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Song C, Cheng X, Bai Y. Association of change in cardiovascular health based on life's essential 8 with incident cardiovascular disease. Am J Prev Cardiol 2024; 18:100668. [PMID: 38646020 PMCID: PMC11033071 DOI: 10.1016/j.ajpc.2024.100668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 03/13/2024] [Accepted: 04/04/2024] [Indexed: 04/23/2024] Open
Abstract
Objective To evaluate whether and to what extent changes in cardiovascular health (CVH) based on life's essential 8 (LE8) are associated with incident cardiovascular disease (CVD). Methods A total of 7,194 participants were derived from UK Biobank. CVH was evaluated using a modified version of LE8. Participants were classified into three groups according to their LE8 score: high CVH (LE8 score≥80), moderate CVH (50≤LE8 score<80), and low CVH (LE8 score<50). Changes in CVH between 2006/2010 and 2012/2013 were analyzed. Results During a median of 10.3 years of follow-up, CVD was observed in 597 participants. Compared to the consistent moderate group, the moderate to low group was associated with about 128 % increased risk of CVD (Hazard ratio [HR]: 2.28; 95 % confidence interval [CI]: 1.61, 3.23), and the relevant HR (95 % CI) was 2.19 (1.46, 3.29) for the consistent low group; no statistically significant results were observed in the other groups. Moreover, no statistically significant exposure-response association between absolute change in LE8 score and incident CVD was documented (Poverall=0.15). Conclusion Change in CVH based on LE8 was associated with the risk of CVD; however, the relationship varied widely in different CVH change patterns.
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Affiliation(s)
- Chao Song
- Nosocomial Infection Control Center, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Xunjie Cheng
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yongping Bai
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
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Hildebrand CA, Patel MB, Tenney AB, Logan JA, Luong KH, Crouch MJ, Osta AE, DeRoo C, Gilliland KO, Harlan TS, Ammerman AS. Culinary Medicine Experiences for Medical Students and Residents in the U.S. and Canada: A Scoping Review. TEACHING AND LEARNING IN MEDICINE 2024:1-27. [PMID: 38686837 DOI: 10.1080/10401334.2024.2340977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/22/2024] [Indexed: 05/02/2024]
Abstract
PHENOMENON Despite the importance of diet in the prevention and management of many common chronic diseases, nutrition training in medicine is largely inadequate in medical school and residency. The emerging field of culinary medicine offers an experiential nutrition learning approach with the potential to address the need for improved nutrition training of physicians. Exploring this innovative nutrition training strategy, this scoping review describes the nature of culinary medicine experiences for medical students and resident physicians, their impact on the medical trainees, and barriers and facilitators to their implementation. APPROACH This scoping review used the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) checklist as guides. Eligible publications described the nature, impact, facilitators, and/or barriers of nutrition and food preparation learning experiences for medical students and/or residents. Additional inclusion criteria were location (U.S. or Canada), allopathic or osteopathic, English, human subjects, and publication year (2002 or later). The search strategy included 4 electronic databases. Two reviewers independently screened titles/abstracts and a third reviewer resolved discrepancies. The full-text review consisted of 2 independent reviews with discrepancies resolved by a third reviewer or by consensus if needed, and the research team extracted data from the included articles based on the nature, impact, barriers, and facilitators of culinary medicine experiences for medical trainees. FINDINGS The publication search resulted in 100 publications describing 116 experiences from 70 institutions. Thirty-seven publications described pilot experiences. Elective/extracurricular and medical student experiences were more common than required and resident experiences, respectively. Experiences varied in logistics, instruction, and curricula. Common themes of tailored culinary medicine experiences included community engagement/service-based learning, interprofessional education, attention to social determinants of health, trainee well-being, and cultural considerations. Program evaluations commonly reported the outcome of experiences on participant attitudes, knowledge, skills, confidence, and behaviors. Frequent barriers to implementation included time, faculty, cost/funding, kitchen space, and institutional support while common facilitators of experiences included funding/donations, collaboratives and partnerships, teaching kitchen access, faculty and institutional support, and trainee advocacy. INSIGHTS Culinary medicine is an innovative approach to address the need and increased demand for improved nutrition training in medicine. The findings from this review can guide medical education stakeholders interested in developing or modifying culinary medicine experiences. Despite barriers to implementation, culinary medicine experiences can be offered in a variety of ways during undergraduate and graduate medical education and can be creatively designed to fulfill some accreditation standards.
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Affiliation(s)
- Caitlin A Hildebrand
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Nutrition at Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- University of North Carolina Center for Health Promotion and Disease Prevention, Chapel Hill, North Carolina, USA
| | - Meghana B Patel
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alyssa B Tenney
- Larner College of Medicine at The University of Vermont, Burlington, Vermont, USA
| | - Julia A Logan
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Khanh H Luong
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Miranda J Crouch
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Amanda E Osta
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Courtney DeRoo
- Department of Health Policy and Management at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kurt O Gilliland
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Timothy S Harlan
- George Washington University School of Medicine, Washington, D.C., USA
| | - Alice S Ammerman
- Department of Nutrition at Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- University of North Carolina Center for Health Promotion and Disease Prevention, Chapel Hill, North Carolina, USA
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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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Megee PC, Uhley V, Grogan J, Silverman A. Foundational and Clinical Science Integration in a Team-Based Learning Module Modeling Care of a Patient With Dyslipidemia. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2024; 20:11397. [PMID: 38595707 PMCID: PMC11001791 DOI: 10.15766/mep_2374-8265.11397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/14/2024] [Indexed: 04/11/2024]
Abstract
Introduction Foundational and clinical science integration, a long-standing goal of undergraduate medical education, benefits learners by promoting retention of critical knowledge and skills as well as their transfer to the clinical setting. We implemented a team-based learning (TBL) module in which foundational knowledge and skills from the disciplines of biochemistry, nutrition, and genetics were leveraged in a simulated patient encounter for diagnosis and management of a patient with dyslipidemia. Methods The TBL was deployed in a first-year medical student cardiovascular system course with 125 students over three academic years. Following individual and team readiness assurance tests (iRAT and tRAT, respectively), teams participated in an initial application exercise requiring consideration of clinical and laboratory data and other risk factors to engage the patient in a shared decision-making process. Using dietary and family history narratives in subsequent application exercises, teams completed recommendations for an individualized diet plan and an assessment of potential disease inheritance patterns to formulate appropriate patient care management strategies. Results Student engagement with prelearning materials and session team activities was high as judged by RAT performance and application exercise outcomes: iRAT question performance ranged from 89% to 99% for individual items, and tRAT performance was routinely 100%. Learners reported that the exercises were impactful and believed the learned foundational knowledge and skills were transferable to future patient care. Discussion The dyslipidemia TBL module provides an illustration for early clinical learners of how foundational knowledge and skills can be operationalized and transferred for optimal patient care.
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Affiliation(s)
- Paul C. Megee
- Associate Professor, Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine
| | - Virginia Uhley
- Associate Professor, Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine
| | - James Grogan
- Professor, Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine
| | - Alan Silverman
- Assistant Professor, Department of Internal Medicine, Oakland University William Beaumont School of Medicine; Clinical Assistant Professor, Department of Internal Medicine, Wayne State University School of Medicine
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5
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Walker MS, Figueiredo NR, de Lara Machado W, Costa CAD, Feoli AMP. Cognitive-behavioral therapy for treating hypertension: a systematic review and meta-analysis. PSYCHOL HEALTH MED 2024; 29:411-426. [PMID: 37990412 DOI: 10.1080/13548506.2023.2282958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/07/2023] [Indexed: 11/23/2023]
Abstract
The aim of the study is to investigate whether cognitive behavioral therapy (CBT) can help in reducing blood pressure (BP) in patients with hypertension, both systolic blood pressure (SBP) and diastolic blood pressure (DBP), this being the primary outcome. This was a systematic review with a meta-analysis that followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. The keywords used for the searches were CBT and hypertension and their respective synonyms, and were applied to the Pubmed, EMBASE and Web of Science databases. Eligibility and data extraction were performed by two independent researchers. They assessed the risk of bias using the Cochrane's RoB 2 tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of the evidence. The data was pooled on the basis that all the analyses had a random effects model. Twenty-two studies were included in this review. In the meta-analysis, 11 studies were included in the analyses of the BP outcomes (SBP and DBP), five studies were included in the follow-up evaluation, and two studies in the body mass index (BMI) analysis. The searches included a total of 2897 patients. The studies presented a high risk of bias and very low quality of evidence. We observed an effect of -0.65 (95% CI: -0.91; -0.39) for CBT-based interventions on SBP with high heterogeneity (I2 85%) and a higher effect of -0.78% (95% CI: -1.13; -0.43) on DBP with even greater heterogeneity (I2 92%). We observed that CBT did have an effect on reducing BP and BMI in hypertensive adults. However, due to the considerable heterogeneity between the studies, the high risk of bias, and the low overall quality of evidence, confidence in these findings should be limited.
