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Clinical guidelines

Guidelines for preventive activities in general practice 9th edition

7.3 Nutrition

Age 0-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-79 >80

Ask adults how many portions of fruits or vegetables they eat in a day and advise to follow the NHMRC’s Australian dietary guidelines (B).85 Brief advice should be given to eat two serves of fruit and five serves of vegetables per day (2 + 5 portions), and to limit sugar, saturated fat, salt and alcohol.

Breastfeeding should be promoted as the most appropriate method for feeding infants (and one that offers protection against infection and some chronic diseases).85 Refer to Chapter 3. Preventive activities in children and young people for nutrition-related recommendations.

Table 7.3.1. Nutrition-related complications: Identifying risk
Who is at risk?What should be done?How often?
Average risk
Adults9,86 Ask about the number of portions of fruits and vegetables eaten per day, and the amount of sugar (including sweetened drinks), salt and alcohol, and saturated fat intaked (II, B)

All patients should be advised to follow the Australian dietary guidelines and eat at least five serves of vegetables and two serves of fruit per day (II, B)
Every two years (IV, D)
Children and adolescents85 Assess growth using the World Health Organization (WHO) weight-for-age and height-for-age charts up to 2 years of age, and body mass index (BMI) for age charts from 2 to 16 years of age

Advise patients to follow Australian dietary guidelines, including eating high quantities of vegetables, fruit, wholegrain cereals, poultry, fish, eggs and low fat milk, yoghurt and cheese products, and less discretionary food choices including sugary soft drinks
At times of child health surveillance or immunisation until 5 years of age then every two years
High risk85,87
  • Overweight or obese
  • High cardiovascular disease (CVD) absolute risk (>15%)
  • A past or first-degree family history of CVD (including stroke) before 60 years of age. For personal history the age does not matter
  • Type 2 diabetes or high risk for diabetes
Provide lifestyle advice to limit intake of foods containing saturated fat, added salt, added sugars (including sugary drinks) and alcohol, and increase serves of fruit and vegetables. (Refer to Section 7.2. Overweight for dietary recommendations for overweight and obesity; II, B)

Provide self-help nutrition education materials and refer to a dietitian, group diet program or phone coaching (II, B)
Every six months (Practice Point)
BMI, body mass index; WHO, World Health Organization
Table 7.3.2. Nutrition-related complications: Preventive interventions
InterventionTechnique
Vitamin supplements Vitamin supplementation is not of established value in asymptomatic individuals* (with the exception of folate and iodine in pregnancy). Routine screening for vitamin D deficiency is not recommended in low-risk populations85
Dietary recommendations Enjoy a wide variety of foods each day, including:85
  • five serves of vegetables (of different types and colours, and legumes/ beans) and two serves of fruit
  • grain or cereals (mostly wholegrain and/or high fibre varieties such as breads, rice, pasta, noodles, polenta, couscous, oats, quinoa and barley)
  • lean meats, fish, poultry, eggs, tofu, nuts and seeds
and
  • drink plenty of water88
Take care to:
  • limit saturated fat and reduce salt
  • limit alcohol intake
  • avoid sugary beverages including soft drink and limit fruit juices
  • limit sugars and foods containing added sugars
  • limit red meat (three to four times per week) and limit or avoid
  • processed meat
  • care for food: prepare and store it safely
  • encourage and support breastfeeding
For specific advice, especially patients with specific conditions, refer to a dietitian

The National Heart Foundation of Australia has a number of nutrition position statements

In children, overweight or obesity is associated with sweet drink consumption, and dental problems are associated with consumption of fatty foods and sweet drinks89
Encourage breastfeeding Encourage and support exclusive breastfeeding until 4 to 6 months of age (there is current controversy about when to introduce foods; refer to Practice Point c in Table 3.2). It is recommended that breastfeeding continue until 12 months of age and thereafter as long as is mutually desired85
*Prevalence of nutritional deficiency is high in certain groups, such as people with alcohol dependence and the elderly living alone or in institutions.

For further information, refer to the RACGP’s SNAP guide, 2nd edn,82 and NHMRC’s Australian dietary guidelines.85

References

  1. National Health and Medical Research Council. Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. Canberra: NHMRC, 2013.
  2. National Health and Medical Research Council. Australian Dietary Guidelines. Canberra: NHMRC, 2013.
  3. Hartleyh L, Igbinedion E, Holmes J, et al. Increased consumption of fruit and vegetables for the primary prevention of cardiovascular diseases. Cochrane Database Syst Rev 2013;6:CD009874.
  4. US Preventive Services Task Force. Healthful diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: Behavioral counseling. Washington, DC: USPSTF, 2014. Available at www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/healthy-diet-andphysical- activity-counseling-adults-with-high-risk-of-cvd [Accessed 23 March 2016].
  5. National Cancer Control Policy. Position statement – Meat and cancer prevention. Sydney, NSW: Cancer Council Australia, 2013. Available at http://wiki.cancer. org.au/policy/Position_statement_-_Meat_and_cancer_prevention#Red_meat [Accessed 23 March 2016].
  6. Hooley M, Skouteris H, Millar L. The relationship between childhood weight, dental caries and eating practices in 83 Guidelines for preventive activities in general practice 9th edition children aged 4–8 years in Australia, 2004–2008. Pediatr Obes 2012;7(6):461–70.
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