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Krishnan S, Sytsma T, Wischmeyer PE. Addressing the Urgent Need for Clinical Nutrition Education in PostGraduate Medical Training: New Programs and Credentialing. Adv Nutr 2024:100321. [PMID: 39424228 DOI: 10.1016/j.advnut.2024.100321] [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: 06/10/2024] [Revised: 10/09/2024] [Accepted: 10/11/2024] [Indexed: 10/21/2024] Open
Abstract
The importance of nutrition in the development of disease, and in the recovery from illness, is among the most fundamental tenets in human biology and optimal health. Nutrition was fundamental in many traditional forms of medicine until its role in medical care experienced a rapid decline over the last century. We believe a key cause of the decline in nutrition's essential role in healthcare and preventative medicine is the escalating crisis of inadequate nutrition education in medical training. Recent data show 75% of United States medical schools have no required clinical nutrition classes and only 14% of residency programs have a required nutrition curriculum. More troubling, only 14% of current healthcare providers feel comfortable discussing nutrition with their patients. The purpose of this paper is to present the evidence illustrating the distinct lack of nutrition education in medical training. Further, we present key examples of existing formal nutrition curricula to incorporate nutritional science into all healthcare providers' education and practices. We discuss existing nutrition fellowships and training programs, including the new Duke Online Clinical Nutrition Fellowship. We also cover a physician nutrition certification allowing physicians to pursue clinical nutrition as a career path. Finally, recent financial incentives and quality measures incentivizing healthcare provider nutrition education is discussed. Thus, in conclusion, we advocate the inclusion of nutrition education curricula as a priority in medical schools, graduate medical education, and continuing medical education. Formal clinical nutrition training should be a requirement for hospital leadership and administrators for all Parenteral Nutrition and Nutrition Team Physician Directors in hospitals worldwide, and this key clinical role must become an essential position in all hospitals. In addition, we immediately need to address the critical shortage of physician nutrition specialists who will serve as the next generation of leaders in clinical nutrition care and research.
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Affiliation(s)
- Sundar Krishnan
- Department of Anesthesiology, Duke University School of Medicine, Durham, United States.
| | - Trevor Sytsma
- Duke University School of Medicine, Durham, United States
| | - Paul E Wischmeyer
- Departments of Anesthesiology and Surgery, Duke University School of Medicine, Durham, United States.
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Krenek AM, Mobley AR, Andrade J, Dahl W, Mathews AE. Behavioral Frameworks and Translational Applications of Culinary Medicine and Culinary Nutrition. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:742-750. [PMID: 39152977 DOI: 10.1016/j.jneb.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 06/30/2024] [Accepted: 07/03/2024] [Indexed: 08/19/2024]
Abstract
Culinary medicine and culinary nutrition programs have emerged as innovative approaches to influencing dietary and lifestyle behavior change. These models vary in reported use of behavioral frameworks for planning purposes and attributing efficacy to current inconsistencies in format and delivery. This report aims to review current practice of behavior change theories in culinary medicine/culinary nutrition, delineate constructs that support positive outcomes, and describe future directions for translational applications in integrating the skills of chefs, nutrition educators, and medical professionals.
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Affiliation(s)
- Andrea M Krenek
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, FL
| | - Amy R Mobley
- Department of Health Education and Behavior, University of Florida, Gainesville, FL
| | - Jeanette Andrade
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, FL
| | - Wendy Dahl
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, FL
| | - Anne E Mathews
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, FL.
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Gokdemir O, Gorgu G, Jotić Ivanović M, Woolley AK, Öztürk A, Rey Seoane M, Reczek L, Bakola M, Aygun O, Küçükerdem HS, Toplu H. Mental distress and nutrition of family physicians, a European based cross-sectional study. Medicine (Baltimore) 2024; 103:e39544. [PMID: 39287305 PMCID: PMC11404895 DOI: 10.1097/md.0000000000039544] [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] [Indexed: 09/19/2024] Open
Abstract
Family physicians are a pillar of the primary healthcare system, and their own mental well-being is integral to their performance. However, many studies have suggested a high prevalence of mental distress. The contributing factors include the emotional demands of the profession, work overload, budgetary constraints, loss of autonomy, and erosion of professional values. Outbreaks such as the COVID-19 pandemic exacerbate distress due to a greater risk of exposure to the virus, increased working hours, and fear of infecting families. Thus, it is crucial to assess risks and provide preventive measures. This study aimed to evaluate the association between the dietary patterns of family physicians and their mood. This study used a cross-sectional descriptive method and a validated Food-Mood Questionnaire (FMQ), shared via social networks across 10 European countries, to collect data from family physicians. Permission to use the FMQ was obtained. The breakfast-pattern subscale had the highest mean score (14.670 ± 4.305). The other subscale mean scores were as follows: health pattern (13.317 ± 5.388), mental distress pattern (11.184 ± 3.824), and western diet pattern (9.827 ± 3.604). According to Pearson correlation test there was a positive correlation between breakfast and Western diet patterns and between breakfast and health patterns. There was a negative correlation between health and mental distress pattern. Evidence suggests that mental distress may arise from different dietary deficiencies. Physicians' nutritional patterns have an impact on health indicators and are distributed in relation to sociodemographic factors, especially the regions they live in. Diet assessment is becoming a vital modifiable risk factor for mental health, but further research in this field is needed.
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Affiliation(s)
- Ozden Gokdemir
- Izmir University of Economics, Faculty of Medicine, Izmir, Turkey
| | - Genco Gorgu
- Marmara District State Hospital/Turkey EYFDM - European Young Family Doctors Movement Mental Health SIG Lead
| | - Marina Jotić Ivanović
- Family Medicine Department, Primary Health Care Center Doboj, Doboj, Bosnia and Herzegovina EYFDM - European Young Family Doctors Movement Lifestyle Medicine SIG Lead
| | | | | | - Miriam Rey Seoane
- ICS- Institud Catalá.de la Salut / CUAP Manso / Barcelona / Spain EYFDM - European Young Family Doctors Movement Emergency Medicine Lead
| | | | - Maria Bakola
- Department of Public Health, University of Patras, Patras, Greece
| | - Olgu Aygun
- Department of Family Medicine, Bozyaka Research and Training Hospital, İzmir, Turkey
| | | | - Hilal Toplu
- Kadikoy Number 9 Health Center, Istanbul, Turkey
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Johnston EA, Torres M, Hansen J, Ochoa K, Mortenson D, De Leon E, Beasley JM. Implementing a Diet Risk Score (DRS) for Spanish-Speaking Adults in a Clinical Setting: A Feasibility Study. Nutrients 2024; 16:2992. [PMID: 39275307 PMCID: PMC11396789 DOI: 10.3390/nu16172992] [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: 07/04/2024] [Revised: 08/30/2024] [Accepted: 09/03/2024] [Indexed: 09/16/2024] Open
Abstract
Tools to briefly assess diet among US Spanish-speaking adults are needed to identify individuals at risk for cardiometabolic disease (CMD) related to diet. Two registered dietitian nutritionists (RDNs) recruited bilingual medical students to translate the validated Diet Risk Score (DRS) into Spanish (DRS-S). Participants were recruited from a federally qualified health center. Students administered the DRS-S and one 24-h recall (Automated Self-Administered 24-Hour (ASA24®) Dietary Assessment Tool) on one day; a second recall was administered within 1 week. Recalls were scored using the Healthy Eating Index (HEI)-2015, a measure of adherence to the Dietary Guidelines for Americans. Spearman correlations, weighted kappa, and ANOVA were conducted using SAS 9.4 to assess the relative validity of the DRS-S. Thirty-one Spanish-speaking adults (female: n = 17, 53%; mean age: 58 (42-69)) completed assessments. The mean DRS-S was 9 (SD = 4.2) (max: 27; higher score = higher risk) and the mean HEI-2015 score was 65.7 (SD = 9.7) (max: 100; higher score = lower risk), with significant agreement between measures (r: -0.45 (p = 0.01)), weighted kappa: -0.3 (p = 0.03). The DRS-S can be used in resource-constrained settings to assess diet for intervention and referral to RDNs. The DRS-S should be tested in clinical care to assess the impact of dietary changes to reduce CMD risk.
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Affiliation(s)
- Emily A. Johnston
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA; (E.D.L.); (J.M.B.)
| | - Maria Torres
- College of Osteopathic Medicine, California Health Sciences University, Clovis, CA 93611, USA; (M.T.); (J.H.); (K.O.); (D.M.)
| | - John Hansen
- College of Osteopathic Medicine, California Health Sciences University, Clovis, CA 93611, USA; (M.T.); (J.H.); (K.O.); (D.M.)
| | - Kimberly Ochoa
- College of Osteopathic Medicine, California Health Sciences University, Clovis, CA 93611, USA; (M.T.); (J.H.); (K.O.); (D.M.)
| | - Daniel Mortenson
- College of Osteopathic Medicine, California Health Sciences University, Clovis, CA 93611, USA; (M.T.); (J.H.); (K.O.); (D.M.)
| | - Elaine De Leon
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA; (E.D.L.); (J.M.B.)
| | - Jeannette M. Beasley
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA; (E.D.L.); (J.M.B.)
- Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY 10003, USA
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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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Bassin SR, Ferreira De Carvalho J, Gulati M. A Review of Plant-Based Diets for Obesity Management. Endocr Pract 2024; 30:779-789. [PMID: 38729570 DOI: 10.1016/j.eprac.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/03/2024] [Accepted: 04/29/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Obesity is the most prevalent chronic disease in the United States with over 70% of the American population suffering from overweight/obesity. Recently, the popularity of plant-based diets (PBDs) has grown, with individuals adopting these diets for ethical, health and environmental reasons. Our aim is to evaluate the effect of a PBD on weight loss among patients who are overweight or obese. METHODS A literature review of PBDs for the treatment of obesity was conducted using PubMed and Scopus. Our search yielded 27 intervention trials (3361 participants) and 6 metanalyses (9168 participants, 61 trials). RESULTS Among the intervention trials evaluated, 75% showed a significant increase in weight loss or decrease in weight in the intervention group, on average -5.0 kg (range -1.8 to -12.1 kg). Other outcomes included energy intake (-420 Kcal/d), systolic blood pressure (-3.78 mmHg), fasting plasma glucose (-2.0 mmol/L), hemoglobin A1c (-0.5%, -3.4 mmol/L), total cholesterol (-0.40 mmol/L), low-density lipoprotein (-0.38 mmol/L), triglyceride levels (+0.13 mmol/L), and fiber intake (+10.8 g/d). The 6 meta-analyses showed weight loss (average -2.9 kg, range -2.02 kg to -4.1 kg), body mass index reduction, and improvements in hemoglobin A1c, low-density lipoprotein, and total cholesterol. CONCLUSION PBDs result in significant weight loss and improve metabolic outcomes. PBDs offer a sustainable approach to long-term weight loss maintenance. Health care providers should encourage open discussions with their patients regarding their dietary habits to assist them in setting feasible lifestyle goals and consider shared medical appointments to support patients in transitioning to PBDs.
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Affiliation(s)
- Sandhya Rao Bassin
- Department of Endocrine, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York.
| | | | - Mahima Gulati
- Department of Medical Sciences, Frank H. Netter MD School of Medicine, Quinnipiac University, Hamden, Connecticut
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Khandalavala B, Emig S, Yousef M, Geske J. Diet quality in medical trainees: a cross-sectional assessment comparing medical students and primary care residents using the Rapid Eating Assessment for Participants-shortened version. BMC Nutr 2024; 10:106. [PMID: 39054563 PMCID: PMC11271206 DOI: 10.1186/s40795-024-00899-x] [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: 09/13/2023] [Accepted: 06/19/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND The diet quality of the US population is significantly unhealthy, with critical long-term implications for the nation's health. A few studies have explored diet quality in the future primary care workforce. This cross-sectional study quantifies the diet quality of medical students and primary care residents at a Midwestern college of medicine in the United States. METHODS 250 medical students and 148 primary care residents were surveyed electronically utilizing the Rapid Eating Assessment for Participants-Shortened Version (REAP-S). The survey consists of 13 questions that can be scored on a scale from 1 to 3, along with 3 questions that are not scored. The average REAP-S score for a US omnivorous diet is 32 (range 13 to 39) with higher scores indicating a higher quality diet. We obtained average REAP-S scores for all respondents and descriptive summary statistics for individual REAP-S items. Students' REAP-S total scores were compared to those of residents and the interaction between student/resident status and BMI category on REAP-S total scores were analyzed using analyses of variance. Differences between students and residents on BMI categories and other outcomes (individual REAP-S items, pandemic dietary and weight changes) were analyzed using Chi-Square Tests of Independence or Fisher's Exact Tests. RESULTS Medical students (n = 99; 39.6% response rate) had a significantly higher mean REAP-S score (30.5, SD = 3.9) than primary care residents (n = 72; 49% response rate) (mean = 28.6, SD = 3.9; p = 0.006). Total mean REAP-S scores were significantly higher for those with BMI < 25 (mean = 30.8, SD = 3.7) than for those with BMI > = 25 (mean = 28.3, SD = 4.0; p < 0.001). There was not a statistically significant interaction between role (student vs. resident) and BMI category on total REAP-S scores (p = 0.39). Most respondents (89.3%) indicated that they were willing to improve their diet. CONCLUSION Our data suggest that the diet quality of surveyed medical students and primary care residents, as quantified by the REAP-S, is suboptimal. Early detection and improvement of diet quality may be necessary for our medical profession trainees to avert potential long-term adverse cardiometabolic health outcomes, and to optimize the health of our future primary care workforce.
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Affiliation(s)
- Birgit Khandalavala
- University of Nebraska Medical Center, Omaha, NE, USA.
- Nebraska Medicine, Omaha, NE, USA.
| | - Stephanie Emig
- University of Nebraska Medical Center, Omaha, NE, USA
- Nebraska Medicine, Omaha, NE, USA
| | - Mira Yousef
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Jenenne Geske
- University of Nebraska Medical Center, Omaha, NE, USA
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Brandt EJ, Kirch M, Ayanian JZ, Chang T, Thompson MP, Nallamothu BK. Dietary Counseling Documentation Among Patients Recently Hospitalized for Cardiovascular Disease. J Acad Nutr Diet 2024; 124:883-895. [PMID: 38462127 DOI: 10.1016/j.jand.2024.03.003] [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: 10/03/2023] [Revised: 02/22/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Diet intervention forms the cornerstone for cardiovascular disease (CVD) management. OBJECTIVE The objective was to measure the frequency of dietary counseling documentation for patients recently hospitalized with CVD. DESIGN This was an observational study. PARTICIPANTS AND SETTING Patients were included from the Michigan Value Collaborative Multipayer Claims Registry from October 2015 to February 2020. MAIN OUTCOME MEASURE The study measured the frequency of medical claims that document dietary counseling ≤90 days after hospitalization (ie, an episode of care) for CVD events (coronary artery bypass grafting, acute myocardial infarction, congestive heart failure, and percutaneous coronary intervention). Dietary counseling documentation was defined as having an encounter-level International Classification of Diseases 10th Revision code for dietary counseling or current procedural terminology code for medical nutrition therapy or cardiac rehabilitation. STATISTICAL ANALYSES PERFORMED Multivariable logistic regression was used to measure variation in documentation across gender, age, comorbidities, hospital geography, CVD event, and insurer. RESULTS There were 175,631 episodes of care (congesitve heart failure 47.1%, acute myocardial infarction 28.7%, percutaneous coronary intervention 17.0%, and coronary artery bypass grafting 7.3%) among 146,185 individuals. Most episodes occurred among men (55.8%) and those older than age 65 years (71.9%). Dietary counseling was documented for 22.8% of episodes and was more common as cardiac rehabilitation (18.6%) than other encounter types (5.1%). In multivariable analysis, there was lower odds for dietary counseling documentation among those older than age 65 years (odds ratio [OR] 0.77; P < .001), women (OR 0.83; P < .001), with chronic kidney disease (OR 0.74; P < .001), or diabetes (OR 0.95; P < .001), but greater odds for those with obesity (OR 1.28; P < .001) and nonmetropolitan hospitals (OR 1.31; P < .001). Compared with coronary artery bypass grafting, acute myocardial infarction (OR 0.29; P < .001), confestive heart failure (OR 0.12; P < .001), and percutaneous coronary intervention (OR 0.36; P < .001) episodes had lower odds to have dietary counseling coded. Compared with Traditional Medicare, Medicaid and Medicare Advantage health maintenance organization plans had lower odds, whereas Commercial or Medicare Advantage preferred provider organization and Commercial health maintenance organization plans had higher odds to have dietary counseling documented. Results were mostly similar when evaluated by race. CONCLUSIONS Dietary counseling was infrequently documented after hospitalization for CVD episodes in medical claims in a Michigan-based multipayer claims database with large variation by reason for hospitalization and patient factors.
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Affiliation(s)
- Eric J Brandt
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
| | - Matthias Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - John Z Ayanian
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Tammy Chang
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Michael P Thompson
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Section of Health Services Research and Quality, Department of Cardiac Surgery, Unversity of Michigan, Ann Arbor, Michigan; Michigan Value Collaborative, Ann Arbor, Michigan
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
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Landry MJ, Ward CP, Koh LM, Gardner CD. The knowledge, attitudes, and perceptions towards a plant-based dietary pattern: a survey of obstetrician-gynecologists. Front Nutr 2024; 11:1381132. [PMID: 38895659 PMCID: PMC11183291 DOI: 10.3389/fnut.2024.1381132] [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: 02/06/2024] [Accepted: 05/15/2024] [Indexed: 06/21/2024] Open
Abstract
Background Obstetricians-gynecologists (OB/GYNs) play a critical role for their pregnant patients during their perinatal period, but research on OB/GYNs knowledge, attitudes, and perceptions regarding plant-based dietary patterns (PBDP) and how this may influence recommendations to patients is lacking. An online cross-sectional survey was conducted to examine OB/GYN's knowledge, attitudes, and perceptions towards a PBDP. Methods Postcards were mailed in June 2023 to a convenience sample of 5,000 OB/GYNs across the US using a mailing list provided by the American College of Obstetricians and Gynecologists. Postcards had a brief study description and a QR code that linked to an online survey asking questions about demographics, behavior (e.g., nutritional habits), and other factors that may influence knowledge, attitudes, and perceptions towards a PBDP for their patients. Results Ninety-six OB/GYNs completed the full questionnaire (~2% response rate). Most (92%) felt that it is within an OB/GYN's role to incorporate nutrition education and counseling within practice. However, 72% felt inadequately trained to discuss nutrition and diet-related issues with patients. Despite a perceived lack of nutrition training, 86% reported that a PBDP was safe and health-promoting, and 81% reported that a well-planned PBDP could adequately meet all nutritional needs of pregnant and lactating patients. Conclusion Findings suggest that OB/GYNs are generally knowledgeable about the components and health benefits of a plant-based diets. However, nutrient adequacy misconceptions and lack of sufficient training to discuss nutrition with patients may result in OB/GYNs not recommending PBDPs to patients. These findings underscore the need to enhance OB/GYN graduate medical education and training by integrating education on PBDPs, therefore improving a clinician's ability to confidently and effectively counsel pregnant persons on this aspect of perinatal care.
