Investigating Whether the Mediterranean Dietary Pattern Is Integrated in Routine Dietetic Practice for Management of Chronic Conditions: A National Survey of Dietitians

Abstract

Evidence supports recommending the Mediterranean dietary pattern (MDP) in the management of cardiovascular disease (CVD), type 2 diabetes (T2D), non-alcoholic fatty liver disease (NAFLD) and solid organ transplant (SOT). However, the evidence-practice gap is unclear within non-Mediterranean countries. We investigated integration of MDP in Australian dietetic practice, and barriers and enablers to MDP implementation for chronic disease management. Dietitians managing CVD, T2D, NAFLD and/or SOT patients (n = 182, 97% female) completed an online survey in November 2019. Fewer than 50% of participants counsel patients with CVD (48%), T2D (26%), NAFLD (31%) and SOT (0–33%) on MDP in majority of their practice. MDP principles always recommended by >50% of participants were promoting vegetables and fruit and limiting processed foods and sugary drinks. Principles recommended sometimes, rarely or never by >50% of participants included limiting red meat and including tomatoes, onion/garlic and liberal extra virgin olive oil. Barriers to counselling on MDP included consultation time and competing priorities. Access to evidence, professional development and education resources were identified enablers. An evidence-practice gap in Australian dietetic practice exists with <50% of participants routinely counselling relevant patient groups on MDP. Strategies to support dietitians to counsel complex patients on MDP within limited consultations are needed.

Exploring dietitians' practice and views of giving advice on dietary patterns to patients with type 2 diabetes mellitus: A qualitative study

“…In particular, they highlighted that educational resources, such as mobile phone apps that offer visual content, clear, concise messages and tips (e.g., recipes, menu plans, food swaps) would facilitate the understanding of specific DP concepts by patients. This agrees with a recent study reporting that dietitians would welcome patient education materials that are visually appealing, user friendly and contain recipes, information on low‐cost alternatives and tips for practical adaptation to current eating habits 24 . Because the integration of nutrition apps in dietetic practice is high, 25 delivery of DP resources through well‐designed smartphone apps might facilitate advice provision and patient take‐up of the advice 26 .…”

“…This training should also incorporate education on DPs, to enhance dietitians’ confidence in providing DP advice. Indeed, several participants in the present study would welcome further training to deliver advice on specific DPs, such as the low‐carbohydrate diet, and earlier research showed that dietitians thought professional development would enable them to provide advice on the MD 24 …”

‘Focus on diet quality’: a qualitative study of clinicians’ perspectives of use of the Mediterranean dietary pattern for non-alcoholic fatty liver disease

“…Patient education resources based on MDP assisted education and goal setting, while sharing these with multidisciplinary colleagues facilitated MDP recommendations. Developing educational tools for patients and other clinicians has been shown to facilitate dietitians actively seeking and reading the scientific literature (31) , and dietitians have indicated that greater access to practical education resources for patients would facilitate MDP implementation in their practice (18) . Dietitians in the current study described that involvement in developing education resources had supported their MDP knowledge and skills.…”

Understanding the Self-Perceived Barriers and Enablers toward Adopting a Mediterranean Diet in Australia: An Application of the Theory of Planned Behaviour Framework

“…Martínez–González et al [ 17 ] have also outlined a number of practical approaches which could be adopted by non-Mediterranean populations in order to shift a Western-style dietary pattern to a more Mediterranean-style diet. Nevertheless, in a recent national survey of Australian Dietitians, Mayr et al [ 65 ] reported a lack of patient education resources, including practical and culturally appropriate low-cost recipe options for diverse patient groups as an important practice-related barrier for practitioners. However, implementing change to dietary and lifestyle behaviours, particularly in patients with chronic disease, is indeed complex and is likely to benefit from multi-disciplinary management in order to facilitate behavioural change [ 66 ].…”