country-specific nutrition situation, perceptions of the nutrition curricula and perceived capacity to offer nutrition counselling. RESULT In all, 190 medical students responded to the survey: 110 international students studying in China and 80 home-country students from Ghana (40), India (20) and Montenegro (20). Home-country students rated the importance of nutrition in health and disease development higher than international students (p<0.05). International students reported not having any specific nutrition courses while home-country students had nutrition courses as part of their curriculum. Only 8.2% of international students and 13.8% of home-country students were able to correctly mention any specific national nutrition guidelines of their home countries. Home-country students were more likely to provide correct nutrition recommendations for infants (χ²(3)=26.349; p=0.001), pregnancy (χ²(3)=9.793; p=0.007), lactating mothers (χ²(3)=9.112; p=0.011), diabetes (χ²(3)=13.619; p=0.001), hypertension (χ²(3)=12.022; p=0.002), overweight/obesity (χ²(3)=8.896; p=0.012) and undernutrition (χ²(3)=7.670; p=0.022) compared with international students. Practical nutrition courses, hours of nutrition education and how often students were asked nutrition-related questions tended to affect and predict the adequacy of nutrition education received and the perceived confidence for nutrition counselling. CONCLUSION International medical students in China are less familiar with the nutrition context in their respective home countries compared with their home-country counterparts. Medical schools in China that train significant numbers of international students need to support these students to become familiar with their respective countries' nutrition contexts.
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Affiliation(s)
- William Kwame Amakye
- School of Food Science and Engineering, South China University of Technology, Guangzhou, China
| | - Sladana Bozovic
- School of Food Science and Engineering, South China University of Technology, Guangzhou, China
| | - Arafat Faraque
- School of Food Science and Engineering, South China University of Technology, Guangzhou, China
| | - Maojin Yao
- Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiaoyan Ren
- School of Food Science and Engineering, South China University of Technology, Guangzhou, China
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Dutra B, Lissauer M, Rashid H. Nutrition Education on the Wards: A Self-Study Module for Improving Medical Student Knowledge of Nutrition Assessment and Interventions. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10968. [PMID: 33094154 PMCID: PMC7566223 DOI: 10.15766/mep_2374-8265.10968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 03/09/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Nutrition plays a key role in the prevention and treatment of disease. Hospitalized patients are often malnourished, which is a major contributor to medical complications, decreased quality of life, lengthened medical stay, increased health care costs, and mortality. However, medical students continue to have inadequate education in nutrition and report feeling poorly trained in nutrition. We proposed an online module that could be used by medical students as a self-study activity to learn about key signs for the diagnosis of malnutrition and the nutrition interventions available in the hospital setting. METHODS Third- and fourth-year medical students at Rutgers Robert Wood Johnson Medical School in medicine, surgery, and critical care clerkships were given access to an online nutrition education module discussing the signs of malnutrition in hospitalized patients and the interventions available in the inpatient setting. A premodule and postmodule survey was given via email at the beginning and at the end of the clerkship. A one-sample t test was used to assess the relationship between the mean scores of the pre- and postmodule surveys. RESULTS One hundred nine out of 255 students responded to the premodule survey. Thirty-two students completed the module and postmodule survey. There was a significant difference in mean scores between students who completed the module and postmodule survey compared to the overall student population prior to having access to the module. DISCUSSION Medical students have limited training in nutrition education, and our findings show that a self-study online module can improve students' knowledge.
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Affiliation(s)
- Barbara Dutra
- Resident, Department of Internal Medicine, University of Texas Health Science Center at Houston
| | - Matthew Lissauer
- Associate Professor of Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School
| | - Hanin Rashid
- Associate Director, Office for Advancing Learning, Teaching, and Assessment, Rutgers Robert Wood Johnson Medical School; Assistant Professor, Department of Psychiatry, Rutgers Robert Wood Johnson Medical School
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García-García FJ, Monistrol-Mula A, Cardellach F, Garrabou G. Nutrition, Bioenergetics, and Metabolic Syndrome. Nutrients 2020; 12:E2785. [PMID: 32933003 PMCID: PMC7551996 DOI: 10.3390/nu12092785] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/05/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022] Open
Abstract
According to the World Health Organization (WHO), the global nutrition report shows that whilst part of the world's population starves, the other part suffers from obesity and associated complications. A balanced diet counterparts these extreme conditions with the proper proportion, composition, quantity, and presence of macronutrients, micronutrients, and bioactive compounds. However, little is known on the way these components exert any influence on our health. These nutrients aiming to feed our bodies, our tissues, and our cells, first need to reach mitochondria, where they are decomposed into CO2 and H2O to obtain energy. Mitochondria are the powerhouse of the cell and mainly responsible for nutrients metabolism, but they are also the main source of oxidative stress and cell death by apoptosis. Unappropriated nutrients may support mitochondrial to become the Trojan horse in the cell. This review aims to provide an approach to the role that some nutrients exert on mitochondria as a major contributor to high prevalent Western conditions including metabolic syndrome (MetS), a constellation of pathologic conditions which promotes type II diabetes and cardiovascular risk. Clinical and experimental data extracted from in vitro animal and cell models further demonstrated in patients, support the idea that a balanced diet, in a healthy lifestyle context, promotes proper bioenergetic and mitochondrial function, becoming the best medicine to prevent the onset and progression of MetS. Any advance in the prevention and management of these prevalent complications help to face these challenging global health problems, by ameliorating the quality of life of patients and reducing the associated sociosanitary burden.
