Effectiveness of Written Dietary Advice for Improving Blood Lipids in Primary Care Adults-A Pragmatic Randomized Controlled Trial (MYDICLIN).

Andreas Rydell,David Iggman,Martin Lindow,Mikael Hellsten

doi:10.3390/nu14051022

Abstract

Lifestyle management is the first line of treatment for moderately elevated blood lipids in healthy individuals. We investigated the effectiveness of providing food-based written advice for lowering low-density lipoprotein (LDL) cholesterol (intervention) or triglycerides (control) in a pragmatic randomized controlled trial with two parallel arms from 2018–2019 at a rural primary health care center. We sent feedback letters after 3 weeks and 6 months. Out of the 113 adult primary care patients randomized, 112 completed the study. There were no differences between the intervention and control groups for changes in LDL cholesterol after 3 weeks (mean ± standard deviation −0.21 ± 0.38 vs. −0.11 ± 0.34 mmol/L, p = 0.45) or 6 months (−0.05 ± 0.47 vs. 0.02 ± 0.41 mmol/L, p = 0.70) (primary outcome). Following the advice to consume plant sterols and turmeric was associated with a reduction in LDL cholesterol after 3 weeks. Following the advice to consume less carbohydrates was associated with reduced triglycerides. In the intervention arm, 14 individuals (25%) reduced their LDL cholesterol by ≥10% after three weeks. Their reduction was attenuated but maintained after six months (−7.1 ± 9.2% or −0.31 ± 0.38 mmol/L, p = 0.01 compared with baseline). They differed only in higher adherence to the advice regarding turmeric. In conclusion, this undemanding intervention had little effect on blood lipids for most individuals.

Highlights

Dyslipidemia causally contributes to atherosclerotic cardiovascular disease, which is a leading cause of disability and premature death
Assuming 20% loss to follow-up in the intervention group and 5% cross-over in the control group, at least n = 222 participants were required for alpha = 0.05 and beta = 0.10 in order to detect an effect of 0.175 ± 0.30 mmol/L (~5%) in the primary outcome variable of low-density lipoprotein (LDL) cholesterol
Advice to consume foods enriched with plant sterols and pulses or soy had the lowest adherence, whereas probiotics and the category of fruits, berries, and vegetables had the highest

Summary

Introduction

Dyslipidemia causally contributes to atherosclerotic cardiovascular disease, which is a leading cause of disability and premature death. For individuals with moderately elevated blood lipids but without previous cardiovascular disease, pharmacological treatment is not always indicated. They may instead primarily benefit from lifestyle modification. For LDL cholesterol, combinations of dietary changes have produced pronounced effects (up to 30% reductions) in strictly controlled metabolic ward studies with high compliance. One such example is the Portfolio Diet, which emphasizes the increased intake of foods with added plant sterols, viscous fibers, soy foods, and nuts [6]. If information delivered by health care personnel could facilitate patients to perform several effective dietary changes simultaneously, this should be enough to produce measurable and clinically meaningful effects

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