“This AHA scientific statement is designed to accelerate efforts to make diet quality assessment an integral part of office-based care delivery by encouraging critical conversations among clinicians, individuals with diet/lifestyle expertise and specialists in information technology,” the committee wrote.
According to research, diet quality is indicated to highly influence the risk for heart disease, obesity, diabetes, and other serious health conditions, note the authors who published their report in the journal Circulation.
“Dietary patterns and quality are not sufficiently prioritized when addressing modifiable risk factors during regular health care office visits,” says Maya Vadiveloo, PhD, RD, an assistant professor in nutrition and food sciences at the University of Rhode Island in Kingston and lead author of the new statement. “Given the evidence that diet contributes to disease and mortality, it is a risk factor worth screening for continuously,” Vadiveloo adds.
The American Heart Association concedes that this won’t necessarily be an easy task due to the lack of understanding regarding the role of diet in disease prevention being what typically will stop most doctors from addressing food with their patients, in addition to the lack of time available during the brief office visits, and the lack on training on how to offer nutrition counseling which limits options to referring patients to registered dietitians. However, these are all barriers that can be overcome, says Vadiveloo.
To help make diet screening become more easier for doctors to do as routine screening the AHA has vetted 15 different tools focussing on diet rather than single food groups or nutrients that can be used by clinicians without nutritional training in less than10 minutes to provide guidance on healthy dietary changes, and link to electronic health records to track eating habits over time.
The association still does not endorse any specific tool, but it did find 3 options that stood out as providing the best rapid snapshot of eating habits: 1) Mediterranean Diet Adherence Screener (MEDAS) This asks 14 questions that cover consumption of healthy fats like olive oil, fruits and vegetables, fish, and red meat; 2) Powell and Greenberg Screening Tool This asks two questions about fruit and vegetable consumption and sugary food and juice intake; and 3) Rapid Eating Assessment for Participants-Shortened (REAP-S) This asks 15 questions that touch on servings of whole grains, fruits, and vegetables, as well as cooking and snacking habits.
Decades old research has linked diet screening and counselling in a doctor’s office to a range of positive health outcomes which includes improvements in body weight, blood pressure, blood sugar, and cholesterol. Those who received nutrition counseling from physicians were found to have lower weight, consumed less saturated fat and have lower cholesterol levels than those not getting this support.
A recent review by the US Preventive Services Task Force linked exercise and diet counseling to improvements in weight, cholesterol, blood sugar, and blood pressure in those who are at high risk for cardiovascular disease. Additionally a report published in Applied Physiology, Nutrition, and Metabolism found dietary assessment and counseling to be associated with increased consumption of fruits, vegetables, nuts and a reduced intake of processed baked goods.
According Susan Roberts, PhD, a senior scientist at the U.S. Department of Agriculture Nutrition Center at Tufts University in Medford, Massachusetts, it is also important to remember that for routine dietary screening and counseling to work in a primary care setting more doctors need to know how to give proper individualized nutritional advice so that they can stop referring patients to registered dietitians for counseling that may be hard for many patients to afford.
“Physicians have very little expertise in giving healthy dietary advice beyond generalities, so ideally if physicians are doing this screening, they will receive education to help them provide good advice based on the results,” says Dr. Roberts, who was not an author of the current paper.
The AHA offers dietary guidelines that are available online for those without doctors offering diet screening or counseling. The association recommends diets rich in a variety of fruits, vegetables, whole grains, low fat dairy products, nuts, legumes, and skinless poultry and fish while limiting saturated fats, trans fats, sodium, red meat, sweets, soda and other sugary drinks. According to the AHA eating patterns that meet this heart healthy criteria include the DASH diet and Mediterranean eating plans.
“The massive health impacts of poor diet quality in the United States and globally and the potential for large reductions in health care costs and enhanced quality of life from population-wide improvements in diet quality provide a strong rationale to increase the delivery of diet assessment, education and counseling by clinicians and other members of the health care team in diverse health care settings,” the committee wrote. “Moreover, the consistent evidence that low nutrition knowledge negatively affects diet quality and clinician-delivered diet counseling improves diet behaviors and cardiometabolic risk factors supports adoption of routine integration of diet assessment and counseling into diverse health care settings.”
