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Long-term effects of nutritional group education for persons at high cardiovascular risk

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Author: Bemelmans, W.J.E. · Broer, J. · Hulshof, K.F.A.M. · Siero, F.W. · May, J.F. · Meyboom-de Jong, B.
Institution: TNO Voeding
Source:European Journal of Public Health, 3, 14, 240-245
Identifier: 237960
doi: doi:10.1093/eurpub/14.3.240
Keywords: Health · Food and Chemical Risk Analysis · Cardiovascular risk · Dietary intake · Nutritional education · Risk factors · saturated fatty acid · adult · article · body weight · cardiovascular risk · cholesterol blood level · controlled study · diastolic blood pressure · energy · female · follow up · group therapy · health program · high risk population · human · ischemic heart disease · major clinical study · male · nutrition · patient counseling · patient education · priority journal · risk factor · Adult · Aged · Analysis of Variance · Blood Pressure · Body Mass Index · Body Weight · Cardiovascular Diseases · Chi-Square Distribution · Cholesterol · Coronary Disease · Counseling · Diet · Dietary Fats · Dietary Fiber · Energy Intake · Fatty Acids · Female · Follow-Up Studies · Fruit · Health Education · Humans · Hypercholesterolemia · Male · Middle Aged · Nutrition Physiology · Risk Factors · Time Factors · Vegetables


Background: Treatment of persons at high risk for coronary heart disease (CHD) should include nutritional counselling, but little is known about the effects of different types of education. Methods: In a quasi-experimental study design the effects of a nutritional education programme (1st year: three group sessions by a dietitian; 2nd year: one group session; 3rd year: additional focus on saturated fat; reinforcement by written nutritional messages annually) (intervention group; n=103) are compared with the effects of a posted leaflet containing standard dietary guidelines (control group; n=163). Participants had hypercholesterolemia (6-8 mmol/l) and at least two other CHD risk factors. Results: After 3 years, no significant differences existed in established CHD risk factors between intervention and control groups (adjusted mean net differences: total cholesterol (0 mmol/l), diastolic blood pressure (-1.1 mm Hg; NS), and body weight (+0.3 kg, NS)). Regarding dietary intake, the intervention group had a lower intake of total (net difference -2.0% of energy, SEM 0.9) and saturated fat (-1.2% of energy, SEM 0.4) and a higher fish (+11 g/day, SEM 4) and vegetables consumption (+21 g/day, SEM 10) during the study period (p<0.05 for all). Conclusion: A nutritional education programme with group sessions changed dietary intake more effectively than a posted leaflet, but no additional positive effects were observed on established CHD risk factors after three years of follow-up.