Skip to main content
American Journal of Public Health logoLink to American Journal of Public Health
. 1997 Sep;87(9):1415–1422. doi: 10.2105/ajph.87.9.1415

Can dietary interventions change diet and cardiovascular risk factors? A meta-analysis of randomized controlled trials.

E Brunner 1, I White 1, M Thorogood 1, A Bristow 1, D Curle 1, M Marmot 1
PMCID: PMC1380963  PMID: 9314790

Abstract

OBJECTIVES: This study evaluated the effectiveness of dietary advice in primary prevention of chronic disease. METHODS: A meta-analysis was conducted of 17 randomized controlled trials of dietary behavior interventions of at least 3 months' duration. Results were analyzed as changes in reported dietary fat intakes and biomedical measures (serum cholesterol, urinary sodium, systolic and diastolic blood pressure) in the intervention group minus changes in the control group at 3 to 6 months and 9 to 18 months of follow-up. RESULTS: After 3 to 6 months, mean net changes in each of the five outcomes favored intervention. For dietary fat as a percentage of food energy, the change was -2.5% (95% confidence interval [CI] = -3.9%, -1.1%). Mean net changes over 9 to 18 months were as follows: serum cholesterol, -0.22 (95% CI = -0.39, -0.05) mmol/L; urinary sodium, -45.0 (95% CI = -57.1, -32.8) mmol/24 hours; systolic blood pressure, -1.9 (95% CI = -3.0, 0.8) mm Hg; and diastolic blood pressure, -1.2 (95% CI = -2.6, 0.2) mm Hg. CONCLUSIONS: Individual dietary interventions in primary prevention can achieve modest improvements in diet and cardiovascular disease risk status that are maintained for 9 to 18 months.

