Good nutrition is a critically important factor in the treatment andprevention of disease as well as the maintenance of good health. Arecent report estimates that roughly 400,000 deaths now occur annuallyin the United States due to poor diet and physical inactivity, secondonly to tobacco as the leading preventable cause of mortality (JAMA 2004;291:1238-1245). Decreasing deaths due to poor diet and physicalinactivity will require many changes, including more effective provisionof nutrition services in medical practice.

Intensive Dietary Counseling Recommended
After an extensive review of current evidence, the US Preventive Services Task Force (USPSTF) found that counseling interventions can produce changes in the core components of a healthy diet (including saturated fat, fiber, fruit, and vegetables) among adult patients at increased risk for diet-related chronic disease. As a result, the USPSTF recommends intensive behavioral dietary counseling for adult patients with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease. This counseling can be delivered by primary care clinicians or by referral to other specialists, such as nutritionists or dietitians.

Nutrition Evaluation and Management in Chronic Illness
Most health professionals recognize that nutrition is an important component of the management of many chronic illnesses, but it can be difficult to implement appropriate nutrition care in medical practice. This handbook is designed to provide a concise, evidence-based reference for the application of nutrition principles and guidelines when caring for patients with common chronic illnesses in the clinic setting.

The modules contained in the handbook address metabolic syndrome, obesity, dyslipidemias, hypertension and diabetes. Each module outlines the goals of nutrition care, provides guidelines for evaluation of nutritional status, and reviews nutritional management. The modules include or contain links to valuable Web-based references and tools, including clinical treatment guidelines, diet assessment methods, estimation of portion sizes, and nutrition content of restaurant foods. The Medical Nutrition Handbook is designed to take advantage of the many excellent resources already available, compiling them in an easy to use format.

Five A's Simplify Diet Counseling
Changes in eating habits require complex changes in behavior, and counseling for behavior change can require more time than is typically available in medical practice. For effective interactions that can be conducted in a minimum amount of time, the USPSTF recommends brief interventions using the '5 A's' format. The modules included in the Medical Nutrition Handbook have been designed around the 5 A's.

• Assess: Ask about/assess behavioral health risk(s) and factors in order to choose appropriate behavior change goals/methods.
• Advise: Give clear, specific, and personalized behavior change advice, including information about personal health harms/benefits.
• Agree: Collaboratively select appropriate treatment goals and methods based on the patient's interest in and willingness to change the behavior.
• Assist: Using behavior change techniques (self-help and/or counseling), aid the patient in achieving agreed-upon goals by acquiring the skills, confidence, and social/environmental supports for behavior change, supplemented with adjunctive medical treatments when appropriate (e.g., pharmacotherapy for tobacco dependence, contraceptive drugs/devices).
• Arrange: Schedule followup contacts (in person or by telephone) to provide ongoing assistance/support and to adjust the treatment plan as needed, including referral to more intensive or specialized treatment.

For more detail on the Five A's Construct for Clinical Counseling see Evidenced-Based Methods for Evaluating Behavioral Counseling Interventions.

Click below to learn more about Nutrition Evaluation and Management of:

The five Nutrition Evaluation and Management topics (Hypertension, Diabetes, Lipid Disorders, Obesity, and Metabolic Syndrome) are also available for CME credit at the University of Wisconsin Office of Continuing Professional Development in Medicine and Public Health. Each topic includes a PowerPoint presentation with audio, a case study, and a quiz.

The Medical Nutrition Handbook was created as part of the Nutrition Academic Award at the University of Wisconsin, funded by a grant from the NHLBI, NIH. Elizabeth Spencer, RD, MS, CDE is the primary author, and Gail Underbakke, RD, MS, and Patrick McBride, MD, MPH have reviewed the content. Craig Jewell is responsible for website construction and maintenance. If you have questions, comments, or suggestions about this site, please email Gail Underbakke at: glu@medicine.wisc.edu.