The attitude toward and the prescription of a low carbohydrate, high fat diet by KwaZulu-Natal clinical dieticians.
Joyner, Stephanie Alexandra.
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Aim: To determine the attitude toward and the prescription of a low carbohydrate, high fat (LCHF) diet by KwaZulu-Natal clinical dieticians working in government or private practice. Objectives: The study set out to determine the following objectives: (i) dieticians’ attitudes toward a LCHF diet, (ii) the prescription of this diet in practice and concerns regarding the diet; (iii) to determine if there is a relationship between the socio-demographic characteristics, areas of work and professional interest as well as research involvement of dieticians and the prescription of a LCHF diet in practice; and to (iv) assess whether dieticians would be willing to adapt their practice methods and attitude after hearing a presentation on the LCHF diet. Method: The email addresses for 155 clinical dieticians, working in either government or private practice, were obtained from a data base. The dieticians were emailed a link to a four-part online questionnaire regarding their area of work, main professional interests, practice methods, prescription or non-prescription of a LCHF diet and research involvement. Results: The response rate to the questionnaire was 58% (n=90). The majority of the subjects were female (n=87, 97%) and had qualified at the University of KwaZulu-Natal (n=67, 74%). Patients with non-communicable diseases were the most common condition counselled by the subjects (71.3%). The latter was also the main area of interest for subjects in private practice. Upon analysis of the section pertaining to research involvement, it was found that the majority of subjects scored poorly in the questions related to the most basic of research involvement skills, with an average score of 40%. Overall, there was a negative attitude toward the prescription of the LCHF diet. Only 17% (n=15) of the subjects had prescribed the LCHF diet in practice and it had been prescribed rarely. The most common condition that the diet was prescribed for was weight loss. Subjects working in private practice were more likely to prescribe a LCHF diet for their patients compared to those working in government. More than 80% of the sample reported that they had never prescribed the diet. The most common reason provided was that it was felt there was a lack of supportive evidence for its use. Discussion: The finding that private practicing dieticians are more likely to prescribe a LCHF diet to patients may be because this type of patient is more likely to be able to afford and sustain a LCHF diet compared to the type of patients seen by subjects working in the government sector. These patients are also more likely to be aware of the LCHF diet compared to government health patients. Very few deiticians prescribed a LCHF diet; this may be a reflection of the dieticians practicing evidence evidence-based nutrition and/or it could be related to harm-avoidance. The very low level of research involvement and skill observed in the study is a concern and should be used as a basis for further investigation. Conclusion and recommendations: The low score obtained by subjects in basic research involvement could be interpreted that more emphasis should be placed on this area in undergraduate training and in the continuing professional development of qualified dieticians. More studies need to be done on the long-term safety and efficacy of a LCHF diet for the prevention and management of NCDs. Dietetic authorities should consider a country-wide advertising campaign to encourage the public to consult a Registered Dietician before following a LCHF diet