Nutrition, Medicine Merge in Chapel Hill : Health: North Carolina is first medical school to link the programs. Four of the six leading causes of death--diabetes, heart disease, cancer, obesity-- are related to eating habits, professor says.

Surely, Peter Bream thought, that short segment on diet in a biochemistry course was not all his medical school planned to teach him about nutrition.

But it was. And his school, the University of North Carolina at Chapel Hill, was not alone in neglecting the subject. In fact, a survey of medical school graduates conducted by the American Medical Assn. in 1990 showed that 65% did not believe they had adequate training in nutrition.

“It seemed strange to me that was all that was taught,” said Bream, a third-year medical student. “It never really was touched upon again.”

The University of North Carolina ended its neglect last year when it became the first to make its nutrition program part of the medical school and part of the school of public health.

“It shows that the clinical specialties realize that nutrition has a role to play in clinical medicine,” said Dr. Bruce Bistrian, professor of medicine at Harvard Medical School and an adviser for the medical nutrition curriculum.

Dr. Stuart Bondurant, dean of the University of North Carolina’s medical school, said having the department in both schools means nutrition study “goes from the individual through the public and it goes from prevention through treatment.”

The training is important because about 50% of patients who visit primary care physicians have problems related to nutrition, according to Dr. Steve Zeisel, nutrition department chairman.

Four of the six leading causes of death--diabetes, heart disease, cancer and obesity--are related to nutrition, he said. Specific examples are demonstrated links between high fat intake and breast cancer, and between insufficient fiber and colon cancer.

“Many doctors don’t ask questions about diet until the patient has a heart attack,” Zeisel said. Doctors should receive enough training in nutrition to identify patients who need advice on their diets before they have heart attacks, he said.

Pairing nutrition with medicine also may benefit research projects, Zeisel said. As doctors become more familiar with the benefits of good nutrition, they may become more active in pushing the National Institutes of Health to fund nutrition research, he said.

Focusing on nutrition also may save money, Zeisel said.

“It’s not very expensive to help people learn how to eat,” he said.

Chapel Hill’s nutrition department also will conduct a lot of its own research, Bondurant said.

This year, the department received a grant from the National Cancer Institute to find ways to increase the intake of anti-cancer fruits and vegetables among blacks in North Carolina. And the National Institutes of Health gave the department training funds for seven students who want to be nutrition scientists.

Other schools also will be able to benefit from the North Carolina program. An interactive computer course that can be used at any school will debut in a class this fall, Zeisel said. The course allows students to work with a computer-generated patient.

Bream, 26, was one of the students who tested the computer curriculum. He said the patient interaction was especially useful.

“You actually worked up a patient and went through all the steps of the interview, the lab work and diagnosis, and you worked along with a doctor in this virtual world,” he said.

The nutrition classes, which began last year for first-year students, will continue through medical school, and nutrition will be emphasized as part of a medical student’s course of study.