High-quality nutrition counselling for hypercholesterolemia by public health nurses in rural areas does not affect total blood cholesterol

Abstract

Background: Diet affects coronary heart disease(CHD). People living in remote areas seldom have access to nutritionist-based intervention strategies exist to improve dietary behaviour. It has been suggested thata public health nurse-based nutrition counselling service might be benefit people with hypercholesterolaemiain rural areas. Objective: To assess the effectiveness in rural areas of an intervention programme by public health nurses in facilitating dietary counselling for hypercholesterolaemia. Setting: Rural county health departments in North Carolina, United States; recruitment August 1994 to November 1996. Method: Cluster randomised controlled trial. PARTICIPANTS Seventeen rural county health departments (incorporating 468 individuals) were randomised. Individuals were included if they were aged between 20 and 70 years; had a total cholesterol levelof >4.7mmol/L within the previous 12 months, and were not being treated for hypercholesterolaemia (either medication- or counselling-based). People with severe chronic or acute medical conditions were excluded from the initial screen. People screened were then enrolled in the study if their low-density lipoprotein-cholesterol (LDL-C) was either >100mg/dL (2.59mmol/L) with known coronary heart disease (CHD), 130 to 159mg/dL (3.37 to 4.12mmol/L) with two or more CHD risk factors, or >4160mg/dL (4.14mmol/L). Intervention: The control ‘minimum’ intervention (nine departments; 252 people) consisted of routine counselling for high cholesterol by a public health nurse. The special intervention (eight departments; 216 people) comprised three individual diet counselling sessions by a public health nurse, referral to a nutritionist if lipid goals were not attained after 3 months and a follow-up phone call and newsletters. Follow-up was 12 months. Main Outcomes: Total cholesterol, LDL-C, body weight and dietary risk assessment (DRA) score based on a food frequency questionnaire. Main Results: There was no significant difference in the total reduction of blood cholesterol between the two groups at either 3 (p=0.9) or12months (p=0.6) follow-up. Weight loss was significantly greater in the special group at 3 (p=0.02) and 6 months (p=0.04), but not by 12 months (p=0.13). The average reduction in total dietary risk assessment score (indicating dietary improvement) was significantly greater in the special intervention group at both 3 (p=0.0006) and 12 months (p=0.005) follow -up. Author's Conclusions: Intensive dietary counselling does not seem to improve blood cholesterol compared with minimal counselling.