Relative efficacy of differential methods of dietary advice: a systematic review

Factors Influencing Men's Experiences and Engagement with the Rugby Fans in Training-New Zealand Pilot Trial: A Healthy Lifestyle Intervention for Men

Health promotion programs designed specifically to support men to improve their lifestyle behaviours are required to improve men's health. This study explored factors that influenced men's experiences of, and engagement with, the Rugby Fans in Training-New Zealand pilot trial, a professional sport-based healthy lifestyle intervention for overweight men. Thirty-five men (mean age = 45, SD = 10 years) who completed the 12-week intervention participated in one of eight semi-structured focus groups. Using inductive thematic analysis, five themes represented the meanings in the data. First, a group of like-minded men all in the same boat recognised the importance of being in similar life situations and having similar reasons for joining the programme. Second, the men described the importance of the support and motivation provided by the team atmosphere created through the programme. Third, the motivational coach recognised the characteristics, skills and knowledge of the coach delivering the programme which created engagement with it. Fourth, the education sessions were valued for the knowledge gained and underpinning philosophies that guided them. Finally, the involvement of the rugby franchise influenced commitment to the programme and created initial interest. These results provide evidence for the key components that should be incorporated into the future development of and improvement to healthy lifestyle interventions for men.

Impact of dietary and obesity genetic risk scores on weight gain

BACKGROUND

Whether genetic background and/or dietary behaviors influence weight gain in middle-aged subjects is debated.

OBJECTIVE

To assess whether genetic background and/or dietary behaviors are associated with changes in obesity markers (BMI, weight, and waist and hip circumferences) in a Swiss population-based cohort.

METHODS

Cross-sectional and prospective (follow-up of 5.3 y) study. Two obesity genetic risk scores (GRS) based on 31 or 68 single nucleotide polymorphisms were used. Dietary intake was assessed using a semiquantitative FFQ. Three dietary patterns "Meat & fries" (unhealthy), "Fruits & vegetables" (healthy), and "Fatty & sugary" (unhealthy), and 3 dietary scores (2 Mediterranean and the Alternative Healthy Eating Index [AHEI]) were computed.

RESULTS

On cross-sectional analysis (N = 3033, 53.2% females, 58.4 ± 10.6 y), obesity markers were positively associated with unhealthy dietary patterns and GRS, and negatively associated with healthy dietary scores and patterns. On prospective analysis (N = 2542, 54.7% females, age at baseline 58.0 ± 10.4 y), the AHEI and the "Fruits & vegetables" pattern were negatively associated with waist circumference gain: multivariate-adjusted average ± SE 0.96 ± 0.25 compared with 0.11 ± 0.26 cm (P for trend 0.044), and 1.14 ± 0.26 compared with -0.05 ± 0.26 cm (P for trend 0.042) for the first and fourth quartiles of the AHEI and the "Fruits & vegetables" pattern, respectively. Similar inverse associations were obtained for changes in waist >5 cm: multivariate-adjusted OR (95% CI): 0.65 (0.50, 0.85) and 0.67 (0.51, 0.89) for the fourth versus the first quartile of the AHEI and the "Fruits & vegetables" dietary pattern, respectively. No associations were found between GRS and changes in obesity markers, and no significant gene-diet interactions were found.

CONCLUSION

Dietary intake, not GRS, are associated with waist circumference in middle-aged subjects living in Lausanne, Switzerland.

Measuring and Leveraging Motives and Values in Dietary Interventions

Why measure and leverage food motives and values? Every failure and every success in dietary change can be connected to motivation. Therefore, this research question naturally arises: How can food motives and values be measured and leveraged to improve diet outcomes from the individual to populations? There are four ways that food motives and values (FMVs) can assist researchers and health professionals. First, FMVs can help to create a personalized approach to dietary change. Second, FMVs can inform content for dietary interventions. Third, these FMV measures can be used in data analysis to elucidate differences in adherence and outcomes among participants. Fourth, public health nutrition messages can be tailored using information on FMVs. Each of these uses has the potential to further the literature and inform future efforts to improve diet. A central aim of our study is to provide specific examples and recommendations on how to measure and leverage FMVs. To do so, we reviewed 12 measures included in the literature citing the Food Choice Questionnaire by Steptoe, Pollard, and Wardle, which was identified as the earliest, highly cited article appearing under the search terms “food motives” AND “food values” AND “eating behavior” AND “measure”. Specific details on how articles were selected from the citing literature are described in the Methods section. We also expound on our reasoning for including the Three-Factor Eating Questionnaire, which made for 13 measures in total. Our main finding is that each measure has strengths and shortcomings to consider in using FMVs to inform nutritional recommendations at different levels.

