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Albin JL, Thomas OW, Marvasti FF, Reilly JM. There and Back Again: A Forty-Year Perspective on Physician Nutrition Education. Adv Nutr 2024:100230. [PMID: 38705195 DOI: 10.1016/j.advnut.2024.100230] [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: 02/05/2024] [Revised: 03/12/2024] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
Medical education faces an urgent need for evidence-based physician nutrition education. Since the publication of the 1985 National Academies report "Nutrition Education in the United States Medical Schools," little has changed. Although several key efforts sought to increase nutrition content in undergraduate medical education over the past 40 y, most medical schools still fail to include the recommended minimum of 25 h of nutrition training. Without foundational concepts of nutrition in undergraduate medical education, graduate medical education unsurprisingly falls short of meeting patient needs for nutritional guidance in clinical practice. Meanwhile, diet-sensitive chronic diseases continue to escalate, although largely preventable and treatable by nutritional therapies and dietary lifestyle changes. Fortunately, recent recognition and adoption of Food is Medicine programs across the country increasingly connect patients with healthy food resources and nutrition education as core to their medical care, and physicians must be equipped to lead these efforts alongside their dietitian colleagues. Filling the gap in nutrition training will require an innovative and interprofessional approach that pairs nutrition with personal wellness, interprofessional practice, and community service learning. The intersectional benefits of connecting these domains will help prepare future physicians to address the social, behavioral, and lifestyle determinants of health in a way that recognizes nourishing food access as a core part of clinical practice. There are numerous strategies to integrate nutrition into education pathways, including didactic and experiential learning. Culinary medicine, an evidence-based field combining the culinary arts with nutritional science and medicine, is 1 promising educational framework with a hands-on, interprofessional approach that emphasizes community engagement. Advancing the critical need for widespread adoption of nutrition education for physicians will require support and engagement across societal stakeholders, including co-leadership from registered dietitian nutritionists, health system and payor reform, and opportunities for clinical innovation that bring this essential field to frontline patient care.
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Affiliation(s)
- Jaclyn Lewis Albin
- Departments of Internal Medicine and Pediatrics, the University of Texas Southwestern Medical Center, Dallas, TX, United States.
| | | | - Farshad Fani Marvasti
- Department of Family, Community, and Preventive Medicine, University of Arizona College of Medicine-Phoenix and School of Nutritional Sciences and Wellness, College of Agricultural, Life and Environmental Sciences, University of Arizona, Tucson, AZ, United States
| | - Jo Marie Reilly
- Clinical Family Medicine and Population and Public Health, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
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2
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Charles JA, Habibullah NK, Bautista S, Davis B, Joshi S, Hull SC. Planting the Seed for Blood Pressure Control: The Role of Plant-Based Nutrition in the Management of Hypertension. Curr Cardiol Rep 2024; 26:121-134. [PMID: 38526748 PMCID: PMC10990999 DOI: 10.1007/s11886-023-02008-z] [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] [Accepted: 11/26/2023] [Indexed: 03/27/2024]
Abstract
PURPOSE OF REVIEW Hypertension results in significant morbidity, mortality, and healthcare expenditures. Fortunately, it is largely preventable and treatable by implementing dietary interventions, though these remain underutilized. Here, we aim to explore the role of healthy dietary patterns in hypertension management and describe approaches for busy clinicians to address nutrition effectively and efficiently with patients. RECENT FINDINGS DASH, Mediterranean, vegetarian, and vegan diets that include minimally processed, plant-based foods as core elements have consistently shown positive effects on hypertension. Recommendations that distill the most healthful components of these diets can significantly impact patient outcomes. Clinicians can harness evidence-based dietary assessment and counseling tools to implement and support behavioral changes, even during brief office visits. Healthful plant-based dietary patterns can often effectively prevent and treat hypertension. Clinicians may help improve patient outcomes by discussing evidence-based nutrition with their patients. Future work to promote infrastructural change that supports incorporating evidence-based nutrition into medical education, clinical care, and society at large can support these efforts.
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Affiliation(s)
- Justin A Charles
- Department of Family Medicine and Public Health, UC San Diego Health, San Diego, CA, USA.
| | | | - Saul Bautista
- Ethos Farm to Health/Ethos Primary Care, Long Valley, NJ, USA
| | - Brenda Davis
- Brenda Davis, Nutrition Consultations, Calgary, AB, Canada
| | - Shivam Joshi
- Department of Veterans Affairs, Orlando, FL, USA
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Sarah C Hull
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
- Program for Biomedical Ethics, Yale School of Medicine, New Haven, CT, USA
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3
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Koh LM, Iradukunda F, Martínez AD, Caetano Schulz KC, Bielitz I, Walker RK. A remotely accessible plant-based culinary intervention for Latina/o/x adults at risk for diabetes: lessons learned. Front Nutr 2024; 11:1298755. [PMID: 38414490 PMCID: PMC10896850 DOI: 10.3389/fnut.2024.1298755] [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: 09/22/2023] [Accepted: 01/25/2024] [Indexed: 02/29/2024] Open
Abstract
Introduction Little research has examined how community-engaged and -participatory dietary interventions adapted to remotely-accessible settings during the COVID-19 pandemic. Objectives To identify lessons learned in design, implementation, and evaluation of a remotely-accessible, community-based, nurse-led approach of a culturally-tailored whole food plant-based culinary intervention for Latina/o/x adults to reduce type 2 diabetes risk, delivered during a pandemic. Methods A mixed methods quasi-experimental design consisting of a pre-post evaluation comprised of questionnaires, culinary classes, biometrics, and focus groups. Lessons learned Community partnerships are essential for successful recruitment/retention. To optimally deliver a remotely-accessible intervention, community leadership and study volunteers should be included in every decision (e.g., timeframes, goals). Recommendations include managing recruitment and supply chain disruption of intervention supplies. Conclusion Future research should focus on increasing accessibility and engagement in minoritized and/or underserved communities, supply chain including quality assurance and delivery of services/goods, study design for sustainable, remotely-accessible interventions, and health promotion.
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Affiliation(s)
- Linda M Koh
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Palo Alto, CA, United States
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, MA, United States
| | - Favorite Iradukunda
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, MA, United States
| | - Airín D Martínez
- School of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, MA, United States
| | | | - Irene Bielitz
- Independent Researcher, Loma Linda, CA, United States
| | - Rae K Walker
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, MA, United States
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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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Haines KL, Ohnuma T, Grisel B, Krishnamoorthy V, Raghunathan K, Sulo S, Kerr KW, Besecker B, Cassady BA, Wischmeyer PE. Early enteral nutrition is associated with improved outcomes in critically ill mechanically ventilated medical and surgical patients. Clin Nutr ESPEN 2023; 57:311-317. [PMID: 37739674 DOI: 10.1016/j.clnesp.2023.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND AIMS Data suggest that guidelines for enteral nutrition (EN) initiation are not closely followed in clinical practice. In addition, critically ill mechanically ventilated (MV) patients have varying metabolic needs, which often increase and persist over time, requiring personalized nutrition intervention. While both over- and under-nutrition can impact patient outcomes, recent data suggest that targeted early EN delivery may reduce mortality and improve clinical outcomes. This study examined if early EN improves clinical outcomes and decreases costs in critically ill patients on MV. METHODS Data from a nationwide administrative-financial database between 2018 and 2020 was utilized to identify eligible adult critical care patients. Patients who received EN within 3 days after intubation (early EN) were compared to patients who started EN after 3 days of intubation (late EN). Outcomes of interest included hospital mortality, discharge disposition, hospital and intensive care unit (ICU) length of stay (LOS), MV days, and total cost. After inverse-probability-of-treatment weighting, outcomes were modeled using a nominal logistic regression model for hospital mortality and discharge disposition, a linear regression model for cost, and Cox proportional-hazards model for MV days, hospital and ICU LOS. RESULTS A total of 27,887 adult patients with early MV were identified, of which 16,772 (60.1%) received early EN. Regression analyses showed that the early EN group had lower hospital mortality (OR = 0.88, 95% CI, 0.82 to 0.94), were more likely to be discharged home (OR = 1.47, 95% CI 1.38 to 1.56), had fewer MV days (HR = 1.23, 95% CI, 1.11 to 1.37), shorter hospital LOS (HR = 1.43, 95% CI, 1.33 to 1.54) and ICU LOS (HR = 1.36, 95% CI, 1.27 to 1.46), and lower cost (-$21,226; 95% CI, -$23,605 to -$18,848) compared to the late EN group. CONCLUSIONS Early EN within 3 days of MV initiation in real-world practice demonstrated improved clinical and economic outcomes. These data suggest that early EN is associated with decreased hospital mortality, increased discharge to home, and decreased hospital and ICU LOS, time on MV, and cost compared to delayed initiation of EN; highlighting the importance of early EN to optimize utcomes ando support the recovery of critically ill patients on MV.
