lifestyle risk factors modification

Smoking cessation

• Ask all people if they smoke and record in their clinical record.
• Use the Ask, Advise, Help (AAH) or RACGP 5As (ask, assess, advise, assist, arrange) models to support people who smoke to quit.
• For people who smoke, offer a referral to a multi-session behavioural intervention (e.g. Quitline referral) and TGA-approved pharmacotherapy if clinically appropriate. See resources.
• Quitting can be difficult and long-term cessation may require repeated attempts. Support people who smoke (including after relapse) with advice and help to access the evidence-based strategies described above.
• Encourage people who use e-cigarettes (whether the product contains nicotine or not) to quit.150
• Reassure people who are anxious about gaining weight after quitting smoking, that the health benefits associated with smoking cessation are likely to far exceed the health risks of being overweight or obese. Consider referral to a relevant allied health professional (e.g. referral to an Accredited Practising Dietitian and/or an exercise physiologist).
• People with a mental health condition may need special support to quit smoking. See the RACGP smoking cessation guidelines152 for more information on how to support people with a mental health condition.

Nutrition

• Nutrition advice should be individualised and take a person-centred approach.
• It is important to contextualise nutrition advice within:
  • the cultural relevance of any recommended healthy eating pattern
  • the person’s primary language
  • financial resources and capacity within families to purchase, store and follow recommended food preparation techniques
  • food security and the availability, accessibility and affordability of healthy food, especially in remote settings
• Advise people to follow a healthy eating patterns:
  • Five serves of vegetables and two serves of fruit daily
• • Dietary salt reduction
    • The World Health Organization (WHO) recommends an intake of less than 5g salt/day (approximately 2000 mg of sodium)
    • The present Australian average intake is in the order of 10g/day.
    • Salt intake can be reduced by:
      • avoiding adding salt to food while cooking (e.g. using herbs and spices to flavour food instead)
      • avoiding highly processed and discretionary (junk) foods as these often have a high salt content
      • where available, buy products labelled as ‘no added salt’ or ‘reduced salt’ (e.g. canned vegetables or fish).
      • Reducing salt intake to recommended levels has no known harms.
  • DASH diet
    • The Dietary Approaches to Stop Hypertension (DASH) diet emphasises fruit, vegetables, fat-free or low-fat dairy products, wholegrains, nuts and legumes, and limits total and saturated fat, cholesterol, red and processed meats, confectionary, added sugars, and sugar-sweetened drinks
    • Whilst DASH diets have been shown to lower BP, the direct effects of DASH diets on cardiovascular events or mortality are unknown due to a lack of clinical trials measuring these outcomes.
  • Mediterranean diet
    • Mediterranean diets are based on a high ratio of monounsaturated to saturated fats (e.g. using olive oil as main cooking ingredient, or high consumption of other foods high in monounsaturated fats)
    • Some Mediterranean diets also include:
      • high intake of fruits, vegetables and legumes, wholegrains, cereals and fish
      • moderate intake of milk and dairy products
      • low intake of meat and meat products
      • Whilst consuming wine is often associated with the Mediterranean diet, alcohol intake should be avoided or limited to minimise the health risks associated with consuming alcohol (see Alcohol reduction).
      • This eating pattern is not associated with any known harms.
  • Fish and fish oil
    • Current dietary guidelines recommend 2–3 serves per week of oily fish that is high in long-chain omega-3 fatty acids (omega-3), with one serve equal to 100 grams of cooked fish.
    • This provides around 250–500mg of marine-sourced omega-3 (eicosapentaenoic [EPA] and docosahexaenoic acid [DHA]) per day
    • A variety of fish oil supplements derived from oily fish containing EPA and/or DHA are available without prescription in varying formulations and doses.
    • Overall, the certainty of the evidence that taking fish oil supplements has any substantial effect on cardiovascular mortality or risk is low.
    • While there is some evidence that increasing intake of omega-3 fatty acids may reduce CHD events and mortality, the effect is small, and number needed to treat for additional beneficial outcome is high.
    • While taking fish oil supplements containing EPA and/or DHA may modestly reduce the risk of CVD, it is unclear what the optimal formulation or dose is, or whether higher doses are more effective.
    • While increasing omega‐3 fatty acid intake may benefit people with hypertriglyceridaemia, it does not reduce LDL cholesterol
    • Fish oil supplements are generally well tolerated but some people experience minor adverse effects such as heartburn, gastrointestinal upset, or bad breath, especially at high doses. High-dose fish oil supplementation has also been associated with rash and atrial fibrillation, so may not be suitable for some people

weight control

• Waist circumference
  • <94 cm males
  • <90 cm Asian males
  • <80 cm females
• BMI <25

smoking

• Cessation of smoking

alcohol

• no more than 2 standard drinks on any day and no more than 4 on any one occasion.

exercise

• Accumulate
  • 150–300 minutes of moderate intensity activity or
  • 75–150 minutes of vigorous activity each week.
• Muscle strengthening activities on at least 2 days each week.