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Consistent prevalence of inadequate micronutrient intakes across six years of second-year medical school students

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DOI: 10.4236/health.2012.47058    3,737 Downloads   6,085 Views   Citations

ABSTRACT

Background: The dietary behaviors of physicians and medical students are strongly associated with their nutrition counseling practices. Little research to date describes their dietary intakes and no recent studies have assessed the adequacy of their micronutrient intakes. As micronutrient imbalances are associated with a variety of chronic diseases, public guidelines target increasing dietary nutrient density. The purpose of this study was to identify micronutrient imbalances in the diets of medical students and determine whether intakes are becoming more compliant with dietary guidelines over time. Methods: From 2000 to 2006, 409 second-year Vanderbilt University medical students completed the Block Brief 2000 food frequency questionnaire prior to the required “Introduction to Clinical Nutrition” course. Nutrient data were compared to Dietary Reference Intake values. Results: Dietary intakes of male students were consistently inadequate for vitamin E, vitamin D, calcium, magnesium and potassium across the six cohorts. Despite a significant increase over time in the number of vegetable servings consumed, the intakes of female students revealed the same inadequacies, as well as inadequate folate and iron intakes. Multivitamin and multimineral supplementation, consumed regularly by 51% of students, closed the gap in meeting estimated micronutrient requirements, except vitamin E. Conclusions: These data can be used to inform the content of nutrition interventions for medical students focused on making optimal food selection choices as well as the content of nutrition education in the medical school curriculum. It is important to enhance medical students’ preparedness as fu- ture health care providers—not only to serve as role models for healthy dietary behaviors, but also to better recognize the nutrition needs of their future patients.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Seabolt, L. , Spence, T. and Silver, H. (2012) Consistent prevalence of inadequate micronutrient intakes across six years of second-year medical school students. Health, 4, 357-365. doi: 10.4236/health.2012.47058.

