Experts urge evaluation of diet at routine check-ups

August 07, 2020

DALLAS, Aug. 7, 2020 -- The time has come for routine health care visits to include some form of dietary assessment and counseling, according to a new scientific statement from the American Heart Association published today in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal. The statement, written by a group of nutrition and cardiovascular disease experts, recommends the adoption of a rapid diet screening tool that can be integrated into electronic health record platforms across all health care settings.

"Dietary patterns and quality are not sufficiently prioritized when addressing modifiable risk factors during regular health care office visits. Given the evidence that diet contributes to disease and mortality, it is a risk factor worth screening for continuously," said Maya Vadiveloo, Ph.D., R.D., chair of the statement writing group and assistant professor of nutrition and health sciences in the College of Health Science at the University of Rhode Island in Kingston, Rhode Island.

Poor diet quality has surpassed all other risk factors for death, accounting for 11 million deaths and about half of cardiovascular disease (CVD) deaths globally, according to the 2017 Global Burden of Disease Study, a comprehensive report on the health impact of diet in 195 countries around the world.

The statement authors reviewed 15 existing screening tools, assessing each to provide insight on the feasibility of incorporating an evidence-based dietary screening tool into routine practice.

The authors list numerous reasons why members of a health care team may not address diet quality during a routine office visit: lack of training and knowledge; lack of time and reimbursement; competing demands during the often short office visit; and that nutrition services aren't integrated into many health care settings.

"However, these barriers can be overcome," said Vadiveloo. "We want a valid, reliable way to assess diet that reflects the best science, and most of the tools assessed take under 10 minutes to use." Three of the tools assessed meet criteria set forth in the statement and may provide a framework to help practices incorporate 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 10 questions and cover major food groups, as well as processed foods and alcohol consumption.

The keys to an effective diet screening tool include:While the statement does not endorse a specific screening tool, it encourages critical conversations among clinicians, individuals with diet/lifestyle expertise and specialists in information technology to adopt rapid diet screening tools for adults in primary care and relevant specialty care and prevention settings.

"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," said Alice H. Lichtenstein, D.Sc., vice-chair of the writing group and lead and senior scientist of the Cardiovascular Nutrition Team at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University in Boston.

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

A healthy diet can improve cardiovascular disease risk and outcomes. What you eat (and how much) can affect other controllable risk factors, such as cholesterol, blood pressure, diabetes and being overweight.
-end-
The scientific statement was written on behalf of the American Heart Association's Council on Lifestyle and Cardiometabolic Health; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; and Stroke Council.

Co-authors and members of the writing group are Cheryl Anderson, Ph.D., M.P.H.; Karen Aspry, M.D., M.S.; Randi Foraker, Ph.D.; Skylar Griggs, M.S., R.D., L.D.N.; Laura L. Hayman, Ph.D., M.S.N.; Emily Johnston, M.P.H., R.D.N., C.D.E.; Neil J. Stone, M.D.; and Anne N. Thorndike, M.D., M.P.H. Author disclosures are in the manuscript.

Additional Resources:

Available multimedia is located on the right column of the release link: https://newsroom.heart.org/news/experts-urge-evaluation-of-diet-at-routine-check-ups?preview=b0751d6475bdf889ea0683fbfb1e1f6e

The Association receives funding primarily from individuals. Foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations and health insurance providers are available at https://www.heart.org/en/about-us/aha-financial-information.

About the American Heart Association

The American Heart Association is a leading force for a world of longer, healthier lives. With nearly a century of lifesaving work, the Dallas-based association is dedicated to ensuring equitable health for all. We are a trustworthy source empowering people to improve their heart health, brain health and well-being. We collaborate with numerous organizations and millions of volunteers to fund innovative research, advocate for stronger public health policies, and share lifesaving resources and information. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.

American Heart Association

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