Randomized controlled trial: Effect of nutritional counselling in general practice

Università degli Studi di Torino, Torino, Piedmont, Italy
International Journal of Epidemiology (Impact Factor: 9.18). 05/2006; 35(2):409-15. DOI: 10.1093/ije/dyi170
Source: PubMed


To investigate the effectiveness of a non-structured 15-min educational intervention by general practitioners (GPs) on modifications of daily diet among healthy adults.
Two arms randomized trial lasting 12 months.
Italian general practitioner wards. Subjects A total of 3,186 men and women aged 18-65 years recruited in the medical ward by their GPs.
An educational intervention and a brochure on the basics of a healthy diet based on the Italian Guidelines for a Correct Nutrition, 1998. The main study goal was to attain an intake of fruits and vegetables >5 servings per day. Follow-up visit every 6 months. Main outcome measures Weight, blood pressure, and a 40-items Food Frequency Questionnaire.
The intervention group showed a slightly reduced net intake of meat and a slightly increased net intake of fruits and vegetables, fish products, and olive oil. Body mass index (BMI) changed only in the treatment arm [-0.41 95% confidence interval (95% CI) -0.11 to -0.53]. The net change at 1 year in the intervention arm was +1.31 (CI 0.90-4.39) for fruits and vegetables, and -0.22 (-0.11 to -0.69) for meat (portions per week). We also computed a 'healthy diet score' reflecting compliance with recommended dietary habits. In the intervention group, the mean score at recruitment was significantly lower than the mean score at the end of follow-up (Crude score change = 0.29; CI 0.19-0.48). No differences were observed in the control group (Crude score change = -0.04; CI -0.22-0.02). The difference in score from baseline to the final visit, comparing the intervention vs the control group, was statistically significant (P < 0.001) (MANOVA adjusted by sex, BMI, education, and time).
A brief educational intervention by GPs can induce multiple diet changes that may lower BMI and potentially reduce chronic disease risk in generally healthy adults.

