Dietary advice for reducing cardiovascular risk
Abstract
Background
Changes in population diet are likely to reduce cardiovascular disease and cancer, but the effect of dietary advice is uncertain.
Objectives
To assess the effects of providing dietary advice to achieve sustained dietary changes or improved cardiovascular risk profile among healthy adults.
Search methods
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.
Selection criteria
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.
Data collection and analysis
Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information.
Main results
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 β‐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).
Authors' conclusions
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.
PICOs
Plain language summary
Dietary advice for reducing cardiovascular risk
Diet is an important determinant of chronic disease risk, particularly heart disease. This review assessed the effects of providing dietary advice to healthy adults in order to produce sustained improvements in their diets. Whether dietary improvement would reduce the risk factors associated with heart disease was also examined. We found 38 trials in which healthy adults were randomly assigned to receive dietary advice or no dietary advice. The dietary improvements recommended to the people in the intervention groups centred largely on the reduction of salt and fat intake and an increase in the intake of fruit, vegetables, and fibre. Advice was delivered in a variety of ways, including one‐to‐one contact, group sessions, and written materials. There were variations in intensity of intervention, ranging from one contact per study participant to 50 hours of counselling over 4 years. The duration of the trials ranged from 3 months to 4 years, with a median follow‐up period of 10 months. There was some evidence of greater effectiveness in people told that they were at risk of heart disease or cancer. Modest improvements were shown in cardiovascular risk factors, such as blood pressure and total and LDL‐cholesterol levels. In the trials that separated effects by gender, women tended to make larger reductions in fat intake, but there was insufficient evidence to show whether this translated to a larger reduction in total cholesterol levels. The trials did not last long enough to answer the question of whether the beneficial changes in cardiovascular risk factors resulted in a reduced incidence of heart disease, stroke, or heart attack.
