Task Force Recommends Dietary Counseling for High-Risk Adults
Many of us start the New Year resolved to make healthful lifestyle changes. “Eat healthier” often tops the list.
Unhealthy diets have been associated with four of the ten leading causes of death: coronary heart disease, some types of cancer, stroke, and type 2 diabetes. What’s more, studies have shown that a healthful diet can reduce your risk for suffering and dying from chronic disease.
Despite the established benefits of a healthful diet, more than 80% of Americans eat fewer than the recommended servings of fruits, vegetables, and whole grains, and get more of their total calories from saturated fat and total fat than they should.
The U.S. Preventive Services Task Force has stepped in to help those at risk for chronic disease start off the new year eating more healthfully. In an article published in the January 2003 issue of the American Journal of Preventive Medicine , the Task Force recommends diet counseling for adults at high risk for heart disease and other chronic conditions. The Task Force’s recommendations are based on a review of the evidence, published in the same issue of the journal, which finds that intensive diet counseling can help at-risk adults eat less fat and more fruits and vegetables. The federal Agency for Healthcare Research and Quality funded this research.
About the Study
A team of researchers led by scientists from the University of North Carolina looked at the results of 21 studies reported in 25 articles published between 1996 and December 2001 that examined the effectiveness of counseling in changing dietary behavior. They included studies that enrolled patients with known risk factors for chronic disease, such as ]]>elevated cholesterol]]> , ]]>hypertension]]> , ]]>obesity]]> , or family history of heart disease, but excluded studies that enrolled patients with diagnosed chronic conditions.
The researchers studied several variables to determine the effectiveness of dietary counseling on the intake of saturated fat, fruits, vegetables, and fiber. Some of these variables included the intensity of the counseling intervention and the setting in which the counseling took place.
The researchers found that medium to high-intensity counseling interventions can produce moderate to large changes in the average daily intake of saturated fat, fiber, and fruits and vegetables in adults who are at increased risk for chronic diseases that may be influenced by diet. Based on these findings, the U.S. Preventive Services Task Force recommended intensive behavioral dietary counseling for adult patients with abnormal lipid levels and other risk factors for cardiovascular and other diet-related chronic diseases.
The review did not find consistently positive results for dietary counseling in adults who were not at high risk for diet-related chronic diseases. Therefore, the Task Force did not make any recommendations regarding this population.
One serious limitation of the review was that it was based on studies that relied on self-reported changes in dietary behavior. Because patients who are undergoing dietary counseling may be more likely to report dietary changes than control patients, the actual benefit of counseling may have been overestimated. Also, while a change in diet is an important first step, the researchers might have done better to measure whether counseling led to an actual reduction in death or morbidity from these conditions.
How Does This Affect You?
This Task Force review found that intensive dietary counseling in adults at risk for serious, diet-related chronic conditions can help them reduce their intake of saturated fat and increase their consumption of fiber, fruits, and vegetables. Other studies have shown that these dietary changes can lower the rates of death and morbidity from these illnesses.
If you are at risk for coronary heart disease, cancer, stroke or diabetes—or you think you may be—make an appointment at the start of this new year to speak with your doctor about a referral for dietary counseling. It may help keep you around for many more New Year’s resolutions in the future.
United States Department of Agriculture
Food Guide Pyramid
United States Department of Agriculture
Nutrition and Your Health: Dietary Guidelines for Americans
Pignone MP, Ammerman A, et al. Counseling to promote a healthy diet in adults: a summary of the evidence for the U.S. Preventive Services Task Force. Am J Prev Med . 2003;24:84-101.
U.S. Preventive Services Task Force. Behavioral counseling in primary care to promote a healthy diet: recommendations and rationale. Am J Prev Med . 2003;24:93-100.
Last reviewed Jan 2, 2003 by ]]>Richard Glickman-Simon, MD]]>
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