Faculty Bibliography

Objective: The objective of this study was to evaluate the relative validity of the nine-item Diet Risk Score (DRS) among Chinese American adults using Healthy Eating Index (HEI)-2015 scores. We provide insights into the application of the Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24) for this population, and report on lessons learned from carrying out participant recruitment during the COVID-19 pandemic. Methods: Thirty-three Chinese American adults (mean age=40; 36% male) were recruited from the community and through ResearchMatch. Participants completed the DRS and two 24-hour food records, which were entered into the ASA 24-Hour Dietary Assessment Tool (ASA24) by community health workers (CHWs). HEI-2015 scores were calculated from each food record and an average score was obtained for each participant. One-way analysis of variance and Spearman correlations were used to compare total and component scores between the DRS and HEI-2015. Results: Mean HEI-2015 score was 56.7/100 (SD 10.6) and mean DRS score was 11.8/27 (SD 4.7), with higher scores reflecting better and worse diets, respectively. HEI-2015 and DRS scores were inversely correlated (r=-0.43, p<0.05). The strongest correlations were between HEI-2015 Total Vegetables and DRS Vegetables (r=-0.5, p<0.01), HEI-2015 Total Vegetables and Green Vegetables (r=-0.43, p=0.01) and HEI-2015 Seafood/Plant Protein and DRS Fish (r=-0.47, p<0.01). The inability to advertise and recruit for the study in person at community centres due to pandemic restrictions impeded the recruitment of less-acculturated individuals. A lack of cultural food items in the ASA24 database made it difficult to record dietary intake as reported by participants. Conclusion: The DRS can be a valuable tool for physicians to identify and reach Chinese Americans at risk of cardiometabolic disease.

INTRODUCTION:Self-rated health has been extensively studied, but the utility of a similarly structured question to rate diet quality is not well characterized. This study aims to assess the relative validity of self-rated diet quality, compared with that of a validated diet quality measure (Healthy Eating Index-2015) and to examine the associations with cardiometabolic risk factors. METHODS:Analyses were conducted in 2020-2021 using cross-sectional data from the National Health and Nutrition Examination Survey, 2011-2018. Nonpregnant adults who responded to the question: How healthy is your overall diet? and provided 2 dietary recalls were eligible (n=16,913). Associations between self-rated diet quality (modeled as a 5-point continuous variable, poor=1 to excellent=5) and Healthy Eating Index-2015 scores and cardiometabolic risk factors were assessed by linear regression, accounting for the complex survey design and adjusting for demographic and lifestyle characteristics. RESULTS:. CONCLUSIONS:Self-rated diet quality was associated with Healthy Eating Index-2015 scores and cardiometabolic disease risk factors. This single-item assessment may be useful in time-limited settings to quickly and easily identify patients in need of dietary counseling to improve cardiometabolic health.

Poor dietary choices are a leading cause of chronic disease, but nutrition is rarely discussed in clinical practice. Nutrition is taught in less than a third of medical schools and physicians in practice empirically report low levels of comfort and self-efficacy in discussing nutrition with patients. A two-part presentation was created and shared with second-year medical students at a college of medicine. Students were given pre-work that included a brief (15 minutes) pre-recorded presentation and an e-resource entitled "Practical Nutrition for the Primary Care Provider" and then engaged in a live virtual session with a brief lecture and question and answer period (45 minutes). A survey was administered following the live presentation to evaluate the extent to which the presentation met the stated objectives and could impact participants' future practice. One-hundred and six students participated in the live lecture. Eighty-eight students (83%) provided survey feedback. Over two-thirds of respondents indicated that the presentation completely met the objectives, 57% indicated that they would definitely talk to patients with chronic disease about nutrition, and 52% indicated they would incorporate diet assessment in visits with patients with chronic disease. Nutrition is integral to disease prevention and management. Many students provided comments on the importance of the topic and benefit of the information. Further research is necessary to determine the optimal time and place for nutrition education in medical training. This presentation and e-resource are evidence-based, brief, and provided tools for participants to access once in practice.

Introduction/UNASSIGNED:Adherence to cardioprotective dietary patterns can reduce risk for developing cardiometabolic disease. Rates of diet assessment and counselling by physicians are low. Use of a diet screener that rapidly identifies individuals at higher risk due to suboptimal dietary choices could increase diet assessment and brief counselling in clinical care. Methods/UNASSIGNED:We evaluated the relative validity and reliability of a 9-item diet risk score (DRS) based on the Healthy Eating Index (HEI)-2015, a comprehensive measure of diet quality calculated from a 160-item, validated food frequency questionnaire (FFQ). We hypothesised that DRS (0 (low risk) to 27 (high risk)) would inversely correlate with HEI-2015 score. Adults aged 35 to 75 years were recruited from a national research volunteer registry (ResearchMatch.org) and completed the DRS and FFQ in random order on one occasion. To measure reliability, participants repeated the DRS within 3 months. Results/UNASSIGNED:=0.36). The DRS ranked 37% (n=47) of subjects in the same quintile, 41% (n=52) within ±1 quintile of the HEI-2015 (weighted κ: 0.28). The DRS had high reliability (n=102, ICC: 0.83). DRS mean completion time was 2 min. Conclusions/UNASSIGNED:ClinicalTrials.gov (NCT03805373).