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Affiliation(s)
- Francesc Josep García-García
- Muscle Research and Mitochondrial Function Laboratory, CELLEX-IDIBAPS, Internal Medicine Department, Faculty of Medicine, University of Barcelona, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; (F.J.G.-G.); (A.M.-M.); (F.C.)
- CIBERER—Centre for Biomedical Research Network in Rare Diseases, 28029 Madrid, Spain
| | - Anna Monistrol-Mula
- Muscle Research and Mitochondrial Function Laboratory, CELLEX-IDIBAPS, Internal Medicine Department, Faculty of Medicine, University of Barcelona, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; (F.J.G.-G.); (A.M.-M.); (F.C.)
- CIBERER—Centre for Biomedical Research Network in Rare Diseases, 28029 Madrid, Spain
| | - Francesc Cardellach
- Muscle Research and Mitochondrial Function Laboratory, CELLEX-IDIBAPS, Internal Medicine Department, Faculty of Medicine, University of Barcelona, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; (F.J.G.-G.); (A.M.-M.); (F.C.)
- CIBERER—Centre for Biomedical Research Network in Rare Diseases, 28029 Madrid, Spain
| | - Glòria Garrabou
- Muscle Research and Mitochondrial Function Laboratory, CELLEX-IDIBAPS, Internal Medicine Department, Faculty of Medicine, University of Barcelona, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; (F.J.G.-G.); (A.M.-M.); (F.C.)
- CIBERER—Centre for Biomedical Research Network in Rare Diseases, 28029 Madrid, Spain
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Hennrikus EF, Skolka MP, Hennrikus N. Social Constructivism in Medical School Where Students Become Patients with Dietary Restrictions. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:505-511. [PMID: 32801986 PMCID: PMC7395697 DOI: 10.2147/amep.s259727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/10/2020] [Indexed: 06/02/2023]
Abstract
BACKGROUND Experiential vertical integration of basic science with clinical concepts remains a challenge in medical school curricula. In addition, training physicians in nutritional competency that translates into patient care is a challenging endeavor ranging from biochemical mechanisms to socioeconomic challenges. METHODS Employing a social constructivism paradigm, we implemented a collaborative cook-off competition in a basic science course where 140 first-year medical students per year translated their studies of inborn errors of metabolism, energy metabolism, micronutrients and immunology into edible creations intended for people with disorders requiring dietary management. After learning about the disorders in lecture, problem-based learning, team-based learning and through patient interviews, four problem-based learning groups (7 students per group) were assigned to prepare food dishes for one of the five assigned disorders. Together, students researched the dietary requirements, shopped, paid for, prepared, presented and shared their food. To the class, faculty and re-invited patients, the groups explained the dietary restrictions, the chosen ingredients, how they prepared the food, and why their dish was suitable for the disorder. Each category was judged and awarded a first-place food prize with a grand prize at the end. At the completion of the course, student feedback was elicited via anonymous evaluations. Over 3 years, 380 comments were collected. We used grounded theory to generate a codebook that was then analyzed by the authors for overarching themes. RESULTS Qualitative results described three major themes: increased relevance of basic science to real life, increased empathy towards complying with dietary restrictions, and increased student group cohesiveness. CONCLUSION The patient-centered cook-off competition taught students the relevance of basic science but in addition, it taught empathy towards the patient experience. We also discovered that the process of food preparation was a bonding experience that promoted collaboration, cohesiveness and friendship within the student class.
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Affiliation(s)
- Eileen F Hennrikus
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Michael P Skolka
- Department of Neurology, Mayo Clinic Hospital, Rochester, MN, USA
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Downer S, Berkowitz SA, Harlan TS, Olstad DL, Mozaffarian D. Food is medicine: actions to integrate food and nutrition into healthcare. BMJ 2020; 369:m2482. [PMID: 32601089 PMCID: PMC7322667 DOI: 10.1136/bmj.m2482] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Sarah Downer
- Center for Health Law and Policy Innovation, Harvard Law School, Harvard University, Cambridge, MA, USA
| | - Seth A Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Timothy S Harlan
- Section of General Internal Medicine George Washington University School of Medicine and Health Sciences, George Washington University Culinary Medicine Program, George Washington University, Washington, DC, USA
| | - Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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Macaninch E, Buckner L, Amin P, Broadley I, Crocombe D, Herath D, Jaffee A, Carter H, Golubic R, Rajput-Ray M, Martyn K, Ray S. Time for nutrition in medical education. BMJ Nutr Prev Health 2020; 3:40-48. [PMID: 33235970 PMCID: PMC7664491 DOI: 10.1136/bmjnph-2019-000049] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 01/13/2023] Open
Abstract
Aim To synthesise a selection of UK medical students' and doctors' views surrounding nutrition in medical education and practice. Methods Information was gathered from surveys of medical students and doctors identified between 2015 and 2018 and an evaluation of nutrition teaching in a single UK medical school. Comparative analysis of the findings was undertaken to answer three questions: the perceived importance of nutrition in medical education and practice, adequacy of nutrition training, and confidence in current nutrition knowledge and skills. Results We pooled five heterogeneous sources of information, representing 853 participants. Most agreed on the importance of nutrition in health (>90%) and in a doctor's role in nutritional care (>95%). However, there was less desire for more nutrition education in doctors (85%) and in medical students (68%). Most felt their nutrition training was inadequate, with >70% reporting less than 2 hours. There was a preference for face-to-face rather than online training. At one medical school, nutrition was included in only one module, but this increased to eight modules following an increased nutrition focus. When medical students were asked about confidence in their nutrition knowledge and on advising patients, there was an even split between agree and disagree (p=0.869 and p=0.167, respectively), yet few were confident in the UK dietary guidelines. Only 26% of doctors were confident in their nutrition knowledge and 74% gave nutritional advice less than once a month, citing lack of knowledge (75%), time (64%) and confidence (62%) as the main barriers. There was some recognition of the importance of a collaborative approach, yet 28% of doctors preferred to get specialist advice rather than address nutrition themselves. Conclusion There is a desire and a need for more nutrition within medical education, as well as a need for greater clarity of a doctor's role in nutritional care and when to refer for specialist advice. Despite potential selection bias and limitations in the sampling frame, this synthesis provides a multifaceted snapshot via a large number of insights from different levels of training through medical students to doctors from which further research can be developed.
