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High-quality nutrition counselling for hypercholesterolaemia by public health nurses in rural areas does not affect total blood cholesterol - commentary

Thompson, R.L. (2005) 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), pp. 187-189.

Record type: Article


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.

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Published date: 2005


Local EPrints ID: 26034
ISSN: 1462-9410
PURE UUID: 3bcff88f-9a07-4dac-80cc-80ac54d25ef0

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Date deposited: 20 Apr 2006
Last modified: 17 Jul 2017 16:08

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