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Randomised trial of lipid lowering dietary advice in general practice: the Effects on serum lipids, lipoproteins, and antioxidants

Randomised trial of lipid lowering dietary advice in general practice: the Effects on serum lipids, lipoproteins, and antioxidants
Randomised trial of lipid lowering dietary advice in general practice: the Effects on serum lipids, lipoproteins, and antioxidants

Objective: To determine the relative efficacy in general practice of dietary advice given by a dietitian, a practice nurse, or a diet leaflet alone in reducing total and low density lipoprotein cholesterol concentration. Design: Randomised six month parallel trial. Setting: A general practice in Oxfordshire. Subjects: 2004 subjects aged 35-64 years were screened for hypercholesterolaemia; 163 men and 146 women with a repeat total cholesterol concentration of 6.0-8.5 mmol/l entered the trial. Interventions: Individual advice provided by a dietitian using a diet history, a practice nurse using a structured food frequency questionnaire, or a detailed diet leaflet sent by post. All three groups were advised to limit the energy provided by fat to 30% or less and to increase carbohydrate and dietary fibre. Main outcome measures: Concentrations of total cholesterol and low density and high density lipoprotein cholesterol after six months; antioxidant concentration and body mass index. Results: No significant differences were found at the end of the trial between groups in mean concentrations of lipids, lipoproteins, and antioxidants or body mass index. After data were pooled from the three groups, the mean total cholesterol concentration fell by 1.9% (0.13 mmol/l, 95% confidence interval 0.06 to 0.22, P<0.001) to 7.00 mmol/l, and low density lipoprotein cholesterol also fell. The total carotenoid concentration increased by 53 nmol/l (95% confidence interval 3.0 to 103, P=0.039). Conclusions: Dietary advice is equally effective when given by a dietitian, a practice nurse, or a diet leaflet alone but results in only a small reduction in total and low density lipoprotein cholesterol. To obtain a better response more intensive intervention than is normally available in primary care is probably necessary. Key messages In this study dietary advice had only a modest effect on lipid and lipoprotein concentrations Personalised advice from a nurse or dietitian was no more effective than a detailed diet leaflet Antioxidant concentrations increased slightly, but this requires further study A mass approach to dietary change is needed to produce significant change.

0959-8138
569
Neil, H. A.W.
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Roe, L.
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Godlee, R. J.P.
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Moore, J. W.
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Clark, G. M.G.
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Brown, J.
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Thorogood, M.
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Stratton, I. M.
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Lancaster, T.
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Mant, D.
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Fowler, G. H.
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Neil, H. A.W.
ded0352b-edc2-499f-a8b9-51f82489f985
Roe, L.
f926a798-dfe8-46bc-b1eb-acc1dbf152ae
Godlee, R. J.P.
97378cf8-1ddd-4388-bb91-69df545e57bc
Moore, J. W.
afd961ae-acbb-4d56-ad5a-b877ff3f314e
Clark, G. M.G.
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Brown, J.
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Thorogood, M.
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Stratton, I. M.
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Lancaster, T.
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Mant, D.
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Fowler, G. H.
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Neil, H. A.W., Roe, L., Godlee, R. J.P., Moore, J. W., Clark, G. M.G., Brown, J., Thorogood, M., Stratton, I. M., Lancaster, T., Mant, D. and Fowler, G. H. (1995) Randomised trial of lipid lowering dietary advice in general practice: the Effects on serum lipids, lipoproteins, and antioxidants. BMJ, 310 (6979), 569. (doi:10.1136/bmj.310.6979.569).

Record type: Article

Abstract

Objective: To determine the relative efficacy in general practice of dietary advice given by a dietitian, a practice nurse, or a diet leaflet alone in reducing total and low density lipoprotein cholesterol concentration. Design: Randomised six month parallel trial. Setting: A general practice in Oxfordshire. Subjects: 2004 subjects aged 35-64 years were screened for hypercholesterolaemia; 163 men and 146 women with a repeat total cholesterol concentration of 6.0-8.5 mmol/l entered the trial. Interventions: Individual advice provided by a dietitian using a diet history, a practice nurse using a structured food frequency questionnaire, or a detailed diet leaflet sent by post. All three groups were advised to limit the energy provided by fat to 30% or less and to increase carbohydrate and dietary fibre. Main outcome measures: Concentrations of total cholesterol and low density and high density lipoprotein cholesterol after six months; antioxidant concentration and body mass index. Results: No significant differences were found at the end of the trial between groups in mean concentrations of lipids, lipoproteins, and antioxidants or body mass index. After data were pooled from the three groups, the mean total cholesterol concentration fell by 1.9% (0.13 mmol/l, 95% confidence interval 0.06 to 0.22, P<0.001) to 7.00 mmol/l, and low density lipoprotein cholesterol also fell. The total carotenoid concentration increased by 53 nmol/l (95% confidence interval 3.0 to 103, P=0.039). Conclusions: Dietary advice is equally effective when given by a dietitian, a practice nurse, or a diet leaflet alone but results in only a small reduction in total and low density lipoprotein cholesterol. To obtain a better response more intensive intervention than is normally available in primary care is probably necessary. Key messages In this study dietary advice had only a modest effect on lipid and lipoprotein concentrations Personalised advice from a nurse or dietitian was no more effective than a detailed diet leaflet Antioxidant concentrations increased slightly, but this requires further study A mass approach to dietary change is needed to produce significant change.

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Published date: 4 March 1995

Identifiers

Local EPrints ID: 486946
URI: http://eprints.soton.ac.uk/id/eprint/486946
ISSN: 0959-8138
PURE UUID: 475945f4-90ae-4646-a465-15089c3a53cc
ORCID for I. M. Stratton: ORCID iD orcid.org/0000-0003-1172-7865

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Date deposited: 08 Feb 2024 17:45
Last modified: 06 Jun 2024 02:10

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Contributors

Author: H. A.W. Neil
Author: L. Roe
Author: R. J.P. Godlee
Author: J. W. Moore
Author: G. M.G. Clark
Author: J. Brown
Author: M. Thorogood
Author: I. M. Stratton ORCID iD
Author: T. Lancaster
Author: D. Mant
Author: G. H. Fowler

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