Live well: a practical and effective low-intensity dietary counseling intervention for use in primary care patients with dyslipidemia--a randomized controlled pilot trial.

BACKGROUND: Diet is the first line of treatment for elevated cholesterol. High-intensity dietary counseling (≥360 minutes/year of contact with providers) improves blood lipids, but is expensive and unsustainable in the current healthcare settings. Low-intensity counseling trials (≤30 minutes/year) have demonstrated modest diet changes, but no improvement in lipids. This pilot study evaluated the feasibility and the effects on lipids and diet of a low-intensity dietary counseling intervention provided by the primary care physician (PCP), in patients at risk for cardiovascular diseases. METHODS: Six month study with a three month randomized-controlled phase (group A received the intervention, group B served as controls) followed by three months of intervention in both groups.Sixty-one adults age 21 to 75 years, with LDL-cholesterol≥3.37 mmol/L, possessing Internet access and active email accounts were enrolled. Diet was evaluated using the Rate-Your-Plate questionnaire. Dietary counseling was provided by the PCP during routine office visits, three months apart, using printed educational materials and a minimally interactive counseling website. Weekly emails were sent reminding participants to use the dietary counseling resources. The outcomes were changes in LDL-cholesterol, other lipid subclasses, and diet quality. RESULTS: At month 3, group A (counseling started at month 1) decreased their LDL-cholesterol by -0.23 mmol/L, (-0.04 to -0.42 mmol/L, P=0.007) and total cholesterol by -0.26 mmol/L, (-0.05 to -0.47 mmol/L, P=0.001). At month 6, total and LDL-cholesterol in group A remained better than in group B (counseling started at month 3). Diet score in group A improved by 50.3 points (38.4 to 62.2, P<0.001) at month 3; and increased further by 11.8 (3.5 to 20.0, P=0.007) at month 6. Group B made the largest improvement in diet at month 6, 55 points (40.0 to 70.1, P<0.001), after having a small but significant improvement at month 3, 22.3 points (12.9 to 31.7, P<0.001). No significant changes occurred in HDL-cholesterol in either group. CONCLUSIONS: A low-intensity dietary counseling provided by the PCP in patients at risk for cardiovascular diseases produced clinically meaningful improvements in both diet and lipids of magnitude similar to changes reported with high intensity interventions. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01695837.

Nutrient adequacy during weight loss interventions: a randomized study in women comparing the dietary intake in a meal replacement group with a traditional food group.

BACKGROUND: Safe and effective weight control strategies are needed to stem the current obesity epidemic. The objective of this one-year study was to document and compare the macronutrient and micronutrient levels in the foods chosen by women following two different weight reduction interventions. METHODS: Ninety-six generally healthy overweight or obese women (ages 25-50 years; BMI 25-35 kg/m2) were randomized into a Traditional Food group (TFG) or a Meal Replacement Group (MRG) incorporating 1-2 meal replacement drinks or bars per day. Both groups had an energy-restricted goal of 5400 kJ/day. Dietary intake data was obtained using 3-Day Food records kept by the subjects at baseline, 6 months and one-year. For more uniform comparisons between groups, each diet intervention consisted of 18 small group sessions led by the same Registered Dietitian. RESULTS: Weight loss for the 73% (n = 70) completing this one-year study was not significantly different between the groups, but was significantly different (p < or = .05) within each group with a mean (+/- standard deviation) weight loss of -6.1 +/- 6.7 kg (TFG, n = 35) vs -5.0 +/- 4.9 kg (MRG, n = 35). Both groups had macronutrient (Carbohydrate:Protein:Fat) ratios that were within the ranges recommended (50:19:31, TFG vs 55:16:29, MRG). Their reported reduced energy intake was similar (5729 +/- 1424 kJ, TFG vs 5993 +/- 2016 kJ, MRG). There was an improved dietary intake pattern in both groups as indicated by decreased intake of saturated fat (< or = 10%), cholesterol (<200 mg/day), and sodium (< 2400 mg/day), with increased total servings/day of fruits and vegetables (4.0 +/- 2.2, TFG vs 4.6 +/- 3.2, MRG). However, the TFG had a significantly lower dietary intake of several vitamins and minerals compared to the MRG and was at greater risk for inadequate intake. CONCLUSION: In this one-year university-based intervention, both dietitian-led groups successfully lost weight while improving overall dietary adequacy. The group incorporating fortified meal replacements tended to have a more adequate essential nutrient intake compared to the group following a more traditional food group diet. This study supports the need to incorporate fortified foods and/or dietary supplements while following an energy-restricted diet for weight loss.