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Nutrition, Vitamins & Supplements for Seniors
Diet Counseling Leads to Only Modest Improvement in
Heart Risks
Those with risk factor elevation - such as high
blood pressure or cholesterol - respond better than those at ‘average’
levels
 Oct. 17, 2007 – Senior citizens, in their unending
fight against heart disease, are frequently advised to select a diet
that will help reduce their risk. A review of 38 studies, however, finds
the that dietary advice does lead to modest improvement in risk factors
such as high cholesterol and blood pressure, especially in people at
higher risk.The reviewer suggests, however, these diets may lead to more
health improvements than the study indicates.
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The Cochrane reviewers looked at 38 studies in
which randomly assigned healthy adults received dietary advice in some
cases and no advice in others. The recommendations usually focused on
reducing fat and salt intake while increasing the intake of fruit,
vegetables and fiber.
People who were received advice on their diets
increased their fruit and vegetable consumption by 1.25 servings over
the course of follow-up. Fiber intake also increased while total dietary
fats and saturated fatty acids fell.
Researchers also noted what they called “modest”
changes for the better in total cholesterol, LDL (or “bad” cholesterol)
and blood pressure.
In studies that separated effects by sex, women
tended to have larger reductions in fat intake.
“Diet is a key health behavior and a definitive
review of the effects of dietary advice among healthy people was
lacking, “ said lead author Eric Brunner, Ph.D., a reader in the
Department of Epidemiology and Public Health at the University College
London Medical School.
“The key question is whether the general population
responds.” The answer is “yes,” Brunner said.
“But the dietary and risk factor changes are
modest. Our findings point to the fact that individuals with risk factor
elevation - such as high blood pressure or cholesterol - respond better
than those at ‘average’ levels of risk, even though average coronary
heart disease risk in Western populations is very high compared to a
country like Japan, where rates of CHD are relatively low.”
Counseling that occurred in health care settings,
such as doctors’ offices, resulted in greater reductions in fat and
increases in fruit and vegetable consumption. However, it was not clear
that these changes translate into lowering of blood cholesterol.
High-intensity interventions involving more than
three personal contacts were associated with larger effects than those
with fewer contacts. However, “there was a dearth of long-duration
studies, meaning that we have little idea of the long-term effects of
counseling,” Brunner said.
“Our review suggests that the average changes in
individual nutrients and related risk factors are likely to be
relatively small,” said Brunner.
“When taken across the entire diet, however,
several small changes in food habits may lead to greater health gains
than the estimates would suggest.”
The more effective, higher-intensity interventions
uncovered by the dietary counseling review may not mesh with the current
U.S. health care system, cautioned Nieca Goldberg, M.D., spokesperson
for the American Heart Association and director of the Women’s Heart
Program at the New York University School of Medicine.
“With the exception of people with diabetes, health
insurance does not pay for targeted nutrition counseling,” Goldberg
said. “This often turns into a barrier to proper education when the
person cannot afford the costs.”
Editor’s Notes:
The Cochrane Library is a publication of The
Cochrane Collaboration, an international organization that evaluates
medical research. Systematic reviews draw evidence-based conclusions
about medical practice after considering both the content and quality of
existing medical trials on a topic.
The Cochrane Collaboration is an international
nonprofit, independent organization that produces and disseminates
systematic reviews of health care interventions and promotes the search
for evidence in the form of clinical trials and other studies of
interventions. Visit http://www.cochrane.org for more information.
Brunner EJ, et al. Dietary advice for reducing
cardiovascular risk (Review). Cochrane Database of Systematic Reviews
2007, Issue 4.
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