As nations seek to address obesity and diet-related chronic disease, understanding shifts in food intake over time is an imperative. However, quantifying intake of basic foods is not straightforward because of the diversity of raw and cooked wholefoods, processed foods and mixed dishes actually consumed. In this study, data from the Australian national nutrition surveys of 1995 and 2011, each involving more than 12,000 individuals and covering more than 4500 separate foods, were coherently disaggregated into basic foods, with cooking and processing factors applied where necessary. Although Australians are generally not eating in a manner consistent with national dietary guidelines, there have been several positive changes. Australians are eating more whole fruit, a greater diversity of vegetables, more beans, peas and pulses, less refined sugar, and they have increased their preference for brown and wholegrain cereals. Adult Australians have also increased their intake of nuts and seeds. Fruit juice consumption markedly declined, especially for younger Australians. Cocoa consumption increased and shifts in dairy product intake were mixed, reflecting one of several important differences between age and gender cohorts. This study sets the context for more detailed research at the level of specific foods to understand individual and household differences.
Objective: To evaluate a primary prevention care model using telephone support delivered through an existing health call centre to general practitioner-referred patients at risk of developing CVD, using objective measures of CVD risk reduction and weight loss. Design: Participants were randomised into two groups: (i) those receiving a telephone-supported comprehensive lifestyle intervention programme (CLIP: written structured diet and exercise advice, plus seven telephone sessions with the Heart Foundation Health Information Service); and (ii) those receiving usual care from their general practitioner (control: written general lifestyle advice). Fasting plasma lipids, blood pressure, weight, waist circumference and height were assessed on general practice premises by a practice nurse at Weeks 0 and 12.
Conclusions:In general practice patients, delivering CLIP through an existing telephone health service is effective in achieving reductions in LDL-C and total cholesterol. While CLIP may have potential for wider implementation to support primary prevention of CVD, longer-term cost-effectiveness data are warranted.
Keywords
Telephone supportWeight loss Lipid reduction General practice CVD affects 3?5 million (17 %) Australians (1) and is a leading cause of death (34 % of all deaths in 2008) (2) . The major risk factors contributing to the burden of CVD in Australia include high blood pressure (42 %), high cholesterol (35 %), physical inactivity (24 %) (3) and overweight and obesity (21?3 %) (1) . It is estimated that 90 % of Australians have at least one modifiable risk factor for CVD (4) . This demonstrates the need for effective models of preventive health care that target elevated blood pressure, high cholesterol and weight to reduce CVD risk (5) .Growing evidence supports effective CVD risk reduction from dietary patterns that include plant sterols (6) , long-chain n-3 fatty acids (7) , fruits and vegetables (8) , nuts (9) and unsaturated oils (10,11) . A previous 6-week clinical-based intervention, conducted in sixty-five hypercholesterolaemic patients, showed that a structured lipid-lowering dietary pattern that utilised the synergistic effect of cardioprotective foods had significant positive health outcomes (12) . When compared with participants who received either (i) qualitative lifestyle advice alone or (ii) qualitative lifestyle advice together with 20 mg simvastatin/d, the intervention group exhibited significantly reduced LDL-cholesterol (LDL-C) by 15 % and reduced weight and waist circumference (12) . However, prior interventions have predominantly relied upon intensive face-to-face counselling, which is limited by financial cost, resource availability and reach.General practitioners offer an alternative delivery approach, as they are well placed to initiate successful
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