Intervention Review

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Interventions to enhance adherence to dietary advice for preventing and managing chronic diseases in adults

  1. Sophie Desroches1,2,*,
  2. Annie Lapointe1,2,
  3. Stéphane Ratté1,
  4. Karine Gravel2,
  5. France Légaré3,
  6. Stéphane Turcotte1

Editorial Group: Cochrane Consumers and Communication Group

Published Online: 28 FEB 2013

DOI: 10.1002/14651858.CD008722.pub2


How to Cite

Desroches S, Lapointe A, Ratté S, Gravel K, Légaré F, Turcotte S. Interventions to enhance adherence to dietary advice for preventing and managing chronic diseases in adults. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD008722. DOI: 10.1002/14651858.CD008722.pub2.

Author Information

  1. 1

    St-François d'Assise Hôpital, Centre de recherche du Centre hospitalier universitaire de Québec (CHUQ), Québec, Québec, Canada

  2. 2

    Université Laval, Département des sciences des aliments et de nutrition, Québec, Canada

  3. 3

    Université Laval, Département de médecine familiale et d'urgence, Québec, Québec, Canada

*Sophie Desroches, Centre de recherche du Centre hospitalier universitaire de Québec (CHUQ), St-François d'Assise Hôpital, 10 Rue de l'Espinay, Office D6-740, Québec, Québec, G1L 3L5, Canada. sophie.desroches@fsaa.ulaval.ca.

Publication History

  1. Publication Status: New
  2. Published Online: 28 FEB 2013

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Characteristics of included studies [ordered by study ID]

MethodsStudy design: randomized controlled trial with one intervention group and one control group


ParticipantsSetting: not known

Country: United States

Chronic disease: obesity (management)

Type of participants: clients (n = 43)

Mean age: intervention and control groups (44)

Sex: intervention and control groups (F: 86%, M: 14%)

Ethnicity: intervention and control groups (37 White, 3 African American, 1 Latino-Hispanique, 1 Native-American, 1 Asian American)


InterventionsGroup 1: single intervention: enablement (behaviour change techniques: barrier identification/problem solving, self-talk); 14 weeks; (n = 22).

Bi-weekly, the intervention took place in small groups during which clients talked about their specific problems and concerns and created their problem-solving self-instructions with the help of the group and the therapist. Homework assignments were given to clients to apply problem-solving self-instruction form regarding eating.

Group 2: control (unstructured support group); 14 weeks; (n = 21)


OutcomesMeasurement of diet adherence: adherence to energy, fat and saturated fat intakes assessed by a three-day food record (baseline, 14 weeks)


NotesDietary advice: energy and fat-restricted diet

Drop-out rate: 0% (calculated)

Providers: doctoral students in counselling psychology


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk"Randomization was carried out by drawing names from a hat"

Allocation concealment (selection bias)High risk"Randomization was carried out by drawing names from a hat"

Blinding (performance bias and detection bias)
Participants
Low risk"During the orientation meeting participants were given detailed information about the study except for the fact that there would be more than one type of 'healthy lifestyle group' (the CBT group and the control group) with no further details given"

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
Low riskNo missing data.

Selective reporting (reporting bias)High riskNo protocol. Some outcomes are reported incompletely (diet adherence, weight).

Other biasUnclear riskBaseline balance between groups. Diet adherence is assessed by self-reported measure. Validation and reliability of self-reported diet adherence are not reported.


MethodsStudy design: randomized controlled trial with one intervention group and one usual care group


ParticipantsSetting: outpatient

Country: Canada

Chronic disease: heart failure (management)

Type of participants: clients (n = 50)

Mean age: intervention (56 ± 3), usual care (61 ± 3)

Sex: intervention (F: 28%, M: 72%) and usual care (F: 32%, M: 68%)

Ethnicity:  not known


InterventionsGroup 1: multiple intervention: individual session with a dietitian + goal setting; 3 months; (n = 25)

An individualized nutrition care plans and goals were developed during a first counselling session with a dietitian and a second counseling session occurred 4 to 6 weeks later.

Group 2: usual care (no goal setting and no follow-up counselling session); once; (n = 25)


OutcomesMeasurement of diet adherence: adherence to sodium-restricted diet assessed by a three-day food record (baseline, 3 months).


NotesDietary advice: sodium-restricted diet (2 g/day)

Drop-out rate: 6% (calculated)

Providers: intervention: dietitian; usual care: clinic nurse


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskSequence generation using a computer random number generator.

Allocation concealment (selection bias)Unclear riskAllocation concealment is not described explicitly in the paper.

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
Low riskPlausible effect size among missing outcomes not enough to have a clinically-relevant impact on observed effect size.

Selective reporting (reporting bias)Unclear riskNo protocol.

Other biasUnclear riskBaseline balance between groups. Diet adherence is assessed by self-reported measure. Validation and reliability of self-reported diet adherence are not reported.


MethodsStudy design: randomized controlled trial with one intervention group and one usual care group


ParticipantsSetting : outpatient

Country : Brazil

Chronic disease: overweight and obesity (prevention/management)

Type of participants: clients (n = 241)

Mean age: intervention (41.1), usual care (39.6)

Sex: intervention (F: 90%, M: 10%) and usual care (F: 87.6%, M: 12.4%)

Ethnicity: intervention (82.5% White, 17.5 % non-White), usual care (87.6% White, 12.4% non-White)


InterventionsGroup 1: single intervention: modelling (nutritional tools); 6 months; (n = 120)

A manual was provided to clients containing photographs illustrating the portion sizes of the prescribed foods in addition to nutritionally balanced food lists, with calorically equivalent alternatives, in 100-cal portions. During monthly follow-up sessions, additional explanations were provided regarding the menu and alternative foods.

Group 2: usual care (no nutritional tools); 6 months; (n = 121)


OutcomesMeasurement of diet adherence: adherence to advice regarding  total energy, protein, fat, carbohydrate, cholesterol, fiber, sodium, fruit, vegetable and sweet food intakes assessed by a weekly food consumption questionnaire (baseline, 6 months).


NotesDietary advice: energy controlled diet, 15 to 30% of energy from total fat; 55 to 75% of energy from total carbohydrate; 10 to 15% of energy from protein; up to 300 mg/day of cholesterol; up to 5 g/day of salt; up to 25 g/day of fiber; at least 400 g/day of fruit and vegetables.

Drop-out rate: 20.3% (calculated)

Providers: dietitians


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskSequence generation referring to a random number table.

Allocation concealment (selection bias)Low riskAllocation concealment using sequentially numbered, opaque, sealed envelopes.

Blinding (performance bias and detection bias)
Participants
High risk"An unblind, randomised, controlled clinical trial was (…)"

Blinding (performance bias and detection bias)
Providers
High risk"An unblind, randomised, controlled clinical trial was (…)"

Blinding (performance bias and detection bias)
Outcome assessors
High risk"Except for laboratory tests, all other outcome indicators were assessed by observers that were unblind of the status of the study participants".

Incomplete outcome data (attrition bias)
All outcomes
High riskPlausible effect size among missing outcomes enough to have a clinically-relevant impact on observed effect size.

Selective reporting (reporting bias)High riskNo protocol. Diet adherence is reported incompletely.

Other biasHigh riskBaseline imbalance between groups (fasting glucose). Diet adherence is assessed by self-reported measure (validated food frequency questionnaire).


MethodsStudy design: randomized controlled trial with two intervention groups


ParticipantsSetting: outpatient

Country: Iran

Chronic disease: chronic end-stage renal disease (management)

Type of participants: clients (n = 63)

Mean age: intervention group 1 (35.9 ± 10.1), intervention group 2 (33.8 ± 8.9)

Sex: intervention group 1 (F: 46.9%, M: 53.1%) and intervention group 2 (F: 48.4%, M: 51.6%)

Ethnicity: intervention groups (100% Asian)


InterventionsGroup 1: multiple intervention: group session + educational tools-booklet; 2 weeks; (n = 32)

Clients attended two educational sessions. An interactive portion of teaching program was held at the end of class and clients were encouraged to offer support to each other. Clients also received a teaching booklet to take home.

Group 2: single intervention: education (educational tools-video); 1 week; (n = 31)

An educational film on a video disc system was shown to each client during two consecutive dialysis sessions in a week.


OutcomesMeasurement of diet adherence: adherence to dietary restriction assessed by bimonthly average values of serum sodium, potassium, calcium, phosphate, albumin, creatinine, uric acid and blood urea nitrogen (baseline, 2  months); adherence to fluid-restricted diet assessed by bimonthly interdialytic weight gain (baseline, 2  months)


NotesDietary advice: 55 g/day of oil; 1.2 to 1.5 g/kg/day of protein; 2 g/day of sodium; 0.5 to 2 g/day of potassium; 1 g/day of phosphorus; restricted water intake (output 24h + 10 ml/kg/day)

Drop-out rate: 0% (calculated)

Provider: renal nurse expert


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk"The random allocation was performed using computer-generated random numbers from 0 to 99."

Allocation concealment (selection bias)High risk"For an equal allocation to the two groups, we took odd numbers to indicate group 1 (oral education) and even numbers to indicate group 2 (video education)."

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
Low riskNo missing data.

Selective reporting (reporting bias)Unclear riskNo protocol.

Other biasUnclear riskBaseline comparisons between groups are not reported. Diet adherence is assessed by objective measures.


MethodsStudy design: randomized controlled trial with one intervention group and one control group


ParticipantsSetting: research center

Country: United States

Chronic disease: overweight and obesity (prevention/management)

Type of participants: clients (n = 174)

Mean age: intervention (52 ± 12), control (54 ± 10)

Sex: intervention (F: 83%, M: 17%) and control (F: 77%, M: 23%)

Ethnicity: intervention (85% Caucasian, 10% Black, 5 % Asian), control (83.3% Caucasian, 16.7% Black, 0% Asian)


InterventionsGroup 1: single intervention: training (feedback); 4 weeks; (n = 89).

Clients received a Palm Zire 21 loaded with the DietMatePro program that displayed personalized target values for energy based on the Harris-Benedict calculation using National Institutes of Health (NIH) guidelines for weight loss as well as fat, saturated fat, and cholesterol goals based on Ornish Prevention Diet recommendations. Additional DietMatePro program features to assist in adhering to the dietary regimen included feedback of comparisons between actual and target intake by meal and by day as well as recipes and meal plans consistent with the assigned diet.

Group 2: control (no feedback);  4 weeks; (n = 85).


OutcomesMeasurement of diet adherence: adherence to energy, fat, saturated fat and cholesterol intakes assessed by a three-day DietMatePro (intervention) or paper-based (control) food diaries and 24-hr recall (4 weeks)


NotesDietary advice: Ornish Diet (individualized target of energy level based on the Harris-Benedict calculation using NIH guidelines for weight loss, 10 to 15% of energy from fat, up to 7% of energy from saturated fat and cholesterol less than 200 mg/day)

Drop-out rate: 8.6% (calculated)

Provider: research assistant


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk"Participants were then randomly assigned to receive either the DietMatePro program or the paper-based food diary as their food recording method based on a randomization table generated by the first author."

Allocation concealment (selection bias)High riskAllocation concealment using an open random allocation schedule (list of random numbers).

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
High risk"Research assistants were aware of the participant's randomization assignment during the assessment."

Incomplete outcome data (attrition bias)
All outcomes
High riskThe proportion of missing outcomes compared with observed risk enough to induce clinically relevant bias in intervention effect estimate.

Selective reporting (reporting bias)Unclear riskNo protocol.

Other biasHigh riskBaseline imbalance between groups (body mass index). Diet adherence is assessed by self-reported measures. Validation of DietMatePro diary with paper based diary is reported. Potential conflict of interest ("All authors were employed at PICS at the time of the study and PICS is the developer of DietMatePro").


MethodsStudy design: randomized controlled trial with one intervention group and one usual care group


ParticipantsSetting: outpatient

Country: United States

Chronic disease: risk of coronary heart disease (prevention)

Type of participants: clients (n = 156)

Mean age: intervention (46.1 ± 7.7), usual care (46.9 ± 6.8)

Sex: intervention (F: 47.6%, M: 52.4%) and usual care (F: 51.4%, M: 48.6%)

Ethnicity: not known


InterventionsGroup 1: multiple intervention: telephone follow-up + barrier identification/problem solving; 2 years; (n = 84) 

Meetings took place every four months and telephone calls occurred three times a year for lipid therapy compliance and dietary counselling. Barriers to implementation of diet, pharmacotherapy, exercise and smoking cessation were discussed. Encounters used standardized prompts that centered on readiness to change, support systems, and the sociocultural, work, and economic environment. 

Group 2: usual care; duration not known; (n = 72)


OutcomesMeasurement of diet adherence: adherence to fat-restricted diet assessed by the Block Health Habits and History Questionnaire food frequency instrument (2 years)


NotesDietary advice: consumption of less than 30% of total energy from fat and less than 300 mg/day of cholesterol

Drop-out rate: 23%

Providers: nurses and physicians


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk"Randomization was done by family using a computerized schema".

Allocation concealment (selection bias)Unclear risk"Each family had a number with a corresponding sealed envelope containing the assignment. The envelopes were opened after all siblings from the same family had been screened."

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
High riskImbalance in numbers of missing data between groups and the proportion of missing outcomes compared with observed event risk enough to induce clinically-relevant bias in intervention effect estimate.

Selective reporting (reporting bias)High riskNo protocol. Some outcomes are reported incompletely (weight, total cholesterol, smoking, physical activity and blood pressure).

Other biasHigh riskBaseline imbalance between groups (HDL-cholesterol). Diet adherence is assessed by self-reported measures (validated food frequency questionnaire).


MethodsStudy design: randomized controlled trial with three intervention groups


ParticipantsSetting: not known

Country: United Kingdom

Chronic disease: overweight and obesity (prevention/management)

Type of participants: clients (n = 53)

Mean age: intervention groups (40)

Sex: intervention groups (F: 100%)

Ethnicity: intervention groups (100% White)


InterventionsGroup 1: single intervention: enablement (behaviour change techniques: teach to use prompts/cues); 16 weeks; (n = 18) 

The aim was to reduce exposure to food cues by discussion of changes to make in food storage habits and common target problem. Each session (weeks 5, 6, 7, 8, 9, 11 and 15) followed the same format: a brief review of recent dieting efforts; a central lesson giving specific detailed advice on ways of reducing contact with food and one area of food management; a discussion of a specific problem from the point of view of the program as practice in problem solving and a summary of the content of the session. 

Group 2: single intervention: enablement (behaviour change techniques: self-talk); 16 weeks; (n = 16) 

The aim was to resist overeating by practising self-talk. Each session (weeks 5, 6, 7, 8, 9, 11 and 15) followed the same format: a brief review of recent efforts, a long period of imaginal rehearsal and a summary of the content of the session. 

Group 3: single intervention: enablement (behaviour change techniques: barrier identification/problem solving); 16 weeks; (n = 19) 

The aim was to improve self-control ability by reviewing problems encountered and discussing about adherence to diet.


OutcomesMeasurement of diet adherence: adherence to energy intake assessed by a daily record (baseline - 3 weeks - 6 weeks - 9 weeks - 12 weeks - 15 weeks).


NotesDietary advice: specific quotas of exchanges, representing 1000 kCal below expected energy requirements, with a minimum of 1000 kCal

Drop-out rate: 24.5% (calculated)

Providers: psychologist and dietitian


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskSequence generation referring to a random number table.

Allocation concealment (selection bias)High riskAllocation concealment using an open random allocation schedule (list of random numbers).

