ABC of nutrition. Nutritional advice for other chronic diseases

Baseline data and design for a randomized intervention study of dietary change in religious organizations

BACKGROUND

Reducing dietary fat has been identified as a potential means of preventing chronic disease. Several studies have identified methods of changing dietary fat consumption in small, intensive intervention settings. Fewer studies have examined how to improve dietary habits of individuals in the general public.

METHODS

The Eating for a Healthy Life (EHL) project was a randomized trial [n = 40 religious organizations (ROs) and 2175 individuals, 1099 in intervention]. The study tested an intervention package of self-help books, motivational messages, and social interactions designed to change dietary behaviors (lowering fat, increasing fruit and vegetable consumption) among members of religious organizations aged 18 and over. The primary outcomes are fat- and fruit- or vegetable-related behaviors measured using the Fat and Fiber Behavior (FFB) Questionnaire.

RESULTS

Religious organizations and their members participated fully in the initial study activities.

CONCLUSIONS

This study will support a rigorous test of the intervention package.

Evaluation of strategies used by family food preparers to influence healthy eating

The family may exert powerful influence on family members' eating habits, though there is very little conclusive literature regarding the specific mechanisms. The authors investigated how often family food preparers use particular strategies to encourage their families to eat more healthily and then related these strategies to healthy eating outcomes in children. We identified significant differences in strategy use between family age subgroups, and we included strategy types in multiple linear regression models to predict differences in families with children. Results indicate that discussing healthy food related to 'Pressuring' strategies and discussing healthy eating related to 'Feeling and looking good' predicted healthy eating outcomes. Findings have implications for designing dietary interventions to have the largest public health impact.

Dietary interventions to prevent disease

Changing dietary behaviors to prevent chronic disease has been an important research focus for the last 25 years. Here we present a review of published articles on the results of research to identify methods to change key dietary habits: fat intake, fiber intake, and consumption of fruits and vegetables. We divided the research reviewed into sections, based on the channel through which the intervention activities were delivered. We conclude that the field is making progress in identifying successful dietary change strategies, but that more can be learned. Particularly, we need to transfer some of the knowledge from the individual-based trials to community-level interventions. Also, more research with rigorous methodology must be done to test current and future intervention options.

Hypertension: are beta-blockers and diuretics appropriate first-line therapies?

OBJECTIVE

To review the existing data on the use of diuretics or beta-blockers as first-line therapy for the treatment of mild to moderate hypertension, and to examine the issues surrounding the impact of these classes as well as the angiotensin-converting enzyme (ACE) inhibitors, calcium-channel blockers (CCBs), alpha-blockers, and alpha-beta-blockers on cardiovascular risk factors and cardiovascular morbidity and mortality.

DATA SOURCES

A MEDLINE search of applicable articles on antihypertensive therapies and their impact on morbidity and mortality. In addition, a MEDLINE search of relevant articles regarding cardiovascular risk factors and the influence of the various antihypertensive therapies on these parameters.

DATA SYNTHESIS

The literature was evaluated with regard to outcome. Trials examining the impact of antihypertensive pharmacotherapy, primarily with diuretics and beta-blockers, have shown them to decrease the incidence of stroke by 33-50 percent. However, their effect on coronary heart disease has been disappointing, showing only a 14 +/- 5 (mean +/- SD) percent decrease. Examination of numerous clinical trials assessing the impact of the various antihypertensive therapies on cardiovascular risk factors, including blood pressure, plasma lipids, diabetic control/insulin sensitivity, and left ventricular hypertrophy was done. The classes included beta-blockers, diuretics, alpha-blockers, ACE inhibitors, and CCBs; the results show a diversity of effect. Diuretics and beta-blockers tend to worsen cardiovascular risk status, whereas the alpha-blockers, ACE inhibitors, and CCBs all show a beneficial effect.

CONCLUSIONS

Diuretics and beta-blockers can effectively reduce cerebrovascular morbidity and mortality, but have a limited effect on reducing cardiovascular disease, especially myocardial infarction. This may be explained, at least in part, by the negative, or lack of positive, effect on individual patients' overall cardiovascular risk status.