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Affiliation(s)
- Marthina S Walker
- Post-Graduation Program in Psychology, Pontifical Catholic University of Rio Grande do Sulepartment, Porto Alegre, Brasil
| | - Natália R Figueiredo
- Post-Graduation Program in Psychology, Pontifical Catholic University of Rio Grande do Sulepartment, Porto Alegre, Brasil
| | - Wagner de Lara Machado
- Post-Graduation Program in Psychology, Pontifical Catholic University of Rio Grande do Sulepartment, Porto Alegre, Brasil
| | - Caroline A D Costa
- Post-Graduation Program in Child-Adolescent Health, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brasil
| | - Ana Maria P Feoli
- Post-Graduation Program in Psychology, Pontifical Catholic University of Rio Grande do Sulepartment, Porto Alegre, Brasil
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6
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Hachey SM, Hamilton C, Goins B, Underwood P, Chao AM, Dolin CD. Nutrition Education and Nutrition Knowledge Among Obstetrics and Gynecology Residents. J Womens Health (Larchmt) 2024. [PMID: 38417037 DOI: 10.1089/jwh.2023.0922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
Background: Nutrition in pregnancy is a component of the Council on Resident Education in obstetrics and gynecology core curriculum; however, no studies currently examine adherence to this goal. Objectives: Our objective was to assess obstetrics and gynecology (Ob/Gyn) residents' education and knowledge surrounding nutrition in pregnancy, including (1) amount of dedicated didactic time to and attitudes toward, (2) subjective comfort in counseling patients on, and (3) objective knowledge of pregnancy-related nutrition. Materials and Methods: This is a cross-sectional electronic survey-based study. A 28-item questionnaire was distributed to residents enrolled in Ob/Gyn training programs across the United States in 2022. Results: From 247 Ob/Gyn residency programs, 218 residents across postgraduate years and from geographically diverse locations consented to participation and completed all survey questions. Almost half (48%) of participants reported 0 hours per year of dedicated nutrition-related education, 49% reported 1-2 hours, and 3% reported >2 hours. Most residents (92%) strongly agreed or agreed that education regarding pregnancy-related nutrition guidelines would be useful for clinical practice. However, less than one-third (31%) of residents reported feeling comfortable counseling patients on nutrition in pregnancy. On assessment of residents' objective knowledge of pregnancy-related nutrition, mean percentage of correct responses was 74%. Conclusions: This study identifies a gap in graduate medical education, specifically a disconnect between the recognized impact of nutrition on pregnancy outcomes and residents' ability to confidently and effectively counsel patients on nutrition in pregnancy. Results demonstrate a need to develop curriculum and interventions to educate Ob/Gyn residents about pregnancy-related nutrition.
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Affiliation(s)
- Sara M Hachey
- Department of Obstetrics and Gynecology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Caitlin Hamilton
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
| | - Bethany Goins
- Department of Obstetrics and Gynecology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Porshia Underwood
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
| | - Ariana M Chao
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Cara D Dolin
- Department of Obstetrics and Gynecology, Cleveland Clinic Lerner College of Medicine, Ob/Gyn and Women's Health Institute, Cleveland, Ohio, USA
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Mozaffarian D, Aspry KE, Garfield K, Kris-Etherton P, Seligman H, Velarde GP, Williams K, Yang E. "Food Is Medicine" Strategies for Nutrition Security and Cardiometabolic Health Equity: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 83:843-864. [PMID: 38383100 DOI: 10.1016/j.jacc.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 02/23/2024]
Abstract
"Food Is Medicine" (FIM) represents a spectrum of food-based interventions integrated into health care for patients with specific health conditions and often social needs. Programs include medically tailored meals, groceries, and produce prescriptions, with varying levels of nutrition and culinary education. Supportive advances include expanded care pathways and payment models, e-screening for food and nutrition security, and curricular and accreditation requirements for medical nutrition education. Evidence supports positive effects of FIM on food insecurity, diet quality, glucose control, hypertension, body weight, disease self-management, self-perceived physical and mental health, and cost-effectiveness or cost savings. However, most studies to date are quasiexperimental or pre/post interventions; larger randomized trials are ongoing. New national and local programs and policies are rapidly accelerating FIM within health care. Remaining research gaps require rigorous, iterative evaluation. Successful incorporation of FIM into health care will require multiparty partnerships to assess, optimize, and scale these promising treatments to advance health and health equity.
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Affiliation(s)
- Dariush Mozaffarian
- Food is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.
| | - Karen E Aspry
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Kathryn Garfield
- Center for Health Law and Policy Innovation, Harvard Law School, Cambridge, Massachusetts, USA
| | | | | | - Gladys P Velarde
- University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Kim Williams
- University of Louisville, Louisville, Kentucky, USA
| | - Eugene Yang
- University of Washington School of Medicine, Seattle, Washington, USA
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Donovan K, Thomas OW, Sweeney T, Ryan TJ, Kytomaa S, Zhao M, Zhong W, Long M, Rajendran I, Sarfaty S, Lenders C. Eat to Treat: The Methods and Assessments of a Culinary Medicine Seminar for Future Physicians and Practicing Clinicians. Nutrients 2023; 15:4819. [PMID: 38004212 PMCID: PMC10674360 DOI: 10.3390/nu15224819] [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: 08/26/2023] [Revised: 10/25/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
Nutrition-associated chronic disease is an epidemic in the United States (US), yet most medical schools lack adequate nutrition education. We developed a six-session culinary medicine (CM) seminar entitled "Eat to Treat: A Nutrition Course for Future Clinicians" that teaches culinary skills, nutrition science, and counseling techniques to improve clinical nutrition management. The seminar was offered in-person to first-year medical students in a medical school-based teaching kitchen from 2017 to 2019. A virtual three-session course was also offered to practicing clinicians in 2020. Voluntary self-efficacy questionnaires were collected at the beginning of the first and last sessions of the student seminar, and paired t-tests determined the course's effect on survey items. A total of 53 first-year medical students attended the program over five semesters, and 39 students (73.6%) completed both surveys. All except one measure of self-efficacy were significantly higher at session 6 than session 1 (p < 0.05). A post-course survey was utilized for the clinician seminar and of the 31 participants, 14 completed the surveys; 93% and 86% of respondents agreed the course was clinically relevant and improved their confidence, respectively. We developed a CM curriculum that improved nutrition knowledge and confidence among a professionally diverse cohort and may represent a scalable education model to improve nutrition education in US medical schools.
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Affiliation(s)
- Kate Donovan
- Department of Pediatrics, Boston Medical Center, Boston, MA 02218, USA
- Department of Food and Nutrition, Boston Medical Center, Boston, MA 02218, USA
| | - Olivia W. Thomas
- Department of Food and Nutrition, Boston Medical Center, Boston, MA 02218, USA
| | - Ty Sweeney
- Department of Medicine, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02218, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Tyler J. Ryan
- Department of Medicine, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02218, USA
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Sonja Kytomaa
- Department of Medicine, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02218, USA
| | - Molly Zhao
- Department of Medicine, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02218, USA
| | - Wayne Zhong
- Department of Medicine, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02218, USA
| | - Michelle Long
- Section of Gastroenterology, Boston Medical Center, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02118, USA
| | - Iniya Rajendran
- Department of General Internal Medicine, Boston Medical Center, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02118, USA
| | - Suzanne Sarfaty
- Department of General Internal Medicine, Boston Medical Center, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02118, USA
| | - Carine Lenders
- Department of Food and Nutrition, Boston Medical Center, Boston, MA 02218, USA
- Department of Pediatrics, Pediatric Nutrition and Fitness for Life, Boston Medical Center, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02118, USA
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Kronsteiner-Gicevic S, Tello M, Lincoln LE, Kondo JK, Naidoo U, Fung TT, Willett WC, Thorndike AN. Validation of the Rapid Prime Diet Quality Score Screener (rPDQS), A Brief Dietary Assessment Tool With Simple Traffic Light Scoring. J Acad Nutr Diet 2023; 123:1541-1554.e7. [PMID: 37244591 DOI: 10.1016/j.jand.2023.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Dietary pattern is a determinant of chronic disease, but nonregistered dietitian nutritionist (non-RDN) clinicians rarely assess diet because of barriers such as time constraints and lack of valid, brief diet quality assessment tools. OBJECTIVE The study aimed to evaluate the relative validity of a brief diet quality screener using both a numeric scoring system and a simple traffic light scoring system. DESIGN A cross-sectional study was conducted using the CloudResearch online platform to compare participants' responses to the 13-item rapid Prime Diet Quality Score screener (rPDQS) and the Automated Self-Administered 24-hour (ASA24) Dietary Assessment Tool. PARTICIPANTS/SETTING The study was conducted in July and August 2021 and included 482 adults ≥18 years of age or older sampled to be representative of the US population. MAIN OUTCOME MEASURES All participants completed the rPDQS and an ASA24; of these, 190 completed a second ASA24 and rPDQS. Responses to rPDQS items were coded using both traffic light (eg, green = healthiest intake, red = least healthy intake) and numeric (eg, consume < 1 time a week, consume ≥ 2 times per day) scoring methods and were compared with food group equivalents and Healthy Eating Index-2015 (HEI-2015) scores estimated from ASA24s. STATISTICAL ANALYSES Deattenuated Pearson correlation coefficients were calculated to account for within-person variation in 24-hour diet recalls. RESULTS Overall, 49% of participants were female, 62% were ≥35 years, and 66% were non-Hispanic White, 13% non-Hispanic Black, 16% Hispanic/Latino, and 5% Asian. For both food groups to encourage (eg, vegetables, whole grains) and to consume in moderation (eg, processed meats, sweets), there were statistically significant associations with intakes assessed by rPDQS, using both traffic light and numeric scoring methods. Total rPDQS scores correlated with the HEI-2015, r = 0.75 (95% confidence interval [CI] = 0.65, 0.82). CONCLUSIONS The rPDQS is a valid, brief diet quality screener that identifies clinically relevant patterns of food intake. Future research is needed to test whether the simple traffic light scoring system is an effective tool that can help non-RDN clinicians provide brief dietary counseling or make referrals to registered dietitian nutritionists, as needed.