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Affiliation(s)
- Krista L Haines
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA; The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Tetsu Ohnuma
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA; Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Braylee Grisel
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Vijay Krishnamoorthy
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA; Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA
| | - Karthik Raghunathan
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA; Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Suela Sulo
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Kirk W Kerr
- Scientific and Medical Affairs, Abbott Nutrition, Columbus, OH, USA.
| | - Beth Besecker
- Scientific and Medical Affairs, Abbott Nutrition, Columbus, OH, USA.
| | - Bridget A Cassady
- Scientific and Medical Affairs, Abbott Nutrition, Columbus, OH, USA.
| | - Paul E Wischmeyer
- Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
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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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Brennan BR, Beals KA, Burns RD, Chow CJ, Locke AB, Petzold MP, Dvorak TE. Impact of Culinary Medicine Course on Confidence and Competence in Diet and Lifestyle Counseling, Interprofessional Communication, and Health Behaviors and Advocacy. Nutrients 2023; 15:4157. [PMID: 37836442 PMCID: PMC10574678 DOI: 10.3390/nu15194157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Most physicians report inadequate training to provide diet and lifestyle counseling to patients despite its importance to chronic disease prevention and management. To fill the nutrition training gap, elective Culinary Medicine (CM) courses have emerged as an alternative to curriculum reform. We evaluated the impact of an interprofessional CM course for medical and health professional students who experienced the hands-on cooking component in person or a in mixed-mode format (in-person and via Zoom) at the University of Utah from 2019-2023 (n = 84). A factorial ANOVA assessed differences between educational environment and changes between pre- and post-course survey responses related to diet and lifestyle counseling, interprofessional communication, and health behaviors and advocacy. Qualitative comments from post-course surveys were analyzed on a thematic level. Students rated themselves as having greater confidence and competence in diet and lifestyle counseling (p < 0.05) and increased ability to prepare eight healthy meals (p < 0.05). Additionally, a Mann-Whitney two-sample rank-sum test was used to compare data from exit survey responses from medical students who took the CM course (n = 48) and did not take the CM course (n = 297). Medical students who took CM were significantly more likely to agree that they could counsel patients about nutrition (p < 0.05) and physical activity (p < 0.05). CM courses may improve students' confidence to provide diet and lifestyle counseling.
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Affiliation(s)
- Britta Retzlaff Brennan
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84112, USA;
| | - Katherine A. Beals
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84112, USA;
| | - Ryan D. Burns
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT 84112, USA;
| | - Candace J. Chow
- Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, USA;
| | - Amy B. Locke
- Department of Family and Preventative Medicine, University of Utah, Salt Lake City, UT 84112, USA; (A.B.L.); (M.P.P.)
| | - Margaret P. Petzold
- Department of Family and Preventative Medicine, University of Utah, Salt Lake City, UT 84112, USA; (A.B.L.); (M.P.P.)
| | - Theresa E. Dvorak
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84112, USA;
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8
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Albin JL, Siler M, Kitzman H. Culinary Medicine eConsults Pair Nutrition and Medicine: A Feasibility Pilot. Nutrients 2023; 15:2816. [PMID: 37375720 DOI: 10.3390/nu15122816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/07/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
The global impact of diet-sensitive disease demands innovative nutrition education for health professionals and widespread, reimbursable clinical models to apply nutrition to practice. Interprofessional collaboration across disciplines and the optimization of emerging telemedicine consultation strategies, including electronic consultation (eConsult), merge to deliver vital innovation in the delivery of nutrition-based clinical care. Aligning with an existing eConsult infrastructure in the institutional electronic health record (EHR), a physician-dietitian team developed a novel Culinary Medicine eConsult. During a pilot phase, the service was introduced to primary care clinicians, and a response algorithm for eConsults was created. During the 12-month pilot phase, the Culinary Medicine team completed 25 eConsults from 11 unique primary care clinicians with a 76% (19/25) insurance reimbursement rate. Topics varied from dietary strategies for preventing and managing common metabolic diseases to specific dietary influences on microbiome health and disease flares. Requesting clinicians reported time saved in their clinic encounters and high patient satisfaction with expert nutrition guidance. EConsults in Culinary Medicine promote the integration of interprofessional nutrition care into existing clinical structures and empower enhanced access to the vital domain of dietary health. EConsults deliver timely answers to clinical questions and create opportunities for further innovation in care delivery as communities, health systems, and payors seek solutions to the growing burden of diet-sensitive diseases.
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Affiliation(s)
- Jaclyn L Albin
- University of Texas Southwestern Medical Center, School of Medicine, Departments of Internal Medicine and Pediatrics, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Milette Siler
- Moncrief Cancer Institute and the University of Texas Southwestern Medical Center, 400 W Magnolia Ave, Fort Worth, TX 76104, USA
| | - Heather Kitzman
- University of Texas Southwestern Medical Center, Peter O'Donnell Jr. School of Public Health, Dallas, TX 75390, USA
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9
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Croskey O, Clark MK. Individualized diet conversation in primary care: A pilot intervention. Nurse Pract 2023; 48:38-46. [PMID: 36975749 DOI: 10.1097/01.npr.0000000000000026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Most primary care providers do not routinely discuss nutrition and diet with their patients, largely due to lack of time, inadequate resources, and perceived complexity of the topic. This article describes development and implementation of a brief protocol for systematically assessing and discussing diet during routine primary care visits to increase the frequency of these conversations and improve patient health outcomes. METHODS The authors developed a protocol for assessing both nutrition and stage of change as well as a guide for engaging in patient-led conversations about nutrition. The protocol was modeled after Screening, Brief Intervention, and Referral to Treatment and informed by the Dietary Guidelines for Americans, the Transtheoretical Model of Behavior Change, and principles of motivational interviewing. It was implemented over three months at a rural health clinic staffed by one NP. RESULTS The protocol and conversation guide were easy to use with minimal training and seamlessly incorporated into clinic workflow. The likelihood of making diet changes increased significantly following the diet conversation, with persons who initially scored lower in readiness to change ultimately reporting significantly greater increases. CONCLUSION A protocol for assessing diet and engaging patients in a stage of change-appropriate diet conversation can be efficiently integrated into a single primary care visit and increase patients' intent to change their diet. Further investigation is needed to evaluate the protocol more completely and in multiple clinics.
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10
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Plotnikoff GA, Dobberstein L, Raatz S. Nutritional Assessment of the Symptomatic Patient on a Plant-Based Diet: Seven Key Questions. Nutrients 2023; 15:1387. [PMID: 36986117 PMCID: PMC10056340 DOI: 10.3390/nu15061387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/01/2023] [Accepted: 03/10/2023] [Indexed: 03/15/2023] Open
Abstract
Plant-based diets, both vegan and vegetarian, which emphasize grains, vegetables, fruits, legumes, nuts, and seeds are increasingly popular for health as well as financial, ethical, and religious reasons. The medical literature clearly demonstrates that whole food plant-based diets can be both nutritionally sufficient and medically beneficial. However, any person on an intentionally restrictive, but poorly-designed diet may predispose themselves to clinically-relevant nutritional deficiencies. For persons on a poorly-designed plant-based diet, deficiencies are possible in both macronutrients (protein, essential fatty acids) and micronutrients (vitamin B12, iron, calcium, zinc, and vitamin D). Practitioner evaluation of symptomatic patients on a plant-based diet requires special consideration of seven key nutrient concerns for plant-based diets. This article translates these concerns into seven practical questions that all practitioners can introduce into their patient assessments and clinical reasoning. Ideally, persons on plant-based diets should be able to answer these seven questions. Each serves as a heuristic prompt for both clinician and patient attentiveness to a complete diet. As such, these seven questions support increased patient nutrition knowledge and practitioner capacity to counsel, refer, and appropriately focus clinical resources.
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Affiliation(s)
| | | | - Susan Raatz
- Department of Food Science and Nutrition, University of Minnesota, Minneapolis, MN 55455, USA
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11
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Lee JS, Xierali IM, Jaini PA, Jetpuri Z, Papa F. Medical Student Perception of Lifestyle Medicine and Willingness to Engage in Lifestyle Counseling: A Pilot Study of Allopathic and Osteopathic Medical Students. Am J Lifestyle Med 2023; 17:280-289. [PMID: 36896036 PMCID: PMC9989491 DOI: 10.1177/15598276211004449] [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: 11/16/2022] Open
Abstract
Introduction. This study assessed medical students' perception of lifestyle medicine and readiness to engage in lifestyle counseling. Methods. All medical students in one allopathic and one osteopathic medical school received a survey involving items designed to measure their awareness and interest in lifestyle medicine, perception of physicians serving as lifestyle role models for patients, and intent to practice lifestyle counseling. Results. Two hundred and eight-nine subjects (145 allopathic and 144 osteopathic students) responded to the survey. A total of 24.1% of responding allopathic students had heard about lifestyle medicine compared with 53.9% of responding osteopathic students (P < .01). A total of 90.5% of allopathic students rated their current knowledge of lifestyle medicine as inadequate or poor compared with 78.7% of osteopathic students (P < .01). Ninety-two percent of all respondents wanted to learn more about lifestyle medicine, while 95.2% believed they would provide more effective counseling if they were trained sufficiently to serve as a healthy lifestyle role model for their patients. Conclusions. Both cohorts favored learning more about lifestyle medicine and believed physicians should provide lifestyle counseling to patients with chronic diseases. Given these findings, and the demonstrated benefits of lifestyle medicine-based health care, the authors suggest that training in lifestyle medicine be increased in undergraduate medical education.
