N° 85 | January 2014

General practitioners can offer effective nutrition care to patients with lifestyle-related chronic disease

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Lifestyle-related chronic diseases, such as overweight and obesity, Type 2 diabetes and cardiovascular disease, account for over 60% of deaths worldwide. Nearly two-thirds of the risk factors for overweight and obesity, Type 2 diabetes and cardiovascular disease relate to poor nutrition behavior.

Importance of nutrition care provided by general practitioners

Nutrition care is a core principle of best practice guidelines for the management of chronic disease, and includes practices such as the assessment of a patient’s nutrition intake, the provision of nutritionrelated advice, and the evaluation of nutrition behaviour on patients’ health outcomes. Patients perceive nutrition care to be an important part of the care provided by general practitioners (GPs) for lifestyle-related chronic disease management. Moreover, the demand on GPs to provide nutrition care is increasing.

Improvement in the nutrition behaviour and risk factors

We conducted a systematic review of published literature that investigated the effectiveness of nutrition care provided by General Practitioners (GPs) in improving the nutrition behaviour and subsequent risk factors in individuals with lifestyle-related chronic disease. Nutrition behaviour outcomes included overall dietary intake, energy consumption, and macronutrient intake. Risk factors included body weight, Body Mass Index (BMI), waist circumference, blood pressure, and serum lipid levels. Of the 131 articles originally screened, nine relevant interventions studies (five American1-5, three European6-8, one Australian9) were chosen according specific criteria:

  • Adult populations (>18 years of age).
  • The effectiveness of the intervention must have been investigated using a control group.
  • The nutrition care must have :
    • been provided by a GP or international equivalent (not included: practice nurses, nutritionists, dietitians); and
    • occurred in standard GP consultation.
  • The intervention must have included identical baseline and follow-up measurements of either nutrition-related behavior or biological indicators of health.

These nine interventions were published between 1989 and 2008 and consisted of 9,564 participants (number of participants included in each study ranged from 77 to 3,179). The interventions incorporated between one and six consultations with a GP, where the GP provided basic nutrition care to the participant (nutrition-related training for the GPs prior to the intervention/national dietary guidelines as supporting material for the nutrition care).
We observed improvements in the nutrition behaviour of participants, such as:

  • An increase in :
    • fruit and vegetable intake by two serves per week6;
    • fish intake to at least one serve per week6; and
    • fibre intake of 0.55 g/1000 kcals4.
  • A reduction of :
    • energy consumption of 0.7 MJ/ day7;
    • meat consumption to three serves or less per week6; and
    • fat intake of 5–10%3,4,7.

Concerning risk factors, we observed significant reductions in participants’ body weight of 0.4–2.3 kg, or 0.2–0.81 kg/m2 1-3,6-7. Reductions in serum choles¬terol levels of 0.46–0.83 mmol/L, and reductions in diastolic blood pressure of 4.0 mm Hg were also observed9. Interestingly, the studies that observed improvements in participants’ nutrition behaviour were not necessarily the same studies that observed improvements in participants’ risk factors. It would appear that the number of consultations is not a determining factor for the effectiveness of nutrition care provided by GPs. This suggests that effective nutrition care can be provided in relatively few consultations, and may not have a significant influence on GPs’ workload. The interventions suggest that GPs may be effective at providing nutrition care to individuals with lifestylerelated chronic disease.

WHAT GAP THIS FILLS

What we already know: The demand on general practitioners (GPs) to provide nutrition care to patients with lifestyle-related chronic disease is increasing. However, it is unclear whether GPs are effective at improving the nutrition behaviour and associated risk factors in these patients.
What this study adds: This systematic review demonstrates that GPs have the potential to provide nutrition care that improves the nutrition behaviour and risk factors in individuals with lifestylerelated chronic dis¬ease. However, the consistency and clinical significance of the intervention outcomes are unclear. Further support is needed for GPs to provide nutrition care to patients.

 

BASED ON: Ball L, Johnson C, Desbrow B, Leveritt M. “General practitioners can offer effective nutrition care to patients with lifestyle-related chronic disease.” J Prim Health Care. 2013 Mar 1;5(1):59-69.

  1. Christian J, et al. Clinic-based support to help overweight patients with type 2 diabetes increase physical activity and lose weight. Arch Intern Med. 2008;168(2):141–6.
  2. Martin P, et al.. Weight loss maintenance following a primary care intervention for lowincome minority women. Obesity. 2008;16(11):2462–7.
  3. Ockene I, et al. Effect of physician-delivered nutrition counseling training and an officesupport program on saturated fat intake, weight, and serum lipid measurements in a hyperlipidemic population—Worcester Area Trial for Counseling in Hyperlipi¬demia (WATCH). Arch Intern Med. 1999;159(7):725–31.
  4. Beresford S, et al. A dietary intervention in primary care practice: the eating patterns study. Am J Public Health. 1997;87(4):610–6.
  5. Logsdon DN, et al. The feasibility of behav¬ioral risk reduction in primary medical care. Am J Prev Med. 1989;5(5):249–56.
  6. Sacerdote C, et al. Randomized controlled trial: effect of nutritional coun¬selling in general practice. Int J Epidemiol. 2006;35(2):409–15.
  7. van der Veen J, et al. Stage-matched nutrition guid¬ance for patients at elevated risk for cardiovascular disease: a randomized intervention study in family practice. J Fam Pract. 2002;51(9):751–8.
  8. Alli C, et al. Feasibility of a long-term low-sodium diet
  9. Salkeld G, et al. The cost-effectiveness of a cardiovascular risk reduction program in general practice. Health Policy. 1997;41(2):105–19.
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