AHA calls for dietary counseling during routine healthcare visits

10 Aug 2020 --- The American Heart Association (AHA) is urging routine healthcare visits to include some form of dietary assessment and counseling. Disease experts recommend the adoption of a rapid diet screening tool that can be integrated into electronic health record platforms across all health care settings, according to a statement published in Circulation: Cardiovascular Quality and Outcomes. However, there are several barriers that would need to be overcome first.

“Dietary screening or counseling is not usually a component of routine medical visits. With more widespread use of electronic health records, there is an enormous unmet opportunity to provide evidence-based clinician-delivered dietary guidance using rapid diet screener tools that must be addressed,” the statement reads.

Overcoming implementation obstacles
According to the AHA, several barriers exist to the implementation of screening and counseling, including:

• Lack of time.
• Sense of futility.
• Lack of reimbursement.
• Lack of training and knowledge.
• Competing demands during the visit.
• Absence of validated rapid diet screener tools with coupled clinical decision support to identify actionable modifications for improvement.

“These barriers can be overcome,” says Dr. Maya Vadiveloo, the statement writing group chair and Assistant Professor of Nutrition and Health Sciences at the University of Rhode Island, US. “We want a valid, reliable way to assess diet that reflects the best science and most of the tools assessed take under ten minutes to use,” she states.

AHA is calling for more varied dietary counseling that can help patients prevent CVD cases.The statement authors reviewed 15 existing screening tools, assessing each to provide insight into the feasibility of incorporating an evidence-based dietary screening tool into routine practice. Three of the assessed tools may provide a framework to help practices integrate diet screening into their workflow. 

The Powell and Greenberg Screening Tool asks two questions about fruit and vegetable consumption and sugary food and juice consumption. The Rapid Eating Assessment for Participants-Shortened assessment and the Mediterranean Diet Adherence Screener ask more than ten questions and cover major food groups, as well as processed foods and alcohol consumption.

“An important component in addition to evaluating diet quality is targeting actionable changes – helping patients set achievable dietary goals – and then following up at the next visit,” adds Alice Lichtenstein, Vice-Chair of the writing group and Senior Scientist of the Cardiovascular Nutrition Team at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, US.

Areas for future study include testing and validating screener tools in diverse populations, as well as among special clinical populations, such as pediatrics and geriatrics, as well as evaluating the feasibility of implementing these tools in clinical settings.

A study from January revealed that people following self-chosen diets with little supervision can still have realistic, health-positive outcomes, albeit the changes achieved without ongoing support were quite modest. In this study, the Mediterranean diet was the easiest to adhere to.

You are what you eat
WHO underlines that people with CVD or who are at high cardiovascular risk need early detection and management using counseling and medicines, as appropriate. High cardiovascular risk can be caused by hypertension, diabetes, hyperlipidemia or an already established disease. 

“Most CVD cases can be prevented by addressing behavioral risk factors such as tobacco use, unhealthy diet and obesity, physical inactivity and harmful use of alcohol using population-wide strategies,” WHO stresses.

In November, NutritionInsight reported on how lacking nutritional training begins in medical studies. Just as with routine healthcare visits, this results in physicians missing out on possibilities to provide patients with comprehensive counseling, as poor diets continue to contribute to global deaths annually.

By Anni Schleicher