Better nutrition advice urgently needed

Nutrition counselling can make a difference in the health of high-risk patients, yet it takes place in a minority of primary care visits, according to a new study in the October issue of the American Journal of Preventive Medicine​.

"The need for nutrition counselling is pressing in light of the epidemic of chronic diseases such as hypertension, diabetes mellitus, obesity and hyperlipidemia [excessive fat content in the blood],"​ said study author Dr Charles B. Eaton, of the family medicine department at Brown Medical School and the Center for Primary Care and Prevention at the Memorial Hospital of Rhode Island in Pawtucket.

Diet changes have enormous potential to reduce the risks of death and illness but few studies have examined nutrition counselling in primary care, according to the study. An estimated 300,000 to 800,000 deaths every year result from nutrition-related diseases like heart disease, stroke, high blood pressure, diabetes and obesity.

Eaton and colleagues analysed data from a study of 138 doctors based in Ohio. In this study, research nurses were given permission to observe 3,475 patient examinations, and administer a questionnaire to patients after their visit. The nurses recorded any discussion of food intake or nutrition during the examination.

About a quarter of patients received nutrition counselling during their doctor visit, according to the study data. Patients who were seeing their doctor for an acute illness were less likely to receive it (17 per cent) than patients with chronic diseases (30 per cent).

The percentage of chronically ill patients receiving counselling falls short of the Healthy People 2010 national nutritional objectives, which suggest that 75 per cent of office visits for hyperlipidemia, cardiovascular disease and diabetes should include nutrition counselling.

Doctors spent an average of less than a minute on nutrition counselling. This finding suggests "that more in-depth nutrition counselling visits will need to occur outside a typical primary care office visit,"​ Eaton said.

Some experts say registered dieticians are best suited for giving nutrition counselling, while others suggest physicians can be trained to offer patients tailored nutrition messages that are supplemented with written educational materials, according to the study.

Eaton and colleagues concluded with the hope that their findings help medical educators create concise nutrition counselling tools "to help physicians optimise nutrition counselling within the context of the time constraints found in real-world, primary care practice."​