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10
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Williams AR, Thomson MD, Britton EL. Associations between blood pressure control and clinical events suggestive of nutrition care documented in electronic health records of patients with hypertension. BMC Med Inform Decis Mak 2023; 23:208. [PMID: 37814248 PMCID: PMC10563207 DOI: 10.1186/s12911-023-02311-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 09/26/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Clinical events suggestive of nutrition care found in electronic health records (EHRs) are rarely explored for their associations with hypertension outcomes. METHODS Longitudinal analysis using structured EHR data from primary care visits at a health system in the US from December 2017-December 2020 of adult patients with hypertension (n = 4,237) tested for associations between last visit blood pressure (BP) control (≤ 140 Systolic BP and ≤ 90 Diastolic BP) and ≥ 1 nutrition care clinical event operationalized as (overweight or obesity (BMI > 25 or 30, respectively) diagnoses, preventive care visits, or provision of patient education materials (PEM)). Descriptive statistics and longitudinal targeted maximum likelihood estimation (LTMLE) models were conducted to explore average treatment effects (ATE) of timing and dose response from these clinical events on blood pressure control overall and by race. RESULTS The median age was 62 years, 29% were male, 52% were Black, 25% were from rural areas and 50% had controlled BP at baseline. Annual documentation of overweight/obesity diagnoses ranged 3.0-7.8%, preventive care visits ranged 6.2-15.7%, and PEM with dietary and hypertension content were distributed to 8.5-28.8% patients. LTMLE models stratified by race showed differences in timing, dose, and type of nutrition care. Black patients who had nutrition care in Year 3 only compared to none had lower odds for BP control (ATE -0.23, 95% CI: -0.38,-0.08, p = 0.003), preventive visits in the last 2 years high higher odds for BP control (ATE 0.31, 95% CI: 0.07,0.54, p = 0.01), and early or late PEMs had lower odds for BP control (ATE -0.08, 95% CI: -0.15,-0.01, p = 0.03 and ATE -0.23, 95% CI: -0.41,-0.05, p = 0.01, respectively). CONCLUSIONS In this study, clinical events suggestive of nutrition care are significantly associated with BP control, but are infrequent and effects differ by type, timing, and patient race. Preventive visits appear to have the most effect; additional research should include examining clinical notes for evidence of nutrition care among different populations, which may uncover areas for improving nutrition care for patients with chronic disease.
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Affiliation(s)
- April R Williams
- Health Behavior and Policy, Virginia Commonwealth University, 830 E Main Street, Richmond, VA, 23219, USA.
| | - Maria D Thomson
- Health Behavior and Policy, Virginia Commonwealth University, 830 E Main Street, Richmond, VA, 23219, USA
| | - Erin L Britton
- Health Behavior and Policy, Virginia Commonwealth University, 830 E Main Street, Richmond, VA, 23219, USA
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Uhlig-Reche H, Ontiveros D, Syzdek R, Mathews P, Dalal L, Amaro A, Wunnava N, Housammy Z, Schmitt B, Sharrief A, Gonzales NR. Description of Baseline Nutrition and Physical Activity Knowledge and Behavior in Acute Stroke/TIA Patients Enrolled in the Health Education on Information Retention and Behavior Change in Stroke (HERBS) Pilot Trial. Nutrients 2023; 15:3761. [PMID: 37686793 PMCID: PMC10490333 DOI: 10.3390/nu15173761] [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: 07/19/2023] [Revised: 08/24/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Lifestyle modifications after stroke are associated with better risk factor control and lower mortality. The primary objective of this study was to describe the knowledge of American Heart Association (AHA) recommendations for diet and exercise in survivors of stroke and transient ischemic attack (TIA). The secondary objectives were to describe their diet and exercise behaviors, self-efficacy (SE), behavioral intent (BI), stage of change, and barriers to change. Data are described from participants enrolled in a prospective educational intervention in mild stroke/TIA survivors. A multiple-choice questionnaire ascertained knowledge of AHA recommendations for diet and exercise, nutrition and physical activity behavior, SE, BI, stage of change, and barriers to change. Twenty-eight stroke/TIA survivors, with a mean age of 61.7 ± 11.8 years, completed questionnaires during their acute hospitalization. Participants underestimated the recommended intake of fruits, vegetables, whole grains, and participation in aerobic exercise and overestimated the recommended intake of sugar and salt. SE demonstrated a significant positive association with combined behavior scores (rs = 0.36, p = 0.043). Greater knowledge of the AHA recommendations was not associated with healthier behavior, greater SE, higher BI, or more advanced stage of change. The gaps between AHA recommendations and stroke/TIA patient knowledge identifies an area for potential intervention in stroke prevention and recovery.
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Affiliation(s)
- Hannah Uhlig-Reche
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Diana Ontiveros
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC 27514, USA
| | - Riley Syzdek
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA (L.D.); (Z.H.)
| | - Patenne Mathews
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Leanne Dalal
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA (L.D.); (Z.H.)
| | - Andrea Amaro
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75235, USA
| | - Nidhi Wunnava
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Zina Housammy
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA (L.D.); (Z.H.)
| | - Barrie Schmitt
- Department of Neurology, Neurohospitalist & Stroke Section, University of Colorado School of Medicine, Aurora, CO 80045, USA (N.R.G.)
| | - Anjail Sharrief
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Nicole R. Gonzales
- Department of Neurology, Neurohospitalist & Stroke Section, University of Colorado School of Medicine, Aurora, CO 80045, USA (N.R.G.)
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Shankar V, Thompson KH, Wylie-Rosett J, Segal-Isaacson CJ. Validation and reliability for the updated REAP-S dietary screener, (Rapid Eating Assessment of Participants, Short Version, v.2). BMC Nutr 2023; 9:88. [PMID: 37468939 PMCID: PMC10357781 DOI: 10.1186/s40795-023-00747-4] [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: 09/09/2022] [Accepted: 07/11/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND The American Heart Association (AHA) chose the REAP-S dietary screener in 2020 as one of three US dietary screeners recommended for integrating dietary assessment into clinical care. The REAP-S v.2 is an updated version that is aligned with the 2020-2025 US Dietary Guidelines and is easily incorporated into electronic medical records and taught to medical students. METHODS The University of New England, Institutional Review Board, approved the study protocol. We evaluated the reliability and validity of the REAP-S v.2 scale by having first-year medical students (n = 167) complete both the REAP-S v.2 and a three-day food record and then analyzing their data with the following statistical techniques: Internal consistency was measured using Cronbach's alpha. Construct validity was assessed with exploratory factor analysis. Criterion validity was evaluated using analysis of variance (ANOVA) that explored the associations between REAP-S v.2 scale item responses and selected nutrient estimates from the food record analyses. The hierarchical cluster analysis classified healthy and unhealthy diet grouping under each subscale. Further using these groupings, cut points for "good" and "bad" diets for each of the three main REAP-S v.2 subscales (Food Sufficiency/Food Insufficiency; Healthy Eating Pattern and Low Nutrient Density Foods) were calculated using receiver operating characteristics (ROC) analysis. Students analyzed their three-day food intake records using an online USDA application called SuperTracker. RESULTS The Cronbach's alpha measuring internal consistency was acceptable for the overall scale at 0.71. The exploratory factor analysis extracted three factors that roughly paralleled the three main subscales, suggesting construct validity. Most selected food record-derived nutrient values were significantly associated with scale items confirming criterion validity. The score cut points suggest that dietary counseling might be needed at ≤ 8, ≤ 10, and ≤ 16 for the above subscales. CONCLUSION The REAP-S v.2 is intended for clinicians to use as a brief dietary screener with their patients. Tested in a population of first-year medical students, the REAP-S v.2 brief dietary screener showed acceptable internal consistency, criterion, and construct validity. It is easily scored and incorporated into the electronic medical record.
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Affiliation(s)
- Viswanathan Shankar
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY USA
| | - Kathryn H. Thompson
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME USA
| | - Judith Wylie-Rosett
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY USA
| | - C. J. Segal-Isaacson
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY USA
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13
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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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Williams A, Britton EL, Thomson MD. Associations between Blood Pressure Control and Documented Nutrition Care Using Structured Data from Electronic Health Records of Patients with Hypertension. RESEARCH SQUARE 2023:rs.3.rs-2191063. [PMID: 37090520 PMCID: PMC10120787 DOI: 10.21203/rs.3.rs-2191063/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Background Documentation in Electronic Health Records (EHRs) of nutrition care events (overweight or obesity (BMI > 25 or 30, respectively) diagnoses, preventive care visits, or provision of patient education materials (PEM)) for chronic diseases is unclear. Methods Cross-sectional analysis using structured EHR data from primary care visits at a health system in the US from January 2018 - December 2020 of adult patients with hypertension (n = 6,419) tested for associations between last visit blood pressure (BP) control (≤ 140 Systolic BP and ≤ 90 Diastolic BP) and aggregate nutrition care events. Descriptive statistics and multiple logistic regression models were constructed to examine the predictive power of nutrition care events for blood pressure control. Results The median age was 62 years, 32% were male, 48% were Black, 26% were from rural areas and 35.9% had controlled BP at last visit. For the 62% of patients with documented nutrition care, 14.6% had an overweight/obesity diagnosis, 26.2% had a preventive care visit, and 42% received PEM with dietary and hypertension content. The models showed patients who had more preventive care visits (aOR 1.12; CL 1.06, 1.18) had higher odds for BP control. Whereas Black patients compared with white patients (aOR 0.84; CL 0.74, 0.95), those with more hypertension medications (aOR 0.97; CL 0.96, 0.99) and more primary care visits over the study period (aOR 0.98; CL 0.97, 0.99) had lower odds for BP control. Conclusions In this study, documented nutrition care in preventive care visits is significantly associated with BP control, but documentation is infrequent. Additional research should include examining clinical notes for evidence of nutrition care, which may uncover areas that show promise for improving nutrition care for patients with chronic disease.
