Journal of

Clinical Medicine

Article
Attitudes toward Nutrition Care among General
Practitioners in Croatia
Albina Dumic 1 , Ivan Miskulin 1 ID
, Nika Pavlovic 1 , Daniela Cacic Kenjeric 2 ID
, Zelimir Orkic 1
and Maja Miskulin 1, * ID
1 Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31 000 Osijek, Croatia;
[email protected] (A.D.); [email protected] (I.M.); [email protected] (N.P.);
[email protected] (Z.O.)
2 Faculty of Food Technology, Josip Juraj Strossmayer University of Osijek, 31 000 Osijek, Croatia;
[email protected]
* Correspondence: [email protected]; Tel.: +385-91-566-0887




Received: 5 March 2018; Accepted: 15 March 2018; Published: 21 March 2018


Abstract: Nutrition care should be an integral part of general practitioners’ (GPs’) daily work with
patients. The aim of this study was to assess the attitudes of Croatian GPs toward nutrition and
nutrition care, and to evaluate the interconnection between their attitudes and implementation of
nutrition care in GPs offices. A cross-sectional study was conducted among 17.0% of randomly
selected GPs, from May to July of 2013, via a specially designed anonymous questionnaire. The study
showed that 36.0% of the Croatian GPs had satisfactory number of positive attitudes (5 or more)
toward nutrition and nutrition care. There was statistically significant difference in the median
number of positive attitudes based on the additional education of GPs in nutrition and their ailment
from chronic diseases (p < 0.001 and p = 0.022, respectively). The Spearman rank correlation between
GPs’ attitudes toward nutrition and nutrition care and their practice, i.e., the implementation of
nutrition care in GPs’ everyday work with patients was rs = −0.235 (p < 0.001). In order to provide
nutrition care in GPs’ offices in Croatia, strategies for changing GPs’ attitudes toward nutrition and
nutrition care are needed.

Keywords: nutrition; attitudes; general practitioners; primary health care; Croatia

1. Introduction
Poor nutrition is one of the most dominant lifestyle-related risk factors for chronic diseases [1,2]
and has also been shown to have adverse effects on acute illnesses [3]. Epidemiological data show
that seven out of the ten leading causes of death are chronic diseases that possess a critical nutrition
component, such as heart disease, cancer and diabetes [4–6].
The World Health Organization has previously recommended that medical professionals be
supported in taking an active role in promoting healthy nutritional behaviors and providing nutrition
care [7]. General practitioners (GPs) provide coordinated holistic health care to individuals and families
in their communities [8]. GPs are therefore positioned in contact with people, and patients expect
their physicians to provide them with health information [9]. They are a trusted source of advice on a
range of issues, including nutrition [1,10,11]. Furthermore, it has been shown that 70% of the general
public visit their GP at least one time each year [10]. Health workers in primary health care settings are
particularly important providers of nutrition care, because they can motivate even healthy individuals
to adopt healthier lifestyles [5]. Furthermore, the primary health care setting has been identified as
an ideal setting for implementing chronic disease management programs, including the provision of
nutrition care [1,12,13].

J. Clin. Med. 2018, 7, 60; doi:10.3390/jcm7040060 www.mdpi.com/journal/jcm

J. Clin. Med. 2018, 7, 60 2 of 8

Nutrition care refers to any practice undertaken by a health professional to improve an individual’s
food-related behavior and subsequent health outcomes [1,2,6,14–16]. Studies have shown that GPs can
be very effective in enhancing patients’ nutrition behavior through the implementation of nutrition
care [17,18]. However, the delivery of nutrition care by doctors has been reported to be quite rare [13,18].
Studies have shown that physicians attitudes towards nutrition and nutrition care are significant
predictors of physicians’ daily nutrition practice [19,20]. Thus, the aim of this study was to explore
the attitudes of Croatian GPs toward nutrition and nutrition care, and to evaluate the interconnection
between their attitudes and implementation of nutrition care in GPs’ offices.

