High-quality nutrition counselling for hypercholesterolaemia by public health nurses in rural areas does not affect total blood cholesterol - commentary
Evidence-based HealthCare, 7, (4), .
Full text not available from this repository.
Background: Diet affects coronary heart disease
(CHD). People living in remote areas seldom have access
to nutritionist-based intervention strategies exist
to improve dietary behaviour. It has been suggested that
a public health nurse-based nutrition counselling service
might be benefit people with hypercholesterolaemia
in rural areas.
Objective: To assess the effectiveness in rural areas
of an intervention programme by public health nurses
in facilitating dietary counselling for hypercholesterolaemia.
Setting: Rural county health departments in
North Carolina, United States; recruitment August
1994 to November 1996.
Method: Cluster randomised controlled trial.
PARTICIPANTS Seventeen rural county health departments
(incorporating 468 individuals) were randomised.
Individuals were included if they were aged
between 20 and 70 years; had a total cholesterol level
of >4.7mmol/L within the previous 12 months, and
were not being treated for hypercholesterolaemia (either
medication - or counselling-based). People with severe
chronic or acute medical conditions were excluded
from the initial screen. People screened were then enrolled
in the study if their low-density lipoprotein-cholesterol
(LDL-C) was either>100mg/dL(2.59mmol/L)
with known coronary heart disease (CHD), 130 to
159mg/dL (3.37 to 4.12mmol/L) with two or more
CHD risk factors, or>4160mg/dL (4.14mmol/L).
Intervention: The control ‘minimum’ intervention
(nine departments; 252 people) consisted of
routine counselling for high cholesterol by a public
health nurse. The special intervention (eight departments;
216 people) comprised three individual diet
counselling sessions by a public health nurse, referral
to a nutritionist if lipid goals were not attained after 3
months and a follow-up phone call and newsletters. Follow-
up was 12 months.
Main Outcomes: Total cholesterol, LDL-C,
body weight and dietary risk assessment (DRA) score
based on a food frequency questionnaire.
Main Results: There was no signi¢cant di¡erence
in the total reduction of blood cholesterol between
the twogroups at either 3 (p=0.9) or12months (p=0.6)
follow-up.Weight loss was signi¢cantly greater in the
special group at 3 (p=0.02) and 6 months (p=0.04),
but not by 12 months (p=0.13). The average reduction
in total dietary risk assessment score (indicating dietary
improvement) was significantly greater in the special intervention
group at both 3 (p=0.0006) and 12 months
(p=0.005) follow -up.
Author's Conclusions: Intensive dietary
counselling does not seem to improve blood cholesterol
compared with minimal counselling.
Actions (login required)