Full text

PDF
1420

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baron J. A., Gleason R., Crowe B., Mann J. I. Preliminary trial of the effect of general practice based nutritional advice. Br J Gen Pract. 1990 Apr;40(333):137–141. [PMC free article] [PubMed] [Google Scholar]
  2. Beresford S. A., Farmer E. M., Feingold L., Graves K. L., Sumner S. K., Baker R. M. Evaluation of a self-help dietary intervention in a primary care setting. Am J Public Health. 1992 Jan;82(1):79–84. doi: 10.2105/ajph.82.1.79. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bingham S. A., Gill C., Welch A., Day K., Cassidy A., Khaw K. T., Sneyd M. J., Key T. J., Roe L., Day N. E. Comparison of dietary assessment methods in nutritional epidemiology: weighed records v. 24 h recalls, food-frequency questionnaires and estimated-diet records. Br J Nutr. 1994 Oct;72(4):619–643. doi: 10.1079/bjn19940064. [DOI] [PubMed] [Google Scholar]
  4. Bingham S. A. Limitations of the various methods for collecting dietary intake data. Ann Nutr Metab. 1991;35(3):117–127. doi: 10.1159/000177635. [DOI] [PubMed] [Google Scholar]
  5. Bloemberg B. P., Kromhout D., Goddijn H. E., Jansen A., Obermann-de Boer G. L. The impact of the Guidelines for a Healthy Diet of The Netherlands Nutrition Council on total and high density lipoprotein cholesterol in hypercholesterolemic free-living men. Am J Epidemiol. 1991 Jul 1;134(1):39–48. doi: 10.1093/oxfordjournals.aje.a115991. [DOI] [PubMed] [Google Scholar]
  6. Boyd N. F., Cousins M., Beaton M., Kriukov V., Lockwood G., Tritchler D. Quantitative changes in dietary fat intake and serum cholesterol in women: results from a randomized, controlled trial. Am J Clin Nutr. 1990 Sep;52(3):470–476. doi: 10.1093/ajcn/52.3.470. [DOI] [PubMed] [Google Scholar]
  7. Bruno R., Arnold C., Jacobson L., Winick M., Wynder E. Randomized controlled trial of a nonpharmacologic cholesterol reduction program at the worksite. Prev Med. 1983 Jul;12(4):523–532. doi: 10.1016/0091-7435(83)90206-2. [DOI] [PubMed] [Google Scholar]
  8. Cappuccio F. P., MacGregor G. A. Does potassium supplementation lower blood pressure? A meta-analysis of published trials. J Hypertens. 1991 May;9(5):465–473. doi: 10.1097/00004872-199105000-00011. [DOI] [PubMed] [Google Scholar]
  9. Chalmers I., Dickersin K., Chalmers T. C. Getting to grips with Archie Cochrane's agenda. BMJ. 1992 Oct 3;305(6857):786–788. doi: 10.1136/bmj.305.6857.786. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Collins R., Peto R., MacMahon S., Hebert P., Fiebach N. H., Eberlein K. A., Godwin J., Qizilbash N., Taylor J. O., Hennekens C. H. Blood pressure, stroke, and coronary heart disease. Part 2, Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet. 1990 Apr 7;335(8693):827–838. doi: 10.1016/0140-6736(90)90944-z. [DOI] [PubMed] [Google Scholar]
  11. Crouch M., Sallis J. F., Farquhar J. W., Haskell W. L., Ellsworth N. M., King A. B., Rogers T. Personal and mediated health counseling for sustained dietary reduction of hypercholesterolemia. Prev Med. 1986 May;15(3):282–291. doi: 10.1016/0091-7435(86)90047-2. [DOI] [PubMed] [Google Scholar]
  12. Cutler J. A., Grandits G. A., Grimm R. H., Jr, Thomas H. E., Jr, Billings J. H., Wright N. H. Risk factor changes after cessation of intervention in the Multiple Risk Factor Intervention Trial. The MRFIT Research Group. Prev Med. 1991 Mar;20(2):183–196. doi: 10.1016/0091-7435(91)90019-z. [DOI] [PubMed] [Google Scholar]
  13. Dodson P. M., Stephenson J., Dodson L. J., Kurnik D., Kritzinger E. E., Taylor K. G., Fletcher R. F. Randomised blind controlled trial of a high fibre, low fat and low sodium dietary regimen in mild essential hypertension. J Hum Hypertens. 1989 Jun;3(3):197–202. [PubMed] [Google Scholar]
  14. Egger M., Smith G. D. Misleading meta-analysis. BMJ. 1995 Mar 25;310(6982):752–754. doi: 10.1136/bmj.310.6982.752. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Farquhar J. W., Fortmann S. P., Flora J. A., Taylor C. B., Haskell W. L., Williams P. T., Maccoby N., Wood P. D. Effects of communitywide education on cardiovascular disease risk factors. The Stanford Five-City Project. JAMA. 1990 Jul 18;264(3):359–365. [PubMed] [Google Scholar]
  16. Fleiss J. L. The statistical basis of meta-analysis. Stat Methods Med Res. 1993;2(2):121–145. doi: 10.1177/096228029300200202. [DOI] [PubMed] [Google Scholar]
