Jonathan Berz, MD, MSc

Disclosures

August 21, 2012

In This Article

What to Do in the Office

The busy primary care provider may ask whether it is useful to perform in-office nutritional counseling. The US Preventive Services Task Force addressed this question in 2003 and concluded that the evidence was insufficient to show benefit of primary care providers giving dietary counseling in unselected populations. However, the report stated that low-intensity counseling of primary care patients, such as repeated 5-minute counseling sessions coupled with patient education materials, is promising, and that more evidence is needed to assess the long-term efficacy. In addition, evidence shows the benefits of intensive dietary counseling in patients with hyperlipidemia and other risk factors for cardiovascular and diet-related chronic diseases. Intensive dietary counseling has been shown to produce significant changes in daily intake of important components of a healthy diet, including fruits, vegetables, and healthy fats.[25]

The 24-hour recall can be a useful tool to get an idea of a patient's nutritional patterns. It can be done during the office visit, often in less than 10 minutes, by reviewing in detail each of the patient's meals and snacks over the past 24 hours. One strategy is to start by asking the patient to describe his or her most recent meal or snack, and then to go backwards until the previous 24 hours are covered. After each meal or snack is described, it is important to ask if the patient consumed anything else because food items are often forgotten until prompted (eg, "What did you have for dessert?"). Remember to ask specifically what beverages were consumed during and between meals. Without prompting, patients may not report beverage intake, and sugar-sweetened beverages can be a substantial contributor to total calories. Replacing them with water can lead to important reductions in caloric intake.[26]

In addition to the 24-hour recall, a number of validated tools can be used to assess a patient's diet. Although the gold standard for nutritional assessment is either the multiday food diary or the food frequency questionnaire, these detailed and lengthy tools are often used in nutritional research and are not practical to use in the typical primary care office setting. As a result, a number of authors have developed tools[27] designed specifically for dietary assessment in primary care settings. Many of the tools focus on specific aspects of the diet, such as intake of fruits and vegetables, dietary fat, and fiber. Most have a low response burden and can be administered in fewer than 10 minutes, making them practical for a busy office practice. Although these tools may not be as specific as the food frequency questionnaire or food diary, they are often able to differentiate between healthy and unhealthy eating, directing providers towards patients who would benefit from dietary counseling.[27]

The following resources provide a number of validated options for in-office nutritional assessments as well as more information about the diets discussed earlier.

Online Resources

USDA Dietary Guidelines for Americans, 2010: Appendix 10 -- The DASH Eating Plan at Various Calorie Levels

USDA: Choose My Plate.gov: Food Groups

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