Evaluating the effectiveness of the food for heart program

Nutrition Research Newsletter, Jan, 2005

Coronary artery disease (CAD) continues to be the leading cause of death in the United States. It is well established that CAD mortality is directly related to serum cholesterol. The Adult Treatment Panel (ATP III) guidelines recommend diet and exercise therapy as cornerstones of hypercholesterolemia management. Registered dietitians performed dietary counseling in most previous research on nutritional management of hyperlipidemia.

The objective of a recent, prospective, randomized controlled study was to assess the effect of the Food For Heart Program, administered by a nondietitian, on serum lipids and body weight in hypercholesterolemic outpatients. The Food For Heart Program is a simple nutrition education program with the core component being the Dietary Risk Assessment, a food frequency questionnaire based on the 20 foods highest in saturated fat and cholesterol in the American diet. The Dietary Risk Assessment has four categories: meats, side dishes/desserts/snacks, dairy/eggs, and spreads/ oils. Each category is designed for use in a separate brief, focused visit. Identified problem foods correspond to an advice sheet with suggestions for more healthful substitutes, an accompanying cookbook provides low-fat recipes.

The study was conducted using a large, urban, university-based family practice. Subjects included 208 adult volunteers meeting ATP HI hypercholesterolemia criteria. Patients taking cholesterol-lowering medications or having had formal nutrition counseling were excluded. The researchers randomly assigned volunteers to an intervention group or a usual care group. The study research assistant, who had no background in nutrition, counseled intervention group subjects during four separate monthly visits. Fasting lipids were obtained and used as the primary endpoint. Body weight was calculated. The researchers also calculated the change in Dietary Risk Assessment score from baseline to study completion.

The results showed that total and low-density lipoprotein cholesterol decreased 0.40 [ or -] 0.65 mmol/L and 0.32 [ or -] 0.58 mmol/L, respectively, in the intervention group (n = 91), compared with 0.06 [ or -] 0.57 mmol/L and 0.0088 [ or -] 0.56 mmol/L in the control group (n = 84) (P < .001). There was no significant change in high-density lipoprotein cholesterol. Intervention subjects lost a small but statistically significant amount of weight, 2.2 [ or -] 7.4 pounds (P < 0.01), and decreased their Dietary Risk Assessment score 5.9 [ or -] 6.5 points (P < .001).

The findings indicate total and low-density lipoprotein cholesterol, weight, and dietary risk for coronary heart disease decreased significantly in hypercholesterolemic patients counseled using the Food For Heart Program, without having a registered dietitian involved.

C. Cheng, C. Graziani, J. Diamond. Cholesterol-lowering effect of the food for heart nutrition education program. J Am Diet Assoc; 104:1868-1872 (December, 2004). [Correspondence: Cynthia Cheng, MD, PhD, University Hospital, Suite 401 Curtis, 1015 Walnut St., Philadelphia, PA 19107. E-mail: Cynthia.Cheng@jefferson.edu].