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
High riskPlausible effect size among missing outcomes enough to have a clinically-relevant impact on observed effect size.

Selective reporting (reporting bias)Unclear riskNo protocol.

Other biasUnclear riskBaseline balance between groups. Diet adherence is assessed by self-reported measure. Validation and reliability of self-reported diet adherence are not reported.


MethodsStudy design: randomized controlled trial with one intervention group and one control group.


ParticipantsSetting: research center

Country: Netherlands

Chronic disease: overweight (prevention)

Type of participants: clients (n = 191)

Mean age: intervention (44.3 ± 12.2), control (43.0 ± 11.3)

Sex: intervention (F: 76.9%, M: 23.1%) and control (F: 88.7%, M: 11.3%)

Ethnicity: not known


InterventionsGroup 1: multiple intervention: motivational interviewing + feedback; 4 weeks; (n = 97) 

A computer assistant represented by an animated iCat showed different facial expressions and provided cooperative feedback following principles from the motivational interviewing method.   

Group 2: control (no computer assistant); 4 weeks; (n = 94)


OutcomesMeasurement of diet adherence: adherence to diet goals assessed by a diary (28 days).


NotesDietary advice: one of the following goals: 20 to 35% of energy from fat; at least two pieces of fruit and 150 to 200 grams of vegetables/day; eat regularly (breakfast, lunch and dinner and a maximum of two in between snacks).

Drop-out rate: 81.7% (calculated)

Provider: none


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskSequence generation is not described explicitly in the paper.

Allocation concealment (selection bias)Unclear riskAllocation concealment is not described explicitly in the paper.

Blinding (performance bias and detection bias)
Participants
Low risk"The participants were not aware there were two groups"

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
High riskPlausible effect size among missing outcomes enough to have a clinically-relevant impact on observed effect size

Selective reporting (reporting bias)Unclear riskNo protocol

Other biasUnclear riskBaseline comparisons between groups are not reported. Diet adherence is assessed by self-reported measure. Validation and reliability of self-reported diet adherence are not reported.


MethodsStudy design: randomized controlled trial with one intervention group and one control group


ParticipantsSetting: outpatient

Country: China

Chronic disease: renal failure (management)

Type of participants: clients (n = 70)

Mean age: intervention (57.6 ± 14.2), control (52.9 ± 14.9)

Sex: intervention (F: 57.1%, M: 42.9%) and control (F: 48.6%, M: 51.4%)

Ethnicity: not known


InterventionsGroup 1: single intervention: modelling (nutritional tools); duration not known; (n = 35) 

Clients received an individualized menu suggestion based on food preferences and learned how to make food substitution using an exchange list and portion-sized food aids. 

Group 2: control (no menu suggestion); duration not known; (n = 35)


OutcomesMeasurement of diet adherence: adherence to protein intake assessed by a three-day food record (baseline, 1 month)


NotesDietary advice: daily protein intake level 0.8 to 1.2 g/kg/day

Drop-out rate: 0% (calculated)

Provider: dietitian


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk"(…) all patients were then randomly assigned to 1 of 2 groups using random numbers"

Allocation concealment (selection bias)Unclear riskAllocation concealment is not described explicitly in the paper.

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
Low riskNo missing data.

Selective reporting (reporting bias)Unclear riskNo protocol.

Other biasUnclear riskBaseline balance between groups. Diet adherence is assessed by self-reported measure. Validation and reliability of self-reported diet adherence are not reported.


MethodsStudy design: randomized controlled trial with one intervention group and one control group.


ParticipantsSetting: outpatient

Country: China

Chronic disease: hypertension (management)

Type of participants: clients (n = 63)

Mean age: intervention (53.3 ± 7.8), control (54.4 ± 7.6)

Sex: intervention (F: 77.4%, M: 22.6%) and control (F: 56.2%, M: 43.8%)

Ethnicity: not known


InterventionsGroup 1: single intervention: education (telephone follow-up); 8 weeks; (n = 31) 

A nurse performed a telephone follow-up every two to three weeks during which she reinforced health self-management behaviours, providing health advice and assessed the need for referrals. 

Group 2: control (no telephone follow-up); 8 weeks; (n = 32)


OutcomesMeasurement of diet adherence: adherence to sodium-restricted diet, control of fat intake and adequate fruit and vegetable consumption assessed by a score (baseline, 8 weeks)


NotesDietary advice: sodium-restricted diet, fat, fruit and vegetable intakes

Drop-out rate: 1.6% (calculated)

Providers: nurses


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk"Patients (…) were randomised to the study or control group using sets of computer-generated random numbers"

Allocation concealment (selection bias)Unclear riskAllocation concealment is not described explicitly in the paper.

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThe outcome assessors were blinded for the satisfaction questionnaire but this study did not address the blinding for other outcomes.

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInsufficient reporting of attrition to permit judgement.

Selective reporting (reporting bias)Unclear riskNo protocol

Other biasHigh riskBaseline balance between groups. Diet adherence is assessed by self-reported measure (validated scale). An effect of intervener could have influenced results.


MethodsStudy design: randomized controlled trial with one intervention group and one control group.


ParticipantsSetting: outpatient

Country: Canada

Chronic disease: coronary artery disease (management)

Type of participants: clients (n = 7)

Mean age: not known

Sex: not known

Ethnicity: not known


InterventionsGroup 1: single intervention: restriction;  7 months; (n = 4) 

INCREMENTAL REDUCTION OF FAT: Meal plan initially targeted intake of 26% to 30% of energy as fat. At two months, patients were given meal plan targeting 20% fat energy intake. Finally, at four months they were given meal plan targeting 10% fat energy intake. 

Group 2: control; 7 months; (n = 3) 

IMMEDIATE REDUCTION OF FAT:  Meal plan consisted to an immediate reduction of fat energy intake (10%). The meal plan was reinforced two and four months after the program.


OutcomesMeasurement of diet adherence: adherence to very low fat diet assessed by a 24-hr recall (7 months)


NotesDietary advice: 10% of energy from fat

Drop-out rate: 0% (calculated)

Provider: dietitian


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskSequence generation is not described explicitly in the paper.

Allocation concealment (selection bias)Unclear riskAllocation concealment is not described explicitly in the paper.

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
Low riskNo missing data.

Selective reporting (reporting bias)High riskNo protocol. Diet adherence is not clearly defined.

Other biasHigh riskBaseline comparisons between groups are not reported. Diet adherence is not clearly defined.


MethodsStudy design: randomized controlled trial with three intervention groups and one control group.


ParticipantsSetting: outpatient

Country: United States

Chronic disease: renal failure (management)

Type of participants: clients (n = 116)

Mean age: intervention and control groups (54.8)

Sex: intervention and control (F: 46%, M: 54%)

Ethnicity: intervention and control groups (50% White)


InterventionsGroup 1: single intervention: incentivisation (contract with reward); 6 weeks; (n = 29) 

A behavioural contract was formulated and consisted of: identifying a behaviour or set of behaviours to be targeted for change in the contract; negotiating with the client a timetable for the accomplishment of the specified behaviours, how should the degree of accomplishment be evaluated, what rewards would be received for appropriate behaviours, when the client would be rewarded; writing out a formal agreement which was subsequently signed by both the nurse and the client; maintaining a record of each client's progress. 

Group 2: multiple intervention: Incentivisation (contract with reward) and persuasion (involvement of a family member or friend) (n = 29)

A behavioural contract was formulated and consisted of: identifying a behaviour or set of behaviours to be targeted for change in the contract; negotiating with the client a timetable for the accomplishment of the specified behaviours, how should the degree of accomplishment be evaluated, what rewards would be received for appropriate behaviours, when the client would be rewarded; writing out a formal agreement which was subsequently signed by both the nurse and the client; maintaining a record of each client's progress. Moreover, a third person selected by the patient participated in the contract agreement along with the patient and the nurse. 

Group 3:single intervention: education (telephone follow-up); 6 weeks; (n = 29)

Weekly, clients were contacted by telephone. Telephone follow-up consisted of: gathering information from clients regarding problems they might be having in following their treatment instructions; providing information to clients about such things as the potential negative health consequences of not adhering to therapy, the benefits to be derived from following treatment instructions, and things the clients could do to achieve better compliance; providing verbal support to clients for maintaining proper adherence to treatment.

Group 4: control (no contract or telephone follow-up); 6 weeks, (n = 29)


OutcomesMeasurement of diet adherence: adherence to potassium-restricted diet and fluid-restricted diet assessed by serum potassium level and weight gain between dialysis treatments (baseline, 6 weeks, 3 months)


NotesDietary advice: potassium-restricted diet and fluid-restricted diet

Drop-out rate: 25% (calculated)

Providers: nurses 


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskSequence generation using a computer random number generator.

Allocation concealment (selection bias)High riskAllocation concealment using case record number.

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
High riskPlausible effect size among missing outcomes enough to have a clinically-relevant impact on observed effect size

Selective reporting (reporting bias)Unclear riskNo protocol.

Other biasLow riskBaseline imbalance between groups but the authors adjusted for initial group differences. Diet adherence is assessed by objective measures.


MethodsStudy design: randomized controlled trial with two intervention groups and one usual care group.


ParticipantsSetting: outpatient

Country: United Kingdom

Chronic disease: type II diabetes (management)

Type of participants: clients (n = 453)

Mean age: intervention and usual care groups (65.9 ± 10)

Sex: intervention and usual care groups (F: 41.3%, M: 58.7%)

Ethnicity: not known


InterventionsGroup 1: Single intervention: training (feedback); 1 year; (n = 150)

LESS INTENSIVE INTERVENTION: clients were asked to use a blood glucose meter to record three fasting, pre-meal or two hour post meal readings on two days during the week. Treatment targets of fasting and pre-meal levels were given.

Group 2: Single intervention: training (feedback); 1 year; (n = 151) 

MOST INTENSIVE INTERVENTION: clients were asked to use a blood glucose meter to record three fasting, pre-meal or two hour post meal readings on two days during the week. Treatment targets of fasting and pre-meal levels were given and clients were trained in interpretation of results. Clients were also asked to view persistently elevated levels as a prompt to set new goals for behaviour change. 

Group 3: usual care (no feedback); 1 year; (n = 152)


OutcomesMeasurement of diet adherence: adherence to the general diet and the specific diet items concerning fruit and vegetables as well as high-fat foods assessed by the Summary of Diabetes Self-Care Activities (baseline, 12 months)


NotesDietary advice: not known

Drop-out rate: 25.2%

Providers: nurses


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk"(…) using a partial minimisation procedure to adjust the randomisation probabilities between groups to balance important covariates (…) using a computer programme".

Allocation concealment (selection bias)Unclear riskAllocation concealment is not described explicitly in the paper.

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Low riskQuestionnaire responses were entered onto computer by staff unaware of intervention allocation.

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInsufficient reporting of attrition to permit judgement.

Selective reporting (reporting bias)Low riskThe study protocol is available and all of the study's pre-specified outcomes that are of interest in the review have been reported in the pre-specified way.

Other biasHigh riskBaseline comparisons between groups are not reported. Diet adherence is assessed by self-reported measure (SDSCA). The Cronbach' s alpha for the Summary of Diabetes Self-Care Activities (SDSCA) (specific diet) was low 0.08.


MethodsStudy design: randomized controlled trial with three intervention groups and one usual care group


ParticipantsSetting: workplace and community

Country: United States

Chronic disease: elevated blood cholesterol (prevention)

Type of participants: clients (n = 173)

Mean age: intervention group 1 (51.1 ± 13.5), intervention group 2 (50.1 ± 17.5), intervention group 3 (50.3 ± 14.6), usual care (53.9 ± 14.9)

Sex: intervention group 1 (F: 45.2%, M: 54.8%), intervention group 2 (F: 46.7%, M: 53.3%), intervention group 3 (F: 44.1%, M: 55.9%) and usual care (F: 44.4%, M: 55.6%)

Ethnicity: intervention group 1 (95.1% White, 26.8% Portuguese), intervention group 2 (94.9% White, 15.4% Portuguese), intervention group 3 (100% White, 26.1% Portuguese), usual care (95.6% White, 29.5% de Portuguese)


InterventionsGroup 1: single intervention: persuasion (reminder); once; (completers: n = 42) 

Clients received a mailed personalized letter including their blood cholesterol level, a reminder to see their physician, a list of the specific lifestyle goals, the subject set at the community-based blood cholesterol Screening, Counseling, Referral Events (SCORE), and a Pawtucket Heart Health Program magnet for refrigerator.

Group 2: single intervention: persuasion (reminder); once; (completers: n = 39) 

Physician received a mailed packet including a letter stating that their patient had been referred on the basis of their blood cholesterol level and coronary heart disease risk factors. There was a listing of the lifestyle goals the subject set at the SCORE, National Cholesterol Education Program (NCEP) guidelines and a reminder postcard (preaddressed to the client) which the physician could mail to the client. 

Group 3: single intervention: persuasion (reminder); once; (completers: n = 47) 

Clients received a mailed personalized letter including their blood cholesterol level, a reminder to see their physician, a list of the specific lifestyle goals, the subject set at the SCORE, and a Pawtucket Heart Health Program magnet for refrigerator. The physician also received a mailed packet including a letter setting that their patient had been referred on the basis of their blood cholesterol level and coronary heart disease risk factors. There was a listing of the lifestyle goals the subject set at the SCORE, NCEP guidelines and a reminder postcard (preaddressed to the client) which the physician could mail to the client. 

Group 4: usual care (no reminder); once; (completers: n = 45)


OutcomesMeasurement of diet adherence: adherence to dietary advice assessed by a telephone questionnaire (baseline, 3 months)


NotesDietary advice: not known

Drop-out rate: not known

Providers: physicians


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskSequence generation is not described explicitly in the paper.

Allocation concealment (selection bias)Unclear riskAllocation concealment is not described explicitly in the paper.

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInsufficient reporting of attrition to permit judgement.

Selective reporting (reporting bias)Unclear riskNo protocol.

Other biasHigh riskBaseline balance between groups. Diet adherence is assessed by self-reported measure. Validation and reliability of self-reported diet adherence are not reported. The time interval between SCORE and survey varied between subject and could influenced results.


MethodsStudy design: randomized controlled trial with one intervention group and one control group.


ParticipantsSetting: research center

Country: United States

Chronic disease: overweight and obesity (prevention/management)

Type of participants: clients (n = 64)

Mean age: intervention (19.1 ± 1.0), control (19.1 ± 1.0)

Sex: intervention and control groups (F: 100%)

Ethnicity: intervention (70% White, 10% African American, 10% Latina/Hispanic, 10% Other), control (66% White, 17% African American, 14% Latina/Hispanic, 3% Other)


InterventionsGroup 1: single intervention: education (group sessions); 8 weeks; (n = 32) 

Participants attended a weekly education group sessions run by a dietitian and an exercise physiologist. 

Group 2: control (no education group sessions); 8 weeks; (n = 32)


OutcomesMeasurement of diet adherence: adherence to Dietary Approaches to Stop Hypertension (DASH) diet assessed by the DASH Diet Index (baseline, 8 weeks)


NotesDietary advice: DASH diet and hypocaloric diet

Drop-out rate: not known

Providers: dietitian and exercise physiologist


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskSequence generation using a computer random number generator.

Allocation concealment (selection bias)Unclear riskAllocation concealment is not described explicitly in the paper.

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInsufficient reporting of attrition to permit judgement.

Selective reporting (reporting bias)Unclear riskNo protocol.

