A Dietitian’s Perspective on Nutrition in Cardiometabolic Risk

LAS VEGAS—Nutrition is a crucial piece of the puzzle in reducing cardiometabolic risk. That’s the point that Linda M. Delahanty, MS, RD, LDN, drove home this morning in her presentation, “Nutrition in Cardiometabolic Risk: A Dietitian’s Perspective.” She shared evidence-based nutrition and lifestyle interventions for reducing cardiometabolic risk, as well as nutrition counseling strategies.

“Nutrition and lifestyle changes can help patients achieve targets for weight loss, glycemic control, blood pressure, and lipid levels with less medication,” said Delahanty, who is the chief dietitian and director of nutrition and behavioral research at Massachusetts General Hospital Diabetes Center in Boston. “Evidence shows that diet and lifestyle modifications have the potential to reduce LDL cholesterol levels by up to 20% to 30%, systolic blood pressure by 19 mm Hg to 50 mm Hg, and diabetes incidence by 58%.”

Delahanty said too often patients are overwhelmed by the number of diet and lifestyle changes that they’re asked to make to improve various elements of their cardiometabolic risk profile. “Then they become so discouraged, frustrated, and confused that they make little to no progress at all,” she explained. “We need to simplify our messages about nutrition and lifestyle, and help patients to prioritize their focus on the health behaviors that will give them the most of what they want—better health outcomes, less medication, better quality of life, and an ability to enjoy eating in the process.”

She recommended a streamlined approach physicians can use to support patients in creating a nutrition plan and implementing lifestyle changes that work for them:

• Tailor discussions with patients based on an assessment of their medical profile, nutrition, and lifestyle habits, and readiness to make nutrition and lifestyle changes.

• Based on that assessment, help each patient to prioritize which health behaviors to focus on.

• For patients who want to lose weight, focus on reducing calories and portions to lose 5% to 10% of body weight, which will simultaneously reduce diabetes and other risk factors.

• For those who are not ready to lose weight, talk to them about focusing on increasing activity or on making a few specific diet changes.

• Try to agree upon 1 to 3 SMART (specific, measurable, achievable, realistic, time-sensitive) goals for each patient.

“When possible, refer patients to meet with a dietitian-nutritionist who has the time and expertise to provide this type of individualized medical nutrition therapy,” Delahanty said. “Telling patients what to do (lose weight and increase activity) is not enough—they need to learn the skills to know how to do it in a sustainable way.”

—Colleen Mullarkey