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Colaprico C, Crispini D, Rocchi I, Kibi S, De Giusti M, La Torre G. Cost and Cost-Effectiveness of the Mediterranean Diet: An Update of a Systematic Review. Nutrients 2024; 16:1899. [PMID: 38931254 PMCID: PMC11206702 DOI: 10.3390/nu16121899] [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: 05/24/2024] [Revised: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
It is well known that the Mediterranean diet (DM) is beneficial for health, as years of research globally have confirmed. The aim of this study was to update a previous systematic review that assessed the cost-effectiveness of adherence to the DM as a strategy for the prevention of degenerative diseases by evaluating the economic performance of this diet. The research approach utilized three electronic databases: PubMed, Scopus, and Web of Science. A comprehensive search was conducted to retrieve articles based on a PRISMA-compliant protocol registered in PROSPERO: CRD 42023493562. Data extraction and analysis were performed on all included studies. One thousand two hundred and eighty-two articles were retrieved, and once duplicates and irrelevant articles were removed, fifteen useful articles were reviewed. The studies indicated a clear link between dietary habits, health, and economic aspects related to dietary cost and health spending. Recognizing the significant health benefits associated with adopting DM and the potential savings on health care spending, it is important for national public health programs to consider policies that support this lifestyle.
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Affiliation(s)
- Corrado Colaprico
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (C.C.); (D.C.); (I.R.); (S.K.); (M.D.G.)
| | | | | | | | | | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (C.C.); (D.C.); (I.R.); (S.K.); (M.D.G.)
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Albin JL, Thomas OW, Marvasti FF, Reilly JM. There and Back Again: A Forty-Year Perspective on Physician Nutrition Education. Adv Nutr 2024; 15:100230. [PMID: 38705195 PMCID: PMC11251405 DOI: 10.1016/j.advnut.2024.100230] [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: 02/05/2024] [Revised: 03/12/2024] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
Medical education faces an urgent need for evidence-based physician nutrition education. Since the publication of the 1985 National Academies report "Nutrition Education in the United States Medical Schools," little has changed. Although several key efforts sought to increase nutrition content in undergraduate medical education over the past 40 y, most medical schools still fail to include the recommended minimum of 25 h of nutrition training. Without foundational concepts of nutrition in undergraduate medical education, graduate medical education unsurprisingly falls short of meeting patient needs for nutritional guidance in clinical practice. Meanwhile, diet-sensitive chronic diseases continue to escalate, although largely preventable and treatable by nutritional therapies and dietary lifestyle changes. Fortunately, recent recognition and adoption of Food is Medicine programs across the country increasingly connect patients with healthy food resources and nutrition education as core to their medical care, and physicians must be equipped to lead these efforts alongside their dietitian colleagues. Filling the gap in nutrition training will require an innovative and interprofessional approach that pairs nutrition with personal wellness, interprofessional practice, and community service learning. The intersectional benefits of connecting these domains will help prepare future physicians to address the social, behavioral, and lifestyle determinants of health in a way that recognizes nourishing food access as a core part of clinical practice. There are numerous strategies to integrate nutrition into education pathways, including didactic and experiential learning. Culinary medicine, an evidence-based field combining the culinary arts with nutritional science and medicine, is 1 promising educational framework with a hands-on, interprofessional approach that emphasizes community engagement. Advancing the critical need for widespread adoption of nutrition education for physicians will require support and engagement across societal stakeholders, including co-leadership from registered dietitian nutritionists, health system and payor reform, and opportunities for clinical innovation that bring this essential field to frontline patient care.
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Affiliation(s)
- Jaclyn Lewis Albin
- Departments of Internal Medicine and Pediatrics, the University of Texas Southwestern Medical Center, Dallas, TX, United States.
| | | | - Farshad Fani Marvasti
- Department of Family, Community, and Preventive Medicine, University of Arizona College of Medicine-Phoenix and School of Nutritional Sciences and Wellness, College of Agricultural, Life and Environmental Sciences, University of Arizona, Tucson, AZ, United States
| | - Jo Marie Reilly
- Clinical Family Medicine and Population and Public Health, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
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Staffier KL, Holmes S, Karlsen MC, Kees A, Shetty P, Hauser ME. Evaluation of the reach and utilization of the American College of Lifestyle Medicine's Culinary Medicine Curriculum. Front Nutr 2024; 11:1338620. [PMID: 38567252 PMCID: PMC10985187 DOI: 10.3389/fnut.2024.1338620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Despite the growing interest in "food as medicine," healthcare professionals have very limited exposure to nutrition as part of their training. Culinary medicine (CM), an evidence-based field integrating nutrition education with culinary knowledge and skills, offers one approach to fill this training gap. The American College of Lifestyle Medicine published a complimentary Culinary Medicine Curriculum (CMC) in 2019, and the objective of this study is to evaluate its reach and utilization, as well as to collect feedback from users. Methods Individuals who downloaded the CMC prior to March 1, 2022 (N = 6,162) were emailed an invitation to participate in an online, cross-sectional survey. The survey included both multiple choice and free-text questions about whether CM sessions were conducted, if and how the CMC was used, if and how it was modified for use, and additional requested resources. Free-text responses were inductively coded, and quantitative data was summarized using descriptive statistics. Results A total of 522 respondents provided consent, indicated that they had downloaded the curriculum, and completed the survey. Of the 522, 366 (70%) reported that they had not led or created any CM sessions. The top-reported reason for not leading a session was lack of time (29%). The remaining respondents who did create a CM session did so across various settings, including academic, clinical, coaching, and other settings, and a variety of professionals delivered the CMC sessions, including physicians (50%), registered dietitian nutritionists (30%), and chefs (25%). The majority of respondents (81%) modified the CMC in some way, with many using the curriculum for guidance or ideas only. Patient education materials (66%) and cooking technique instruction videos (59%) were among top requested resources. Discussion The CMC is a versatile resource that can be successfully adapted for use across various settings and by various types of health professionals and practitioners. Future research should investigate whether training in CM results in improved health outcomes for patients/clients. The curriculum will continue to grow to address the needs of users by expanding to include more digital content such as curriculum videos and cooking technique videos.
