MEDICAL NUTRITION MANAGEMENT

This course provides an overview of the role of nutrition and lifestyle choices for optimising health at all stages of pregnancy. A case study is used to inform about the role of nutrition for conception and fertility. Lifestyle choices including key nutrients for pre-conception and optimising fertility are suggested. The patient case then moves to nutrition through pregnancy and addresses nausea and vomiting, and how a healthy diet reduces outcome risks for mother and infant including key nutrients and foods to avoid. Lifestyle considerations through pregnancy are outlined. The case study then moves to lactation post-partum and stresses the importance of healthy nutrition for lactation/promoting lactation and includes foods to avoid. Management plans and evidence-based practice guidelines are suggested at each stage. Supplements in pregnancy are mentioned and the course concludes with summarising practical nutrition considerations in pregnancy.  

This course outlines the shift to weight-inclusive health care and recognizes that both health behaviours and genetics may influence body weight. Weight classifications and limitations of BMI screening are discussed together with contributing chronic disease risk factors. A case study is presented to consider weight management dietary strategies including bariatric surgery, medication, nutrition and physical activity. Evidence based weight management strategies, potential risks of the diet culture, weight cycling and the relationship between dieting and mental health are discussed. A healthy lifestyle is preferable to a diet. People in bigger bodies may avoid medical care until conditions are advanced, to avoid weight bias and stigma.  The non-diet approach looks at common assumptions in health care and the key principles of health at every size, including weight inclusivity, health enhancement, respectful care, eating for well-being and life-enhancing movement. The case study is revisited and options discussed including strategies to engage patients.  

This course introduces and defines the features and pathogenesis of metabolic syndrome and insulin resistance. General practitioners are uniquely placed to diagnose and manage this condition. Screening tools, medical complications and risk factors are explained together with the complexities, incidence and prevalence of metabolic syndrome and insulin resistance. Common features of this condition are described including abdominal (visceral) obesity, insulin resistance, dyslipidaemia and microalbuminuria. Risk factors affecting the endocrine, cardiovascular and gastrointestinal systems are outlined as well as the relationship with coronary heart disease and non-alcoholic fatty liver disease. The role of the gut microbiome in patients with metabolic syndrome is mentioned. A case study reinforces learning. The second section focusses on environmental determinants including lifestyle choices, nutrition, physical activity and medications. Low energy and ketogenic states are detailed in addition to a change in overall dietary patterns. Referral options to dieticians and surgery are mentioned. A case study concludes this course. 

This course focuses on the key nutritional problems for patients with diabetes and discusses healthy eating, defines carbohydrates, examines the glycaemic index vs glycaemic load, and includes the nutrition priorities for people with diabetes. The goals of diabetes management include healthy eating to positively influence glycaemic control, blood pressure, hyperlipidaemia and overweight/obesity. A healthy diet, physical activity and in some cases, pharmacological intervention contribute to glycaemic control. Carbohydrates (CHOs) are mentioned before moving to explaining the glycaemic index (GI) and its role in diabetes management. Nutritional priorities are discussed including weight loss, healthy eating and individualised plans. Low carbohydrate diets are defined including their relationship with GI and managing diabetes. The benefits and disadvantages of a low CHO/ketogenic diet in relation to managing diabetes are discussed. A case study reinforces course content.  

GPs play an important role in directing patients with cardiovascular disease (CVD) to evidence-based nutrition advice and resources. This course discusses the evolution of evidence and heart health nutrition recommendations including the National Heart Foundation Eating for Heart Health Position Statement and other recent cardiovascular disease management and heart failure guidelines. Nutrient supplements are discussed together with cardiovascular nutrition controversies including food trends and omega-3, anti-inflammatory dietary components, and weight management. The second section discusses the key principles and evidence for the DASH and Mediterranean diets supported by evidence-based research. Guides are provided for the GP and the patient approach including patients with lower health literacy.

The first section of this course outlines the main functions of the gut microbiota, its significance for gut health and factors that affect its composition. Factors that affect gut microbiota include delivery mode, diet, age, disease and medications. The gut microbiota interacts with the body including the immune and nervous systems. Short term consumption of different diets alters microbial community structure and gene expression. The second section covers the appropriate use of specific prebiotics and probiotics in the treatment of irritable bowel syndrome (IBS) and functional constipation. Probiotics and prebiotics are explained including food sources for both. The mechanisms and effect on the gut microbiota are outlined. Evidence based research and guidelines supports the course content.  

The course focuses on the changing nutritional requirements for patients diagnosed with cancer across treatment, during survivorship and end-stage care. As some cancer treatments can affect appetite, patients may be at nutritional risk – the ESPEN guide outlines the three categories for patients at risk: precachexia, cachexia and refractory cachexia. Multi-modal treatments are discussed including dietary counselling and sample meal plans. Nutritional recommendations for minimizing recurrence risk are listed. The GP and dietitian’s roles are outlined for managing these patients. The second section suggests recommended evidence-based nutrition management to improve the nutritional status and quality of life for patients with cancer. Omega-3 fatty acids and other ‘hot topics’ including ginger and adjuvant therapies are mentioned. The impact of chemotherapy on nutrition and gastronomy is explained. In end stage care, nutritional focus is for symptom management and quality of life.  Evidence-based guidelines and research support the course content.  

Athletes’ nutritional needs are principally determined by their training load and body mass. This course focusses on key nutritional priorities for athletes, safe and effective supplement options and nutrition priorities to maximise daily training performance, manipulate recovery and maintain immune function. Planning nutritional requirements for competitions and understanding athletes at risk of nutritional deficiencies are discussed. A case study of a triathlete reinforces learning. Timing of daily dietary intake including carbohydrate and protein guidelines, and barriers to fuelling/refuelling are included. Relative energy deficiency in sport (RED-S) and the potential consequences of RED-S are discussed including the stages of iron deficiency, RED-S assessment tools, and return to play guides. Muscle protein balance after exercise is considered including guides. Plant based protein supplements and guides to strategic eating to promote muscle protein synthesis are detailed. Expert assistance is strongly advised before supplement use. The course includes Information on supplements, sports foods and drinks.