Update on Nutrition, Metabolism, and Lifestyle Curricula for Medical Education, Research, and Practice: USA.

Although physicians are expected to counsel their patients about nutrition-related health conditions, surveys report minimal to no medical nutrition education improvements in the United States medical schools. From 1998 to 2005, the National Institutes of Health (NIH) introduced and funded the Nutrition Academic Award program among 21 medical schools to incorporate nutrition into their curricula. Since then, nutrition champions have developed several education models and continue to advocate for inclusion of nutrition content in the U.S. Medical Licensing Examination and for recognition of nutrition as a national subspecialty in medicine. As a result, the American Society for Nutrition (ASN) and NIH published recommendations for remodeling nutrition education, training, and research. As medical education has shifted to a competency-based system, an inter-professional and competency-based approach to curricular changes was recommended. As a result, ASN aims to launch a coordinating center using a public-private partnership platform to achieve those goals. This collaborative will further allow for inclusion of all healthcare professionals engaged in improving patients' nutrition-related outcomes. This article describes the educational context and steps needed to advance the field of medical nutrition, metabolism, and lifestyles in the United States.

Physician attitudes and practices and patient awareness of the cardiovascular complications of diabetes.

OBJECTIVES: Studies were conducted to: 1) assess physicians' attitudes and practices in managing cardiovascular disease (CVD) risks in diabetes; and 2) determine the awareness of CVD risks among diabetic patients. BACKGROUND: Cardiovascular disease is the leading cause of premature death among diabetic patients. As diabetes is often seen as a "glucose-centric" disease, it is unclear whether diabetic patients are talking with their doctors about CVD and other key clinical parameters of diabetes care such as blood pressure and cholesterol. METHODS: An online survey was completed by a nationally representative sample of 900 physicians. The 95% confidence interval is approximately +/-2.5%. Before this study, a telephone survey of 2,008 people with diabetes was conducted using random, direct-dial screenings of U.S. households. RESULTS: Ninety-one percent of physicians believe that their patients with diabetes are "very" or "extremely" likely to have a cardiovascular event. Although physicians report discussing CVD risk factors with 88% of their diabetic patients, they perceive their diabetic patients as being only moderately knowledgeable about their increased CVD risks. Sixty-eight percent of the people with diabetes do not consider CVD to be a serious complication of diabetes; they are more likely to be aware of complications such as blindness (65%) or amputation (36%) rather than heart disease (17%), heart attack (14%), or stroke (5%). Physicians perceive "poor compliance" with behavioral modifications and medication regimens as the greatest barriers to the management of CVD risks in diabetic patients. CONCLUSION: Materials should be made available to help facilitate communication about CVD risks, and strategies for improving compliance with life-style modifications and multiple drug therapies should be explored. Efforts should continue to promote a comprehensive approach to the management of diabetes to include aggressive control of blood glucose and other CVD risk factors.