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Affiliation(s)
| | - Shannon Holmes
- American College of Lifestyle Medicine, Chesterfield, MO, United States
| | | | - Alexandra Kees
- American College of Lifestyle Medicine, Chesterfield, MO, United States
| | - Paulina Shetty
- American College of Lifestyle Medicine, Chesterfield, MO, United States
| | - Michelle E. Hauser
- Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, United States
- Internal Medicine-Obesity Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
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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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Fals AM, Brennan AM. Teaching Kitchens and Culinary Gardens as Integral Components of Healthcare Facilities Providing Whole Person Care: A Commentary. Nutrients 2023; 15:4162. [PMID: 37836446 PMCID: PMC10574558 DOI: 10.3390/nu15194162] [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] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Child and adult obesity continue to be major health concerns in the United States and can contribute to the development of chronic diseases. Culinary medicine, which incorporates teaching kitchens and gardens, may be a useful strategy for preventing and/or treating obesity-related disease by providing the knowledge and skills that encourage consumption of whole plant-based foods prepared at home. Though emerging research describes the benefits of culinary medicine-based programming, examples of teaching kitchens and culinary gardens being integrated into current clinical practice is minimal. Here, we describe the development of innovative, community-centered culinary medicine programming borne from interdisciplinary collaboration at a leading healthcare system. Preliminary outcomes suggest improvements in anthropometrics, cardiometabolic risk factors, and participation in healthy lifestyle behaviors in pediatric weight management patients, as well as improved confidence, knowledge, and likelihood to prepare whole food, plant-based meals in healthcare employees following participation in culinary medicine workshops. Hospitals and culinary medicine partners can support each other through shared knowledge, vision, and resources to provide value-based care to patients in the community. Collaboration among gardeners, chefs, architects, educators, and healthcare professionals can transfer traditional physician-driven care to patients, empowering them with the tools, resources, and confidence to improve health and wellbeing.
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Affiliation(s)
- Angela M Fals
- AdventHealth for Children, 601 E. Rollins St., Orlando, FL 32803, USA
| | - Andrea M Brennan
- AdventHealth Research Institute, 800 N. Magnolia Ave., Orlando, FL 32803, USA
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McGuire MF, Chen PM, Smith-Morris C, Albin J, Siler MD, Lopez MA, Pruitt SL, Merrill VC, Bowen ME. Redesigning Recruitment and Engagement Strategies for Virtual Culinary Medicine and Medical Nutrition Interventions in a Randomized Trial of Patients with Uncontrolled Type 2 Diabetes. Nutrients 2023; 15:4124. [PMID: 37836408 PMCID: PMC10574259 DOI: 10.3390/nu15194124] [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: 08/25/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
In-person culinary medicine (CM) can improve health behaviors, but its translation to virtual platforms and impact on diabetes outcomes are not well described. We designed a pragmatic trial comparing the effectiveness of virtual CM (eCM) to Medical Nutrition Therapy on diabetes outcomes among patients with uncontrolled diabetes within a safety-net healthcare system. All participants were provided cooking equipment and food from a food pantry. Due to low initial eCM participation, recruitment was paused, and eight semi-structured interviews were conducted to solicit feedback on study appeal, operations, and barriers to participation. Rapid thematic analysis was used to modify study operations. We found that participants were interested in the study and motivated by health concerns. While they valued food distribution and cooking equipment, they highlighted transportation barriers and conflicts with the pick-up time/location. Some eCM participants expressed discomfort with the virtual platform or preferred to observe rather than cook along. Study operations were modified by (1) moving supply pick-up to a familiar community clinic and diversifying food pick-up locations; (2) offering an in-person orientation to the program to increase comfort with the virtual platform; (3) emphasizing the credibility and relatability of the eCM instructor and encouraging participation of family members. This redesign led to the recruitment of 79 participants, of whom 75% attended at least one class. In conclusion, participant feedback informed pragmatic changes in study operations that increased engagement in this ongoing trial and may inform future eCM program design.
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Affiliation(s)
- Molly F. McGuire
- University of Texas Southwestern Medical Center, Division of General Internal Medicine, Dallas, TX 75390, USA (M.E.B.)
| | - Patricia M. Chen
- Peter O’Donnell Jr. School of Public Health, Dallas, TX 75390, USA
| | | | - Jaclyn Albin
- University of Texas Southwestern Medical Center, Division of Combined Internal Medicine and Pediatrics, Dallas, TX 75390, USA
| | - Milette D. Siler
- University of Texas Southwestern Medical Center, Division of General Internal Medicine, Dallas, TX 75390, USA (M.E.B.)
- Moncrief Cancer Institute, Fort Worth, TX 76104, USA
| | | | - Sandi L. Pruitt
- Peter O’Donnell Jr. School of Public Health, Dallas, TX 75390, USA
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Vincent C. Merrill
- University of Texas Southwestern Medical Center, Division of General Internal Medicine, Dallas, TX 75390, USA (M.E.B.)
| | - Michael E. Bowen
- University of Texas Southwestern Medical Center, Division of General Internal Medicine, Dallas, TX 75390, USA (M.E.B.)
- Peter O’Donnell Jr. School of Public Health, Dallas, TX 75390, USA
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7
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Jerome NE, Edwards NE, Ding QP. Impact of Mediterranean Dietary Education on Symptoms for Adults at Risk for Nonalcoholic Fatty Liver Disease. Gastroenterol Nurs 2023; 46:359-370. [PMID: 37639568 DOI: 10.1097/sga.0000000000000753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/01/2023] [Indexed: 08/31/2023] Open
Abstract
This 2-month quasi-experimental study focused on the impact of education regarding the Mediterranean diet on symptoms for adults who are at risk for nonalcoholic fatty liver disease (NAFLD). The study was conducted on a sample of 28 adults who presented to Pinnacle clinical research for NAFLD screening via a fibroscan. These individuals who are at risk for NAFLD received a single 15-minute one-on-one in person education regarding the Mediterranean diet. The diet encourages fruits, vegetables, whole grains, legumes, nuts, seeds, fish, and olive oil. The results of the study showed that the Mediterranean diet education was associated with significant improvement of abdominal symptoms ( t = 3.34, p = .03), improvement of fatigue symptoms ( t = 5.88, p < .001), and decrease in hepatic steatosis ( t = 5.77, p < .001). Our study suggests that the education on the Mediterranean diet may be associated with improvement of self-reported abdominal symptoms, fatigue, and steatosis score.