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Affiliation(s)
- Matthew J. Landry
- Department of Population Health and Disease Prevention, Program in Public Health, University of California, Irvine, Irvine, CA, United States
| | - Catherine P. Ward
- Stanford Prevention Research Center, School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Linda M. Koh
- Stanford Prevention Research Center, School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Christopher D. Gardner
- Stanford Prevention Research Center, School of Medicine, Stanford University, Palo Alto, CA, United States
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Mertens HL, Kaifie A. [Nutrition counseling in medical practices-a cross-sectional study]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:721-729. [PMID: 38639815 PMCID: PMC11166768 DOI: 10.1007/s00103-024-03870-0] [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: 10/09/2023] [Accepted: 03/18/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION The purpose of this study was to assess the status of nutrition care and counseling in German medical practices, including physicians' nutrition interest and knowledge, existing obstacles, and possible ways of improving nutrition care. METHODS After development and a two-stage pretest, questionnaires with 32 items were distributed to all resident doctors of general medicine, internal medicine, gynecology and obstetrics, orthopedics, and occupational medicine in Aachen (n = 360) in early spring 2022. RESULTS The response rate was 29.2% and n = 105 participants were included in the analysis. During their consultation hours, 85.7% of the doctors conducted nutrition counseling (NC). While doctors estimated that 39.5% of their patients need NC, they counseled only 28.1%. General practitioners spent an average of 13 min on NC; all other specialties spent 9.5 min. Most participants felt well informed about healthy nutrition (95.2%). Nutrition was of high personal interest to 57.7% of the participants, and 47.6% considered it important for their work as a doctor. Barriers preventing better NC included the lack of nutrition education during medical studies (89.5%) and specialist training (79.6%), and the lack of time (75.2%). Most participants were willing to conduct more NC if they were paid better and had more time for NC during their working hours. DISCUSSION Doctors consider NC a relevant part of their work, despite many barriers. To make better use of NC as a measure for treating and preventing common diseases, improvements like better nutrition education for doctors, better funding, and more time for NC are required.
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Affiliation(s)
- Hannah Luisa Mertens
- Institut für Arbeits‑, Sozial- und Umweltmedizin, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
| | - Andrea Kaifie
- Institut für Arbeits‑, Sozial- und Umweltmedizin, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
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Leblay L, Bélanger A, Desjardins C, Filiatrault M, Paquette JS, Drouin-Chartier JP. Relationship Between Diet Quality and Antihypertensive Medication Intensity Among Adults With Metabolic Syndrome-Associated High Blood Pressure. CJC Open 2024; 6:30-39. [PMID: 38313343 PMCID: PMC10837706 DOI: 10.1016/j.cjco.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/24/2023] [Indexed: 02/06/2024] Open
Abstract
Background Management of high blood pressure (BP), a key feature of the metabolic syndrome (MetS), relies on diet and medication. Whether these modalities are used as complements has never been evaluated in real-world settings. This study assessed the relationship between diet quality and antihypertensive medication intensity among adults with MetS-associated high BP. Methods This cross-sectional study included 915 adults with MetS-associated high BP from the CARTaGENE cohort (Québec, Canada), of whom 677 reported using BP-lowering medication. Antihypertensive medication intensity was graded per the number of BP-lowering classes used simultaneously. Diet quality was assessed using the Dietary Approach to Stop Hypertension (DASH) score. Results No evidence of a relationship between antihypertensive medication intensity and diet quality was found (β for each additional antihypertensive = -0.05; 95% CI, -0.35; 0.26 DASH score points). However, among men aged < 50 years and women aged < 60 years, the DASH score was inversely associated with medication intensity (β = -0.72; 95% CI, -1.24, -0.19), whereas this relationship tended to be positive among older participants (β = 0.32; 95% CI, -0.05, 0.69). Among participants with low Framingham risk score, the DASH score was inversely associated with medication intensity (β = -0.70; 95% CI, -1.31, -0.09), but no evidence of an association was found among individuals at moderate (β = 0.00; 95% CI, -0.45, 0.45) or high (β = 0.30, 95% CI, -0.24, 0.84) risk. Conclusions In this cohort of adults with MetS-associated high BP, there was an overall lack of complementarity between diet quality and BP-lowering medication, especially among younger individuals and those with a lower risk for cardiovascular disease for whom diet quality was inversely associated with intensity of medication.
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Affiliation(s)
- Lise Leblay
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, Québec, Canada
- Faculté de Pharmacie, Université Laval, Québec City, Québec, Canada
| | - Amélie Bélanger
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, Québec, Canada
- Faculté de Pharmacie, Université Laval, Québec City, Québec, Canada
| | - Clémence Desjardins
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, Québec, Canada
- Faculté de Pharmacie, Université Laval, Québec City, Québec, Canada
| | - Mathieu Filiatrault
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, Québec, Canada
- Faculté de Pharmacie, Université Laval, Québec City, Québec, Canada
| | - Jean-Sébastien Paquette
- Département de médecine familiale et de médecine d'urgence, Faculté de Médecine, Université Laval, Québec City, Québec, Canada
- VITAM, Centre de recherche en santé durable, Université Laval, Québec City, Québec, Canada
- Centre Hospitalier Régionale de Lanaudière, Saint-Charles-Borromée, Québec City, Québec, Canada
| | - Jean-Philippe Drouin-Chartier
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, Québec, Canada
- Faculté de Pharmacie, Université Laval, Québec City, Québec, Canada
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12
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Moran AJ, Roberto CA. A "Food Is Medicine" Approach to Disease Prevention: Limitations and Alternatives. JAMA 2023; 330:2243-2244. [PMID: 38032668 DOI: 10.1001/jama.2023.24472] [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] [Indexed: 12/01/2023]
Abstract
This Viewpoint argues that although “food is medicine” programs may help some patients prevent diet-related diseases, changing food industry behavior and ensuring that existing nutrition assistance programs are accessible and health-promoting are better strategies to make a difference.
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Affiliation(s)
- Alyssa J Moran
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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13
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Tsiampalis T, Kouvari M, Belitsi V, Kalantzi V, Androutsos O, Bonoti F, Panagiotakos DB, Kosti RI. Physicians' Words, Patients' Response: The Role of Healthcare Counselling in Enhancing Beneficial Lifestyle Modifications for Patients with Cardiometabolic Disorders: The IACT Cross-Sectional Study. Healthcare (Basel) 2023; 11:2982. [PMID: 37998474 PMCID: PMC10671259 DOI: 10.3390/healthcare11222982] [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: 09/29/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023] Open
Abstract
Background: Preventive cardiology aims to educate patients about risk factors and the importance of mitigating them through lifestyle adjustments and medications. However, long-term adherence to recommended interventions remains a significant challenge. This study explores how physician counselling contributes to successful behavior changes in various aspects of lifestyle. Methods: A cross-sectional study conducted in Greece in 2022-2023 included 1988 participants. Validated questionnaires assessed patients' characteristics, dietary habits, and lifestyle choices. Results: The findings revealed that patients who received lifestyle advice from physicians demonstrated increased compliance with the Mediterranean diet and a higher involvement in physical activity. Notably, they were also less likely to be non-smokers. Importantly, physicians' recommendations had a more pronounced association with adherence level to the Mediterranean diet compared to other lifestyle behaviors. Additionally, specific dietary components like cereal, legume, and red meat consumption were significantly associated with physicians' guidance. Conclusions: This study highlights the complex relationship between patients' cardiometabolic health, lifestyle decisions, and healthcare professionals' guidance. The substantial influence of physicians on Mediterranean diet adherence underscores the necessity for a multidisciplinary healthcare approach. Collaborative efforts involving physicians, dietitians, and fitness experts can offer comprehensive support to patients in navigating the intricate landscape of cardiometabolic health.
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Affiliation(s)
- Thomas Tsiampalis
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 38221 Trikala, Greece or (T.T.); (V.B.); (V.K.); (O.A.); (F.B.)
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece; (M.K.); (D.B.P.)
| | - Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece; (M.K.); (D.B.P.)
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia
| | - Vasiliki Belitsi
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 38221 Trikala, Greece or (T.T.); (V.B.); (V.K.); (O.A.); (F.B.)
| | - Vasiliki Kalantzi
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 38221 Trikala, Greece or (T.T.); (V.B.); (V.K.); (O.A.); (F.B.)
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 38221 Trikala, Greece or (T.T.); (V.B.); (V.K.); (O.A.); (F.B.)
| | - Fotini Bonoti
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 38221 Trikala, Greece or (T.T.); (V.B.); (V.K.); (O.A.); (F.B.)
| | - Demosthenes B. Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece; (M.K.); (D.B.P.)
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia
| | - Rena I. Kosti
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 38221 Trikala, Greece or (T.T.); (V.B.); (V.K.); (O.A.); (F.B.)
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14
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Kronsteiner-Gicevic S, Tello M, Lincoln LE, Kondo JK, Naidoo U, Fung TT, Willett WC, Thorndike AN. Validation of the Rapid Prime Diet Quality Score Screener (rPDQS), A Brief Dietary Assessment Tool With Simple Traffic Light Scoring. J Acad Nutr Diet 2023; 123:1541-1554.e7. [PMID: 37244591 DOI: 10.1016/j.jand.2023.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Dietary pattern is a determinant of chronic disease, but nonregistered dietitian nutritionist (non-RDN) clinicians rarely assess diet because of barriers such as time constraints and lack of valid, brief diet quality assessment tools. OBJECTIVE The study aimed to evaluate the relative validity of a brief diet quality screener using both a numeric scoring system and a simple traffic light scoring system. DESIGN A cross-sectional study was conducted using the CloudResearch online platform to compare participants' responses to the 13-item rapid Prime Diet Quality Score screener (rPDQS) and the Automated Self-Administered 24-hour (ASA24) Dietary Assessment Tool. PARTICIPANTS/SETTING The study was conducted in July and August 2021 and included 482 adults ≥18 years of age or older sampled to be representative of the US population. MAIN OUTCOME MEASURES All participants completed the rPDQS and an ASA24; of these, 190 completed a second ASA24 and rPDQS. Responses to rPDQS items were coded using both traffic light (eg, green = healthiest intake, red = least healthy intake) and numeric (eg, consume < 1 time a week, consume ≥ 2 times per day) scoring methods and were compared with food group equivalents and Healthy Eating Index-2015 (HEI-2015) scores estimated from ASA24s. STATISTICAL ANALYSES Deattenuated Pearson correlation coefficients were calculated to account for within-person variation in 24-hour diet recalls. RESULTS Overall, 49% of participants were female, 62% were ≥35 years, and 66% were non-Hispanic White, 13% non-Hispanic Black, 16% Hispanic/Latino, and 5% Asian. For both food groups to encourage (eg, vegetables, whole grains) and to consume in moderation (eg, processed meats, sweets), there were statistically significant associations with intakes assessed by rPDQS, using both traffic light and numeric scoring methods. Total rPDQS scores correlated with the HEI-2015, r = 0.75 (95% confidence interval [CI] = 0.65, 0.82). CONCLUSIONS The rPDQS is a valid, brief diet quality screener that identifies clinically relevant patterns of food intake. Future research is needed to test whether the simple traffic light scoring system is an effective tool that can help non-RDN clinicians provide brief dietary counseling or make referrals to registered dietitian nutritionists, as needed.