Other biasUnclear riskBaseline balance between groups not reported. Diet adherence is assessed by self-reported measure. Validation and reliability of self-reported diet adherence are not reported.


MethodsStudy design: randomized controlled trial with one intervention group and one control group


ParticipantsSetting: outpatient

Country: United Kingdom

Chronic disease: hyperlipidaemia (prevention)

Type of participants: clients (n = 13)

Mean age: not known

Sex: intervention group (F: 25%, M: 75%) and control group (F: 40%, M: 60%)

Ethnicity: intervention and control groups (100% Caucasian)


InterventionsGroup 1: single intervention: modelling (nutritional tools); once; (n = 8) 

Clients received standard low-fat dietary advice with an additional package containing details on improving the practical implementation of a low-fat diet, such as low-fat cooking methods, low-fat recipe adaptation and eating out on a low-fat diet. 

Group 2: control (standard dietary advice with no information package); duration: not known; (n = 5)


OutcomesMeasurement of diet adherence: adherence to total daily energy intake and proportion of energy from fat assessed by a food-frequency questionnaire (baseline, 12 weeks)


NotesDietary advice: low-fat diet

Drop-out rate: 0% (calculated)

Providers: not known


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskSequence generation is not described explicitly in the paper.

Allocation concealment (selection bias)Unclear riskAllocation concealment is not described explicitly in the paper.

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInsufficient reporting of attrition to permit judgement.

Selective reporting (reporting bias)High riskNo protocol. Body mass index is reported incompletely. Diet adherence is not clearly defined.

Other biasHigh riskBaseline imbalance between groups (% fat). Diet adherence is not clearly defined.


MethodsStudy design: randomized controlled trial with one intervention and one control group


ParticipantsSetting: outpatient

Country: Canada

Chronic disease: type II diabetes (management)

Type of participants: clients (n = 87)

Mean age: intervention (60.4 ± 7.9), control (59.0 ± 12.1)

Sex: intervention (F: 68%, M: 32%) and control (F: 69.4%, M: 30.6%)

Ethnicity: intervention and control groups (100% Portuguese)


InterventionsGroup 1: multiple intervention: group sessions + barrier identification/problem solving + nutritional tools; 3 months; (n = 41) 

The education intervention lasted 15 hrs over three consecutive weekdays in which didactic methods, mutual goal setting, situational problem solving, cognitive reframing and role-playing methods were used. Some nutritional tools were provided such as food models, kitchen demonstration, real food samples and food product labels. 

Group 2: control; 3 months; (n = 46) 

Clients met the dietitian individually.


OutcomesMeasurement of diet adherence: adherence to dietary advice assessed by the Summary of diabetes Self-care activities Questionnaire (baseline, 3 months)


NotesDietary advice: based on an assessment of clients' metabolic profile and on existing comorbidities such as renal nephropathy or gastrointestinal complications: 1) a limited and consistent intake of carbohydrates at each meal; 2) an adequate daily intake of fruit and vegetables; 3) a  lower intake of saturated fat; 4) a reduced fat in cooking.

Drop-out rate: 29.9% (calculated)

Providers: dietitian, nurse, pharmacist, physiotherapist


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk"Participants were randomly assigned (generated random number list)…"

Allocation concealment (selection bias)High riskAllocation concealment using an open random allocation schedule (list of random numbers).

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Low risk"DEC (Diabetes Education Centre) providers were also blinded to patients' research participation status and were caring for all the participants regardless of the intervention assignment".

Blinding (performance bias and detection bias)
Outcome assessors
Low risk"The research assistants were blinded to participants' intervention status."

Incomplete outcome data (attrition bias)
All outcomes
High riskPlausible effect size among missing outcomes enough to have a clinically-relevant impact on observed effect size.

Selective reporting (reporting bias)Unclear riskNo protocol.

Other biasLow riskBaseline balance between groups. Diet adherence is assessed by self-reported measure (validated Summary of Diabetes Self-care Activities Questionnaire).


MethodsStudy design: randomized controlled trial with two intervention groups


ParticipantsSetting: research center

Country: United States

Chronic disease: irritable bowel syndrome (management)

Type of participants: clients (n = 81)

Mean age: intervention group 1 (45.8 ± 14.1), intervention group 2 (46.1 ± 14.5)

Sex: intervention group 1 (F: 82.1%, M: 17.9%) and intervention group 2 (F: 88.1%, M: 11.9%)

Ethnicity: intervention group 1 (87.2% White, 0% African American, 5.1% Asian/Indian, 7.7% Native American), intervention group 2 (83.3% White, 4.8% African American, 9.5% Asian/Indian, 0% Native American, 2.4% Unknown)


InterventionsGroup 1: single intervention: education (individual sessions with a nurse); 9 weeks; (n = not known) 

The intervention included 9 hours of face-to-face sessions in which the nurse reviewed the previous homework assignment and discussed how to individualize dietary modifications. 

Group 2: multiple intervention: individual sessions with a nurse + telephone follow-up; 9 weeks; (n = not known) 

The intervention included two face-to-face sessions, six telephone sessions and one final face-to-face session in which the nurse reviewed the previous homework assignment and discussed how to individualize dietary modifications.


OutcomesMeasurement of diet adherence: adherence to American Dietetic Association recommendations for fiber intake (more than 20 g/day) and Food Guide Pyramid for fruit intake (more than 2 servings/day) and vegetable intake (more than 3 servings /day) assessed by a  food-frequency questionnaire (baseline, 3 months, 6 months)


NotesDietary advice: individualized based on the symptoms: 25 g of fiber/day in constipation-predominant and 20 g of fiber/day for diarrhoea-predominant

Drop-out rate: not known

Providers: research nurses 

A usual care group was included in this study. Since no active treatment was provided in the usual care group, this group was not described in the Cochrane review.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk"(…) participants were randomly assigned using a customized computer program (…)"

Allocation concealment (selection bias)Unclear riskAllocation concealment is not described explicitly in the paper.

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInsufficient reporting of attrition to permit judgement.

Selective reporting (reporting bias)Unclear riskNo protocol.

Other biasHigh riskBaseline imbalance between groups (fiber, vegetables and fruit). Diet adherence is assessed by self-reported measure (validated food frequency questionnaire).


MethodsStudy design: randomized controlled trial with two intervention groups and one usual care group


ParticipantsSetting: outpatient

Country: United States

Chronic disease: hypertension (management)

Type of participants: clients (n = 281)

Mean age: intervention group 1 (53.9 ± 5.7), intervention group 2 (53.4 ± 5.7), usual care (52.7 ± 6.5)

Sex: intervention group 1 (F: 65.2%, M: 34.8%), intervention group 2 (F: 63.5%, M: 36.5%), usual care (F: 73.1%, M: 26.9%)

Ethnicity: intervention and usual care groups (100% African American)


InterventionsGroup 1: multiple intervention: telephone follow-up + motivational interviewing; 18 months; (n = 92)

SIMULTANEOUS BEHAVIOUR CHANGE: a brief in-clinic session with a health educator was provided to clients every six months to review the benefits of the recommended three behavioural changes (stop smoking, reduce dietary sodium level and increase physical activity), the home-based, self-help (printed manual, motivational videotape), instructional materials developed to facilitate behaviour change and the schedule of telephone counselling session. All three behaviours were reviewed at each clinic session. There were seven telephone follow-ups between each in-clinic session. 

Group 2: multiple intervention: telephone follow-up + motivational interviewing; 18 months; (n = 96) 

SEQUENTIAL BEHAVIOUR CHANGE:  a brief in-clinic session with a health educator was provided to clients every six months to review the benefits of the recommended behavioural change (stop smoking, reduce dietary sodium level and increase physical activity), the home-based, self-help (printed manual, motivational videotape), instructional materials developed to facilitate behaviour change and the schedule of telephone counselling session. The protocol addressed a new behaviour every 6 months. There were seven motivational interviewing telephone follow-ups between each in-clinic session. 

Group 3: usual care (no telephone follow-up); once; (n = 93) 

A brief review of educational materials was provided regarding the three targets behaviours (stop smoking, reduce dietary sodium level and increase physical activity).


OutcomesMeasurement of diet adherence: adherence to sodium-restricted diet assessed by 24-hr urine sodium level <100mEq/l/day) (baseline, 6 months, 18 months)


NotesDietary advice: sodium-restricted diet (less than 100 mEq/l/day (urinary))

Drop-out rate: 20.4%

Provider: health educator


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskSequence generation is not described explicitly in the paper.

Allocation concealment (selection bias)Unclear riskAllocation concealment is not described explicitly in the paper.

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
High riskThe proportion of missing outcomes compared with observed event risk enough to have a clinically-relevant impact on the intervention effect estimate

Selective reporting (reporting bias)High riskNo protocol. Blood glucose is reported incompletely.

Other biasHigh riskBaseline imbalance between groups (diastolic blood pressure). Diet adherence is assessed by objective measure. The order in which the behaviors were introduced to each participant in the sequential group was randomized to avoid confounding of outcomes with patient preferences.


MethodsStudy design: randomized controlled trial with one intervention group and one usual care group


ParticipantsSetting: outpatient

Country: China

Chronic disease: angina pectoris or myocardial infarction (management)

Type of participants: clients (n = 167)

Mean age: intervention (62.1 ± 7.4), usual care (61.4 ± 7.6)

Sex: intervention (F: 31.3%, M: 68.7%) and usual care (F: 26.2%, M: 73.8%)

Ethnicity: intervention and usual care groups (100% Chinese)


InterventionsGroup 1: multiple intervention: telephone follow-up + individual session with nurse + goal setting; 12 weeks; (n = 83) 

After discharge from the hospital, clients received a weekly home visit during the first three weeks and alternating home visit and telephone follow-up every other week from week 4 to 12. The cardiac rehabilitation program consisted of: setting of the goals for walking performance, smoking cessation, Adult Treatment Panel step II (ATP step II) diet adherence and medication adherence; setting of the goals for cardiac physiological risk control; clients conducted a goal-directed self-managed rehabilitative care in medication management, angina management, physical exercise, dietary management and smoking cessation according to the recommended guidelines on a daily basis; keeping a log record for tracking progress as well as for self-evaluation and self-reinforcement. 

Group 2: usual care (no cardiac rehabilitation program); duration: not known; (n = 84)


OutcomesMeasurement of diet adherence: adherence to ATP step II diet assessed by a 3-day food record (baseline, 3 months, 6 months)


NotesDietary advice: ATP step II diet (< 8% of total energy from saturated fat and < 250 mg/d of cholesterol)

Drop-out rate: 15.6% (calculated)

Provider: cardiac nurse


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk"(…) randomised assignment of subjects into an intervention group and a control group according to a computer-generalized random table".

Allocation concealment (selection bias)Low riskAllocation concealment using central allocation.

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Low risk"They (research assistants) were blinded to patient group assignment"

Incomplete outcome data (attrition bias)
All outcomes
High riskThe proportion of missing outcomes compared with observed event risk enough to have a clinically-relevant impact on the intervention effect estimate.

Selective reporting (reporting bias)High riskNo protocol. Smoking cessation is reported incompletely.

Other biasUnclear riskBaseline balance between groups. Diet adherence is assessed by self-reported measure. Validation and reliability of self-reported diet adherence are not reported.


MethodsStudy design: randomized controlled trial with four intervention groups 


ParticipantsSetting: outpatient

Country: United Kingdom

Chronic disease: overweight (prevention)

Type of patients: clients (n = 80)

Mean age: intervention groups: 50.3 ± 13.5

Sex: intervention groups (F: 100%)

Ethnicity: not known


InterventionsGroup 1: single intervention: education (group sessions); 16 weeks; (n = 19) 

Clients met the dietitian every four weeks in small groups of five to seven clients. 

Group 2: multiple intervention: individual sessions with a dietitian + teach to use prompts/cues; 16 weeks; (n = 20) 

Clients saw the dietitian every four weeks individually. Clients were provided with one set of leaflets on each of their first four visits. These provided specific detailed advice on how to reduce their exposure to food cues by making a variety of changes in their habits, and were based on the cue avoidance programme and the food management programme. 

Group 3: multiple intervention: group sessions + teach to use prompts/cues; 16 weeks, (n = 21) 

Clients met the dietitian every four weeks in small groups of five to seven clients. Clients were provided with one set of leaflets on each of their first four visits. These provided specific detailed advice on how to reduce their exposure to food cues by making a variety of changes in their habits, and were based on the cue avoidance programme and the food management programme. 

Group 4: single intervention: education (individual sessions with a dietitian); 16 weeks; (n = 20) 

Clients met the dietitian individually every four weeks.


OutcomesMeasurement of diet adherence: adherence to the diet allowance assessed by a diary (16 weeks)


NotesDietary advice: energy levels 1000 kCal below expected energy requirements, with a minimum of 1000 kCal/day

Drop-out rate: not known

Providers: dietitians

Four additional groups were included in this study. Since the clients in these groups did not complete a diary to assess adherence to dietary advice, these four groups were not described in the Cochrane review.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskSequence generation is not described explicitly in the paper.

Allocation concealment (selection bias)Unclear riskAllocation concealment is not described explicitly in the paper.

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
High riskPlausible effect size among missing outcomes enough to have a clinically-relevant impact on observed effect size.

Selective reporting (reporting bias)Unclear riskNo protocol.

Other biasUnclear riskBaseline comparisons between groups are not reported. Diet adherence is assessed by self-reported measure. Validation and reliability of self-reported diet adherence are not reported.


MethodsStudy design: randomized controlled trial with two intervention groups


ParticipantsSetting: outpatient

Country: United States

Chronic disease: non-insulin-dependent diabetes (management)

Type of participants: clients (n = 83)

Mean age: intervention group 1 (56.2 ± 16.0), intervention group 2 (60.2 ± 13.8)

Sex: intervention group 1 (F: 66.7%, M: 33.3%) and intervention group 2 (F: 70.7%, M: 29.3%)

Ethnicity: not known


InterventionsGroup 1: single intervention: education (educational tools - booklet); 3 weeks; (completers: n = 42) 

Clients assisted to three workshops at one week intervals during which a Colorado State University Diet Guide for Planning Prudent Diet, worksheets for planning and evaluating menus, leader's guide, and three slide-cassette tape programs on diabetes, using the diet guide and expanding the diet guide were provided. 

Group 2: single intervention: modelling (nutritional tools); 3 weeks; (completers: n = 41) 

Clients assisted to three workshops at one week intervals during which the exchange lists for meal planning was provided and used as the menu planning and evaluation tool. A slide-cassette tape program was also used to help teach the exchange lists.


OutcomesMeasurement of diet adherence: adherence to Recommended Dietary Allowances of the Food and Nutrition Board (energy, protein, vitamins (A, C, thiamine, riboflavin, niacin), and minerals (calcium, phosphorus, iron and zinc)) assessed by a three-day food record (baseline, 3 months, 6 months)


NotesDietary advice: prudent diet

Drop-out rate: not known

Providers: dietitian and senior author


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskSequence generation referring to a random number table.

Allocation concealment (selection bias)High riskAllocation concealment using an open random allocation schedule.

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Low risk"Food records were reviewed and blind coded for computer processing and analysis so that data analyzers were not aware of treatment group"

Incomplete outcome data (attrition bias)
All outcomes
High riskPlausible effect size among missing outcomes enough to have a clinically-relevant impact on observed effect size.

Selective reporting (reporting bias)High riskNo protocol. Diet adherence is not clearly defined.