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Affiliation(s)
- Nirupama Esther Jerome
- Nirupama Esther Jerome, DNP, FNP-C, is Doctor of Nursing Practice, School of Nursing, Purdue University, West Lafayette, Indiana
- Nancy E. Edwards, PhD, ANP-BC, RN, is Professor, School of Nursing, Purdue University, West Lafayette, Indiana
- Qinglan (Priscilla) Ding, PhD, MBBS, MS, AGPCNP-BC, is Assistant Professor, School of Nursing, Purdue University, West Lafayette, Indiana
| | - Nancy E Edwards
- Nirupama Esther Jerome, DNP, FNP-C, is Doctor of Nursing Practice, School of Nursing, Purdue University, West Lafayette, Indiana
- Nancy E. Edwards, PhD, ANP-BC, RN, is Professor, School of Nursing, Purdue University, West Lafayette, Indiana
- Qinglan (Priscilla) Ding, PhD, MBBS, MS, AGPCNP-BC, is Assistant Professor, School of Nursing, Purdue University, West Lafayette, Indiana
| | - Qinglan Priscilla Ding
- Nirupama Esther Jerome, DNP, FNP-C, is Doctor of Nursing Practice, School of Nursing, Purdue University, West Lafayette, Indiana
- Nancy E. Edwards, PhD, ANP-BC, RN, is Professor, School of Nursing, Purdue University, West Lafayette, Indiana
- Qinglan (Priscilla) Ding, PhD, MBBS, MS, AGPCNP-BC, is Assistant Professor, School of Nursing, Purdue University, West Lafayette, Indiana
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8
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Eisenberg DM, Pacheco LS, McClure AC, McWhorter JW, Janisch K, Massa J. Perspective: Teaching Kitchens: Conceptual Origins, Applications and Potential for Impact within Food Is Medicine Research. Nutrients 2023; 15:2859. [PMID: 37447185 PMCID: PMC10343805 DOI: 10.3390/nu15132859] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
There is a need to identify innovative strategies whereby individuals, families, and communities can learn to access and prepare affordable and nutritious foods, in combination with evidence-based guidance about diet and lifestyle. These approaches also need to address issues of equity and sustainability. Teaching Kitchens (TKs) are being created as educational classrooms and translational research laboratories to advance such strategies. Moreover, TKs can be used as revenue-generating research sites in universities and hospitals performing sponsored research, and, potentially, as instruments of cost containment when placed in accountable care settings and self-insured companies. Thus, TKs can be considered for inclusion in future health professional training programs, and the recently published Biden-Harris Administration Strategy on Hunger, Nutrition and Health echoes this directive. Recent innovations in the ability to provide TK classes virtually suggest that their impact may be greater than originally envisioned. Although the impact of TK curricula on behaviors, outcomes and costs of health care is preliminary, it warrants the continued attention of medical and public health thought leaders involved with Food Is Medicine initiatives.
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Affiliation(s)
- David M. Eisenberg
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (L.S.P.); (K.J.); (J.M.)
| | - Lorena S. Pacheco
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (L.S.P.); (K.J.); (J.M.)
| | | | | | - Kate Janisch
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (L.S.P.); (K.J.); (J.M.)
| | - Jennifer Massa
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (L.S.P.); (K.J.); (J.M.)
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Albin JL, Siler M, Kitzman H. Culinary Medicine eConsults Pair Nutrition and Medicine: A Feasibility Pilot. Nutrients 2023; 15:2816. [PMID: 37375720 DOI: 10.3390/nu15122816] [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: 05/16/2023] [Revised: 06/07/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
The global impact of diet-sensitive disease demands innovative nutrition education for health professionals and widespread, reimbursable clinical models to apply nutrition to practice. Interprofessional collaboration across disciplines and the optimization of emerging telemedicine consultation strategies, including electronic consultation (eConsult), merge to deliver vital innovation in the delivery of nutrition-based clinical care. Aligning with an existing eConsult infrastructure in the institutional electronic health record (EHR), a physician-dietitian team developed a novel Culinary Medicine eConsult. During a pilot phase, the service was introduced to primary care clinicians, and a response algorithm for eConsults was created. During the 12-month pilot phase, the Culinary Medicine team completed 25 eConsults from 11 unique primary care clinicians with a 76% (19/25) insurance reimbursement rate. Topics varied from dietary strategies for preventing and managing common metabolic diseases to specific dietary influences on microbiome health and disease flares. Requesting clinicians reported time saved in their clinic encounters and high patient satisfaction with expert nutrition guidance. EConsults in Culinary Medicine promote the integration of interprofessional nutrition care into existing clinical structures and empower enhanced access to the vital domain of dietary health. EConsults deliver timely answers to clinical questions and create opportunities for further innovation in care delivery as communities, health systems, and payors seek solutions to the growing burden of diet-sensitive diseases.
