For Better CV Health, Ask About Diet and Propose Change, Says AHA

Greater uptake of screening tools and the expansion of electronic health records may soon make it easier for busy clinicians to counsel patients about diet, according to a new scientific statement from the American Heart Association (AHA). These efforts, the authors say, will pay dividends in terms of cardiovascular health.

Maya Vadiveloo, PhD, RD (University of Rhode Island, Kingston), chair of the writing group, told TCTMD the time is ripe for change. Suboptimal diet is increasingly being recognized as a “leading risk factor for cardiovascular disease and other chronic diseases,” as evidenced by a 2017 report from the Global Burden of Diseases, Injuries, and Risk Factors Study, she pointed out. Recent research has also linked malnutrition to worse outcomes after ACS.

On top of that is “real interest among physicians to talk with their patients about diet,” Vadiveloo noted.

As of now, though, “screening or counseling is not usually a component of routine medical visits,” she and her co-authors observe, and “numerous barriers exist to the implementation of screening and counseling.” These include a lack of training, knowledge, time, and reimbursement; a sense of futility; competing demands during the visit; and a dearth of quick, validated screening tools linked with clinical recommendations for modifying care.

Vadiveloo stressed that the AHA does not endorse any particular screening tools. Rather, this document, published online last week ahead of print in Circulation: Cardiovascular Quality and Outcomes, is intended to show clinicians options that might fit into the workflow of their practices.

A Starting Point

Not only is it necessary to “get an accurate snapshot of what a patient usually eats,” Vadiveloo explained, but it’s also important to know what to say next. Screening is an opportunity to understand why patients are making certain choices before being able to then suggest healthier patterns and provide any necessary resources, such as information about where they can get affordable and culturally appropriate foods or seek input from a registered dietician.

It’s important and it’s like smoking was 30 years ago—we need to start asking questions about diet more [often]. Maya Vadiveloo

“Even with adequate calorie consumption,” said Vadiveloo, “people can still be undernourished, which is part of the reason we wanted to focus on total diet: to look at nutrient-dense food groups like fruits, vegetables, whole grains, healthy fats, all of the things the American Heart Association emphasizes in healthy dietary patterns. When you assess total diet, you can see a patient’s level of risk relatively quickly.”

Identifying just a few changes that patients can make right away is helpful, she stressed. “Any time people start making improvements in their diet it’s associated with improvements in their health. It’s never too late to start the conversation and to start making those changes. . . . It’s important and it’s like smoking was 30 years ago—we need to start asking questions about diet more [often].”

Vadiveloo and colleagues make the case for why diet screening tools are needed, outline what’s required for them to be valid and feasible in real-world use, review existing tools, and discuss how they can be applied through electronic health records.

“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,” they write. “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 CVD and other chronic diseases linked to poor diet quality.”