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Affiliation(s)
- Jenny Sunghyun Lee
- The Department of Preventive Medicine, Loma Linda University Medical School, Loma Linda, California
| | - Imam M Xierali
- Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Paresh Atu Jaini
- Department of Psychiatry, John Peter Smith Hospital, Fort Worth, Texas
| | - Zaiba Jetpuri
- Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Frank Papa
- Department of Medical Education, University of North Texas Health Science Center, Fort Worth, Texas
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12
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Kreft M, Smith B, Hopwood D, Blaauw R. The use of social media as a source of nutrition information. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2023. [DOI: 10.1080/16070658.2023.2175518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- Megan Kreft
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Brittany Smith
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Daniella Hopwood
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Renee Blaauw
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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13
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Tierney WM, Henning JM, Altillo BS, Rosenthal M, Nordquist E, Copelin K, Li J, Enriquez C, Lange J, Larson D, Burgermaster M. User-Centered Design of a Clinical Tool for Shared Decision-making About Diet in Primary Care. J Gen Intern Med 2023; 38:715-726. [PMID: 36127543 PMCID: PMC9971535 DOI: 10.1007/s11606-022-07804-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/08/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Health information technology is a leading cause of clinician burnout and career dissatisfaction, often because it is poorly designed by nonclinicians who have limited knowledge of clinicians' information needs and health care workflow. OBJECTIVE Describe how we engaged primary care clinicians and their patients in an iterative design process for a software application to enhance clinician-patient diet discussions. DESIGN Descriptive study of the steps followed when involving clinicians and their at-risk patients in the design of the content, layout, and flow of an application for collaborative dietary goal setting. This began with individual clinician and patient interviews to detail the desired informational content of the screens displayed followed by iterative reviews of intermediate and final versions of the program and its outputs. PARTICIPANTS Primary care clinicians practicing in an urban federally qualified health center and two academic primary care clinics, and their patients who were overweight or obese with diet-sensitive conditions. MAIN MEASURES Descriptions of the content, format, and flow of information from pre-visit dietary history to the display of evidence-based, guideline-driven suggested goals to final display of dietary goals selected, with information on how the patient might reach them and patients' confidence in achieving them. KEY RESULTS Through three iterations of design and review, there was substantial evolution of the program's content, format, and flow of information. This involved "tuning" of the information desired: from too little, to too much, to the right amount displayed that both clinicians and patients believed would facilitate shared dietary goal setting. CONCLUSIONS Clinicians' well-founded criticisms of the design of health information technology can be mitigated by involving them and their patients in the design of such tools that clinicians may find useful, and use, in their everyday medical practice.
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Affiliation(s)
- William M Tierney
- The Department of Population Health, Dell Medical School, University of Texas at Austin, Health Discovery Building, Suite 4.700, 1701 Trinity Street, Austin, TX, 78712, USA.
- The Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, USA.
| | - Jacqueline M Henning
- The Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA
| | - Brandon S Altillo
- The Department of Population Health, Dell Medical School, University of Texas at Austin, Health Discovery Building, Suite 4.700, 1701 Trinity Street, Austin, TX, 78712, USA
- The Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, USA
- Lone Star Circle of Care, Georgetown, TX, USA
| | - Madalyn Rosenthal
- The Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA
| | - Eric Nordquist
- The School of Information, University of Texas at Austin, Austin, TX, USA
- Sentier Strategic Resources, Austin, TX, USA
| | - Ken Copelin
- The School of Information, University of Texas at Austin, Austin, TX, USA
- Sentier Strategic Resources, Austin, TX, USA
| | - Jiaxin Li
- The School of Information, University of Texas at Austin, Austin, TX, USA
- Sentier Strategic Resources, Austin, TX, USA
| | | | - Jordan Lange
- The Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA
| | - Dagny Larson
- The Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA
| | - Marissa Burgermaster
- The Department of Population Health, Dell Medical School, University of Texas at Austin, Health Discovery Building, Suite 4.700, 1701 Trinity Street, Austin, TX, 78712, USA
- The Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA
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Mayr HL, Savill H, Law L, Campbell KL, Hill J, Palmer M, Hickman IJ, Kelly JT. ‘We work in silos’: Exploring clinicians' perspectives on the dietary management of coronary heart disease and type 2 diabetes in an Australian public hospital and community health service. Nutr Diet 2022. [DOI: 10.1111/1747-0080.12789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Hannah L. Mayr
- Department of Nutrition and Dietetics Princess Alexandra Hospital Brisbane Queensland Australia
- Faculty of Health Sciences and Medicine, Bond University Nutrition and Dietetics Research Group Bond University Gold Coast Queensland Australia
- Greater Brisbane Clinical School, Faculty of Medicine The University of Queensland Brisbane Queensland Australia
- Centre for Functioning and Health Research Metro South Hospital and Health Service Brisbane Queensland Australia
| | - Holly Savill
- Faculty of Health Sciences and Medicine, Bond University Nutrition and Dietetics Research Group Bond University Gold Coast Queensland Australia
| | - Lynette Law
- Faculty of Health Sciences and Medicine, Bond University Nutrition and Dietetics Research Group Bond University Gold Coast Queensland Australia
| | - Katrina L. Campbell
- Greater Brisbane Clinical School, Faculty of Medicine The University of Queensland Brisbane Queensland Australia
- Metro North Hospital and Health Service Brisbane Queensland Australia
| | - Jan Hill
- Department of Nutrition and Dietetics Princess Alexandra Hospital Brisbane Queensland Australia
| | - Michelle Palmer
- Department of Nutrition and Dietetics Logan Hospital Brisbane Queensland Australia
| | - Ingrid J. Hickman
- Department of Nutrition and Dietetics Princess Alexandra Hospital Brisbane Queensland Australia
- Greater Brisbane Clinical School, Faculty of Medicine The University of Queensland Brisbane Queensland Australia
| | - Jaimon T. Kelly
- Centre for Online Health, Faculty of Medicine The University of Queensland Brisbane Queensland Australia
- Centre for Health Services Research, Faculty of Medicine The University of Queensland Brisbane Queensland Australia
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15
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Qubty L, Hicks-Roof K. How might enhanced interprofessional collaboration between primary care physicians and registered dietitian nutritionists impact clinical outcomes related to obesity and associated illnesses? A commentary. Public Health Nutr 2022; 26:1-4. [PMID: 36458843 PMCID: PMC9989699 DOI: 10.1017/s1368980022002518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/10/2022] [Accepted: 11/22/2022] [Indexed: 12/04/2022]
Abstract
The unsettling worldwide prevalence of obesity and obesity-related illnesses seems to be well-understood. What seems to be lacking, however, is a strategy of how best to fix the issue. Meagre nutrition content in medical school curricula may contribute to limited primary care physician (PCP) knowledge of the role nutrition has in health ailments and the understanding of a registered dietitian nutritionist (RDN) scope of practice. In USA, RDN are health care practitioners specialised in nutrition and who are experts in treating obesity and obesity-related illnesses. An increased RDN involvement in patient care has been shown to promote improvements in nutrition-related clinical outcomes. Therefore, enhanced collaboration between PCP and RDN has the potential to ameliorate the obesity epidemic. Tactics to promote collaboration may include enhancing nutrition education in medical school and providing nutrition-focussed continuing education for practicing physicians. The seriousness of the obesity epidemic underscores the need for interprofessional collaboration between PCP and allied health professionals who are uniquely trained to address obesity and obesity-related illnesses.
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Affiliation(s)
- Leah Qubty
- Department of Applied Health Sciences, Bethel University, St. Paul, MN, USA
| | - Kristen Hicks-Roof
- Department of Nutrition & Dietetics, Brooks College of Health, University of North Florida, Jacksonville, FL32224, USA
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16
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Clark BE, Pope L, Belarmino EH. Personal bias in nutrition advice: A survey of health professionals' recommendations regarding dairy and plant-based dairy alternatives. PEC INNOVATION 2022; 1:100005. [PMID: 37364024 PMCID: PMC10194179 DOI: 10.1016/j.pecinn.2021.100005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 06/28/2023]
Abstract
Objective To examine the association between health professionals' personal dietary behaviors and their professional nutrition recommendations on dairy and plant-based dairy alternatives. Methods A cross-sectional survey of 331 U.S. health professionals examined willingness to recommend dairy and/or plant-based dairy alternatives to patients across personal milk preference, and dietary pattern. Results Plant-based milk preference (OR 4.52; p < 0.001) and following a vegetarian dietary pattern (OR 1.91; p = 0.019) were associated with greater odds of recommending plant-based dairy alternatives to patients. Plant-based milk preference (OR 0.16; p < 0.001), following a vegetarian dietary pattern (OR 0.45; p = 0.009), and considering one's diet to be "plant-based" (OR 0.41; p = 0.005) were associated with lessor odds of recommending dairy to patients. Dietetics professionals were more likely than all other health professionals to recommend both dairy and plant-based dairy alternatives to patients. Conclusion Health professionals' nutrition recommendations may reflect their personal nutrition choices. Improved nutrition training, focusing on evidence-based recommendations, reducing personal bias in practice, and routinely including registered dietitians on interprofessional healthcare teams may improve the quality of nutrition advice given to U.S. consumers. Innovation This paper is the first to examine if health professionals' personal health behaviors are associated with their health advice on dairy and/or plant-based dairy alternatives.