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Affiliation(s)
- Elaine Macaninch
- Nutrition and Dietetics, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.,NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK
| | - Luke Buckner
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK
| | - Preya Amin
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK.,School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Iain Broadley
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK.,Bristol Medical School, University of Bristol, Bristol, UK
| | - Dominic Crocombe
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK.,York Teaching Hospital NHS Foundation Trust, York, UK
| | - Duleni Herath
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK.,School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Ally Jaffee
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK.,Bristol Medical School, University of Bristol, Bristol, UK
| | - Harrison Carter
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK
| | - Rajna Golubic
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK
| | - Minha Rajput-Ray
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK
| | - Kathy Martyn
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK.,School of Health Sciences, University of Brighton, Brighton, UK
| | - Sumantra Ray
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK
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Norris ME, Cachia MA, Johnson MI, Rogers KA, Martin CM. Expectations and Perceptions of Students' Basic Science Knowledge: Through the Lens of Clerkship Directors. MEDICAL SCIENCE EDUCATOR 2020; 30:355-365. [PMID: 34457678 PMCID: PMC8368669 DOI: 10.1007/s40670-019-00913-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Basic sciences are a cornerstone of undergraduate medical education (UME) as they provide a necessary foundation for the clinical sciences to be built upon and help foster trainees' competency. However, research indicates that students' basic science knowledge is not well retained, and as a result, students are ill-prepared, with respect to their basic science knowledge, when entering clerkship. One potential reason why students may not be prepared for clerkship is a lack of understanding as to which basic science concepts are critical for medical students to retain from pre-clerkship. We facilitated interviews with all core UME clerkship directors to establish which basic science concepts they expect students to know prior to each clerkship rotation, along with student's basic science strengths and areas of improvement. Interviews revealed that students are expected to have some knowledge of every basic science prior to clerkship, with pharmacology being a strong focus, as many specialties deal with common drugs and classes of drugs. Additionally, general anatomy and physiology knowledge were deemed student strengths in two rotations. Clerkship directors focused on perceived areas of improvement more than perceived strengths, with the most prevalent areas being pharmacology, microbiology, and detailed anatomy. These results represent views of clerkship directors from one Canadian institution; however, since clerks rotate through institutions across Canada, this data provides the impetus for creating a national discussion to help foster standardization of UME curricula, with the overarching goal of ensuring all graduates are proficient in the necessary fundamentals as they transition into residency.
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Affiliation(s)
- Madeleine E. Norris
- Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario Canada
| | - Mark A. Cachia
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario Canada
| | - Marjorie I. Johnson
- Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario Canada
| | - Kem A. Rogers
- Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario Canada
| | - Charys M. Martin
- Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario Canada
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Petit L, Le Pape P, Delestras S, Nguyen C, Marchand V, Belli D, Bonnabry P, Bajwa N, Fonzo‐Christe C. E‐Learning Training to Improve Pediatric Parenteral Nutrition Practice: A Pilot Study in Two University Hospitals. JPEN J Parenter Enteral Nutr 2019; 44:1089-1095. [DOI: 10.1002/jpen.1730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 09/29/2019] [Accepted: 10/05/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Laetitia‐Marie Petit
- Geneva University HospitalsDepartment of Pediatrics, Pediatric Gastroenterology, Hepatology, and Nutrition Unit Geneva Switzerland
| | - Pauline Le Pape
- Geneva University HospitalsPharmacy Division Geneva Switzerland
| | | | - Christina Nguyen
- Centre Hospitalier Universitaire Sainte‐JustineDepartment of Pharmacy and University of Montreal Montreal Québec Canada
| | - Valerie Marchand
- Centre Hospitalier Universitaire Sainte‐JustineDepartment of Pediatric Gastroenterology, Hepatology and NutritionUniversity of Montreal Montreal Québec Canada
| | - Dominique Belli
- Geneva University HospitalsDepartment of Pediatrics, Pediatric Gastroenterology, Hepatology, and Nutrition Unit Geneva Switzerland
| | - Pascal Bonnabry
- Geneva University HospitalsPharmacy Division Geneva Switzerland
- University of Geneva – University of LausanneSchool of Pharmaceutical Sciences Geneva Switzerland
| | - Nadia Bajwa
- Geneva University HospitalsDepartment of Pediatrics Geneva Switzerland
- University of Geneva Faculty of MedicineUnit of Development and Research in Medical Education Geneva Switzerland
| | - Caroline Fonzo‐Christe
- Geneva University HospitalsPharmacy Division Geneva Switzerland
- Geneva University HospitalsDepartment of Pediatrics, Neonatology and Paediatric Intensive Care Unit Geneva Switzerland