2. Materials and Methods

2.1. Study Population and Survey

From among the doctors who work in primary health care offices in Croatia and are registered
in the register of GPs managed by the Croatian National Institute of Public Health, 800 potential
participants (30.6%) were chosen by random selection and were sent an anonymous questionnaire
via post. Along with the questionnaire, each GP, a potential participant, received an explanation of
the study, an informed consent form and two envelopes containing the address of the lead author.
They were asked to sign the consent form before answering the questionnaire and to put the signed
informed consent form in one envelope, and the answered questionnaire in the other envelope and
then send them to the lead author. Thereby, the anonymity of the study was ensured and by no
means could the personal data, specifically the name and surname, of the participants be connected to
the answers provided in the questionnaire. The answered questionnaires that arrived via post were
assigned codes, and the data provided within the questionnaires were later analyzed using that code.
The response rate was 55.5% (444/800). The study included 17.0% (444/2.612) of doctors who work in
primary health care offices in Croatia, and the study participant sample was representative for this
population of Croatian doctors. The described cross-sectional study was conducted from 1 May to
31 July 2013. The study was approved by the Ethics Committee of the Faculty of Medicine Osijek,
Croatia (Ethical Approval Code: 2158-61-07-12-35).

2.2. Questionnaire
This study was conducted through an anonymous self-administered questionnaire composed of
30 questions divided into four sections. The first section of the questionnaire (six questions) referred to
the sociodemographic characteristics of the study participants such as age, gender, education, length
of service, additional education in the field of nutritional science, and ailments from chronic diseases
where improper nutrition poses as a risk factor. The second section of the questionnaire (ten questions)
referred to the GP’s knowledge of the field of nutritional science. The third section of the questionnaire
(ten questions) involved the attitudes the GPs had toward the significance of the nutrition in the
treatment and prevention of chronic diseases and toward the nutrition care while the fourth section of
the questionnaire (four questions) referred to the nutrition counselling practice of GPs in their daily
work with patients. The questionnaire used in this study was previously validated with a smaller
group of participants in 2012. Within this paper, questions about the sociodemographic characteristics
of the study participants, questions about the GPs’ attitudes toward the significance of the nutrition in
the treatment and prevention of chronic diseases and their attitudes toward the nutrition care as well as
question regarding the implementation of nutrition care in the GPs’ everyday work with patients were
analyzed. In the analysis of a satisfactory number of positive attitudes, a cut-off value of 5 positive
attitudes was applied, because it has been shown that positive attitudes of 50% or more are sufficient
to ensure acceptable nutrition care in GPs offices.
J. Clin. Med. 2018, 7, 60 3 of 8

2.3. Statistical Analysis

Upon confirming the normality of the data distribution by the Kolmogorov-Smirnov test, all data
were processed by the methods of descriptive statistics. The numerical variables were described as
median and interquartile range. The Mann-Whitney U test was used for the comparison of numerical
variables among the groups. The categorical variables were described in absolute and relative frequencies.
The χ2 -test was used for the comparison of categorical variables between the groups. The Spearman’s
correlation coefficient (rs ) was calculated to test the correlation between the implementation of nutrition
care in GPs everyday work with patients and their attitudes toward nutrition and nutrition care. The
level of statistical significance was set at p < 0.05. Statistical analysis was done using the statistical
package Statistica for Windows 2010 (version 10.0, StatSoft Inc., Tulsa, OK, USA).

3. Results
A total of 444 participants (81.3% of females and 18.7% of males) were included in the study. The
mean age of all the participants was 50 years old, ranging from 25 to 67 years. Among all the participants,
67.3% were specialists in family medicine and 32.7% were doctors who had licenses for an independent
practice, but without a finished specialization in the field of family medicine. According to the length
of service, 65.1% of the participants had 15 or more and 34.9% had 0–14 years of service. Among the
participants, 9.5% had completed additional educational programs in the field of nutritional science and
30.6% had suffered from some chronic disease with unbalanced nutrition posing as a risk factor. Among
all participants, there were 36.0% with a satisfactory number (5 or more) of positive attitudes toward the
significance of nutrition in the treatment and prevention of chronic diseases and toward nutrition care,
and 64.0% with an unsatisfactory number (4 or less) of positive attitudes.
Table 1 shows the Croatian GPs with and without a satisfactory number of positive attitudes
toward the significance of the nutrition in the treatment and prevention of chronic diseases and toward
nutrition care according to their sociodemographic characteristics.

Table 1. The Croatian GPs with and without a satisfactory number of positive attitudes toward the
significance of nutrition in the treatment and prevention of chronic diseases and toward nutrition care
according to their sociodemographic characteristics.

