How nutrition could make a significant difference to chronic disease

Anastasia Tsirtsakis

6/10/2021 3:50:37 PM

A new study has highlighted the clear benefits of personalised nutrition support in community-based health services, such as general practice.

A man unpacking groceries.
A key modifiable risk factor of chronic disease is diet.

The increasing prevalence of chronic disease has been identified as one of the greatest challenges facing primary care.
The latest figures show that nearly half (47.3%) of Australians have one or more chronic conditions – up from 42.2% in 2007–08.
But new research, led by Dr Katelyn Barnes from Griffith University, suggests that incorporating nutrition advice could make a significant difference in the management of chronic disease.
To determine the cost of providing nutrition care to patients, researchers reviewed nine studies conducted in Australia, the UK, Ireland and Europe. Patients included had either cardiovascular disease, diabetes, obesity or malnutrition.
The findings showed that nutrition care was ‘more effective … than usual care over the short-term’.
Dr Barnes, whose clinical work has centred on chronic disease management, said there are clear benefits to personalised nutrition support in community-based health services.
‘The studies we examined showed that over 3–24 months, a person who is eating healthier may have fewer visits to health professionals, reduced medications and feel more productive,’ she said.
‘And [it’s] only slightly more costly.’
It is estimated that 20% of Australians have multimorbidity. In 2019, endocrine and metabolic conditions, including diabetes, were among the most common health concerns managed by GPs.
Study co-author, Associate Professor Lauren Ball said it is clear that general practice has an ‘absolutely vital role’ when it comes to either offering nutrition care direct to patients, or linking them to dietetic services.
‘They are the gatekeepers,’ she told newsGP.
‘It doesn’t mean that GPs need to do any extensive dietary assessment or do what an accredited practicing dietitian would do … just advocating to the patient about the importance of healthy eating or referring on to a dietitian in the clinic or a service that’s available [can make a difference].’
However, there are still many barriers.
Associate Professor Ball says nutrition is not always front of mind and that in some cases, a lack of confidence – particularly when it comes to discussing weight management – can be an issue, resulting in nutrition falling by the wayside. 
‘GPs are so good with their intentions that you wouldn’t want to risk putting a patient offside, so some GPs just opt to leave that conversation for another time or not raise it at all,’ she said.
‘So feeling confident in what to say and what advice to give are definitely key ways that GPs could be more supported to support patients to eat well.’
A key factor, however, is insufficient consultation time and the fact that nutrition care is yet to have an MBS item number.
‘Nutrition is something that many GPs believe is important, but don’t necessarily feel that the service and the system is structured to enable it to be part of all consultations,’ Associate Professor Ball said.
‘So getting it on the schedule as a recognised core component of care [is important].’
The review suggests effective strategies to incorporate nutrition care in primary care settings, including:

  • making time for nutrition care in usual consultations
  • investing in technology that supports positive dietary behaviours between consultations
  • funding for dedicated primary care nutrition and dietetics services.
Though the study authors found nutrition care to be more costly than usual care, the increase is within recommended ranges for viable health investments.

Dr Barnes said the findings were timely, as the Federal Government works towards the Primary Health Care 10–Year Plan, and warned that failing to consider nutrition would have its own costs.
‘Nutrition clearly has a prominent role in our future health system,’ she said.
‘Overall, benefits from a person’s dietary improvements are felt by multiple parties including governments, general businesses, health insurance and services, and individual people through lower health care spending, and improved quality of life and economic productivity.’
Associate Professor Ball agrees. She says nutrition can oftentimes be forgotten due to innovation in medical technology and treatment, but says the evidence around the benefits of nutrition on health and wellbeing are undeniable.
‘The more that we invest in nutrition care, the better outcomes we will have for patients,’ she said.
‘We’ll have less use of health services overall, less use of medications, less ED presentations, and so we’ll also save money.
‘So I do hope that we see mention of it in the 10-year primary care plan because it’s certainly not going away; it’s the number one modifiable risk factor for most of the leading causes of morbidity and mortality.
‘The big question is, how much do we want to invest in primary care?’
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cardiovascular disease diabetes malnutrition nutrition obesity primary care

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Dr Cecilia Catherine Senior   7/10/2021 7:44:18 AM

It seems to me that doctors, having admitted that they get only a few hours of “ nutrition” lectures in med school , are not considered to know a thing about food. Food and what we eat has now become like a religion some almost a cult. So how can we necessarily expect the dietary advice to not be as harmful as no advice at all. Guidelines which have recommended up to 60% of calories from carbohydrates when there is not one essential carbohydrate, has led to obesity and increasing numbers of type 2 diabetics.