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Available from: Rosalba Rosato, Mar 25, 2015
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    • "Seven of the studies were carried out in the United States (Djuric et al., 2008; Kim et al., 2010; Masley et al., 2001; Pierce et al., 2007; Sternfeld et al., 2009; Tuttle et al., 2008; Walker et al., 2009), four in the United Kingdom (Baron et al., 1990; Hardcastle et al., 2008; Logan et al., 2010; Roderick et al., 1997), and one each in Spain (Zazpe et al., 2008), The Netherlands (Bemelmans et al., 2000), and Italy (Sacerdote et al., 2006). "
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    ABSTRACT: Objective: To evaluate the effects on healthy eating or the Mediterranean diet adherence achieved by interventions suitable for implementation in primary care settings. Methods: Medline (PubMed) and The Cochrane Library bibliographic searches retrieved randomized controlled trials published in English or Spanish, January 1990-January 2013. The inclusion criteria were adult population, >3 months follow-up, and interventions suitable for primary care settings. Exclusion resulted if studies focused exclusively on weight loss or did not analyze food intake (fats, fruits and vegetables--F&V, fiber) or Mediterranean diet adherence. Validity (risk of bias) was independently evaluated by two researchers; discrepancies were reviewed until a consensus was reached. Results: Of the 15 included articles (14 studies), only 3 studies surpassed 12-months follow-up. Ten interventions emphasized healthy nutrition (n = 9948); 4 added activity levels (n = 3816). Six trials included participants with cardiovascular risk; 7 were community-based; 1 focused on women with cancer. Eleven studies showed 9.7% to 59.3% increased F&V intake with counseling interventions, compared to baseline (-13.3% to 27.8% in controls). Seven studies reported significant differences between intervention and control groups. Conclusion: Nutritional counseling moderately improves nutrition, increases intake of fiber, F&V, reduces dietary saturated fats, and increases physical activity. Studies with longer follow-up are needed to determine long-term effects, cardiovascular morbidity, and mortality.
    Preventive Medicine 12/2014; 76. DOI:10.1016/j.ypmed.2014.12.011 · 3.09 Impact Factor
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    • "Effectively understanding and addressing this subset has proven to be difficult, with clinicians often reporting obesity treatment as being " doomed to failure " [5], frustrating, and ineffective [6]. This stance is problematic , as clinicians are able to positively influence patients' health related behaviour by providing patients with some form of behavioural counselling, especially when patients actively participate [7] [8]. Patient centered care may decrease "
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    ABSTRACT: Individuals seeking healthcare treatment in the context of obesity often experience difficulty engaging in discussions around their health and face challenges finding consensus with practitioners on care plans that best suit their lives. The complex set of biological, social, and environmental variables that have contributed to the higher prevalence of obesity are well illustrated in the foresight obesity system map. Effectively understanding and addressing key variables for each individual has proven to be difficult, with clinicians facing barriers and limited resources to help address patients' unique needs. However, productive discussions inspired by patient centered care may be particularly effective in promoting behaviour change. Tools based on systems science that facilitate patient centered care and help identify behaviour change priorities have not been developed to help treat adult obesity. This project created and pilot tested a card based clinical communication tool designed to help facilitate conversations with individuals engaged in health behaviour change. The health communication cards were designed to help direct conversation between patients and healthcare providers toward issues relevant to the individual. Use of the cards to facilitate patient driven conversations in clinical care may help to streamline conversations, set realistic care plan goals, and improve long term rates of compliance.
    02/2014; 2014:579083. DOI:10.1155/2014/579083
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    • "There was evidence of appreciable heterogeneity (I2 = 88.0%, p < 0.001) (Figure  2). Vegetable consumption was increased by 0.25 (0.06 to 0.44, p = 0.01) servings per day, with less evidence of heterogeneity among studies was I2 = 58.4%, p = 0.091 (Figure  2).Three studies [30-32] reporting intervention effects on consumption of fruit and vegetable combined together showed a pooled effect of 0.50 (0.13 to 0.87, 0.008) servings per day. There was evidence of substantial heterogeneity (I2 = 90.5%; p < 0.001) (Figure  2). "
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    ABSTRACT: A diet rich in fruit, vegetables and dietary fibre and low in fat is associated with reduced risk of chronic disease. This review aimed to estimate the effectiveness of interventions to promote healthy diet for primary prevention among participants attending primary care. A systematic review of trials using individual or cluster randomisation of interventions delivered in primary care to promote dietary change over 12 months in healthy participants free from chronic disease or defined high risk states. Outcomes were change in fruit and vegetable intake, consumption of total fat and fibre and changes in serum cholesterol concentration. Ten studies were included with 12,414 participants. The design and delivery of interventions were diverse with respect to grounding in behavioural theory and intervention intensity. A meta-analysis of three studies showed an increase in fruit consumption of 0.25 (0.01 to 0.49) servings per day, with an increase in vegetable consumption of 0.25 (0.06 to 0.44) serving per day. A further three studies that reported on fruit and vegetable consumption together showed a pooled increment of 0.50 (0.13 to 0.87) servings per day. The pooled effect on consumption of dietary fibre, from four studies, was estimated to be 1.97 (0.43 to 3.52) gm fibre per day. Data from five studies showed a mean decrease in total fat intake of 5.2% of total energy (1.5 to 8.8%). Data from three studies showed a mean decrease in serum cholesterol of 0.10 (-0.19 to 0.00) mmol/L. Presently-reported interventions to promote healthy diet for primary prevention in primary care, which illustrate a diverse range of intervention methods, may yield small beneficial changes in consumption of fruit, vegetables, fibre and fat over 12 months. The present results do not exclude the possibility that more effective intervention strategies might be developed.
    BMC Public Health 12/2013; 13(1):1203. DOI:10.1186/1471-2458-13-1203 · 2.26 Impact Factor
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