Number of Participants (%)

Participant Characteristics With Satisfactory Number of Without Satisfactory Number p*
Overall
Positive Attitudes (5 or More) of Positive Attitudes (4 or Less)
Gender
Male 22 (13.7) 61 (21.5) 83 (18.7)
0.057
Female 138 (86.3) 223 (78.5) 361 (81.3)
Length of service (years)
0–14 50 (31.2) 105 (37.0) 155 (34.9)
0.254
15 or more 110 (68.8) 179 (63.0) 289 (65.1)
Age group (years)
Younger (45 or less) 52 (32.5) 114 (40.1) 166 (37.4)
0.126
Older (46 or more) 108 (67.5) 170 (59.9) 278 (62.6)
Education
Doctors with a license for
independent practice without 58 (36.3) 87 (30.6) 145 (32.7)
a finished specialization 0.247
Specialist in family medicine 102 (63.7) 197 (69.4) 299 (67.3)
Additional education about nutrition
Yes 35 (21.9) 7 (2.5) 42 (9.5)
<0.001
No 125 (78.1) 277 (97.5) 402 (90.5)
Suffering from chronic diseases
Yes 35 (21.9) 101 (35.6) 136 (30.6)
0.003
No 125 (78.1) 183 (64.4) 308 (69.4)
Overall 160 (36.0) 284 (64.0) 444 (100.0)
* χ2 -test.
J. Clin. Med. 2018, 7, 60 4 of 8

The median number of positive attitudes held by Croatian GPs toward the significance of nutrition
in the treatment and prevention of chronic diseases and toward nutrition care was 3.00 (interquartile
range 3.00–9.00). There was no statistically significant difference in the median number of positive
attitudes between males and females (p = 0.337), between GPs with 14 or less and GPs with 15 or more
years of experience (p = 0.381), between younger GPs (45 years old or less) and older GPs (46 years
old or more) (p = 0.163), or between specialists of family medicine and GPs without specialization
(p = 0.578). The study revealed that the GPs with additional education in nutrition and the GPs
who had not been suffering from a chronic disease had more positive attitudes toward nutrition and
nutrition care (p < 0.001 and p = 0.022, respectively).
Table 2 shows attitudes of the Croatian GPs toward the significance of nutrition in the
treatment and prevention of chronic diseases according to the sociodemographic characteristics of
study participants.

Table 2. Attitudes of the Croatian GPs toward the significance of nutrition in the treatment and
prevention of chronic diseases according to the sociodemographic characteristics of study participants.

Number of Positive Attitudes

Participant Characteristics p*
Median (25–75%) Min—Max
Gender
Male 3.00 (3.00–4.00) 2.00–5.00
0.075
Female 3.00 (3.00–4.00) 2.00–5.00
Length of service (years)
0–14 3.00 (3.00–5.00) 1.00–5.00
0.486
15 or more 3.00 (3.00–5.00) 1.00–5.00
Age group (years)
Younger (45 or less) 3.00 (3.00–5.00) 1.00–5.00
0.223
Older (46 or more) 3.00 (3.00–5.00) 1.00–5.00
Education
Doctors with a license for independent
3.00 (3.00–5.00) 2.00–5.00
practice without a finished specialization 0.300
Specialist in family medicine 3.00 (3.00–5.00) 1.00–5.00
Additional education about nutrition
Yes 5.00 (4.00–5.00) 2.00–5.00
<0.001
No 3.00 (3.00–5.00) 1.00–5.00
Suffering from chronic diseases
Yes 3.00 (3.00–3.75) 2.00–5.00
0.009
No 3.00 (3.00–5.00) 1.00–5.00
Overall 3.00 (3.00–5.00) 1.00–5.00
* Mann-Whitney U test.

Table 3 shows attitudes of Croatian GPs toward nutrition care according to the sociodemographic
characteristics of study participants.
The study showed that during their everyday work with patients, 95.7% of Croatian GPs provide
nutrition care, while 4.3% of them do not provide such care at all. Among those who provide nutrition
care, there were 19.5% who provide nutrition care for all patients regardless of their individual health
risks and 80.5% who provide such care only for patients considered at risk with regard to their bad
nutritional habits and/or elevated body mass index.
The Spearman rank correlation between GPs attitudes toward nutrition and nutrition care
and their practice, i.e., the implementation of nutrition care in GPs everyday work with patients,
was rs = −0.235 (p < 0.001).
J. Clin. Med. 2018, 7, 60 5 of 8

Table 3. Attitudes of Croatian GPs toward the nutrition care according to the sociodemographic
characteristics of study participants.

