Primary Health Care: Open Access

A primary care viewpoint on nutrition and the health

Carrie Nolan^{* *}Correspondence: Carrie Nolan, Department of Medical Sciences, University of Auckland, New Zealand, Email:

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Prespective

Perspective

Because there is now universal consensus on the best diet for preventing both coronary heart disease and cancer, nutrition should be prioritised. The government has said in recent years that primary care is an ideal place for providing nutrition education to the general populace. However, we argue that there is now a mismatch between the public's willingness to receive nutritional guidance from primary care providers and primary care providers' unwillingness to fulfil this duty. Dissatisfaction with the quality of nutrition education obtained by primary care providers is frequently identified as a barrier to giving patients dietary recommendations. With this in mind, we'll go through some instructional initiatives that could encourage primary care providers to become more involved in offering dietary advice to their patients. The problem for those delivering nutrition training to primary care practitioners is persuading them that dietary intervention is desirable and that they can contribute to dietary change within the current primary care organisation. Increased motivation, as well as the skills and information needed to fulfil this position, are important outcomes of such training. Diet may make a huge difference, and at this moment of rethinking priorities, the importance of nutrition should be firmly established on the health-care agenda [1].

A Primary Care Physician's Role in Your Health Care

The present NHS prioritisation climate comes to the fore the argument over the efficient and effective management of illnesses that are directly linked to our modern lifestyle. Diet, in combination with other lifestyle variables, is implicated in the development of a large proportion of the most frequent chronic illnesses in the UK, including coronary heart disease (CHD) [2,3], diabetes, obesity, and cancer, and should be considered a fundamental concern in such a debate. The management of these illnesses occupies a significant portion of the NHS's resources. The cost of pharmacological treatment for all persons at risk of CHD already exceeds NHS resources, and the cost of weight loss with new obesity treatments has been calculated at £344.80 per kilogramme lost. Over 30 years of nutritional research has resulted in universal agreement on the best diet for preventing CHD. Evidence suggests that minor reductions in blood cholesterol, obtained through a change in diet, can contribute to a considerable reduction in CHD morbidity and mortality at the population level. The OXCHECK and British Family Heart studies in primary care in the United Kingdom demonstrated that a nurse-led lifestyle modification programme for the reduction of cardiovascular risk can result in modest risk reduction, which, if more widely implemented, would result in meaningful improvements in population health. Changes in fat, salt, and fibre intake, as well as fruit, vegetable, and fish consumption, have all had positive benefits on hypertension, hyperlipidemia, and diabetes control. Even little weight loss in overweight people can result in significant benefits in blood pressure, blood lipids, glucose control, and overall health [4].

Despite this, the medical profession in the United Kingdom is divided on the importance of nutrition in disease prevention. Tunstall-Pedoe remarked in a 1990 report about CHD prevention in medical school that "a vast body of academic and professional medical opinion supports no action or teaching on the subject (of diet)." Despite the fact that the Royal College of General Practitioners and the Royal College of Physicians have acknowledged the role of the general practitioner in CHD prevention, this is still the case [5].

Since the 1970s, the government has issued nutritional guidelines for the prevention of cardiovascular disease. Despite repeated recommendations,4 dietary change in the general population is gradual. The government's Nutrition Task Force advocated a coordinated approach incorporating food producers and manufacturers, public health interventions, and education in order to speed progress toward the Health of the Nation CHD targets. They did say, however, that primary care is an ideal setting for providing opportunistic nutritional counselling to the general public.

References

1. Wald, N.J. “Cholesterol and coronary heart disease: to screen or not to screen.” In Marmot M, Elliot (eds). Cornary Heart Disease Epidemiology, From Aetiology To Public Health. Oxford Medical Publications (1995): 358–368.
2. Muir, J. “RCP reports on the role of drugs for obesity.” (Editorial) Guidelines in Practice 2(1999):3.
3. Wood, D. “European and American recommendations for coronary heart disease prevention.” Eur Heart J 19.Suppl A(1998):A12– A19.
4. Law, M.R., et al. “By how much and how quickly does serum cholesterol concentration lower risk of ischaemic heart disease?” Br Med J 308(1994):367–373.
5. Helen, M., et al. “Nutrition and the health care agenda: a primary care perspective.” Family Pract 17.2(2000):197–202.