Olendzki Barbara, Speed Christopher, Domino Frank J
Department of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
Am Fam Physician. 2006 Jan 15;73(2):257-64.
Physicians face several barriers to counseling their patients about nutrition, including conflicting evidence of the benefit of counseling, limited training and understanding of the topic, and imperfect and varied guidelines to follow. Because cardiovascular disease remains the leading cause of death in industrialized nations, family physicians should provide more than pharmacologic interventions. They must identify the patient's dietary habits and attitudes and provide appropriate counseling. Tools are available to help, and a seven-step approach to nutritional therapy for the dyslipidemic patient may be useful. These steps include recommending increased intake of plant proteins; increased intake of omega-3 fatty acids; modification of the types of oils used in food preparation; decreased intake of saturated and trans-fatty acids; increased intake of whole grains and dietary fiber (especially soluble fiber) and decreased intake of refined grains; modification of alcohol intake, if needed; and regular exercise. Recommendations should be accompanied by patient information handouts presenting acceptable substitutions for currently identified detrimental food choices.
医生在为患者提供营养咨询方面面临诸多障碍，包括关于咨询益处的证据相互矛盾、对该主题的培训和理解有限，以及可供遵循的指南不完善且各不相同。由于心血管疾病仍是工业化国家的首要死因，家庭医生应提供的不仅仅是药物干预。他们必须识别患者的饮食习惯和态度，并提供适当的咨询。有一些工具可供帮助，针对血脂异常患者的营养治疗七步法可能会有所帮助。这些步骤包括建议增加植物蛋白的摄入量；增加ω-3脂肪酸的摄入量；改变食物制备中使用的油的种类；减少饱和脂肪酸和反式脂肪酸的摄入量；增加全谷物和膳食纤维（尤其是可溶性纤维）的摄入量，减少精制谷物的摄入量；如有必要，改变酒精摄入量；以及定期锻炼。建议应附带患者信息手册，列出目前已确定的有害食物选择的可接受替代物。