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Affiliation(s)
- Bridget E. Clark
- Department of Nutrition and Food Sciences, University of Vermont, Burlington, VT, USA
| | - Lizzy Pope
- Department of Nutrition and Food Sciences, University of Vermont, Burlington, VT, USA
| | - Emily H. Belarmino
- Department of Nutrition and Food Sciences, University of Vermont, Burlington, VT, USA
- Gund Institute for Environment, University of Vermont, Burlington, VT, USA
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17
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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: 11] [Impact Index Per Article: 5.5] [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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18
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Villalona S, Ortiz V, Castillo WJ, Garcia Laumbach S. Cultural Relevancy of Culinary and Nutritional Medicine Interventions: A Scoping Review. Am J Lifestyle Med 2022; 16:663-671. [PMID: 36389044 PMCID: PMC9644144 DOI: 10.1177/15598276211006342] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 02/14/2021] [Accepted: 03/11/2021] [Indexed: 10/15/2023] Open
Abstract
Background. Taking into account the disproportionate impacts of disease burden from chronic conditions by racial and ethnic group, this scoping review sought to examine the extent to which nutritional interventions incorporated culturally relevant topics into their design and analyses. Methods. A literature search of 5 databases was conducted for any peer-reviewed studies on nutritional and culinary medicine interventions published between 2000 and 2019. Results. Studies were divided into 2 categories, medical education interventions (n = 12) and clinical/community interventions (n = 20). The majority of medical education interventions were not culturally tailored and focused on obesity/weight management within the Northeast and Southeast United States. In contrast, clinical/community interventions were primarily culturally tailored for Latinos/Hispanics and African American/Black populations residing in the Northeast and diagnosed with prediabetes/diabetes mellitus or hypertension/cardiovascular disease. Conclusions. This review identified an existent gap and need for inclusive studies that consider the culturally relevant topics into the design and implementation of nutritional intervention studies. Studies within medical education appeared to be the area where these changes can be most beneficial. There may be some value among clinic and communal-based studies in stratifying heterogeneous subgroups because of the missed cultural nuances missed when grouping larger racial cohorts.
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Affiliation(s)
| | - Vanessa Ortiz
- Rutgers Robert Wood Johnson Medical School,
Piscataway, New Jersey
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19
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Bawazir Z, Alrasheedi A, Aljehany B. Nutritional Knowledge and Attitudes among Physician Interns Graduated from King Abdul-Aziz University, Jeddah, Saudi Arabia. Healthcare (Basel) 2022; 10:healthcare10091788. [PMID: 36141400 PMCID: PMC9498823 DOI: 10.3390/healthcare10091788] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/30/2022] [Accepted: 09/04/2022] [Indexed: 01/22/2023] Open
Abstract
This study aimed to assess the nutritional knowledge and attitudes of physician interns graduated from King Abdul-Aziz University. A cross-sectional study was conducted among 100 physician interns who graduated in 2019, 2020, and 2021. An online self-administered questionnaire was used to collect data. A modified version of a validated questionnaire was used and provided to the participants in both Arabic and English versions, of which participants could choose one. This questionnaire consisted of three sections, including demographic data (five questions), attitude (47 questions), and knowledge (40 questions). A total of 100 (54 female and 46 male) participants completed the questionnaire. The nutrition and diabetes axis had the highest percentage of correct answers among the knowledge axes (55.6%), while the percentage of correct answers for the axis of nutrition and heart disease was the lowest (44%). There were no significant differences among most of the knowledge axes according to sex. However, there were significant differences between the averages of the answers of the male and female groups in the axis of nutrition and obesity only, where the male group had more correct answers than the female group. The average attitude of the study participants was almost good, with slight differences between males and females. A total of 51% of the participants were satisfied with the medical nutrition curriculum. The inadequacy of the nutritional curriculum among medical students was reflected in their satisfaction with their college programs and thus in their knowledge, attitudes, and confidence in providing nutritional counseling to patients. Intern physicians need to improve their clinical nutrition knowledge and skills to be able to provide patients with appropriate nutrition advice.
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20
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Villette C, Vasseur P, Lapidus N, Debin M, Hanslik T, Blanchon T, Steichen O, Rossignol L. Vegetarian and Vegan Diets: Beliefs and Attitudes of General Practitioners and Pediatricians in France. Nutrients 2022; 14:nu14153101. [PMID: 35956277 PMCID: PMC9370229 DOI: 10.3390/nu14153101] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 02/01/2023] Open
Abstract
Studies suggest a decreasing trend in the consumption of meat products and a growing interest in vegetarian diets. Medical support may be relevant, especially when switching to a vegan diet. Our objective was to describe the beliefs and attitudes of primary care physicians toward vegetarian diets. A cross-sectional survey was conducted among general practitioners and pediatricians thorough a questionnaire including socio-demographic characteristics, specific care to vegetarians, and the risks and benefits of vegetarian diets according to physicians. Out of the 177 participating physicians, 104 (59%) have seen at least one vegetarian patient in consultation in the last three months. Half of the physicians declared that they would dissuade their patients from switching to a vegan diet (n = 88, 51%) and 14% (n = 24) from switching to an ovo-lacto-vegetarian (OLV) diet. Most physicians (n = 141, 88%) did not feel informed enough about these diets. Physicians thought that the most frequent deficiencies for OLV and vegan diets were iron (76% and 84%, respectively) and protein (45% and 79%, respectively). These results highlight the fact that French primary care physicians feel concerned by this subject and need more information on these diets. Specific recommendations would be useful to support their practice and relationship with vegetarians.
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Affiliation(s)
- Cécile Villette
- Département de Médecine Générale, Université de Paris Cité, 16 rue Henri Huchard, F75018 Paris, France
| | - Pauline Vasseur
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, INSERM, IPLESP, 27 rue de Chaligny, F75012 Paris, France
| | - Nathanael Lapidus
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, INSERM, IPLESP, 27 rue de Chaligny, F75012 Paris, France
- Public Health Department, Saint-Antoine Hospital, AP-HP, Sorbonne Université, F75012 Paris, France
| | - Marion Debin
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, INSERM, IPLESP, 27 rue de Chaligny, F75012 Paris, France
| | - Thomas Hanslik
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, INSERM, IPLESP, 27 rue de Chaligny, F75012 Paris, France
- UFR Simone Veil-Santé, Université Versailles Saint Quentin en Yvelines, 55 Avenue de Paris, F78000 Versailles, France
- AP-HP, Hôpital Ambroise Paré, Service de Médecine Interne, 9 Avenue Charles de Gaulle, F92100 Boulogne Billancourt, France
| | - Thierry Blanchon
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, INSERM, IPLESP, 27 rue de Chaligny, F75012 Paris, France
| | - Olivier Steichen
- AP-HP, Hôpital Tenon, Service de Médecine Interne, Sorbonne Université, 4 rue de la Chine, F75020 Paris, France
| | - Louise Rossignol
- Département de Médecine Générale, Université de Paris Cité, 16 rue Henri Huchard, F75018 Paris, France
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, INSERM, IPLESP, 27 rue de Chaligny, F75012 Paris, France
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21
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Selected Organizational and Managerial Aspects of Health and Nutrition Education of Various Types of Consumers of Spa Treatment Services in Poland. Nutrients 2022; 14:nu14112337. [PMID: 35684136 PMCID: PMC9183019 DOI: 10.3390/nu14112337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/29/2022] [Accepted: 06/01/2022] [Indexed: 02/04/2023] Open
Abstract
Consumer education, including nutrition education, understood as a process based on scientific principles, is becoming a very effective element in influencing the health of the population in the modern world. This work is based on direct research carried out in 2016–2018 in the form of a questionnaire interview among patients—consumers of educational services in spa treatment facilities. The research sample was N = 1000 (600 people were tested with the use of PAPI (Paper and Pencil Interview), and 400 people with the use of CAWI (Computer-Assisted Web Interview)) and concerned a representative group of spa patients in Poland. In addition, as a supplement, a direct survey was conducted in the form of a Computer-Assisted Telephone Interview with managers of spa treatment facilities (N = 50). Consumers of spa treatment services differ from each other, and types can be distinguished based on their professional activity status and the type of entity that pays for their stay in the spa, and, using cluster analysis, the status of professional activity in relation to their education level. The nutritional education system is based on highly specialized medical personnel. At the same time, it does not use the available assessment tools based on proven monitoring and evaluation indicators. Health education, which also includes nutritional education, apart from disease prevention, is the basic tool for health promotion in spa treatment conditions, enabling the introduction of a permanent change in the patients’ lifestyles, the additional advantages of which are low costs and relatively high efficiency. In the course of the study, several useful patient profiles were also distinguished, thanks to which it is possible to select dedicated educational methods for selected groups of recipients.
