Abstract
BackgroundA diet rich in fruit, vegetables and dietary fibre and low in fat is associated with reduced risk of chronic disease. This review aimed to estimate the effectiveness of interventions to promote healthy diet for primary prevention among participants attending primary care.MethodsA systematic review of trials using individual or cluster randomisation of interventions delivered in primary care to promote dietary change over 12 months in healthy participants free from chronic disease or defined high risk states. Outcomes were change in fruit and vegetable intake, consumption of total fat and fibre and changes in serum cholesterol concentration.ResultsTen studies were included with 12,414 participants. The design and delivery of interventions were diverse with respect to grounding in behavioural theory and intervention intensity. A meta-analysis of three studies showed an increase in fruit consumption of 0.25 (0.01 to 0.49) servings per day, with an increase in vegetable consumption of 0.25 (0.06 to 0.44) serving per day. A further three studies that reported on fruit and vegetable consumption together showed a pooled increment of 0.50 (0.13 to 0.87) servings per day. The pooled effect on consumption of dietary fibre, from four studies, was estimated to be 1.97 (0.43 to 3.52) gm fibre per day. Data from five studies showed a mean decrease in total fat intake of 5.2% of total energy (1.5 to 8.8%). Data from three studies showed a mean decrease in serum cholesterol of 0.10 (-0.19 to 0.00) mmol/L.ConclusionPresently-reported interventions to promote healthy diet for primary prevention in primary care, which illustrate a diverse range of intervention methods, may yield small beneficial changes in consumption of fruit, vegetables, fibre and fat over 12 months. The present results do not exclude the possibility that more effective intervention strategies might be developed.
Highlights
A diet rich in fruit, vegetables and dietary fibre and low in fat is associated with reduced risk of chronic disease
Earlier systematic reviews of the effectiveness of dietary interventions for primary prevention are limited in their applicability to primary care by the inclusion of studies set in work places, shopping centres and churches
These studies were conducted in samples representing the primary care general population in Japan [27] (1 study), USA [28,31,32,34,35,36] (6 studies), Italy [30] (1 study) and UK [29,33] (2 studies).The randomised study sample size varied among studies and ranged from 213 to 3,179 participants with 12,414 participants randomised in total
Summary
A diet rich in fruit, vegetables and dietary fibre and low in fat is associated with reduced risk of chronic disease. The regularity of patient consultations in primary care [12], and the value that patients place on medical advice [13], offer opportunities for general practitioners to play important roles in promoting health and preventing disease. This may include the provision of advice on healthy eating. Earlier systematic reviews of the effectiveness of dietary interventions for primary prevention are limited in their applicability to primary care by the inclusion of studies set in work places, shopping centres and churches. Some reviews have included non-randomised studies [14] and trials with short follow-up, as well as participants with established medical conditions, or patients with defined highrisk status [14,15,16,17], with the possibility of diet restrictions and which would limit the participation in diet promotion intervention
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