Promotion of healthy nutrition: at the core of the primary and secondary preventions

Poor dietary habits are expanded around the world and are responsible for most non-communicable diseases. Dietary recommendations are essential to curb this trend and should be supported by healthcare practitioners in clinical practice, but their implementation is poor. This clinical consensus aimed to contextualize healthcare professional’s role in nutritional counselling as part of primary and secondary care. It highlights the major role of nutritional care in health and its necessity to be included in primary care, secondary care, and public health. This consensus also provides key messages to improve nutritional care and recommendations for future guidelines.

Non-communicable diseases such as cardiovascular diseases, strokes or cancer represent one of the major burdens worldwide. In fact, these diseases are responsible for 74% of total deaths worldwide in 2019. Non-communicable diseases result from the combination of various factors, including behavioural factors such as poor dietary habits (WHO, 2023). Healthier diets have the capacity to reduce the risk of developing these diseases and should be entirely considered as part of primary healthcare (Marques-Vidal et al., 2020).

To help the promotion of healthy nutritional habits at all levels of primary and secondary care, healthcare professionals have to participate in continuous medical education. Indeed, healthcare professionals agree to the fact that nutrition is a key element of health, and they recognize their role in nutritional counselling. Despite this, several barriers prevent healthcare practitioners from providing nutritional care, such as a limited training about nutrition in medical schools, a lack of time during consultations, an inadequate knowledge and counselling skills (Carter, 2022) and patients barriers (de Mestral, 2020). This consensus paper contextualizes the clinician’s role in nutrition management in primary and secondary care, providing practical examples of how this could be achieved.

Nutritional care: essential element of primary care in clinical practice

Optimal nutritional support and lifestyle approaches to patients in primary care can benefit both the patients and the healthcare system. In fact, appropriate investment in nutrition could save 3,7 million lives worldwide by 2025 (WHO, 2019). Primary care professionals’ motivation to provide nutritional care varies according to their practice and experience, with most of them feeling insufficiently trained in this topic (Smith et al., 2015). Studies showed that education events and policies made by professionals could help increase their confidence and competence about nutritional counselling (Crowley et al., 2020).

This consensus paper highlights the need of primary care practices to incorporate screening and counselling for all individuals and to put primary prevention at the core of patient’s healthcare. It also mentions that continuous medical education should focus on nutrition and public awareness to maintain healthy eating habits that are essential for health and disease prevention (Downer et al., 2020).

According to this consensus paper, nutritional counselling is a two-part interaction: 1) interpreting the results of dietary assessment and identifying nutritional problems; and 2) discussing goals with the patient and how to achieve them. To provide nutritional counselling, physicians should provide education, ascertain patient willingness to change, support the change, and make sure the patient understands the important information, accepts having a nutritional modification and is motivated to work towards new goals.

Importance of nutritional counselling in secondary prevention

This consensus paper focuses on cardiac rehabilitation programmes and children with cardiovascular disease to show the evidence of nutritional counselling in secondary care (Ambrosetti et al., 2021). Nutrition is expected to lead to a better quality of life, a better cardiovascular risk management and increased survival. However, despite the cardioprotective effect of individualized nutritional plans, adherence and compliance remain difficult during cardiac rehabilitation (Ma et al., 2010).

According to the European Association of Preventive Cardiology, this issue has five dimensions: the patient, the disease, the healthcare provider, the therapy, and the healthcare system. All should be optimized simultaneously to maximize the benefits of the nutritional therapy. A multi-disciplinary team approach is required to achieve long term best possible results for patients and to support them.

Concerning childhood and adolescence, healthy eating ensures performances and enables adequate growth processes and healthy development. While dietary recommendations for children often focus on obesity, healthy nutrition also plays an essential role in children with other chronic diseases. Healthy dietary habits have the highest importance in the prevention of cardiovascular diseases and elimination of cardiovascular risk factors (Funtikova et al., 2015). It is needed that healthcare professionals such as physicians can identify children with cardiovascular diseases to refer them early to a paediatric cardiology centre that will provide adequate support and nutritional counselling.

Nutrition in public health: how is Europe doing?

To provide nutritional counselling at the population level, most countries in Europe use information and education, such as dietary guidelines, in their nutritional policy to improve dietary behaviours. But they tend to fail regarding socially disadvantaged groups, widening social inequalities in diet. Low-agency population policies, such as the development of mandatory nutrient lists on packaged food, taxes on food or easy-to-understand labelling can result in more significant and equitable improvements in diet and health. According to the authors, combining these two strategies will likely improve diets and narrow inequalities, as recommended by the European Food and Nutrition Action Plan 2015-2020 (Adams et al., 2016).

The consensus paper also highlights the benefits of workplace-based dietary interventions that can reach as many individuals as possible for prolonged periods and are part of large-scale strategies (Glympi et al., 2020). It also shows that schools are a powerful tool through which nutrition education can be promoted in the society: healthy dietary habits adopted early can reduce the risk of illness and contributes to the emotional well-being and productivity of children (Baltag et al., 2022).

The authors suggest educating both the public and the healthcare professionals, especially by implementing nutritional counselling in the medical curriculum that would be extremely beneficial (Aspry et al., 2018). Nutrition represents an impactful driver of many cardiovascular risk factors such as obesity, dyslipidaemia and diabetes, but is also a highly evolving field. Future guidelines should then consider the evolving speed of this domain to ensure the provision of optimal nutritional support by healthcare professionals.

Based on: Vassiliou et al. Promotion of healthy nutrition in primary and secondary cardiovascular disease prevention: a clinical consensus statement from the European Association of Preventive Cardiology, European Journal of Preventive Cardiology, 30, 696-706, 2023.