Number of Positive Attitudes

Participant Characteristics p*
Median (25–75%) Min–Max
Gender
Male 0.00 (0.00–4.00) 0.00–5.00
0.323
Female 0.00 (0.00–4.00) 0.00–5.00
Length of service (years)
0–14 0.00 (0.00–4.00) 0.00–5.00
0.145
15 or more 0.00 (0.00–4.00) 0.00–5.00
Age group (years)
Younger (45 or less) 0.00 (0.00–4.00) 0.00–5.00
0.416
Older (46 or more) 1.00 (0.00–4.00) 0.00–5.00
Education
Doctors with a license for independent
0.00 (0.00–4.00) 0.00–5.00
practice without a finished specialization 0.610
Specialist in family medicine 0.00 (0.00–4.00) 0.00–5.00
Additional education about nutrition
Yes 4.00 (3.00–5.00) 0.00–5.00
<0.001
No 0.00 (0.00–4.00) 0.00–5.00
Suffering from chronic diseases
Yes 0.00 (0.00–2.75) 0.00–5.00
0.024
No 1.00 (0.00–4.00) 0.00–5.00
Overall 0.00 (0.00–4.00) 0.00–5.00
* Mann-Whitney U test.

4. Discussion
In this paper, we assessed attitudes of Croatian GPs toward the significance of nutrition in the
treatment and prevention of chronic diseases and toward nutrition care and the implementation of
nutrition care in their everyday work with patients. The study showed that only 36.0% of Croatian
GPs had a satisfactory number of positive attitudes (5 or more) toward investigated variables, pointing
to the rather unsatisfactory situation regarding the researched issues within the study population.
The determined proportion of Croatian GPs with a satisfactory number of positive attitudes was much
lower than the proportions of GPs determined in similar studies conducted in New Zealand, Taiwan,
the USA, and the UK, where the percentage of positive attitudes toward nutritional statements were
above 90%, above 95%, 82%, and 99%, respectively [2,9,21,22].
The present study showed that there was no statistically significant difference in the proportion
of Croatian GPs with and without a satisfactory number of positive attitudes toward the significance
of the nutrition in the treatment and prevention of chronic diseases and toward the nutrition care
between males and females, between GPs with 14 or less and GPs with 15 or more years of experience,
between younger GPs (45 years old or less) and older GPs (46 years old or more), or between specialists
of family medicine and GPs without specialization. Some of these results are different when compared
to the results of similar studies conducted elsewhere. For example, studies conducted in Taiwan, USA
and Canada found that the investigated attitudes varied with age, with younger GPs tending to have
more positive attitudes [9,21,23]. However, some of the results are similar to the results of other studies.
As in this study, a study conducted in New Zealand did not find a difference in the proportion of
positive attitudes between doctors with a specialization in family medicine and doctors without the
specialization [2].
The present study revealed that additional education in nutrition and personal ailment from
chronic diseases significantly influences the GPs’ attitudes toward the significance of nutrition in the
treatment and prevention of chronic diseases and toward nutrition care. The connection between
additional education in nutrition and physicians’ attitudes was also detected in study conducted
among GPs in the USA [21]. The latter connection has been further confirmed in recent studies that
J. Clin. Med. 2018, 7, 60 6 of 8