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Gudzune KA, Johnson VR, Bramante CT, Stanford FC. Geographic Availability of Physicians Certified by the American Board of Obesity Medicine Relative to Obesity Prevalence. Obesity (Silver Spring) 2019; 27:1958-1966. [PMID: 31515965 PMCID: PMC6868336 DOI: 10.1002/oby.22628] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 05/20/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this study is to determine the distribution of adult and pediatric American Board of Obesity Medicine (ABOM) diplomates relative to the prevalence of obesity by US state. METHODS Data from the ABOM physician directory were used to determine original specialty and US state. Physicians were labeled as "adult medicine" physicians (i.e., internal medicine, family medicine, or internal medicine and pediatrics), "pediatric medicine" physicians (i.e., pediatrics, family medicine, or internal medicine and pediatrics), and "other physicians" (i.e., surgical specialty, other specialty, or unknown). Prevalence of obesity by state, according to the Centers for Disease Control and Prevention, was used for adults and adolescents in 2017 and for children in 2014. Counts of ABOM-certified adult medicine physicians and pediatric medicine physicians were conducted relative to obesity prevalence by state. RESULTS A total of 2,577 US-based ABOM-certified physicians were included (79% from adult medicine, 38% from pediatric medicine, and 15% from other fields). All US states had more than one ABOM-certified adult medicine physician, although geographic disparities existed in physician availability relative to obesity prevalence. Fewer pediatric medicine ABOM diplomates were available in all states. CONCLUSIONS Promotion of ABOM training and certification in certain geographic locations and among pediatric physicians may help address disparities in ABOM diplomate availability relative to obesity burden.
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Affiliation(s)
- Kimberly A Gudzune
- Division of General Internal Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Veronica R Johnson
- Center for Obesity Medicine and Metabolic Performance, Department of Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Carolyn T Bramante
- Division of General Internal Medicine, Department of Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Management, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- Program in Health Disparities Research, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Fatima Cody Stanford
- Weight Center and Departments of Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
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Allen KE, Gumber D, Ostfeld RJ. Heart Failure and a Plant-Based Diet. A Case-Report and Literature Review. Front Nutr 2019; 6:82. [PMID: 31245377 PMCID: PMC6579888 DOI: 10.3389/fnut.2019.00082] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 05/20/2019] [Indexed: 12/23/2022] Open
Abstract
A 54-year-old female with grade 3 obesity body mass index (BMI 45.2 kg/m2) and type II diabetes (hemoglobin A1c 8.1%) presented to her primary care physician in May 2017 with a chief complaint of left lower extremity edema. Work-up revealed heart failure with depressed left ventricular systolic function. Upon diagnosis, she substantially altered her lifestyle, changing her diet from a "healthy western" one to a whole food plant-based one. Guideline directed medical therapy for heart failure was also utilized. Over five and a half months, she lost 22.7 kg and reversed her diabetes without the use of diabetes medications. Her left ventricular systolic function normalized. Although causality cannot be determined, this case highlights the potential role of a plant-based diet in helping to reverse heart failure with reduced ejection fraction. This article will review how a minimally processed whole food plant-based dietary pattern and similar dietary patterns, such as the Dietary Approach to Stop Hypertension diet, may contribute to the reversal of left ventricular dysfunction.
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Affiliation(s)
- Kathleen E. Allen
- Department of Food and Nutrition, NewYork-Presbyterian, New York, NY, United States
| | - Divya Gumber
- Division of Cardiology, Montefiore Health System, Bronx, NY, United States
| | - Robert J. Ostfeld
- Division of Cardiology, Montefiore Health System, Bronx, NY, United States
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Johnston BC, Seivenpiper JL, Vernooij RW, de Souza RJ, Jenkins DJ, Zeraatkar D, Bier DM, Guyatt GH. The Philosophy of Evidence-Based Principles and Practice in Nutrition. Mayo Clin Proc Innov Qual Outcomes 2019; 3:189-199. [PMID: 31193887 PMCID: PMC6543447 DOI: 10.1016/j.mayocpiqo.2019.02.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 02/27/2019] [Indexed: 01/26/2023] Open
Abstract
The practice of evidence-based nutrition involves using the best available nutrition evidence, together with clinical experience, to conscientiously work with patients' values and preferences to help them prevent (sometimes), resolve (sometimes), or cope with (often) problems related to their physical, mental, and social health. This article outlines the 3 fundamental principles of evidence-based practice as applied to the field of clinical nutrition. First, optimal clinical decision making requires awareness of the best available evidence, which ideally will come from unbiased systematic summaries of that evidence. Second, evidence-based nutrition provides guidance on how to decide which evidence is more or less trustworthy-that is, how certain can we be of our patients' prognosis, diagnosis, or of our therapeutic options? Third, evidence alone is never sufficient to make a clinical decision. Decision makers must always trade off the benefits with the risks, burden, and costs associated with alternative management strategies, and, in so doing, consider their patients' unique predicament, including their values and preferences.