References

[1] US Department of Health and Human Services. http://health.gov/dietaryguidelines/2010.asp
[2] Frank, E., Galuska, D., Elon, L. and Wright, E. (2004) Per- sonal and clinical exercise-related attitudes and behaviors of freshmen US medical students, Research Quarterly for Exercise & Sport, 75, 112-121.
[3] Frank, E. (2004) Physician health and patient care. The Journal of the American Medical Association, 291, 637.doi:10.1001/jama.291.5.637
[4] Frank, E., Rothenberg, R., Lewis, C. and Belodoff, B.F. (2000) Correlates of physicians’ prevention-related prac- tices Findings from the Women Physicians’ Health Study. Archives of Family Medicine, 9, 359-367. doi:10.1001/archfami.9.4.359
[5] Frank, E., Wright, E.H., Serdula, M.K., Elon, L.K. and Bald- win, G. (2002) US women physicians’ personal and clinical nutrition-related practices. The American Journal of Clinical Nutrition, 75, 326-332.
[6] Spencer, E.H., Frank, E., Elon, L.K., Hertzberg, V.S., Ga- luska, D. and Serdula, M.K. (2006) Predictors of nutrition counseling behaviors and attitudes among US medical students. The American Journal of Clinical Nutrition, 84, 655-662.
[7] Frank, E., Breyan, J. and Elon, L. (2000) Physician dis- closure of healthy personal behaviors improves credibility and ability to motivate. Archives of Family Medicine, 9, 287-290. doi:10.1001/archfami.9.3.287
[8] Podell, R.N., Gary, L.R. and Keller, K. (1975) A profile of clinical nutrition knowledge among physicians and medical students. Journal of Medical Education, 50, 888- 892.
[9] Phillips, M.G. (1971) The nutrition knowledge of medical students. Journal of Medical Education, 46, 86-90.
[10] Mlodinow, S.G. and Barrett-Connor, E. (1989) Physicians’ and medical students’ knowledge of nutrition. Academic Medicine, 64, 105-106. doi:10.1097/00001888-198902000-00017
[11] Davis, C.H. (1994) The report to Congress on the appro- priate federal role in assuring access by medical students, residents, and practicing physicians to adequate training in nutrition. Public Health Report, 109, 824-826.
[12] Conroy, M.B., Delichatsios, H.K., Hafler, J.P. and Rigotti, N.A. (2004) Impact of a preventive medicine and nutria- tion curriculum for medical students. The American Jour- nal of Preventive Medicine, 27, 77-80. doi:10.1016/j.amepre.2004.03.009
[13] Talip, W.A., Steyn, N.P., Visser, M., Charlton, K.E. and Temple, N. (2003) Development and validation of a know- ledge test for health professionals regarding lifestyle modi- fication. Nutrition, 19, 760-766.doi:10.1016/S0899-9007(03)00101-1
[14] Frankle, R.T., Williams, E.R. and Christakis, G. (1972) Nu- trition education in the medical school: experience with an elective course for first-year medical students. The American Journal of Clinical Nutrition, 25, 709-719.
[15] Thomson, C.A., Taren, D., Koff, N., Marian, M., Canfield, L., Bassford, T. and Ritenbaugh, C. (2000) An integrated nutrition curriculum in medical education. Journal of Cancer Education, 15, 127-129.
[16] Ammerman, A., McGaghie, W.C., Siscovick, D.S., Max- well, K., Cogburn, W.E. and Simpson, R.J. Jr. (1989) Medi- cal students’ knowledge, attitudes, and behavior concern- ing diet and heart disease. The American Journal of Pre- ventive Medicine, 5, 271-278.
[17] Van Horn, L. (2006) The nutrition academic award: brief history, overview and legacy. The American Journal of Clinical Nutrition, 83, 936S-40S.
[18] Wong, V., Millen, B.E., Geller, A.C., Rogers, A.E., Maury, J.J. and Prout, M.N. (2004) What’s in store for medical students? Awareness and utilization of expert nutrition guidelines among medical school preceptors. Preventive Medicine, 239, 753-759. doi:10.1016/j.ypmed.2004.02.046
[19] Mellen, P.B., Palla, S.L., Goff, D.C. Jr. and Bonds, D.E. (2000) Prevalence of nutrition and exercise counseling for patients with hypertension. United States, 1999 to 2000. Journal of General Internal Medicine, 19, 917-924. doi:10.1111/j.1525-1497.2004.30355.x
[20] Heimburger, D.C., Ullmann, D.O., Ramsey, M.J., Woold- ridge, N.H., Epps, L.A., Hardin, J.M. and Hsu, C. (1994) Dietary habits of first-year medical students assessed dur- ing clinical nutrition course. Nutrition, 10, 214-220.
[21] Banks, W.L. Jr., Chan, W.M. and Williams, W.L. (1989) Use of food frequency questionnaire results to emphasize nutritional concepts for first year medical students—Medical College of Virginia. Bulletin of the New York Academy of Medicine, 65, 928-934.
[22] Spencer, E.H., Elon, L.K., Hertzberg, V.S., Stein, A.D. and Frank, E. (2005) Validation of a brief diet survey in- strument among medical students. Journal of the Ameri- can Dietetic Association, 105, 802-806.doi:10.1016/j.jada.2005.02.003
[23] US Department of Health and Human Services (2010) Dietary Guidelines for Americans. Office of Disease Pre- vention and Health Promotion http://health.gov/dietaryguidelines/2010.asp
[24] Holick, M.F. (2004) Vitamin D: Importance in the pre- vention of cancers, type 1 diabetes, heart disease, and os- teoporosis. The American Journal of Clinical Nutrition, 79, 362-371.
[25] Bakhireva, L.N., Barrett-Connor, E., Kritz-Silverstein, D. and Morton, D.J. (2004) Modifiable predictors of bone loss in older men: A prospective study. The American Journal of Preventive Medicine, 6, 436-442. doi:10.1016/j.amepre.2004.02.013
[26] Centers for Disease Control and Prevention (1991) Use of folic acid for prevention of spina bifida and other neural tube defects: 1983-1991. Morbidity and Mortality Weekly Report, 30, 513-516.
[27] Blot, I., Papiernik, E., Kaltwasser, J.P., Werner, E. and Tchernia, G. (1981) Influence of routine administration of folic acid and iron during pregnancy. Gynecologic and Obstetric Investigation, 6, 294-304. doi:10.1159/000299659
[28] Krishna, G.G. and Kapoor, S.C. (1991) Potassium deple- tion exacerbates essential hypertension. Annals of Inter- nal Medicine, 115, 77-83