Attitudes and barriers to providing dietary advice: perceptions of dental hygienists and oral health therapists

OBJECTIVES

Effective dietary counselling in a dental setting can significantly reduce the risk of oral disease. However, studies suggest that dental professionals are not instigating dietary advice on a regular basis, and there is a lack of current information of the barriers experienced that limit the delivery of dietary advice. The aim of this study was to investigate the current attitudes and practice behaviours of dental hygienists and oral health therapists in NSW, Australia, regarding dietary advice, and identify the barriers that limit its delivery.

METHODS

A convenience sample of dental hygienists and oral health therapists were surveyed using a mail-out questionnaire. The questionnaire investigated the demographic data of participants, the attitudes and practice behaviours of participants, the perceived barriers and current dietary resources accessed by participants.

RESULTS

Of 987 dental hygienists and oral health therapists, 426 participants responded. The study results suggest that many dental hygienists and oral health therapists have positive beliefs regarding the importance of dietary counselling. However, there are a multitude of barriers preventing the delivery of dietary advice; these include time, patient compliance, patient knowledge of nutrition topics, personal counselling skills and practitioners' knowledge of nutrition.

CONCLUSION

Whilst dental hygienists and oral health therapists recognize the importance of diet and have positive attitudes towards providing dietary advice to patients, this study identified many barriers preventing implementation in practice. This information may be used to develop targeted strategies aimed at overcoming these barriers and improving behaviours.

A qualitative study of adherence to nutritional treatment: perspectives of patients and dietitians

BACKGROUND

Effective interaction between care providers and patients is crucial for the success of most medical treatments; in nutritional medical treatment, it is of paramount importance. The aim of the present study was to ascertain the role of the dietitian-patient relationship and the counseling approach in influencing individual patient decisions to adhere to counseling by persisting with nutritional treatment.

METHODS

We conducted focus groups with two types of patients, namely, those who had consulted dietitians only once and those who had attended at least three appointments. We divided these two groups into 12 focus groups. In addition, in-depth interviews were held with 17 clinical dietitians. Our qualitative research was based on the perceptions of patients and dietitians.

RESULTS

When the encounter between the dietitian and the patient followed the standard educational and informative approach, both the short-term nature of the interaction and the absence of an individualized therapeutic program discouraged patients from persisting with treatment. In contrast, the counseling and therapeutic nutritional approach promoted nutritional guidance through broader behavioral and lifestyle therapies. This approach appears more appropriate for chronically ill patients. The dietitians and some of the patients understand that the profession is changing from the informative and educational approach to a therapeutic counseling approach, but it is difficult for them to adapt to the new model.

CONCLUSION

Most patients appear to want individualized, not standardized, treatment. In order to change patients' eating patterns, dietitians must adopt a more therapeutic approach and relate to patients' cultural needs and desires to achieve sustainable results.

Adding diet and exercise counseling to the health promotion plan alleviates anthropometric and metabolic complications in patients with metabolic syndrome

We investigated the effects of individual (IC) and group (GC) diet and exercise counseling in men with metabolic syndrome. Participants received exercise instruction and exercise load was monitored. IC participants received individual diet counseling sessions and general consultations at baseline and monthly. GC participants received a group diet counseling session at baseline and general consultations at baseline and monthly. In the IC group, body mass index (BMI) percent body fat, waist circumference, diastolic blood pressure, low-density lipoprotein cholesterol, glycosylated hemoglobin A_1c, and liver function levels were reduced significantly after 3 months, whereas in the GC group, waist circumference and levels of liver function were reduced. Exercise load was negatively correlated with change in BMI and waist circumference in the IC group, and positively correlated with changes in high-density lipoprotein cholesterol levels in all subjects and in the GC group. Diet and exercise counseling, especially IC, may benefit patients with metabolic syndrome.