proved that additional training in nutrition can facilitate positive changes in physicians’ attitudes
toward nutrition care [24–26]. Regarding the personal ailment from chronic diseases and attitudes
toward the significance of nutrition in the treatment and prevention of chronic diseases and toward
nutrition care, it seems that Croatian GPs who have already suffered from chronic diseases with
improper nutrition posing as a risk factor, despite their illness, still do not recognize the significance
of nutritional factors in their etiology. The latter is quite disturbing since GPs having less favorable
personal attitudes toward nutrition is bad model for their patients, who perceive GPs as a trusted
source of advice on a range of issues, including nutrition [10]. It is well known that those physicians
who modified their own nutrition were more likely to apply nutrition care in their practice. This fact
can probably explain why those Croatian GPs who had not suffered from chronic diseases with
improper nutrition posing as a risk factor had more positive attitudes toward the significance of
nutrition in the treatment and prevention of chronic diseases and toward nutrition care [21].
The study showed that during their daily everyday work with patients, 95.7% of Croatian GPs
provided nutrition care, but they predominantly practice a therapeutic approach, since of these, 80.5%
provided such care only for patients considered at risk with regard to their bad nutritional habits
and/or elevated body mass index, and only 19.5% provided nutrition care for all patients regardless of
their individual health risks. This situation is similar to the situation discovered in the study conducted
among GPs in Saudi Arabia, where physicians also seemed to identify nutritional problems as part of
chronic disease care more often than for screening purposes, which suggests a therapeutic rather than
preventive approach toward such problems [27].
Considering the interconnection between Croatian GPs’ attitudes toward nutrition and nutrition
care and the implementation of nutrition care in their offices, this study revealed that despite
the very modest percentage of GPs with positive attitudes toward nutrition and nutrition care of
only 36%, over 95% of Croatian GPs provide nutrition care to their patients in everyday practice.
Studies conducted in Australia, Saudi Arabia, and the USA have also pointed to the noticeable gap that
exists between physicians’ attitudes and their current practice with regard to nutrition and nutrition
care, but in these studies, patients did not receive nutrition care despite the largely positive attitudes of
their GPs [8,27,28]. Considering that, the situation in Croatia can be viewed as not so critical, because
the most important thing is that patients eventually get nutrition care, although room for improvement
certainly exists, especially in the reorientation of such care toward primary prevention, as already
mentioned [13]. Contrary to the aforementioned studies, studies in Taiwan and Canada have shown
that physicians attitudes were strongly associated with providing nutrition care [9,23].
The findings of this study significantly increase our understanding regarding the Croatian GPs’
attitudes toward nutrition and nutrition care. Our evaluation is based on the nationally representative
sample of Croatian GPs, with a high representation of different age cohorts of GPs. As previously
emphasized, 17.0% of doctors who work in primary health care offices in Croatia had been questioned
for this study, so their answers can be considered representative.
However, our study is not without limitations. Its cross-sectional design makes it difficult to
establish causality. Nonetheless, it gives a clear snapshot of the attitudes and practice of Croatian GPs
with regard to nutrition and nutrition care. As with all self-administered studies, the present study was
subject to volunteer bias, although the effects of this are minimized by the response rate of nearly 60%.
Furthermore, self-reported data do not always reflect daily clinical practice, and attitudes are often
influenced by the daily workload in practice and physicians’ actual mood. Results might also have
been subject to a social desirability response bias, whereby respondents give socially desirable and
acceptable responses rather than reporting their actual attitudes or practice. Despite latter observation,
it is widely accepted that self-report measures of nutrition-related competences could be used as a
proxy for actual measures of competence. In addition, it was established that findings of self-reports
are usually as valid as more elaborate and expensive tests [11].
Future studies should explore factors contributing to the current status of GPs’ attitudes
toward nutrition care in Croatia, especially those connected with the general situation within the
J. Clin. Med. 2018, 7, 60 7 of 8

Croatian health system. Also, future studies should consider the attitudes of future doctors and its
interconnection with the place that nutrition, nutrition care and public health in general have within
the curricula of medical faculties in Croatia.
In conclusion, one can say that there is a rather modest percentage of Croatian GPs with positive
attitudes toward nutrition and nutrition care and no interconnection between GPs’ attitudes and
implementation of nutrition care in their offices. In order to increase the proportion of Croatian
GPs with positive attitudes, and also to empower the Croatian GPs in their nutrition care practices,
it is necessary to design and implement health policy measures that are predominantly oriented
toward prevention.

Author Contributions: A.D. made substantial contributions to the conception and design of the manuscript,
she participated in the acquisition of the data and in the analysis and interpretation of data; she revised the article
critically for important intellectual content, and she gave final approval of the version of the manuscript to be
published. I.M. made substantial contributions to the conception and design of the manuscript, he participated in
the acquisition of the data and in the analysis and interpretation of data; he drafted the article, and he gave final
approval of the version of the manuscript to be published. N.P. made substantial contributions to the conception
and design of the manuscript and participated in the analysis and interpretation of data; she revised the article
critically for important intellectual content, and she gave final approval of the version of the manuscript to be
published. D.C.K. made substantial contributions to the conception and design of the manuscript and participated
in the analysis and interpretation of data; she revised the article critically for important intellectual content, and she
gave final approval of the version of the manuscript to be published. Z.O. made substantial contributions to the
conception and design of the manuscript and participated in the analysis and interpretation of data; he revised the
article critically for important intellectual content, and he gave final approval of the version of the manuscript to be
published. M.M. made substantial contributions to the conception and design of the manuscript, she participated
in the acquisition of the data and in the analysis and interpretation of data; she drafted the article and she gave
final approval of the version of the manuscript to be published.
Conflicts of Interest: The authors declare no conflict of interest.