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Nutrition and physical activity knowledge, attitudes, and practices of inpatient cirrhosis care providers. Eur J Gastroenterol Hepatol 2023; 35:453-460. [PMID: 36719821 DOI: 10.1097/meg.0000000000002512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hospitalization is a high-risk period for cirrhosis-associated sarcopenia and frailty. This study aimed to measure the knowledge, attitudes, and practice patterns (KAP) of multidisciplinary cirrhosis providers about inhospital nutrition and physical activity care. METHODS We conducted an online survey of cirrhosis care providers at a combination of 38 hospitals and healthcare centres in Alberta, Canada. Analysis included descriptive statistics and content analysis. RESULTS Three hundred thirty-eight responses were analyzed. Across all providers, nutrition and physical activity knowledge and attitude (KA) scores were higher than practice (P) scores. Physicians had lower nutrition KA ( P = 0.010) and nutrition P ( P < 0.001) scores than nonphysicians. Previous cirrhosis-related nutrition or physical activity education was associated with higher nutrition KA ( P < 0.001), nutrition P ( P = 0.036), and physical activity P scores ( P < 0.001). Over half of the participants reported not providing patients with educational resources for nutrition or physical activity and not carrying out nutrition screening. Participant suggestions to optimize care included enhancing patient and provider education, standardizing screening and intervention processes, increasing patient-centered support, and promoting collaboration within the healthcare team. Eighty percentage of participants were willing to provide patients with resources if these were readily available. CONCLUSION While provider knowledge and attitudes about the importance of nutrition and physical activity in hospitalized patients with cirrhosis are reasonable, there is considerable room to optimize the delivery of best practices in this patient population. Optimization will require readily available educational and personnel resources and interdisciplinary collaboration to promote system change.
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Tanumihardjo JP, Davis H, Christensen J, Smith RA, Kauffman-Smith S, Gunter KE. Hospital-Based, Community Teaching Kitchen Integrates Diabetes Education, Culinary Medicine, and Food Assistance: Case Study During the COVID-19 Pandemic. J Gen Intern Med 2023; 38:33-37. [PMID: 36864275 PMCID: PMC9980866 DOI: 10.1007/s11606-022-07931-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 11/01/2022] [Indexed: 03/04/2023]
Abstract
BACKGROUND Recent USDA Economic Research Service Population Survey cites a stabilization of food insecurity overall in the USA between 2019 and 2020, but Black, Hispanic, and all households with children cited increases - underscoring that the COVID-19 pandemic caused severe disruptions to food insecurity for historically disenfranchised populations. AIM Describe lessons learned, considerations, and recommendations from the experience of a community teaching kitchen (CTK) in addressing food insecurity and chronic disease management among patients during the COVID-19 pandemic. SETTING The Providence CTK is co-located at Providence Milwaukie Hospital in Portland, Oregon. PARTICIPANTS Providence CTK serves patients who report a higher prevalence of food insecurity and multiple chronic conditions. PROGRAM DESCRIPTION Providence CTK has five components: chronic disease self-management education, culinary nutrition education, patient navigation, a medical referral-based food pantry (Family Market), and an immersive training environment. PROGRAM EVALUATION CTK staff highlight that they provided food and education support when it was needed most, leveraged existing partnerships and staffing to sustain operations and Family Market accessibility, shifted delivery of educational services based-on billing and virtual service considerations, and repurposed roles to support evolving needs. DISCUSSION The Providence CTK case study provides a blueprint for how healthcare organizations could design a model of culinary nutrition education that is immersive, empowering, and inclusive.
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Affiliation(s)
| | - Heidi Davis
- Community Teaching Kitchen, Providence Milwaukie Hospital, Providence Health & Services, Milwaukie, OR, USA.
| | - Jill Christensen
- Community Teaching Kitchen, Providence Milwaukie Hospital, Providence Health & Services, Milwaukie, OR, USA
| | - Rachel A Smith
- Community Health Division, Providence Health & Services, Portland, OR, USA
| | | | - Kathryn E Gunter
- Section of General Internal Medicine, University of Chicago, Chicago, IL, USA
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Helbach A, Dumm M, Moll K, Böttrich T, Leineweber CG, Mueller W, Matthes J, Polidori MC. Improvement of Dietary Habits among German Medical Students by Attending a Nationwide Online Lecture Series on Nutrition and Planetary Health ( "Eat This!"). Nutrients 2023; 15:nu15030580. [PMID: 36771284 PMCID: PMC9920441 DOI: 10.3390/nu15030580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 01/24/2023] Open
Abstract
Nutrition is a major influential factor in optimizing human health and environmental sustainability. Medical students often do not follow national dietary guideline recommendations. Raising awareness of a healthy lifestyle is important as physicians with healthy lifestyle behaviors are more likely to counsel on nutrition. Our study aims to evaluate a Germany-wide online lecture series on nutritional medicine, "Eat This!". Before and after the course, 520 medical students who participated and 64 who did not participate in the course (comparison group) filled out an online survey. To assess the students' dietary habits, a validated FFQ was used. According to this questionnaire, only 31% of the lecture participants consumed enough fruits and 24% consumed enough vegetables, while almost half of the students exceeded the recommended maximum amount of crisps and sweets. After attending the lecture series, guideline adherence with respect to fruits and vegetables showed a significant increase, as did awareness of healthy nutrition and percentage of students with low-risk lifestyle habits. Our results show that low-threshold approaches, such as "Eat This!", can positively influence the dietary behaviors and lifestyle habits of medical students. This can help future doctors fulfill their role in the fight against the global burden of non-communicable diseases.
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Affiliation(s)
- Anna Helbach
- Department II of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
- Institute of General Practice, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
| | - Moritz Dumm
- Center of Pharmacology, Faculty of Medicine, University Hospital of Cologne, University of Cologne, 50931 Cologne, Germany
| | - Katharina Moll
- Faculty of Medicine, University Clinic Hamburg Eppendorf, 20251 Hamburg, Germany
| | - Tim Böttrich
- Faculty of Medicine, University of Gießen, 35392 Gießen, Germany
| | - Can Gero Leineweber
- Medical Department B of Internal Medicine, Brandenburg Medical School, University Hospital Ruppin-Brandenburg, 16816 Neuruppin, Germany
| | - Wiebke Mueller
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
| | - Jan Matthes
- Center of Pharmacology, Faculty of Medicine, University Hospital of Cologne, University of Cologne, 50931 Cologne, Germany
| | - Maria Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress-Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany
- Correspondence:
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18
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A scoping review of nutrition education interventions to improve competencies, lifestyle and dietary habits of medical students and residents. J Nutr Sci 2023; 12:e31. [PMID: 37008413 PMCID: PMC10052561 DOI: 10.1017/jns.2023.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 01/13/2023] [Accepted: 01/30/2023] [Indexed: 03/06/2023] Open
Abstract
Abstract
We reviewed the available research and gave an overview of the effects of nutrition education interventions (NEIs) on medical students’ and residents’ knowledge of nutrition, attitudes towards nutrition care, self-efficacy, dietary practices and readiness to offer nutrition care. From 28 May through 29 June 2021, we searched Google Scholar, PubMed, ProQuest, Cochrane and ProQuest to retrieve 1807 articles. After conducting de-duplication and applying the eligibility criteria and reviewing the title and abstract, 23 papers were included. The data were descriptively and narratively synthesised, and the results were displayed as frequencies, tables and figures. Twenty-one interventions were designed to increase participants’ knowledge of nutrition-related topics, and eighteen studies found that nutrition knowledge had significantly improved post-intervention. Only four of the eleven studies that reported on attitudes about nutrition post-intervention showed a meaningful improvement. The self-efficacy of participants was examined in more than half of the included studies (n 13, 56⋅5 %), and eleven of these studies found a significant increase in the participants’ level of self-efficacy to offer nutrition care post-intervention. At the post-intervention point, seven interventions found that dietary and lifestyle habits had significantly improved. The review demonstrated the potential of NEIs to enhance participants’ dietary habits and nutrition-related knowledge, attitudes and self-efficacy. Reduced nutrition knowledge, attitude and self-efficacy scores during the follow-up, point to the need for more opportunities for medical students and residents to learn about nutrition after the intervention.
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Vadiveloo MK, Thorndike AN, Lichtenstein AH. Integrating Diet Screening Into Routine Clinical Care: The Time Is Now. J Am Heart Assoc 2022; 12:e028583. [PMID: 36583426 PMCID: PMC9973602 DOI: 10.1161/jaha.122.028583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Maya K. Vadiveloo
- Department of Nutrition and Food Sciences, College of Health SciencesUniversity of Rhode IslandKingstonRI
| | - Anne N. Thorndike
- Harvard Medical SchoolBostonMA,Division of General Internal Medicine, Department of MedicineMassachusetts General HospitalBostonMA
| | - Alice H. Lichtenstein
- Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center on AgingTufts UniversityBostonMA
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Storz MA, Oksche A, Schlasius-Ratter U, Schillings V, Beckschulte K, Huber R. Nutrition Coverage in Medical Licensing Examinations in Germany: An Analysis of Six Nationwide Exams. Nutrients 2022; 14:nu14245333. [PMID: 36558492 PMCID: PMC9780865 DOI: 10.3390/nu14245333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
The state of nutrition education in medicine is inadequate, with nutrition-related topics being poorly integrated into lectures. Most medical students receive only a few contact hours of nutrition instruction during their entire time at medical school. Identifying potential barriers that may explain the paucity of nutritional knowledge in medical students is thus of paramount importance. The extent of nutrition coverage in the second part of Germany's nationwide medical licensing exam is currently unknown. We addressed this issue and assessed nutrition content, as well as students' scores, in this pivotal test prior to their graduation. We performed a post hoc analysis of six nationwide medical licensing examinations (2018-2020) undertaken by 29,849 medical students and screened 1920 multiple-choice questions for nutrition-related content. Nutrition-related questions accounted for a minority of the questions (2.1%, n = 40/1920). A considerable number of the questions (n = 19) included only a single nutrition-related answer option that was frequently incorrect and served as a distractor. About 0.5% of questions were entirely nutrition related. Despite undeniable barriers, the inclusion of additional nutrition-related examination questions could serve as an incentive to engage students and medical schools in enhancing medical nutrition education. The recently published competence-oriented learning objective catalog in Germany could play a pivotal role in this context, leading to better recognition of nutrition-related topics in medical education.