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15
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Sugimoto S, Recker D, Halvorson EE, Skelton JA. Are Future Doctors Prepared to Address Patients' Nutritional Needs? Cooking and Nutritional Knowledge and Habits in Medical Students. Am J Lifestyle Med 2023; 17:736-745. [PMID: 38511108 PMCID: PMC10948926 DOI: 10.1177/15598276211018165] [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: 03/22/2024] Open
Abstract
Background. Many diseases are linked to lifestyle in the United States, yet physicians receive little training in nutrition. Medical students' prior knowledge of nutrition and cooking is unknown. Objective. To determine incoming medical students' prior nutrition knowledge, culinary skills, and nutrition habits. Methods. A dual-methods study of first-year medical students. Cross-sectional survey assessing prior knowledge, self-efficacy, and previous education of cooking and nutrition. Interviews of second-year medical students explored cooking and nutrition in greater depth. Results. A total of 142 first-year medical students participated; 16% had taken a nutrition course, with majority (66%) learning outside classroom settings. Students had a mean score of 87% on the Nutritional Knowledge Questionnaire versus comparison group (64.9%). Mean cooking and food skills score were lower than comparison scores. Overall, students did not meet guidelines for fiber, fruit, vegetables, and whole grains. Interviews with second-year students revealed most learned to cook from their families; all believed it important for physicians to have this knowledge. Conclusions. Medical students were knowledgeable about nutrition, but typically self-taught. They were not as confident or skilled in cooking, and mostly learned from their family. They expressed interest in learning more about nutrition and cooking.
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Affiliation(s)
- Sam Sugimoto
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Drew Recker
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Joseph A. Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
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16
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Brummel B, van Heumen C, Smits A, van den Berg M, Ezendam NPM, Pijnenborg JMA, de van der Schueren MAE, Wilkinson SA, van der Meij BS. Barriers to and facilitators of a healthy lifestyle for patients with gynecological cancer: a systematic review of qualitative and quantitative research with healthcare providers and patients. Maturitas 2023; 177:107801. [PMID: 37541112 DOI: 10.1016/j.maturitas.2023.107801] [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: 05/31/2023] [Revised: 07/12/2023] [Accepted: 07/16/2023] [Indexed: 08/06/2023]
Abstract
The prevalence of an unhealthy lifestyle among patients with gynecological cancer is high and associated with increased risk of all-cause mortality. Although lifestyle changes have the potential to improve outcomes, lifestyle counseling is not routinely integrated into standard care. This review explores research on the barriers to and facilitators of both the promotion of healthy lifestyles by healthcare providers (HCPs) and healthy lifestyle changes by patients with gynecological cancer. The Theoretical Domains Framework (TDF) was used to deductively code the identified factors for a comprehensive understanding of the barriers and facilitators. A search across five databases yielded a total of 12,687 unique studies, of which 43 were included in the review. Of these 43, 39 included gynecological cancer patients and only 6 included HCPs. Among the barriers identified for HCPs, most studies evaluated barriers regarding weight loss counseling. Limited knowledge, reluctance to address weight loss, skepticism about the benefits, and workload concerns were commonly reported barriers for HCPs. HCPs will benefit from education and training in lifestyle counseling, including effective communication skills like motivational interviewing. Gynecological cancer patients lacked tools, support, knowledge, and faced mental health issues, environmental constraints, and physical limitations. The review emphasizes the importance of addressing these barriers and utilizing identified facilitators, such as social support, to promote and support healthy lifestyle behaviors on the part of patients and their promotion by HCPs. Future research should focus not only on patients but also on supporting HCPs and implementing necessary changes in current practices.
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Affiliation(s)
- Bo Brummel
- Department of Human Nutrition and Health, Wageningen University & Research, 6708 WE Wageningen, the Netherlands; Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, 5037 AB Tilburg, the Netherlands
| | - Cindy van Heumen
- Department of Human Nutrition and Health, Wageningen University & Research, 6708 WE Wageningen, the Netherlands
| | - Anke Smits
- Department of Obstetrics & Gynecology, Radboudumc, 6525 GA Nijmegen, the Netherlands
| | - Manon van den Berg
- Department of Gastroenterology and Hepatology- Dietetics, Radboudumc, 6525 GA Nijmegen, the Netherlands
| | - Nicole P M Ezendam
- Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, 5037 AB Tilburg, the Netherlands; Netherlands Comprehensive Cancer Organisation, 5612 HZ Eindhoven, the Netherlands
| | | | - Marian A E de van der Schueren
- Department of Human Nutrition and Health, Wageningen University & Research, 6708 WE Wageningen, the Netherlands; Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, 6525 EN Nijmegen, the Netherlands
| | - Shelley A Wilkinson
- Department of Obstetric Medicine, Mater Mothers Hospital, South Brisbane 4101, Australia; Lifestyle Maternity, Brisbane, QLD 4069, Australia
| | - Barbara S van der Meij
- Department of Human Nutrition and Health, Wageningen University & Research, 6708 WE Wageningen, the Netherlands; Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, 6525 EN Nijmegen, the Netherlands; Bond University Nutrition and Dietetics Research Group, Bond University, Gold Coast, QLD 4226, Australia.
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17
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Tan X, Xie H, Wang D. Nutrition and Physical Activity Counseling by General Practitioners in China. Risk Manag Healthc Policy 2023; 16:2151-2162. [PMID: 37868022 PMCID: PMC10588712 DOI: 10.2147/rmhp.s427481] [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: 07/28/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction To reduce unhealthy lifestyles in China, it is critical to implement effective strategies. Counseling provided by physicians is important for assisting patients in improving their lifestyles, and general practitioners (GPs) are the main providers of lifestyle counseling to patients. However, few studies have focused on the lifestyle counseling practices by GPs in China, particularly in regard to nutrition and physical activity. Objective The aims of this study are: (i) to examine the current practice of Chinese GPs in counseling patients regarding nutrition and physical activity; (ii) to understand the common barriers to such counseling by Chinese GPs; and (iii) to study the association between GPs' personal lifestyle choices and their practices in lifestyle counseling. Methods A cross-sectional, self-reported online questionnaire was conducted among GPs in Hunan province, China. A total of 198 GPs completed the questionnaire. Results The majority of GPs provide nutrition and physical activity counseling to less than 40% of their patients, spending less than three minutes per counseling session. The main reported barriers to counseling on nutrition and physical activity are inadequate time and a lack of knowledge or experience. GPs primarily acquire knowledge through medical books and journals, followed by science popularization. Furthermore, GPs who maintain healthier lifestyle habits, possess a better understanding of lifestyle guidelines, conduct longer office visits, and exhibit higher self-efficacy are more likely to provide counseling to patients. Conclusion This study highlights the need for improvement in nutrition and physical activity counseling among Chinese GPs. GPs' personal nutrition and physical activity habits may measurably influence their counseling practice. We recommend that GPs themselves adopt healthier lifestyle habits to potentially improve their counseling practice. Moreover, proactive measures should be taken to assist GPs in overcoming barriers encountered with lifestyle counseling.
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Affiliation(s)
- Xian Tan
- Hengyang Medical School, University of South China, Hengyang, Hunan, People's Republic of China
- Institute for Future Sciences, University of South China, Changsha, Hunan, People's Republic of China
| | - Hebin Xie
- The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan, People's Republic of China
| | - Danling Wang
- Hengyang Medical School, University of South China, Hengyang, Hunan, People's Republic of China
- Institute for Future Sciences, University of South China, Changsha, Hunan, People's Republic of China
- The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan, People's Republic of China
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18
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Dumm M, Moll K, Helbach A, Leineweber CG, Böttrich T, Ruhtenberg CS, Polidori MC, Matthes J. Implementing nutritional medicine into medical curricula: A student-initiated course improves knowledge and attitudes. Clin Nutr ESPEN 2023; 57:181-189. [PMID: 37739654 DOI: 10.1016/j.clnesp.2023.06.043] [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: 04/11/2023] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND & AIMS Although the risks and opportunities of nutrition in health trajectories are well known, it is rarely addressed in doctors' daily routine. This is partly related to physicians' lack of confidence in their ability to provide nutritional counselling, possibly due to insufficient training in medical school. Our study aimed at assessing the status quo of nutrition in the German medical curricula and the impact of a recently implemented, student-initiated online teaching initiative on perceived competence, knowledge and attitudes. METHODS "Eat This!" was the first Germany-wide initiative for online nutritional medicine (NM) education, consisting of 11 digital lectures on nutrition basics, nutrition medicine and public health nutrition. The contact time with NM during studies as well as the effects on students' attitudes towards NM, their self-perceived competence in NM and their nutrition knowledge were assessed from October 2020 to February 2021 in a cross-sectional as well as a prospective study using online questionnaires. RESULTS Over 1500 medical students from 42 German faculties participated in the lecture series and the online survey. One hundred and twenty-two students formed a control group. Although considering the topic relevant, students rated their training in NM as insufficient, in terms of both quality and quantity. Initially, they did not feel able to counsel patients and rated their knowledge as low. However, self-ratings and the score in a 33-item multiple-choice test knowledge improved by participating in Eat This! as did their attitude towards nutrition and planetary health. No such changes were observed in the control group of 122 students not attending the course. CONCLUSION Our results show that education in NM at German medical schools is perceived insufficient despite high student interest. But even low-threshold educational options like "Eat This!" can improve students' perceived competence, knowledge, and attitudes, and thus be an efficient and cost-effective way to address related deficits.
