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Viewpoint
March 21, 2019

Nutrition Education in Medical School, Residency Training, and Practice

Author Affiliations
  • 1Gaples Institute, Deerfield, Illinois
  • 2Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 3Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
  • 4Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
  • 5Editor, JAMA Cardiology
JAMA. 2019;321(14):1351-1352. doi:10.1001/jama.2019.1581

Nutrition education in medical school is rudimentary, at best, and limited for the duration of graduate medical education for many specialties. Requirements for meaningful nutrition education in all phases of medical training are long overdue.

In randomized clinical trials, dietary interventions have proven to both prevent and manage important diseases, such as diabetes and cardiovascular disease.1,2 For example, compared with control groups, a Mediterranean-style diet was shown to reduce recurrent cardiovascular events by 72% (absolute difference, 2.83 events per year).1 In individuals with elevated fasting blood glucose, a combination of dietary changes and physical activity reduced the risk of developing diabetes by 58% (absolute difference, 6.2 cases per 100 person-years), compared with a 31% reduction in individuals receiving metformin (absolute difference, 3.2 cases per 100 person-years).2 However, the substantial body of evidence that supports the benefits of nutritional interventions has not adequately translated into action in medical training or practice.

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    2 Comments for this article
    EXPAND ALL
    Lifestyle Medicine Core Competencies Curriculum
    Bob Carr, MD, MPH, FACPM | President, American College of Preventive Medicine
    The authors of this Viewpoint emphasize the need for nutritional education in medical school, residency training, and practice.

    The American College of Preventive Medicine (ACPM) couldn’t agree more.

    Our country is facing unsustainable health care costs and immense disease burden that threatens the viability of a high-quality of life for all Americans. We have enough research, evidence-based guidelines, and high-quality educational tools and programs to enable this basic and fundamental change to the healthcare system.

    The ACPM joined with faculty and colleagues from the American College of Lifestyle Medicine to develop a
    Lifestyle Medicine Core Competencies program that offers 30 hours of Continuing Medical Education (CME) units to address this fundamental gap in physician skills, knowledge and acumen.

    Let’s not continue to just manage downstream illness and preventable chronic diseases, but fix the problem upstream by providing all physicians with a functional understanding of the key factors and elements to ensure proper nutritional skills and acumen.

    The health of our citizens along with our country’s viability, security and competitive advantage are at stake.
    CONFLICT OF INTEREST: None Reported
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    Knowledge gap of physicians in the field of clinical nutrition-A major concern
    Jogenananda Pramanik, MBBS. MD | Lincoln College School of Medicine, Mandeville, Manchester Parish, Jamaica, West Indies
    The authors of this insightful article expressed their concerns that nutrition education in medical school is rudimentary (1). Clinical conditions like diabetes mellitus involve almost all the organ systems due to failure of hormonal control of metabolism of major dietary components such as carbohydrates and lipids. On the other hand, dietary components like omega-3-fatty acids control production of pro-inflammatory mediators like prostaglandins and thromboxane, which are involved in a majority of the inflammatory disorders. A majority of dietary components are intricately integrated in multi-organ system disorders like cardiovascular dysmetabolic syndrome, of which the knowledge base of dietitians or nutritionists seem to be grossly inadequate. It seems a herculean job for dietitians or nutritionists to take care of patients suffering from different systemic disorders, and on the other hand, for clinicians to narrow their knowledge gap in the field of clinical nutrition.

    Requirements for meaningful nutrition education in all phases of medical training are long overdue (1). Clinical nutrition must be included in graduate and postgraduate medical curricula using vertical and horizontal integration with all other basic and clinical subjects. Clinical nutrition topics may be distributed all over the graduate and post graduate medical curriculum that come in relation to the respective topics in basic or clinical subjects (eg nutrition advice for patients suffering from renal failure, endocrine disorders, and malignancy). We need to reassess the medical curriculum and do necessary addition and alterations to provide all physicians a functional understanding of the key factors and elements to ensure proper nutritional skills and acumen (2).

    References:
    1. Devries S, Willett W, Bonow R O, View point: Nutrition Education in Medical School, Residency Training, and Practice. JAMA. 2019; 321(14):1351-1352. doi:10.1001/jama.2019.1581.
    2. Carr B Comment: Lifestyle Medicine Core Competencies Curriculum (May 7, 2019) JAMA. 2019; 321(14):1351-1352. doi:10.1001/jama.2019.1581.
    CONFLICT OF INTEREST: None Reported
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