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Effectiveness of a dietary intervention strategy in general practice: effects on blood lipids, health and well-being

Published online by Cambridge University Press:  01 December 1998

UI Træden ,
L Holm ,
B Sandström ,
PK Andersen  and
M Jarden
UI Træden*
Affiliation:
Institute of Public Health, Department of Social Medicine and Psychosocial Health, University of Copenhagen, Denmark
L Holm
Affiliation:
Research Department of Human Nutrition, the Royal Veterinary and Agricultural University, Frederiksberg, Denmark
B Sandström
Affiliation:
Research Department of Human Nutrition, the Royal Veterinary and Agricultural University, Frederiksberg, Denmark
PK Andersen
Affiliation:
Institute of Public Health, Department of Biostatistics, University of Copenhagen, Denmark
M Jarden
Affiliation:
Institute of Public Health, Department of Biostatistics, University of Copenhagen, Denmark
*
*Corresponding author: Fax +45 31 35 11 81
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Abstract

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Objectives:

To evaluate the effect of a dietary treatment programme on blood cholesterol concentration in hypercholesterolaemic patients in general practice and to analyse subjectively experienced side-effects.

Design:

A 1-year parallel trial comparing a new treatment programme with conventional treatment.

Setting:

General practitioners in Roskilde county, Denmark.

Subjects:

355 men and women, aged 20–60 years, with a persistent blood cholesterol concentration above age- and gender-specific cut-off points (265 in an intervention group and 90 in a control group).

Intervention:

A treatment strategy based on collaboration between doctor and dietitian using individual dietary advice and feedback from measured biological parameters.

Main outcome measures:

Serum lipids, body weight, blood pressure, dietary behaviour, health parameters, quality of life parameters and acceptance by patients and general practitioners.

Results:

Total blood cholesterol concentration decreased by 14% (1.07 mmol l−1, P < 0.0001) in 159 patients in the intervention group, not having any lipid altering drug during treatment, in addition to 3% from screening to start of treatment. In 65 patients in the control group, without any lipid altering drug, the reduction of cholesterol concentration was 4% (0.27 mmol l−1, P < 0.01; intervention vs. control P < 0.001). In the intervention group overweight subjects (body mass index > 30) reduced body weight by 6% (P < 0.0001). Systolic blood pressure was reduced by 11% (P < 0.0001) and diastolic blood pressure by 10% (P < 0.0001) and 19% (P < 0.003) for intervals 90–110 mmHg and > 110 mmHg, respectively. Risk score decreased and self-assessed health, physical and psychological well-being improved.

Conclusions:

The treatment strategy tested proved to be efficient, without side-effects and well accepted by patients and general practitioners. The results strongly suggest that hypercholesterolaemia can efficiently be treated non-pharmacologically in general practice.

Keywords

Dietary interventionBlood cholesterolGeneral practicePublic healthWell-being
Type
Research Article
Information
Public Health Nutrition , Volume 1 , Issue 4 , December 1998 , pp. 273 - 281
Copyright
Copyright © The Nutrition Society 1998