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Affiliation(s)
- Bradley C. Johnston
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - John L. Seivenpiper
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Robin W.M. Vernooij
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Russell J. de Souza
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - David J.A. Jenkins
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Dennis M. Bier
- Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX
| | - Gordon H. Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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Marshall AP, Takefala T, Williams LT, Spencer A, Grealish L, Roberts S. Health practitioner practices and their influence on nutritional intake of hospitalised patients. Int J Nurs Sci 2019; 6:162-168. [PMID: 31406886 PMCID: PMC6608649 DOI: 10.1016/j.ijnss.2019.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/20/2019] [Accepted: 03/06/2019] [Indexed: 11/05/2022] Open
Abstract
Objectives In the hospital setting, poor dietary intake interacts with disease and represents a major and modifiable cause of malnutrition. Understanding barriers to adequate dietary intake is an important strategy to guide the development of interventions to improve nutrition intake. The aim of this study reported in this paper was to explore patient, family and health care professionals' perceptions of barriers to and enablers of adequate nutrition care and dietary intake of medical inpatients. Methods An exploratory qualitative study design incorporating group and individual interviews of patients (n = 14), their family members (n = 4), and health care professionals (n = 18) was undertaken. Participants were recruited pragmatically, using a mix of convenience and purposive sampling. A theoretically informed, semi-structured interview schedule was based on observations of practice and the Theoretical Domains Framework. Interviews were audio-recorded, transcribed verbatim and analysed inductively using a general inductive approach. Results Three key themes emerged from analysing participant interviews. Siloed approaches to nutrition care reflected the diverse range of health care professionals responsible for nutrition care but who often worked in isolation from their colleagues. Competing work priorities for nurses reflected the challenge in prioritise nutrition care which was often constrained because of other care needs or work-related pressures. Helping patients to eat highlighted that nurses were often the only health care professional who would provide assistance to patients at mealtimes and lack of available staff could negatively influence patients' nutrition intakes. Conclusions We have identified many complex and interrelated barriers which preclude adequate dietary intake in acute medical patients. These predominantly reflect issues inherent in the hospital culture and environment. Multi-faceted and sustainable interventions that support a facilitating nutrition culture and multidisciplinary collaboration, inclusive of patients and families, are needed to address these underlying barriers.
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Affiliation(s)
- Andrea P Marshall
- Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, QLD, Australia.,School of Nursing and Midwifery, Griffith University, Parklands Drive, Southport, QLD, Australia.,Nursing and Midwifery Education and Research Unit, Gold Coast University Hospital, 1 Hospital Blvd, QLD, Australia
| | - Tahnie Takefala
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD, Australia
| | - Lauren T Williams
- Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, QLD, Australia.,School of Allied Health Sciences, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD, Australia
| | - Alan Spencer
- Department of Nutrition and Dietetics, Gold Coast Health, 1 Hospital Blvd, QLD, Australia
| | - Laurie Grealish
- Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, QLD, Australia.,School of Nursing and Midwifery, Griffith University, Parklands Drive, Southport, QLD, Australia.,Nursing and Midwifery Education and Research Unit, Gold Coast University Hospital, 1 Hospital Blvd, QLD, Australia
| | - Shelley Roberts
- Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, QLD, Australia.,School of Allied Health Sciences, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD, Australia.,Department of Nutrition and Dietetics, Gold Coast Health, 1 Hospital Blvd, QLD, Australia
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Karlsen MC, Rogers G, Miki A, Lichtenstein AH, Folta SC, Economos CD, Jacques PF, Livingston KA, McKeown NM. Theoretical Food and Nutrient Composition of Whole-Food Plant-Based and Vegan Diets Compared to Current Dietary Recommendations. Nutrients 2019; 11:nu11030625. [PMID: 30875784 PMCID: PMC6471973 DOI: 10.3390/nu11030625] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/27/2019] [Accepted: 03/06/2019] [Indexed: 12/16/2022] Open
Abstract
Public interest in popular diets is increasing, in particular whole-food plant-based (WFPB) and vegan diets. Whether these diets, as theoretically implemented, meet current food-based and nutrient-based recommendations has not been evaluated in detail. Self-identified WFPB and vegan diet followers in the Adhering to Dietary Approaches for Personal Taste (ADAPT) Feasibility Survey reported their most frequently used sources of information on nutrition and cooking. Thirty representative days of meal plans were created for each diet. Weighted mean food group and nutrient levels were calculated using the Nutrition Data System for Research (NDSR) and data were compared to DRIs and/or USDA Dietary Guidelines/MyPlate meal plan recommendations. The calculated HEI-2015 scores were 88 out of 100 for both WFPB and vegan meal plans. Because of similar nutrient composition, only WFPB results are presented. In comparison to MyPlate, WFPB meal plans provide more total vegetables (180%), green leafy vegetables (238%), legumes (460%), whole fruit (100%), whole grains (132%), and less refined grains (−74%). Fiber level exceeds the adequate intakes (AI) across all age groups. WFPB meal plans failed to meet the Recommended Dietary Allowances (RDA)s for vitamin B12 and D without supplementation, as well as the RDA for calcium for women aged 51–70. Individuals who adhere to WFBP meal plans would have higher overall dietary quality as defined by the HEI-2015 score as compared to typical US intakes with the exceptions of calcium for older women and vitamins B12 and D without supplementation. Future research should compare actual self-reported dietary intakes to theoretical targets.
