A review of primary healthcare practitioners' views about nutrition: implications for medical education

Dietary Modification Combined with Nutrition Education and Counseling for Metabolic Comorbidities in Multiple Sclerosis: Implications for Clinical Practice and Research

PURPOSE OF REVIEW

Metabolic comorbidities such as obesity, diabetes, hypertension, and dyslipidemia are common to multiple sclerosis (MS) and are associated with negative outcomes of the disease. Dietary intervention has the potential to improve MS co-morbidities; thus, it is a high priority for people living with MS to self-manage their disease. The present review aimed to summarize the recent evidence on the impacts of combining dietary modification with nutrition education and counseling on managing metabolic comorbidity markers in MS.

RECENT FINDINGS

Evidence suggests important roles for tailored dietary change strategies and nutrition education and counseling in managing metabolic comorbidities for MS. There is also indirect evidence suggesting a relationship between dietary fiber, the gut microbiome, and improved metabolic markers in MS, highlighting the need for more research in this area. For people living with MS, addressing both barriers and facilitators to dietary changes through behavior change techniques can help them achieve sustainable and tailored dietary behavior changes. This will support person-centered care, ultimately improving metabolic comorbidity outcomes. Metabolic comorbidities in MS are considered modifiable diseases that can be prevented and managed by changes in dietary behavior. However, the impact of targeted dietary interventions on mitigating MS-related metabolic comorbidities remains inadequately explored. Therefore, this review has provided insights into recommendations to inform future best practices in MS. Further well-designed studies based on tailored dietary strategies applying behavior change theories are needed to address the underlying determinants of dietary practice in this population.

Self-Perceived Nutritional Competency of Primary Healthcare Physicians in Qassim, Saudi Arabia

INTRODUCTION

Overnutrition plays a vital role in the development of a spectrum of non-communicable diseases. Diet-related disorders have a huge impact on personal health as well as the country's economy for the management of such disorders. The study aims to assess the primary healthcare physicians' nutrition competency, which will be beneficial for evaluating the current situation and future strategies, training, nutrition care, and disease prevention.

METHODOLOGY

Among 147 primary healthcare physicians by simple random sampling from four cities and two rural areas of Qassim, Saudi Arabia, from December 2022 to December 2023 using a validated (NUTCOMP) tool. Data were entered, cleaned, and analyzed with SPSS software version 21.0 (IBM Corp., Armonk, NY). Informed consent was obtained from all study participants. Chi-square and ANOVA tests were applied to draw the significant differences.

RESULTS

A total of 147 participants enrolled in this study, and the mean age and standard deviation (SD) of the study population were 34.38 ± 6.57. More than half of the physicians (n = 76, 51.7%) continued education on nutrition. Significant mean differences were observed between some and focused nutrition content received physicians versus no nutrition content received physicians concerning nutrition skill, communication, and nutrition attitude consecutively (P < 0.0001, P < 0.0001, and P < 0.0001). The mean nutrition knowledge, skill, communication, attitude score, and SD of PHCC physicians were 26.91 ± 5.42 (maximum 35), 31.19 ± 6.18 (maximum 40), 36.73 ± 7.48 (maximum 45), and 34.74 ± 6.23 (maximum 40), respectively.

CONCLUSIONS

Our study results show primary healthcare physicians perceive themselves to have good nutritional competency.

Exploring Lifestyle and Dietary Patterns in Pregnancy and Their Impact on Health: A Comparative Analysis of Two Distinct Groups 10 Years Apart

The significance of dietary patterns during pregnancy is highlighted by accumulating evidence, emphasizing their pivotal role in promoting a healthy pregnancy for both the mother and the child. This study aimed to assess the current dietary patterns of pregnant women, compare the energy and nutrient intake of two distinct groups with a 10-year interval, and identify changes in dietary patterns. EPIC FFQ was applied, and its data were interpreted with the FETA program version 6 (CAMB/PQ/6/1205). By means of principal component analysis, three different food patterns were identified in each study group: vegetarian, balanced, and traditional (2013); and prudent, vegetarian, and modern (2023). Analyzing the relationship between food groups and gestational weight, we found that gestational weight gain in 2013 was positively correlated with eggs and egg dishes and milk and milk products, whereas in 2023, gestational weight gain was positively correlated with fats and oils, non-alcoholic beverages, and the modern pattern. Additionally, in 2023, pre-gestational BMI correlated positively with eggs and egg dishes. The balanced pattern emerged as a predictor for a lower likelihood of inadequate gestational weight gain in both groups. Furthermore, normal and overweight pregnant women showed a reduced likelihood of excessive gestational weight gain.