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Affiliation(s)
- Maximilian Andreas Storz
- Center for Complementary Medicine, Department of Internal Medicine II, Freiburg University Hospital, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Correspondence:
| | - Alexander Oksche
- IMPP-Institut für Medizinische und Pharmazeutische Prüfungsfragen, 55116 Mainz, Germany
- Rudolf-Buchheim-Institut of Pharmacology, University of Giessen, 35392 Giessen, Germany
| | - Ute Schlasius-Ratter
- IMPP-Institut für Medizinische und Pharmazeutische Prüfungsfragen, 55116 Mainz, Germany
| | - Volker Schillings
- IMPP-Institut für Medizinische und Pharmazeutische Prüfungsfragen, 55116 Mainz, Germany
| | - Kai Beckschulte
- Center for Complementary Medicine, Department of Internal Medicine II, Freiburg University Hospital, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Roman Huber
- Center for Complementary Medicine, Department of Internal Medicine II, Freiburg University Hospital, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
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Giosuè A, Recanati F, Calabrese I, Dembska K, Castaldi S, Gagliardi F, Vitale M, Vaccaro O, Antonelli M, Riccardi G. Good for the heart, good for the Earth: proposal of a dietary pattern able to optimize cardiovascular disease prevention and mitigate climate change. Nutr Metab Cardiovasc Dis 2022; 32:2772-2781. [PMID: 36323607 DOI: 10.1016/j.numecd.2022.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/26/2022] [Accepted: 08/01/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Human and planetary health are inextricably interconnected through food systems. Food choices account for 50% of all deaths for cardiovascular diseases (CVD) - the leading cause of death in Europe - and food systems generate up to 37% of total greenhouse gas (GHG) emissions. METHODS AND RESULTS Based on a systematic revision of meta-analyses of prospective studies exploring the association between individual foods/food groups and the incidence of CVD, we identified a dietary pattern able to optimize CVD prevention.. This dietary pattern was compared to the current diet of the European population. The nutritional adequacy of both diets was evaluated according to the European Food Safety Authority (EFSA) recommended nutrient intake for the adult population, and their environmental impact was evaluated in terms of carbon footprint (CF). As compared to the current diet, the desirable diet includes higher intakes of fruit, vegetables, wholegrains, low glycemic index (GI) cereals, nuts, legumes and fish, and lower amounts of beef, butter, high GI cereals or potatoes and sugar. The diet here identified provides appropriate intakes of all nutrients and matches better than the current Europeans' one the EFSA requirements. Furthermore, the CF of the proposed diet is 48.6% lower than that of the current Europeans' diet. CONCLUSION The transition toward a dietary pattern designed to optimize CVD prevention would improve the nutritional profile of the habitual diet in Europe and, at the same time, contribute to mitigate climate change by reducing the GHG emissions linked to food consumption almost by half.
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Affiliation(s)
- Annalisa Giosuè
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | | | - Ilaria Calabrese
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | | | - Simona Castaldi
- Dipartimento di Scienze e Tecnologie Ambientali Biologiche e Farmaceutiche, Università degli studi della Campania Luigi Vanvitelli, Caserta, Italy
| | - Francesca Gagliardi
- Dipartimento di Economia Politica e Statistica, Università degli Studi di Siena, Siena, Italy
| | - Marilena Vitale
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - Olga Vaccaro
- Department of Pharmacy, "Federico II" University of Naples, Naples, Italy
| | - Marta Antonelli
- Division Impacts on Agriculture, Forests and Ecosystem Services (IAFES), Foundation Euro-Mediterranean Center on Climate Change (CMCC), Viterbo, Italy.
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
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22
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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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Rehman S, Jianglin Z. Micronutrient deficiencies and cardiac health. Front Nutr 2022; 9:1010737. [PMID: 36313070 PMCID: PMC9614333 DOI: 10.3389/fnut.2022.1010737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
Inadequate diet and nutritional quality are potentially correlated with an escalated risk of cardiac-related morbidity and mortality. A plethora of knowledge is available regarding the influence of heart-healthy dietary patterns in response to disability-adjusted life years (DALYs), yet little is known regarding the best approaches to adopt. In response, the present investigation aims to bridge this knowledge gap by implementing mathematical machine learning grey methodology to assess the degree of influence and the potential contributing factors in DALYs due to ischemic heart disease and stroke, in conjunction with the Hurwicz (Min-Max) criterion. The outcomes highlighted that a diet low in fruits is a potential contributor to IHD-related DALYS, whereas a diet low in vegetables is a more grounded contributor to stroke-related DALYs in Spain, among others. Moreover, the Hurwicz approach highlighted IHD to be more impacted due to dietary and nutritional factors than stroke. In conclusion, our investigation strongly supports a balanced diet and precision nutrition guidelines as a strategy for reducing cardiac-related diseases in the Spanish population. It is a public health primary consideration to build an ambiance that encourages, rather than hinders, compliance with cardioprotective dietary practices among all people.
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Affiliation(s)
- Shazia Rehman
- Department of Biomedical Sciences, Pak-Austria Fachhochschule, Institute of Applied Sciences and Technology, Haripur, Pakistan
| | - Zhang Jianglin
- Department of Dermatology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China,Candidate Branch of National Clinical Research Center for Skin Diseases, Shenzhen, China,*Correspondence: Zhang Jianglin
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Jain S, Higashi RT, Bonnema R, Albin J. Empowering learners to provide dietary counselling. CLINICAL TEACHER 2022; 19:e13521. [PMID: 36072998 DOI: 10.1111/tct.13521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 08/10/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite calls to increase dietary counselling by physicians to help address the epidemic of lifestyle-related chronic disease, medical education does not equip future physicians with the training to provide effective dietary counselling. In addition to the multiple barriers that clinician educators face in implementing clinically relevant nutrition education curricula, evaluation modalities in the nutrition education literature that assess student skills and behaviour remain limited. APPROACH We implemented a brief, virtual nutrition education intervention in a US medical school during the outpatient clinical clerkship and assessed how our curriculum influenced students' development of dietary counselling skills. EVALUATION Student feedback revealed appreciation for learning how to approach conversations about diet in a non-judgmental manner and specific strategies to use during counselling. We thematically analysed the free-text responses from 81 dietary counselling encounter forms submitted by students. Three emergent themes reflected the key dietary counselling skills students demonstrated during patient encounters: (1) eliciting drivers of current eating patterns and barriers to healthier eating patterns, (2) individualising recommendations and (3) recommending evidence-based strategies. IMPLICATIONS After receiving brief, clinically relevant, virtual nutrition education, students were able to successfully apply dietary counselling skills to patient care. In conjunction with indirect skill assessment through targeted documentation, we offer a sustainable approach for feasible nutrition education paired with meaningful evaluation.
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Affiliation(s)
- Seema Jain
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Robin T Higashi
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rachel Bonnema
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jaclyn Albin
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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Caldow G, Palermo C, Wilson AN. 'What do doctors think they need to know about nutrition?'-a qualitative study of doctors with formal nutrition training. BMC Nutr 2022; 8:85. [PMID: 35996126 PMCID: PMC9394029 DOI: 10.1186/s40795-022-00577-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 08/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Doctors are on the frontline of patient care and in an ideal position to provide nutritional advice, yet can feel ill-equipped to do so. The aim of this study was to explore the nutrition knowledge, skills and practice required for nutrition-competent medical graduates, and their role in providing nutrition advice and care, from the perspective of doctors with formal nutrition training. METHODOLOGY We conducted an exploratory qualitative research study. A purposive sample of 12 medical doctors and students with formal nutrition training across Australia participated in in-depth semi structured interviews. Data were analysed thematically. RESULTS There were four main themes identified: 1. Identifying the role of doctors in nutrition care; 2. Understanding the interrelatedness of the social determinants of health and nutrition status is key; 3. Optimising nutrition care through multidisciplinary collaboration; and 4. Providing evidence-based nutrition care. CONCLUSION This exploratory study suggests that doctors consider that nutrition competent medical graduates require skills in referring to dietitians, an understanding and application of the social determinants of health, and practise applying multidisciplinary and evidence-based nutrition care.
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Affiliation(s)
- G Caldow
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - C Palermo
- Monash Centre for Scholarship in Health Education, Monash University, Melbourne, Australia
| | - A N Wilson
- Maternal, Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia.
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Lepre B, Mansfield KJ, Beck EJ. Attitudes, work roles and barriers to nutrition care - Interviews with Australian and UK-based medical doctors. J Hum Nutr Diet 2022; 36:920-931. [PMID: 35996856 DOI: 10.1111/jhn.13079] [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: 02/14/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Poor diet is implicated in multiple chronic diseases. While doctors may be well-placed to facilitate nutrition care, nutrition remains a low priority in medical education internationally. Consensus is required on nutrition competencies as a benchmark for education with a regulatory framework to ensure implementation. The aim of this qualitative study was to explore work roles, attitudes, barriers, and enablers in the delivery of nutrition care amongst a cohort of Australian and UK doctors. METHODOLOGY Semi-structured interviews were conducted with primary care doctors/GPs (n=14) and medical specialists (n=8) based in Australia and the United Kingdom to explore work roles, attitudes, barriers and enablers in the delivery of nutrition care. RESULTS Framework analysis identified five key themes: 1) Knowledge and skills in nutrition to support medical nutrition care, 2) The delivery of nutrition education, 3) Multidisciplinary and interdisciplinary care, 4) Systemic barriers and facilitators to care and, 5) The need for a paradigm shift. Participants acknowledged nutrition as an important component of medical care but recognised they are currently ill-equipped to support such care, identifying limitations to the systems supporting integrated care. Participants identified that nutrition sits within both a health promotion and medical/treatment model, but they currently work only within the latter. CONCLUSION Participants highlighted a lack of knowledge and training around nutrition, without which change is not possible. Efforts to improve the nutrition capacity of the medical workforce must be matched by increased investments in primary prevention, including nutrition - a paradigm shift from the medical model. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Breanna Lepre
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW, Australia.,Illawarra Health & Medical Research Institute, Northfields Ave, Wollongong, NSW, Australia.,NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
| | - Kylie J Mansfield
- Illawarra Health & Medical Research Institute, Northfields Ave, Wollongong, NSW, Australia.,Graduate School of Medicine, University of Wollongong, Northfields Ave, Wollongong, NSW, Australia
| | - Eleanor J Beck
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW, Australia.,Illawarra Health & Medical Research Institute, Northfields Ave, Wollongong, NSW, Australia
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27
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Kian F, Farhadian H, Choobchian S. Do Iranian households benefit from food according to their health characteristics? A case study from Alborz Province, Iran. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-021-01631-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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The Application of Rehabilitation Therapy Occupational Competency Evaluation Model in the Improvement of College Students’ Innovation and Entrepreneurship. Occup Ther Int 2022; 2022:7478736. [PMID: 35832098 PMCID: PMC9236807 DOI: 10.1155/2022/7478736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/24/2022] [Accepted: 06/01/2022] [Indexed: 11/18/2022] Open
Abstract
This paper constructs an evaluation model of occupational competency in rehabilitation therapy and applies it to the improvement of college students’ innovative and entrepreneurial competencies. Based on clarifying the connotation of college students’ entrepreneurial competency, this study carries out research on the evaluation system of college students’ entrepreneurial competency. First, the method of qualitative research is used to conduct in-depth interviews with college students and entrepreneurial mentors to understand the views of these groups on college students’ entrepreneurial competency, and the coding of the interview contents is carried out by applying the rooting theory, and finally, a theoretical model of the composition of college students’ entrepreneurial competency is derived. The front-line position of talent cultivation is the construction of faculty, because the faculty with high-quality vocational ability is an indispensable prerequisite for the development of universities, and the teaching level of the faculty is the key factor for the effectiveness of teaching to appear. Based on the perspective of role theory, we analyze the problems and reasons for the lack of competency in the role-playing process; integrate the three stages of understanding the role, playing the role, and adjusting the role with the competency model; and propose strategies to improve the competency of youth social workers in the process of playing the role, to help workers accurately understand the role, correctly play the role, and reasonably adjust the role. The curriculum is designed to cultivate the competency of college student nursing positions, which is conducive to improving the professional quality of college student nursing service providers and regulating college student nursing practice so that they can actively respond to problems. This will strengthen the entire teaching faculty and enhance the professional competence of full-time teachers.