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22
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Clark BE, Pope L, Belarmino EH. Perspectives from healthcare professionals on the nutritional adequacy of plant-based dairy alternatives: results of a mixed methods inquiry. BMC Nutr 2022; 8:46. [PMID: 35550654 PMCID: PMC9097167 DOI: 10.1186/s40795-022-00542-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 05/04/2022] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Healthcare professionals are important sources of nutrition and health information for Americans. As plant-based (PB) dairy alternative products increase in popularity, concerns have been raised about their nutritional adequacy, and whether consumers understand nutritional differences to dairy. Healthcare professionals directly advise consumers on dietary choices, therefore we sought to examine their understanding and opinions of PB dairy alternatives. METHODS We analyzed comments submitted to the U.S. Food and Drug Administration (FDA) by health professionals (n = 191) in 2018-2019 in response to a request for public comment on the nutrition of PB dairy alternatives and the use of dairy terms like "milk", "cheese", and "yogurt" on their labels. Survey data from healthcare professionals (n = 417) was collected in 2020-2021. Comments and survey responses to open-ended questions were coded using template analysis and thematically analyzed. Logistic regression models examined perceptions across health professional characteristics for close-ended survey responses. RESULTS Three-fourths of health professionals believe consumers are confused about the nutritional differences between dairy and PB dairy alternatives. Over half (53%) do not believe either product is nutritionally superior to the other. Many believe dairy products have higher nutrient value, but also believe PB dairy alternatives can be part of a healthful diet. Compared to other types of health professionals, dietetics professionals demonstrated a more accurate understanding of the nutritional value of both products and were more likely to believe nutrients like protein (OR 2.02; 95% CI 1.22-3.34, p = 0.006) and vitamin D (OR 2.46; 95% CI 1.48-4.09, p = 0.001) may be nutrients of concern for PB dairy alternative consumers. They were also more likely to believe consumers are confused about these products (OR 3.44; 95% CI 1.65-7.21; p = 0.001). Health professionals who submitted comments to the FDA showed stronger opinions in favor of PB dairy alternatives. CONCLUSIONS Although PB dairy alternatives have nutritional value in certain diets, responses from health professionals suggest that changing their labeling to be different than dairy may reduce confusion. Improved nutrition education among health professionals may also be necessary.
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Affiliation(s)
- Bridget E Clark
- Department of Nutrition and Food Sciences, University of Vermont, 256 Carrigan Wing, 109 Carrigan Drive, Burlington, VT, 05405-0086, USA
| | - Lizzy Pope
- Department of Nutrition and Food Sciences, University of Vermont, 256 Carrigan Wing, 109 Carrigan Drive, Burlington, VT, 05405-0086, USA
| | - Emily H Belarmino
- Department of Nutrition and Food Sciences, University of Vermont, 256 Carrigan Wing, 109 Carrigan Drive, Burlington, VT, 05405-0086, USA.
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23
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Belardo D, Michos ED, Blankstein R, Blumenthal RS, Ferdinand KC, Hall K, Klatt K, Natajaran P, Ostfeld RJ, Reddy K, Rodriguez R, Sriram U, Tobias DK, Gulati M. Practical, Evidence-Based Approaches to Nutritional Modifications to Reduce Atherosclerotic Cardiovascular Disease: An American Society for Preventive Cardiology Clinical Practice Statement. Am J Prev Cardiol 2022; 10:100323. [PMID: 35284849 PMCID: PMC8914096 DOI: 10.1016/j.ajpc.2022.100323] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/15/2022] [Accepted: 02/28/2022] [Indexed: 02/06/2023] Open
Abstract
Despite numerous advances in all areas of cardiovascular care, cardiovascular disease (CVD) is the leading cause of death in the United States (US). There is compelling evidence that interventions to improve diet are effective in cardiovascular disease prevention. This clinical practice statement emphasizes the importance of evidence-based dietary patterns in the prevention of atherosclerotic cardiovascular disease (ASCVD), and ASCVD risk factors, including hyperlipidemia, hypertension, diabetes, and obesity. A diet consisting predominantly of fruits, vegetables, legumes, nuts, seeds, plant protein and fatty fish is optimal for the prevention of ASCVD. Consuming more of these foods, while reducing consumption of foods with saturated fat, dietary cholesterol, salt, refined grain, and ultra-processed food intake are the common components of a healthful dietary pattern. Dietary recommendations for special populations including pediatrics, older persons, and nutrition and social determinants of health for ASCVD prevention are discussed.
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Affiliation(s)
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ron Blankstein
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Roger S. Blumenthal
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Keith C. Ferdinand
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Kevin Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Kevin Klatt
- Baylor College of Medicine, Houston, TX, USA
| | - Pradeep Natajaran
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Koushik Reddy
- Department of Medicine, James A. Haley VA Medical Center – University of South Florida, Tampa, FL, USA
| | | | - Urshila Sriram
- Department of Nutrition, College of Natural, Behavioral, and Health Sciences, Simmons University, Boston, MA, USA
| | - Deirdre K. Tobias
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston MA, USA
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24
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Hartwell M, Torgerson T, Essex R, Campbell B. Public Awareness of a Plant-Based Diet Following the Release of "Game Changers" and "What The Health" Documentaries. Am J Lifestyle Med 2022; 16:190-196. [PMID: 35370517 PMCID: PMC8971697 DOI: 10.1177/15598276211044106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Poor diet is a leading cause of premature death and thus diet and lifestyle changes are needed; yet, no consensus exists regarding diets that provide the greatest benefit. One of these diets gaining popularity around the world is a plant-based, vegan diet. Recently, Netflix documentaries What the Health (2017) and The Game Changers (2019) have attempted to improve public awareness of veganism and plant-based diets. METHODS We used Google Trends to obtain data for keywords specific to plant-based diets, veganism, and documentary-specific terms over a time period before and after the release of the Netflix documentaries. We then created a forecasted model for trended search terms using autoregressive integrated moving algorithms and compared the actual trends to the forecast model to determine the effect of the documentaries on each selected term. RESULTS Search interest for the term "plant-based diet" increased significantly-2.8 times the mean forecasted value for What the Health (t = 12.892, df = 30.012, P < .001) and 2 times the forecasted mean for The Game Changers (t = 19.826, df = 30.118, P < .001). Additionally, following the release of The Game Changers, mean search interest for "plant-based athlete" was 2.8 times higher than the forecasted values. CONCLUSION The documentaries What the Health (2017) and The Game Changers (2019) are associated with an increased interest in plant-based diets based on Google search trends, highlighting the need for continued research regarding plant-based diets and their health benefits related to chronic disease.
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Affiliation(s)
- Micah Hartwell
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Trevor Torgerson
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Ryan Essex
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Ben Campbell
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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Santos L. The impact of nutrition and lifestyle modification on health. Eur J Intern Med 2022; 97:18-25. [PMID: 34670680 DOI: 10.1016/j.ejim.2021.09.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/12/2021] [Accepted: 09/27/2021] [Indexed: 12/30/2022]
Abstract
The main recommendations from public health entities include healthy diets and physical activity as the main lifestyle factors impacting the development of chronic diseases such as cardiovascular and metabolic diseases, cancer, and even neurological diseases. Randomized clinical trials have been designed to demonstrate those lifestyle modifications can change the pattern of chronic diseases development and progression. Among these, nutrition is one of the most impacting factors. Therefore, nutrition and diets were also included in different randomized clinical trials, and most of them showed a favorable impact of nutrition modification on the participant's health. Nevertheless, study designs were considerably different, and future studies are needed to support nutrition modifications further. The choice of a healthy considered diet, like the Mediterranean diet, was shown to impact chronic diseases, cardiovascular risk, and adult life expectancy mainly due to its anti-inflammatory and antioxidant properties. Furthermore, a high intake of fibers, fruits, and vegetables together with a low intake of fat and energy-dense, processed foods contribute to an inflammation reduction and a more robust immune system leading. Besides these well-known properties, all lifestyle modifications must be personalized according to the availability of foods, geographic localizations, and the healthy status of the patient.
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Affiliation(s)
- Lèlita Santos
- Internal Medicine Service, Coimbra Hospital and University Centre, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Portugal; CIMAGO Research Centre, Faculty of Medicine, University of Coimbra, Portugal.