  17. Foreyt J. P., Scott L. W., Mitchell R. E., Gotto A. M. Plasma lipid changes in the normal population following behavioral treatment. J Consult Clin Psychol. 1979 Jun;47(3):440–452. doi: 10.1037//0022-006x.47.3.440. [DOI] [PubMed] [Google Scholar]
  18. Frantz I. D., Jr, Dawson E. A., Ashman P. L., Gatewood L. C., Bartsch G. E., Kuba K., Brewer E. R. Test of effect of lipid lowering by diet on cardiovascular risk. The Minnesota Coronary Survey. Arteriosclerosis. 1989 Jan-Feb;9(1):129–135. doi: 10.1161/01.atv.9.1.129. [DOI] [PubMed] [Google Scholar]
  19. Frison L., Pocock S. J. Repeated measures in clinical trials: analysis using mean summary statistics and its implications for design. Stat Med. 1992 Sep 30;11(13):1685–1704. doi: 10.1002/sim.4780111304. [DOI] [PubMed] [Google Scholar]
  20. Ginsberg H. N., Barr S. L., Gilbert A., Karmally W., Deckelbaum R., Kaplan K., Ramakrishnan R., Holleran S., Dell R. B. Reduction of plasma cholesterol levels in normal men on an American Heart Association Step 1 diet or a Step 1 diet with added monounsaturated fat. N Engl J Med. 1990 Mar 1;322(9):574–579. doi: 10.1056/NEJM199003013220902. [DOI] [PubMed] [Google Scholar]
  21. Hellénius M. L., de Faire U., Berglund B., Hamsten A., Krakau I. Diet and exercise are equally effective in reducing risk for cardiovascular disease. Results of a randomized controlled study in men with slightly to moderately raised cardiovascular risk factors. Atherosclerosis. 1993 Oct;103(1):81–91. doi: 10.1016/0021-9150(93)90042-s. [DOI] [PubMed] [Google Scholar]
  22. Henderson M. M., Kushi L. H., Thompson D. J., Gorbach S. L., Clifford C. K., Insull W., Jr, Moskowitz M., Thompson R. S. Feasibility of a randomized trial of a low-fat diet for the prevention of breast cancer: dietary compliance in the Women's Health Trial Vanguard Study. Prev Med. 1990 Mar;19(2):115–133. doi: 10.1016/0091-7435(90)90014-b. [DOI] [PubMed] [Google Scholar]
  23. Hjermann I., Velve Byre K., Holme I., Leren P. Effect of diet and smoking intervention on the incidence of coronary heart disease. Report from the Oslo Study Group of a randomised trial in healthy men. Lancet. 1981 Dec 12;2(8259):1303–1310. doi: 10.1016/s0140-6736(81)91338-6. [DOI] [PubMed] [Google Scholar]
  24. Koopman H., Spreeuwenberg C., Westerman R. F., Donker A. J. Dietary treatment of patients with mild to moderate hypertension in a general practice: a pilot intervention study (1). The first three months. J Hum Hypertens. 1990 Aug;4(4):368–371. [PubMed] [Google Scholar]
  25. Kristiansen I. S., Eggen A. E., Thelle D. S. Cost effectiveness of incremental programmes for lowering serum cholesterol concentration: is individual intervention worth while? BMJ. 1991 May 11;302(6785):1119–1122. doi: 10.1136/bmj.302.6785.1119. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Law M. R., Frost C. D., Wald N. J. By how much does dietary salt reduction lower blood pressure? III--Analysis of data from trials of salt reduction. BMJ. 1991 Apr 6;302(6780):819–824. doi: 10.1136/bmj.302.6780.819. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Law M. R., Wald N. J., Thompson S. G. By how much and how quickly does reduction in serum cholesterol concentration lower risk of ischaemic heart disease? BMJ. 1994 Feb 5;308(6925):367–372. doi: 10.1136/bmj.308.6925.367. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. MacMahon S., Peto R., Cutler J., Collins R., Sorlie P., Neaton J., Abbott R., Godwin J., Dyer A., Stamler J. Blood pressure, stroke, and coronary heart disease. Part 1, Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet. 1990 Mar 31;335(8692):765–774. doi: 10.1016/0140-6736(90)90878-9. [DOI] [PubMed] [Google Scholar]
  29. Mensink R. P., Katan M. B. Effect of dietary fatty acids on serum lipids and lipoproteins. A meta-analysis of 27 trials. Arterioscler Thromb. 1992 Aug;12(8):911–919. doi: 10.1161/01.atv.12.8.911. [DOI] [PubMed] [Google Scholar]
  30. Mojonnier M. L., Hall Y., Berkson D. M., Robinson E., Wethers B., Pannbacker B., Moss D., Pardo E., Stamler J., Shekelle R. B. Experience in changing food habits of hyperlipidemic men and women. J Am Diet Assoc. 1980 Aug;77(2):140–148. [PubMed] [Google Scholar]