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Affiliation(s)
- Jaclyn L Albin
- University of Texas Southwestern Medical Center, School of Medicine, Departments of Internal Medicine and Pediatrics, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Milette Siler
- Moncrief Cancer Institute and the University of Texas Southwestern Medical Center, 400 W Magnolia Ave, Fort Worth, TX 76104, USA
| | - Heather Kitzman
- University of Texas Southwestern Medical Center, Peter O'Donnell Jr. School of Public Health, Dallas, TX 75390, USA
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Gayoso L, Goni L, de la O V, Domper J, C R, Ruiz-Canela M, Etxeberria U. An intensive culinary intervention programme to empower type 2 diabetic patients in cooking skills: The SUKALMENA pilot study. Int J Gastron Food Sci 2023. [DOI: 10.1016/j.ijgfs.2023.100721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
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Delivering Food Resources and Kitchen Skills (FoRKS) to Adults with Food Insecurity and Hypertension: A Pilot Study. Nutrients 2023; 15:nu15061452. [PMID: 36986184 PMCID: PMC10051267 DOI: 10.3390/nu15061452] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
Food insecurity affects nearly 50 million Americans and is linked to cardiovascular disease risk factors and health disparities. The purpose of this single-arm pilot study was to determine the feasibility of a 16-week dietitian-led lifestyle intervention to concurrently address food access, nutrition literacy, cooking skills, and hypertension among safety-net primary care adult patients. The Food Resources and Kitchen Skills (FoRKS) intervention provided nutrition education and support for hypertension self-management, group kitchen skills and cooking classes from a health center teaching kitchen, medically tailored home-delivered meals and meal kits, and a kitchen toolkit. Feasibility and process measures included class attendance rates and satisfaction and social support and self-efficacy toward healthy food behaviors. Outcome measures included food security, blood pressure, diet quality, and weight. Participants (n = 13) were on average {mean (SD)} aged 58.9 ± 4.5 years, 10 were female, and 12 were Black or African American. Attendance averaged 19 of 22 (87.1%) classes and satisfaction was rated as high. Food self-efficacy and food security improved, and blood pressure and weight declined. FoRKS is a promising intervention that warrants further evaluation for its potential to reduce cardiovascular disease risk factors among adults with food insecurity and hypertension.
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Monlezun DJ, Badalamenti A, Javaid A, Marmagkiolis K, Honan K, Kim JW, Patel R, Akhanti B, Halperin D, Dasari A, Koutroumpakis E, Kim P, Lopez-Mattei J, Yusuf SW, Cilingiroglu M, Mamas MA, Gregoric I, Yao J, Hassan S, Iliescu C. Artificial intelligence-augmented analysis of contemporary procedural, mortality, and cost trends in carcinoid heart disease in a large national cohort with a focus on the "forgotten pulmonic valve". Front Cardiovasc Med 2023; 9:1071138. [PMID: 36843627 PMCID: PMC9945326 DOI: 10.3389/fcvm.2022.1071138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/30/2022] [Indexed: 02/11/2023] Open
Abstract
Background Carcinoid heart disease is increasingly recognized and challenging to manage due to limited outcomes data. This is the largest known cohort study of valvular pathology, treatment (including pulmonary and tricuspid valve replacements [PVR and TVR]), dispairties, mortality, and cost in patients with malignant carcinoid tumor (MCT). Methods Machine learning-augmented propensity score-adjusted multivariable regression was conducted for clincal outcomes in the 2016-2018 U.S. National Inpatient Sample (NIS). Regression models were weighted by the complex survey design and adjusted for known confounders and the likelihood of undergoing valvular procedures. Results Among 101,521,656 hospitalizations, 55,910 (0.06%) had MCT. Patients with MCT vs. those without had significantly higher inpatient mortality (2.93 vs. 2.04%, p = 0.002), longer mean length of stay (12.20 vs. 4.62, p < 0.001), and increased mean total cost of stay ($70,252.18 vs. 51,092.01, p < 0.001). There was a step-wise increased rate of TVR and PVR with each subsequent year, with significantly more TV (0.16% vs. 0.01, p < 0.001) and PV (0.03 vs. 0.00, p = 0.040) diagnosed with vs. without MCT for 2016, with comparable trends in 2017 and 2018. There were no significant procedural disparities among patients with MCT for sex, race, income, urban density, or geographic region, except in 2017, when the highest prevalence of PV procedures were performed in the Western North at 50.00% (p = 0.034). In machine learning and propensity score augmented multivariable regression, MCT did not significantly increase the likelihood of TVR or PVR. In sub-group analysis restricted to MCT, neither TVR nor PVR significantly increased mortality, though it did increase cost (respectively, $141,082.30, p = 0.015; $355,356.40, p = 0.012). Conclusion This analysis reflects a favorable trend in recognizing the need for TVR and PVR in patients with MCT, with associated increased cost but not mortality. Our study also suggests that pulmonic valve pathology is increasingly recognized in MCT as reflected by the upward trend in PVRs. Further research and updated societal guidelines may need to focus on the "forgotten pulmonic valve" to improve outcomes and disparities in this understudied patient population.