Is there scope for community health nurses to address lifestyle risk factors? the community nursing SNAP trial

Background

This paper examines the opportunity and need for lifestyle interventions for patients attending generalist community nursing services in Australia. This will help determine the scope for risk factor management within community health care by generalist community nurses (GCNs).

Methods

This was a quasi-experimental study conducted in four generalist community nursing services in NSW, Australia. Prior to service contacts, clients were offered a computer-assisted telephone interview to collect baseline data on socio-demographics, health conditions, smoking status, physical activity levels, alcohol consumption, height and weight, fruit and vegetable intake and 'readiness-to-change' for lifestyle risk factors.

Results

804 clients participated (a response rate of 34.1%). Participants had higher rates of obesity (40.5% vs 32.1%) and higher prevalence of multiple risk factors (40.4% vs 29.5%) than in the general population. Few with a SNAPW (Smoking-Nutrition-Alcohol-Physical-Activity-Weight) risk factor had received advice or referral in the previous 3 months. The proportion of clients identified as at risk and who were open to change (i.e. contemplative, in preparation or in action phase) were 65.0% for obese/overweight; 73.8% for smokers; 48.2% for individuals with high alcohol intake; 83.5% for the physically inactive and 59.0% for those with poor nutrition.

Conclusions

There was high prevalence of lifestyle risk factors. Although most were ready to change, few clients recalled having received any recent lifestyle advice. This suggests that there is considerable scope for intervention by GCNs. The results of this trial will shed light on how best to implement the lifestyle risk factor management in routine practice.

Biomarker evaluation does not confirm efficacy of computer-tailored nutrition education

OBJECTIVE

To evaluate the efficacy of computer-tailored nutrition education with objective outcome measures.

DESIGN

A 3-group randomized, controlled trial with posttests at 1 and 6 months post-intervention.

SETTING

Worksites and 2 neighborhoods in the urban area of Rotterdam.

PARTICIPANTS

A convenience sample of healthy Dutch adults (n = 442).

INTERVENTIONS

A computer-tailored intervention delivered on CD-ROM; a computer-tailored intervention delivered in print; and a generic information condition.

MAIN OUTCOME MEASURES

Blood lipids (total, high-density lipoprotein, and low-density lipoprotein cholesterol, and triacylglycerol) were measured by analyzing venous blood samples.

ANALYSIS

Linear mixed model procedure.

RESULTS

There were no significant differences among the 3 intervention groups in total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triacylglycerol.

CONCLUSIONS AND IMPLICATIONS

Contrary to results based on self-report data, no effects of the computer-tailored interventions were found based on objective outcomes. This contradiction calls for a critical reflection on the use of computer-tailored nutrition education interventions and the need to improve those interventions. Furthermore, this study indicates that feasible methods are needed to objectively assess the impact of computer-tailored nutrition education interventions in free-living subjects.

The implications of nutrition services within the health care system on the quality of life and longevity, in developed countries: a re-analysis of 38 studies

BACKGROUND

The United Nations' Global Population Pyramid is undertaking a shift from pyramid to cube. The concomitant decline in fertility and mortality rates produces a higher portion of older people, and, thus, an increased number of deaths due to cancer and cardiovascular disease (CVD). Limited studies have investigated the effect of health care services on longevity. In this work, findings from studies throughout the world are presented and re-analysed in order to evaluate the effect of health care services on population's health status.

METHODS

Studies that have assessed the associations of nutritional and other health care services (i.e., physicians supply, technical support, inter-collaboration) on longevity and health status were retrieved (searches in PubMed, EMBASE, Scopus, up to January 2010), and summarized here.

RESULTS

Few studies, mostly located in the US and the UK, have evaluated the role of health care services on population's health status. The majority of the studies reported a beneficial association between the frequency of physicians and mortality, while some other studies reported weak or no associations between physician's supply and longevity. Also nutritional services (screening) seem to promote better clinical outcome.