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Morton KF, Pantalos DC, Ziegler C, Patel PD. A Place for Plant-Based Nutrition in US Medical School Curriculum: A Survey-Based Study. Am J Lifestyle Med 2022; 16:271-283. [PMID: 35706597 PMCID: PMC9189581 DOI: 10.1177/1559827620988677] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Purpose. To evaluate medical students' and family medicine residents' perceptions of their current degree of nutrition training in general and regarding a whole-foods, plant-based (WFPB) diet. Methods. An original survey instrument was administered to medical students and family medicine residents. Quantitative and qualitative data were collected to evaluate perceptions of nutrition education in medical training, a WFPB diet, and ideas for nutrition-focused curricular reform. Results. Of the 668 trainees surveyed, 200 responded (response rate = 30%). Of these, 22% agreed that they received sufficient nutrition education in medical school and 41% agreed that a WFPB diet should be a focus. Respondents with personal experiences with a plant-based diet were more willing to recommend it to future patients. Common ideas for curricular reform were instruction on a WFPB diet along with other healthy dietary patterns, patient counseling, a dedicated nutrition course, and electives. Conclusions. Nutrition education in US medical training needs improvement to address the growing burden of obesity-related chronic disease. Proper nutrition and lifestyle modification should therefore play a larger role in the education of future physicians. A focus on plant-predominant diets, such as the WFPB diet, may be an acceptable and effective addition to current medical school curriculum, and deserves further study.
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Affiliation(s)
- Kara F. Morton
- Department of Undergraduate Medical Education,
University of Louisville School of Medicine, Louisville, Kentucky
| | - Diana C. Pantalos
- Department of Pediatrics, University of
Louisville, Louisville, Kentucky
| | - Craig Ziegler
- University of Louisville Office of Undergraduate
Medical Education, Louisville, Kentucky
| | - Pradip D. Patel
- Department of Pediatrics, University of
Louisville, Louisville, Kentucky
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Abstract
PURPOSE OF REVIEW The number of published studies on the health effects of plant-based diets has increased dramatically in the last decade. The purpose of this narrative review is to update the most recent evidence from large prospective cohort studies and meta-analyses on the effects of plant-based dietary patterns on cardiovascular outcomes and risk factors and total mortality. RECENT FINDINGS Most new data from large prospective cohort studies carried out in the USA, Europe, and Asia continue to show inverse associations between plant-based diets and the incidence of ischemic heart disease and stroke, while less data exist for heart failure incidence. New analyses suggest that only some components of plant-based diets are associated with cardiovascular benefit. Recent meta-analyses show inverse associations between plant-protein intake and all-cause mortality, although heterogeneity exists, and small mortality risks from some animal proteins, notably processed meats. New studies continue to demonstrate small but favorable effects of plant-based diets on traditional risk factors and suggest other emerging mechanisms by which plant-based diets exert cardiovascular benefits. The recommendation to consume a plant-based diet to reduce cardiovascular risk remains an evidence-based strategy based on observational studies. New data highlight the importance of ensuring that these diets are nutrient-rich and low in plant foods associated with signals of harm. For this reason, assessment of diet quality is important even in patients who report adherence to plant-based diets. Large randomized trials with hard cardiovascular endpoints might strengthen this evidence-base, but feasibility is limited.
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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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Lepre B, Trigueiro H, Johnsen JT, Khalid AA, Ball L, Ray S. Global architecture for the nutrition training of health professionals: a scoping review and blueprint for next steps. BMJ Nutr Prev Health 2022; 5:106-117. [PMID: 35814726 PMCID: PMC9237864 DOI: 10.1136/bmjnph-2021-000354] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/17/2022] [Indexed: 11/03/2022] Open
Abstract
BackgroundThis paper provides an overview of capacity-building efforts in the context of nutrition education for medical and healthcare professionals.MethodsContent analysis of eighteen reports related to nutrition education and capacity building, and interviews with key personnel from the WHO and NNEdPro Global Centre for Nutrition and Health were synthesised. Recommendations to improve nutrition education and subsequent nutrition capacity of healthcare professionals were identified based on policy guidance and interviews.FindingsMost included documents noted the importance of nutrition education and capacity building for medical and healthcare professionals. Healthcare professionals and the ‘health sector’ were positioned as central to achieving improved public health, and the promotion of nutrition knowledge and awareness in the general population.ConclusionIncreased focus on nutrition education and capacity of the health workforce are key to improvements in population health and well-being. The WHO is well placed to support global nutrition education.RecommendationsKey recommendations from the literature review and interviews include improved global data collection mechanisms, a pledge from governments to prioritise nutrition education and capacity building, along with implementation of standardised nutrition curricula for all healthcare sectors. This would include the development and expansion of on-line resources.
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Affiliation(s)
- Breanna Lepre
- NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW, Australia
| | | | | | | | - Lauren Ball
- NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
- Menzies Health Institute, Queensland, Griffith University - Gold Coast Campus, Southport, Queensland, Australia
| | - Sumantra Ray
- NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
- School of Biomedical Sciences, Ulster University, Coleraine, UK
- School of Humanities and Social Sciences, University of Cambridge, Cambridge, UK
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Welsh JA, Lange SJ, Figueroa J, Walsh S, Gooding H, Cheung P. Impact of a brief training on motivational interviewing and the 5A's approach on weight‐related counseling practices of pediatricians. Obes Sci Pract 2022; 8:466-473. [PMID: 35949275 PMCID: PMC9358740 DOI: 10.1002/osp4.588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 11/08/2022] Open
Abstract
Background Objectives Methods Results
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Affiliation(s)
- Jean A. Welsh
- Department of Pediatrics Emory University School of Medicine Atlanta Georgia USA
- Department of Child Advocacy Children's Healthcare of Atlanta Atlanta Georgia USA
| | - Samantha J. Lange
- Department of Child Advocacy Children's Healthcare of Atlanta Atlanta Georgia USA
| | - Janet Figueroa
- Department of Pediatrics Emory University School of Medicine Atlanta Georgia USA
- Department of Child Advocacy Children's Healthcare of Atlanta Atlanta Georgia USA
| | - Stephanie Walsh
- Department of Pediatrics Emory University School of Medicine Atlanta Georgia USA
- Department of Child Advocacy Children's Healthcare of Atlanta Atlanta Georgia USA
| | - Holly Gooding
- Department of Pediatrics Emory University School of Medicine Atlanta Georgia USA
| | - Patricia Cheung
- Rollins School of Public Health Emory University Atlanta Georgia USA
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Alqahtani NM, Alqahtani AMM, Alqahtani HMS, Jathmi AYJ, Alqahtani BMS, Alshehri AA, Alqahtani AMA. Physicians’ Knowledge and practice of Nutrition Education in Health Care Centers of Saudi Arabia: Systematic Review. ARCHIVES OF PHARMACY PRACTICE 2022. [DOI: 10.51847/nhisq9dmhy] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lichtenstein AH, Appel LJ, Vadiveloo M, Hu FB, Kris-Etherton PM, Rebholz CM, Sacks FM, Thorndike AN, Van Horn L, Wylie-Rosett J. 2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association. Circulation 2021; 144:e472-e487. [PMID: 34724806 DOI: 10.1161/cir.0000000000001031] [Citation(s) in RCA: 315] [Impact Index Per Article: 105.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Poor diet quality is strongly associated with elevated risk of cardiovascular disease morbidity and mortality. This scientific statement emphasizes the importance of dietary patterns beyond individual foods or nutrients, underscores the critical role of nutrition early in life, presents elements of heart-healthy dietary patterns, and highlights structural challenges that impede adherence to heart-healthy dietary patterns. Evidence-based dietary pattern guidance to promote cardiometabolic health includes the following: (1) adjust energy intake and expenditure to achieve and maintain a healthy body weight; (2) eat plenty and a variety of fruits and vegetables; (3) choose whole grain foods and products; (4) choose healthy sources of protein (mostly plants; regular intake of fish and seafood; low-fat or fat-free dairy products; and if meat or poultry is desired, choose lean cuts and unprocessed forms); (5) use liquid plant oils rather than tropical oils and partially hydrogenated fats; (6) choose minimally processed foods instead of ultra-processed foods; (7) minimize the intake of beverages and foods with added sugars; (8) choose and prepare foods with little or no salt; (9) if you do not drink alcohol, do not start; if you choose to drink alcohol, limit intake; and (10) adhere to this guidance regardless of where food is prepared or consumed. Challenges that impede adherence to heart-healthy dietary patterns include targeted marketing of unhealthy foods, neighborhood segregation, food and nutrition insecurity, and structural racism. Creating an environment that facilitates, rather than impedes, adherence to heart-healthy dietary patterns among all individuals is a public health imperative.