Other biasUnclear riskBaseline balance between groups. Diet adherence is assessed by self-reported measure. Validation and reliability of self-reported diet adherence are not reported.


MethodsStudy design: randomized controlled trial with one intervention group and one usual care group


ParticipantsSetting: outpatient

Country: Finland

Chronic disease: non-insulin-dependent diabetes (management)

Type of participants: clients (n = 86)

Mean age: intervention (F: 53.7 ± 6.3, M: 50.7 ± 7.7), usual care (F: 54.4 ± 6.4, M: 54.0 ± 6.6)

Sex: intervention (F: 47.5%, M: 52.5%) and usual care (F: 39.1%, M: 60.9%)

Ethnicity: intervention and usual care groups (100% white)


InterventionsGroup 1: multiple intervention: individual session with a dietitian + nutritional tools + goal setting; 12 months; (n = 40) 

During each bimonthly visits, the clinical dietitians and the client set one or two clear short-term goals for dietary change and a goal for weight loss. A food preparation practice was also provided.                                                                                            

Group 2: usual care; duration: not known; (n = 46)


OutcomesMeasurement of diet adherence: adherence to total fat, saturated fat, unsaturated fat, carbohydrates, fiber and cholesterol intake assessed by a three-day food record (baseline, 3 months, 15 months)


NotesDietary advice: restricted energy, fat (especially saturated fatty acid) and dietary cholesterol intakes, increased unsaturated fatty acid and unrefined carbohydrate intakes and avoided large amounts of simple carbohydrates

Drop-out rate: 0% (calculated)

Providers: intervention: physician, nurse and clinical dietitian; usual care: physician and nurse


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskSequence generation referring to a random number table.

Allocation concealment (selection bias)Low riskAllocation concealment using sequentially numbered, opaque, sealed envelopes.

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
High riskThe proportion of missing outcomes compared with observed risk enough to induce clinically-relevant bias in intervention effect estimate.

Selective reporting (reporting bias)High riskNo protocol. Diet adherence is reported incompletely.

Other biasUnclear riskBaseline comparisons between groups are not reported. Diet adherence is assessed by self-reported measure. Validation and reliability of self-reported diet adherence are not reported.


MethodsStudy design: randomized controlled trial with two intervention groups


ParticipantsSetting: outpatient

Country: United Kingdom

Chronic disease: coronary heart disease (management)

Type of participants: clients (n = 40)

Mean age: intervention group 1 (57.7 ± 7.8), intervention group 2 (58.0 ± 9.2)

Sex: intervention group 1 (F: 19%, M: 81%) and intervention group 2 (F: 15.8%, M: 84.2%)

Ethnicity: not known


InterventionsGroup 1: single intervention: modelling (nutritional tools); 4 months; (n = 21) 

Clients received detailed information regarding the implementation of the Mediterranean diet and were provided with a diet sheet, which contained detailed advice and information on the Mediterranean diet, the potential health benefits of the diet, recipe ideas and a sample meal plan. Then, they received a home visit from the dietitian at week one and at months one, two and four. 

Group 2: single intervention: enablement (behavior change techniques: barrier identification/problem solving, goal setting); 4 months; (n = 19) 

Interventions were tailored to the individual, with personal specific advice and setting of short-and long-term goals based on their stage of change measure, which reflected their readiness to adopt a Mediterranean diet. Clients were provided a diet sheet and also a Help to change booklet, which contained a list of the common difficulties found when making dietary change, as well as suggestions for overcoming these. They received a home visit from the dietitian at week one and at months one, two and four.


OutcomesMeasurement of diet adherence: adherence to Mediterranean diet assessed by a validated questionnaire (baseline, 6 months, 12 months)


NotesDietary advice: seven to ten portions of fruit and vegetables/day, more whole grain cereals, more fish (four portions/week), less meat (approximately once/week), and butter and cream were replaced with an olive-oil based spread. The oils recommended for salads and food preparation were olive and rapeseed oils. Moderate alcohol consumption, in the form of wine, was allowed at meals. Patients were also advised to include unsalted nuts as snacks.

Drop-out rate: 15.5%

Provider: dietitian 

A usual care group was included in this study. Since the Mediterranean diet was not provided in the usual care group, this group was not described in the Cochrane review.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk"Willing participants (n = 61) were randomised (using a block randomisation approach with computer generated random numbers) …"

Allocation concealment (selection bias)High riskAllocation concealment using an open random allocation schedule (list of random numbers).

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
High riskPlausible effect size among missing outcomes enough to have a clinically-relevant impact on observed effect size.

Selective reporting (reporting bias)Unclear riskNo protocol.

Other biasLow riskBaseline balance between groups. Diet adherence is assessed by self-reported measure (validated questionnaire).


MethodsStudy design: randomized controlled trial with two intervention groups and one control group


ParticipantsSetting: outpatient

Country: United States

Chronic disease: coronary artery disease (management)

Type of participants: clients (n = 215)

Mean age: intervention group 1 (59.7 ± 8.5), intervention group 2: (63.1 ± 7.7), control (61.1 ± 8.7)

Sex: intervention group 1 (F: 14%, M: 86%), intervention group 2 (F: 11%, M: 89%) and control (F: 16%, M: 84%)

Ethnicity: intervention group 1 (81.5% White, 1.5% Asian, 13.8% Hispanic, 1.5% African American, 1.5% Other), intervention group 2 (82.7% White, 4% Asian, 10.7% Hispanic, 2.7% African American), control (85.3% White, 4% Asian, 10.7% Hispanic)


InterventionsGroup 1: single intervention: education (educational tools - video); once; (n = 65) 

Mastery tape was made to depict these clients as calm and confident at the time of release, as making steady progress with no mention of complications during the six months after surgery, and as adjusting to the recommended exercise and low-fat diet with relative ease. 

Group 2: multiple intervention: educational tools- video + relapse prevention/coping planning; once; (n = 75) 

Coping tape was edited so that the same clients mention concerns they are experiencing about hospital release and cope with effort but successfully with a variety of difficulties (e.g. heart rhythm disturbances, fatigue, diet changes) 

Group 3:control (no video); once; (n = 75)


OutcomesMeasurement of diet adherence: adherence to cholesterol and saturated fat-restricted diet assessed by the cholesterol-saturated fat subscale of the Diet Habit Survey (1 month - 3 months)


NotesDietary advice: low-cholesterol and low-fat diet

Drop-out rate: 9%

Provider: cardiothoracic nurse specialist


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskSequence generation referring to a random number table.

Allocation concealment (selection bias)Low riskAllocation concealment using sequentially numbered, opaque, sealed envelopes.

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInsufficient reporting of attrition to permit judgement.

Selective reporting (reporting bias)Unclear riskNo protocol.

Other biasUnclear riskBaseline comparisons between groups are not reported. Diet adherence is assessed by self-reported measure (validated Diet Habit Survey).


MethodsStudy design: randomized controlled trial with two intervention groups and one usual care group


ParticipantsSetting: outpatient

Country: United Kingdom

Chronic disease: insulin dependent diabetes (management)

Type of participants: clients (n = 40)

Mean age: intervention group 1 (31.6 ± 8.3), intervention group 2 (36.5 ± 15.3), usual care (35.6 ± 10.4)

Sex: intervention group 1 (F: 38.5%, M: 61.5%), intervention group 2 (F: 46.2%, M: 53.8%) and usual care (F: 42.9%, M: 57.1%)

Ethnicity: not known


InterventionsGroup 1: single intervention: modelling (nutritional tools); 6 months; (n = 13) 

Clients had individual assessment, dietary pamphlet containing 10 g carbohydrate exchange lists and were asked to come three times to the hospital canteen in groups of four or five where they had lunch with both dietitian and doctor. Participants were asked to help themselves to a variety of hot and cold dishes and to make up their carbohydrate allowance to what had been prescribed for them previously. After lunch they were shown a display of other items of food so that they could see and feel exactly how much of each item did in fact contain 10 g carbohydrate. 

Group 2: single intervention: education (education tools - video); 6 months; (n = 13) 

Clients had individual assessment and a dietary pamphlet containing 10 g carbohydrate exchange lists and viewed a 24 minutes videotape. This was viewed on three separate occasions while sitting in an armchair in a quiet room, and without dietitian or doctor being present. The videotape began with an explanation of the importance of eating a balanced diet and maintaining a consistent carbohydrate profile. It then took the viewer through a day in the life of two insulin treated patients with very different dietary requirements and lifestyles. It ended by suggesting that the viewer should try to work out his or her own carbohydrate profile with the dietitian's help. 

Group 3: usual care: no lunchtime nor video; 6 months; (n = 14) 

Clients were assessed by a dietitian and received individual instructions about what carbohydrate distribution would be appropriate for them. In addition to a pamphlet containing 10 g exchange lists they were given simple menus to emphasize the carbohydrate profile they should stick to from day to day. Clients were seen for dietary instruction three times.


OutcomesMeasurement of diet adherence: adherence to day to day consistency in carbohydrate intake assessed by a seven-day food record (baseline, 6 months)


NotesDietary advice: an appropriate total daily intake of carbohydrate was determined jointly by the client and dietitian. This was then broken down into 10 g carbohydrate exchanges. Clients were asked to keep to an agreed distribution of carbohydrate exchanges in the form of three main meals and three snacks.

Drop-out rate: not known

Providers: dietitian and doctor


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskSequence generation is not described explicitly in the paper.

Allocation concealment (selection bias)Unclear riskAllocation concealment is not described explicitly in the paper.

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
Low riskMissing outcome data balanced in numbers across intervention groups, with similar reasons for missing data across groups.

Selective reporting (reporting bias)Unclear riskNo protocol.

Other biasUnclear riskBaseline balance between groups. Diet adherence is assessed by self-reported measure. Validation and reliability of self-reported diet adherence are not reported.


MethodsStudy design: randomized controlled trial with one intervention group and one control group


ParticipantsSetting: outpatient

Country: Norway

Chronic disease: hypertension (management)

Type of participants: clients (n = 34)

Mean age: intervention (53), control (52)

Sex: intervention (F: 37%, M: 63%) and control (F: 47%, M: 53%)

Ethnicity: intervention and control groups: 100% Caucasian


InterventionsGroup 1: single intervention: training (feedback); 12 weeks; (n = 15) 

Clients measured their fasting morning chloride concentration on six different occasions during the trial. A recommendation of 30 to 50% reduction of urine chloride concentration compared with the initial value at the inclusion visit was set. 

Group 2: control (no self-monitoring); 1 month: (n = 19)


OutcomesMeasurement of diet adherence: adherence to sodium-restricted diet assessed by urine sodium excretion (baseline, 1 month, 3 months)


NotesDietary advice: fresh fish and meat should be preferred for dinner (canned, salted or smoked food is only rarely allowed), fruit and vegetables should be used plentifully, boil potatoes without salt, salt should not be used during food processing, spices and herbs should be used plentifully, lemon juice adds flavour to your food, roasting your food in the oven or microwave conserves its natural flavours, when frying, use oil instead of butter, ask for salt-reduced soups or sauces, for baking bread, use 1 teaspoon salt/litre of liquid.

Drop-out rate: 0%

Provider: general practitioner


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskSequence generation referring to a random number table.

Allocation concealment (selection bias)Low riskAllocation concealment using sequentially numbered, opaque, sealed envelopes.

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
Low riskNo missing data.

Selective reporting (reporting bias)High riskNo protocol. Some outcomes of interest are reported incompletely (weight and HDL-cholesterol).

Other biasUnclear riskBaseline comparisons between groups are not reported. Diet adherence is assessed by objective measure.


MethodsStudy design: randomized controlled trial with one intervention group and one control group


ParticipantsSetting: research center

Country: United States

Chronic disease: overweight and obesity (prevention and management)

Type of participants: clients (n = 123)

Mean age: intervention (47.1 ± 11.1),control (46.5 ± 10.7)

Sex: intervention (F: 89%, M: 12%) and control (F: 77%, M: 23%)

Ethnicity: intervention(100% White, 0% Black), control (98% White, 2% Black)


InterventionsGroup 1: single intervention: education (individual session with a dietitian); 12 months; (n = 61) 

Monthly, clients attended an in-person meeting in place of an online chat. 

Group 2: control (online chat without in-person meeting); 12 months; (n = 62)


OutcomesMeasurement of diet adherence: adherence to energy intake assessed by the Block 98.2 food frequency questionnaire (baseline, 6 months, 12 months)


NotesDietary advice: 1200 to 2100 calorie diet based on baseline body weight, eating a diet abundant in fruit, vegetables and whole grains and moderate in fat, sugar, salt, and alcohol

Drop-out rate: 21%

Providers: dietitian and master's level graduate student


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskSequence generation is not described explicitly in the paper.

Allocation concealment (selection bias)Unclear riskAllocation concealment is not described explicitly in the paper.

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInsufficient reporting of attrition to permit judgement.

Selective reporting (reporting bias)High riskNo protocol. Weekly goals met (calories) is reported incompletely.

Other biasUnclear riskBaseline imbalance between groups (body weight) but repeated measures analysis of covariance was performed to control for baseline weight differences. Diet adherence is assessed by self-reported measure. Validation and reliability of self-reported diet adherence are not reported.


MethodsStudy design: randomized controlled trial with one intervention group and one control group


ParticipantsSetting: outpatient

Country: United States

Chronic disease: myocardial infarction (management)

Type of participants: clients (n = 115)

Mean age: intervention and control groups: 54

Sex: intervention (F: 27%, M: 73%) and control (F: 11%, M: 89%)

Ethnicity: intervention (98% White, 2% Black), control (87% White, 13% Black)


InterventionsGroup 1: multiple intervention: individual session with nurse + barrier identification/problem solving, goal setting; 60 days; (n = 58) 

Clients completed a cardiac rehabilitation program during hospitalization and were visited at home 30 days after discharge. The intervention included a discussion of assessment data, identification of problems and establishment of goals. 

Group 2: control (no nurse intervention); duration: not known; (n = 57)


OutcomesMeasurement of diet adherence: adherence to diet assessed by the Health Behavior scale (Baseline, 30 days, 60 days, 1 year, 2 years)


NotesDietary advice: not known

Drop-out rate: 55.7% (calculated)

Providers: cardiovascular nurses


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskSequence generation is not described explicitly in the paper.

Allocation concealment (selection bias)High risk"During hospitalization, 115 subjects were alternately assigned to an experimental (n = 58) or control group (n = 57)."

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
High riskPlausible effect size among missing outcomes enough to have a clinically-relevant impact on observed effect size.

Selective reporting (reporting bias)High riskNo protocol. Some outcomes of interest in the review are reported incompletely (weight, blood pressure).

Other biasLow riskBaseline balance between groups. Diet adherence is assessed by self-reported measure (validated Health Behavior scale).


MethodsStudy design: randomized controlled trial with one intervention group and one control group


ParticipantsSetting: outpatient

Country: United Kingdom

Chronic disease: end-stage kidney failure (management)

Type of participants: clients (n = 67)

Mean age: intervention (60.4 ± 15.6), control (54.9 ± 15.9)

Sex: intervention (F: 26.5%, M: 73.5%) and control (F: 48.5%, M: 51.5%)

Ethnicity: intervention (52.9% White, 20.6% Indo-Asian, 14.7% Black, 11.8% Other), control (48.5% White, 15.2% Asian, 30.3% Black, 6.1% Other)


InterventionsGroup 1: multiple intervention: individual session with dietitian + educational tools-booklet + reminder + motivational interviewing; 6 months; (n = 34) 

Clients received a monthly dietetic consultation. A variety of strategies were employed to encourage dietary modification including motivational counseling, negotiation, behaviour modification therapy, reminders, reinforcement, supportive care and written and verbal education. 