CONCLUSION

Although very few data are available, it seems that there is a positive correlation between the quality and quantity of health care services and longevity. Strong primary health care seems to be effective on the population's health outcome. Active health policy and enhancement of health and nutritional services within the health care system may contribute to improved population's health and their overall quality of life.

Effectiveness of a lifestyle intervention on metabolic syndrome. A randomized controlled trial

BACKGROUND

Intensive lifestyle intervention significantly reduces the progression to diabetes in high-risk individuals.

OBJECTIVE

It is not known whether a program of moderate intervention might effectively reduce metabolic abnormalities in the general population.

DESIGN

Two-arm randomized controlled 1-year trial.

PATIENTS

Three hundred and thirty-five patients participated from a dysmetabolic population-based cohort of 375 adults aged 45-64 years in northwestern Italy.

MEASUREMENTS

We compared the effectiveness of a general recommendation-based program of lifestyle intervention carried out by trained professionals versus standard unstructured information given by family physicians at reducing the prevalence of multiple metabolic and inflammatory abnormalities.

RESULTS

At baseline, clinical/anthropometric/laboratory and lifestyle characteristics of the intervention (n = 169) and control (n = 166) groups were not significantly different. The former significantly reduced total/saturated fat intake and increased polyunsaturated fat/fiber intake and exercise level compared to the controls. Weight, waist circumference, high-sensitivity C-reactive protein, and most of the metabolic syndrome components decreased in the intervention group and increased in the controls after 12 months. Lifestyle intervention significantly reduced metabolic syndrome (odds ratio [OR] = 0.28; 95% CI 0.18-0.44), with a 31% (21-41) absolute risk reduction, corresponding to 3.2 (2-5) patients needing to be treated to prevent 1 case after 12 months. The intervention significantly reduced the prevalence of central obesity (OR = 0.33; 0.20-0.56), and hypertriglyceridemia (OR = 0.48; 0.31-0.75) and the incidence of diabetes (OR = 0.23; 0.06-0.85).

CONCLUSION

A lifestyle intervention based on general recommendations was effective in reducing multiple metabolic/inflammatory abnormalities. The usual care by family physicians was ineffective at modifying progressive metabolic deterioration in high-risk individuals.

Development of a Nutrition Counselling Care Map For Dyslipidemia

Purpose: Care maps or clinical pathways for nutrition therapy of dyslipidemia could add to current practice guidelines, by providing templates for feasible and recommended diet counselling processes. A care map was therefore developed by engaging expert and generalist dietitians and external experts from across Canada in a multi-stage consensus process.

Methods: First, a qualitative study was undertaken with a convenience sample of 12 practitioners to identify possible diet care options, using hypothetical client scenarios and cognitive analysis. Second, these care options were rated for five case scenarios considered typical (overweight clients, with or without clinical cardiovascular disease and other comorbidities, potentially motivated to change, consuming high-fat diets, and facing various major barriers to eating behaviour change). The rating was conducted through a survey of participants. Highly appropriate, recommended, and feasible options for counselling were ranked through a two-round modified Delphi process, with teleconference discussions between rounds.

Results: Forty-nine professionals started the consensus process; 39 (80%) completed all aspects. Numerous care processes were appropriate for all clients, with additional focus on barriers for low-income clients, sodium intake for clients with hypertension, and smoking cessation in smokers.

Conclusions: The resulting care map, “Dietitians’ Quick Reference Guide for Clinical Nutrition Therapy for Overweight Clients with Dyslipidemia,” provides a basis for current practice and new effectiveness studies.

Randomized controlled trial: effect of nutritional counselling in general practice

OBJECTIVES

To investigate the effectiveness of a non-structured 15-min educational intervention by general practitioners (GPs) on modifications of daily diet among healthy adults.

DESIGN

Two arms randomized trial lasting 12 months.

SETTING

Italian general practitioner wards. Subjects A total of 3,186 men and women aged 18-65 years recruited in the medical ward by their GPs.

