Telephone-Delivered Dietary Intervention in Patients with Age-Related Macular Degeneration: 3-Month Post-Intervention Findings of a Randomised Controlled Trial

Abstract

There is an evidence–practice gap between the dietary recommendations for age-related macular degeneration (AMD) presented in the literature and those practiced by patients. This study reports on the 3-month post-intervention results of a randomised controlled trial (RCT) evaluating telephone-delivered counselling to improve dietary behaviours among AMD patients. A total of 155 AMD patients (57% female, aged 78 ± 8 years; control: 78, intervention: 77), primarily residing in New South Wales, Australia, were recruited. Participants completed a baseline questionnaire and a short dietary questionnaire (SDQ-AMD). The intervention included an evidence-based nutrition resource and four monthly calls with a dietitian. Immediately post-intervention, intervention participants repeated the SDQ-AMD and completed a feedback form. At 3 months post-intervention, both study arms repeated the SDQ-AMD. Statistical analyses included t-tests and McNemar’s test. Intervention participants reported satisfaction with the tailored phone calls, nutrition resource and nutrition education provided. At 3 months post-intervention, there was no statistically significant difference between study arms in the proportion of participants meeting the dietary goals nor in intake (mean servings ± SE) of total vegetables (primary outcome) and other key food groups; however, there was a significantly higher intake of nuts (secondary outcome) (3.96 ± 0.51 vs. 2.71 ± 0.32; p = 0.04) among participants in the intervention versus control group. Within the intervention arm, there were also significant improvements in intakes of the following secondary outcomes: dark green leafy vegetables (0.99 ± 0.17 vs. 1.71 ± 0.22; p = 0.003) and legumes (0.69 ± 0.10 vs. 1.12 ± 0.16; p = 0.02) and intake of sweets and processed/prepared foods (8.31 ± 0.76 vs. 6.54 ± 0.58, p = 0.01). In summary, although there were few dietary differences between study arms at 3 months post-intervention, the intervention involving four monthly calls was acceptable and helpful to the participants. This type of intervention therefore has the potential to provide people with AMD the needed support for improving their nutrition knowledge and dietary practices, especially if continued over a longer period.

Development, implementation and evaluation of the online Movement, Interaction and Nutrition for Greater Lifestyles in the Elderly (MINGLE) program: The protocol for a pilot trial

“…Amongst people with AMD, positive participant responses to virtual programs have also been reported in another evidence-based intervention developed by our group, which aimed to improve the dietary intakes of people with AMD through telehealth nutrition intervention [ 17 ]. This telehealth intervention involved the provision of an evidence-based workbook on nutrition and AMD links, together with monthly individual phone calls with a dietitian over four months, which significantly improved the participants’ dietary intake of nutrient-rich dark green leafy vegetables and legumes and reduced consumption of packaged and processed foods [ 17 ].…”

“…Using Phase 1 findings, the proposed MINGLE program will be modified to better suit people with AMD. The proposed MINGLE program, adapted from WTL and the dietary telehealth intervention [ 17 ], will run for 1-hour per week for 10 weeks online via Zoom. Participants will be divided into subgroups based on participant preference to available session timings (e.g., morning/afternoon).…”

“…A question about dairy intake has also been added given evidence of a protective association between dairy intake and AMD [ 27 ]. The scoring criteria for the SDQ-AMD has been described previously [ 17 ] however will also be modified to provide a score for dairy intake.…”

“…To address the impacts of vision loss caused by AMD, including the increased prevalence of loneliness, depression and falls risk, as well as to improve AMD-related lifestyle risk factors (poor diet and physical inactivity), we aimed to build on our prior research by developing a holistic program called MINGLE (Movement, Interaction and Nutrition for Greater Lifestyles in the Elderly) and piloting this novel program in a sample of older Australian adults with AMD. Therefore, this study aims to: 1) develop the MINGLE program tailored to AMD patients, by incorporating the successful aspects of existing evidence-based interventions developed by our group (WTL-Z and a dietary intervention [ 17 ]); and 2) deliver the MINGLE program online via Zoom [ 18 ] in a non-randomised group of AMD patients. Although our prior research has shown that online delivery of WTL-Z can effectively reduce loneliness and depression, this study was conducted in normal sighted older adults residing in the UK.…”

What Advice Is Currently Given to Patients with Age-Related Macular Degeneration (AMD) by Eyecare Practitioners, and How Effective Is It at Bringing about a Change in Lifestyle? A Systematic Review

“…An important point to consider is that the studies that were reported recently (2020 and later) [ 50 , 52 , 57 , 62 , 78 ] show that there are improved rates of advice provision amongst practitioners compared to earlier studies [ 35 , 36 , 43 , 45 , 49 , 54 , 55 ]. However, this review highlights that there is still a need for further education for practitioners, specifically about the importance of smoking cessation advice.…”