Group 2: control (no dietetic consultation); once; (n = 33)


OutcomesMeasurement of diet adherence: adherence to phosphate-restricted diet assessed by serum phosphate concentrations (baseline, 3 months, 6 months, 12 months).


NotesDietary advice: phosphate-restricted diet

Drop-out rate: 1.5% (calculated)

Provider: dietitian


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk"Random number generation".

Allocation concealment (selection bias)Unclear riskAllocation concealment is not described explicitly in the paper.

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
Low riskMissing outcomes are balanced between groups and the proportion of missing outcomes compared with observed event risk not enough to have a clinically-relevant impact on the intervention effect estimate.

Selective reporting (reporting bias)High riskNo protocol. Achieving target phosphate (at 6 months) is reported incompletely.

Other biasLow riskBaseline balance between groups . Diet adherence is assessed by objective measure.


MethodsStudy design: randomized controlled trial with one intervention group and one control group


ParticipantsSetting: outpatient

Country: United States

Chronic disease: peripheral artery disease (management)

Type of participants: clients (n = 21)

Mean age: intervention (53), control (49)

Sex: intervention (F: 27.3%, M: 72.7%) and control (F: 20%, M: 80%)

Ethnicity: not known


InterventionsGroup 1: single intervention: education (telephone follow-up); 12 months; (n = 11) 

Clients received quarterly a telephone call to reinforce smoking cessation and diet information.

Group 2: control (no telephone follow-up); once; (n = 10)


OutcomesMeasurement of diet adherence: adherence assessment not known


NotesDietary advice: not known

Drop-out rate: 0% (calculated)

Providers: advanced practice nurses and physicians


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskSequence generation is not described explicitly in the paper.

Allocation concealment (selection bias)Unclear riskAllocation concealment is not described explicitly in the paper.

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
Low riskOnly one missing data. The reason for this missing data not likely related to true outcome.

Selective reporting (reporting bias)High riskNo protocol. Diet adherence is reported incompletely.

Other biasUnclear riskBaseline comparisons between groups are not reported. Diet adherence is not clearly defined.


MethodsStudy design: randomized controlled trial with two intervention groups and one control group


ParticipantsSetting: outpatient

Country: Canada

Chronic disease: type II diabetes (management)

Type of participants: clients (n = 75)

Mean age: intervention group 1 (56.6 ± 8.0), intervention group 2 (57.5 ± 10.7), control (54.7 ± 14.1)

Sex: intervention group 1 (F: 50%, M: 50%), intervention group 2 (F: 45.8%, M: 54.2%) and control (F: 63.4%, M: 36.6%)

Ethnicity: not known


InterventionsGroup 1: single intervention: persuasion (reminder); 6 months; (n = 18) 

Knowledge and self-care practice, which serve as a reminder, were assessed at 2 weeks, 3 months and 6 months. 

Group 2: single intervention: persuasion (reminder); 6 months; (n = 24) 

Knowledge and self-care practice, which serve as a reminder, were assessed at 3 months and 6 months. 

Group 3: control (no reminder); 6 months; (n = 33)


OutcomesMeasurement of diet adherence: adherence to frequency of meals and snacks assessed by a simple question of frequency of meals and snacks (Baseline, 4 days, 2 weeks, 3 months, 6 months)


NotesDietary advice: eating 3 meals and 3 snacks/day

Drop-out rate: 0%

Providers: nurses, dietitians, physicians, exercise physiologist, podiatrist, ophthalmologist 

A second control group was included in this study. Since this control group was not randomized, this group was not described in the Cochrane review.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskSequence generated by shuffling cards or envelopes.

Allocation concealment (selection bias)Unclear riskAllocation concealment is not described explicitly in the paper.

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
Low riskNo missing data.

Selective reporting (reporting bias)High riskNo protocol. Some outcomes of interest in the review are reported incompletely (diet adherence, exercise, glucose monitoring and weight).

Other biasHigh riskBaseline imbalance between groups (percentage of males, body mass index). Diet adherence is assessed by self-reported measure. Validation and reliability of self-reported diet adherence are not reported. Some patients attending the program gave kind donation.


MethodsStudy design: randomized controlled trial with one intervention group and one control group


ParticipantsSetting: outpatient

Country: United States

Chronic disease: hypertension (management)

Type of participants: clients (n = 27)

Mean age: not described

Sex: intervention and control groups (F: 100%)

Ethnicity: intervention (7 Caucasian, 6 Minority), control (7 Caucasian, 7 Minority)


InterventionsGroup 1: single intervention: modelling (nutritional tools); 30 days; (n = 13) 

Clients were exposed to a Cognitive Representations of the Dietary Approaches to Stop Hypertension (DASH) diet program consisting in three separate paper wheels (knowledge dimension, attitude dimension and skill dimension) and a bar chart displaying their baseline Cognitive Representations of the DASH diet.  All three wheels contained the same set of 18 goals. For each goal, each wheel contained one message framed to support that goal in the information dimension of that wheel. Clients were  instructed to do the following every morning for a 30-day period: review an unhealthy Cognitive Representations of the DASH diet from her bar chart, use the wheels to view the three messages for that goal, and record in the notebook the feelings and thoughts she has about the goal she selected. 

Group 2: control (no wheel nor bar chart); 30 days; (n = 14)


OutcomesMeasurement of diet adherence: adherence to DASH diet assessed by the Health Promotion Lifestyle Profile survey (baseline, 30 days, 60 days, 90 days)


NotesDietary advice: DASH diet

Drop-out rate: not known

Providers: not known 

Two control groups were included in this study. Since patients in these control groups did not follow the DASH diet, these control groups were not described in the Cochrane review.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk"Then, researchers used a computer program to randomise participants".

Allocation concealment (selection bias)Unclear risk"Group assignment was determined in numerical sequence from 48 numbered envelopes matching the stratified sampling criteria representative of a Salomon Four-Group Design."

Blinding (performance bias and detection bias)
Participants
Low risk"(…) study participants were unaware of their group assignments".

Blinding (performance bias and detection bias)
Providers
High risk"Because researchers provided one of the experimental groups, but not either control group, (...) the study was not blinded to the researchers".

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskInsufficient reporting of attrition to permit judgement

Selective reporting (reporting bias)Unclear riskNo protocol.

Other biasLow riskBaseline balance between groups. Diet adherence is assessed by self-reported measure (Health Promotion Lifestyle Profile survey). Internal consistency of Health Promotion Lifestyle Profile survey described.


MethodsStudy design: randomized controlled trial with one intervention group and one control group


ParticipantsSetting: outpatient

Country: South Africa

Chronic disease: hypertension (management)

Type of participants: clients (n = 83)

Mean age: intervention (56.3 ± 11.5), control (58.6 ± 11.2)

Sex: intervention (F: 70.7%, M: 29.3%) and control (F: 66.7%, M: 33.3%)

Ethnicity: intervention (26.8% Black, 41.5% Coloured-mixed, 14.6% Indians, 17.1% White), control (14.3% Black, 54.8% Coloured-mixed, 23.8% Indians, 7.1% White


InterventionsGroup 1: single intervention: education (telephone follow-up); 24 weeks; (n = 41) 

Clients received monthly a telephone call to provide support. 

Group 2: control (no telephone follow-up); 24 weeks; (n = 42)


OutcomesMeasurement of diet adherence: non-adherence to alcohol intake and adherence to sodium-restricted diet assessed by a yes/no question (baseline, 24 weeks, 36 weeks)


NotesDietary advice: prudent diet

Drop-out rate: 63.9% (calculated)

Provider: physiotherapist


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskSequence generated by drawing of lots (clear or colored balls from a closed bag).

Allocation concealment (selection bias)Low riskAllocation concealment using central allocation.

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Low risk"The first author and a research assistant undertook all reassessments. Neither the first author nor the research assistant had been involved in the intervention and they were blinded to the data obtained at baseline and to which groups the patients belonged."

Incomplete outcome data (attrition bias)
All outcomes
High riskThe proportion of missing outcomes compared with observed risk enough to induce clinically-relevant bias in intervention effect estimate.

Selective reporting (reporting bias)High riskNo protocol. Blood pressure is reported incompletely.

Other biasHigh riskBaseline imbalance between groups (alcohol adherence). Diet adherence is assessed by self-reported measures. Validation and reliability of self-reported diet adherence are not reported.


MethodsStudy design: randomized controlled trial with one intervention group and one usual care group


ParticipantsSetting: outpatient

Country: Taiwan

Chronic disease: end-stage renal disease (management)

Type of participants: clients (n = 64)

Mean age: intervention (57.51 ± 11.41), usual care (57.94 ± 11.62)

Sex: intervention and usual care groups (F: 58.1%, M: 41.9%)

Ethnicity: not known


InterventionsGroup 1: multiple intervention: stress management, goal setting + feedback; 4 weeks; (n = 32) 

The program consisted of 12 sessions conducted three times per week while clients were receiving dialysis. Clients learned to relax muscles through listening to audiotaped instructions. Clients were encouraged to set attainable objectives such as ‘decreasing a cup of tea or water a day'. If the goals were achieved, praise and recognition rewards were given. Individual counselling sessions were offered stressing physical and emotional adjustment to the chronic illness. Clients recorded their food and liquid intake daily, and these records were reviewed during each treatment. 

Group 2: usual care; duration: not known; (n = 32)


OutcomesMeasurement of diet adherence: adherence to fluid-restricted diet assessed by mean weight gains between dialysis sessions (baseline, 1 month, 3 months, 6 months)


NotesDietary advice: fluid-restricted diet

Drop-out rate: 3.1% (calculated)

Providers: nephrology nurse specialists, physicians, dietitians, social workers


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskSequence generation is not described explicitly in the paper.

Allocation concealment (selection bias)Unclear riskAllocation concealment is not described explicitly in the paper.

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Low risk"Only the researcher knew which treatment patients were receiving, and care providers were not informed of participant's treatment group."

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
Low riskPlausible effect size among missing outcomes not enough to have a clinically-relevant impact on observed effect size.

Selective reporting (reporting bias)Unclear riskNo protocol.

Other biasLow riskBaseline imbalance for body weight change but baseline differences in weight gain between groups were taken into account in the repeated-measured analysis by using the baseline values as a covariate. Diet adherence is assessed by objective measure.


MethodsStudy design: randomized controlled trial with one intervention group and one control group


ParticipantsSetting: outpatient

Country: China

Chronic disease: renal failure (management)

Type of participants: clients (n = 120)

Mean age: intervention and control groups (62.4)

Sex: intervention and control groups (F: 46.9%, M: 53.1%)

Ethnicity: not known


InterventionsGroup 1: multiple intervention: telephone follow-up + goal setting; 6 weeks; (n = 60) 

Clients received a weekly telephone call consisting to monitoring changes from the specific health concerns identified in the previous interaction, monitoring progress, providing health advice, reinforcing health self-management behaviours, and assessing need for referral and reviewing the health goals with the patient and setting mutual goals 

Group 2: control (no telephone follow-up); duration: not known; (n = 60)


OutcomesMeasurement of diet adherence: non-adherence to diet and fluid-restricted diet assessed by dialysis diet and fluid non-adherence questionnaire (baseline, 7 weeks, 13 weeks)


NotesDietary advice: dialysis diet and fluid-restricted diet

Drop-out rate: 18.3% (calculated)

Providers: renal nurses and general nurses


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk"120 sets of computer-generated random numbers were used, and patients who fitted the criteria were randomised to the study or control group."

Allocation concealment (selection bias)Unclear riskAllocation concealment is not described explicitly in the paper.

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
High riskPlausible effect size among missing outcomes enough to have a clinically-relevant impact on observed effect size.

Selective reporting (reporting bias)High riskNo protocol. Some outcomes of interest in the review are reported incompletely (blood glucose, HDL-cholesterol, triglyceride).

Other biasLow riskBaseline balance between groups. Diet adherence is assessed by self-reported measure (validated questionnaire).


MethodsStudy design: cluster-randomized controlled trial with two populations including one intervention group and one usual care group each

Two populations were studied in this study: clients with coronary heart disease (population 1) and clients at high risk of cardiovascular disease (population 2).


ParticipantsSetting:

  • Population 1: outpatient


  • Population 2: outpatient


Country:

  • Population1: France, Italy, Poland, Spain, Sweden, United Kingdom


  • Population2: Denmark, Italy, Poland, Spain, Netherlands, United Kingdom


Chronic disease:

  • Population 1: coronary heart disease (management)


  • Population 2: high risk of coronary heart disease (prevention)


Type of participants:

  • Population 1: clients (n = 3088)


  • Population 2: clients (n = 2317)


Mean age:

  • Population 1: intervention (62.5 ± 9.9), usual care (63.0 ± 9.6)


  • Population 2: intervention (62.0 ± 7.6), usual care (62.8 ± 7.3)


Sex:

  • Population 1: intervention (F: 30%, M: 70%) and usual care (F: 30%, M: 70%)


  • Population 2: intervention (F: 50%, M: 50%) and usual care (F: 43%, M: 57%)  


Ethnicity: not known


InterventionsPopulation 1 :

Group 1: multiple intervention: individual session with nurse + motivational interviewing; (n = 1589) 

Clients and their partners attended at least eight weekly sessions with multidisciplinary team using stages of change and motivational interviews. Clients were provided with a personal record card for lifestyle and risk factor targets. Nurses also coordinated a rolling program of eight weekly workshops for coronary heart disease, cardiovascular risk (lifestyle and risk factors control), cardioprotective medication and return to work and leisure. 

Group 2: usual care; duration: not known; (n = 1499) 

Population 2:

Group 1: multiple intervention: individual session with nurse + motivational interviewing; (n = 1189) 

Clients and their partners attended at least eight weekly sessions with nurse and the family doctor using stages of changes and motivational interviews. Clients were provided with a personal record card for lifestyle and risk factor targets. Nurses also coordinated a rolling program of eight weekly workshops for lifestyle and risk factors. 

Group 2: usual care; duration: not known; (n = 1128)


OutcomesMeasurement of diet adherence: adherence to saturated fat, oily fish, fish, and fruit and vegetables intake assessed by a food-habit questionnaire (baseline, 1 year)


NotesDietary advice: < 10% of energy from saturated fat, > 400 g/day of fruit and vegetables, > 20 g/day of fish, > 3 times/week of oily fish, < 30 g/day of alcohol

Drop-out rate: not known

Providers:

  • Population 1: nurses, dietitians, physiotherapists, cardiologists


  • Population 2: nurses, family doctors


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskSequence generation is not described explicitly in the paper.

Allocation concealment (selection bias)Unclear riskAllocation concealment is not described explicitly in the paper.

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Unclear riskThis study did not assess this item.

Incomplete outcome data (attrition bias)
All outcomes
High riskThe proportion of missing outcomes compared with observed risk enough to induce clinically-relevant bias in intervention effect estimate.

Selective reporting (reporting bias)High riskNo protocol. Some outcomes of interest in the review are reported incompletely (HDL-cholesterol, triglyceride).

Other biasUnclear riskBaseline comparisons between groups are not reported. Diet adherence is assessed by self-reported measure (validated food habit questionnaire).


