Dietary advice for reducing cardiovascular risk
ABSTRACT Changes in population diet are likely to reduce cardiovascular disease and cancer, but the effect of dietary advice is uncertain.
To assess the effects of providing dietary advice to achieve sustained dietary changes or improved cardiovascular risk profile among healthy adults.
We searched the Cochrane Central Register of Controlled Trials, DARE and HTA databases on The Cochrane Library (Issue 4 2006), MEDLINE (1966 to December 2000, 2004 to November 2006) and EMBASE (1985 to December 2000, 2005 to November 2006). Additional searches were done on CAB Health (1972 to December 1999), CVRCT registry (2000), CCT (2000) and SIGLE (1980 to 2000). Dissertation abstracts and reference lists of articles were checked and researchers were contacted.
Randomised studies with no more than 20% loss to follow-up, lasting at least 3 months involving healthy adults comparing dietary advice with no advice or minimal advice. Trials involving children, trials to reduce weight or those involving supplementation were excluded.
Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information.
Thirty-eight trials with 46 intervention arms (comparisons) comparing dietary advice with no advice were included in the review. 17,871 participants/clusters were randomised. Twenty-six of the 38 included trials were conducted in the USA. Dietary advice reduced total serum cholesterol by 0.16 mmol/L (95% CI 0.06 to 0.25) and LDL cholesterol by 0.18 mmol/L (95% CI 0.1 to 0.27) after 3-24 months. Mean HDL cholesterol levels and triglyceride levels were unchanged. Dietary advice reduced blood pressure by 2.07 mmHg systolic (95% CI 0.95 to 3.19) and 1.15 mmHg diastolic (95% CI 0.48 to 1.85) and 24-hour urinary sodium excretion by 44.2 mmol (95% CI 33.6 to 54.7) after 3-36 months. Three trials reported plasma antioxidants where small increases were seen in lutein and beta-cryptoxanthin, but there was heterogeneity in the trial effects. Self-reported dietary intake may be subject to reporting bias, and there was significant heterogeneity in all the following analyses. Compared to no advice, dietary advice increased fruit and vegetable intake by 1.25 servings/day (95% CI 0.7 to 1.81). Dietary fibre intake increased with advice by 5.99 g/day (95% CI 1.12 to 10.86), while total dietary fat as a percentage of total energy intake fell by 4.49 % (95% CI 2.31 to 6.66) with dietary advice and saturated fat intake fell by 2.36 % (95% CI 1.32 to 3.39).
Dietary advice appears to be effective in bringing about modest beneficial changes in diet and cardiovascular risk factors over approximately 10 months but longer term effects are not known.
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ABSTRACT: Primary care clinicians have considerable potential to provide preventive care. This study describes their preventive care delivery. A survey of 384 community health nurses and allied health clinicians from in New South Wales, Australia was undertaken (2010-11) to examine the assessment of client risk, provision of brief advice and referral/follow-up regarding smoking inadequate fruit and vegetable consumption, alcohol misuse, and physical inactivity; the existence of preventive care support strategies; and the association between supports and preventive care provision. Preventive care to 80% or more clients was least often provided for referral/follow-up (24.7-45.6% of clinicians for individual risks, and 24.2% for all risks) and most often for assessment (34.4-69.3% of clinicians for individual risks, and 24.4% for all risks). Approximately 75% reported having 9 or fewer of 17 supports. Provision of care was associated with: availability of a paper screening tool; training; GP referral letter; and number of supports. The delivery of preventive care was limited, and varied according to type of care and risk. Supports were variably associated with elements of preventive care. Further research is required to increase routine preventive care delivery and the availability of supports.Patient Education and Counseling 11/2013; DOI:10.1016/j.pec.2013.10.017 · 2.60 Impact Factor
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ABSTRACT: A comprehensive nutritional assessment was conducted on Celebrity Chefs recipes, with comparison against national healthy eating guidelines. Food preparation recipes (n=904), covering a wide range of meal types, from 26 dominant British based Celebrity Chefs were randomly sampled from literature and web sources. Recipes were blindly analysed through dietary analysis software by three trained dietetic researchers (CV 6.9%). The nutritional value of each recipe was compared against national healthy eating benchmark guidelines using a healthy eating index (HEI). Overall average energy, protein, total carbohydrate and total fat per suggested portion was 2.3MJ, 25g, 44g and 31g, respectively; with differences observed between Celebrity Chefs (P<0.001). The overall average recipe composition of n=22 Celebrity Chefs presented high fat, n=24 high SFA, n=17 high sugars and n=7 high salt content. Negative HEI was observed in 87% of recipes. Male and British originated Celebrity Chefs presented higher nutritional variables than Female (P<0.001) and International originated (P<0.001) Celebrity Chefs, respectively. The nutritional values of British based Celebrity Chefs recipes, in adjunct with their likely influence on food preparation habits of the public, suggest Celebrity Chefs are a likely hidden contributing factor to Britain’s obesity epidemic and its associated public health issues.
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ABSTRACT: Aim This qualitative study explored the professional and practice-based factors affecting the role legitimacy and adequacy of practice nurses in managing obese patients. BACKGROUND: There are strong clinical, financial and practical reasons for tackling obesity in UK general practice. Although practice nurses may seem to be in an ideal position to manage obesity, there remain questions about their role adequacy (sense of self-efficacy in responding to patients' problems) and role legitimacy (their perceived boundaries of professional responsibility and right to intervene). METHODS: Semi-structured face-to-face interviews were conducted with 22 practice nurses in Lambeth, Southwark and Lewisham in South London. Interviews were digitally recorded and transcribed. Key themes were identified following coding of the data. Findings Factors that positively affected nurses' role adequacy and legitimacy were: their belief that obesity management was part of their chronic disease management and health promotion remit; their confidence in their own communication skills and ability to build rapport with patients; having attended training and being supported to take extra time for obesity management. Factors negatively affecting their role legitimacy and adequacy were: their low awareness and use of guidance; lack of knowledge of referral options; limited knowledge and use of non-medical and non-persuasive approaches; perceived lack of expertise in motivating patients, as well as in nutrition, child obesity and assessment; belief that there were some contexts in which it was more appropriate to raise the issue than others; lack of culturally appropriate materials and language barriers; belief that they had limited impact on outcome and that the patient is responsible for lack of success. Other factors negatively affecting their role adequacy and legitimacy included their ambivalence about the effectiveness of the interventions offered; perceived lack of priority for obesity management within practices; lack of time; workload and lack of clarity on protocols and roles within the practice.Primary Health Care Research & Development 04/2012; 13(4):353-63. DOI:10.1017/S1463423612000059