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Affiliation(s)
- Micaela C Karlsen
- Friedman School of Nutrition Science and Policy, Tufts University,150 Harrison Ave, Boston, MA 02111, USA.
| | - Gail Rogers
- Friedman School of Nutrition Science and Policy, Tufts University,150 Harrison Ave, Boston, MA 02111, USA.
| | - Akari Miki
- Nutritional Epidemiology Program at Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, 711 Washington St, Boston, MA 02111, USA.
| | - Alice H Lichtenstein
- Friedman School of Nutrition Science and Policy, Tufts University,150 Harrison Ave, Boston, MA 02111, USA.
- Department of Medicine, Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA.
| | - Sara C Folta
- Friedman School of Nutrition Science and Policy, Tufts University,150 Harrison Ave, Boston, MA 02111, USA.
| | - Christina D Economos
- Friedman School of Nutrition Science and Policy, Tufts University,150 Harrison Ave, Boston, MA 02111, USA.
- Department of Medicine, Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA.
| | - Paul F Jacques
- Friedman School of Nutrition Science and Policy, Tufts University,150 Harrison Ave, Boston, MA 02111, USA.
- Nutritional Epidemiology Program at Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, 711 Washington St, Boston, MA 02111, USA.
| | - Kara A Livingston
- Nutritional Epidemiology Program at Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, 711 Washington St, Boston, MA 02111, USA.
| | - Nicola M McKeown
- Friedman School of Nutrition Science and Policy, Tufts University,150 Harrison Ave, Boston, MA 02111, USA.
- Nutritional Epidemiology Program at Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, 711 Washington St, Boston, MA 02111, USA.
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Robinson AL. Show Me Your Objectives: Nutrition Education in a US Medical School Curriculum. MEDICAL SCIENCE EDUCATOR 2019; 29:121-129. [PMID: 34457459 PMCID: PMC8368314 DOI: 10.1007/s40670-018-00645-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Health authorities around the globe have called for improvement in nutrition education in medical schools. It was deemed necessary to study our current curriculum to document what exists and identify gaps. This project surveyed nutrition education objectives within a US medical school during 1 year followed by informal interviews of faculty aimed toward improvement in the curriculum. METHODS A survey tool was created using the list of competencies in Table 1 of "Nutrition Competencies for Graduating Medical Students" from the Nutrition in Medicine (NIM) project. Educational objectives for all 26 courses encompassing the first-, second-, and third-year curriculum at the University of New Mexico School of Medicine (UNM SOM) were surveyed in order to identify the current nutrition curriculum content. Faculty course directors were contacted after data collection to verify accuracy and fill in any missing information. RESULTS Out of 61 competencies, at least one was covered in 16 of 26 courses (62%) by survey of objectives. Additional content in nutrition education was identified for 4/16 (25%) of these courses through follow-up faculty interviews. Findings were discussed with three key curricular groups. DISCUSSION The study results highlighted the importance of accurately publishing objectives to fully reflect course content. This project demonstrates an approach that may be utilized at other medical schools to assess nutrition education curricula and create a structure for dialog within their own institutions.
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Affiliation(s)
- Amy L. Robinson
- Department of Internal Medicine, University of New Mexico, School of Medicine, MSC10 5550, Albuquerque, NM 87131-0001 USA
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41
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Uy MJA, Pereira MA, Berge JM, Loth KA. How Should We Approach and Discuss Children's Weight With Parents? A Qualitative Analysis of Recommendations From Parents of Preschool-Aged Children to Physicians. Clin Pediatr (Phila) 2019; 58:226-237. [PMID: 30428705 PMCID: PMC6461358 DOI: 10.1177/0009922818812489] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The primary objective of this study was to describe parents' preference for how physicians should approach diet and weight-related advice for their child. Semi-structured interviews were conducted with parents (n = 40) of preschoolers, transcribed verbatim, and double-coded using an inductive thematic analysis approach. Parents identified recommendations for how physicians should approach conversations about weight. Themes included (1) Tone and Approach are Important, (2) Avoid Judgment, (3) Have Regard for Parental Expertise, (4) Consider the Timing of the Discussion with Parents, and (5) Equip Parents with Concrete and Individualized Recommendations. Future research should focus on developing brief, effective communication tools to guide discussions with parents about child nutrition and weight. Opportunities to learn about and practice the use of these brief interventions should be incorporated into medical education with the goal of providing clinicians the learning opportunities, skills/tools, and resources needed to adequately and respectfully discuss weight and diet with parents and children.