MethodsStudy design: randomized controlled trial with one intervention group and one usual care group


ParticipantsSetting: outpatient

Country: China

Chronic disease: coronary heart disease (management)

Type of participants: clients (n = 220)

Mean age: intervention (72.9 ± 6.4), usual care (71.6 ± 4.1)

Sex: intervention (F: 49%, M: 51%) and usual care (F: 53%, M: 47%)

Ethnicity: not known


InterventionsGroup 1: multiple intervention: telephone follow-up + individual session with a nurse + goal setting; 4 weeks; (n = 107) 

Nurse provided one home visit on the second day after discharge and another in the third week and made two telephone calls in the second and fourth weeks. Nurse set goals with the clients and assessed whether the clients achieved them. 

Group 2: usual care (no visit nor telephone follow-up) ; duration: not known; (n = 113)


OutcomesMeasurement of diet adherence: adherence to diet assessed by a seven-day recall questionnaire (baseline, 4 weeks, 12 weeks)


NotesDietary advice: not known

Drop-out rate: 9.1% (calculated)

Providers: nurses


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk"The patients who agreed to participate would be assigned to the study or control group using a computer-generated randomised table, with a computer number "0" belonged to the control group and "1" the study group."

Allocation concealment (selection bias)Low risk"...the head nurse asked the eligible patients to draw sealed envelop that contained a slip indicating the group the patient be entered..."

Blinding (performance bias and detection bias)
Participants
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Providers
Unclear riskThis study did not assess this item.

Blinding (performance bias and detection bias)
Outcome assessors
Low risk"The measurement team was blinded of which group the subjects were in."

Incomplete outcome data (attrition bias)
All outcomes
Low riskMissing outcome data balanced in numbers across intervention groups, with similar reasons for missing data across groups.

Selective reporting (reporting bias)Unclear riskNo protocol.

Other biasHigh riskBaseline imbalance between groups (number of chronic diseases). Diet adherence is assessed by self-reported measure (validated 7-day recall questionnaire).

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Abramson 1980No measure of adherence outcome.

Agras 1996Provision of meals, food items or dietary supplements.

Ammerman 2003No measure of adherence outcome.

Arnaud-Battandier 1999Provision of meals, food items or dietary supplements.

Ashurst 2003Interventions had not the same dietary advice component.

Atwood 1992Interventions had not the same dietary advice component.

Babamoto 2009No measure of adherence outcome.

Basler 1982No measure of adherence outcome.

Baum 1991No measure of adherence outcome.

Befort 2008No measure of adherence outcome.

Berra 2007No measure of adherence outcome.

Berteus 2008Interventions had not the same dietary advice component.

Bertram 1990Intervention not intended to improve diet adherence.

Boeka 2010No measure of adherence outcome.

Borg 2002No measure of adherence outcome.

Bosworth 2008No measure of adherence outcome.

Brekke 2003No measure of adherence outcome.

Brekke 2005aNo measure of adherence outcome.

Brekke 2005bNo measure of adherence outcome.

Brekke 2009No measure of adherence outcome.

Broekhuizen 2010No measure of adherence outcome.

Bruckert 2008Interventions had not the same dietary advice component.

Burke 2005Interventions had not the same dietary advice component.

Burke 2006aNo measure of adherence outcome.

Burke 2006bNo measure of adherence outcome.

Burke 2007No measure of adherence outcome.

Burke 2008No measure of adherence outcome.

Burke 2010No measure of adherence outcome.

Burkett 1990No measure of adherence outcome.

Campbell 1984No measure of adherence outcome.

Campbell 1990Interventions had not the same dietary advice component.

Campbell 1998Interventions had not the same dietary advice component.

Cangiano 1991Provision of meals, food items or dietary supplements.

Cangiano 1992Provision of meals, food items or dietary supplements.

Cangiano 1998Provision of meals, food items or dietary supplements.

Carels 2005Interventions had not the same dietary advice component.

Carels 2005aInterventions had not the same dietary advice component.

Carson 1988No measure of adherence outcome.

Casebeer 1999No measure of adherence outcome.

Cegala 2000No measure of adherence outcome.

Chang 2009No measure of adherence outcome.

Cheyette 2007No measure of adherence outcome.

Chlebowski 1993Interventions had not the same dietary advice component.

Costa 2008No measure of adherence outcome.

Darlington 1986No measure of adherence outcome.

Davidson 1996Provision of meals, food items or dietary supplements.

De Zwaan 2005Provision of meals, food items or dietary supplements.

Dechamps 2009No measure of adherence outcome.

Del 2009Provision of meals, food items or dietary supplements.

Demark-Wahnefried 2006Interventions had not the same dietary advice component.

Dennis 2001No measure of adherence outcome.

Digenio 2009Interventions had not the same dietary advice component.

Domenech 1995Interventions had not the same dietary advice component.

Donnelly 2003Provision of meals, food items or dietary supplements.

Dyson 1997No measure of adherence outcome.

Eriksson 2009No measure of adherence outcome.

Evers 1987Interventions had not the same dietary advice component.

Farmer 2009No measure of adherence outcome.

Fehily 1991Interventions had not the same dietary advice component.

Ferrante 2010Interventions had not the same dietary advice component.

Fitzgibbon 2005No measure of adherence outcome.

Forget 1990Provision of meals, food items or dietary supplements.

Forli 2001Provision of meals, food items or dietary supplements.

Forrester 2010Interventions had not the same dietary advice component.

Fox 1996No measure of adherence outcome.

Frohling 1990Provision of meals, food items or dietary supplements.

Frost 2007Interventions had not the same dietary advice component.

Fuchs 1993No measure of adherence outcome.

Glasgow 2003No measure of adherence outcome.

Gorin 2010No measure of adherence outcome.

Grancelli 2003Interventions had not the same dietary advice component.

Greene 1977No measure of adherence outcome.

Hakala 1993Provision of meals, food items or dietary supplements.

Hartwell 1986No measure of adherence outcome.

Harvey-Berino 2004No measure of adherence outcome.

Harvey-Berino 2009No measure of adherence outcome.

Hebert 2001Interventions had not the same dietary advice component.

Henkin 2000Interventions had not the same dietary advice component.

Heraief 1985Provision of meals, food items or dietary supplements.

Hyman 1998No measure of adherence outcome.

Jolly 1998No measure of adherence outcome.

Jolly 2007No measure of adherence outcome.

Jones 2003No measure of adherence outcome.

Jula 1990Interventions had not the same dietary advice component.

Kaiman 2000Provision of meals, food items or dietary supplements.

Kalodner 1991Interventions had not the same dietary advice component.

Kalter-Leibovici 2010No measure of adherence outcome.

Kattelmann 2009Interventions had not the same dietary advice component.

Khoo 2007Provision of meals, food items or dietary supplements.

Kim 2006No measure of adherence outcome.

Kirkman 1994Interventions had not the same dietary advice component.

Koelewijn-van Loon 2009Interventions had not the same dietary advice component.

Korhonen 1983No measure of adherence outcome.

Korhonen 2003No measure of adherence outcome.

Krier 1999Interventions had not the same dietary advice component.

Kumanyika 1993Interventions had not the same dietary advice component.

Lampman 1977Interventions had not the same dietary advice component.

Laws 2004No measure of adherence outcome.

Leermakers 1999Intervention not intended to improve diet adherence

Lesley 2007No measure of adherence outcome.

Lindahl 2009Not a real-life setting.

Locatelli 1990Interventions had not the same dietary advice component.

Lopez 2006No measure of adherence outcome.

Manchanda 2000Interventions had not the same dietary advice component.

Mathus-Vliegen 1993Intervention not intended to improve diet adherence

McCarron 1998Provision of meals, food items or dietary supplements.

McConnon 2007No measure of adherence outcome.

McConnon 2009No measure of adherence outcome.

Melchionda 2006No measure of adherence outcome.

Melin 2003Not a real-life setting.

Metz 1997Provision of meals, food items or dietary supplements.

Metz 2000Provision of meals, food items or dietary supplements.

Mhurchu 1998No measure of adherence outcome.

Milas 1995Interventions had not the same dietary advice component.

Miller 2009Interventions had not the same dietary advice component.

Morgan 2009No measure of adherence outcome.

Nir 2004Interventions had not the same dietary advice component.

Nugent 1984No measure of adherence outcome.

Oldroyd 2006Interventions had not the same dietary advice component.

Ornish 1998Interventions had not the same dietary advice component.

Pater 2000No measure of adherence outcome.

Pettman 2008No measure of adherence outcome.

Pierce 1997Interventions had not the same dietary advice component.

Pierce 2002Interventions had not the same dietary advice component.

Pierce 2007Interventions had not the same dietary advice component.

Pijls 2000Interventions had not the same dietary advice component.

Pringle 1993No measure of adherence outcome.

Rabkin 1983No measure of adherence outcome.

Racette 1995Interventions had not the same dietary advice component.

Rallidis 2009Provision of meals, food items or dietary supplements.

Rhew 2007Study did not involve a nutritional intervention

Rimmer 2000No measure of adherence outcome.

Robertson 1992No measure of adherence outcome.

Rosman 1989Interventions had not the same dietary advice component.

Rosman 1990Interventions had not the same dietary advice component.

Roumen 2008No measure of adherence outcome.

Sadur 1999No measure of adherence outcome.

Sartorio 2003No measure of adherence outcome.

Schapira 1991No measure of adherence outcome.

Sevick 2008Interventions had not the same dietary advice component.

Shaw-Stuart 2000No measure of adherence outcome.

Singh 1991Interventions had not the same dietary advice component.

Singh 1992Interventions had not the same dietary advice component.

Sisk 2006No measure of adherence outcome.

Smith 1997No measure of adherence outcome.

Sone 2010No measure of adherence outcome.

Southard 2003No measure of adherence outcome.

Sperduto 1986No measure of adherence outcome.

Thoolen 2009No measure of adherence outcome.

Tilley 1997No measure of adherence outcome.

Toobert 1998Interventions had not the same dietary advice component.

Toobert 2000Interventions had not the same dietary advice component.

Torgerson 1999Provision of meals, food items or dietary supplements.

Tsang 2001No measure of adherence outcome.

Vale 2003Interventions had not the same dietary advice component.

van der Weijden 1998Interventions had not the same dietary advice component.

van Gool 2006Interventions had not the same dietary advice component.

Verges 1998No measure of adherence outcome.

Voils 2009No measure of adherence outcome.

von Gruenigen 2008No measure of adherence outcome.

Wadden 1997No measure of adherence outcome.

Wadden 2009Provision of meals, food items or dietary supplements.

Webber 2010No measure of adherence outcome.

Wing 1986No measure of adherence outcome.

Wing 1996No measure of adherence outcome.

Wing 1999No measure of adherence outcome.

Wing 2003Intervention not intended to improve diet adherence.

Witmer 2004No measure of adherence outcome.

Wright 1981No measure of adherence outcome.

Zismer 1982No measure of adherence outcome.

 
Characteristics of studies awaiting assessment [ordered by study ID]

MethodsStudy design: not known

ParticipantsSetting: not known

Country: Canada

Chronic disease: not known

Type of participants: clients

InterventionsThe intervention Community Cardiovascular Hearts in Motion is a multidisciplinary, multi-vascular program combining nutrition intervention, weekly exercise, and risk factor management including motivational interviewing and behaviour change techniques.

OutcomesMeasurement of diet adherence: not known

NotesDietary advice: not known

Provider: dietitian 

No response to attempted contact with author.


MethodsStudy design: randomized controlled trial with one intervention group and one usual care group.

ParticipantsSetting: not known

Country: Italy

Chronic disease: obesity (management)

Type of participants: clients

InterventionsThe study compared an intervention using a psychological therapy combined with the usual diet treatment with an usual care group receiving only the usual diet.

OutcomesMeasurement of diet adherence: adherence to diet

NotesDietary advice: not known

Provider: not known

The study was published in Italian and only the abstract was available in English.


MethodsStudy design: randomized controlled trial with one intervention group and one usual care group.

ParticipantsSetting: outpatient

Country: United Kingdom

Chronic disease: type II diabetes (management)

Type of participants: clients

InterventionsA brief, tailored lifestyle self-management intervention including assessment, clients’ participation in goal setting, selection of personalized strategies to overcome barriers.

OutcomesMeasurement of diet adherence: adherence to fat restriction assessed by the Kristal Food Habits Questionnaire and the Block Fat Screener

NotesDietary advice: not known

Provider: not known 

The corresponding author was contacted in order to have more information about the dietary advice provided in both groups. However, no response to attempted contact with author.


MethodsStudy design: not known

ParticipantsSetting: not known

Country: not known

Chronic disease: not known

Type of participants: not known

InterventionsNot known

OutcomesMeasurement of diet adherence: not known

NotesDiet: not known

Provider: not known 

Abstract unobtainable.


MethodsStudy design: randomized controlled trial with one intervention group and one control group.

ParticipantsSetting: not known

Country: United States

Chronic disease: congestive heart failure (management)

Type of participants: clients

InterventionsA behavioural intervention consisting of feedback on the three-day sodium intake of the clients and a discussion of problem-solving strategies to reduce future sodium intake was compared to a control group. Both groups received the usual dietary education class.

OutcomesMeasurement of diet adherence: adherence to dietary sodium advice assessed by a three-day dietary intake log.

NotesDietary advice: sodium-restricted diet

Provider: not known 

Contact with author: data no longer available. Therefore, the inclusion criteria of use of provision of meals, food items or dietary supplements could not be assessed.


MethodsStudy design: randomized controlled trial with two intervention groups and one control group.

ParticipantsSetting: outpatient

Country: Spain

Chronic disease: hypertension (management)

Type of participants: clients

InterventionsThe study compared an educative sessions intervention and an intervention consisting to provide written information to clients with a control group.

OutcomesMeasurement of diet adherence: not known

NotesDietary advice: not known

Providers: nurses 

No response to attempted contact with author(s).


MethodsStudy design: not known

ParticipantsSetting: not known

Country: Canada

Chronic disease: not known

Type of participants: clients

InterventionsThe intervention was a web-based, self-monitoring wellness program.

OutcomesMeasurement of diet adherence: not known

NotesDietary advice: not known

Provider: not known 

No response to attempted contact with author.


MethodsStudy design: not known

ParticipantsSetting: not known

Country: not known

Chronic disease: not known

Type of participants: not known

InterventionsNot known

OutcomesMeasurement of diet adherence: not known

NotesDietary advice: not known

Provider: not known   

Abstract unobtainable.


MethodsStudy design: randomized controlled trial with one intervention group and one usual care group.

ParticipantsSetting: not known

Country: Germany

Chronic disease: type II diabetes (management)

Type of participants: clients

InterventionsThe study compared an intense nutritional training program (diet, knowledge about diabetes, physical activities and other lifestyle factors) with an usual care group.

OutcomesMeasurement of diet adherence: not known

NotesDietary advice: not known

Provider: not known

No response to attempted contact with author.


MethodsStudy design: randomized controlled trial with one intervention group and one control group.

ParticipantsSetting: outpatient

Country: Korea

Chronic disease: type II diabetes (management)

Type of participants: clients

InterventionsThe study compared a telephone follow-up  intervention including self-monitoring blood glucose levels, diet and exercise, feedback from a dietitian and an informative booklet with a control group.

OutcomesMeasurement of diet adherence: adherence to diet assessed by a self-reported adherence questionnaire

NotesDietary advice: not known

Providers: nurse, dietitian 

The corresponding authors were contacted in order to have more information about the dietary advice provided in both groups. However, no response to attempted contact with authors.


MethodsStudy design: randomized controlled trial with one intervention group and one control group.