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Adherence to COVID-19 nutritional guidelines and their impact on the clinical outcomes of hospitalized COVID-19 patients. Clin Nutr ESPEN 2021; 46:491-498. [PMID: 34857240 PMCID: PMC8450053 DOI: 10.1016/j.clnesp.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/01/2021] [Accepted: 09/11/2021] [Indexed: 11/25/2022]
Abstract
Background & aims Coronavirus disease 2019 (COVID-19) patients are at high risk of malnutrition, and their doctors are part of a multidisciplinary team, including nutritionists. However, adherence to nutritional guidelines may be difficult in the context of capacity constraints during the COVID-19 pandemic. The aim of this study was to investigate barriers to doctors' adherence to nutritional guidelines and the impacts of guideline adherence on the outcomes of hospitalized COVID-19 patients. Methods A multinational electronic survey involving 51 doctors was conducted between November 2020 and January 2021 from 17 COVID-19-designated hospitals in countries with high (Indonesia) and low (Vietnam) numbers of confirmed COVID-19 cases. Results In general, doctors reported concerns related to nutritional practices in patients with Covid-19 which included feeling stress when performing medical nutritional therapy (65%), lacking self-efficacy or confidence in performing nutritional care (49%), lacking clear nutritional guidelines (45%), and experiencing budget limitations (33%). A regression analysis adjusted for age, country, and the number of hospitalized COVID-19 cases revealed that guideline knowledge (β: −1.01 (−1.78, −0.23); p = 0.012) and awareness of guidelines (β: −1.37 (−2.66, −0.09); p = 0.037) were negatively correlated with the length of stay of critically ill COVID-19 patients, but non-significant after adjusting for specialization of the doctor. When stratified according to country, a significant relationship between guideline adherence and length of stay of critically ill patients was only found in Vietnam [guideline adherence: β: −0.55 (−1.08, −0.03); p = 0.038; guideline knowledge: β: −1.01 (−1.9, −0.13); p = 0.027] after adjusting for age, specialty, and number of hospitalized COVID-19 cases. In Indonesia, the significant relationship between guideline adherence and mortality of COVID-19 patients remained strong (β: −14 (−27, −1); p = 0.033) after adjusting for age, specialty, and number of hospitalized COVID-19 cases Conclusions Inadequate nutritional knowledge is a key barrier to guideline adherence, and this was international and may be related to doctors' specialties and the COVID-19 pandemic. Adherence to nutritional guidelines may represent a prognostic factor for survival in COVID-19 patients.
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Leggett LK, Ahmed K, Vanier C, Sadik A. A Suggested Strategy to Integrate an Elective on Clinical Nutrition with Culinary Medicine. MEDICAL SCIENCE EDUCATOR 2021; 31:1591-1600. [PMID: 34603833 PMCID: PMC8446146 DOI: 10.1007/s40670-021-01346-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 06/02/2023]
Abstract
Time allocated to nutrition education in the medical school curriculum stands in contrast to high mortality rates attributable to poor diet in patients. Counseling patients on nutrition-related diseases is a critical skill for physicians, particularly those entering primary care. The crowded medical school curriculum has made adding hours of nutrition instruction difficult. This study evaluates the attitudes of undergraduate medical students at a single institution regarding the need for and relevance of nutrition education and reports on organization of and students' responses to a short experimental elective. Student attitudes regarding nutrition in medicine and a proposed nutrition elective were surveyed. Results helped formulate a short experimental elective. A two-session experimental course was completed, after which the participants were surveyed. Students agreed or strongly agreed with statements regarding the importance of nutrition in clinical practice. Greater than 60% of students surveyed in each class were interested in the proposed elective. All participants found the elective with culinary medicine sessions at least moderately useful to their needs as future healthcare providers. The majority of participants (more than 93%) reported being likely to both take and recommend the elective should it be offered in the future. Medical students consider nutrition an essential aspect of a patient encounter, but do not feel prepared to counsel future patients on dietary changes for management and/or prevention of nutrition linked diseases. There is strong student support for creating an elective in clinical nutrition with culinary medicine sessions to address the gap in their education and improve their confidence. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-021-01346-3.
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Affiliation(s)
- Lindsey K. Leggett
- College of Osteopathic Medicine, Touro University Nevada, Henderson, NV USA
| | - Kareem Ahmed
- College of Osteopathic Medicine, Touro University Nevada, Henderson, NV USA
| | - Cheryl Vanier
- College of Osteopathic Medicine, Touro University Nevada, Henderson, NV USA
| | - Amina Sadik
- College of Osteopathic Medicine, Touro University Nevada, Henderson, NV USA
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Prevention and Reversal of Morbidity in Today's Cardiovascular Patient: Role of Lifestyle Modification and Nutrition in the Current Era. Curr Cardiol Rep 2021; 23:143. [PMID: 34410533 DOI: 10.1007/s11886-021-01577-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW The prevalence of cardiovascular disease despite good medical therapy is on the rise, driven by risk factors such as hypertension, diabetes, hypercholesterolemia, and obesity. As healthcare providers, we must seek to better advise patients on preventative strategies through lifestyle changes. RECENT FINDINGS Guideline recommendations have been published by professional societies on the prevention of heart disease through lifestyle changes; however, limited education and experience with these lifestyle-modifying methods hinders appropriate counseling and treatment of patients. Robust data support the use of lifestyle medicine to reduce cardiovascular morbidity and risk. These include, a more plant-based whole food diet, regular exercise, stress relief, connectedness, and other lifestyle approaches. This review will help further the understanding of the front-line clinician in cardiovascular prevention.
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Magallanes E, Sen A, Siler M, Albin J. Nutrition from the kitchen: culinary medicine impacts students' counseling confidence. BMC MEDICAL EDUCATION 2021; 21:88. [PMID: 33541352 PMCID: PMC7863372 DOI: 10.1186/s12909-021-02512-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/26/2021] [Indexed: 06/02/2023]
Abstract
BACKGROUND Although a poor diet is the number one risk factor for early death in the United States and globally, physicians receive little to no training in dietary interventions and lack confidence counseling patients about lifestyle modifications. Innovative, interprofessional strategies to address these gaps include the emergence of culinary medicine, a hands-on approach to teaching the role of food in health outcomes. We sought to assess the impact of a culinary medicine elective on counseling confidence, awareness of an evidence-based approach to nutrition, and understanding of the role of interprofessional teamwork in dietary lifestyle change among medical students at one undergraduate medical school. METHODS We administered pre- and post-course surveys to two cohorts of medical students (n = 64 at pre-test and n = 60 at post-test) participating in a culinary medicine enrichment elective. Chi-square analysis was used to assess the relationship between participation in the course and a positive response to each survey item. RESULTS Compared with the baseline, students participating in culinary medicine were more likely to feel confident discussing nutrition with patients (29% vs 92%; p < 0.001), to feel familiar with the Mediterranean diet (54% vs. 97%; p < 0.001), and to understand the role of dietitians in patient care (37% vs. 93%; p < 0.001). CONCLUSIONS Culinary medicine shows promise as an impactful educational strategy among first-year medical students for increasing counseling confidence, promoting familiarity with evidence-based nutrition interventions, and augmenting understanding of the role of interprofessional engagement to address lifestyle-related disease.
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Affiliation(s)
- Emily Magallanes
- UT Southwestern School of Medicine, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Ahana Sen
- Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Milette Siler
- Moncrief Cancer Institute at UT Southwestern, 400 W. Magnolia Ave, Fort Worth, TX, 76104, USA
| | - Jaclyn Albin
- Departments of Pediatrics and Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
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Siopis G, Colagiuri S, Allman-Farinelli M. People With Type 2 Diabetes Report Dietitians, Social Support, and Health Literacy Facilitate Their Dietary Change. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:43-53. [PMID: 33077370 DOI: 10.1016/j.jneb.2020.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/22/2020] [Accepted: 09/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To describe the experiences and perspectives of people with type 2 diabetes mellitus (T2DM) regarding dietetic services and to suggest improvements for their access and delivery. DESIGN Semistructured telephone interviews. SETTING Urban and rural Australia. PARTICIPANTS A total of 30 English-speaking adults with T2DM recruited by means of electronic advertisements and posters. PHENOMENON OF INTEREST Engagement with services, adherence to diet, and perspectives regarding dietetic services. ANALYSIS Capability, opportunity, and motivation model of behavior and theoretical domains framework informed the analysis. RESULTS Participants were predominantly middle-aged, White, university-educated, and full-time professionals. Most had been diagnosed with T2DM for 2 years or more, were overweight or obese, were on glucose-lowering medication, and had visited the dietitian at least once. Two inter-related behaviors were identified: eating a healthy diet for T2DM and participating with dietetic services. Health literacy, as well as support by family, friends, and professionals, were reported as enablers for both these behaviors. Barriers stated included misconceptions about diets and the role of dietitians, unpleasant previous experiences with services, and lack of social support. CONCLUSIONS AND IMPLICATIONS These data support that improving health literacy of people with T2DM, in conjunction with social support by family and friends and professional support by dietitians, is likely to facilitate dietary behavior change.
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Affiliation(s)
- George Siopis
- School of Life and Environmental Sciences, The University of Sydney, Sydney, Australia.