  31. Morgan T., Adam W., Gillies A., Wilson M., Morgan G., Carney S. Hypertension treated by salt restriction. Lancet. 1978 Feb 4;1(8058):227–230. doi: 10.1016/s0140-6736(78)90479-8. [DOI] [PubMed] [Google Scholar]
  32. Murray D. M., Kurth C., Mullis R., Jeffery R. W. Cholesterol reduction through low-intensity interventions: results from the Minnesota Heart Health Program. Prev Med. 1990 Mar;19(2):181–189. doi: 10.1016/0091-7435(90)90019-g. [DOI] [PubMed] [Google Scholar]
  33. ROSE G. A., THOMSON W. B., WILLIAMS R. T. CORN OIL IN TREATMENT OF ISCHAEMIC HEART DISEASE. Br Med J. 1965 Jun 12;1(5449):1531–1533. doi: 10.1136/bmj.1.5449.1531. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Ramsay L. E., Yeo W. W., Jackson P. R. Dietary reduction of serum cholesterol concentration: time to think again. BMJ. 1991 Oct 19;303(6808):953–957. doi: 10.1136/bmj.303.6808.953. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Rimm E. B., Giovannucci E. L., Stampfer M. J., Colditz G. A., Litin L. B., Willett W. C. Reproducibility and validity of an expanded self-administered semiquantitative food frequency questionnaire among male health professionals. Am J Epidemiol. 1992 May 15;135(10):1114–1136. doi: 10.1093/oxfordjournals.aje.a116211. [DOI] [PubMed] [Google Scholar]
  36. Rogers M. C. Sir John Scott Burdon-Sanderson (1828-1905): a pioneer in electrophysiology. Circulation. 1969 Jul;40(1):1–2. doi: 10.1161/01.cir.40.1.1. [DOI] [PubMed] [Google Scholar]
  37. Rose G. Strategy of prevention: lessons from cardiovascular disease. Br Med J (Clin Res Ed) 1981 Jun 6;282(6279):1847–1851. doi: 10.1136/bmj.282.6279.1847. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Schapira D. V., Kumar N. B., Lyman G. H., Baile W. F. The effect of duration of intervention and locus of control on dietary change. Am J Prev Med. 1991 Nov-Dec;7(6):341–347. [PubMed] [Google Scholar]
  39. Silman A. J., Locke C., Mitchell P., Humpherson P. Evaluation of the effectiveness of a low sodium diet in the treatment of mild to moderate hypertension. Lancet. 1983 May 28;1(8335):1179–1182. doi: 10.1016/s0140-6736(83)92463-7. [DOI] [PubMed] [Google Scholar]
  40. Smith G. D., Song F., Sheldon T. A. Cholesterol lowering and mortality: the importance of considering initial level of risk. BMJ. 1993 May 22;306(6889):1367–1373. doi: 10.1136/bmj.306.6889.1367. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Sorensen G., Morris D. M., Hunt M. K., Hebert J. R., Harris D. R., Stoddard A., Ockene J. K. Work-site nutrition intervention and employees' dietary habits: the Treatwell program. Am J Public Health. 1992 Jun;82(6):877–880. doi: 10.2105/ajph.82.6.877. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Stott N. Screening for cardiovascular risk in general practice. BMJ. 1994 Jan 29;308(6924):285–286. doi: 10.1136/bmj.308.6924.285. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Turpeinen O., Karvonen M. J., Pekkarinen M., Miettinen M., Elosuo R., Paavilainen E. Dietary prevention of coronary heart disease: the Finnish Mental Hospital Study. Int J Epidemiol. 1979 Jun;8(2):99–118. doi: 10.1093/ije/8.2.99. [DOI] [PubMed] [Google Scholar]
  44. Watts G. F., Lewis B., Brunt J. N., Lewis E. S., Coltart D. J., Smith L. D., Mann J. I., Swan A. V. Effects on coronary artery disease of lipid-lowering diet, or diet plus cholestyramine, in the St Thomas' Atherosclerosis Regression Study (STARS) Lancet. 1992 Mar 7;339(8793):563–569. doi: 10.1016/0140-6736(92)90863-x. [DOI] [PubMed] [Google Scholar]
  45. White E., Shattuck A. L., Kristal A. R., Urban N., Prentice R. L., Henderson M. M., Insull W., Jr, Moskowitz M., Goldman S., Woods M. N. Maintenance of a low-fat diet: follow-up of the Women's Health Trial. Cancer Epidemiol Biomarkers Prev. 1992 May-Jun;1(4):315–323. [PubMed] [Google Scholar]
  46. Willett W. C., Sampson L., Stampfer M. J., Rosner B., Bain C., Witschi J., Hennekens C. H., Speizer F. E. Reproducibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol. 1985 Jul;122(1):51–65. doi: 10.1093/oxfordjournals.aje.a114086. [DOI] [PubMed] [Google Scholar]
  47. Yusuf S., Wittes J., Friedman L. Overview of results of randomized clinical trials in heart disease. II. Unstable angina, heart failure, primary prevention with aspirin, and risk factor modification. JAMA. 1988 Oct 21;260(15):2259–2263. [PubMed] [Google Scholar]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

RESOURCES