Structured advice provided by a dietitian increases adherence of consumers to diet and lifestyle changes and lowers blood low‐density lipoprotein (LDL)‐cholesterol: the Increasing Adherence of Consumers to Diet &amp; Lifestyle Changes to Lower (LDL) Cholesterol (ACT) randomised controlled trial

Sialvera, Theodora-Eirini; Papadopoulou, Areti; Efstathiou, Stamatis P.; Trautwein, Elke A.; Ras, Rouyanne T.; Kollia, Natasa; Farajian, Paul; Goumas, G.; Dimakopoulos, Ioannis; Papavasiliou, Kleopatra; Koutsouri, Anastasia; Zampelas, Antonis

doi:10.1111/jhn.12508

Cited by 24 publications

(28 citation statements)

References 27 publications

(32 reference statements)

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“…Doctors’ medical training and basic nutrition education provide them with the tools to recognise ‘at risk’ patients and refer them to trained specialists, such as dietitians, who have the time, funding, knowledge and practical skills to provide effective medical nutrition therapy and elicit behaviour change (Sialvera et al . ). Doctors can also signpost patients to evidenced‐based nutrition resources, such as those provided online and in print by leading nutrition authorities ( e.g .…”

Section: How Can Doctors Provide Nutrition Advice Without Being Nutrmentioning

confidence: 97%

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Are doctors nutritionists? What is the role of doctors in providing nutrition advice?

et al. 2018

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Diet and nutritional status impact on health outcomes. The global rise of dietrelated non-communicable diseases plus the double burden of obesity and malnutrition means that it is imperative more than ever that all healthcare professionals are able to provide at least basic evidence-based nutrition advice. Improving an individual's diet requires more than just information provision, it requires consistent and long-term support to change and maintain new behaviours. Doctors acknowledge that nutrition plays a crucial role in health and agree that providing nutrition advice is part of their role. However, providing sufficiently detailed nutrition advice that is relevant to a patient's health goals, useful for the patient, and that results in measurable changes, is not common in practice settings. Numerous challenges and barriers have been identified for why doctors do not provide nutrition recommendations to their patients. A lack of nutrition education and training, time constraints during appointments, and patients who have access to an ever-growing body of nutrition and health information via the Internet and social media, together may explain why doctors tend not to include nutrition advice in their care plans. This paper outlines both short-and long-term strategies for improving doctors' engagement with nutrition interventions and collaborative working with dietitians in the context of collaborative care. Having doctors support and advocate for evidenced-based nutrition practice is a crucial element of the World Health Organization's Decade of Action on Nutrition achieving measurable success.

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Section: How Can Doctors Provide Nutrition Advice Without Being Nutrmentioning

confidence: 97%

“…These guidelines could flow into financial models to support the provision of basic nutrition advice within a consultation, and referral pathways to dietitians for complex cases (Sialvera et al . ).…”

Section: The Way Forwardmentioning

confidence: 97%

Are doctors nutritionists? What is the role of doctors in providing nutrition advice?

et al. 2018

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“…The 'Increasing Adherence of Consumers to Diet & Lifestyle Changes to Lower (LDL) Cholesterol (ACT)' randomised controlled trial aimed to improve blood lipid levels in mildly-to-moderately hypercholesterolaemic individuals via structured dietary advice provided by either a dietician or physician, as well as to provide valuable information for healthcare professionals on methods of increasing patient's compliance to lifestyle and dietary changes. The findings concerning blood lipid changes and improvement of dietary habits and physical activity have been reported previously (14) . The aim of the present study was to assess the perceived effectiveness and easiness of the specific dietary and behavioural guidance given by physicians or dietitians at specific time intervals as part of the ACT study and also to examine actual and perceived (forecasted) compliance.…”

Section: Introductionmentioning

confidence: 67%

“…Evidence suggests that regular physical exercise is beneficial, although adherence remains a major hurdle, with a lack of time often being cited as a major barrier (28) . Although the present intervention was not specifically tailored to investigate any increase in physical activity, the improvement of dietary habits, including the increase in the consumption of PS, in combination with a shift in physical activity towards more moderate intensity levels, is suggested to have resulted in the observed beneficial effects on blood lipid profiles (14) .…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and easiness of adherence to behavioural guidelines for diet and lifestyle changes for cholesterol‐lowering: the Increasing Adherence of Consumers to Diet & Lifestyle Changes to Lower (LDL) Cholesterol (ACT) randomised controlled trial

