Nutrition and the Primary Care Clinician (original) (raw)

Nutrition Guide for Physicians and Related Healthcare Professionals

Nutrition Guide for Physicians and Related Healthcare Professionals, 2017

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Cross-sectional and longitudinal analyses of nutrition guidance by primary care physicians

European Journal of Clinical Nutrition, 1999

Objective: To investigate in primary care physicians (PCPs) the determinants of a nutrition guidance practice (`noticing patients' overweight and guidance of treatment'), as well as their mechanism of action, in a crosssectional and a longitudinal approach. Design: Mixed longitudinal design. Five years follow up study of a previous cross-sectional study in October 1992. Subjects: A representative sample of 675 Dutch PCPs, in practice for 5 up to 20 y. Interventions: A shortened version of the Wageningen PCPs Nutritional Practices Questionnaire was mailed to the subjects in August 1997. Main outcome measure: To obtain with the LISREL-program a model of the mechanism of action of determinants of the dependent variable`noticing patients' overweight and guidance of treatment' with an adequate ®t of the empirical data, both in the cross-sectional and in the longitudinal approach. Results: The same set of predisposing factors and intermediary factors explains the dependent variable both in two different representative cross-sectional study populations of PCPs, and in a cohort cross-sectional study at two points in time.

Nutrition guidance by primary care physicians: models and circumstances

European Journal of Clinical Nutrition, 1999

The perception of primary care physicians of the ability to in¯uence the lifestyle and eating habits of patients is an important factor in nutrition guidance practices. This perception is based on assumptions about the kind of in¯uencing process that is effective or not and on the capacity of primary care physicians to play an effective role in these processes. The ®rst elements is dealt with in this article. Three models are distinguished. The ®rst model is the prescription model, based on a medical optimum and on information transfer as a metaphor. The second model is the persuasion model, based on a medical optimum, but presupposing blockades that have to be cornered by persuasive communication. The third is the interaction model. It is not based upon a medical but on an ef®cacy optimum, and on sharing of information and continuous involvement of the client in the interaction. Behind these three models we can perceive different views on communication and knowledge. Moreover, these three models are more or less appropriate with regard to different circumstances. The current stress on the psychological, social and cultural meaning of food and the new information context in which clients live, asks for more attention to the interaction model.

Physician informational needs in providing nutritional guidance to patients

Family medicine

This study's objective was to assess patient nutrition inquiries and related physician resources to identify the nutrition topics about which physicians most need information for patients and practice. A survey was mailed to a 50% random sample of Washington Academy of Family Physicians (WAFP) members (n=778) to identify the top 10 patient nutrition inquiries that the physician would like to be better equipped to answer. The responding physicians' use of nutrition resources (journals, pamphlets, Web resources, toll-free numbers, and referrals to registered dietitians) was also recorded. A total of 306 (39.3%) physicians responded. The majority wanted more information on weight management (66.5%), followed by information on herbals, botanicals, and other complementary and alternative medicines (CAM) (36.4%) and vitamin and mineral supplements (24.4%). Other common nutrition inquiries for which respondents wanted more information included diet for prevention of disease, high protein-low carbohydrate diets, and childhood nutrition. A minority of respondents used nutrition Web resources and toll-free numbers. Nearly all respondents reported referring patients to registered dietitians. Physicians in our survey expressed a need for information on topics such as obesity, CAM, and life cycle and disease-specific diets. Medical nutrition educators should consider the educational needs of the practicing physician.

Nutritional assessment and counseling for prevention and treatment of cardiovascular disease

American Family Physician, 2006

Physicians face several barriers to counseling their patients about nutrition, including conflicting evidence of the benefit of counseling, limited training and understanding of the topic, and imperfect and varied guidelines to follow. Because cardiovascular disease remains the leading cause of death in industrialized nations, family physicians should provide more than pharmacologic interventions. They must identify the patient's dietary habits and attitudes and provide appropriate counseling. Tools are available to help, and a seven-step approach to nutritional therapy for the dyslipidemic patient may be useful. These steps include recommending increased intake of plant proteins; increased intake of omega-3 fatty acids; modification of the types of oils used in food preparation; decreased intake of saturated and trans-fatty acids; increased intake of whole grains and dietary fiber (especially soluble fiber) and decreased intake of refined grains; modification of alcohol intake,...

Dietary Counseling Is an Important Component of Cardiac Rehabilitation

Journal of the American Dietetic Association, 2005

ardiovascular disease (CVD) remains the number one cause of death in the United States (1). CVD, which encompasses hypertension, coronary heart disease (CHD), congestive heart failure, stroke, and congenital heart defects, killed 931,108 Americans in 2001 (1). CHD alone is the single largest cause of death among Americans; in 2004 it was estimated that 700,000 Americans would experience a coronary attack and 500,000 would have a recurrent attack. The total estimated direct and indirect cost of CVD for 2005 is $393.5 billion (1). Many of the risk factors associated with CVD are modifiable through lifestyle interventions and can play a major role in reducing the personal, societal, and financial burden of the disease. Medical nutrition therapy (MNT), an important component of disease management, is recognized as a cornerstone of therapy for the prevention and treatment of chronic diseases and is an essential element of national standards of care guidelines for many chronic diseases (2). The American Heart Association and the National Heart, Lung, and Blood Institute among others have endorsed MNT as a critical component of CVD management guidelines. The National Cholesterol Education Program Adult Treatment Panel III (3) recommends that therapeutic lifestyle changes including dietary modifications be an integral component of lipid-lowering interventions aimed at lowering the risk of CVD. The Institute of Medicine, in its review of existing evidence, found MNT to be effective in treating conditions such as dyslipidemia, hypertension, and heart failure (4), resulting in its recommendation that MNT services be reimbursed. Furthermore, the Institute of Medicine report identified registered dietitians (RDs) as the single group of health care professionals qualified to provide nutrition therapy. MNT has been shown to be cost-effective in improving patient outcomes. Prosser and colleagues (5) observed dietary interventions to be more cost effective in the primary and secondary prevention of CVD than pharma