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Affiliation(s)
- Dominique J. Monlezun
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States,Center for Artificial Intelligence and Health Equities, Global System Analytics and Structures (GSAS), New Orleans, LA, United States,*Correspondence: Dominique J. Monlezun ✉
| | - Andrew Badalamenti
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Awad Javaid
- Division of Cardiovascular Medicine, Kirk Kerkorian School of Medicine at the University of Nevada-Las Vegas, Las Vegas, NV, United States
| | - Kostas Marmagkiolis
- Division of Cardiovascular Disease, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Kevin Honan
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Jin Wan Kim
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Rishi Patel
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Bindu Akhanti
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Dan Halperin
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Arvind Dasari
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Efstratios Koutroumpakis
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Peter Kim
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Syed Wamique Yusuf
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Mehmet Cilingiroglu
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom
| | - Igor Gregoric
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - James Yao
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Saamir Hassan
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Cezar Iliescu
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
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Razavi AC, Latoff A, Dyer A, Albin JL, Artz K, Babcock A, Cimino F, Daghigh F, Dollinger B, Fiellin M, Johnston EA, Jones GM, Karch RD, Keller ET, Nace H, Parekh NK, Petrosky SN, Robinson A, Rosen J, Sheridan EM, Warner SW, Willis JL, Harlan TS. Virtual teaching kitchen classes and cardiovascular disease prevention counselling among medical trainees. BMJ Nutr Prev Health 2023; 6:6-13. [PMID: 37559965 PMCID: PMC10407392 DOI: 10.1136/bmjnph-2022-000477] [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: 04/18/2022] [Accepted: 12/15/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hands-on culinary medicine education for medical trainees has emerged as a promising tool for cardiovascular health promotion. PURPOSE To determine whether virtual culinary medicine programming associates with Mediterranean diet (MedDiet) adherence and lifestyle medicine competencies among medical trainees across the USA. METHOD A total of 1433 medical trainees across 19 sites over a 12-month period were included. The Cooking for Health Optimisation with Patients-Medical Trainees survey composed of 61 questions regarding demographics, nutritional attitudes, dietary habits including MedDiet score and lifestyle medicine counselling competencies. Multivariable logistic regression assessed the association of virtual culinary medicine education with MedDiet intake and nutritional attitudes. RESULTS There were 519 medical trainees who participated in virtual culinary medicine education and 914 medical trainees who participated in their standard nutrition curricula. More than one-half of participants were women (n=759) and the mean age was 27 years old. Compared with students enrolled in traditional nutrition curricula, participants in virtual culinary medicine education were 37% more likely to adhere to MedDiet guidelines for fruit intake (OR 1.37, 95% CI 1.03 to 1.83, p=0.03). Virtual culinary medicine education was associated with higher proficiency in lifestyle medicine counselling categories, notably recommendations involving fibre (OR 4.03; 95% CI 3.05 to 5.34), type 2 diabetes prevention (OR 4.69; 95% CI 3.51 to 6.27) and omega fatty acids (OR 5.21; 95% CI 3.87 to 7.02). Virtual culinary medicine education had a similar, although higher magnitude association with MedDiet counselling competency (OR 5.73, 95% CI 4.26 to 7.70) when compared with historical data previously reported using hands-on, in-person culinary medicine courseware (OR 4.97, 95% CI 3.89 to 6.36). CONCLUSIONS Compared with traditional nutritional educational curricula, virtual culinary medicine education is associated with higher MedDiet adherence and lifestyle medicine counselling competencies among medical trainees. Both virtual and hands-on culinary medicine education may be useful for cardiovascular health promotion.
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Affiliation(s)
- Alexander C Razavi
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anna Latoff
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Amber Dyer
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | | | - Kristi Artz
- Spectrum Health, Grand Rapids, Michigan, USA
| | | | | | - Farzaneh Daghigh
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Beth Dollinger
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, USA
| | - Maya Fiellin
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Emily A Johnston
- Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Grace Marie Jones
- Touro University California College of Osteopathic Medicine, Vallejo, California, USA
| | - Robert D Karch
- University of Central Florida College of Medicine, Orlando, Florida, USA
| | | | - Heather Nace
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | | | | | - Amy Robinson
- University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Jessica Rosen
- New York Medical College School of Medicine, Valhalla, New York, USA
| | - Eva M Sheridan
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Susan W Warner
- The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - Timothy S Harlan
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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14
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Moore MA, Cousineau BA, Rastorguieva K, Bonnet JP, Bergquist SH. A Teaching Kitchen Program Improves Employee Micronutrient and Healthy Dietary Consumption. Nutr Metab Insights 2023; 16:11786388231159192. [PMID: 36923451 PMCID: PMC10009100 DOI: 10.1177/11786388231159192] [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: 12/14/2022] [Accepted: 02/06/2023] [Indexed: 03/18/2023] Open
Abstract
Objective To measure changes in micronutrient adequacy and diet quality in healthcare and university employees who underwent a 10-week teaching kitchen program. Methods Thirty-eight healthcare and university employees participated in a 10-week teaching kitchen program. Twenty-seven completed self-administered, 24-hour dietary recalls to measure dietary intake at baseline and 3-months. Micronutrient adequacy and diet quality was assessed using Dietary Reference Intakes (DRIs) and the Healthy Eating Index (HEI). Results Seventy percent of participants were classified as low or moderate micronutrient adequacy at baseline. The proportion of participants with high micronutrient adequacy increased from 30% to 48% at 3-month follow-up. Total HEI and most HEI components increased at follow-up; with a statistically significant increase in seafood/plant protein score (P = .007). Conclusions and Implications for Practice Our results suggest an inadequacy in micronutrient intake in university and healthcare employees and that teaching kitchens may help improve micronutrient adequacy and diet quality.
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Affiliation(s)
- Miranda A Moore
- Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA.,Department of Medicine, Emory University, Atlanta, GA, USA
| | - Benjamin A Cousineau
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
| | - Krystyna Rastorguieva
- Woodruff Health Sciences Center, Office of Well-Being, Emory University, Atlanta, GA, USA
| | - Jonathan P Bonnet
- Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA
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15
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Doxey RS, Wolferz RH, Stewart KL, Goossen R, Imber L. Building Flavor and Confidence in the Kitchen: A Pilot Virtual Cooking Class on Healthy Snacking. Am J Lifestyle Med 2023; 17:64-70. [PMID: 36636388 PMCID: PMC9830242 DOI: 10.1177/15598276221125686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Cooking meals at home is associated with more healthful eating and even other healthy behaviors, such as increased physical activity, but for many there are numerous barriers to making this a reality. Healthy teaching kitchen interventions aim to help patients overcome these barriers. Our pilot program worked to address this issue by demonstrating the feasibility and acceptability of a virtual culinary medicine session designed for outpatient clinic patients. Participants were recruited from a single community primary care clinic for a virtual culinary medicine session. Of the 29 subjects who attended the class, 13 (45%) filled out the pre-course survey, and 8 (26%) filled out the post-course survey. Average participant confidence in preparing snacks at home from fresh ingredients increased from 3.62 to 4.38 out of 5 after attending this session, though the results were not statistically (OR .47; P = .172; 95% CI .16 to 1.3). Post-participation comments were overwhelmingly positive. This study showed that a virtual cooking class is feasible in a community clinic setting and is positively received. In addition, a culinary class teaching healthy cooking techniques paired with nutrition training may improve patient's confidence in the kitchen.
