Role of nutrition in primary care

Abstract

This editorial opinion is written by an internist and focuses on adult medicine, with less information included on applications to children and to pregnant and lactating women. It reviews the role of nutrition in primary care in the immediate past, the present, and into the next millennium; attitudes of physicians toward using nutrition concepts in patient care; delivery of primary care; specifics of nutrition content, education, and training; sources of information; and predictions of the future. As we enter the new millennium, nutrition may regain its importance in the provision of primary care. In the early part of the 20th century, nutrition principles were vital in treating patients with serious infectious disease for whom there were no antibiotic “cures.” The advent of antibiotics minimized the need for and role of such supportive care of patients with infections. The discovery of vitamins and the essentiality in the diet of many minerals simplified applied nutrition, and nutritional deficiencies vanished. We entered a new era in which the role of nutrition evolved into prevention of disease and promotion of health. In the present millennium, knowledge in these areas will be enhanced, and physicians and other health providers must not only learn but also apply their new nutrition information in patient care. We need to overcome the situation at the end of the 20th century in which the patient often knows more about nutrition than does the doctor; the physician’s negative attitude toward the role of nutrition in his or her practice must improve.1 Reimbursement for nutrition services is problematic, presenting serious obstacles and economic deterrents to applying nutrition concepts and practices optimally in patient care. We need to acquire and disseminate new information about the impact of nutrition counseling on the outcome of the patient’s problem (e.g., evidence-based medicine). These strategies will result in enhancing the motivation of physicians to incorporate nutrition into their practices. Family physicians, pediatricians, and internists are the usual providers of primary care, with gynecologists increasingly performing that task for women. Nutrition counseling may be performed by non-physician nutrition specialists; in many cases, counseling is not the role of nutrition professionals, but rather is included in the role of patient educators. The caregiver’s knowledge of nutrition is best learned in medical or graduate school, residency training, and continuing education. New discoveries are reported in scientific journals and newsletters, often are publicized first in the media, and increasingly are available on the internet. Educational materials are published in CD-ROM format and in interactive videos for self-study. Information from reliable sources must be provided not only to the physician but also to the patient and the public. The primary caregiver must be aware of the safety and efficacy and utility of non-traditional therapies and be wary of nutrition myths and fads and information from advertising.