Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-23T01:34:35.682Z Has data issue: false hasContentIssue false

Impact of Mediterranean diet education versus posted leaflet on dietary habits and serum cholesterol in a high risk population for cardiovascular disease

Published online by Cambridge University Press:  02 January 2007

Wanda JE Bemelmans*
Affiliation:
Department of General Practice, University of Groningen, Anton Deusinglaan, 9713 AW Groningen, the Netherlands
Jan Broer
Affiliation:
Regional Public Health Service, GGD Groningen, Postbus 584, 9700 AN Groningen, the Netherlands
Jeanne HM de Vries
Affiliation:
Department of Human Nutrition and Epidemiology, Wageningen Agricultural University, Postbus 8129, 6700 EV Wageningen, the Netherlands
Karin Fam Hulshof
Affiliation:
TNO Nutrition and Food Research Institute, Postbus 360, 3700 AJ Zeist, the Netherlands
Jo F May
Affiliation:
Department of Cardiology, Groningen University Hospital, Postbus 30001, 9700 RB Groningen, the Netherlands
Betty Meyboom-de Jong
Affiliation:
Department of General Practice, University of Groningen, Anton Deusinglaan, 9713 AW Groningen, the Netherlands
*
*Corresponding author: Email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective

To investigate the impact of intensive group education on the Mediterranean diet on dietary intake and serum total cholesterol after 16 and 52 weeks, compared to a posted leaflet with the Dutch nutritional guidelines, in the context of primary prevention of cardiovascular disease (CVD).

Design

Controlled comparison study of an intervention group given intensive group education about the Mediterranean diet and a control group of hypercholesterolaemic persons given usual care by general practitioners (GPs).

Setting

A socioeconomically deprived area in the Netherlands with an elevated coronary heart disease (CHD) mortality ratio.

Subjects

Two hundred and sixty-six hypercholesterolaemic persons with at least two other CVD risk factors.

Results

After 52 weeks, the intervention group decreased total and saturated fat intake more than the control group (net differences were 1.8 en% (95%CI 0.2–3.4) and 1.1 en% (95%CI 0.4–1.9), respectively). According to the Mediterranean diet guidelines the intake of fish, fruit, poultry and bread increased in the intervention group, more than in the control group. Within the intervention group, intake of fish (+100%), poultry (+28%) and bread (+6%) was significantly increased after 1 year (P < 0.05). The intensive programme on dietary education did not significantly lower serum cholesterol level more (−3%) than the posted leaflet (−2%) (net difference 0.06 mmol l−1, 95%CI −0.10 to 0.22). Initially, the body mass index (BMI) decreased more in the intervention group, but after 1 year the intervention and control group gained weight equally (+1%).

Conclusions

Despite beneficial changes in dietary habits in the intervention group compared with the control group, after 1 year BMI increased and total fat and saturated fat intake were still too high.