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Lam NV, Sulo S, Nguyen HA, Nguyen TN, Brunton C, Duy NN, Ngoc Bui MT, Nguyen HT, Vu TT, Truong QB, Nguyen HB. High prevalence and burden of adult malnutrition at a tertiary hospital: An opportunity to use nutrition-focused care to improve outcomes. CLINICAL NUTRITION OPEN SCIENCE 2021. [DOI: 10.1016/j.nutos.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Johnston EA, Beasley JM, Jay M. Training Medical Students in Diet Assessment and Brief Counseling. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:1337-1342. [PMID: 34819760 PMCID: PMC8608407 DOI: 10.2147/amep.s333370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/12/2021] [Indexed: 06/13/2023]
Abstract
Poor dietary choices are a leading cause of chronic disease, but nutrition is rarely discussed in clinical practice. Nutrition is taught in less than a third of medical schools and physicians in practice empirically report low levels of comfort and self-efficacy in discussing nutrition with patients. A two-part presentation was created and shared with second-year medical students at a college of medicine. Students were given pre-work that included a brief (15 minutes) pre-recorded presentation and an e-resource entitled "Practical Nutrition for the Primary Care Provider" and then engaged in a live virtual session with a brief lecture and question and answer period (45 minutes). A survey was administered following the live presentation to evaluate the extent to which the presentation met the stated objectives and could impact participants' future practice. One-hundred and six students participated in the live lecture. Eighty-eight students (83%) provided survey feedback. Over two-thirds of respondents indicated that the presentation completely met the objectives, 57% indicated that they would definitely talk to patients with chronic disease about nutrition, and 52% indicated they would incorporate diet assessment in visits with patients with chronic disease. Nutrition is integral to disease prevention and management. Many students provided comments on the importance of the topic and benefit of the information. Further research is necessary to determine the optimal time and place for nutrition education in medical training. This presentation and e-resource are evidence-based, brief, and provided tools for participants to access once in practice.
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Affiliation(s)
- Emily A Johnston
- Biomedical Education, California Health Sciences University College of Osteopathic Medicine, Clovis, CA, USA
| | | | - Melanie Jay
- Department of Medicine and Department of Population Health, NYU Langone Health, New York, NY, USA
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Kris-Etherton PM, Petersen KS, Després JP, Anderson CAM, Deedwania P, Furie KL, Lear S, Lichtenstein AH, Lobelo F, Morris PB, Sacks FM, Ma J. Strategies for Promotion of a Healthy Lifestyle in Clinical Settings: Pillars of Ideal Cardiovascular Health: A Science Advisory From the American Heart Association. Circulation 2021; 144:e495-e514. [PMID: 34689589 DOI: 10.1161/cir.0000000000001018] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Engagement in healthy lifestyle behaviors is suboptimal. The vast majority of the US population does not meet current recommendations. A healthy lifestyle is defined by consuming a healthy dietary pattern, engaging in regular physical activity, avoiding exposure to tobacco products, habitually attaining adequate amounts of sleep, and managing stress levels. For all these health behaviors there are well-established guidelines; however, promotion in clinical settings can be challenging. It is critical to overcome these challenges because greater promotion of heathy lifestyle practices in clinical settings effectively motivates and initiates patient behavior change. The 5A Model (assess, advise, agree, assist, and arrange) was developed to provide a framework for clinical counseling with requisite attention to the demands of clinical settings. In this science advisory, we present strategies, based on the 5A Model, that clinicians and other health care professionals can use for efficient lifestyle-related behavior change counseling in patients at all levels of cardiovascular disease risk at every visit. In addition, we discuss the underlying role of psychological health and well-being in lifestyle-related behavior change counseling, and how clinicians can leverage health technologies when providing brief patient-centered counseling. Greater attention to healthy lifestyle behaviors during routine clinician visits will contribute to promoting cardiovascular health.
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Golabi S, Amini M, Zahedi A, Adelipour M, Shamekhi Z, Fakharzadeh L, Mansouri S, Naghashpour M. Application of community-based nutrition education needs assessment in reviewing the course plan of medical and nursing students. Med J Islam Repub Iran 2021; 35:80. [PMID: 34291004 PMCID: PMC8285544 DOI: 10.47176/mjiri.35.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Training needs assessment is the process of recognizing educational needs. This study aimed to apply a community-based nutrition education needs assessment to revise the nutrition course plan in the curriculum of the doctorate of medicine and that of the baccalaureate of nursing.
Methods: The study was designed in 2 phases: (1) nutritional needs assessment; (2) community-based revision of nutrition course plan. In the first phase, 13 nutrition professionals working in the region set out 5 priorities of nutrition-related health problems in the community by a training need assessment based on a survey and scoring system. Then, an expert panel determined the priorities of behavioral and nonbehavioral causes of the nutrition-related health problems by the nominal group technique (NGT). The results of the first phase were used to review the topics of nutrition course plans up to 20%.
Results: The priorities identified in Abadan, Khorramshahr, and Shadegan were obesity and type 2 diabetes mellitus in adults as well as anemia in pregnant women, respectively. Also, wrong eating habits and insufficient nutrition knowledge were among the most important behavioral causes of nutrition-related health problems in the target community. These results were applied to a community-based review of nutrition course plans for medical and nursing students.
Conclusion: The use of nutritional needs assessment approaches by a survey and nominal group technique with a group of professionals provided an opportunity for a community-based review of the nutrition course plan for medical and nursing students as a first phase in the development of a community-based nutrition course plane.
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Affiliation(s)
- Sahar Golabi
- Abadan Faculty of Medical Sciences, Abadan, Iran
| | - Mitra Amini
- Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Maryam Adelipour
- Department of Biochemistry, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zahra Shamekhi
- Sepidan Bagherololoom Higher Education college, Shiraz University of Medical Sciences, Shiraz, Iran
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Johnston EA, Arcot A, Meengs J, Dreibelbis TD, Kris-Etherton PM, Wiedemer JP. Culinary Medicine for Family Medicine Residents. MEDICAL SCIENCE EDUCATOR 2021; 31:1015-1018. [PMID: 34457944 PMCID: PMC8368964 DOI: 10.1007/s40670-021-01283-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 06/02/2023]
Abstract
BACKGROUND Physicians are inadequately trained to effectively provide lifestyle counseling to manage the obesity epidemic. ACTIVITY Family and community medicine residents participated in a culinary medicine course taught by two Registered Dietitian Nutritionists (RDNs) in University Park, PA, in March 2020. RESULTS All residents (n = 13) reported increased knowledge, 92% (n = 12) reported increased confidence, and 84.6% (n = 11) reported they intended to make changes to their practice based on the class. Most participating residents (85%, n = 11) would attend follow-up classes. DISCUSSION Residents recognized the importance of nutrition in clinical care and found the information to be applicable to practice.
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Affiliation(s)
- Emily A. Johnston
- Department of Nutritional Sciences, Penn State University, University Park, PA USA
| | - Amrita Arcot
- Department of Nutritional Sciences, Penn State University, University Park, PA USA
| | - Jennifer Meengs
- Department of Nutritional Sciences, Penn State University, University Park, PA USA
| | | | | | - Joseph P. Wiedemer
- Penn State Family and Community Medicine Residency at Mount Nittany Medical Center, State College, PA USA
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Bassin SR, Al-Nimr RI, Allen K, Ogrinc G. The state of nutrition in medical education in the United States. Nutr Rev 2021; 78:764-780. [PMID: 31968104 DOI: 10.1093/nutrit/nuz100] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Despite the significant impact diet has on health, there is minimal nutrition training for medical students. This review summarizes published nutrition learning experiences in US medical schools and makes recommendations accordingly. Of 902 articles, 29 met inclusion criteria, describing 30 learning experiences. Nutrition learning experiences were described as integrated curricula or courses (n = 10, 33%), sessions (n = 17, 57%), or electives (n = 3, 10%). There was heterogeneity in the teaching and assessment methods utilized. The most common was lecture (n = 21, 70%), often assessed through pre- and/or postsurveys (n = 19, 79%). Six studies (26%) provided experience outcomes through objective measures, such as exam or standardized patient experience scores, after the nutrition learning experience. This review revealed sparse and inconsistent data on nutrition learning experiences. However, based on the extant literature, medical schools should build formal nutrition objectives, identify faculty and physician leadership in nutrition education, utilize preexisting resources, and create nutrition learning experiences that can be applied to clinical practice.
