Abstract and Introduction
Abstract
Purpose: To examine associations between personal nutritional patterns and various indicators of health, disease risk, and chronic illness in a diverse, representative sample of adult patients from primary care settings.
Methods: As part of a survey of adult patients conducted in the waiting rooms of 4 primary care practices in North Carolina (recruitment rate 74.8%), a 7-item nutrition screen was administered to 1788 study participants. Other questionnaire items addressed disease and functional status, race/ethnicity, health habits, and demographic factors.
Results: Respondents included 292 African Americans (17.3%), 1004 non-Hispanic whites (59.4%), 255 Hispanics (15.1%), and 126 American Indians (7.4%); mean age 47.5 years. Thirty percent reported eating 3 or more fast food meals weekly, 29% drank 3 or more high-sugar beverages weekly, 22% ate 3 or more high-fat snacks weekly, 36% ate 3 or more desserts weekly, 11% reported eating "a lot" of margarine, butter, or meat fat; 62% ate 2 or fewer fruits or vegetables daily; and 42% reported consuming protein less than 3 times a week. Scores on a summary measure were worse for prediabetics than for diabetics, for young adults compared with older persons, and for persons reporting good/excellent health versus fair/poor health.
Conclusions: People at high risk for developing chronic illnesses later in life reported poorer diets in comparison with people who are already ill. This probably represents increased nutritional awareness and motivation among people with chronic diseases. Because primary care patients have a high prevalence of chronic disease risk factors, the primary care office setting may constitute a particularly appropriate location for nutrition education.
Introduction
Overweight and obesity are major causes of morbidity and mortality in the United States. Annual deaths due to overweight and obesity are estimated to be between 112,000 and 414,000. The National Health and Nutrition Examination Survey (1999-2000) indicated that nearly two thirds of US adults are overweight (body mass index [BMI] ≥25) and nearly one third are obese (BMI ≥30). The prevalence of overweight and obesity in minorities, especially minority women, is generally higher than that of whites in the United States.
Excess weight is an important risk factor for chronic illness, including type 2 diabetes. Nearly 70% to 80% of type 2 diabetic patients are either overweight or obese. The prevalence and incidence of both obesity and diabetes have steadily increased in the United States in both genders, all ages, all educational levels, and all smoking levels over the past several years. Diabetes prevalence varies by ethnic group; diabetes prevalence in whites is 8.7%, whereas Hispanics, African Americans, and American Indians have prevalences that are 1.7, 1.8, and 2.2 times greater, respectively. Data from 2005 estimated the prevalence of diabetes in the United States to be 20.8 million people, or 7.0% of the population. An additional 20 million have prediabetes, a strong risk factor for developing diabetes later in life. The cost of diabetes in the United States is enormous; direct and indirect costs were estimated at $132 billion in 2002. Extensive risks are associated with long-term type 2 diabetes, especially with prolonged diagnosis. For instance, by the time many patients are diagnosed, vascular damage has already occurred. Therefore, preventing the disease or delaying its onset provide the best approaches to reducing diabetes complications.
Diet can influence the development of type 2 diabetes; recent epidemiologic studies have shown that a low-fiber diet, high trans-fatty acid intake, low unsaturated-to-saturated fat intake ratio, and the absence of or excess alcohol consumption to be associated with an increased risk of type 2 diabetes. Lifestyle interventions have been successful in addressing type 2 diabetes. For example, the Diabetes Prevention Program demonstrated that the 2-year incidence of diabetes in high-risk persons could be decreased 58% by adherence to a lifestyle intervention which included a diet based on the Food Guide Pyramid and regular, moderate physical activity.
Primary care settings have great potential as sites for lifestyle-related chronic disease prevention and management. Developing successful assessment methods and management approaches to address nutrition-related disease in these settings is, therefore, a high priority. To develop such interventions, primary care physicians need to understand the factors that influence the dietary habits of their patients and how these factors vary across patient populations. This study used an established diet screening instrument to assess the habits of a diverse sample of 1788 primary care patients and factors associated with them.