References
1. Martin, L.; Leveritt, M.D.; Desbrow, B.; Ball, L.E. The self-perceived knowledge, skills and attitudes of
Australian practice nurses in providing nutrition care to patients with chronic disease. Fam. Pract. 2014, 31,
201–208. [CrossRef] [PubMed]
2. Crowley, J.; Ball, L.; Han, D.Y.; McGill, A.T.; Arroll, B.; Leveritt, M.; Wall, C. Doctors’ attitudes and confidence
towards providing nutrition care in practice: Comparison of New Zealand medical students, general practice
registrars and general practitioners. J. Prim. Health Care 2015, 7, 244–250. [PubMed]
3. Kris-Etherton, P.M.; Akabas, S.R.; Douglas, P.; Kohlmeier, M.; Laur, C.; Lenders, C.M.; Levy, M.D.; Nowson, C.;
Ray, S.; Pratt, C.A.; et al. Nutrition competencies in health professionals’ education and training: A new
paradigm. Adv. Nutr. 2015, 6, 83–87. [CrossRef] [PubMed]
4. Hicks, K.; Murano, P. Physician Perspectives on Nutrition Counseling and Nutrition Focused Continuing
Medical Education in Texas. Soc. Med. 2016, 10, 99–105.
5. Mogre, V.; Scherpbier, A.J.J.A.; Stevens, F.; Aryee, P.; Cherry, M.G.; Dornan, T. Realist synthesis of educational
interventions to improve nutrition care competencies and delivery by doctors and other healthcare
professionals. BMJ Open 2016, 6, e010084. [CrossRef] [PubMed]
6. Ball, L.; Barnes, K.; Laur, C.; Crowley, J.; Ray, S. Setting priorities for research in medical nutrition education:
An international approach. BMJ Open 2016, 6, e013241. [CrossRef] [PubMed]
7. World Health Organization. WHO Technical Report Series: Diet, Nutrition, and the Prevention of Chronic Diseases;
World Health Organization: Geneva, Switzerland, 2003; ISBN 92 4 120916 X.
8. Nowson, C.A.; O’Connell, S.L. Nutrition Knowledge, Attitudes, and Confidence of Australian General
Practice Registrars. J. Biomed. Educ. 2015, 2015, 219198. [CrossRef]
9. Hu, S.P.; Wu, M.Y.; Liu, J.F. Nutrition knowledge, attitude and practice among primary care physicians in
Taiwan. J. Am. Coll. Nutr. 1997, 16, 439–442. [CrossRef] [PubMed]
10. Hopper, D.; Barker, M.E. Dietary advice, nutritional knowledge and attitudes towards nutrition in primary
health care. J. Hum. Nutr. Diet. 1995, 8, 279–286. [CrossRef]
J. Clin. Med. 2018, 7, 60 8 of 8