[29] Coruzzi, P., Brambilla, L., Brambilla, V., et al. (2001) Potassium depletion and salt sensitivity in essential hy- pertension. The Journal of Clinical Endocrinology & Metabolism, 86, 2857-2562. doi:10.1210/jc.86.6.2857
[30] Sommer, A. and West, K.P. Jr. (1996) Vitamin A defi- ciency: Health, survival and vision. Oxford University Press, New York.
[31] Dawson, H.D. and Ross, A.C. (1999) Chronic marginal vitamin A status effects the distribution and function of T cells and natural T cells in aging Lewis rats. Journal of Nutrition, 129, 1782-1790.
[32] Stephensen, C.B. (2001) Vitamin A, infection and immune function. The Annual Review of Nutrition, 21, 167-192. doi:10.1146/annurev.nutr.21.1.167
[33] Mocchegiani, E., Giacconi, R., Muzzioli, M. and Cipriano, C. (2000) Zinc, infections and immunosenescence. Mech- anisms of Ageing and Development, 121, 21-35. doi:10.1016/S0047-6374(00)00194-9
[34] Wintergerst, E.S., Maggini, S. and Hornig, D.H. (2006) Immune-enhancing role of vitamin C and zinc and effect on clinical condition. Annals of Nutrition and Metabolism, 50, 85-94.doi:10.1159/000090495
[35] Selhub, J., Jacques, P.F., Wilson, P.W., Rush, D. and Ro- senberg, I.H. (1993) Vitamin status and intake as primary determinants of homocysteinemia in an elderly popula- tion. The Journal of the American Medical Association, 270, 2693-2698.doi:10.1001/jama.1993.03510220049033
[36] Ali, M.M. and Vaidya, R.R. (2007) Vitamin D and cancer. Journal of Cancer Research, 4, 225-230. doi:10.4103/0973-1482.38998
[37] White, E., Shannon, J.S. and Patterson, R.E. (1997) Re- lationship between vitamin and calcium supplement use and colon cancer. Cancer Epidemiology, Biomarkers & Prevention, 6, 769-774.
[38] Kampman, E., Slattery, M.L., Caan, B. and Potter, J.D. (2000) Calcium, vitamin D, sunshine exposure, dairy products and colon cancer risk (United States). Cancer Causes Control, 11, 459-466.doi:10.1023/A:1008914108739
[39] Block, G., Hartman, A.M., Naughton, D. (1990) A re- duced dietary questionnaire: Development and validation. Epidemiology, 1, 58-64. doi:10.1097/00001648-199001000-00013
[40] United States Department of Agriculture (2000) Agricul- tural Research Service. Nutrient Data Laboratory. http://www.ars.usda.gov/nutrientdata/
[41] Institute of Medicine (2005) Food and Nutrition Board. The dietary reference intakes for energy, carbohydrates, fiber, fat, protein and amino acids (macronutrients). Na- tional Academies Press, Washington DC.
[42] Institute of Medicine (2000) Food and Nutrition Board. Dietary reference intakes: Applications in dietary assess-ment. National Academies Press, Washington DC.
[43] United States Department of Agriculture. http://www.mypyramid.gov/
[44] Britten, P., Marcoe, K., Yamini, S. and Davis, C. (2006) Development of food intake patterns for the MyPyramid food guidance system, Journal of Nutrition Education and Behavior, 38, S78-S92. doi:10.1016/j.jneb.2006.08.007
[45] Mitchell, D.C., Frank, L.R., Hartman, T.J. and Curran, J.M. (2009) Consumption of dry beans, peas, and lentils could improve diet quality in the US population. Journal of the American Dietetic Association, 109, 909-913. doi:10.1016/j.jada.2009.02.029
[46] American Dietetic Association (2000) Position of the American Dietetic Association: Fortification and nutria-tional supplements. Journal of the American Dietetic As- sociation, 105, 1300-1311.
[47] Spencer, E.H., Bendich, A. and Frank, E. (2006) Vitamin and mineral supplement use among US medical students: A longitudinal study. Journal of the American Dietetic Association, 106, 1975-1983.doi:10.1016/j.jada.2006.09.003
[48] Frank, E., Carrera, J.S., Elon, L. and Herzberg, V.S. (2006) Basic demographics, health practices, and health status of U.S. medical students. The American Journal of Preven- tive Medicine, 31, 499-505. doi:10.1016/j.amepre.2006.08.009
[49] Subar, A.F., Kipnis, V., Troiano, R.P., et al. (2003) Using intake biomarkers to evaluate the extent of dietary mis- reporting in a large sample of adults: The OPEN study. American Journal of Epidemiology, 158, 1-13. doi:10.1093/aje/kwg092
[50] Block, G. (2000) Invited commentary: Another perspec- tive on food frequency questionnaires. American Journal of Epidemiology, 154, 1103-1104.doi:10.1093/aje/154.12.1103
[51] Wakimoto, P. and Block, G. (2001) Dietary intake, dietary patterns, and changes with age: An epidemiological per- spective. The Journals of Gerontology: Series A, 56, 65- 80.
[52] US Department of Agriculture and US Department of Health and Human Services (2000) What we eat in Amer- ica, NHANES 2007-2008.
[53] Chung, M., Balk, E.M., Brendel, M., Ip, S., Lau, J., Lee, J., et al. (2009) Vitamin D and calcium: Systematic review of health outcomes. Agency for Healthcare Research and Quality, Rockville.
[54] Selhub, J. and Paul, L. (2011) Folic acid fortification: Why not vitamin B12 also? Biofactors, 37, 269-271. doi:10.1002/biof.173
[55] Garcia, O.P., Long, K.Z. and Rosado, J.L. (2009) Impact of micronutrient deficiencies on obesity. Nutrition Re- views, 67, 559-572. doi:10.1111/j.1753-4887.2009.00228.x
[56] Mothersbaugh, D.L., Hermann, R.O. and Warland, RH. (1993) Perceived time pressure and recommended dietary practices: The moderating effect of knowledge of nutri- tion. Journal of Consumer Affairs, 27, 106-126. doi:10.1111/j.1745-6606.1993.tb00740.x
[57] Dyrbye, L.N., Thomas, M.R. and Shanafelt, T.D. (2006) Systematic review of depression, anxiety, and other indi- cators of psychological distress among US and Canadian medical students. Academic Medicine, 81, 354-373. doi:10.1097/00001888-200604000-00009
[58] Drewnowski, A. and Darmon, N. (2005) Food choices and diet costs: An economic analysis. Journal of Nutrition, 135, 900-904.
[59] Futch, L.S., Wingard, D.L. and Felice, M.E. (1988) Eating pattern disturbances among women medical and grad- uate students. Journal of Adolescent Health, 9, 378-383. doi:10.1016/0197-0070(88)90032-0

  
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