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Díaz-Zavala RG, Candia-Plata MDC, Martínez-Contreras TDJ, Esparza-Romero J. Lifestyle intervention for obesity: a call to transform the clinical care delivery system in Mexico. Diabetes Metab Syndr Obes 2019; 12:1841-1859. [PMID: 31571959 PMCID: PMC6750852 DOI: 10.2147/dmso.s208884] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 08/07/2019] [Indexed: 12/11/2022] Open
Abstract
Obesity and its comorbidities have become the most important public health problems for Latin America. In Mexico obesity has increased dramatically to the point where the government has declared it an epidemiological emergency. The most recent national data showed overweight and obesity affects 72.5% of adults, or around 56 million Mexicans. Most Mexican adults with obesity are undiagnosed. According to data derived from a national representative survey, only 20% of adults with BMI >30 kg/m2 were diagnosed with obesity by a health provider. Likewise, only 8% of individuals with obesity had received treatment for obesity. Interventions offered in the Mexican health care delivery system generally consist of traditional consultations with recommendations on diet and exercise, visits are monthly to quarterly, and validated behavior change protocols are not used. Evidence from clinical trials has shown that weight loss with this type of treatment is generally less than 1 kg per year. In contrast, intensive lifestyle interventions - protocols focusing on achieving changes in diet, physical activity, and moderate weight loss using behavioral strategies with weekly or bi-weekly sessions for the first 3 to 6 months, and a maintenance phase with trained interventionists - as implemented in the Diabetes Prevention Program and the Look AHEAD studies achieved weight loss of 7-9% at one year. Additionally, translation studies of these interventions to the community and to real-world clinical practice have achieved weight loss of around 4%. Adaptations of intensive lifestyle interventions have been implemented in the United States, both in clinical practice and in the community, and this type of intervention represents a potential model to combat obesity in Mexico and other Latin American countries. It is essential that primary care providers in Mexico implement clinical practice guidelines based on the best evidence available as discussed here to effectively treat obesity. The authors make recommendations to improve the treatment of obesity in the clinical care delivery system in Mexico using intensive lifestyle interventions.
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Affiliation(s)
- Rolando Giovanni Díaz-Zavala
- Nutrition Health Promotion Center, Department of Chemical and Biological Sciences, University of Sonora, Hermosillo, Sonora, Mexico
- Correspondence: Rolando Giovanni Díaz-ZavalaNutrition Health Promotion Center, Department of Chemical and Biological Sciences, University of Sonora, Blvd. Luis Encinas y Rosales S/N, Hermosillo, Sonora83000, México. C.P.Email
| | | | | | - Julián Esparza-Romero
- Diabetes Research Unit, Department of Public Nutrition and Health, Research Center for Food and Development CIAD, Hermosillo, Sonora, Mexico
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Johnston BC, Alonso-Coello P, Bala MM, Zeraatkar D, Rabassa M, Valli C, Marshall C, El Dib R, Vernooij RWM, Vandvik PO, Guyatt GH. Methods for trustworthy nutritional recommendations NutriRECS (Nutritional Recommendations and accessible Evidence summaries Composed of Systematic reviews): a protocol. BMC Med Res Methodol 2018; 18:162. [PMID: 30518328 PMCID: PMC6280455 DOI: 10.1186/s12874-018-0621-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 11/16/2018] [Indexed: 12/14/2022] Open
Abstract
Background Recent systematic reviews and editorials suggest that many organizations that produce nutritional guideline recommendations do not adhere to internationally recognized standards set forth by the Institute of Medicine (IoM), Guidelines International Network (GIN), Appraisal of Guidelines Research and Evaluation (AGREE), and Grading Recommendations, Assessment, Development and Evaluation (GRADE). Methods The potential solution is an independent group with content expertise and skilled in the methodology of systematic reviews and practice guidelines to produce trustworthy guideline recommendations, recommendations that are supported by publication in a top tier journal. The BMJ Rapid Recommendations project has recently demonstrated the feasibility and utility of this approach. Here, we are proposing trustworthy nutritional guideline recommendations based on internationally accepted guideline development standards, recommendations that will be informed by rigorous and novel systematic reviews of the benefits and harms associated with nutritional exposures, as well as studies on the values and preferences related to dietary behaviors among members of the international community. Discussion Adhering to international guideline standards, conducting high quality systematic reviews, and actively assessing the values and preferences of key stakeholders is expected to improve the quality of nutritional guidelines and their relevance to end-users, particularly patients and community members. We will send our work for peer review, and if found acceptable, we will publish our nutritional recommendations in top-tier general medicine journals.
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Affiliation(s)
- Bradley C Johnston
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada. .,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
| | - Pablo Alonso-Coello
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Malgorzata M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Montserrat Rabassa
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain
| | - Claudia Valli
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain
| | - Catherine Marshall
- Cochrane Consumer and Honorary Patron of the Guidelines International Network, Wellington, New Zealand
| | - Regina El Dib
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada.,Institute of Science and Technology, Unesp - Univ Estadual Paulista, São José dos Campos, Brazil
| | - Robin W M Vernooij
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada.,Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Per O Vandvik
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Medicine, Innlandet Hospital Trust-division, Gjøvik, Norway
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
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Baute V, Sampath-Kumar R, Nelson S, Basil B. Nutrition Education for the Health-care Provider Improves Patient Outcomes. Glob Adv Health Med 2018; 7:2164956118795995. [PMID: 30159213 PMCID: PMC6109840 DOI: 10.1177/2164956118795995] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/06/2018] [Accepted: 07/10/2018] [Indexed: 11/15/2022] Open
Abstract
Nutrition education is globally lacking in medical training, despite the fact that dietary habits are a crucial component of physician self-care, disease prevention, and treatment. Research has shown that a physician’s health status directly affects the quality of their preventative health counseling and patient outcomes, yet on average less than 20 hours over 4 years of medical education is spent teaching nutrition. This leaves providers with a gap in knowledge regarding this critical component of health. In a recent study, only 14% of resident physicians reported being adequately trained to provide nutritional counseling. Educating health-care professionals on how to eat well provides an opportunity to improve physician and patient well-being.