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Siopis G, Colagiuri S, Allman-Farinelli M. Doctors identify regulatory barriers for their patients with type 2 diabetes to access the nutritional expertise of dietitians. Aust J Prim Health 2021; 27:312-318. [PMID: 33352088 DOI: 10.1071/py20228] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/07/2020] [Indexed: 11/23/2022]
Abstract
Diet is central to the management of type 2 diabetes (T2D) and better outcomes are achieved when the dietary intervention is delivered by a dietitian. Yet, many people with T2D never see a dietitian. It has been proposed that doctors prefer to provide the dietary advice themselves or rely on medication to treat their patients instead of referring them to a dietitian. This study aimed to collect the opinions and perspectives of doctors with regard to the dietary management of people with T2D in Australia. GPs and physicians treating people with T2D were recruited to participate in semistructured interviews conducted over the telephone. Inductive thematic analysis of content was conducted. Five GPs and seven physicians participated in the study. The qualitative analysis identified four main themes: the importance and role of diet in the management of T2D; the perceived value of dietetic care; access to dietetic services; and patients' motivation to consult a dietitian. All participants acknowledged the importance of diet in the treatment of T2D and all but one preferred to refer patients to a dietitian for nutritional management. Among the reported barriers to accessing dietetic services were: specialist physicians' lack of access to the national referral scheme for chronic conditions; patients' financial circumstances; and inadequacy of the number of subsidised sessions. It is important to facilitate and subsidise access to dietetic services through existing mechanisms by increasing the number of visits on the chronic disease management scheme and providing referral rights to specialist physicians.
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Affiliation(s)
- George Siopis
- Charles Perkins Centre, School of Life and Environmental Sciences, The University of Sydney, Sydney, NSW 2006, Australia; and Corresponding author.
| | - Stephen Colagiuri
- Charles Perkins Centre, Boden Collaboration, The University of Sydney, Sydney, NSW 2006, Australia
| | - Margaret Allman-Farinelli
- Charles Perkins Centre, School of Life and Environmental Sciences, The University of Sydney, Sydney, NSW 2006, Australia
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Advancing European nutrition - are pharmacists eligible partners in the process? Eur J Clin Nutr 2021; 75:1349-1358. [PMID: 33531633 PMCID: PMC7851801 DOI: 10.1038/s41430-020-00846-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 12/01/2020] [Accepted: 12/10/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND/OBJECTIVES Pharmacists may play an important role in disease prevention through the public education about dietary and lifestyle behaviors, however their expertise is constantly ignored. The study primarily aimed to identify nutrition knowledge and dietary habits among Polish pharmacists. SUBJECTS A total sample screened consisted of 1412 respondents, yet 667 (573 females and 94 males) pharmacists finally participated in the study. A validated questionnaire for Polish population, the Dietary Habits and Nutrition Beliefs Questionnaire, was used for the evaluation. RESULTS The majority of pharmacists (94%) were current non-smokers with BMI levels below 25 kg/m2 (66.5%). Female pharmacists had higher the Pro-Healthy (pHDI-10) score (p < 0.001) and lower the Non-Healthy (nHDI-14) score (p = 0.004) compared to the males. In the self-assessment of nutritional habits, the pHDI-10 was significantly higher in the "very good" group compared to the "poor" (p < 0.001) and the "very poor" (p = 0.015) group, and the "poor group" had higher nHDI-14 when compared to "very good" (p < 0.001) and "good" (p < 0.001) groups. The nutrition knowledge test score was above average in over 72% of respondents, was correlated with the pHDI-10 (r = 0.16), yet the score decreased with age (r = -0.19). CONCLUSIONS We believe that our analysis justifies the inevitability to benefit from pharmacists' expertise. Pharmacists with around-the-clock accessibility should be eligible partners, as members of an interdisciplinary team, in the process of advancing population-based nutrition.
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Mattson MP. Applying available knowledge and resources to alleviate familial and sporadic neurodegenerative disorders. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2020; 177:91-107. [PMID: 33453944 DOI: 10.1016/bs.pmbts.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Here I present the scientific rationale and implementation strategies for elimination of early-onset neurodegenerative disorders (EONDD) from future generations, and for risk reduction and treatments for the more common late-onset neurodegenerative disorders (LONDD). Young adults with a family history of an EONDD should be educated on the genetics and familial burden of EONDD. They can then be genotyped and, if positive for the mutation, counseled as to how they can ensure that none of their children will be affected by choosing either adoption or in vitro fertilization and preimplantation genetic testing. LONDD risk reduction will require education of physicians and patients on the benefits of regular intermittent bioenergetic and cognitive challenges (exercise, intermittent fasting, intellectual challenges and social engagement) for brain health, and on specific risk-reduction regimens. Regulations will be required to counteract the disease-promoting mercenary practices of the processed food and pharmaceutical industries. Clinical trials of pharmacological interventions should shift to small trials of agents that substantially mimic mechanisms of action of exercise and intermittent fasting to bolster neuronal bioenergetics and stress resistance.
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Affiliation(s)
- Mark P Mattson
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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Siopis G, Wang L, Colagiuri S, Allman‐Farinelli M. Cost effectiveness of dietitian‐led nutrition therapy for people with type 2 diabetes mellitus: a scoping review. J Hum Nutr Diet 2020; 34:81-93. [DOI: 10.1111/jhn.12821] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/06/2020] [Accepted: 09/12/2020] [Indexed: 11/28/2022]
Affiliation(s)
- G. Siopis
- Charles Perkins Centre School of Life and Environmental Sciences The University of Sydney Sydney NSW Australia
| | - L. Wang
- Charles Perkins Centre School of Life and Environmental Sciences The University of Sydney Sydney NSW Australia
| | - S. Colagiuri
- Boden Collaboration The University of Sydney Sydney NSW Australia
| | - M. Allman‐Farinelli
- Charles Perkins Centre School of Life and Environmental Sciences The University of Sydney Sydney NSW Australia
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Freeman AM, Aggarwal M. Malnutrition in the Obese. J Am Coll Cardiol 2020; 76:841-843. [DOI: 10.1016/j.jacc.2020.06.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 11/24/2022]
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Putting Knowledge into Practice: Low-Income Women Talk about Food Choice Decisions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145092. [PMID: 32679700 PMCID: PMC7400203 DOI: 10.3390/ijerph17145092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 12/28/2022]
Abstract
Insights into barriers and facilitators for healthy eating are needed to improve low-income women's diets and to decrease disease risk. The study objectives were to explore women's qualitative perceptions of influences on their food choices such as food security, their knowledge of nutrition-related health risk factors and self-efficacy for diet change, and their dietary intakes in practice. Thirty-six women, aged 19-50, who were eligible to receive income-based assistance were recruited in central Iowa. Focus group discussions on defining healthy foods, influences on food choice, and nutrition information sources were analyzed using a socioecological model framework. Demographics, nutrient intake estimates, food security status, health behaviors, and self-efficacy for nutrition behavior change were collected by survey. Most participants were White (61%), single (69%), food insecure (69%), and living with children (67%). Few women met dietary recommendations. Barriers to healthy eating include cost, convenience/preparation time, family taste preferences, and limitations of federal food assistance programs. Facilitators are high self-efficacy for nutrition change and health knowledge on average. These results challenge the strategy of using nutrition education to improve healthy eating and instead show that intervention messaging should focus on limited, achievable steps to improve dietary choices that fit within cost, convenience, and taste constraints.
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Education and Diet in the Scientific Literature: A Study of the Productive, Structural, and Dynamic Development in Web of Science. SUSTAINABILITY 2020. [DOI: 10.3390/su12124838] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Nutrition-related education is necessary to protect and improve the health status of schoolchildren and to minimize the risk of future diseases. The objective of this research was to analyze the trajectory and transcendence of the concepts “education” and “diet” in the Web of Science literature. The methodology focused on bibliometry, analyzing both the performance and the structural and dynamic development of the concepts through a co-word analysis. A total of 1247 documents were analyzed, and the results show that scientific production experienced a turning point in 2009, in comparison to the level of production reported in previous years. The medium of papers and the language of English were the most common. In relation to the research topic, before 2014, scientific production focused on medical and disease-related aspects; however, since 2014, it has focused on disease prevention and feeding. It was therefore concluded that the theme “diet and education” has been researched for more than 20 years, although it is only in the last decade that it has become more relevant—particularly studies focusing on disease prevention and the type of food, specifically fruit, which is presented as the most outstanding issue for researchers in this field of knowledge.
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Moullet C, Schmutz E, Laure Depeyre J, Perez MH, Cotting J, Jotterand Chaparro C. Physicians' perceptions about managing enteral nutrition and the implementation of tools to assist in nutritional decision-making in a paediatric intensive care unit. Aust Crit Care 2020; 33:219-227. [PMID: 32414683 DOI: 10.1016/j.aucc.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/08/2020] [Accepted: 03/14/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND For critically ill children hospitalised in paediatric intensive care units, adequate nutrition reduces their risk of morbidity and mortality. Barriers may impede optimal nutritional support in this population. Moreover, physicians are usually responsible for prescribing nutrition, although they are not experts. Therefore, tools may be used to assist in nutritional decision-making, such as nutrition protocols. OBJECTIVES The objective of this two-stage qualitative study was to explore the perceptions of physicians about their management of enteral nutrition in a paediatric intensive care unit and the implementation of a nutrition protocol and computerised system. METHODS This study involved semistructured interviews with physicians at the Paediatric Intensive Care Unit of Lausanne University Hospital, Switzerland. Research dietitians conducted interviews before (stage one) and after (stage two) the implementation of a nutrition protocol and computerised system. During stage one, six junior physicians and five fellows were interviewed. At stage two, 12 junior physicians, 12 fellows, and five senior physicians were interviewed. Interviews were recorded, with data transcribed verbatim before a thematic analysis using a framework method. RESULTS Three themes emerged from thematic analysis: "nutritional knowledge", "nutritional practices", and "resources to manage nutrition". During stage one, physicians, especially junior physicians, reported a lack of nutritional knowledge for critically ill children and stated that nutritional issues primarily depended on senior physicians, who themselves had various practices. All physicians were in favour of a nutrition protocol and computerised system. At stage two, interviewees stated that they used both tools regularly. They reported improved nutritional knowledge, more systematic and consistent nutritional practices, and increased attention to nutrition. CONCLUSIONS The implementation of a nutrition protocol and computerised system by a multiprofessional team helped physicians in the paediatric intensive care unit to manage nutritional support and increase their attention to nutrition.
