Intervention Review

Dietary advice given by a dietitian versus other health professional or self-help resources to reduce blood cholesterol

  1. Rachel L Thompson1,*,
  2. Carolyn D Summerbell2,
  3. Lee Hooper3,
  4. Julian PT Higgins4,
  5. Paul Little5,
  6. Diane Talbot6,
  7. Shah Ebrahim7

Editorial Group: Cochrane Effective Practice and Organisation of Care Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 22 MAY 2003

DOI: 10.1002/14651858.CD001366

Database Title

Additional Information

How to Cite

Thompson RL, Summerbell CD, Hooper L, Higgins JPT, Little P, Talbot D, Ebrahim S. Dietary advice given by a dietitian versus other health professional or self-help resources to reduce blood cholesterol. Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: CD001366. DOI: 10.1002/14651858.CD001366.

Author Information

  1. 1

    Southampton General Hospital, The Wessex Institute for Health R & D, Southampton, Hampshire, UK

  2. 2

    Wolfson Research Institute, Durham University, School of Medicine and Health, Stockton-on-Tees, UK

  3. 3

    University of East Anglia, School of Medicine, Health Policy & Practice, Norwich, UK

  4. 4

    MRC Biostatistics Unit, Cambridge, UK

  5. 5

    University of Southampton School of Medicine, Department of Community Clinical Sciences, Southampton, UK

  6. 6

    The Linwood Centre, Leicester, Leicestershire, UK

  7. 7

    London School of Hygiene & Tropical Medicine, Department of Epidemiology & Population Health, London, UK

*Rachel L Thompson, The Wessex Institute for Health R & D, Southampton General Hospital, Level B, South Academic Block, Southampton, Hampshire, SO16 6YD, UK. rlt@soton.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

The average level of blood cholesterol is an important determinant of the risk of coronary heart disease. Blood cholesterol can be reduced by dietary means. Although dietitians are trained to provide dietary advice, for practical reasons it may be given by other health professionals or using self-help resources.

Objectives

To assess the effects of dietary advice given by a dietitian compared with another health professional, or the use of self-help resources, in reducing blood cholesterol in adults.

Search methods

We searched The Cochrane Library (to Issue 3 2002), the EPOC trial register (October 2002), MEDLINE (1966 to September 2002), EMBASE (1980 to September 2002), Cinahl (1982 to August 2002), Human Nutrition (1991 to 1998), Science Citation Index, Social Sciences Citation Index, hand searched conference proceedings on nutrition and heart disease, and contacted experts in the field.

Selection criteria

Randomised trials of dietary advice given by a dietitian compared with another health professional or self-help resources. The main outcome was difference in blood cholesterol between dietitian groups compared with other intervention groups.

Data collection and analysis

Two reviewers independently extracted data and assessed study quality.

Main results

Twelve studies with 13 comparisons were included. Four studies compared dietitian with doctor, seven with self-help resources, and only one study was found for dietitian versus nurse and dietitian versus counsellor comparisons. Participants receiving advice from dietitians experienced a greater reduction in blood cholesterol than those receiving advice only from doctors (-0.25 mmol/L (95% CI -0.37, -0.12 mmol/L)). There was no statistically significant difference in change in blood cholesterol between dietitians and self-help resources (-0.10 mmol/L (95% CI -0.22, 0.03 mmol/L)). No statistically significant differences were detected for secondary outcome measures between any of the comparisons with the exception of dietitian versus nurse for HDLc, where the dietitian group showed a greater reduction (-0.06 mmol/L (95% CI -0.11, -0.01)) and dietitian versus counsellor for body weight, where the dietitian group showed a greater reduction (-5.80 kg (95% CI -8.91, -2.69 kg)).

Authors' conclusions

Dietitians were better than doctors at lowering blood cholesterol in the short to medium term, but there was no evidence that they were better than self-help resources. There was no evidence that dietitians provided better outcomes than nurses.
The results should be interpreted with caution as the studies were not of good quality and the analysis was based on a limited number of trials.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Dietary advice by dietitians to lower blood cholesterol can be more effective than advice by doctors, but may not be more effective than self-help resources.

Blood cholesterol level is an important indicator of the risk of heart disease. This review looked at the effectiveness of dietary advice given by dietitians to lower blood cholesterol, compared with the effectiveness of dietary advice given by other types of health professional or using self-help resources. The review found that advice by dietitians to lower blood cholesterol was more effective than that of doctors (in the short to medium term), but possibly not more effective than using self-help resources. There was no evidence to suggest that dietary advice given by dietitians was more effective than that given by nurses.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

降低血中膽固醇的飲食建議: 營養師, 其他醫療專業人員和病人自己尋求的醫療協助

血中膽固醇的含量是心血管疾病很重要的危險因子並且可以由飲食控制. 雖然營養師能提供專業的飲食建議, 但在實際臨床上, 卻常常是由其他醫事人員或病患自己尋求資源協助

目標

本研究在比較營養師和其他醫療人員提供的營養諮詢建議, 在降低成人血中膽固醇的飲食控制上, 是否有明顯差異

搜尋策略

找尋到2002年為止的Cochrane資料庫, EPOC臨床試驗登記, Medline, EMBASE, Cinahl, Human Nutrition, Science Citation Index, Social Sciences Citation Index當中, 整理當中和營養及心臟疾病有關的文章

選擇標準

此為一隨機抽樣試驗, 比較營養師的飲食建議和其他醫療人員(或病人自己找尋的資源)提供的營養諮詢建議, 在降低血中膽固醇上, 是否有明顯差異. 以血中膽固醇含量為實驗主要結果

資料收集與分析

兩位獨立的評論者分別從資料庫中找尋並分析過去符合標準的研究

主要結論

在12組研究中, 4組比較營養師和醫師給的建議, 7組比較營養師和病人自己找尋的飲食資訊, 1組比較營養師和護士給的建議. 結果顯示, 在降低血中膽固醇方面, 營養師的建議明顯比醫師的建議更有效(降低更多的血中膽固醇−0.25 mmol/L (95% CI −0.37, −0.12 mmol/L). 但營養師的建議和病人自己尋求的醫療資源及護士建議比較起來, 則沒有統計學上的顯著差異. 在次要療效部份, 營養師的飲食建議對HDLc的控制比護士建議有效(−0.06 mmol/L (95% CI −0.11, −0.01)); 而營養師的建議在體重控制方面, 也比其他顧問更好(−5.80 kg (95% CI −8.91, −2.69 kg)).

作者結論

結果顯示, 在降低血中膽固醇方面, 營養師的建議明顯比醫師的建議更好(降低更多的血中膽固醇), 但並沒有比病人自己尋求的醫療資源或護士的建議來的好. 在解讀這個結論時, 必須注意文章討論的研究品質參差不齊, 樣本數目也不夠多.

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

本篇研究在探討營養師的營養諮詢建議, 在降低成人血中膽固醇的飲食控制上, 是否比醫師, 護士或病人自己尋求的資源來得有效. 結果顯示, 在降低血中膽固醇方面, 營養師的建議可能比醫師的建議更好(降低更多的血中膽固醇), 但並沒有足夠的證據顯示營養師的建議比病人自己尋求的醫療資源或護士的建議來的好.

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