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Affiliation(s)
- Moritz Dumm
- University Hospital Cologne, Centre of Pharmacology, Gleueler Straße 24, 50931 Cologne, Germany; University of Cologne, Faculty of Medicine, Joseph-Stelzmann-Straße 20, 50931 Cologne, Germany; Gemeinschaftskrankenhaus Havelhöhe, Department Intensive Care, First Aid & Cardiology, Kladower Damm 221, 14089 Berlin, Germany
| | - Katharina Moll
- University of Hamburg, Faculty of Medicine, Martinistraße 52, 20246 Hamburg, Germany
| | - Anna Helbach
- Institute of General Practice, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Can Gero Leineweber
- Medical Department B of Internal Medicine, Brandenburg Medical School, University Hospital Ruppin-Brandenburg, Fehrbelliner Straße 38, 16816, Germany
| | - Tim Böttrich
- University of Gießen, Faculty of Medicine, Klinikstraße 29, 35392 Gießen, Germany
| | | | - Maria Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany; Cologne Excellence Cluster on Cellular Stress-Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan Matthes
- University Hospital Cologne, Centre of Pharmacology, Gleueler Straße 24, 50931 Cologne, Germany; University of Cologne, Faculty of Medicine, Joseph-Stelzmann-Straße 20, 50931 Cologne, Germany.
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19
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Alzaben AS, Aljahdali AA, Alasousi LF, Alzaben G, Kennedy L, Alhashem A. Nutritional Knowledge, Attitudes, and Practices among Family Physician Practitioners in Gulf Countries (Bahrain, Kuwait, Saudi Arabia, and UAE). Healthcare (Basel) 2023; 11:2633. [PMID: 37830670 PMCID: PMC10572505 DOI: 10.3390/healthcare11192633] [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] [Received: 09/01/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023] Open
Abstract
Family physicians serve as pivotal points of contact within global healthcare systems. Nutrition plays a significant role in lifestyle and preventive medicine. With the rise of chronic and non-communicable diseases in Gulf Cooperation Council (GCC) countries, these physicians advise patients and the public on diet-related conditions. This descriptive cross-sectional study assessed the nutritional knowledge and practices across the GCC. Combining survey data from multiple GCC sites, a sample of family physicians was generated. Registered GCC family physicians received email invitations containing participant information, informed consent forms, and a self-administered online questionnaire. Analysis of data from four GCC countries involving 8751 family physicians and nutrition experts revealed an average nutrition knowledge score of 62%. Nearly all participants recognized the importance of nutrition in preventing and treating chronic diseases. Common nutritional practices included recommending regular exercise (92%), referring patients to dietitians for nutrition-related concerns (70%), and providing nutrition advice (68.6%). GCC family physicians underscore the significance of nutrition in preventing and managing chronic ailments. Therefore, incorporating nutritional counseling into their practices is essential. This study highlights the need to integrate nutrition education into medical curricula and ongoing professional development, given that only 62% of GCC family physicians correctly answered nutrition-related questions.
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Affiliation(s)
- Abeer S. Alzaben
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Adulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia;
| | - Abeer A. Aljahdali
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, King Abdulaziz University, P.O. Box 80215, Jeddah 21589, Saudi Arabia;
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI 48109, USA
| | - Lulua F. Alasousi
- Kuwait Family Medicine Board, Faculty of Primary Health Care, Kuwait Institute for Medical Specializations, Ministry of Health, Safat P.O. Box 1793, Kuwait;
| | - Ghadeer Alzaben
- Department of Surgery, Awali Hospital, Awali P.O. Box 2555, Bahrain;
| | - Lynne Kennedy
- Public Health and Nutrition, College of Natural and Health Sciences, Zayed University, Abu Dhabi P.O. Box 144534, United Arab Emirates;
| | - Anwar Alhashem
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Adulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia;
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20
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van Dijk ML, Te Loo LM, Vrijsen J, van den Akker-Scheek I, Westerveld S, Annema M, van Beek A, van den Berg J, Boerboom AL, Bouma A, de Bruijne M, Crasborn J, van Dongen JM, Driessen A, Eijkelenkamp K, Goelema N, Holla J, de Jong J, de Joode A, Kievit A, Klooster JV, Kruizenga H, van der Leeden M, Linders L, Marks-Vieveen J, Mulder DJ, Muller F, van Nassau F, Nauta J, Oostvogels S, Oude Sogtoen J, van der Ploeg HP, Rijnbeek P, Schouten L, Schuling R, Serné EH, Smuling S, Soeters MR, Verhagen EALM, Zwerver J, Dekker R, van Mechelen W, Jelsma JGM. LOFIT (Lifestyle front Office For Integrating lifestyle medicine in the Treatment of patients): a novel care model towards community-based options for lifestyle change-study protocol. Trials 2023; 24:114. [PMID: 36803271 PMCID: PMC9936650 DOI: 10.1186/s13063-022-06960-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/25/2022] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND A healthy lifestyle is indispensable for the prevention of noncommunicable diseases. However, lifestyle medicine is hampered by time constraints and competing priorities of treating physicians. A dedicated lifestyle front office (LFO) in secondary/tertiary care may provide an important contribution to optimize patient-centred lifestyle care and connect to lifestyle initiatives from the community. The LOFIT study aims to gain insight into the (cost-)effectiveness of the LFO. METHODS Two parallel pragmatic randomized controlled trials will be conducted for (cardio)vascular disorders (i.e. (at risk of) (cardio)vascular disease, diabetes) and musculoskeletal disorders (i.e. osteoarthritis, hip or knee prosthesis). Patients from three outpatient clinics in the Netherlands will be invited to participate in the study. Inclusion criteria are body mass index (BMI) ≥25 (kg/m2) and/or smoking. Participants will be randomly allocated to either the intervention group or a usual care control group. In total, we aim to include 552 patients, 276 in each trial divided over both treatment arms. Patients allocated to the intervention group will participate in a face-to-face motivational interviewing (MI) coaching session with a so-called lifestyle broker. The patient will be supported and guided towards suitable community-based lifestyle initiatives. A network communication platform will be used to communicate between the lifestyle broker, patient, referred community-based lifestyle initiative and/or other relevant stakeholders (e.g. general practitioner). The primary outcome measure is the adapted Fuster-BEWAT, a composite health risk and lifestyle score consisting of resting systolic and diastolic blood pressure, objectively measured physical activity and sitting time, BMI, fruit and vegetable consumption and smoking behaviour. Secondary outcomes include cardiometabolic markers, anthropometrics, health behaviours, psychological factors, patient-reported outcome measures (PROMs), cost-effectiveness measures and a mixed-method process evaluation. Data collection will be conducted at baseline, 3, 6, 9 and 12 months follow-up. DISCUSSION This study will gain insight into the (cost-)effectiveness of a novel care model in which patients under treatment in secondary or tertiary care are referred to community-based lifestyle initiatives to change their lifestyle. TRIAL REGISTRATION ISRCTN ISRCTN13046877 . Registered 21 April 2022.
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Affiliation(s)
- Marlinde L van Dijk
- Amsterdam UMC, VU University Medical Center, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, 1081BT, Amsterdam, The Netherlands.
- Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
- Health Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
- Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Leonie M Te Loo
- Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Health Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, The Netherlands
| | - Joyce Vrijsen
- Department of Orthopedics, Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Inge van den Akker-Scheek
- Department of Orthopedics, Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sanne Westerveld
- Department of Orthopedics, Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjan Annema
- Department of Orthopedics, Ommelander Hospital Groningen, Scheemda, Groningen, The Netherlands
| | - André van Beek
- Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jip van den Berg
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Alexander L Boerboom
- Department of Orthopedics, Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Adrie Bouma
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martine de Bruijne
- Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jeroen Crasborn
- Health Insurance Expertise (formerly Zilveren Kruis), Utrecht, The Netherlands
| | - Johanna M van Dongen
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Anouk Driessen
- Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Health Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Karin Eijkelenkamp
- Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nies Goelema
- Department of Orthopedics, Ommelander Hospital Groningen, Scheemda, Groningen, The Netherlands
| | - Jasmijn Holla
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, The Netherlands
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | - Johan de Jong
- Institute of Sports Studies, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Anoek de Joode
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arthur Kievit
- Department of Orthopedics, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Josine Van't Klooster
- Department of Strategy, Development and External Relations, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hinke Kruizenga
- Department of Nutrition & Dietetics, Amsterdam UMC location Vrije Universiteit, De Boelelaan, 1117, Amsterdam, The Netherlands
| | - Marike van der Leeden
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences Research Institute, Amsterdam Public Health Research Institute, Amsterdam UMC location Vrije Universiteit, Amsterdam, The Netherlands
| | - Lilian Linders
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, The Netherlands
| | - Jenny Marks-Vieveen
- Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Health Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Anesthesiology, Amsterdam UMC location Vrije Universiteit, De Boelelaan, 1117, Amsterdam, The Netherlands
| | - Douwe Johannes Mulder
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Femke van Nassau
- Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Health Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Joske Nauta
- Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Health Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | | | - Hidde P van der Ploeg
- Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Health Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | - Linda Schouten
- Team Sportservice Noord-Holland, Haarlem, The Netherlands
| | - Rhoda Schuling
- Institute of Sports Studies, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Erik H Serné
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit, De Boelelaan, 1117, Amsterdam, The Netherlands
| | - Simone Smuling
- Huis voor de Sport in Groningen, Groningen, The Netherlands
| | - Maarten R Soeters
- Department of Internal Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Evert A L M Verhagen
- Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Health Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Johannes Zwerver
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Sports Valley, Sports Medicine, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Rienk Dekker
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Willem van Mechelen
- Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Health Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Judith G M Jelsma
- Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Health Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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21
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Jih J, Nguyen A, Woo J, Tran WC, Wang A, Gonzales N, Fung J, Callejas J, Nguyen TT, Ritchie CS. A photo-based communication intervention to promote diet-related discussions among older adults with multi-morbidity. J Am Geriatr Soc 2023; 71:577-587. [PMID: 36450690 PMCID: PMC9957898 DOI: 10.1111/jgs.18145] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/13/2022] [Accepted: 10/22/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Little is known about how to best communicate with older adults about dietary behaviors and related factors in complex chronic disease care. Photo-based communication could promote efficient information exchange and activate patients to effectively communicate their lived experiences. We conducted a pilot study to assess the feasibility and acceptability of a photo-based patient-clinician communication intervention to promote dietary discussions in geriatric primary care. METHODS Older adult patients with 2+ concurrent chronic conditions received in-person training on photo-taking with a smartphone before taking photos in response to the prompt, "What aspects of your everyday life affect what you eat and how much you have to eat?" Patients then shared photos and their narratives with their primary care clinician during a clinic visit. Patients and clinicians completed separate audio-recorded post-visit interviews to assess perspectives on the intervention. Interview transcripts were analyzed using a thematic analysis approach. RESULTS Fourteen patient-clinician dyads completed the study. All except one patient-clinician dyad (93%) completed the intervention as trained. 93% of patients and 86% of clinicians reported that they would "definitely" or "probably" be willing to engage in a future visit with photo-sharing. Patients and clinicians shared similar perspectives on how sharing of photos during the visit enhanced communication and information exchange about dietary practices and other health-related factors, influenced clinical recommendations made during the visits, and strengthened the patient-clinician relationship. CONCLUSION Incorporation of a photo-based patient-clinician communication intervention to promote discussions regarding diet and other health-related factors could be a patient-centered strategy to help deliver comprehensive geriatric primary care.