It is critical that diet quality be assessed and discussed at the point of care with clinicians and other members of the healthcare team to reduce the incidence and improve the management of diet-related chronic disease, especially cardiovascular disease. Dietary screening or counseling is not usually a component of routine medical visits. Moreover, numerous barriers exist to the implementation of screening and counseling, including lack of training and knowledge, lack of time, sense of futility, lack of reimbursement, competing demands during the visit, and absence of validated rapid diet screener tools with coupled clinical decision support to identify actionable modifications for improvement. With more widespread use of electronic health records, there is an enormous unmet opportunity to provide evidence-based clinician-delivered dietary guidance using rapid diet screener tools that must be addressed. In this scientific statement from the American Heart Association, we provide rationale for the widespread adoption of rapid diet screener tools in primary care and relevant specialty care prevention settings, discuss the theory- and practice-based criteria of a rapid diet screener tool that supports valid and feasible diet assessment and counseling in clinical settings, review existing tools, and discuss opportunities and challenges for integrating a rapid diet screener tool into clinician workflows through the electronic health record.

Objective/UNASSIGNED:We assessed factors related to the integration of an office-based diet quality screener: nutrition counselling, cardiometabolic risk factors and patient/physician satisfaction. Methods/UNASSIGNED:We evaluated the impact of a 10-item diet quality measure (self-rated diet quality question and a 9-item Mediterranean Diet Score (MDS)) prior to the cardiology visit on assessment of nutrition counselling, cardiometabolic risk factors and patient/provider satisfaction. Study staff trained the nine participating physicians on the purpose and use of the screener. To assess physician uptake of the diet quality screener, we reviewed all charts having a documented dietitian referral or visit and a 20% random sample of remaining participants that completed the screener at least once to determine the proportion of notes that referenced the diet quality screener and documented specific counselling based on the screener. Results/UNASSIGNED:. Almost one-fifth (18.5%) of participants rated their diet as fair or poor, and mean MDS (range 0-9) was moderate (mean 5.6±1.8 SD). Physicians referred 22 patients (2.5%) to a dietitian. Conclusion/UNASSIGNED:Integrating the screener into the electronic health record did not increase dietitian referrals, and improvements in screener scores were modest among the subset of patients completing multiple screeners. Future work could develop best practices for physicians in using diet quality screeners to allow for some degree of standardisation of nutrition referral and counselling received by the patients.

Background/UNASSIGNED:Dynamic nutrition education strategies may help prepare physicians to provide nutrition guidance to patients. Activity/UNASSIGNED:We pilot tested a nutrition-focused iBook chapter with a group of medical students and residents (June 2017) through pre and post-test Qualtrics surveys. Results/UNASSIGNED:All 29 respondents recognized the role of nutrition in medical care. Two-thirds reported some nutrition training in their medical education; nearly 90% reported this training was inadequate. Few (17%) reported reading scholarly nutrition articles; 84% reported they would recommend the iBook to their peers. Conclusions/UNASSIGNED:An iBook is a resource that could be used to teach nutrition to medical trainees.

PURPOSE OF REVIEW/OBJECTIVE:Recent studies have documented that diet quality in the US is poor and linked to higher rates of cardiovascular disease (CVD), other non-communicable diseases, and total mortality. As a result, nutrition counseling in clinical practice is an evidence-based strategy endorsed by numerous stakeholders. However, medical nutrition education (MNE) in the US has been inadequate, and physician knowledge, competencies, and practices related to diet counseling have been documented to be insufficient. National scientific meetings and conferences offer opportunities to translate new scientific evidence, guidelines, and competencies to clinicians in attendance and to publicize this evidence widely. This review assessed the adequacy of, and trends in, nutrition education provided at recent major US scientific meetings that offer continuing medical education (CME), with a focus on CVD-related conferences. RECENT FINDINGS/RESULTS:The authors found no reviews that have assessed the scope and type of nutrition-related educational programming at major conferences. We therefore investigated nutrition-related programming at CVD-related CME conferences in the US from 2013 to 2018. National scientific CVD-related conferences in the USA have offered variable amounts of programming related to practical applications of nutrition science. We did not observe an increase in nutrition-related offerings, despite the increase in diet-related diseases and the growing evidence base for the role of nutrition in the prevention and management of chronic disease. Increasing nutrition-related CME programming at national scientific meetings can lead to greater translation of nutrition evidence to patients by healthcare providers and improved health outcomes in the population.