Dietary advice for reducing cardiovascular risk

University College London Medical School, Department of Epidemiology and Public Health, 1-19 Torrington Place, London, UK, WC1E 6BT.
Cochrane database of systematic reviews (Online) (Impact Factor: 5.94). 02/2007; DOI: 10.1002/14651858.CD002128.pub3
Source: PubMed

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.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To identify critical periods in the variation in body composition during a school year and determine possible causes. Methods: A total of 363 boys and girls aged between 10 and 14 years participated in the study. Before and after the Winter Holidays (WIH) and National Holidays (NAH) (July and September, respectively), measurements were taken of body weight, body fat percentage, waist pe- rimeter, time spent on physical activity and hours of sleep in order to determine the variations. The normality of the data was confirmed and the means were compared with an alpha significance level of p<0.05. Results: The school children increased in weight by 600 g and 510 g in the NAH and WIH, respectively (p<0.0001), and their body fat percentage was signifi- cantly increased during both periods (0.51%); however, the waist perimeter measurement saw no significant changes. It can also be seen that in NAH physical activity dropped by an important amount (-41 min, p<0.0001), though this did not occur in WIH. A significant increase in hours of sleep was also seen during the two holiday periods (~1 to 2 hours/day). Conclusion: It is concluded that both NAH and WIH can be considered critical periods due to the sharp in- crease in body weight and body fat percentage in the school children, where a possible cause is the reduction in time spent on physical activity.
    Nutricion hospitalaria: organo oficial de la Sociedad Espanola de Nutricion Parenteral y Enteral 01/2014; 30(4):782-786. · 1.25 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Die Beratung hinsichtlich modifizierbarer Risikofaktoren für den Schlaganfall sollte fester Bestandteil einer ärztlichen Sprechstunde sein. Insbesondere ist zu erläutern, dass Änderungen des Lebensstils höchst effizient in Bezug auf das individuelle Risikoprofil sein können. Die folgende Übersicht beschreibt die Bedeutung der ,,Lifestyle“-Faktoren wie Ernährung, Rauchen, Alkoholkonsum, psychische Befindlichkeit, Sport, Zahnhygiene und Schlafstörungen für das Schlaganfallrisiko anhand der aktuellen Datenlage. Sie soll zeigen, dass Änderungen der Lebensgewohnheiten im Rahmen einer Primärprävention höchst wirksam sein können. Entsprechende Empfehlungen und Präventionsstrategien werden formuliert.
    Der Nervenarzt 01/2008; 79(10). DOI:10.1007/s00115-008-2528-9 · 0.86 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the effectiveness of multifactorial interventions carried out in the community setting to decrease cardiovascular risk in healthy patients. Systematic review of the MEDLINE (via PubMed), Web of Science and Cochrane Library databases from January 1980 to January 2014. Identified for inclusion were systematic reviews of clinical trials that included multifactorial interventions carried out in primary care or community settings, targeting more than one cardiovascular risk factor, and implementing more than one type of intervention. The methodological quality of the included articles was evaluated using the AMSTAR tool. Eight systematic reviews were selected, including 219 studies. All of these reviews provided information about the effectiveness of multifactorial interventions in reducing mortality and morbidity due to cardiovascular diseases. Four reviews reported moderate effectiveness and four showed limited effectiveness. Multifactorial community interventions improve cardiovascular risk factors and have a small but potentially important effect on mortality. These interventions seem to be more effective in the at-risk population and when they are carried out at a high level of intensity. Copyright © 2014. Published by Elsevier Inc.
    Preventive Medicine 12/2014; DOI:10.1016/j.ypmed.2014.11.028 · 2.93 Impact Factor