Effects of a dietetic treatment in older, undernourished, community-dwelling individuals in primary care: a randomized controlled trial.

Purpose: Undernutrition is a prevalent problem in older, community-dwelling individuals. Aim of this study was to determine the effects of a dietetic treatment in older, undernourished, community-dwelling individuals.

Methods: A parallel randomized controlled trial was performed in 146 non-institutionalized, undernourished individuals aged ≥65 years in primary care.

Nutrition and physical activity guidance practices in general practice: a critical review.

Objective: The aim of this critical review is to provide insight into the main outcomes of research on communication about nutrition and/or physical activity between GPs and patients for prevention or treatment of overweight and obesity.

Methods: Relevant studies were identified by a computerized search of multiple electronic databases (MEDLINE, PsycINFO) for all available papers between 1 January 1995 and 1 January 2012. In addition, two independent reviewers judged all studies on ten quality criteria.

Generalizability of systematic reviews of the effectiveness of health care interventions to primary health care: concepts, methods and future research.

Background: There is a push to make clinical decision making more evidence based and patient oriented. However, current systematic reviews are limited by the lack of consideration of generalizability.

Objective: To develop a guide for investigators (systematic reviewers) on how to adapt the methodology of a systematic review to facilitate the exploration of the results to primary care.

A longitudinal study of changes in noticing and treating patients' overweight by Dutch GPs between 1997 and 2007.

Background: One of the stakeholders in tackling the rise and health consequences of overweight and obesity is the general practice physician (GP). GPs are in a good position to inform and give nutrition guidance to overweight patients.

Objective: Assessment of working mechanism of determinants of the nutrition guidance practice: noticing patients' overweight and guidance of treatment by GPs [linear analysis of structural relations (LISREL) path model] in a longitudinal study.

Primary care and public health a natural alliance? The introduction of the guidelines for obesity and undernutrition of the Dutch College of General Practitioners.

The prevalence of obesity and overweight is increasing globally and forms a huge public health problem. On the other hand, the prevalence of malnutrition or undernutrition is substantial, especially in nursing homes or in the elderly at home. Primary care and public health are separate disciplines.

Weight loss in head and neck cancer patients little noticed in general practice.

Introduction: In head and neck cancer patients, weight loss increases morbidity and mortality, and decreases treatment tolerance and quality of life. Early nutritional intervention has beneficial effects on these factors.

Aim: We observed patients' weight courses after specialists' care and surveyed nutrition-related documentation by general practitioners (GPs).

The SNAQ(RC), an easy traffic light system as a first step in the recognition of undernutrition in residential care.

Objective: Development and validation of a quick and easy screening tool for the early detection of undernourished residents in nursing homes and residential homes.

Design: Multi-center, cross sectional observational study.

Setting: Nursing homes and residential homes.

[Summary of the Dutch College of General Practitioners' practice guidelines on obesity].

Adults with obesity have a decreased life expectancy and an increased risk of disease. Preferred treatment is a combination of lifestyle interventions, consisting of changes in diet, physical exercise and psychological support. Normal weight is not an achievable target in most adults, but even a 5-10% weight loss yields significant health gains.

Improving nutritional management within high-risk groups.

The current pitfalls and future possibilities of nutritional management are discussed by two patients with tongue cancer who have suffered from substantial weight loss. Their nutritional problems are illustrative of those among other (cancer) patient groups. The main concerns are the lack of early case finding and dietary treatment, and insufficient nutritional information transfer through referral letters.

Longitudinal changes in GPs' task perceptions, self-efficacy, barriers and practices of nutrition education and treatment of overweight.

Background: GPs play a role in prevention by giving nutrition education and advice on overweight. Over the years, GP's tasks and working environment changed.

Objective: To know how task perceptions, perceptions of own ability and perceived barriers regarding nutrition education and treatment of overweight of Dutch GPs have developed from 1992 to 2007.

The development of a minimal intervention strategy to address overweight and obesity in adult primary care patients in The Netherlands.

Background: Currently, overweight and obesity do not receive the attention they deserve from the Dutch GPs, mostly because of a lack of an effective intervention strategy to tackle this difficult health problem.

Objective: To develop a minimal intervention strategy (MIS) addressing overweight and obesity among adult primary care patients, resulting in a prototype.

Methods: Following the intervention mapping protocol, the MIS is based on literature study, existing interventions, psychosocial theories, stakeholder interviews and a questionnaire study among stakeholders.

Nutrition guidance in The Netherlands: the role of the GP in the translation from population strategy to individual approach.

An important pitfall of nutritional guidance in medical practice is how to deal with the prevention paradox: a nutritional advice that is good for the population as a whole is not necessarily proven effective for the individual patient. Evidence-based guidelines are needed to support GPs to translate these advices to the individual patient. We illustrate this with two examples: obesity and undernutrition.

Diet and nutrition advice from the Cochrane Library: is it useful for the consumers and family physicians?

