Walk the Talk with Your Fork: Do Dietitians Eat Better?
As a nutrition scientist, part of my training covered dietary recommendations. I know what I should be eating, both in terms of food groups and the nutrients that I can expect to obtain from those foods. As a result, my diet and lifestyle is generally healthy. I start out the day well with natural muesli, low-fat milk and a single glass of 100% fruit juice. My lunch is usually whole grain bread with cheese or peanut butter. I normally serve at least 200 grams of vegetables with dinner. I also have an active lifestyle due to my location in the Netherlands where cycling is a form of transportation rather than recreation. That’s the good news. On the other hand, when I need to conjure up a mid-week dinner in no time that is likely to be eaten by my fussy five year old daughter, I tend to rely on convenient foods such as sausages and fish fingers that contain a lot of salt and saturated fat. I am also very partial to indulging in chocolate.
When I look at my food group report from foods eaten over the last 24 hours, I can see that I have consumed too many calories from sugar, and I should have eaten more vegetables. The fish fingers that I had for dinner means that my sodium intake is almost double what it should have been, and I should have eaten more vegetables because my potassium and vitamin C intakes were too low. We ran out of peanut butter so I ate more cheese than normal, which pushed up my saturated fat consumption to 10% of my total calories (although the chocolate biscuits also did not help my saturated fat intake…). I also did not meet recommendations for choline or vitamin D.
But perhaps I am a special case. Recently, Sugimoto and colleagues looked at the diets of around 100 female dietitians in Japan and compared them to the diets of a similar number of non-dietitians. All participants worked in welfare facilities, and the non-dietitians were employed as clerical staff or care workers. Participants completed two diet history questionnaires (which also included questions to assess nutrition knowledge) and a lifestyle questionnaire, and 24-hour urine samples were collected to measure sodium and potassium excretion. Half the participants completed 4-day semi-weighted food records.
Both the dietitians and non-dietitians were similar in BMI, educational attainment and lifestyle, however there were significant differences by age (dietitians were older) and smoking status (dietitians were less likely to smoke). The survey found that dietitians exhibited more healthy dietary behaviors in general such as using less seasonings when cooking, checking food labels when shopping, and having a better knowledge of diseases linked to excessive salt intakes when compared to non-dietitians. They also reported lower energy intake, even though their BMI and physical activity levels were similar. According to the food intake analysis from the dietary records, dietitians consumed less fat and sodium, and more potassium, than non-dietitians. When looking at the urinary sodium and potassium excretion values, however, there was no difference in sodium excretion, only the crude potassium excretion was higher in the dietitians, however the ratio of sodium to potassium differed significantly in the crude model and also when adjusted for age and smoking status.
The authors concluded that the increased nutrition knowledge of dietitians did not correspond to a meaningful reduction in sodium intakes compared to non-dietitians. I only just met these potassium intake guidelines (although I would be better off trying to meet 5000 mg), and my sodium intake was much too high; Japanese dietitians also consumed too much sodium and not enough potassium. This raises questions about whether more education is a solution to reducing sodium intakes in populations. For example, as Bruins and colleagues report, a reduction of sodium by 25% in a single product group (packaged soups) can have a noticeable impact on disease such as stroke, heart attacks, angina and heart failure in a population. The World Health Organisation has called for a global reduction in sodium intake to below 2000 mg per day (5 grams of salt) and an increase in potassium intake to above 3500 mg per day. The World Health Organization recommends that governments and the food industry work together to reduce the sodium supply to the population. I would welcome a reduction in the sodium content of convenience foods. Reliance on nutrition knowledge of individuals is clearly not effective.
Sugimoto, M.; Asakura, K.; Masayasu, S.; Sasaki, S. Relationship of nutrition knowledge and self-reported dietary behaviors with urinary excretion of sodium and potassium: Comparison between dietitians and nondietitians. Nutrition Research 2016, 36, 440-451, http://dx.doi.org/10.1016/j.nutres.2015.12.012.
Bruins, M.J.; Dötsch-Klerk, M.; Matthee, J.; Kearney, M.; van Elk, K.; Weber, P.; Eggersdorfer, M. A Modelling Approach to Estimate the Impact of Sodium Reduction in Soups on Cardiovascular Health in the Netherlands. Nutrients 2015, 7, 8010-8019. http://www.mdpi.com/2072-6643/7/9/5375
World Health Organisation. Fact sheet number 393: Salt reduction. September 2014. http://www.who.int/mediacentre/factsheets/fs393/en/
Tool used for my own dietary intake assessment: USDA Supertracker https://www.supertracker.usda.gov/login.aspx