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Affiliation(s)
- Vanessa Baute
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Sarah Nelson
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Barbara Basil
- Wake Forest School of Medicine, Winston-Salem, North Carolina
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Grammatikopoulou MG, Katsouda A, Lekka K, Tsantekidis K, Bouras E, Kasapidou E, Poulia KA, Chourdakis M. Is continuing medical education sufficient? Assessing the clinical nutrition knowledge of medical doctors. Nutrition 2018; 57:69-73. [PMID: 30153582 DOI: 10.1016/j.nut.2018.05.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/24/2018] [Accepted: 05/13/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Provision of nutritional support (NS) can improve disease outcome and shorten hospital length of stay. NS, often prescribed by medical doctors, requires adequate clinical nutrition (CN) expertise. The aim of this study was to investigate self-perceived and actual CN knowledge among medical doctors in Greece. METHODS Internal medicine physicians and surgical specialties (residents and specialized) were asked to self-evaluate their CN expertise, via a seven-item questionnaire and to complete a 20-question multiple-choice test on CN topics, with the aim of evaluating their actual CN knowledge. Participants were discouraged from accessing literature/information during the completion of either questionnaire. RESULTS Of 182 invited medical doctors, 115 (50.4% surgical specialties) participated in the study (63.2% response rate). The majority of participants (65.2%) demonstrated inadequate CN knowledge, with 30.4% of those scoring low having a high self-perception of their CN expertise. Comparison of perceived and actual CN knowledge revealed that only 56.5% of the participants estimated their knowledge correctly. Those who had participated in CN continuous medical education courses demonstrated increased related expertise (P = 0.002). CONCLUSIONS Medical doctors in Greece demonstrate low knowledge of fundamental CN principles, jeopardizing the provision of high-quality and efficient NS. Most importantly, the majority of participants overestimated their CN knowledge and prescribe artificial nutrition or participate in related decision making. Physicians' CN knowledge should be enhanced accordingly, either by attending CN modules during their studies, by participating in basic and advanced courses or CN-specific continuous medical education, or both.
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Affiliation(s)
- Maria G Grammatikopoulou
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Areti Katsouda
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kyriaki Lekka
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kyriakos Tsantekidis
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanouil Bouras
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eirini Kasapidou
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Michael Chourdakis
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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46
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Mogre V, Stevens F, Aryee PA, Scherpbier AJ. Nutrition in Medicine: Medical Students׳ Satisfaction, Perceived Relevance and Preparedness for Practice. HEALTH PROFESSIONS EDUCATION 2018. [DOI: 10.1016/j.hpe.2017.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Wegener J. Equipping Future Generations of Registered Dietitian Nutritionists and Public Health Nutritionists: A Commentary on Education and Training Needs to Promote Sustainable Food Systems and Practices in the 21st Century. J Acad Nutr Diet 2018; 118:393-398. [PMID: 29311036 DOI: 10.1016/j.jand.2017.10.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/26/2017] [Indexed: 01/01/2023]
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48
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Silver HJ, Pratt KJ, Bruno M, Lynch J, Mitchell K, McCauley SM. Effectiveness of the Malnutrition Quality Improvement Initiative on Practitioner Malnutrition Knowledge and Screening, Diagnosis, and Timeliness of Malnutrition-Related Care Provided to Older Adults Admitted to a Tertiary Care Facility: A Pilot Study. J Acad Nutr Diet 2018; 118:101-109. [DOI: 10.1016/j.jand.2017.08.111] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 08/17/2017] [Indexed: 01/04/2023]
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Schoendorfer N, Gannaway D, Jukic K, Ulep R, Schafer J. Future Doctors' Perceptions about Incorporating Nutrition into Standard Care Practice. J Am Coll Nutr 2017; 36:565-571. [DOI: 10.1080/07315724.2017.1333928] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Deanne Gannaway
- University of Queensland, Teaching and Educational Development Institute, Brisbane, Australia
| | - Katherine Jukic
- University of Sydney, Sydney Medical School, Sydney, Australia
| | - Robin Ulep
- University of Queensland, Medical Education, Brisbane, Australia
| | - Jennifer Schafer
- University of Queensland, Medical Education, Brisbane, Australia
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50
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Visser M, Volkert D, Corish C, Geisler C, de Groot LC, Cruz-Jentoft AJ, Lohrmann C, O'Connor EM, Schindler K, de van der Schueren MA. Tackling the increasing problem of malnutrition in older persons: The Malnutrition in the Elderly (MaNuEL) Knowledge Hub. NUTR BULL 2017. [DOI: 10.1111/nbu.12268] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M. Visser
- VU University Medical Center; Amsterdam The Netherlands
- Vrije Universiteit Amsterdam; Amsterdam The Netherlands
| | - D. Volkert
- Friedrich-Alexander-Universität Erlangen-Nürnberg; Erlangen-Nürnberg Germany
| | - C. Corish
- University College Dublin; Dublin Ireland
| | - C. Geisler
- Christian-Albrechts-Universität; Kiel Germany
| | | | | | | | | | | | - M. A. de van der Schueren
- VU University Medical Center; Amsterdam The Netherlands
- HAN University of Applied Sciences; Nijmegen The Netherlands
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