Dietary advice for reducing cardiovascular risk

  • Review
  • Intervention

Authors

  • EJ Brunner,

  • M Thorogood,

  • K Rees,

  • G Hewitt


Dr Eric Brunner, Reader in Epidemiology and Public Health, Department of Epidemiology and Public Health, University College London Medical School, 1-19 Torrington Place, London, WC1E 6BT, UK. e.brunner@ucl.ac.uk.

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 strategy

We searched the Cochrane Controlled Trials Register on The Cochrane Library (Issue 2 2000), MEDLINE (January 1966 to December 2000), EMBASE (January 1985 to December 2000), DARE (December 2000), CAB Health (December 1999), dissertation abstracts, and reference lists of articles. We contacted researchers in the field.

Selection criteria

Randomised studies with no more than 20% loss to follow-up, lasting at least three months involving healthy adults comparing dietary advice with no advice or less intensive 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

Twenty-three trials with 29 intervention arms (comparisons) comparing dietary advice with no advice were included in the review.
Dietary advice reduced total serum cholesterol by 0.13 mmol/l (95% CI 0.03 to 0.23) and LDL cholesterol by 0.13 mmol/l (95% CI 0.01 to 0.25) after 3-12 months. Mean HDL cholesterol levels were unchanged. Dietary advice reduced blood pressure by 2.10 mmHg systolic (95% CI 1.37 to 2.83) and 1.63 mmHg diastolic (95% CI 0.56 to 2.71) and 24-hour urinary sodium excretion by 44.2 mmol (95% CI 33.6 to 54.7) after 3-36 months. Plasma triglycerides, ß-carotene and red cell folate were each measured in one small study which suggested no significant effect. 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 1.24 servings/day (95% CI 0.43 to 2.05). Dietary fibre intake increased with advice by 7.22 g/day (95% CI 2.84 to 11.60), while total dietary fat as a percentage of total energy intake fell by 6.18 % (95% CI 4.00 to 8.36) with dietary advice and saturated fat intake fell by 3.28 % (95% CI 1.92 to 4.64).

Authors' conclusions

Dietary advice appears to be effective in bringing about modest beneficial changes in diet and cardiovascular risk factors over approximately 9 months but longer term effects are not known.

Plain language summary

Plain language summary

Dietary advice to encourage healthy people to make beneficial changes in diet and cardiovascular risk factors.

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 23 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 fruits, 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 counseling over four years. The duration of the trials ranged from three months to four years, with a median follow-up period of nine 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.

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