ParticipantsSetting: not known

Country: United States

Chronic disease: chronic kidney disease (management)

Type of participants: clients

InterventionsThe study compared an intervention group in which clients monitored dietary intake with a personal digital assistant (PDA) programmed with their dietary prescription and received PDA feedback regarding % of daily targets consumed and counselling based on Social Cognitive Theory with a control group.

OutcomesMeasurement of diet adherence: not known

NotesDietary advice: sodium-restricted diet

Provider: not known 

Contact with author(s): information provided does not allow including or excluding the study.


MethodsStudy design: randomized controlled trial with three intervention groups.

ParticipantsSetting: community

Country: Taiwan

Chronic disease: overweight and obesity (prevention/management)

Type of participants: clients

InterventionsThe study compared: 1) an individualized weight control education, 2) a group weight control education and 3) a mail-delivered weight control education.

OutcomesMeasurement of diet adherence: not known

NotesDietary advice: not known

Provider: not known 

No response to attempted contact with authors.


MethodsStudy design: not known

ParticipantsSetting: not known

Country: not known

Chronic disease: not known

Type of participants: not known

InterventionsNot known

OutcomesMeasurement of diet adherence: not known

NotesDietary advice: not known

Provider: not known                                                              

Abstract unobtainable.


MethodsStudy design: not known

ParticipantsSetting: not known

Country: United States

Chronic disease: not known

Type of participants: clients

InterventionsThe study compared an Aramark Nutrition Concepts© Survival Skills diet education using a condensed one-page handout with a traditional diet education using in-depth material.

OutcomesMeasurement of diet adherence: adherence to diet assessed by a telephone survey

NotesDietary advice: not known

Provider: dietitian 

Address for authors correspondence not found.


MethodsStudy design: randomized controlled trial with one intervention group and one control group.

ParticipantsSetting: not known

Country: Netherlands

Chronic disease: glucose intolerance (prevention)

Type of participants: clients

InterventionsThe study compared an intensive intervention aiming to stimulate the dietary change and the physical activity with a control group.

OutcomesMeasurement of diet adherence: adherence to diet assessed by a three-day food record

NotesDietary advice: Dutch guidelines for a healthy diet (Dutch Nutrition Council)

Providers: dietitians and trainers

The author was contacted in order to obtain more information about the dietary advice provided in both groups. However, there was no response to our attempted contact with author.


MethodsStudy design: randomized controlled trial with one intervention group and one control group.

ParticipantsSetting: not known

Country: United Kingdom

Health problem: type II diabetes (management)

Type of participants: clients

InterventionsThe study compared an intensive group using self-monitoring of food intake and feedback with a control group.

OutcomesMeasurement of diet adherence: not known

NotesDietary advice: diabetes United Kingdom guidelines on low fat and complex carbohydrate/ no sugar.

Providers: dietitians and nurses 

Contact with author: information do not allow including or excluding the study.


MethodsStudy design: randomized controlled trial with two intervention groups.

ParticipantsSetting: not known

Country: United Kingdom

Chronic disease: obesity (management)

Type of participants: clients

InterventionsThe study compared an intense intervention using motivational interviewing with a less intense intervention.

OutcomesMeasurement of diet adherence: not known

NotesDietary advice: not known

Provider: not known

Contact with author: information do not allow including or excluding the study.


MethodsStudy design: randomized controlled trial with one intervention group and one control group.

ParticipantsSetting: outpatient

Country: Korea

Chronic disease: type II diabetes (management)

Type of participants: clients

InterventionsThe study compared a diabetes outpatient intensive management program including multidisciplinary diabetes education, complication monitoring and telephone counseling with a control group.

OutcomesMeasurement of diet adherence: adherence to diet assessed by a self-report questionnaire on adherence

NotesDietary advice: not known

Providers: endocrinologist, diabetes education nurse, family physician, rehabilitation therapist, dermatologist, psychologist, dietitian, pharmacist, ophthalmologist and physiotherapist.

The corresponding author was contacted in order to obtain more information about the dietary advice provided in both groups. However, there was no response to attempted contact with author.


MethodsStudy design: not known

ParticipantsSetting: not known

Country: not known

Chronic disease: not known

Type of participants: not known

InterventionsNot known

OutcomesMeasurement of diet adherence: not known

NotesDietary advice: not known

Provider: not known

Abstract unobtainable.


MethodsStudy design: not known

ParticipantsSetting: outpatient

Country: United States

Chronic disease: diabetes (management)

Type of participants: clients

InterventionsThe study compared an intervention using graphic teaching aids with a control group.

OutcomesMeasurement of diet adherence: adherence to diet assessed by dietitian’s appointment log and by information obtained during each visit of every client

NotesDietary advice: decreasing fat consumption, eating meals at regular intervals and controlling portion size

Provider: dietitian

Address for authors correspondence not found.

 
Characteristics of ongoing studies [ordered by study ID]

Trial name or titleHome Based Blood Pressure Intervention for Blacks

MethodsStudy design: cluster-randomized controlled trial with two intervention groups and one usual care group

ParticipantsSetting: outpatient

Country: United States

Chronic disease: hypertension (management)

Type of participants: clients

InterventionsTwo interventions will be tested and compared to a usual care group: 1) a “basic” intervention delivering key evidence-based reminders to home care nurses and patients while the patient is receiving traditional postacute home health care, 2) an “augmented” intervention that includes that same as the basic intervention plus transition to an ongoing hypertension home support program that extends support for 12 months.

OutcomesMeasurement of diet adherence: adherence to healthy diet

Starting dateNot described

Contact informationDr Penny H. Feldman: pfeldman@vnsny.org

NotesDietary advice: Dietary Approaches to Stop Hypertension (DASH) recommendations

Providers: nurses


Trial name or titleThe effectiveness of a self-management intervention to improve outcomes in prevalent haemodialysis patients: a randomised controlled trial

MethodsStudy design: randomized controlled trial with one intervention group and one usual care group.

ParticipantsSetting: outpatient

Country: Singapore

Chronic disease: end-stage renal disease (management)

Type of participants: clients

InterventionsOne intervention will be tested and compared to an usual care group: a group-based self-management intervention including address of misconceptions, group discussion of possible coping strategies, identification of barriers to change, training in specific management strategies, identification of individual goals to be achieved, formulation of actions plans to achieve these goals and review previously set goals.

OutcomesMeasurement of diet adherence: adherence to dietary restrictions assessed by values of blood phosphate, calcium phosphate and potassium levels and gain between dialysis sessions

Starting dateAugust 2010

Contact informationDr Konstadina Griva: Department of Psychology, Faculty of Arts and Social Sciences, National University of Singapore, Block AS4 #02-28, 9 arts link

NotesDietary advice: not described

Providers: psychologist, dietitian and nurse


Trial name or titleTitle: Nurse-led motivational interviewing to change the lifestyle of patients with type II diabetes (MILD-project): protocol for a cluster, randomized, controlled trial on implementing lifestyle recommendations

MethodsStudy design: cluster-randomized controlled trial with one intervention group and one control group

ParticipantsSetting: outpatient

Country: Netherlands

Chronic disease: type II diabetes  (management)

Type of participants: clients

InterventionsOne intervention will be tested and compared to a control group: the clients will receive an intervention using motivational interviewing. The primary care nurse who will provide the intervention will receive training in an implementation strategy with motivational interviewing as the core component. Other components of this strategy will be adaptation of the diabetes protocol to local circumstances, introduction of a social map for lifestyle support, and educational and supportive tools for sustaining motivational interviewing.

OutcomesMeasurement of diet adherence: adherence to diet assessed by a self-reported questionnaire

Starting dateMarch 2007

Contact informationDr Renate Jansink: r.jansink@iq.umcn.nl

NotesDietary advice: Dutch guidelines norms

Providers: nurses


Trial name or titleEvaluation of lifestyle interventions to treat elevated cardiometabolic risk in primary care (E-LITE): a randomised controlled trial

MethodsStudy design: randomized controlled trial with two intervention groups and an usual care group.

ParticipantsSetting: outpatient

Country: United States

Chronic disease: overweight and obesity with pre-diabetes and/or metabolic syndrome (prevention and management)

Type of participants: clients

InterventionsTwo interventions will be tested and compared to an usual care group: 1) information technology-assisted self-management, 2) information technology-assisted self-management combined with care management.

OutcomesMeasurement of diet adherence: adherence to diet assessed by a three-day food record.

Starting dateNot described

Contact informationDr Jun Ma: maj@pamfri.org

NotesDietary advice: total fat reduction (to 25% of energy), energy balance and restriction (with a goal of a 500- to 1000-calorie reduction diet), saturated fat intake (to < 10% of energy), cholesterol intake (to < 300 mg/day), consumption of a high plant-based diet that includes a variety of fruit and vegetables, whole grains, and low-fat dairy products and reduction of high glycemic index carbohydrates.

Providers: dietitian and exercise physiologist


Trial name or titlePartners for life: a theoretical approach to developing an intervention for cardiac risk reduction

MethodsStudy design: randomized controlled trial with one intervention group and one control group.

ParticipantsSetting: outpatient

Country: United States

Chronic disease: coronary artery disease(management)

Type of participants: clients

InterventionsA standard behavioral treatment group including a couples intervention will be compared to a standard behavioral treatment (control).

OutcomesMeasurement of diet adherence: adherence to dietary recommendations       

Starting dateNot described

Contact informationDr Tamara Goldman Sher: t-sher@northwestern.edu

NotesDietary advice: weight loss or dietary modification based on current American Heart Association recommendations

Providers: therapist

 
Comparison 1. Nutritional tools versus control in diet adherence

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Continuous data2Std. Mean Difference (IV, Random, 95% CI)Totals not selected

   1.1 Adherence to energy intake at 6 months
1Std. Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   1.2 Adherence to protein intake at 6 months
1Std. Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   1.3 Adherence to fat intake at 6 months
1Std. Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   1.4 Adherence to carbohydrate intake at 6 months
1Std. Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   1.5 Adherence to cholesterol intake at 6 months
1Std. Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   1.6 Adherence to fiber intake at 6 months
1Std. Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   1.7 Adherence to sodium intake at 6 months
1Std. Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   1.8 Adherence to fruit intake at 6 months
1Std. Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   1.9 Adherence to vegetable intake at 6 months
1Std. Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   1.10 Adherence to sweet food intake at 6 months
1Std. Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   1.11 Adherence to energy intake at 12 weeks
1Std. Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   1.12 Adherence to fat intake at 12 weeks
1Std. Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

 
Comparison 2. Multiple interventions versus control in diet adherence

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Continuous data4Std. Mean Difference (IV, Random, 95% CI)Totals not selected

   1.1 Adherence to sodium-restricted diet at 3 months
1Std. Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   1.2 Adherence to diet at 3 months
1Std. Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   1.3 Adherence to fluid-restricted diet at 1 month
1Std. Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   1.4 Adherence to fluid-restricted diet at 3 months
1Std. Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   1.5 Adherence to fluid-restricted diet at 6 months
1Std. Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   1.6 Non-adherence to diet (days) at 7 weeks
1Std. Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   1.7 Non-adherence to diet (days) at 13 weeks
1Std. Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   1.8 Non-adherence to diet (degree) at 7 weeks
1Std. Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   1.9 Non-adherence to diet (degree) at 13 weeks
1Std. Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   1.10 Non-adherence to fluid-restricted diet (days) at 7 weeks
1Std. Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   1.11 Non-adherence to fluid-restricted diet (days) at 13 weeks
1Std. Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   1.12 Non-adherence to fluid-restricted diet (degree) at 7 weeks
1Std. Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

   1.13 Non-adherence to fluid-restricted diet (degree) at 13 weeks
1Std. Mean Difference (IV, Random, 95% CI)0.0 [0.0, 0.0]

 2 Dichotomous data5Risk Ratio (M-H, Random, 95% CI)Totals not selected

   2.1 Adherence to sodium-restricted diet at 18 months
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   2.2 Adherence to fat intake at 3 months
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   2.3 Adherence to saturated fat intake at 3 months
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   2.4 Adherence to unsaturated fat intake at 3 months
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   2.5 Adherence to carbohydrate intake at 3 months
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   2.6 Adherence cholesterol intake at 3 months
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   2.7 Adherence to saturated fat intake at 15 months
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   2.8 Adherence to fat intake at 15 months
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   2.9 Adherence to unsaturated fat intake at 15 months
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   2.10 Adherence to carbohydrate intake at 15 months
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   2.11 Adherence to fiber intake at 15 months
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   2.12 Adherence to cholesterol intake at 15 months
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   2.13 Adherence to phosphate-restricted diet at 3 months
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   2.14 Adherence to saturated fat intake at 1 year - CHD patients
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   2.15 Adherence to oily fish intake at 1 year - CHD patients
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   2.16 Adherence to fish intake at 1 year - CHD patients
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   2.17 Adherence to fruit and vegetable intake at 1 year - CHD patients
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   2.18 Adherence to oily fish intake at 1 year - high risk CHD patients
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   2.19 Adherence to fish intake at 1 year - high-risk CHD patients
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   2.20 Adherence to fruit and vegetable intake at 1 year - high-risk CHD patients
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   2.21 Adherence to diet at 4 weeks
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

   2.22 Adherence to diet at 12 weeks
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 
Table 1. Summary of results: education

StudyIntervention group (description)Comparative group(s) (description)Effects on adherenceNo of studies
(no of participants
Quality of the evidence
(GRADE)

Favours intervention groupFavours comparative   groupNo difference








Telephone follow-up4 (283)⊝⊝⊝

Very low 2,4

In summary, among studies using a control/usual care group, three out of ten diet adherence outcomes favoured the intervention group compared to control group and seven diet adherence outcomes had no significant difference between groups. However, these three diet adherence outcomes favouring the intervention group were no longer significant at a later time point.

Chiu 2010Telephone follow-upControl   Adherence to sodium-restricted diet, fat, fruit and vegetable intakes at 8 weeks






Cummings 1981Telephone follow-upControl;

Interventions:

(1) contract;               

(2) contract with the involvement of a family member or friend
vs control: Adherence to potassium-restricted diet and fluid-restricted diet at 6 weeksvs control: Adherence to potassium-restricted diet and fluid-restricted diet at 3 months;

vs (1) (2): Adherence to potassium-restricted diet and fluid-restricted diet at 6 weeks and 3 months                  






Racelis 1998Telephone follow-upControl   Adherence to diet






Stewart 2005Telephone follow-upControl Adherence to sodium-restricted diet at 24 weeks Adherence to sodium-restricted diet at 36 weeks;

Non-adherence to alcohol intake at 24 and 36 weeks








Group sessions2 (144)⊝⊝

Low 1,2

In summary, these studies did not allow us to draw conclusions on the effect of group sessions on diet adherence outcomes.

Gill 2010 *Group sessionsControl   






Jones 1986Group sessionsInterventions:

(1) Group sessions and teach to use prompts/cues;

(2) Individual sessions with a dietitian;

(3) Individual sessions with a dietitian and teach to use prompts/cues
  vs (1) (2) (3): Adherence to diet at 16 weeks








Individual sessions with a dietitian2 (203)⊝⊝

Low 1,2

In summary, these studies did not allow us to draw conclusions on the effect of individual sessions with a dietitian on diet adherence outcomes.

Jones 1986Individual sessions with a dietitianInterventions:

(1) Group sessions and teach to use prompts/cues;

(2) Individual sessions with a dietitian;

(3) Individual sessions with a dietitian and teach to use prompts/cues
  vs (1) (2) (3): Adherence to diet at 16 weeks






Micco 2007 *Individual sessions with a dietitianControl   








Individual sessions with a nurse1 (81)⊝⊝⊝

Very low 1,2,3

In summary, this study did not allow us to draw conclusions on the effect of individual sessions with a nurse on diet adherence outcomes.

