(P24-129-23) Integrating Routine Nutritional Assessment Into Community Medicine: What Clinical Vignettes Reveal

Objectives: To identify community malnutrition and improve patient outcomes by practicing cultural humility and integrating routine nutritional assessment into community medicine, using 24-hour food recall, micronutrient testing, as-needed supplementation, patient nutrition education, and clinical follow-up.

Methods: The presenter established a registry to document nutritional deficiencies, given evidence of malnutrition at a Federally Qualified Health Center serving Medicaid and Medicare patients and the uninsured. Multi-disciplinary research and publication are planned to expand the registry data, evaluate impact, and collaborate to document these problems and join forces to address them. Analytical tools will identify predictive factors; patient benefits from remediation will be documented. Physicians and patients will evaluate the program via interviews analyzed with qualitative research techniques.

Results: Of 1600 patients’ data to date, 325 (20%) were nutritionally deficient and 96 (6%) had clinical scurvy. Clinical observation also indicates most have diets putting them at risk for poor health outcomes and unnecessary medications. With two clinical vignettes, the presenter will illustrate the critical role of micronutrient testing and personalized nutrition counseling. Case 1. A 38 y.o. White female presented with severe depression, headache, caries, and chest pain. Evaluation revealed she had clinical scurvy. Supplemental Vitamin C was added; her mood improved and pain diminished enough to stop her pain medications and antidepressants. Case 2. A 40-year-old man presented with anxiety and depression. He reported a poor diet and lack of energy. Laboratory tests revealed multiple micronutrient deficiencies. After targeted supplementation and nutrition education, his mood and energy improved dramatically.

Conclusions: Abundant research establishes the overwhelming importance of good nutrition for health. A new model of primary and community care is needed, to better support patients and for physicians to more effectively treat the whole person by focusing on nutrition and prevention.

Funding Sources: Battle Creek Community Foundation, Michigan Department of Health and Human Services, United States Department of Agriculture, Homer Stryker School of Medicine.