After smoking and obesity, the biggest driver of Australia’s disease burden is malnutrition; however, it is rare for patients to be offered personalized, nutritional interventions when seeking healthcare.
For people with a chronic disease management plan, only 1-2% of allied health services include referrals to Accredited Practicing Dietitians (APDs); There are no routine APD referrals for pregnant women.
A side effect of this is that intake of discretionary (i.e. ‘energy-dense, nutrient-poor’) foods is twice that recommended by the Australian Healthy Eating Guidelines and contributes to half the burden of heart disease. If healthy eating habits were the default, the burden of diseases such as bowel cancer, diabetes and stroke would be reduced by up to 25%.
Award-winning Professor Clare Collins, Director of the Hunter Institute for Medical Research and the Food and Nutrition Research Program at Newcastle University, wants to see dietary controls introduced into our healthcare system in a model that more closely mirrors dentistry.
He believes that many important events should trigger nutritional intervention, especially early pregnancy and detection of chronic disease risk.
“If I were in charge of the health department, I would introduce a Medicare product that would allow people to have dietary control during these important life stages,” he said. Hospital + Health.
“Currently the system only offers this to people who are already living with chronic diseases, and even then it may be an afterthought.
“Yes, we see dietitians playing a central role in treating kidney disease and diabetes, but many other conditions are also overlooked.
“The role nutrition currently plays in disease management pales in comparison to its impact on the disease burden.”
surprising findings
Collins believes more work is needed to ensure medical colleagues deliver evidence-based messages about dietary intake. Nutrition is a seemingly complex field, he says, and many of the latest research findings are counter-intuitive.
“It is possible that some of our medical colleagues contributed to misinformation. Some may not know the answers, but they are adept at giving advice. “There are also those who were trained years ago and cannot keep up with the latest guidelines.”
The most surprising of the latest findings is that inadequate consumption of legumes such as beans and chickpeas constitutes the highest nutritional risk factor for chronic disease. The second highest dietary risk factor is a diet low in whole grains or fiber.
“These findings are counterintuitive and difficult to understand, especially given guidelines on carbohydrate consumption. Yes, people need to be careful about their intake of highly processed carbohydrates, but it’s important to choose bread that’s packed with enough whole grains to taste like nuts. Allied health teams on this front and There is great benefit in working more closely with medical colleagues.”
Although nutrition information leaflets can be useful, Collins believes they are only adequate for certain patient groups. Referring physicians must be skilled at determining who needs additional nutritional support, he said.
“If someone is really interested in nutrition and seems good at finding information, a brochure may be of use to them. If someone seems desperate for advice and their HBA1 is outside the Richter scale, a referral to an APD is warranted. Our medical colleagues will make the most of this.”
However, Collins argued that many doctors may be overestimating their patients’ knowledge of nutrition.
“It is common for people with obesity to be told to go out and lose weight. What we may not realize is that many of these patients have never been given adequate nutritional advice from a suitably qualified professional.
“A large portion of the public is unaware that we start from the nutritional pyramid created decades ago and that nutritional counseling includes support for realistic goal setting and support for changes in food behaviors.”
Huge potential for improvement
Underrepresentation of nutrition in chronic disease management harms patients, and a greater emphasis on diet is the missing piece of the disease prevention puzzle, Collins says.
“If a miracle happened and the entire population suddenly started following current recommended dietary guidelines, then we would see a 50% reduction in the burden of disease due to heart disease and a 25% reduction in the burden of diabetes.”
Collins would also like to see nutrition play a bigger role in managing mental health, given a new finding that dietary improvements are effective for depression.
“This is a huge missed opportunity. If you’re not eating healthily, the first thing you’ll feel is a poorer sense of well-being. You won’t feel like you’re firing on all cylinders. We now know that improving people’s diets can significantly improve well-being, and we’re doing people a poor service by withholding this evidence-based advice.”
“I hope to see our future healthcare system give nutrition the attention and funding it deserves,” he concluded.