INTERVENTIONS

An educational intervention and a brochure on the basics of a healthy diet based on the Italian Guidelines for a Correct Nutrition, 1998. The main study goal was to attain an intake of fruits and vegetables >5 servings per day. Follow-up visit every 6 months. Main outcome measures Weight, blood pressure, and a 40-items Food Frequency Questionnaire.

RESULTS

The intervention group showed a slightly reduced net intake of meat and a slightly increased net intake of fruits and vegetables, fish products, and olive oil. Body mass index (BMI) changed only in the treatment arm [-0.41 95% confidence interval (95% CI) -0.11 to -0.53]. The net change at 1 year in the intervention arm was +1.31 (CI 0.90-4.39) for fruits and vegetables, and -0.22 (-0.11 to -0.69) for meat (portions per week). We also computed a 'healthy diet score' reflecting compliance with recommended dietary habits. In the intervention group, the mean score at recruitment was significantly lower than the mean score at the end of follow-up (Crude score change = 0.29; CI 0.19-0.48). No differences were observed in the control group (Crude score change = -0.04; CI -0.22-0.02). The difference in score from baseline to the final visit, comparing the intervention vs the control group, was statistically significant (P < 0.001) (MANOVA adjusted by sex, BMI, education, and time).

CONCLUSIONS

A brief educational intervention by GPs can induce multiple diet changes that may lower BMI and potentially reduce chronic disease risk in generally healthy adults.

Personalized nutrition communication through ICT application: how to overcome the gap between potential effectiveness and reality

The potential effectiveness of personalized nutrition communication through the Internet is promising in terms of addressing personal relevance, flexibility, interactive options and amount of people that can be reached. However, little research on the contribution to behaviour change has been done. The MyFood program at Wageningen University aims at providing insight into strategies to implement personalized nutrition communication through interactive tools. In this article we present the framework for research on social acceptance of personalized nutrition communication through interactive computer technology as part of the MyFood program.

Potentials and pitfalls for nutrition counselling in general practice

This paper was based on collaborative research efforts from Wageningen University and the University Medical Centre St Radboud in The Netherlands and describes the rationale for web-based nutrition counselling applications in general practice as well as some of the frequently used models and theories (predominantly the Stages of Change Model). General practitioners can play an important role in cardiovascular risk reduction by giving nutrition counselling to patients at elevated cardiovascular risk. Unfortunately, general practitioners perceive barriers that may limit their nutrition counselling practices. Some of these barriers may be overcome using computer and Internet technologies. Computerized reminders for preventive services, and websites with reliable high-quality information may prove to be valuable additions to usual care. Cooperation with dietitians may also lead to improvements in nutrition counselling in general practice. For example, general practitioners could use their unique position to create awareness and motivation among patients. They could subsequently refer motivated patients to dietitians for detailed personal dietary advice.

Nutrition guidance by family doctors in a changing world: problems, opportunities, and future possibilities

During the Third Heelsum International Workshop, Nutrition Guidance of Family Doctors Towards Best Practice, December 10-12, 2001, Heelsum, the Netherlands, 17 papers were presented. Each paper was discussed by all the participants at the workshop. These discussions were tape-recorded, transcribed, rearranged into topics, and summarized here. There are situations that call for nutrition advice to be given by general practitioners (GPs). GPs are trusted, they are not selling any particular food, and patients accept that their GPs may talk to them about diet. Compared with dietitians, GPs have much less time to advise about diet, so they must condense information. It is easier for a GP to give dietary advice if the patient is registered on the practice's list and if the GP can be paid for preventive work. Six topics seemed to be particularly new and challenging in our changing world: (1) Use of dietary supplements, herbal preparations, and functional foods; (2) patients as partners; (3) computers in practices; (4) evidence-based medicine; (5) the Internet; and (6) the obesity epidemic. These topics were reported as problems and then discussed as opportunities. The aim of the Heelsum Collaboration on General Practice Nutrition was to facilitate the nutrition work of GPs in their practices by researching the problems and barriers and by testing solutions. In line with this aim, some suggestions for research are provided.