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Is it worth giving dietary advice to healthy people to cut risk factors?

A summary of a new Cochrane review that could apply to your next consultation

A summary of a new Cochrane review that could apply to your next consultation

There is uncertainty about whether dietary advice given to healthy individuals effects change. This review looked at the impact of dietary advice given to healthy adults and aimed to identify the factors influencing the effectiveness of that advice.

Method

We searched the Cochrane Controlled Trials Register, dissertation abstracts, and reference lists of articles. We also contacted researchers in the field. Only randomised trials lasting at least three months, involving healthy adults, and comparing dietary advice with no advice or less intensive advice were included.

Trials involving children, trials to reduce weight or those involving supplementation were excluded. As a result we included 23 trials in the review, lasting from three months to four years and with a median follow-up period of nine months.

Main results

Compared with no advice, dietary advice increased fruit and vegetable intake (by 1.24 servings/day) and increased dietary fibre intake (by 7.22 g/day). Total dietary fat as a percentage of total energy intake fell (by 6.18 per cent) with dietary advice and saturated fat intake fell by 3.28 per cent (95 per cent CI 1.92 to 4.64).

Modest improvements were shown in cardiovascular risk factors, including blood pressure (reduced by 2.10 mmHg systolic (95 per cent CI 1.37 to 2.83) and 1.63 mmHg diastolic (95 per cent CI 0.56 to 2.71)), total serum cholesterol (down by 0.13 mmol/l (95 per cent CI 0.03 to 0.23)) and LDL-cholesterol levels (reduced by 0.13 mmol/l (95 per cent CI 0.01 to 0.25)) after three to 12 months. Mean HDL cholesterol levels were unchanged.

Authors' conclusions

Giving dietary advice via brief interventions appears to be effective in bringing about modest beneficial changes in diet and cardiovascular risk factors over approximately nine months but longer-term effects are not known. 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. There appears to be little if any gain in effectiveness by locating health promotion in primary care in contrast to work places and other non-healthcare settings. Brief dietary interventions aimed at the whole population are likely to produce health gain.

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