Background: The role of nutrition in public health is well established. This raises the need for reliable and up to date evidence and its ready accessibility for health professionals and consumers.

Objectives: The principal objectives are to evaluate whether nutrition-related Cochrane Systematic Reviews contain clear guidance on nutritional aspects that may be applicable to individual patient care.

Encounters for common illnesses in general practice increased in obese patients.

Background: Obese patients are known to have more chronic medical conditions.

Objective: To compare the frequency of encounter for episodes of the 10 most common illnesses in general practice between obese and non-overweight patients.

Methods: Data were derived from the Continuous Morbidity Registration, containing data from four general practices in and around Nijmegen (The Netherlands).

Co-morbidity obese children in family practice in The Netherlands: the results of a pilot study.

Objectives: The aim of this pilot study was to assess the prevalence of co-morbidity in obese children. Particular emphasis was on cardiovascular risk.

Method: In this retrospective, cross-sectional, observational study the data of 155 obese children, who visited a paediatric obesity outdoor clinic, have been studied.

Vulvovaginal candidiasis: diagnostic and therapeutic approaches used by Dutch general practitioners.

Objective: To establish how general practitioners (GPs) in the Netherlands diagnose and treat vaginal candidiasis.

Methods: Questionnaires were sent to 1160 Dutch GPs. The GPs were asked to make an inventory of the annual number of consultations for vulvovaginal candidiasis.

Whole grain foods for the prevention of type 2 diabetes mellitus.

Background: Diet as one aspect of lifestyle is thought to be one of the modifiable risk factors for the development of type 2 diabetes mellitus (T2DM). Information is needed as to which components of the diet could be protective for this disease.

Objectives: To asses the effects of whole-grain foods for the prevention of T2DM.

A prospective study on malnutrition and quality of life in patients with head and neck cancer.

The objective of this observational prospective study in patients with squamous cell carcinoma (SCC) of the oral, oropharyngeal and hypopharyngeal cavity was to look into the relation between malnutrition (>or=10% unintended weight loss within 6 months) and specific quality of life (QoL) parameters longitudinally. Bodyweight and QoL were monitored in 47 patients with SCC at diagnosis, end of treatment and six months after treatment. EORTC QoLQ-C30 and H&N 35 questionnaires were used to assess QoL.

Limited evidence for effects of diet for type 2 diabetes from systematic reviews.

Objective: Systematic reviews are an appraised method to summarize research in a concise and transparent way, and may enable to draw conclusions beyond the sum of results of individual studies. We assessed the results, quality and external validity of systematic reviews on diet in patients with type 2 diabetes.

Design, Setting, Subjects: We systematically searched for systematic reviews on nutritional interventions in patients with type 2 diabetes that used a reproducible search strategy in at least one major database that applied some form of quality assessment.

Nutritional deficiency in general practice: a systematic review.

Objective: Nutritional deficiency is an independent risk factor for mortality. Despite its clinical relevance, the prevalence in a primary care setting is poorly documented. We performed a systematic review of reported prevalence and clinical assessment of nutritional deficiency in general practice.

Nutritional deficiency in Dutch primary care: data from general practice research and registration networks.

Objective: To explore incidence and prevalence rates of nutritional deficiency in adults in general practice.

Methods: Six Dutch general practice research and registration networks supplied incidence and prevalence rates of nutritional deficiency by the International Classification of Primary Care (ICPC) or 'E-list' labels ('loss of appetite, feeding problem adult, iron, pernicious/folate deficiency anaemia, vitamin deficiencies and other nutritional disorders, weight loss'). In case of disease-related nutritional deficiency, we asked whether this was labelled separately ('co-registered') or included in the registration of the underlying disease.

The Cochrane Library: more systematic reviews on nutrition needed.

The knowledge and relevance of nutrition as well as the demand for well-funded advices increase. The Cochrane Collaboration plays a leading role within the evidence-based medicine and practice. We advocate therefore more specialized nutritional interest within the Cochrane Collaboration.

How can a proposed Cochrane diet and nutrition field work effectively?

The Cochrane Database currently provides relatively little evidence-based guidance about nutrition relevant to general practitioners. This situation could be improved by the establishment of a new Cochrane Field to identify relevant studies, prioritize topics to include nutrition, work with Cochrane methodologists on the inclusion of observational studies, and disseminate results of Cochrane reviews to general practitioners and their patients. A Diet and Nutrition Field could be established as a separate entity or as a Subgroup of the existing Primary Health Care (PHC) Field.

Organisation of a proposed Cochrane Diet and Nutrition Field.

The Cochrane Collaboration helps people make well-informed decisions about health care by preparing, maintaining and promoting the accessibility of systematic reviews of the effects of healthcare interventions. In all, 51 Cochrane Review Groups are responsible for preparing and maintaining the reviews. Most of these Review Groups are problem-based.