Magriplis

Sialvera

Papadopoulou³

et al. 2019

J Human Nutrition Diet

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Background The present study aimed to assess perceived effectiveness and easiness of behavioural diet and lifestyle changes related to dyslipidaemia given by physicians or dieticians as a result of diet and lifestyle modifications being difficult to maintain. Methods One‐hundred hypercholesterolaemic individuals were enrolled in a parallel, randomised 6‐week study. Fifty were advised by dietitians (dietitian group: DG) in six weekly face‐to‐face behavioural therapy sessions and 50 received standard advice from physicians (physician group: PG). All individuals were followed‐up for another 6 weeks under real‐life conditions. Questionnaires regarding perceived effectiveness, easiness of adhering, forecasted and actual adherence to specific cholesterol‐lowering advice were completed. Results Scores of perceived effectiveness of advice for sufficient exercise, limiting saturated fat (SFA) intake, eating fish twice a week, consuming plenty of fresh fruit and vegetables, and limiting salt intake different scientifically (all P < 0.05) in PG and DG between study phases. Scores of the individuals' perception of effectiveness at all study phases were higher in the DG compared to PG for sufficient exercise, limiting SFA intake, eating fish twice a week, eating plenty of fruits and vegetables, and limiting salt intake, whereas scores of easiness were significant only for fish consumption (P = 0.008) and using foods with added plant sterols (all P < 0.05). DG and PG significantly differed in forecasted (week 6) versus actual adherence (week 12) to various chances, with DG reporting higher adherence. Conclusions Lifestyle and dietary changes related to dyslipidaemia can be achieved with continuous education, monitoring and follow‐ups by dieticians, as well as potentially other trained healthcare professionals.

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“…A common feature of such intervention studies is structured counseling by dietitians and physicians, usually in health care clinics, (Estruch et al, 2018) research clinics or in hospitals (Sialvera et al, 2017). However, specialized clinics suffer from high costs and limited capacity.…”

Section: Introductionmentioning

confidence: 99%

A randomized controlled trial in Norwegian pharmacies on effects of risk alert and advice in people with elevated cardiovascular risk

Svendsen

Telle-Hansen

Mørch-Reiersen³

et al. 2018

Preventive Medicine Reports

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We investigated if alerting subjects to elevated total cholesterol (TC), hemoglobin A1c (HbA1c) and blood pressure (BP) (cardiovascular disease (CVD) risk factors that are usually asymptomatic), and if providing advice would result in reduced risk. We conducted a multicenter (50 community pharmacies) parallel three-arm 8-week randomized controlled trial (RCT) with a 52-week follow-up visit. During six days of screening, TC, HDL- and LDL-cholesterol, triglycerides, HbA1c, BP and body mass index (BMI) were assessed in 1318 individuals. Of these, 582 with a measured and predefined elevated ad hoc CVD risk score were randomized to either Alert/advice (n = 198) (immediately alerted of their screening result and received healthy lifestyle-advice), Advice-only (n = 185) (received only advice) or Control (n = 199) (not alert, no advice). Changes in risk score and self-reported health-related behaviors (diet, alcohol, physical activity) were assessed in pharmacies after 8 weeks (N = 543; 93%). Although the primary analysis showed no significant difference between groups, the Control group had the largest reduction in risk score of 14%. The total (uncontrolled) sample (N = 543) reduced the risk score by 3.2% beyond estimated regression towards the mean and improved their health-related behaviors. Among the 65% (n = 377) who returned 52 weeks after baseline, 14% reported started using CVD preventive medication after the screening. The study demonstrated that while assessing risk factors and behaviors in pharmacies proved efficient and possibly led to a small risk decrease, alerting people to their screening result did not seem to be more effective than a self-directed approach. ClinicalTrials.gov identifier: NCT02223793.

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Structured advice provided by a dietitian increases adherence of consumers to diet and lifestyle changes and lowers blood low‐density lipoprotein (LDL)‐cholesterol: the Increasing Adherence of Consumers to Diet & Lifestyle Changes to Lower (LDL) Cholesterol (ACT) randomised controlled trial

Abstract: Although structured counselling by dietitians and common standard advice by physicians were equally effective with respect to improving blood cholesterol after 6 weeks, dietitians were more effective in the longer-term (i.e. 6 weeks after the end of the intervention period).

Cited by 24 publications

References 27 publications

Are doctors nutritionists? What is the role of doctors in providing nutrition advice?

Are doctors nutritionists? What is the role of doctors in providing nutrition advice?

Effectiveness and easiness of adherence to behavioural guidelines for diet and lifestyle changes for cholesterol‐lowering: the Increasing Adherence of Consumers to Diet & Lifestyle Changes to Lower (LDL) Cholesterol (ACT) randomised controlled trial

A randomized controlled trial in Norwegian pharmacies on effects of risk alert and advice in people with elevated cardiovascular risk

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