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Affiliation(s)
- Clémence Moullet
- Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Rue des Caroubiers 25, 1227 Carouge, Geneva, Switzerland.
| | - Elodie Schmutz
- HES-SO Master, University of Applied Sciences and Arts Western Switzerland, Avenue de Provence 6, 1007 Lausanne, University of Lausanne, Switzerland.
| | - Jocelyne Laure Depeyre
- Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Rue des Caroubiers 25, 1227 Carouge, Geneva, Switzerland.
| | - Marie-Hélène Perez
- Pediatric Intensive Care Unit, Lausanne University Hospital (CHUV/UNIL), Rue Du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Jacques Cotting
- Pediatric Intensive Care Unit, Lausanne University Hospital (CHUV/UNIL), Rue Du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Corinne Jotterand Chaparro
- Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Rue des Caroubiers 25, 1227 Carouge, Geneva, Switzerland.
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López Núñez JA, López-Belmonte J, Moreno-Guerrero AJ, Marín-Marín JA. Dietary Intervention through Flipped Learning as a Techno Pedagogy for the Promotion of Healthy Eating in Secondary Education. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093007. [PMID: 32357445 PMCID: PMC7246569 DOI: 10.3390/ijerph17093007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 12/04/2022]
Abstract
Technological progress in the educational field has led to the application of active and innovative teaching methods, such as flipped learning, including in the field of dietary education. This is considered a mixed formative approach that combines face-to-face and outside the classroom education. The objective of this research was to analyze the effectiveness of flipped learning methodology on a traditional training practice in dietary training, both in the sixth grade of primary education and in the fourth level of secondary education. A quasi-experimental design was adopted with two experimental groups, two control groups and only posttest. The final sample was composed of 115 students divided into four groups, two of each educational stage mentioned. A didactic unit consisting of six sessions in all groups was applied. Two different training methodologies were followed according to the nature of the group (control-traditional; experimental-flipped learning). The results reveal that flipped learning is effective both in primary education and in secondary education, being more influential in student development in this last stage. It is concluded that the flipped learning approach has meant an improvement of the academic indicators evaluated after a diet education program.
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Devries S. A global deficiency of nutrition education in physician training: the low hanging fruit in medicine remains on the vine. Lancet Planet Health 2019; 3:e371-e372. [PMID: 31538619 DOI: 10.1016/s2542-5196(19)30173-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/10/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Stephen Devries
- Gaples Institute for Integrative Cardiology, Deerfield, IL 60015, USA; Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Aggarwal M. The Reply. Am J Med 2019; 132:e594. [PMID: 31221369 DOI: 10.1016/j.amjmed.2019.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 01/28/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Monica Aggarwal
- Division of Cardiovascular Medicine, Health Science Center, University of Florida, Gainesville
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Baty V. Do Physicians Need a Storyteller Education in the Field of Nutrition? Am J Med 2019; 132:e593. [PMID: 30149888 DOI: 10.1016/j.amjmed.2018.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/09/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
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Vallée Marcotte B, Cormier H, Garneau V, Robitaille J, Desroches S, Vohl MC. Nutrigenetic Testing for Personalized Nutrition: An Evaluation of Public Perceptions, Attitudes, and Concerns in a Population of French Canadians. Lifestyle Genom 2019; 11:155-162. [DOI: 10.1159/000499626] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/12/2019] [Indexed: 11/19/2022] Open
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Albus C, Waller C, Fritzsche K, Gunold H, Haass M, Hamann B, Kindermann I, Köllner V, Leithäuser B, Marx N, Meesmann M, Michal M, Ronel J, Scherer M, Schrader V, Schwaab B, Weber CS, Herrmann-Lingen C. Significance of psychosocial factors in cardiology: update 2018. Clin Res Cardiol 2019; 108:1175-1196. [DOI: 10.1007/s00392-019-01488-w] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/29/2019] [Indexed: 12/13/2022]
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Mondala MM, Sannidhi D. Catalysts for Change: Accelerating the Lifestyle Medicine Movement Through Professionals in Training. Am J Lifestyle Med 2019; 13:487-494. [PMID: 31523214 DOI: 10.1177/1559827619844505] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
While the Western diet has evolved to become increasingly high in saturated fat, cholesterol, protein, sugar, and salt intake, nutrition education and training of health care professionals to counsel their patients on the hazards of such a diet has trailed behind. Primary care physicians have an opportunity to bridge the gap by providing nutrition and dietary counseling as key components in the delivery of preventive services. Increasing research points to the value of a whole-foods plant-based diet in combating chronic disease, yet the knowledge of health professionals about the topic is comparable to that of the general public. This education crisis is apparent in medical training with restricted time for dedicated lectures on nutrition, physical activity, restorative sleep, emotional well-being, and avoidance of risky substance use. Together, educators and learners are valuable catalysts for culture change in medical education, training, and clinical practice. Barriers to physician ability to counsel about lifestyle are many, but one that stands out is lack of training and comfort with counseling. This has implications for the training of health care professionals. American College of Lifestyle Medicine has a committee, Professionals in Training, composed of interprofessional and multidisciplinary students, residents, and fellows nationally and worldwide who are committed to expanding exposure to lifestyle medicine and implementation of lifestyle medicine in parallel curriculum and personal care.
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Affiliation(s)
- Melissa M Mondala
- Department of Preventative and Family Medicine, Loma Linda University Health, Loma Linda, California (MMM).,Department of Family Medicine and Public Health, University of California San Diego, San Diego, California (DS)
| | - Deepa Sannidhi
- Department of Preventative and Family Medicine, Loma Linda University Health, Loma Linda, California (MMM).,Department of Family Medicine and Public Health, University of California San Diego, San Diego, California (DS)
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Rippe JM. Lifestyle Medicine: The Health Promoting Power of Daily Habits and Practices. Am J Lifestyle Med 2018; 12:499-512. [PMID: 30783405 PMCID: PMC6367881 DOI: 10.1177/1559827618785554] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 12/29/2022] Open
Abstract
There is no longer any serious doubt that daily habits and actions profoundly affect both short-term and long-term health and quality of life. This concept is supported by literally thousands of research articles and incorporated in multiple evidence-based guidelines for the prevention and/or treatment of chronic metabolic diseases. The study of how habits and actions affect both prevention and treatment of diseases has coalesced around the concept of "lifestyle medicine." The purpose of this review is to provide an up-to-date summary of many of the modalities fundamental to lifestyle medicine, including physical activity, proper nutrition, weight management, and cigarette smoking cessation. This review will also focus specifically on how these modalities are employed both in the prevention and treatment of chronic diseases including coronary heart disease, diabetes, obesity, and cancer. The review concludes with a Call to Action challenging the medical community to embrace the modalities of lifestyle medicine in the daily practice of medicine.
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Reddy KR, Freeman AM, Esselstyn CB. An Urgent Need to Incorporate Evidence-Based Nutrition and Lifestyle Medicine Into Medical Training. Am J Lifestyle Med 2018; 13:40-41. [PMID: 30627076 DOI: 10.1177/1559827618781764] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
It is well established that evidence based clinical nutrition and lifestyle practices play a pivotal role in the prevention, treatment and potential reversal of various common chronic diseases. However, this area of science is under appreciated at all levels of medical education and training. Most medical schools and residency programs do not offer any organized training in nutrition and lifestyle medicine. Given recent data on the rising cost and loss of quality of life secondary to preventable causes, there is an absolute need for a drastic reform of the US medical education system.
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Affiliation(s)
- Koushik R Reddy
- James A. Haley Veterans Hospital, Trinity, Florida (KRR).,National Jewish Health, Denver, Colorado (AMF).,Cleveland Clinic, Cleveland, Ohio (CBE)
| | - Andrew M Freeman
- James A. Haley Veterans Hospital, Trinity, Florida (KRR).,National Jewish Health, Denver, Colorado (AMF).,Cleveland Clinic, Cleveland, Ohio (CBE)
| | - Caldwell B Esselstyn
- James A. Haley Veterans Hospital, Trinity, Florida (KRR).,National Jewish Health, Denver, Colorado (AMF).,Cleveland Clinic, Cleveland, Ohio (CBE)
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