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Affiliation(s)
- Richmond S. Doxey
- Internal Medicine, University of Utah Health, Salt Lake City, UT, USA (RSD); Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA (RHW, RG); Nutrition Care Services
Department, University of Utah Health Hospitals and
Clinics, Salt Lake City, UT, USA (KLS, LI)
| | - Richard H. Wolferz
- Internal Medicine, University of Utah Health, Salt Lake City, UT, USA (RSD); Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA (RHW, RG); Nutrition Care Services
Department, University of Utah Health Hospitals and
Clinics, Salt Lake City, UT, USA (KLS, LI)
| | - Kelly L. Stewart
- Internal Medicine, University of Utah Health, Salt Lake City, UT, USA (RSD); Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA (RHW, RG); Nutrition Care Services
Department, University of Utah Health Hospitals and
Clinics, Salt Lake City, UT, USA (KLS, LI)
| | - Rachel Goossen
- Internal Medicine, University of Utah Health, Salt Lake City, UT, USA (RSD); Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA (RHW, RG); Nutrition Care Services
Department, University of Utah Health Hospitals and
Clinics, Salt Lake City, UT, USA (KLS, LI)
| | - Lindsey Imber
- Internal Medicine, University of Utah Health, Salt Lake City, UT, USA (RSD); Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA (RHW, RG); Nutrition Care Services
Department, University of Utah Health Hospitals and
Clinics, Salt Lake City, UT, USA (KLS, LI)
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16
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Novotny D, Urich SM, Roberts HL. Effectiveness of a Teaching Kitchen Intervention on Dietary Intake, Cooking Self-Efficacy, and Psychosocial Health. AMERICAN JOURNAL OF HEALTH EDUCATION 2022. [DOI: 10.1080/19325037.2022.2142337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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17
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Muacevic A, Adler JR, Flexman N, Mikati N. Recipes for Health: A Community-Based Nutrition and Culinary Intervention. Cureus 2022; 14:e32322. [PMID: 36627985 PMCID: PMC9825116 DOI: 10.7759/cureus.32322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Obesity is a major public health concern in the United States, especially since it has been associated with an increased incidence of multiple co-morbidities. Positive eating behavior modifications learned through nutrition education sessions are the main interventions proposed to target overweight and obesity. OBJECTIVE The aim of this study was to determine if nutrition education and hands-on cooking classes will result in improvement in eating habits and cooking skills to manage chronic disease. Methods: A convenience sample of 21 participants were recruited from primary health clinics in Miami-Dade, Broward, and Palm Beach counties. A total of eight weekly virtual lessons were conducted, which included both a culinary and a nutrition education portion. At baseline and post-intervention, participants filled out a validated questionnaire with questions related to nutrition knowledge and behavior, fruit and vegetable consumption, and cooking skills. Weight was self-reported. Statistical analysis was conducted using IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, New York, United States) and included descriptive statistics and a paired t-test to compare pre- and post-intervention data. RESULTS Throughout the eight weeks, subject attendance ranged from 61-95%. Nineteen participants completed the post-intervention questionnaire. Results showed a statistically significant mean weight loss of 3.74 ±5.26 lbs (p=0.006) and a statistically significant mean BMI change of -0.66 ±0.86 (p=0.004) at post-intervention compared to baseline. In addition, subjects reported increased confidence in dietary habits and culinary skills post-intervention. CONCLUSION Our results show exciting data in support of this project's objectives that a healthy cooking intervention can increase nutrition knowledge, increase confidence in healthy food choices, increase confidence in food preparation skills, and improve weight and BMI in participants.
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18
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Goh LML, Chow LM, Ng SY, Chow DWS, Lim RBT. Impact of an Interactive Health Corner Using the Culinary Education Approach in Promoting Long-Term Dietary Changes among Patients Who Seek Public Primary Care Services. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11488. [PMID: 36141759 PMCID: PMC9517567 DOI: 10.3390/ijerph191811488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/30/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
An unhealthy diet is a major risk factor for chronic diseases. Although nutrition education and cooking demonstrations have resulted in favourable dietary changes, it is unclear whether this is sustainable for longer periods. This study aims to evaluate the long-term impact of a nutrition-led cooking intervention using the culinary education approach on dietary patterns based on My Healthy Plate (MHP). This was a quasi-experimental study involving patients who sought public primary care services in two polyclinics (mean age 59.3 years old). A self-administered survey was done at baseline, 6 months, and 1 year for both the intervention and the comparison groups. Participants in the intervention group were exposed to the health corner, which provided nutrition education and cooking demonstrations using the culinary education approach. A total of 216 participants completed the study at 1 year with a follow-up rate of 86%. Adjusted risk ratios (aRR) were obtained from negative binomial regression. Compared with the comparison group, participants in the intervention group were more likely to report adhering to the requirements of MHP at 6 months (aRR 1.83, 95% CI 1.12-2.99) and 1 year (aRR 1.54, 95% CI 1.10-2.16). Participants in the intervention group were less likely to add salt or sauces to food at 6 months (aRR 0.29, 95% CI 0.12-0.75) and 1 year (aRR 0.21, 95% CI 0.07-0.61) and more likely to remove fat when eating meat at 1 year (aRR 0.30, 95% CI 0.13-0.67) than the comparison group. The interventions at the health corner had a positive impact in helping patients achieve MHP recommendations, not adding salt and sauces to their food, and removing animal fat before eating. There is potential for expanding this initiative to improve healthy eating practices in other polyclinics.
