AHA encourages rapid diet assessment in primary care to combat diet-related diseases

Primary care clinicians and certain subspecialists should adopt rapid diet assessment screening tools to reduce the incidence and improve the management of diet-related chronic diseases, especially cardiovascular disease, according to the American Heart Association (AHA).

In a recent scientific statement, published online on Aug. 7 by Circulation: Cardiovascular Quality and Outcomes, an AHA writing group reviewed the evidence behind 15 brief diet screener tools and detailed the three that met the greatest number of theoretical and practice-based validity criteria: the Mediterranean Diet Adherence Screener (MEDAS) and its variations; the modified, shortened Rapid Eating Assessment for Participants; and the modified version of the previously validated Starting the Conversation tool. The EHR is the ideal platform to prompt clinicians and other members of the health care team to capture dietary data and deliver dietary advice to patients, according to the paper. Such data may be collected through a patient-completed screening tool in an EHR portal or through manual entry by clinicians and other members of the health care team.

The statement includes a clinical decision support chart for selecting which rapid diet screener tool is most appropriate to use within the constraints of specific clinical settings. If the dietary screener will not be administered during the clinical visit, the chart suggested administering the MEDAS through the EHR patient portal. For clinicians administering the dietary screening during the visit who have fewer than five minutes to spare, the clinical decision support chart suggested administering the two-question Nutrition Screening Protocol. While these questions can be asked by the clinician, a medical staff member, a web-based educational site, or a community resource person, “It may be advantageous for clinicians to administer the questions, given the high level of respect for their advice and their ability to motivate patients to change behaviors,” the statement said. If the patient screens positive for nutrition risk, the AHA recommended referring for further assessment. For clinicians who have fewer than 10 minutes, the chart suggested they administer the modified Starting the Conversation tool and, if the patient screens positive for nutrition risk, work on goal setting, consider referral for lifestyle counseling, and provide nutrition education materials. Finally, for clinicians who have 10 minutes or more, the chart recommended administering the MEDAS to identify areas for dietary improvement and using clinical decision support tools for dietary counseling and monitoring.

“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 authors wrote. “In the future, providing regular diet assessment and recommendations based on validated clinical tools will help patients address the lifestyle changes they need for healthier lives and reduce the public health and economic burdens from [cardiovascular disease] and other chronic diseases linked to poor diet quality.”