Type
Research Article
Copyright
Copyright © CABI Publishing 2000

References

1Dalstra, JAA, Reitsma, JB. Cardiovascular Disease in the Netherlands in 1995. Statistics of Morbidity and Mortality. [in Dutch]. Den Haag: Dutch Heart Foundation, 1997.Google Scholar
2Mackenbach, JP, Looman, CWN, Kunst, AE. Geographic variation in the onset of decline of ischemic heart disease mortality in the Netherlands. Am. J. Public Health 1989; 79: 1621–7.CrossRefGoogle ScholarPubMed
3Mackenbach, JP, Kunst, AE, Looman, CWN. Regional differences in mortality due to ischemic heart diseases [in Dutch]. Ned. Tijdschr. Geneeskd. 1990; 134: 596601.Google Scholar
4Broer, J, Wiegersma, PA. Elevated mortality due to ischaemic heart disease. Exploration of available data [in Dutch]. Tijdschr. Soc. Gezondheidsz. 1993; 1: 21–6.Google Scholar
5Broer, J. Regional Mortality Patterns 1987–1993 [in Dutch]. Groningen: Public Health Department, 1996.Google Scholar
6Bloemberg, BPM, Doornbos, G, van Oostrom, MA. Regional Health Profiles. Presentations of Facts from Existing Registrations [in Dutch]. Bilthoven: National Institute of Public Health and Environmental Protection, 1992.Google Scholar
7Lynch, JW, Kaplan, GA, Cohen, RD, Tuomilehto, J, Salonen, JT. Do cardiovascular risk factors explain the relation between socioeconomic status, risk of all-cause mortality, cardiovascular mortality, and acute myocardial infarction. Am. J. Epidemiol. 1996; 144: 934–42.CrossRefGoogle ScholarPubMed
8Broer, J, Wiegersma, PA. Health Interview Survey 1994 and Health Interview Survey 1998 [in Dutch]. Groningen: Regional Health Service, 1994, 1998.Google Scholar
9De Lorgeril, M, Renaud, S, Mamelle, N, et al. Mediterranean alpha-linolenic acid rich diet in secondary prevention of coronary heart disease. Lancet 1994; 343: 1454–9.CrossRefGoogle ScholarPubMed
10Renaud, S, Lorgeril M, de, Delaye, J, et al. Cretan Mediterranean diet for prevention of coronary heart disease. Am. J. Clin. Nutr. 1995; 61 (Suppl.): S1360–7.CrossRefGoogle ScholarPubMed
11van der Weijden, T, Grol, RPTM, Schouten, BJ, Knottnerus, A.Barriers to working according cholesterol guidelines. Eur. J. Public Health 1998; 8: 113–18.CrossRefGoogle Scholar
12Truswell, AS, Hiddink, GJ, Hautvast, JGAJ. Family doctors and patients: is effective nutrition interaction possible? Eur. J. Clin. Nutr. 1999; 53 (Suppl. 2): 12 (editoral).CrossRefGoogle ScholarPubMed
13Neil, HAW, Roe, L, Godlee, RJP, et al. Randomised trial of lipid lowering dietary advice in general practice: the effects on serum lipids, lipoproteins, and antioxidants. BMJ 1995; 310: 569–73.CrossRefGoogle ScholarPubMed
14Tang, JL, Armitage, JM, Lancaster, T, Silagy, CA, Fowler, GH, Neil, HAW. Systematic review of dietary interventation trials to lower total cholesterol in free-living subjects. BMJ 1998; 316: 1213–20.CrossRefGoogle Scholar
15Denke, MA. Cholesterol-lowering diets. A review of the evidence. Arch. Intern. Med. 1995; 155: 1726.CrossRefGoogle Scholar
16Hulshof, KFAM, Kistemaker, C, Bouman, M. The Intake of Energy and Dietary Nutrients by Dutch Population Groups – the National Food Consumption Survey 1997–1998 [in Dutch]. Report No. V98.805. Zeist: TNO Nutrition and Food Research Institute, 1998.Google Scholar
17Rose, GA, Blackburn, H. Cardiovascular Survey Methods. Geneva: WHO, 1968.Google ScholarPubMed
18Feunekes, GIJ, Staveren van, WA, Vries de, JHM, Burema, J, Hautvast, JGAJ. Relative and biomarker-based validity of a food-frequency questionnaire estimating intake of fats and cholesterol. Am. J. Clin. Nutr. 1993; 58: 489–96.CrossRefGoogle Scholar
19Ocke, MC, Bueno de Mesquita, HB, Pols, MA, Smit, HA, Staveren van, WA, Kromhout, D.The Dutch EPIC food frequency questionnaire. II. Relative validity and reproducibility for nutrients. Int. J. Epidemiol. 1997; 26 (Suppl. 1), 4958.CrossRefGoogle ScholarPubMed
20Kistemaker, C, Aarnink, EJM, Hulshof, KFAM. The Consumption of Separate Food Products in the Netherlands, Stratified for Age and Gender [in Dutch]. TNO Report No. V93.418. Zeist: TNO Nutrition and Food Research Institute, 1993.Google Scholar
21NEVO. Netherlands Food Composition Table (NEVO Table 1996) [in Dutch]. The Hague: Netherlands Centre for Nutrition Education, 1996.Google Scholar
22Voskuil, DW, Feskens, EJM. Composition of a Food Table with Contents of Alpha-Linolenic Acid on Behalf of the Zutphen Study [ in Dutch]. National Institute of Public Health and the Environment, Report No. 441 111 006. Bilthoven: National Institute of Public Health and the Environment, 1994.Google Scholar