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Affiliation(s)
- Jane Jih
- Division of General Internal Medicine and Multiethnic Health Equity Research Center, University of California San Francisco
- Asian American Research Center on Health, San Francisco, CA
| | - Antony Nguyen
- Division of General Internal Medicine and Multiethnic Health Equity Research Center, University of California San Francisco
- Department of Epidemiology, Columbia University Mailman School of Public Health
| | - Jasmin Woo
- Division of General Internal Medicine and Multiethnic Health Equity Research Center, University of California San Francisco
- School of Nursing, University of California San Francisco
| | - Wen-Ching Tran
- Department of Medicine, University of California Los Angeles
| | - Abby Wang
- Stanford-O’Connor Family Medicine Residency
| | - Nikko Gonzales
- Department of Medicine, University of California Los Angeles
| | - Jennifer Fung
- Division of General Internal Medicine and Multiethnic Health Equity Research Center, University of California San Francisco
| | | | - Tung T. Nguyen
- Division of General Internal Medicine and Multiethnic Health Equity Research Center, University of California San Francisco
- Asian American Research Center on Health, San Francisco, CA
| | - Christine S. Ritchie
- Division of Geriatrics and Palliative Care and Mongan Center, Massachusetts General Hospital
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22
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Helbach A, Dumm M, Moll K, Böttrich T, Leineweber CG, Mueller W, Matthes J, Polidori MC. Improvement of Dietary Habits among German Medical Students by Attending a Nationwide Online Lecture Series on Nutrition and Planetary Health ( "Eat This!"). Nutrients 2023; 15:580. [PMID: 36771284 PMCID: PMC9920441 DOI: 10.3390/nu15030580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 01/24/2023] Open
Abstract
Nutrition is a major influential factor in optimizing human health and environmental sustainability. Medical students often do not follow national dietary guideline recommendations. Raising awareness of a healthy lifestyle is important as physicians with healthy lifestyle behaviors are more likely to counsel on nutrition. Our study aims to evaluate a Germany-wide online lecture series on nutritional medicine, "Eat This!". Before and after the course, 520 medical students who participated and 64 who did not participate in the course (comparison group) filled out an online survey. To assess the students' dietary habits, a validated FFQ was used. According to this questionnaire, only 31% of the lecture participants consumed enough fruits and 24% consumed enough vegetables, while almost half of the students exceeded the recommended maximum amount of crisps and sweets. After attending the lecture series, guideline adherence with respect to fruits and vegetables showed a significant increase, as did awareness of healthy nutrition and percentage of students with low-risk lifestyle habits. Our results show that low-threshold approaches, such as "Eat This!", can positively influence the dietary behaviors and lifestyle habits of medical students. This can help future doctors fulfill their role in the fight against the global burden of non-communicable diseases.
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Affiliation(s)
- Anna Helbach
- Department II of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
- Institute of General Practice, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
| | - Moritz Dumm
- Center of Pharmacology, Faculty of Medicine, University Hospital of Cologne, University of Cologne, 50931 Cologne, Germany
| | - Katharina Moll
- Faculty of Medicine, University Clinic Hamburg Eppendorf, 20251 Hamburg, Germany
| | - Tim Böttrich
- Faculty of Medicine, University of Gießen, 35392 Gießen, Germany
| | - Can Gero Leineweber
- Medical Department B of Internal Medicine, Brandenburg Medical School, University Hospital Ruppin-Brandenburg, 16816 Neuruppin, Germany
| | - Wiebke Mueller
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
| | - Jan Matthes
- Center of Pharmacology, Faculty of Medicine, University Hospital of Cologne, University of Cologne, 50931 Cologne, Germany
| | - Maria Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress-Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany
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23
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Ferguson CC, Jung SE, Lawrence JC, Douglas JW, Halli-Tierney A, Bui C, Ellis AC. A Qualitative Analysis of Experiences With Food-Related Activities Among People Living With Parkinson Disease and Their Care-Partners. J Appl Gerontol 2023; 42:131-140. [PMID: 36062816 DOI: 10.1177/07334648221118358] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objectives: The purpose of this qualitative study was to explore factors associated with the ability of people with PD to perform food-related activities (FRAs). Methods: Eleven dyads, older adults with Parkinson disease (PD) and their care-partners (n = 22), completed virtual semi-structured interviews guided by the Social Cognitive Theory (SCT) that were independently analyzed by two coders via directed content analysis. Results: The following themes were identified-(1) Personal: perception of a healthy diet, perception of how nutrition influences PD, confidence in following a healthy diet, and barriers to performing FRA; (2) Environmental: previous sources of nutrition information and willingness to changing their diet with a registered dietitian; and (3) Behavioral: modifications to FRA due to food-medication interactions, and skills necessary to maintain a healthy diet. Discussion: Findings from this study highlight the need for nutrition intervention research to inform evidence-based guidelines in order to provide tailored education for people with PD and care-partners.
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Affiliation(s)
- Christine C Ferguson
- Department of Human Nutrition and Hospitality Management, 8063The University of Alabama, Tuscaloosa, AL, USA.,UAB/Lakeshore Research Collaborative, School of Health Professions, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Seung Eun Jung
- Department of Human Nutrition and Hospitality Management, 8063The University of Alabama, Tuscaloosa, AL, USA
| | - Jeannine C Lawrence
- Department of Human Nutrition and Hospitality Management, 8063The University of Alabama, Tuscaloosa, AL, USA
| | - Joy W Douglas
- Department of Human Nutrition and Hospitality Management, 8063The University of Alabama, Tuscaloosa, AL, USA
| | - Anne Halli-Tierney
- Department of Family, Internal, and Rural Medicine, 8063The University of Alabama, Box 870326, Tuscaloosa, AL, USA
| | - Chuong Bui
- Alabama Life Research Institute, 8063The University of Alabama, Tuscaloosa, AL, USA
| | - Amy C Ellis
- Department of Human Nutrition and Hospitality Management, 8063The University of Alabama, Tuscaloosa, AL, USA
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24
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Angotti AA, Silva JGSTD, Martins PA. Knowledge of health professionals about vegetarian diets: integrative review. REVISTA CIÊNCIAS EM SAÚDE 2022. [DOI: 10.21876/rcshci.v12i4.1278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective: To assess studies on the knowledge of health professionals regarding vegetarian diets. Methods: This integrative review was conducted from November to December 2020 and updated in January 2022 in 5 databases and the gray literature. Two investigators performed the article selection. The inclusion criteria were scientific articles with any study design that addressed the intended topic with no date or language limitation. Results: Eleven studies were included. The main common finding was that health professionals, except dietitians, were not satisfied with the available nutritional information in general, not only regarding vegetarian diets. Despite this gap, half of the studies showed a positive view by professionals concerning the vegetarian diet.Conclusions: Many professionals do not feel confident about encouraging a vegetarian diet since they do not know the details of its benefits and risks.
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25
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Vrkatić A, Grujičić M, Jovičić-Bata J, Novaković B. Nutritional Knowledge, Confidence, Attitudes towards Nutritional Care and Nutrition Counselling Practice among General Practitioners. Healthcare (Basel) 2022; 10:2222. [PMID: 36360563 PMCID: PMC9691229 DOI: 10.3390/healthcare10112222] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/30/2022] [Accepted: 11/03/2022] [Indexed: 08/04/2023] Open
Abstract
Nutritional care represents any practice provided by a health professional, aimed to improve the patient's health outcomes by influencing patient's dietary habits. Clearly, dietitians are the ones supposed to provide top-quality nutrition care, but their services are often inaccessible to many for various reasons. This obliges general practitioners (GPs) in primary health care to provide nutritional counselling to their patients to a certain extent. Preconditions to successful nutritional counselling are GPs with adequate nutritional knowledge, positive attitudes towards nutrition and nutritional care, self-confident and competent in nutritional counselling. Therefore, the aim of this review is to summarise currently available information on nutritional knowledge, confidence and attitudes towards nutritional care and nutrition counselling practice of GPs, as well as barriers towards provision of nutritional counselling. GPs do not consistently obtain satisfying results in nutrition knowledge assessments and their self-confidence in nutrition counselling skills varies. Studies suggest that nutritional counselling practice still has not met its full potential, and GPs frequently report various barriers that impair nutritional counselling practice. Thus, health policies that help overcome barriers and create stimulating environment for GPs to implement nutrition counselling strategies efficiently are the key to improving quality and quantity of nutritional counselling.