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Affiliation(s)
- Sandhya R Bassin
- Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Rima I Al-Nimr
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Kathleen Allen
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Greg Ogrinc
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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Lepre B, Mansfield KJ, Ray S, Beck E. Reference to nutrition in medical accreditation and curriculum guidance: a comparative analysis. BMJ Nutr Prev Health 2021; 4:307-318. [PMID: 34308139 PMCID: PMC8258055 DOI: 10.1136/bmjnph-2021-000234] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/10/2021] [Accepted: 02/17/2021] [Indexed: 01/04/2023] Open
Abstract
Objective Poor diet is a leading cause of death worldwide. Doctors are well placed to provide dietary advice, yet nutrition remains insufficiently integrated into medical education. Enforcement of curriculum or accreditation requirements such as nutrition requires relevant regulatory frameworks. The aim of this review was to identify nutrition content or requirements for nutrition education in accreditation standards or formal curriculum guidance for medical education internationally. Design Non-systematic comparative analysis. Data sources An internet search using the Google Search engine, the WHO Directory of Medical Schools and Foundation for Advancement of International Medical Education and Research Directory of Organizations that Recognise/Accredit Medical Schools was conducted through September 2020 to identify government and organisational reports as well as publications from regulatory and professional bodies relevant to medical education. Eligibility criteria Eligible publications included (A) accreditation standards, (B) competency standards or a framework, (C) curricula, and (D) assessment content. Data extraction and synthesis We stratified findings by country or region and both preregistration and postregistration education. Findings were synthesised based on the existence of nutrition content or requirements for nutrition education within systems used to guide medical education internationally. Results This review found that despite an emphasis on meeting the needs of the community and the demands of the labour market, only 44% of accreditation and curriculum guidance included nutrition. Nutrition remains inadequately represented in accreditation and curriculum guidance for medical education at all levels internationally. Accreditation standards provide a mandated framework for curricula and inclusion of nutrition in accreditation frameworks provides an incentive for the integration of nutrition into medical education. Conclusions This review is a call to action for the medical profession including government, health agencies and educational and accreditation entities. The inclusion of nutrition in medical education has appeared throughout medical education literature for more than five decades, yet without consensus standards there is little likelihood of uniform adoption.
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Affiliation(s)
- Breanna Lepre
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
| | - Kylie J Mansfield
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Sumantra Ray
- NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
| | - Eleanor Beck
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
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Flynn MM, George P, Schiffman FJ. Improving Food Security in Medical Students Using a Cooking Program. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2021. [DOI: 10.1080/19320248.2019.1693470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Paul George
- Family Medicine and Medical Science, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Fred Jay Schiffman
- Lifespan Cancer Institute, The Miriam Hospital, Providence, Rhode Island, USA
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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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Bernstein J. Not the Last Word: Thought for Food. Clin Orthop Relat Res 2021; 479:242-245. [PMID: 33394760 PMCID: PMC7899713 DOI: 10.1097/corr.0000000000001624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/07/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Joseph Bernstein
- J. Bernstein, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Cardiometabolic medicine: a review of the current proposed approaches to revamped training in the United States. Cardiovasc Endocrinol Metab 2021; 10:168-174. [PMID: 34386718 PMCID: PMC8352603 DOI: 10.1097/xce.0000000000000243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/17/2020] [Indexed: 11/26/2022]
Abstract
Cardiovascular disease (CVD) remains the leading cause of mortality in the United States, and the population of patients with cardiometabolic conditions, including obesity, metabolic syndrome and diabetes mellitus, continues to grow. There is a need for physicians with specific training in cardiometabolic medicine to provide a ‘medical home’ for patients with cardiometabolic disease, rather than the fractured care that currently exists in the United States. Cardiometabolic specialists will head multidisciplinary clinics, develop practice guidelines, and lead through research. Proposals for US training in cardiometabolic medicine include: maintain the current training model, a dedicated 2–3 year fellowship following internal medicine residency, a 1-year fellowship following either internal medicine residency or fellowship in cardiology or endocrinology, and certification available to any interested clinician. This review discusses the pros and cons of these approaches. The authors believe that a dedicated cardiometabolic training fellowship has significant advantages over the other options.
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Williams A, Diffenderfer A, Carlyle K. Hands-on Cooking in Medical Schools: Diffusion of a Prevention Education Innovation. MEDICAL SCIENCE EDUCATOR 2020; 30:1591-1598. [PMID: 34457827 PMCID: PMC8368565 DOI: 10.1007/s40670-020-01109-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 06/02/2023]
Abstract
Educating physicians early and often on how to have conversations with patients about diet to prevent and treat chronic disease is imperative, yet under realized. Some innovative medical schools have begun implementing hands-on cooking (HOC) programs to fill this gap, but how these programs are promoted is unknown. This study assessed the prevalence and innovation characteristics of HOC programs offered to medical students in the USA. Content analysis of webpages was conducted using a Diffusion of Innovation (e.g., relative advantage, compatibility, complexity, trialability, and observability) framework. Themes of relative advantage included increasing students' confidence, improvements in medical and interprofessional education, and translating into a benefit to patients through improved care. Compatibility codes showed only a quarter of webpages referred to the program as "evidence-based." Complexity codes showed most (86%) webpages clearly described the course. About half the webpages described the program as an elective, suggesting trialability of this innovation. Many (43%) of the programs referenced use of a standardized "culinary medicine" curriculum, contributing to the observability of this innovation. Within the sample of schools, 35% provided HOC programs for their students. These findings suggest HOC programs have a strong foothold in healthcare education and provide a framework from which future studies might examine what effects innovative, successful HOC programs have on curriculum development, student experience, and, ultimately, patient outcomes.
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Affiliation(s)
- April Williams
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA USA
| | - Anna Diffenderfer
- Individual Interdisciplinary Program, Montana State University, Bozeman, MT USA
| | - Kellie Carlyle
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA USA
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Eisenberg DM, Imamura BEnvD A. Teaching Kitchens in the Learning and Work Environments: The Future Is Now. Glob Adv Health Med 2020; 9:2164956120962442. [PMID: 33224633 PMCID: PMC7649940 DOI: 10.1177/2164956120962442] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/03/2020] [Accepted: 09/09/2020] [Indexed: 12/30/2022] Open
Abstract
The learning and working environments of today's hospitals and health systems are designed to predict, diagnose, treat, and manage disease. However, the food environments in these settings are often extraordinarily unappealing, unhealthy, and can adversely impact the well-being of health professionals. What if future health-care sites were designed as showrooms of the most appealing and nutritious foods? What if future cafeterias included ventilated "Teaching Kitchens" as extensions to the everyday "grab and go" check-out lines? What if health-care providers, trainees, staff, and community members had access to foods that were healthy, delicious, affordable, sustainable, and easy to prepare? Most importantly, what if health professionals learned to make these healthy, delicious recipes as part of their required training? "See one, do one, teach one" could become, "See one, taste one, make one, teach one". Teaching Kitchens could serve as both learning laboratories and clinical research centers, whereby teaching kitchen curricula could be tested, through sponsored research, for their impact on behaviors, clinical outcomes, and costs. What if spaces adjacent to Teaching Kitchens were designated "Mindful Eating Spaces," where self-selected patrons could enjoy a "Culinary Feast alongside a Technological Fast" in an effort to carve out a brief oasis of mindful, resilience-building reflection during any given day? This article describes the rationale for and necessary components of such a futurist "Teaching Kitchen" within future working and learning environments. Importantly, if and when Teaching Kitchens are built within health-care settings, they may serve as catalysts of personal and societal health enhancement for all.
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Affiliation(s)
- David M Eisenberg
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Anthony Imamura BEnvD
- Culinary Medicine, MedStar Health, Washington, District of Columbia, USA.,Culinary Arts & Design, MedStar Health, Washington, District of Columbia, USA
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Crowley J, Ball L, Wall C. How does self-perceived nutrition competence change over time during medical training? A prospective longitudinal observational study of New Zealand medical students. BMJ Nutr Prev Health 2020; 3:270-276. [PMID: 33521538 PMCID: PMC7841807 DOI: 10.1136/bmjnph-2020-000080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/25/2020] [Accepted: 09/16/2020] [Indexed: 12/31/2022] Open
Abstract
Objectives Medical nutrition education aims to equip doctors with nutrition knowledge, skills, attitudes and confidence to counsel patients to improve their diet. This study aimed to describe changes in medical students’ self-perceived nutrition competence at three time points during medical training. Design Prospective longitudinal observational study. Setting The University of Auckland, School of Medicine. Participants Year 2 medical students (phase 1, preclinical) were surveyed in May 2016. Participants repeated the survey in February 2018 as Year 4 students and July 2019 (phase 2, clinical) as Year 5 students. Primary outcome measure Primary outcome measure was self-perceived nutrition competence measured using the validated NUTrition Competence (NUTCOMP) survey. Results In 2016, 102 of 279 eligible Year 2 medical students completed the survey (response rate (RR 36.7%)). In 2018, 89 Year 4 students repeated the survey (RR 87.3%) and 30 students as Year 5 students in 2019 (RR 29.41%). There was a significant increase in total NUTCOMP scores (knowledge, skills, confidence to counsel and attitude towards nutrition) between Year 2 and Year 4 (p=0.012). There was a significant increase in the confidence to counsel construct (mean difference 7.615, 95% CI 2.291 to 12.939, p=0.003) between Year 2 and Year 4. Constructs with lowest scores at all time points were nutrition knowledge and nutrition skills. There was clear desire for more nutrition education from all students: Year 2 (mean=3.8 out of 5 (1.1)), Year 4 (mean=3.9 out of 5 (0.9)), Year 5 (mean=3.8 out of 5 (0.8)). Conclusion Medical students’ self-perceived nutrition competence in providing nutrition care increased modestly at three points throughout medical training. There remains opportunity for further supporting medical students to increase their competence in nutrition care, which could be achieved through mandatory and greater medical nutrition education.
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Affiliation(s)
- Jennifer Crowley
- Discipline of Nutrition and Dietetics, The University of Auckland, Auckland, New Zealand
| | - Lauren Ball
- Menzies Health Institute Queensland, Griffith University-Gold Coast Campus, Southport, Queensland, Australia
| | - Clare Wall
- Discipline of Nutrition and Dietetics, The University of Auckland, Auckland, New Zealand
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50
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Sackeim MG, Lengyel E. Healthy food for trainees: a call to action. Postgrad Med J 2020; 97:740-741. [PMID: 32820089 PMCID: PMC8543187 DOI: 10.1136/postgradmedj-2020-138506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2020] [Indexed: 11/23/2022]
Affiliation(s)
| | - Ernst Lengyel
- OB/GYN, University of Chicago, Chicago, Illinois, USA
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