11. Mogre, V.; Aryee, P.A.; Stevens, F.C.J.; Scherpbier, A.J.J.A. Future Doctors’ Nutrition-Related Knowledge,
Attitudes and Self-Efficacy Regarding Nutrition Care in the General Practice Setting: A Cross-Sectional
Survey. Med. Sci. Educ. 2017, 27, 481–488. [CrossRef]
12. Fogelman, Y.; Vinker, S.; Lachter, J.; Biderman, A.; Itzhak, B.; Kitai, E. Managing obesity: A survey of attitudes
and practices among Israeli primary care physicians. Int. J. Obes. Relat. Metab. Disord. 2002, 26, 1393–1397.
[CrossRef] [PubMed]
13. Dumic, A.; Miskulin, I.; Matic Licanin, M.; Mujkic, A.; Cacic Kenjeric, D.; Miskulin, M. Nutrition Counselling
Practices among General Practitioners in Croatia. Int. J. Environ. Res. Public Health 2017, 14, 1499. [CrossRef]
[PubMed]
14. Ball, L.E.; Hughes, R.M.; Leveritt, M.D. Nutrition in general practice: Role and workforce preparation
expectations of medical educators. Aust. J. Prim. Health 2010, 16, 304–310. [CrossRef] [PubMed]
15. Ball, L.; Hughes, R.; Desbrow, B.; Leveritt, M. Patients’ perceptions of nutrition care provided by general
practitioners: Focus on Type 2 diabetes. Fam. Pract. 2012, 29, 719–725. [CrossRef] [PubMed]
16. Ball, L.; Leveritt, M.; Cass, S.; Chaboyer, W. Effect of nutrition care provided by primary health professionals
on adults’ dietary behaviours: A systematic review. Fam. Pract. 2015, 32, 605–617. [CrossRef] [PubMed]
17. Ball, L.; Johnson, C.; Desbrow, B.; Leveritt, M. General practitioners can offer effective nutrition care to
patients with lifestyle-related chronic disease. J. Prim. Health Care 2013, 5, 59–69. [PubMed]
18. Mogre, V.; Stevens, F.; Aryee, P.A.; Scherpbier, A.J.J.A. Nutrition in Medicine: Medical Students’ Satisfaction,
Perceived Relevance and Preparedness for Practice. Health Prof. Educ. 2017, 27, 481–488. [CrossRef]
19. Rurik, I.; Torzsa, P.; Ilyés, I.; Szigethy, E.; Halmy, E.; Iski, G.; Kolozsvári, L.R.; Mester, L.; Móczár, C.; Rinfel, J.;
et al. Primary care obesity management in Hungary: Evaluation of the knowledge, practice and attitudes of
family physicians. BMC Fam. Pract. 2013, 14, 156. [CrossRef] [PubMed]
20. Smith, S.; Seeholzer, E.L.; Gullett, H.; Jackson, B.; Antognoli, E.; Krejci, S.A.; Flocke, S.A. Primary Care
Residents’ Knowledge, Attitudes, Self-Efficacy, and Perceived Professional Norms Regarding Obesity,
Nutrition, and Physical Activity Counseling. J. Grad. Med. Educ. 2015, 7, 388–394. [CrossRef] [PubMed]
21. Levine, B.S.; Wigren, M.M.; Chapman, D.S.; Kerner, J.F.; Bergman, R.L.; Rivlin, R.S. A national survey of
attitudes and practices of primary-care physicians relating to nutrition: Strategies for enhancing the use of
clinical nutrition in medical practice. Am. J. Clin. Nutr. 1993, 57, 115–119. [CrossRef] [PubMed]
22. Moore, H.; Adamson, A.J. Nutrition interventions by primary care staff: A survey of involvement, knowledge
and attitude. Public Health Nutr. 2002, 5, 531–536. [CrossRef] [PubMed]
23. Wynn, K.; Trudeau, J.D.; Taunton, K.; Gowans, M.; Scott, I. Nutrition in primary care: Current practices,
attitudes, and barriers. Can. Fam. Phys. 2010, 56, e109–e116.
24. Lindorff-Larsen, K.; Højgaard Rasmussen, H.; Kondrup, J.; Staun, M.; Ladefoged, K.; Scandinavian Nutrition
Group. Management and perception of hospital undernutrition-a positive change among Danish doctors
and nurses. Clin. Nutr. 2007, 26, 371–378. [CrossRef] [PubMed]
25. Bjerrum, M.; Tewes, M.; Pedersen, P. Nurses’ self-reported knowledge about and attitude to nutrition—Before
and after a training programme. Scand. J. Caring Sci. 2012, 26, 81–89. [CrossRef] [PubMed]
26. Sunguya, B.F.; Poudel, K.C.; Mlunde, L.B.; Urassa, D.P.; Yasuoka, J.; Jimba, M. Nutrition training improves
health workers’ nutrition knowledge and competence to manage child undernutrition: A systematic review.
Front. Public Health 2013, 1, 37. [CrossRef] [PubMed]
27. Alshammari Al-Shammari, Y.f.Y.F. Attitudes and practices of primary care physicians in the management of
overweight and obesity in Eastern Saudi Arabia. Int. J. Health. Sci. 2014, 8, 151–158. [CrossRef]
28. Vetter, M.L.; Herring, S.J.; Sood, M.; Shah, N.R.; Kalet, A.L. What do resident physicians know about
nutrition? An evaluation of attitudes, self-perceived proficiency and knowledge. J. Am. Coll. Nutr. 2008, 27,
287–298. [CrossRef] [PubMed]

© 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access
article distributed under the terms and conditions of the Creative Commons Attribution
(CC BY) license (http://creativecommons.org/licenses/by/4.0/).