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Affiliation(s)
- Aleksandra Vrkatić
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
| | - Maja Grujičić
- Department of General Education Subjects, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
| | - Jelena Jovičić-Bata
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
| | - Budimka Novaković
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
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26
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Williams AR, Hines AL, Dow AW, Sabo RT, Thomson MD. Are primary care providers' nutrition care and food insecurity screening practices associated with their perceptions of team-based care? Fam Pract 2022; 39:860-867. [PMID: 35325099 DOI: 10.1093/fampra/cmac017] [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] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Screening for food insecurity (FI) and providing nutrition care are important management strategies for chronic diseases, but rates are low. Aspects of team-based care and providers' nutrition competence may help inform interventions to improve these services. The objectives of this study were to describe US primary care providers' FI screening and nutrition care practices (counselling, referrals, and time spent counselling) and test for associations with scored measures of their perceptions of team-based care (care continuity, patient-centredness, coordination with external providers and resources) and nutrition competence (confidence counselling and attitudes towards nutrition). METHODS Cross-sectional online survey data of primary care providers were described and analysed for associations using Wilcoxon rank sum tests. RESULTS Of provider respondents (N = 92), 35% (n = 32) worked in clinics that screen for FI and had higher team perceptions (P = 0.006) versus those who do not. Those who reported counselling >30% patients about nutrition (57%, n = 52) and referring >10% patients to nutrition professionals (24%, n = 22) had significantly better attitudes towards nutrition (P = 0.013 and P = 0.04, respectively) compared with those with lower counselling and referral rates. Half (n = 46) of the providers reported spending >3-min counselling each patient about nutrition and had higher patient-centred care (P = 0.004) and nutrition competence (P < 0.001) compared with those who spent less time counselling. CONCLUSION Providers in clinics that screen for FI had higher overall perceptions of team-based care, but their nutrition competence was not significantly different. Meanwhile, reported more time counselling was associated with a culture of patient-centredness. Promoting team-based care may be a mechanism for improving FI screening and nutrition care.
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Affiliation(s)
- April R Williams
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
| | - Anika L Hines
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
| | - Alan W Dow
- School of Medicine, IPE Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Roy T Sabo
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA.,C. Kenneth and Dianne Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Maria D Thomson
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
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27
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Calandra JM, Shofer FS, Chao AM, Swanson RL. Nutrition Education, Understanding, and Counseling Practices Among Physiatrists: A Survey Study. Cureus 2022; 14:e28756. [PMID: 36211094 PMCID: PMC9531699 DOI: 10.7759/cureus.28756] [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] [Accepted: 09/02/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Nutritional counseling is relevant to physiatry practice. However, physiatrists' nutrition knowledge base and their frequency of incorporating nutritional education into routine clinical encounters are currently unknown. The objective of this study was to assess physiatrists' nutrition education, nutrition knowledge, willingness to implement nutrition counseling in clinical practice, and perceived barriers to providing nutritional counseling to patients, using an online survey. The hypothesis was that few physiatrists offer dietary counseling to their patients on a routine basis and that barriers likely include time constraints in a typical office visit, lack of provider confidence in providing dietary recommendations, and lack of provider reimbursement. METHODS This study was a cross-sectional online survey that was distributed via email to a convenience sample of 179 resident, fellow, and attending physiatrists associated with two major academic institutions. The survey consisted of 26 questions regarding demographics, nutrition counseling practices and attitudes, basic nutrition knowledge, and perceived barriers to providing nutrition counseling. RESULTS Of 59 participants, 78% reported receiving education in nutrition and/or behavioral counseling in medical school. In contrast, 39% of participants did not feel adequately trained to discuss nutrition and diet-related issues with patients. Barriers to providing nutritional counseling were time constraints (83%), socioeconomic factors outside of patients' control preventing them from adhering to a healthier diet (76%), and not having enough nutrition knowledge to do so appropriately (62%). Respondents (86%) either agreed or strongly agreed that additional training in nutrition would allow them to provide better clinical care in the prevention of progressive cardiovascular and neurovascular disease. Further, respondents (85%) either agreed or strongly agreed that they would be interested in a web-based continuing medical education training in nutrition behavioral counseling and evidence-based dietary recommendations. CONCLUSIONS The findings refuted the hypothesis that few physiatrists in the sample offer dietary counseling to their patients on a routine basis. Results demonstrated that many of them acknowledge its relevance and would be interested in further education on the subject. Physiatrists also appear to have perceived barriers to offering nutritional counseling, but some of them varied by the amount of medical experience. Based on these findings, this study demonstrated that it would be worthwhile to develop such a continuing medical education activity with a focus on populations commonly treated by physiatrists.
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Affiliation(s)
- Jessica M Calandra
- Physical Medicine and Rehabilitation, MossRehab, Albert Einstein Healthcare Network, Elkins Park, USA
- Physical Medicine and Rehabilitation, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Frances S Shofer
- Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
- Physical Medicine and Rehabilitation, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Ariana M Chao
- Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, USA
- Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Randel L Swanson
- Center for Neurotrauma, Neurodegeneration and Restoration, Cpl. Michael J. Crescenz VA Medical Center, Philadelphia, USA
- Physical Medicine and Rehabilitation, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
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28
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Ng CH, Lim WH, Chin YH, Yong JN, Zeng RW, Chan KE, Tan DJH, Fu CE, Tang ASP, Goh LH, Devi K, Chew NWS, Mak LYL, Tamaki N, Huang DQ, Noureddin M, Siddiqui MS, Loomba R, Sanyal AJ, Muthiah M. Living in the non-alcoholic fatty liver disease silent epidemic: a qualitative systematic review of patients' perspectives. Aliment Pharmacol Ther 2022; 56:570-579. [PMID: 35791632 DOI: 10.1111/apt.17121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/04/2022] [Accepted: 06/22/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) affects one-fourth of the global population. Yet, the care of these patients is limited and awareness of NAFLD remains low in the general public. Investigations into the lives of these patients are often forgotten and traditional quantitative studies only paint part of the picture. AIM To assess the first-hand accounts of these individuals and their perspective on living with NAFLD. METHODS A systematic search was conducted on Medline, Embase, CINAHL, PsycINFO and Web of Science database for qualitative literature regarding patients' perspectives on NAFLD. An inductive thematic analysis was conducted to generate themes and supportive subthemes. RESULTS We incuded eight articles in the review. There were three major themes including the impact on the quality of life, knowledge and information, and attitudes and perceptions on care. The impact of the quality of life details the emotional and physical distress of NAFLD. Knowledge and information include the lack of sufficient communication between healthcare providers and patients with a distinct knowledge gap. Attitudes and perceptions on care extrapolate the current active participation of patients and needs of the patients and the future care that they desire. CONCLUSION This review synthesises first-hand accounts of individuals with NAFLD. With the growing burden of NAFLD, future public interventions must consider individual views for success to be found. The identified themes serve as a forefront for consideration for public policies. Ultimately, NAFLD is a multisystem disease, which must be managed by a multidisciplinary team.
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Affiliation(s)
- Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jie Ning Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Kai En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Clarissa Elysia Fu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ansel Shao Pin Tang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lay Hoon Goh
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kamala Devi
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas W S Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre, National University Hospital, Singapore
| | - Lung-Yi Loey Mak
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Nobuharu Tamaki
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, San Diego, California, USA.,Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Mazen Noureddin
- Cedars-Sinai Fatty Liver Program, Division of Digestive and Liver Diseases, Department of Medicine, Comprehensive Transplant Center, Cedars-Sinai Medical Centre, Los Angeles, California, USA
| | - Mohammad Shadab Siddiqui
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, San Diego, California, USA
| | - Arun J Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore
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29
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Healthy Food, Healthy Teeth: A Formative Study to Assess Knowledge of Foods for Oral Health in Children and Adults. Nutrients 2022; 14:nu14142984. [PMID: 35889941 PMCID: PMC9319718 DOI: 10.3390/nu14142984] [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: 05/20/2022] [Revised: 07/10/2022] [Accepted: 07/16/2022] [Indexed: 12/10/2022] Open
Abstract
Eating patterns characterised by low intakes of processed carbohydrates and higher intakes of fat- and Vitamin D-rich foods are associated with protection against dental caries. The aim of this formative study was to evaluate the extent to which the knowledge of children and adults of foods for oral health reflects dietary guideline advice, and the evidence base for foods associated with increased and decreased caries burdens. Using a novel card-sorting task, the participants categorised foods according to their knowledge of each food for oral health. There were no differences between children and adults in the categorisation of fresh, minimally processed foods. Fish, chicken, and red meat were categorised as healthy by significantly fewer children than adults. High-sugar foods were correctly characterised as unhealthy by nearly all participants. More children categorised breakfast cereals as healthy than adults. There were no statistically significant differences between children and adults for the categorisation of brown or wholegrain breads categorised as healthy. The alignment of the participants’ beliefs with dietary guideline recommendations suggests education through health promotion initiatives is successful in achieving knowledge acquisition in children and adults. However, recommendations to increase the intake of refined carbohydrates inadvertently advocate foods associated with increased caries burdens.
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McLeod MR, Chionis L, Gregg B, Gianchandani R, Wolfson JA. Knowledge and attitudes of lower Michigan primary care physicians towards dietary interventions: A cross-sectional survey. Prev Med Rep 2022; 27:101793. [PMID: 35656221 PMCID: PMC9152810 DOI: 10.1016/j.pmedr.2022.101793] [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: 10/14/2021] [Revised: 04/01/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022] Open
Abstract
Physicians rarely counsel patients about dietary interventions despite the proven efficacy of such interventions. Physicians both over- and under-estimated their knowledge on different dietary interventions. >90% of participating physicians expressed interest in continuing education on dietary interventions.