23Hulshof, PJM, Kosmeijer, T, Zock, PL, Bovenkamp van de, P, Katan, MB. Analyses of Foods of the Department of Human Nutrition and Epidemiology. Part 12. Margarines, Fats, Cookies and Snacks, 1996 [in Dutch]. Report No. 90-6754-520-1. Wageningen: Department of Human Nutrition and Epidemiology, Wageningen Agricultural University, 1996.Google Scholar
24Broer, J, Siero, FW, Bemelmans, WJE, Meyboom-de Jong, B. Impact of group nutrition education and surplus value of prochaska based stage-matched information on health-related cognitions and on Mediterranean nutrition behaviour. Submitted for publication.Google Scholar
25Hoving, EB, Jansen, G, Volmer, M, Doormaal van, JJ, Muskiet, FAJ. Profiling of plasma cholesterol ester and triglyceride fatty acids as their methyl esters by capillary gas chromatography, preceded by a rapid aminopropyl-silica column chromatographic separation of lipid classes. J. Chromatogr. Biomed. Appl. 1988; 434: 395409.CrossRefGoogle ScholarPubMed
26Noruŝis, MJ. SPSS for Windows. Base System User's Guide, Release 6.0. Chicago, USA: SPSS Inc., 1993.Google Scholar
27WHO Expert Committee. Physical Status: the Use and Interpretation of Anthropometry. Technical Report Series. Geneva: World Health Organization, 1995.Google Scholar
28Heerstrass, DW, Ocke, MC, Bueno de Mesquita, HB, Peeters, PH, Seidell, JC. Underreporting of energy, protein and potassium intake in relation to body mass index. Int. J. Epidemiol. 1998; 27(2): 186–93.CrossRefGoogle ScholarPubMed
29Goldberg, GR, Black, AE, Jebb, SA, et al. Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Derivation of cut-off values to identify under-reporting. Eur. J. Clin. Nutr. 1991; 45: 569–81.Google Scholar
30Zock, PL, Mensink, RP, Harryvan, J, Vries de, JHM, Katan, MB. Fatty acids in serum cholesteryl esters as quantitative biomarkers of dietary intake in humans. Am. J. Epidemiol. 1997; 145: 1114–22.CrossRefGoogle ScholarPubMed
31Kramish Campbell, M, De Vellis, BM, Strecher, VJ, Ammerman, AS, De Vellis, RF, Sandler, RS. Improving dietary behavior: the effectiveness of tailored messages in primary care settings. Am. J. Public Health 1994; 84(5), 783–7.CrossRefGoogle Scholar
32Rimm, EB, Klatsky, A, Grobbe, D, Stampfer, MJ. Review of moderate alcohol consumption and reduced risk of coronary heart disease: is the effect due to beer, wine, or spirits. BMJ 1996; 312: 731–6.CrossRefGoogle ScholarPubMed
33Kannel, WB, Ellisson, RC. Alcohol and coronary heart disease; the evidence for a protective effect. Clin. Chim. Acta 1996; 246: 5976.CrossRefGoogle ScholarPubMed
34Yuan, JM, Ross, RK, Gao, YT, Henderson, BE, Yu, MC. Follow up study of moderate alcohol intake and mortality among middle aged men in Shanghai, China. BMJ 1997; 314(7073): 1823.CrossRefGoogle ScholarPubMed
35Van-Gaal, LF, Wauters, MA, De-Leeuw, IH. The beneficial effects of modest weight loss on cardiovascular risk factors. Int. J. Obes. Relat. Metab. Disord. 1997; 21 (Suppl.): S5–9.Google ScholarPubMed
36Marckmann, P, Gronbaek, M.Fish consumption and coronary heart disease mortality. A systematic review of prospective cohort studies. Eur. J. Clin. Nutr. 1999; 53: 585–90.CrossRefGoogle ScholarPubMed
37Daviglus, ML, Stamler, J, Orencia, AJ, et al. Fish consumption and the 30-year risk of fatal myocardial infarction. N. Engl. J. Med. 1997; 336(15): 1046–53.CrossRefGoogle ScholarPubMed
38Siscovick, DS, Raghunathan, TE, King, I, et al. Dietary intake and cell membrane levels of long-chain n-3 polyunsaturated fatty acids and the risk of primary cardiac arrest. JAMA 1995; 274(17): 1363–7.CrossRefGoogle ScholarPubMed
39Singh, RB, Niaz, MA, Sharma, JP, Kumar, R, Rastogi, V, Moshiri, M.Randomized, double-blind, placebo-controlled trial of fish oil and mustard oil in patients with suspected acute myocardial infarction: the Indian experiment of infarct survival – 4. Cardiovasc. Drugs Ther. 1997 11(3): 485–91.CrossRefGoogle ScholarPubMed
40Pang, D, Allman-Farinelli, MA, Wong, T, Barnes, R, Kingham, KM. Replacement of linoleic acid with alpha-linolenic acid does not alter blood lipids in normolipidaemic men. Br. J. Nutr. 1998; 80(2): 163–7.CrossRefGoogle Scholar
41Ocke, MC, Bueno de Mesquita, HB, Goddijn, HE, Jansen, A, Pols, MA, Staveren van, WA. The Dutch EPIC food frequency questionnaire. I. Description of the questionnaire, and relative validity and reproducibility for food groups. Int. J. Epidemiol. 1997; 26 (Suppl. 1): 3748.CrossRefGoogle ScholarPubMed
42Ebrahim, S, Smith, GD. Systematic review of randomised controlled trials of multiple risk factor interventions for preventing coronary heart disease. BMJ 1997; 314: 1666–74.CrossRefGoogle ScholarPubMed