Hsueh 2007Individual sessions with a nurseIntervention:  telephone follow-up and individual sessions with a nurse  Adherence to fiber, vegetable and fruit intakes at 3 and 6 months








Educational tools-video 3 (318)

Moderate 1

In summary, among studies using a control/usual care group, two out of three diet adherence outcomes favoured the intervention group compared to the control/usual care group and one diet adherence outcome had no significant difference between groups. However, one out of two diet adherence outcomes favouring the intervention group was no longer significant at a later time point.

Baraz 2010Educational tools - videoIntervention: group sessions and educational tools – booklet  Adherence to diet and fluid-restricted diet at 2 months






Mahler 1999Educational tools - videoControl;

Intervention:

(1) video and relapse prevention/coping planning
vs control: Adherence to cholesterol and saturated fat-restricted diet at 1 month vs control: Adherence to cholesterol and saturated fat-restricted diet at 3 months;

vs (1): Adherence to cholesterol and saturated fat-restricted diet at 1 and 3 months;






McCulloch 1983Educational tools - videoUsual care;

Intervention:

(1) nutritional tool
vs usual care: Adherence to day to day consistency in carbohydrate intake at 6 months vs (1): Adherence to day to day consistency in carbohydrate intake at 6 months








Educational tools-booklet1 (83)⊝⊝⊝

Very low,2,3,4

In summary, this study did not allow us to draw conclusions on the effect of booklet on diet adherence outcomes.

Kendall 1987Educational tools - bookletIntervention: nutritional tool  Adherence to energy, protein, vitamin A, vitamin C, thiamin, riboflavin, niacin, calcium, phosphorus, iron, zinc intakes at 3 and 6 months

 *The authors did not report measures of adherence for both groups, making comparison between groups impossible.
GRADE - Factors decreasing the quality level of a body of evidence:
1 Limitations in the design and implementation of available studies suggesting high likelihood of bias.
2 Indirectness of evidence
3  Imprecision of results
4  Downgraded by two levels due to important limitations in the design and implementation of available studies suggesting high likelihood of bias.
 
Table 2. Summary of results: persuasion

StudyIntervention group (description)Comparative group(s) (description)Effects on adherenceNo of studies
(no of participants)
Quality of the evidence
(GRADE)

Favours intervention groupFavours comparative groupNo difference

Reminders2 (248)

Moderate 1

In summary, among studies using a control/usual care group, 3 out of 19 diet adherence outcomes had no significant difference between groups. It was impossible to assess this result for 16 diet adherence outcomes since data and/or statistical analyses needed for comparison between groups were not provided.

Gans 1994Reminder - clientUsual care  Adherence to diet at 3 months

Gans 1994Reminder - physicianUsual care  Adherence to diet at 3 months

Gans 1994Reminder - client and physicianUsual care  Adherence to diet at 3 months

Ryan 2002 *Reminder - 2 weeks, 3 and 6 monthsControl   

Ryan 2002 *Reminder - 3 and 6 monthsControl   

 *The authors did not report measures of adherence for both groups, making comparison between groups impossible.
GRADE - Factors decreasing the quality level of a body of evidence:
1 Limitations in the design and implementation of available studies suggesting high likelihood of bias.
2 Indirectness of evidence
3  Imprecision of results
4  Downgraded by two levels due to important limitations in the design and implementation of available studies suggesting high likelihood of bias.
 
Table 3. Summary of results: incentivisation

StudyIntervention group (description)Comparative group(s) (description)Effects on adherenceNo of studies
(no of participants)
Quality of the evidence
(GRADE)

Favours intervention groupFavours comparative groupNo difference

Contracts with rewards1 (116)⊝⊝

Low 1,3

In summary, among studies using a control/usual care group, two out of four diet adherence outcomes favoured the intervention group compared to the control group and two diet adherence outcomes had no significant difference between groups. However, these two diet adherence outcomes favouring the intervention group were no longer significant at three months.

Cummings 1981ContractControl;

Interventions: 

(1) telephone follow-up;        

(2) contract with the involvement of a family member or friend

 
vs control: Adherence to potassium-restricted diet and fluid-restricted diet at 6 weeks vs control: Adherence to potassium-restricted diet and fluid-restricted diet at 3 months;                           

vs (1) (2): Adherence to potassium-restricted diet and fluid-restricted diet at 6 weeks and 3 months

 GRADE - Factors decreasing the quality level of a body of evidence:
1 Limitations in the design and implementation of available studies suggesting high likelihood of bias.
2 Indirectness of evidence
3  Imprecision of results
4  Downgraded by two levels due to important limitations in the design and implementation of available studies suggesting high likelihood of bias.
 
Table 4. Summary of results: training

StudyIntervention group (description)Comparative group(s) (description)Effects on adherenceNo of studies
(no of participants)
Quality of the evidence
(GRADE)

Favours intervention groupFavours comparative groupNo difference

Feedback3 (661)⊝⊝

Low 4

In summary, among studies using a control/usual care group, one out of seven diet adherence outcomes favoured the intervention group compared to the control/usual care group, four favoured the control group whereas two had no significant difference between groups.

Beasley 2008FeedbackControlAdherence to energy, fat, saturated fat and cholesterol intakes  at 4 weeks  

French 2008Feedback – less intensiveUsual care Adherence to general diet and specific diet at 12 months 

French 2008Feedback – most intensiveUsual care Adherence to general diet and specific diet at 12 months 

Meland 1994FeedbackControl  Adherence to sodium-restricted diet at 1 and 3 months

 GRADE - Factors decreasing the quality level of a body of evidence:
1 Limitations in the design and implementation of available studies suggesting high likelihood of bias.
2 Indirectness of evidence
3  Imprecision of results
4  Downgraded by two levels due to important limitations in the design and implementation of available studies suggesting high likelihood of bias.
 
Table 5. Summary of results: restriction

StudyIntervention group (description)Comparative group(s) (description)Effects on adherenceNo of studies
(no of participants)
Quality of the evidence
(GRADE)

Favours intervention groupFavours comparative groupNo difference

Restriction1 (7)⊝⊝⊝

Very low1,2,3

In summary, this study did not allow us to draw conclusions on the effect of restriction on diet adherence outcomes.

Conrad 2000*RestrictionControl        Adherence to very low fat diet at 7 months

 *The authors did not report measures of adherence for both groups, making comparison between groups impossible.
GRADE - Factors decreasing the quality level of a body of evidence:
1 Limitations in the design and implementation of available studies suggesting high likelihood of bias.
2 Indirectness of evidence
3  Imprecision of results
4  Downgraded by two levels due to important limitations in the design and implementation of available studies suggesting high likelihood of bias.
 
Table 6. Summary of results: modelling

StudyIntervention group (description)Comparative group(s) (description)Effects on adherenceNo of studies
(no of participants)
Quality of the evidence
(GRADE)

Favours intervention groupFavours comparative groupNo difference

Nutritional tools7 (514)⊝⊝⊝

Very low2,4

In summary, among studies using a control/usual care group, 3 out of 17 diet adherence outcomes favoured the intervention group and 11 diet adherence outcomes had no significant difference between groups. It was impossible to assess this result for three diet adherence outcomes as data and/or statistical analyses needed for comparison between groups were not provided.

Assuncao 2010Nutritional toolsUsual careAdherence to sodium at 6 months Adherence to energy, protein, fat, carbohydrate, cholesterol, fiber, fruit,  vegetable and sweet food intakes at 6 months

Chen 2006Nutritional toolsControlAdherence to protein intake at 1 month  

Grace 1996Nutritional toolsControlAdherence to fat intakes at 12 weeks Adherence to energy at 12 weeks

Kendall 1987Nutritional toolsIntervention: educational tool - booklet  Adherence to energy, protein, vitamin and mineral intakes at 3 and 6 months

Logan 2010Nutritional toolsIntervention: Barrier identification/problem solving and goal setting  Adherence to Mediterranean diet at 6 and 12 months

McCulloch 1983Nutritional toolsUsual care;

Intervention:

(1) educational tool - video
  vs control and  (1): Adherence to day to day consistency in carbohydrate intake at 6 months

Scisney-Matlock 2006*Nutritional toolsControl   

 *The authors did not report measures of adherence for both groups, making comparison between groups impossible.
GRADE - Factors decreasing the quality level of a body of evidence:
1 Limitations in the design and implementation of available studies suggesting high likelihood of bias.
2 Indirectness of evidence
3  Imprecision of results
4  Downgraded by two levels due to important limitations in the design and implementation of available studies suggesting high likelihood of bias.
 
Table 7. Summary of results: enablement

StudyIntervention group (description)Comparative group(s) (description)Effects on adherenceNo of studies
(no of participants)
Quality of the evidence
(GRADE)

Favours intervention     groupFavours comparative groupNo

difference

Behaviour change techniques3 (136) 

 

 

 

 

 

 

 

 

 

⊝⊝⊝

Very low2,4

In summary, only one study used a control group and three out of three diet adherence outcomes had no difference between groups.

Aldarondo 1999Barrier identification/problem solving and self-talkControl  Adherence to energy, fat and saturated fat intakes at 14 weeks

Bennett 1986Teach to use prompts/cuesInterventions:   (1) self-talk;     

(2) barrier identification/problem solving
vs (1) (2): Adherence to energy intake  between baseline and 15 weeks  

Bennett 1986Self-talkInterventions:

(1) teach to use prompts/cue;   

(2) barrier identification/problem solving
 vs (1): Adherence to energy intake  between baseline and 15 weeksvs (2): Adherence to energy intake  between baseline and 15 weeks

Bennett 1986Barrier identification/problem solvingInterventions:

(1) teach to use prompts/cue;  

(2) self-talk
 vs (1): Adherence to energy intake  between baseline and 15 weeksvs (2): Adherence to energy intake  between baseline and 15 weeks

Logan 2010Barrier identification/problem solving and goal settingIntervention: Nutritional tools  Adherence to Mediterranean diet at 6 and 12 months

 GRADE - Factors decreasing the quality level of a body of evidence:
1 Limitations in the design and implementation of available studies suggesting high likelihood of bias.
2 Indirectness of evidence
3  Imprecision of results
4  Downgraded by two levels due to important limitations in the design and implementation of available studies suggesting high likelihood of bias.
 
Table 8. Summary of results: multiple interventions

StudyIntervention group (description)Comparative group(s) (description)Effects on adherenceNo of studies
(no of participants)
Quality of the evidence
(GRADE)

Favours intervention groupFavours comparative groupNo difference

Multiple interventions18 (7700)**

In summary, among studies using a control/usual care group, 21 out of 56 diet adherence outcomes favoured the intervention group whereas 32 diet adherence outcomes had no significant difference between groups. It was impossible to assess this result for three diet adherence outcomes as data and/or statistical analyses needed for comparison between groups were not provided. However, 4 out of 21 diet adherence outcomes favouring the intervention group was no longer significant at a later time point.

Arcand 2005Individual sessions with a dietitian and goal settingUsual care  Adherence to sodium-restricted diet at 3 months

Baraz 2010Intervention: group sessions and educational tools – bookletIntervention: educational tools - video  Adherence to diet and fluid-restricted diet at 2 months

Becker 1998Telephone follow-up and barrier identification/problem solvingUsual care  Adherence to fat-restricted diet at 2 years

Blanson 2009Motivational interviewing and self-monitoring and feedback-diaryControl  Adherence to diet at 28 days

Cummings 1981Contract with the involvement of a family member or friendControl;

Interventions:

(1) telephone follow-up;                (2) contract
vs control: Adherence to potassium-restricted diet and fluid-restricted diet at 6 weeks vs control: Adherence to potassium-restricted diet and fluid-restricted diet at 3 months;

vs (1) (2): Adherence to potassium-restricted diet and fluid-restricted diet at 3 months           

Gucciardi 2007Group sessions, nutritional tools and barrier identification/problem solvingControlAdherence to diet at 3 months  

Hsueh 2007Telephone follow-up and individual sessions with a nurseIntervention: Individual sessions with a nurse  Adherence to fiber, vegetable and fruit intake at 3 and 6 months

Hyman 2007Telephone follow-up and motivational interviewing - simultaneousUsual care;

Intervention:

(1) telephone follow-up and motivational interviewing -  sequential
vs usual care and (1): Adherence to sodium-restricted diet at 6 months vs usual care and (1): Adherence to

sodium-restricted diet at 18 months

Hyman 2007Telephone follow-up and motivational interviewing -  sequentialUsual care;

Intervention: (1) telephone follow-up and motivational interviewing - simultaneous
 vs (1): Adherence to sodium-restricted diet at 6 monthsvs control: Adherence to sodium-restricted diet at 6 months and 18 months;             vs (1): Adherence to sodium-restricted diet at 18 months

Jiang 2004Individual sessions with a nurse, telephone follow-up and goal settingUsual careAdherence to ATP step II diet at 3 and 6 months.  

Jones 1986Group sessions and teach to use prompts/cuesInterventions:

(1) group sessions;

(2) individual sessions with a dietitian;

(3) individual sessions with a dietitian and teach to use prompts/cues
  vs (1) (2) (3): adherence to diet at 16 weeks

Jones 1986Individual sessions with a dietitian and teach to use prompts/cuesInterventions:

(1) group sessions;              

(2) individual sessions with a dietitian;            

(3) group sessions and teach to use prompts/cues
  vs (1) (2) (3): adherence to diet at 16 weeks

Laitinen 1993Individual sessions with a dietitian, nutritional tools and goal settingUsual careAdherence to saturated fat intakes at 15 months

 

 
 Adherence to saturated  fat intakes at 3 months; Adherence to total fat, unsaturated fat, carbohydrate, fiber and cholesterol intakes at 3 and 15 months         

Mahler 1999Educational tools – video and relapse prevention/coping planningControl; 

Intervention:

(1) educational tools - video
vs control: Adherence to cholesterol and saturated fat-restricted diet at 1 month. vs control: Adherence to cholesterol and saturated fat-restricted diet at 3 months;                                

vs (1): Adherence to cholesterol and saturated fat -restricted diet at 1 and 3 months

Miller 1988Individual sessions with a nurse and barrier identification/problem solving and goal settingControlAdherence to diet at 2 years Adherence to diet at 30 days, 60 days and 1 year

Morey 2008Individual sessions with a dietitian, educational tools-booklet, reminders, motivational interviewingControlAdherence to phosphate-restricted diet at 3 months  

Tsay 2003Self-monitoring and feedback-diary, stress management and goal settingUsual careAdherence to fluid-restricted diet at 3 months and 6 months Adherence to fluid-restricted diet at 1 month

Wong 2010Telephone follow-up and goal settingControl  Non-adherence to diet (days and degree) at 7 weeks and 13 weeks

Non-adherence to fluid-restricted diet (days and degree) at 7 weeks and 13 weeks

Wood 2008 – coronary heart diseaseIndividual sessions with a nurse and motivational interviewingUsual careAdherence to saturated fat, oily fish, fish and fruit and vegetable intakes at 1 year  

Wood 2008 – high risk of coronary heart diseaseIndividual sessions with a nurse and motivational interviewingUsual careAdherence to oily fish, fish and fruit and vegetables intakes at 1 year  

Zhao 2004Telephone follow-up, individual sessions with a dietitian and goal settingUsual careHigh adherence to diet at 4 and 12 weeks  

 **Multiple interventions included a variety of interventions, which did not allow the use of GRADE.