Nutrition Literacy and Patient Safety: Could this impact your patients?
As a registered dietitian, I know that the misunderstanding of basic nutrition or medical nutrition therapy can have major consequences for patient outcomes. I have seen the link between nutrition literacy and patient safety many times. Some of the more memorable encounters include:
- A newborn infant admitted near death because her mother did not know that crushed chips in soda placed in a bottle was not a nutritionally sound diet for infants. Chips and soda were typical foods for the mother.
- Another mother caused her child to fail-to-thrive due to her obsession with a fat-free diet. She was literally starving her child of much needed fat and calories for normal growth and development.
- One man living with diabetes, who was post-op toe amputation from complications due to poor blood sugar control, had taken his insulin at 8am but had not yet eaten breakfast. When I went to his home at 10am to check on him, I inquired about a potential low blood sugar reaction and he pulled open a drawer of candy. Instead, he should have eaten within a half hour of taking his insulin to keep his blood sugar stable and to prevent future complications.
- A grandmother with morbid obesity was homebound and bedbound with good family support but chronic readmissions. I was checking on her post-discharge from the hospital and was pleased to find a wide variety of fruits and vegetables in her refrigerator. When I inquired from her granddaughter why they were all still in the package, she replied, “The dietitian at the hospital told us we needed to buy more fruits and vegetables…but, we don’t know what to do with them.”
EatRight, LiveRight, FeelRight
This year’s theme for National Nutrition Month® is EatRight, LiveRight, FeelRight! Sounds like an easy concept. However, people are limited in capacity to achieve these aspirations by their level of nutrition literacy. Nutrition literacy requires skills and capabilities empowering people to be food and health literate. These concepts also raise the questions do people have adequate access to nutritious foods and knowledge about food for proper selection or skills for preparation?
Nearly one billion people living in the world today are hungry on a daily basis, and over thirty percent of the world’s population experiences malnutrition in one form or another (World Food Program, 2018). The burden of malnutrition falls most heavily on girls and women who make up nearly two-thirds of this statistic (World Hunger, 2016). Babies born to mothers who are malnourished are at greater risk for low birth weight, which further places the baby at risk for early mortality, under five years of age. In the United States (U.S.), 40 million people are “food insecure” or lack access to healthy foods. This includes more than 12 million children. Malnutrition in children is the biggest contributor to childhood mortality, opening the door to opportunistic infections by inhibiting the effectiveness of the immune system (World Hunger, 2016).
However, good nutrition and access to healthy foods are not only essential for maternal and child health outcomes but for all populations. Good nutrition is important for prevention and management of chronic conditions such as obesity, heart disease, diabetes, and some types of cancer. Additionally, proper nutrition is one aspect of preventing obesity, which is a major health risk globally and in the United States. While the importance of good nutrition is well understood by clinicians, putting nutrition recommendations into practice can be very challenging for many families. For example, some places in the United States, labeled “food deserts,” lack healthy food that is affordable for the families that live there or sometimes lack healthy food entirely (USDA, 2009). Additionally, these neighborhoods frequently have more fast food restaurants and convenience stores that only sell unhealthy food options (USDA, 2009). Those living in low income neighborhoods generally have to travel further to access a supermarket, and 2.3 million households live more than one mile from a supermarket and do not have transportation (USDA, 2009). As a result, disparities exist in achieving the goal to EatRight, LiveRight, FeelRight!
Additionally, nutrition literacy causes health barriers without regard to socioeconomic status. Even the most affluent of households suffer from chronic diseases or complications related to poor nutrition literacy. Previously, public health promotion strategies have focused on nutrition education but have not been successful in changing dietary intake (Vidgen, 2016). Explicitly supporting and building food literacy infrastructure may more effectively address the self-efficacy people need to navigate the current food system and make healthy food decisions (Vidgen, 2016). Promoting National Nutrition Month®, the Academy of Nutrition and Dietetics recommends multi-faceted interventions to address poor food and nutrition literacy. Registered Dietitians receive specific training to help people navigate food and nutrition, complex phenomena made up of multiple factors of environment and lived experience, empowering people to eat healthy and reducing disease risk among populations. The Academy also supports advocacy for nutrition policy to help correct environmental, knowledge/skill and access barriers therefore, create a culture where everyone can EatRight, LiveRight, FeelRight!
- US Department of Agriculture. (USDA). (2009). Access to affordable and nutritious food: measuring and understanding food deserts and their consequences. Washington, DC: Report to Congress.
- Vidgen HA (editor) (2016) Food Literacy: Key Concepts for Health and Education. London: Routledge.
- World Food Program (2018). Zero Hunger. Retrieved from http://www1.wfp.org/zero-hunger
- World Hunger (2016). Women and Hunger Facts. Retrieved from https://www.worldhunger.org/women-and-hunger-facts/
Written by Teresa Wagner, DrPH, MS, CPH, RD/LD on March 14, 2019