AHA outlines options for brief point-of-care dietary screenings for CVD prevention
Point-of-care rapid dietary screening may be an easily adopted and effective tool for prevention of CVD and other chronic diseases, according to a scientific statement from the American Heart Association.
“Poor-quality diets continue to be the leading risk factor for CVD and other chronic diseases in the U.S. and globally, yet we do not regularly assess it in health care settings,” Maya Vadiveloo, PhD, RD, FAHA, assistant professor of nutrition and food sciences at the University of Rhode Island and chair of the statement writing committee, told Healio. “Our primary message to cardiac clinicians is that it is important to start discussions about diet with patients. While the AHA does not endorse any one tool, valid rapid diet screening tools exist and can be adapted to different practice settings and administered by various members of the health care team without specialized knowledge in nutrition. Some of these tools can be quickly scored and provide direct evidence-based recommendations about specific dietary changes a patient can make to promote their health.
“This information could be used to help start the conversation with patients about diet, identify goals and monitor their diet over time, or refer them to other clinicians or resources to help patients improve their diet quality,” Vadiveloo said in an interview. “A second purpose of this scientific statement was to compile a list of existing, valid tools for clinicians, which they can review to determine what would be appropriate for their practice setting.”
The statement added that in the U.S., adults aged 20 to 65 years achieve just 60% to 65% on ideal dietary scores, and although diet quality is associated with socioeconomic indicators, nutrition knowledge is correlated irrespectively of education and income.
“This AHA scientific statement is designed to accelerate efforts to make diet quality assessment an integral part of office-based care delivery by encouraging critical conversations among clinicians, individuals with diet/lifestyle expertise and specialists in information technology,” the committee wrote.
In order of least to most time intensive, AHA outlined four brief and unique diet screeners to both improve patient nutritional knowledge and guide the integration of dietary screening into clinical practice.
Powell and Greenberg screening tool
This low time-intensive option for dietary screening would involve a clinician querying a patient about their weekly intake of at least five fruits and vegetable and the frequency of sugary food and drink consumption.
Having a conversation
A conversation about intake of fast food, fruit and vegetables, sugary drinks, snack chips or crackers, desserts, butter, meat fat, beans, nuts, chicken and fish in the months prior to the office visit may also be considered. According to the statement, these points are modified to reflect current nutrition guidance, but have not yet been validated by clinical research for dietary screening.
The 16-point Rapid Eating Assessment for Participants-Shortened (REAP-S) questionnaire is designed to assess the patient’s week-to-week eating habits. REAP-S, compared with its predecessor, REAP, focuses less on dietary fat.
In an analysis published in the Nutrition Journal (Johnston CS, et al. Nutr J. 2018;doi:10.1186/s12937-018-0399-x), the scores of the REAP-S screening tool were found to be moderately associated with the Healthy Eating Index-2010 in addition to the nutrient density of the patient’s diet.
Lastly, the 14-point Mediterranean Diet Adherence Screener (MEDAS) evaluates total dietary quality and can be administered across diverse populations, remotely or in person.
Developed for evaluation for the PRIMED study (Schröder H, et al. J Nutr. 2011;doi:10.3945/jn.110.135566), a higher MEDAS score was associated with elevated HDL (P < .0001) and lower BMI, waist circumference, triglyceride concentrations, triglyceride to HDL ratio, fasting glucose concentrations, cholesterol to HDL ratio and 10-year CAD risk, compared with a full-length, 135-item food frequency questionnaire.
“The massive health impacts of poor diet quality in the United States and globally and the potential for large reductions in health care costs and enhanced quality of life from population-wide improvements in diet quality provide a strong rationale to increase the delivery of diet assessment, education and counseling by clinicians and other members of the health care team in diverse health care settings,” the committee wrote. “Moreover, the consistent evidence that low nutrition knowledge negatively affects diet quality and clinician-delivered diet counseling improves diet behaviors and cardiometabolic risk factors supports adoption of routine integration of diet assessment and counseling into diverse health care settings.”