References

1Law, MR, Wald, NJ, Wu T Hackshaw, A, Bailey, A. Systematic underestimation of association between serum cholesterol concentration and ischaemic heart disease in observational studies: data from the BUPA study. Br. Med. J. 1994; 308: 363–6.Google Scholar
2Law, MR, Wald, NJ, Thompson, SG. By how much and how quickly does reduction in serum cholesterol lower risk of ischaemic heart disease? Br. Med. J. 1994; 308: 367–72.Google Scholar
3Blankenhorn, HD, Nessim, SA, Johnson, RL, Sanmarco, ME, Azen, SP, Cashin-Hemphill, . Beneficial effects of combined Cholestipol-Niacin therapy on coronary atherosclerosis and coronary venous bypass grafts (CLAS). J. Am. Med. Assoc. 1987; 257: 3233–40.Google Scholar
4Ornish, D, Brown, S, Scherwitz, LW, et al. Can lifestyle changes reverse coronary heart disease? Lancet 1990; 336: 129–33.Google Scholar
5Buchwald, H, Varco, RL, Matts, JP, et al. Effect of partial ileal bypass surgery on mortality and morbidity from coronary heart disease in patients with hypercholesterolemia. N. Engl. J. Med. 1990; 323: 964–55.Google Scholar
6Brown, G, Albers, JJ, Fisher, LD, et al. Regression of coronary heart disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B. N. Engl. J. Med. 1990; 323: 1289–98.Google Scholar
7Kane, JP, Malloy, MJ, Ports, TA, Phillips, NR, Diehl, JC, Havel, RJ. Regression of coronary atherosclerosis during treatment of familia hypercholesterolemia with combined drug regimes. J. Am. Med. Assoc. 1990; 264: 3007–12.Google Scholar
8Watts, GF, Lewis, B, Brunt, JN, et al. Effects on coronary artery disease of lipid lowering diet, or diet plus cholestyramine, in the St Thomas Atherosclerosis Regression Study (STARS). Lancet 1991; 339: 563–9.Google Scholar
9The Expert Panel. Arch. Intern. Med. 1998; 148: 36–69.Google Scholar
10Knopp, RH, Walden, CE, Retzlaff, BM et al. Long-term cholesterol-lowering effects of 4 fat-restricted diets in hypercholesterolemic and combined hyperlipidemic men. J. Am. Med. Asoc. 1997; 278: 1509–15.CrossRefGoogle ScholarPubMed
11Imperial Cancer Research Fund Oxcheck Study Group. Effectiveness of health check conducted by nurses in primary care: final results of the Oxcheck study. Br. Med. J. 1995; 310: 1099–104.Google Scholar
12Family Heart Study Group. Randomised controlled trial evaluating cardiovascular screening and intervention in general practice: principal results of British family heart study. Br. Med. J. 1994; 308: 313–20.CrossRefGoogle Scholar
13Neil, HAW, Roe, L, Godlee, RJP, et al. Randomised trial of lipid lowering dietary advice in general practice: the effects on serum lipids, lipoproteins, and antioxidants. Br. Med. J. 1995; 310: 569–73.Google Scholar
14The Danish Health Board. Preventing Ischemic Heart Disease. Copenhagen: the Danish Health Board, 1991.Google Scholar
15UK Nutritional Epidemiology Group. Guidelines to indicate how papers submitted to EJCN should describe the methods by which the diet of a group of people was assessed. Eur. J. Clin. Nutr. 1993; 47: 379–80.Google Scholar
16Hagerup, L, Eriksen, M, Schroll, M, Hollnagel, H, Agner, E. Larsen, S. The Glostrup population studies. Collection of epidemiologic tables. Scund. J. Soc. Med. 1981: S20.Google Scholar
17Black, AE, Goldberg, GR, Jebb, SA. Critical evaluation of energy intake using fundamental principles of energy physiology. 1. Derivation of cut-off limits to identify under recording. Eur. J. Clin. Nutr. 1991; 45: 569–81.Google Scholar
18Black, AE, Goldberg, GR, Jebb, SA. Critical evaluation of energy intake data using fundamental principles of energy physiology. 2. Evaluating the results of published surveys. Eur. J. Clin. Nutr. 1991; 45: 583–99.Google Scholar
19Træden, UI. Diet guidance in primary health care. An intervention against increased blood cholesterol level among patients in the county of Roskilde. Copenhagen: FADL Publishers, 1995.Google Scholar
20Anggaard, EE, Land, JM, Lenihan, CJ, et al. Prevention of cardiovascular disease in general practice: a proposed model. Br. Med. J. 1986; 293: 177–8.Google Scholar
21Hjerman, I, Holme, I, Byre, KV, Leren, P. Effect of diet and smoking intervention on the incidence of coronary heart disease. Lancet 1981; II: 1303–10.Google Scholar
22Assmann, G, Schulte, H. Relation of high-density lipoprotein cholesterol and triglycerides to incidence of atherosclerotic coronary artery disease (the PROCAM experience) Am. J. Cardiol. 1992; 70: 733–7.Google Scholar
23Stensvold, I, Tverdal, Aa, Urdal, P, Graff-Iversen, S. Non-fasting serum triglyceride concentration and mortality from coronary heart disease and any cause in middle aged Norwegian women. Br. Med. J. 1993; 307: 1318–22.Google Scholar
24Waaler, TH. Heigh, weight and mortality. The Norwegian experience. Acta. Med. Scand. 1984; suppl: 679.Google Scholar
25Bengtsson, C, Björkelund, C, Lapidus, L, Lissner, L. Associations of serum lipid concentrations and obesity with mortality in women: 20 year follow up of participants in prospective population study in Gothenburg, Sweden. Br. Med. J. 1993; 307: 1385–8.CrossRefGoogle ScholarPubMed
26Manson, JAE, Willett, WC, Stampfer, MJ, et al. Body weight and mortality among women. N. Engl. J. Med. 1995; 333: 677–85.Google Scholar
27Law, MR, Frost, CD, Wald, NJ III. Analysis of data from trials of salt reduction. Br. Med. J. 1991; 301: 819–24.Google Scholar
28Idler, EL, Benyamini, Y. Self-rated health and mortality: a review of twenty-seven community studies. J. Health. Soc. Behav. 1997; 38: 21–37.Google Scholar