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Affiliation(s)
- Lynette Mei Lim Goh
- Clinical Services, National University Polyclinics, National University Health System, Singapore 609606, Singapore
| | - Li Ming Chow
- Clinical Services, National University Polyclinics, National University Health System, Singapore 609606, Singapore
| | - Su Yi Ng
- Clinical Services, National University Polyclinics, National University Health System, Singapore 609606, Singapore
| | - Dana Wai Shin Chow
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore 117549, Singapore
| | - Raymond Boon Tar Lim
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore 117549, Singapore
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19
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PERSİL ÖZKAN Ö, ERGİNBAŞ Ç. Koroner Arter Hastalarının Akdeniz Diyetine Bağlılık Durumunun Değerlendirilmesi. İSTANBUL GELIŞIM ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2022. [DOI: 10.38079/igusabder.1022939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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20
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Frayna C, Devantier C, Harris B, Kingsley K, Polanski JM. Education Regarding and Adherence to Recommended Nutrition Guidelines among Dental Students. Dent J (Basel) 2021; 9:dj9080093. [PMID: 34436005 PMCID: PMC8393618 DOI: 10.3390/dj9080093] [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: 05/06/2021] [Revised: 07/28/2021] [Accepted: 08/05/2021] [Indexed: 11/16/2022] Open
Abstract
The Dietary Guidelines for Americans (DGA) were developed to reduce or prevent many types of chronic illness, including cancer, heart disease and diabetes. Healthcare provider recommendations may be influenced by understanding of and adherence to the DGA, which may be incorporated into provider training, medical and dental clinical curricula—although few studies have evaluated adherence to the DGA among dental students. This approved retrospective study of voluntary student responses from a first-year dental school nutrition course included a short dietary and exercise survey administered as part of the DGA learning module. A total of N = 299 students completed the voluntary nutrition survey, yielding a response rate of 91.4%. Daily fruit and vegetable intake, dairy and whole grain servings among UNLV-SDM students were significantly lower than the DGA recommendations but higher than U.S. averages for 18–30-year-olds—although neither group met DGA recommendations. This study represents one of the first to evaluate the dietary intake of U.S. dental students for comparison with the DGA for positive health behaviors. These data demonstrate a lack of adherence to the DGA among highly educated dental students and the need for the curricular inclusion of diet and nutrition into the dental school curriculum.
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Affiliation(s)
- Camille Frayna
- Pediatric Dentistry Postgraduate Program, School of Dental Medicine, University of Nevada, 1700 W. Charleston Blvd., Las Vegas, NV 89106, USA;
| | - Christoffer Devantier
- Department of Clinical Sciences, School of Dental Medicine, University of Nevada, 1700 W. Charleston Blvd., Las Vegas, NV 89106, USA; (C.D.); (B.H.)
| | - Braden Harris
- Department of Clinical Sciences, School of Dental Medicine, University of Nevada, 1700 W. Charleston Blvd., Las Vegas, NV 89106, USA; (C.D.); (B.H.)
| | - Karl Kingsley
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada, 1001 Shadow Lane, Las Vegas, NV 89106, USA;
- Correspondence: ; Tel.: +1-702-774-2623; Fax: +1-702-774-2721
| | - Joshua M. Polanski
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada, 1001 Shadow Lane, Las Vegas, NV 89106, USA;
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21
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Sotos-Prieto M, Del Rio D, Drescher G, Estruch R, Hanson C, Harlan T, Hu FB, Loi M, McClung JP, Mojica A, Puglielli D, Toong K, Yangarber F, Kales SN. Mediterranean diet - promotion and dissemination of healthy eating: proceedings of an exploratory seminar at the Radcliffe institute for advanced study. Int J Food Sci Nutr 2021; 73:158-171. [PMID: 34225548 DOI: 10.1080/09637486.2021.1941804] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The traditional Mediterranean diet is considered the world's most evidence-based eating pattern for promoting health and longevity. However, institutional food environments and their busy consumers often sacrifice health benefits for the convenience of faster and cheaper foods that generally are of lower quality and are more processed, and thus, contribute to the current epidemics of obesity and diabetes. Expert consensus has even identified the Mediterranean diet as the easiest to follow among healthy eating patterns. Nonetheless, fewer American families cook at home and many food services have been slow to implement healthier food options compatible with the Mediterranean diet. In September 2019, we convened a group of thought leaders at an exploratory seminar entitled: "Mediterranean Diet: Promotion and Dissemination of Healthy Eating", hosted by the Radcliffe Institute for Advanced Studies at Harvard University. The multidisciplinary faculty discussed best practices for translating traditional Mediterranean lifestyle principles to modern society.
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Affiliation(s)
- Mercedes Sotos-Prieto
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.,IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain.,IMDEA-Food Institute, CEI UAM + CSIC, Madrid, Spain.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Daniele Del Rio
- School of Advanced Studies on Food and Nutrition, University of Parma, Parma, Italy
| | - Greg Drescher
- The Culinary Institute of America, Hyde Park, NY, USA
| | - Ramon Estruch
- Internal Medicine Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain.,Ciber Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Chavanne Hanson
- Global, Food Choice Architecture and Nutrition Manager, Google, Mountain View, CA, USA
| | - Timothy Harlan
- School of Medicine, Tulane University, New Orleans, MA, USA
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Maria Loi
- Loi Estiatorio and Loi Brand, New York, NY, USA
| | - James P McClung
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | | | | | - Ken Toong
- University of Massachusetts, Amherst, MA, USA
| | | | - Stefanos N Kales
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
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22
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Gardiner P, McGonigal L, Villa A, Kovell LC, Rohela P, Cauley A, Rinker D, Olendzki B. Our Whole Lives for Hypertension and Cardiac Risk Factors (OWL-H)—Combining a Teaching Kitchen Group Visit with an Online Platform: A Feasibility Trial (Preprint). JMIR Form Res 2021; 6:e29227. [PMID: 35576575 PMCID: PMC9152723 DOI: 10.2196/29227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background Hypertension (HTN) affects millions of Americans. Our Whole Lives: an eHealth toolkit for Hypertension and Cardiac Risk Factors (OWL-H) is an eHealth platform that teaches evidence-based lifestyle strategies, such mindfulness and cooking skills, to improve self-management of HTN. Objective The primary goal of this pilot study was to evaluate the feasibility of OWL-H combined with teaching kitchen medical group visits (TKMGVs) in a low-income population of participants with HTN. Methods We conducted a pre-post 8-week study to assess the feasibility of a hybrid program (a web-based 9-module self-management program, which includes mindfulness and Mediterranean and Dietary Approaches to Stop Hypertension diet) accompanied by 