Background Dietary interventions are first-line therapies for the prevention and management of many chronic diseases, yet primary care physicians prescribe these interventions infrequently. Objectives This study investigates primary care physicians’ current knowledge and opinions regarding the delivery of dietary interventions. This work aims to identify modifiable barriers to prescribing dietary interventions to prevent and treat diet-related diseases. Methods We designed and fielded an anonymous, cross-sectional survey of faculty and resident physicians across the Internal Medicine, Family Medicine, and Pediatrics departments in three academic and community hospitals in lower Michigan. Data were collected between January 15 and April 15, 2019. Self-rated knowledge and attitudes were measured on a 5-point Likert scale. Objective scores were calculated for each question as percentage answered correctly among all respondents. Objective knowledge scores were compared based on participants’ years in practice. Results Response rate was 23% (356 responses). The sample was 62.3% female and 75.3% non-Hispanic White, and 56.7% were age 40 or younger. Average objective knowledge score was 70.3% (±17.2) correct. Mean self-rated knowledge score was 2.51 (±0.96) on a scale of 1(Poor) − 5(Excellent). Overall agreement with a statement of importance of dietary interventions was 3.99 (±0.40) on a scale of 1 (strongly disagree) to 5 (strongly agree). A majority (91.7%) of respondents indicated they would like more opportunities to learn about the evidence supporting dietary interventions. Conclusions Physicians desire to incorporate dietary interventions into their practice. Findings encourage the development of educational strategies to support dietary intervention use among primary care physicians.
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Recognising undernutrition in a community hospital: the nursing judgement is insufficient. Eur J Clin Nutr 2022; 76:1611-1614. [PMID: 35444266 PMCID: PMC9019789 DOI: 10.1038/s41430-022-01145-y] [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: 02/06/2022] [Revised: 04/03/2022] [Accepted: 04/06/2022] [Indexed: 12/01/2022]
Abstract
Introduction Standardised nutritional screening methods improve the rate of recognising older patients with undernutrition, which is strongly encouraged in hospitals and residential settings. Therefore, our study compared the rates of identifying undernutrition before and after introducing the Mini Nutritional Assessment (MNA®) in a community hospital. Methods This was a single-centre, retrospective, observational before–after study. Participants were subjects aged 65 years or older, admitted to a community hospital from May 2018 to December 2020. The nursing assessment at admission included the MNA® from January 2020. The prevalence of undernutrition gathered by nursing diagnoses from 2018 to 2019 was compared with data obtained using the MNA® in 2020. Then, a confirmatory analysis was conducted to compare the prevalence of undernutrition in 2020 when both nursing diagnoses and the MNA® were used. Results We analysed data of approximately 316 patients (238 before and 78 after introducing the MNA®). Overall, results showed that 47.1% (n = 149) of the patients were undernourished. As observed, the prevalence of undernutrition was 38.6% (n = 92) in 2018–2019 and 73.1% (n = 57) in 2020 (p < 0.001). In 2020, however, 38.5% of patients (n = 30) were identified as undernourished using the MNA® but not using nursing diagnoses. Therefore, the correlation between these two methods was poor (Pearson’s correlation 0.169, p = 0.14). Conclusion Identifying elderly patients with undernutrition significantly increased after introducing the MNA®. Undernutrition is a common condition that should be systematically screened using a validated tool to activate personalised nutritional interventions promptly.
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Practical Tools for Assessing Diet Quality in Clinical Settings. CURRENT CARDIOVASCULAR RISK REPORTS 2021. [DOI: 10.1007/s12170-021-00677-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Johnston EA, Arcot A, Meengs J, Dreibelbis TD, Kris-Etherton PM, Wiedemer JP. Culinary Medicine for Family Medicine Residents. MEDICAL SCIENCE EDUCATOR 2021; 31:1015-1018. [PMID: 34457944 PMCID: PMC8368964 DOI: 10.1007/s40670-021-01283-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 06/02/2023]
Abstract
BACKGROUND Physicians are inadequately trained to effectively provide lifestyle counseling to manage the obesity epidemic. ACTIVITY Family and community medicine residents participated in a culinary medicine course taught by two Registered Dietitian Nutritionists (RDNs) in University Park, PA, in March 2020. RESULTS All residents (n = 13) reported increased knowledge, 92% (n = 12) reported increased confidence, and 84.6% (n = 11) reported they intended to make changes to their practice based on the class. Most participating residents (85%, n = 11) would attend follow-up classes. DISCUSSION Residents recognized the importance of nutrition in clinical care and found the information to be applicable to practice.
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Affiliation(s)
- Emily A. Johnston
- Department of Nutritional Sciences, Penn State University, University Park, PA USA
| | - Amrita Arcot
- Department of Nutritional Sciences, Penn State University, University Park, PA USA
| | - Jennifer Meengs
- Department of Nutritional Sciences, Penn State University, University Park, PA USA
| | | | | | - Joseph P. Wiedemer
- Penn State Family and Community Medicine Residency at Mount Nittany Medical Center, State College, PA USA
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Motivations Behind Lifestyle Changes. Am J Lifestyle Med 2021. [DOI: 10.1177/15598276211015137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Lifestyle modification has been demonstrated as a powerful tool in combating the morbidity and mortality of disease. Due to lack of training or education not enough physicians are discussing lifestyle changes with patients. The objective of this study was to determine what influenced participants to make lifestyle changes, and if it was a physician, what was said or done to motivate that decision. Inclusion criterion was participants were enrolled in a program dedicated to dietary modifications. One hundred participants were surveyed. Eighty-eight percent were over the age of 50; 78% were female; 92% were White; and 70% had a bachelor’s degree or higher. Sixty-eight percent felt they had not been educated by their health care provider about nutrition; 41% of participants felt information provided was the most impactful statement; 60% of participants noted that their medical diagnosis had a moderate to significant impact on their decision to make a lifestyle change. This study emphasizes that dietary modifications are not being discussed enough to alter the health decisions of patients in the clinical setting. Furthermore, it is paramount physicians take into account patient motivations when discussing lifestyle changes, as well as the role that proper patient education plays in motivating patients to make a change.
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Vadiveloo M, Lichtenstein AH, Anderson C, Aspry K, Foraker R, Griggs S, Hayman LL, Johnston E, Stone NJ, Thorndike AN. Rapid Diet Assessment Screening Tools for Cardiovascular Disease Risk Reduction Across Healthcare Settings: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes 2020; 13:e000094. [PMID: 32762254 DOI: 10.1161/hcq.0000000000000094] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is critical that diet quality be assessed and discussed at the point of care with clinicians and other members of the healthcare team to reduce the incidence and improve the management of diet-related chronic disease, especially cardiovascular disease. Dietary screening or counseling is not usually a component of routine medical visits. Moreover, numerous barriers exist to the implementation of screening and counseling, including lack of training and knowledge, lack of time, sense of futility, lack of reimbursement, competing demands during the visit, and absence of validated rapid diet screener tools with coupled clinical decision support to identify actionable modifications for improvement. With more widespread use of electronic health records, there is an enormous unmet opportunity to provide evidence-based clinician-delivered dietary guidance using rapid diet screener tools that must be addressed. In this scientific statement from the American Heart Association, we provide rationale for the widespread adoption of rapid diet screener tools in primary care and relevant specialty care prevention settings, discuss the theory- and practice-based criteria of a rapid diet screener tool that supports valid and feasible diet assessment and counseling in clinical settings, review existing tools, and discuss opportunities and challenges for integrating a rapid diet screener tool into clinician workflows through the electronic health record.
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Rashid A. Yonder: Parkinson's disease, dietary education, antipsychotic medications, and genomic results. Br J Gen Pract 2019; 69:566. [PMID: 31672821 PMCID: PMC6808565 DOI: 10.3399/bjgp19x706397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Johnston E, Mathews T, Aspry K, Aggarwal M, Gianos E. Strategies to Fill the Gaps in Nutrition Education for Health Professionals through Continuing Medical Education. Curr Atheroscler Rep 2019; 21:13. [PMID: 30820681 DOI: 10.1007/s11883-019-0775-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW Recent studies have documented that diet quality in the US is poor and linked to higher rates of cardiovascular disease (CVD), other non-communicable diseases, and total mortality. As a result, nutrition counseling in clinical practice is an evidence-based strategy endorsed by numerous stakeholders. However, medical nutrition education (MNE) in the US has been inadequate, and physician knowledge, competencies, and practices related to diet counseling have been documented to be insufficient. National scientific meetings and conferences offer opportunities to translate new scientific evidence, guidelines, and competencies to clinicians in attendance and to publicize this evidence widely. This review assessed the adequacy of, and trends in, nutrition education provided at recent major US scientific meetings that offer continuing medical education (CME), with a focus on CVD-related conferences. RECENT FINDINGS The authors found no reviews that have assessed the scope and type of nutrition-related educational programming at major conferences. We therefore investigated nutrition-related programming at CVD-related CME conferences in the US from 2013 to 2018. National scientific CVD-related conferences in the USA have offered variable amounts of programming related to practical applications of nutrition science. We did not observe an increase in nutrition-related offerings, despite the increase in diet-related diseases and the growing evidence base for the role of nutrition in the prevention and management of chronic disease. Increasing nutrition-related CME programming at national scientific meetings can lead to greater translation of nutrition evidence to patients by healthcare providers and improved health outcomes in the population.
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Affiliation(s)
- Emily Johnston
- Department of Nutritional Sciences, Penn State University, University Park, PA, 16802, USA.
| | - Tony Mathews
- NYU Langone Health, NYU School of Medicine, New York, NY, 10016, USA
| | - Karen Aspry
- Alpert Medical School, and Lifespan Cardiovascular Institute, Brown University, Providence, RI, USA
| | - Monica Aggarwal
- Division of Cardiology, University of Florida, Gainesville, FL, USA
| | - Eugenia Gianos
- Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY, 10075, USA
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