- •Worldwide death rates from cardiovascular disease (CVD) are rising, and are often due, in part, to poor diet quality.
- •New survey data of international cardiologists shows that nutrition knowledge and the ability to apply nutrition to everyday care is very limited.
- •Nutrition counseling during patient visits worldwide is very limited, in part due to knowledge gaps and limited time, despite the beliefs by most that this would improve outcomes.
- •Empowering health care providers with the tools they need in nutrition and lifestyle medicine could significantly combat CVD worldwide.
- Forouzanfar M.H.
- Alexander L.
- Anderson H.R.
- et al.
- Uusitalo U.
- Pietinen P.
- Puska P.
- World Health Organization (WHO)
- Centers for Disease Control and Prevention (CDC)
Modifying Eating Habits and Risk Factors
The Mediterranean and Plant-Based Diets
- World Health Organization (WHO)
International Efforts for Dietary Modification
|Continent||Major Regions||Example Countries||Predominant Ingredients||Example Food||Comments|
|Africa||North Africa + Middle East||Algeria, Morocco, Tunisia, Egypt, Israel, Iran, Iraq, Turkey||Wheat, spices (saffron, nutmeg, cinnamon, ginger, cloves, chilies), tomatoes, potatoes, seafood, goat, lamb, beef, dates, almonds, olives, olive oil, lemons, peppers, rice, vegetables, milk, cereal grains, honey, sesame seeds, meats||Couscous, stewed meats such as lamb tagine, grilled meats such as kebabs, dolma such as stuffed grape leaves||Less pork consumption due to religion – Islam and Judaism|
|Sub-Saharan Africa||South Africa, Namibia, Botswana||Grains, red meat, dried meats, potatoes, rice, butter, sugar, beans, milk, vegetables, corn, curry, lemon, rice, fruits and vegetables, cornmeal||Braai (barbecued red meat), stewed meats, biltong (dried, cured meat)||Also referred to as “rainbow cuisine” due to a mix of influence from native tribes, Europe and Asia|
|Americas||North||United States, Canada||Meats, wheat||Burgers, pasta, “fast food”||Immigrant European cuisine|
|South and Central||Brazil, Ecuador, Belize, Costa Rica||Corn, beans, potatoes, less meats||Rice and chicken, rice and beans|
|Rice, ginger, garlic sesame, soy and tofu, seafood|
Rice, noodles, tofu, pork, beef, mutton, duck, pigeon
|Rice, sushi, pickled and fresh vegetables|
Rice/noodles with tofu and meat
|Korea: pickled cabbage (Kimchi)|
|South West||India, Vietnam, Malaysia||Vegetables, coconut milk, chickpeas, lentils, rice, wheat, yogurt, seafood||Coconut milk-based curries, biryani, chapati (flat bread), roti||Less beef in locations with predominant Hinduism, less pork with predominant Islam|
|Europe||North||Norway, Belgium, Germany||Wheat, rye, butter, meat, cured meat, rice, pickled food||Sausages, polenta, smoked salmon||Also can be divided as Eastern and Western Europe|
|South||Italy, Malta, Croatia||Olive oil, pasta, vegetables, seafood||Pasta dishes, Mediterranean cuisine|
|Oceania||Australia, New Zealand, islands in the Pacific||Sweet potato, taro, fish, fruits||Meats, barbecued meats, seafood||Immigrant European cuisine as well as native Aboriginal Australian cuisine|
The Role of the Physician in Impacting Patients' Diets
State of Nutrition Education in International Medical Training
Physician and Nutritional Counseling of Patients
Nutrition Education in Medical School
Graduate Nutrition Education
- American Heart Association (AHA)
- World Health Organization (WHO)
Lack of Fruit and Vegetable Consumption—an International Problem
Hospital Readmission Due to Cardiovascular Disease
Solutions to Improving Educational Efforts
- •Patient Adherence to Therapy: Patient adherence to therapies is positively related to physicians effectively counseling on the topics. In addition, patients feel that physicians are the most authoritative and credible sources for information51,58on diet and nutrition, despite the inadequate training they actually receive on this topic. The minimal time physicians spend educating patients on nutrition likely stems from their lack of education: over 52% of those polled felt that they did not possess enough expertise on this topic.
- •Improved Education of Physicians: Improved education on topics of nutrition is essential at all levels of physician training. From the survey data, it is worth noting that the majority of physicians were open to online nutrition education modules and to education conferences on nutrition. Working on providing effective and thorough nutrition education to physicians that target different levels of education is essential. Thus, online modules such as the Nutrition in Medicine modules developed by the University of North Carolina at Chapel Hill, which provide nutrition education tailored to medical students, as well as practicing physicians, may be useful in addressing deficits in nutrition education.59,
- •Lifestyle Changes are the Key to Decreasing Cardiovascular Morbidity and Mortality: Based on these results, an ideal physician–patient encounter for the risk reduction and treatment of cardiovascular disease would incorporate a discussion on lifestyle modification, including dietary counseling, in addition to optimal medical and revascularization therapies. In fact, this approach would likely not only empower patients to help themselves, but also may reduce the burden of disease, and even the number of drugs and treatments required, saving costs to the system as a whole.
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The views expressed in this paper are from the American College of Cardiology's Nutrition and Lifestyle Committee as part of the Prevention of Cardiovascular Disease Council and do not necessarily reflect the position of the American College of Cardiology.
Conflicts of Interest: AF has done nonpromotional speaking with Boehringer Ingelheim; all other others have no potential conflicts of interest to report.
Authorship: All authors had access to the data and a role in writing this manuscript.