3 in-person TKMGVs among patients with HTN. Data including demographics, platform use, and satisfaction after using OWL-H were examined. Outcome data collected at baseline and 8 weeks included the Mediterranean Diet Questionnaire, Hypertension Self-Care Profile Self-Efficacy Instrument, Blood Pressure Knowledge Questionnaire, and the number of self-reported blood pressure readings. For the statistical analysis, we used descriptive statistics, paired sample t tests (1-tailed), and qualitative methods. Results Of the 25 enrolled participants, 22 (88%) participants completed the study. Participants’ average age was 57 (SD 12.1) years, and 46% (11/24) of them reported a household income <US $30,000 per year. Among the 22 participants who logged in to OWL-H, the average number of mindfulness practices completed was 7 and the average number of module sessions accessed was 4. In all, 73% (16/22) of participants reported that they were “very satisfied” with using OWL-H to help manage their HTN. Participants’ blood pressure knowledge significantly increased from baseline (mean 5.58, SD 1.44) to follow-up (mean 6.13, SD 1.23; P=.03). Participants significantly increased their adherence to a Mediterranean diet from baseline (mean 7.65, SD 2.19) to follow-up (mean 9, SD 1.68; P=.004). Participants’ self-efficacy in applying heart-healthy habits, as measured by the Hypertension Self-Care Profile Self-Efficacy Instrument, increased from baseline (mean 63.67, SD 9.06) to follow-up (mean 65.54, SD 7.56; P=.14). At the 8-week follow-up, 82% (18/22) of the participants had self-reported their blood pressure on the OWL-H platform at least once during the 8 weeks. Conclusions The eHealth platform for HTN self-management, OWL-H, and accompanying in-person TKMGVs have the potential to effectively improve lifestyle management of HTN. Trial Registration ClinicalTrials.gov NCT03974334; https://clinicaltrials.gov/ct2/show/NCT03974334
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Affiliation(s)
- Paula Gardiner
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Lisa McGonigal
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Ariel Villa
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Lara C Kovell
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Pallavi Rohela
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Andrew Cauley
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Diana Rinker
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Barbara Olendzki
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
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Obesity, Mediterranean Diet, and Public Health: A Vision of Obesity in the Mediterranean Context from a Sociocultural Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073715. [PMID: 33918238 PMCID: PMC8038135 DOI: 10.3390/ijerph18073715] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/19/2021] [Accepted: 03/30/2021] [Indexed: 12/12/2022]
Abstract
Obesity is a disease that straddles medico-nutritional, psychological, and socio-cultural boundaries. There is a clear relationship between lifestyle and obesity, and today the Mediterranean diet in the Mediterranean area may represent an interesting corrective asset. However, we should not be under any misapprehension about the model’s capacity for action in non-nutritional terms. Our societies are experiencing a process of rapid change, and the Mediterranean area is no exception. The aim of this article is to present a view of obesity in the Mediterranean context from an open, mainly socio-cultural perspective, but from different points of view (medical, nutritional), seeking points of convergence and elements that contribute to the understanding of and approach to the disease in the context of the Mediterranean diet. As a public health and a multidimensional social problem, obesity must be dealt with in a holistic, open, and cross-disciplinary manner to ensure that it can be understood coherently. The only way to keep the usefulness of the Mediterranean diet within desirable limits will be our societies’ vitality and interest in rapidly adapting the Mediterranean diet to social change, thus providing valid answers to today’s needs.
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24
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Razavi AC, Dyer A, Jones M, Sapin A, Caraballo G, Nace H, Dotson K, Razavi MA, Harlan TS. Achieving Dietary Sodium Recommendations and Atherosclerotic Cardiovascular Disease Prevention through Culinary Medicine Education. Nutrients 2020; 12:E3632. [PMID: 33255901 PMCID: PMC7761274 DOI: 10.3390/nu12123632] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 12/13/2022] Open
Abstract
Sodium-reduction initiatives have been a cornerstone of preventing hypertension and broader atherosclerotic cardiovascular disease (ASCVD) since the early 1970s. For nearly 50 years, public health and clinical guidelines have concentrated on consumer education, behavioral change, and, to a lesser extent, food policy to help reduce sodium intake among Americans. While these efforts undoubtedly helped improve awareness, average sodium consumption remains at approximately 4200 mg/day in men and 3000 mg/day in women, well above the United States Dietary Guidelines of 2300 mg/day. Culinary medicine is an emerging discipline in clinical and public-health education that provides healthcare professionals and community members with food-based knowledge and skills. With the hands-on teaching of kitchen education to individuals, culinary medicine provides eaters with tangible strategies for reducing sodium through home cooking. Here, we review opportunities for culinary medicine to help improve both individual- and population-level sodium-reduction outcomes through five main areas: increasing adherence to a plant-forward dietary pattern, food literacy, the enhancement of complementary flavors, disease-specific teaching-kitchen modules, and the delivery of culturally specific nutrition education. Through this process, we hope to further underline the value of formal, hands-on teaching-kitchen education among healthcare professionals and community members for ASCVD prevention.
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Affiliation(s)
- Alexander C. Razavi
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, LA 70119, USA; (A.D.); (M.J.); (A.S.); (H.N.); (M.A.R.)
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Amber Dyer
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, LA 70119, USA; (A.D.); (M.J.); (A.S.); (H.N.); (M.A.R.)
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Matthew Jones
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, LA 70119, USA; (A.D.); (M.J.); (A.S.); (H.N.); (M.A.R.)
| | - Alexander Sapin
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, LA 70119, USA; (A.D.); (M.J.); (A.S.); (H.N.); (M.A.R.)
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Graciela Caraballo
- George Washington University Culinary Medicine Program, George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA; (G.C.); (K.D.); (T.S.H.)
| | - Heather Nace
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, LA 70119, USA; (A.D.); (M.J.); (A.S.); (H.N.); (M.A.R.)
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Kerri Dotson
- George Washington University Culinary Medicine Program, George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA; (G.C.); (K.D.); (T.S.H.)
| | - Michael A. Razavi
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, LA 70119, USA; (A.D.); (M.J.); (A.S.); (H.N.); (M.A.R.)
| | - Timothy S. Harlan
- George Washington University Culinary Medicine Program, George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA; (G.C.); (K.D.); (T.S.H.)
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