Do Primary Health Professionals in Brazil Have a Misperception about Food? The Role of Food Literacy as a Positive Predictor

Risk perception is socially constructed; psychological elements control people's reactions to a hazard, and even health professionals may have difficulty determining what healthy food is. This work aimed to measure food literacy and food risk perceptions among primary healthcare professionals in a Brazilian city. In the first phase, 280 health professionals working in primary care in Rio Claro, Brazil, were studied. The Short Food Literacy Questionnaire (SFLQ-Br) and scales of risk and benefit perception of 50 foods were used. In the second phase, 20 professionals were interviewed to investigate the responses to different foods observed in the first phase. In this second phase, 16 users of the health system were also enrolled to understand their perceptions and how the nutrition messages conveyed by the health team reached them. Professionals scored an average of 34.5 on food literacy (for which there is a maximum score of 52). They showed difficulty with dietary guidelines and their interpretation. Food's risk and benefit perception were generally consistent with the recommendations of the Food Guide for the Brazilian Population. However, some processed foods or those with no proven health benefits were considered healthy by the study participants, indicating a biased perception (e.g., gelatin, processed turkey breast, cream crackers, and cereal bars). Less misperception was observed when food literacy was higher, which positively predicted risk perception. The reasons for identifying benefits of these foods ranged from the false impression that they are natural and nutritious foods to the comparative claim that they are better for health than similar foods. The results indicate the need to educate health professionals based on current references to avoid bias in population counseling.

Standard Patient History Can Be Augmented Using Ethnographic Foodlife Questions

The relationship between what and how individuals eat and their overall and long-term health is non-controversial. However, for decades, food and nutrition discussions have often been highly medicalized. Given the significant impact of poor nutrition on health, broader discussions about food should be integrated into routine patient history taking. We advocate for an expansion of the current, standard approach to patient history taking in order to include questions regarding patients' 'foodlife' (total relationship to food) as a screening and baseline assessment tool for referrals. We propose that healthcare providers: (1) routinely engage with patients about their relationship to food, and (2) recognize that such dialogues extend beyond nutrition and lifestyle questions. Mirroring other recent revisions to medical history taking-such as exploring biopsychosocial risks-questions about food relationships and motivators of eating may be essential for optimal patient assessment and referrals. We draw on the novel tools of 'foodlife' ethnography (developed by co-author ethnographer J.J.L., and further refined in collaboration with the co-authors who contributed their clinical experiences as a former primary care physician (D.M.E.), registered dietitian (J.W.M.), and diabetologist (H.Z.)) to model a set of baseline questions for inclusion in routine clinical settings. Importantly, this broader cultural approach seeks to augment and enhance current food intake discussions used by registered dietitian nutritionists, endocrinologists, internists, and medical primary care providers for better baseline assessments and referrals. By bringing the significance of food into the domain of routine medical interviewing practices by a range of health professionals, we theorize that this approach can set a strong foundation of trust between patients and healthcare professionals, underscoring food's vital role in patient-centered care.

Defining and supporting a professional role for pharmacists associated with traditional and complementary medicines: a cross-country survey of pharmacists

Introduction: An estimated 80% of the world's population use traditional and complementary medicine (T&CM) products as part of their healthcare, with many accessed through pharmacy. This cross-cultural study posed a set of professional practice responsibilities and actions to pharmacists related to T&CM products, with a view toward developing consensus, safeguarding, and promoting the health of the public. Methods: Data were collected from 2,810 pharmacists across nine countries during 2022 via a cross-sectional online survey reported in accordance with the guidelines of STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) and the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Results: Of the 2,810 participants from nine countries, 2,341 completed all sections of the survey. Of these, most agreed (69%) that T&CM product use was common in the community they served, but most did not have adequate training to support consumer needs. Over 75% acknowledged that there were known and unknown safety risks associated with T&CM use. Of 18 professional responsibilities posed, 92% agreed that pharmacists should be able to inform consumers about potential risks, including T&CM side effects and drug-herb interactions. The provision of accurate scientific information on the effectiveness of T&CM products, skills to guide consumers in making informed decisions, and communication with other healthcare professionals to support appropriate and safe T&CM product use were all ranked with high levels of agreement. In order to effectively fulfill these responsibilities, pharmacists agreed that regulatory reforms, development of T&CM education and training, and access to quality products supported by high-quality evidence were needed. Conclusion: General agreement from across nine countries on eighteen professional responsibilities and several stakeholder actions serve as a foundation for the discussion and development of international T&CM guidelines for pharmacists.

Nutritional Knowledge, Confidence, Attitudes towards Nutritional Care and Nutrition Counselling Practice among General Practitioners

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.