Introduction

Medical Nutrition Therapy (MNT), a personalized, evidence-based nutrition plan, is a foundational aspect of treatment for Cardiovascular-kidney metabolic (CKM) syndrome rooted in visceral obesity. Despite clinical guidelines recommending comprehensive lifestyle and nutritional support, MNT is not adequately emphasized in clinical practice, which focuses on medication.

This study aims to assess the prevalence of and factors associated with MNT engagement in the general US population, focusing on individuals with CKM syndrome.

Methods

Data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 cycles were analyzed. MNT was assessed via the question: “When was the last time {you/SP} saw a diabetes nurse educator or dietitian or nutritionist for {your/his/her} diabetes?” Individuals who saw one of these professionals for diabetes even more than five years ago were considered to have engaged in MNT. CKM syndrome was defined using a composite of objective and self-reported variables. Medications, including GLP-1/GIP receptor agonists and SGLT-2s, were identified from the RXQ_RX medication data file. Weighted percentages accounted for the complex survey design. A multivariable logistic regression model was used to identify factors associated with MNT.

Results

Overall MNT engagement was 60% (23.8% in the past year, 36.3% between one and two years). Compared to those with high education, individuals with low education [OR 0.46, 95% CI: 0.24-0.86] and medium education [OR 0.50, 95%CI: 0.28-0.89] were significantly less likely to receive MNT. The non-Hispanic Asian population was 50% significantly less likely to engage in MNT compared to the non-Hispanic White population. About 40% of those with CKM did not receive MNT, and only 1.2% were on GLP-1 drugs.

Conclusions

Almost 75% of the population did not engage in MNT in the past year. Several socio-demographic and health-related factors were associated with less MNT engagement, highlighting a critical gap in care. The low MNT engagement among those with CKM syndrome and the low use of GLP-1s is vital for informing future clinical guidelines and improving patient outcomes for CKM through personalized lifestyle and nutritional support. A key limitation is using a self-reported proxy for MNT. Future research should use more recent and health system-based data sources.

References

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