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: 6.03). 02/2007; 4(4):CD002128. DOI: 10.1002/14651858.CD002128.pub3
Source: PubMed


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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    • "In a previous analysis of studies recruiting mainly younger adults, Brunner et al.[56] reported that, compared with no advice, offering any type of dietary advice increased self-reported F&V intake by 1.25 servings/day (95% CI 0.7 to 1.81). As in our study, Brunner et al.[56] found greater increases in intakes of fruits than of vegetables. Out of 10 studies examining effects on F&V consumption, Pignone et al.[57] found that 30% of studies reported small to no increases (<0.3 servings/day), 50% observed medium increases (from 0.3 to 0.8 serving/day) and 20% reported large increases (1.4 and 3.2 servings/day). "
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    ABSTRACT: Retirement from work involves significant lifestyle changes and may represent an opportunity to promote healthier eating patterns in later life. However, the effectiveness of dietary interventions during this period has not been evaluated. We undertook a systematic review of dietary interventions among adults of retirement transition age (54 to 70 years). Twelve electronic databases were searched for randomized controlled trials evaluating the promotion of a healthy dietary pattern, or its constituent food groups, with three or more months of follow-up and reporting intake of specific food groups. Random-effects models were used to determine the pooled effect sizes. Subgroup analysis and meta-regression were used to assess sources of heterogeneity. Out of 9,048 publications identified, 67 publications reporting 24 studies fulfilled inclusion criteria. Twenty-two studies, characterized by predominantly overweight and obese participants, were included in the meta-analysis. Overall, interventions increased fruit and vegetable (F&V) intake by 87.8 g/day (P <0.00001), with similar results in the short-to-medium (that is, 4 to 12 months; 85.6 g/day) and long-term (that is, 12 to 58 months; 87.0 g/day) and for body mass index (BMI) category. Interventions produced slightly higher intakes of fruit (mean 53.7 g/day) than of vegetables (mean 41.6 g/day), and significant increases in fish (7 g/day, P = 0.03) and decreases in meat intake (9 g/day, P <0.00001). Increases in F&V intakes were positively associated with the number of participant intervention contacts. Dietary interventions delivered during the retirement transition are therefore effective, sustainable in the longer term and likely to be of public health significance.
    Full-text · Article · Apr 2014 · BMC Medicine
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    • "Although changes in nutritional habits [40,41], physical activity and endurance exercise [42,43] are all known to be among important determinants of serum lipid levels; the decreasing trends in lipid levels in our population could hardly be explained by life style changes (i.e. physical activity), since it was shown that low physical activity is common in Iranian population [44,45]. "
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    ABSTRACT: To examine trends in the population levels of serum lipids among a Middle-Eastern adult population with high prevalence of dyslipidemia. A population-based cohort of adult Iranian participants, aged >=20 years underwent four consecutive examinations between 1999-2001 and 2008-2011. Trends in age and multivariate-adjusted mean lipid levels were calculated using generalized estimating equations. At each of the 4 assessments, there were significant decreases in levels of total cholesterol (TC) (multivariate-adjusted means, 5.21 vs. 4.88 mmol/L in men; 5.42 vs. 5.07 mmol/L in women), triglycerides (TGs) (2.11 vs. 1.94 mmol/L in men; 1.88 vs. 1.74 mmol/L in women), and an increase in HDL-C level in both genders (0.95 vs. 1.058 mmol/L in men; 1.103 vs. 1.246 mmol/L in women) in multivariate analyses (all Ps <0.001); however, body mass index (BMI) significantly increased simultaneously (25.92 vs. 27.45 kg/m2 in men; 27.76 vs. 30.02 kg/m2 in women) (P < 0.001). There were significant (P < 0.001) increases in fasting plasma glucose (FPG) levels only among men (5.35 vs. 5.73 mmol/L). Results did not change after excluding participants that had cardiovascular disease or used lipid lowering drugs during follow-up. There were significant decreases in the prevalence of hypercholesterolemia, low HDL-C, hypertriglyceridemia (all Ps <0.001) during follow-up. Furthermore, the consumption of lipid lowering drugs significantly increased (P <0.001). During a 10 years follow-up, favorable trends were observed in the population levels of TC, triglycerides, HDL-C, which could not be fully accounted for by the increase observed in the consumption of lipid lowering drugs. These favorable trends were counterbalanced by the progressive increase in general obesity and FPG level.
    Full-text · Article · Jan 2014 · Lipids in Health and Disease
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    • "In such countries, the majority of adults have at least one chronic disease risk [4] [5] [6], and a substantial proportion have three or more [4] [6] [7]. Routine, opportunistic delivery of preventive care by primary health care service providers to all clients is recommended to reduce this disease burden [8] [9] [10] [11] with systematic review evidence supporting the efficacy of such care [12] [13] [14] [15] [16]. It has been recommended that such care be provided for multiple risks [8] [9] [10], and given the competing priorities and brevity of a clinical consultation, that its essential elements include: risk assessment, brief advice and referral/follow-up [10] [11] [17]. "
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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.
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