Effectiveness of medical nutrition therapy in the management of adult dyslipidemia: A systematic review and meta-analysis.

Cardiovascular disease (CVD) is a leading cause of mortality in the United States. Many primary risk factors, such as dyslipidemia and blood pressure, are modifiable with diet and lifestyle interventions. Therefore, the objective of this systematic review and meta-analysis was to evaluate the effectiveness of medical nutrition therapy (MNT) interventions provided by registered dietitian nutritionists (RDN) or international equivalents, compared to usual care or no MNT, on lipid profile and blood pressure (secondary outcome) in adults with dyslipidemia. The databases MEDLINE, CINAHL, Cochrane CENTRAL, and Cochrane Database of Systematic Reviews were searched for randomized controlled trials (RCTs) published between January 2005 and July 2021. Meta-analyses were performed using a random-effects model for lipid outcomes (seven RCTs, n=838), systolic blood pressure (SBP) (three RCTs, n=308), and diastolic blood pressure (DBP) (two RCTs, n=109). Compared to usual care or no intervention, MNT provided by RDNs improved total cholesterol (total-C) [mean difference (95% CI): -20.84 mg/dL (-40.60, -1.07), P=0.04]; low-density lipoprotein cholesterol (LDL-C) [-11.56 mg/dL (-21.10, -2.03), P=0.02]; triglycerides (TG) [-32.55 mg/dL (-57.78, -7.32), P=0.01];; and SBP [ -8.76 mm Hg (-14.06 lower to -3.45) P<0.01].High-density lipoprotein cholesterol (HDL-C) [1.75 mg/dl (-1.43, 4.92), P=0.28] and DBP [-2.9 mm Hg (-7.89 to 2.09), P=0.25] were unchanged. Certainty of evidence was moderate for total-C, LDL-C, and TG, and low for HDL-C, SBP, and DBP. In conclusion, in adults with dyslipidemia, MNT interventions provided by RDNs are effective for improving serum lipids/lipoproteins and SBP levels.

The Importance of Health Values Among Health Care Providers.

Medical professionals' healthy eating and physical activity behaviors are likely to wane as other life events and everyday pressures increase. This is vital because as health behaviors decrease, the likelihood that this topic is addressed with patients also decreases. Increased training to improve health care providers' knowledge about lifestyle behaviors may be inadequate to actually bring about a healthier lifestyle. The area of personal identity and value formation may shed light on a significant barrier in this area. Developing health care professionals who have values consistent with a healthy diet and physical activity, instead of just being informed about it, would increase the likelihood that healthy behavior changes are discussed with patients. Strategies to encourage value formation around healthy lifestyles among medical professionals are discussed.

Food insecurity and housing instability during early childhood as predictors of adolescent mental health.

This study examined the effects of food insecurity and housing instability experiences during early childhood on adolescent anxiety and depressive symptoms through maternal depression and parenting stress. This longitudinal study included 4 waves of data from the Fragile Families and Child Well-Being Study (n = 2,626). Food insecurity was measured when the child was 5 years of age using the U.S. Department of Agriculture's 18-item Food Security Scale. Housing instability was also measured when the child was 5 years of age based on an affirmative response to 6 housing adversity items. Maternal depression and parenting stress were measured when the child was 9 years of age. Anxiety and depressive symptoms were assessed when the child (now adolescent) was 15 years of age using 6 items of the Brief Symptom Inventory 18 anxiety subscale and 5 items of the Centers for Epidemiologic Studies Depression Scale, respectively. Two structural equation models assessed the associations between food insecurity and housing instability on adolescent anxiety (Model 1) and depressive symptoms (Model 2) through maternal depression and parenting stress simultaneously, controlling for sociodemographic characteristics. Results suggest that experiencing both food insecurity and housing instability during early childhood increases the risk of long-term adolescent depressive (indirect: B = 0.008, 95% CI [0.002, 0.016]) and anxiety (indirect: B = 0.012, 95% CI [0.002, 0.026]) symptoms through maternal depression to parenting stress. Screening for food insecurity and housing instability during early childhood could potentially identify both mothers who are at risk for depression and parenting stress and children who are at increased risk for anxiety or depressive symptoms during adolescence. (PsycInfo Database Record (c) 2020 APA, all rights reserved).