Review and Special articleCounseling to promote a healthy diet in adults: A summary of the evidence for the U.S. Preventive Services Task Force
Introduction
D . iseases associated with unhealthy dietary behavior rank among the leading causes of illness and death in the United States.1, 2 Major diseases in which diet plays a role include coronary heart disease, some types of cancer, stroke, hypertension, obesity, osteoporosis, and non-insulin-dependent diabetes mellitus.1 All of these diseases are major causes of morbidity and mortality in this country.3 Although diet is associated with multiple health outcomes, the ability of counseling to change dietary patterns and improve health is unclear. In this report, counseling is defined as a cooperative mode of interaction between the patient and primary care physician or related healthcare staff members to assist patients in adopting behaviors associated with improved health outcomes.4
To address the question of whether counseling can improve dietary patterns, we performed an extensive systematic evidence review on behalf of the U.S. Preventive Services Task Force (USPSTF).1 This larger report comprehensively updated the chapter on dietary counseling from the second edition of the Guide to Clinical Preventive Services,5 and it is available from the Agency for Healthcare Research and Quality (AHRQ) at http://www.preventiveservices.ahrq.gov.
In 1996, the USPSTF recommended counseling adults and children older than 2 years to limit intakes of saturated fat and cholesterol, to maintain caloric balance in diets, and to emphasize foods that are high in fiber.5 An updated recommendation,6 dealing specifically with the question of dietary counseling, accompanies this summary of the evidence and is also available at http://www.preventiveservices.ahrq.gov.
Section snippets
Methods
We searched the MEDLINE database for randomized controlled trials (RCTs) published between 1966 and December 2001 that examined the effectiveness of counseling in changing dietary behavior. Search terms are provided in Appendix A. We supplemented our searches by reviewing the bibliographies of included articles and querying experts in the field during an extensive peer review process.
We included only studies that had been conducted with patients similar to those found in primary care practices
Results
We identified a total of 129 abstracts for review from our literature searches. After review of the 129 abstracts, we identified 74 articles that reported on examining the effect of counseling on dietary behavior. After full article review, we excluded an additional 49 articles from our analysis because they did not meet our eligibility criteria. Reasons for exclusion are provided in Appendix B.
We retained 21 studies reported in 25 articles that met our eligibility criteria.10, 11, 12, 13, 14,
Discussion
Researchers have used a wide range of interventions to examine the effect of behavioral counseling on dietary patterns among predominantly healthy adult patients. Among the studies we identified, low-intensity interventions in unselected primary care adult patients produced small or medium changes in self-reported dietary outcomes. Medium- to high-intensity interventions generally produced medium or large changes in dietary behavior, but these studies were generally conducted either in adult
Acknowledgements
This study was developed by the RTI—University of North Carolina Evidence-based Practice Center (UNC EPC), under contract to the Agency for Healthcare Research and Quality (Contract No. 290-97-0011), Rockville, MD. We acknowledge the assistance of David Atkins, MD, MPH, Chief Medical Officer of the AHRQ Center for Practice and Technology Assessment, and Jean Slutsky, PA, MSPH, the Task Order Officer, for their advice and counsel throughout this project. Finally, we thank our RTI-UNC EPC
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