Prepared Meal Plan Research Articles

Food as Medicine for Secondary Prevention of Cardiovascular Events Following an Acute Coronary Syndrome.

Cardiovascular disease is the leading cause of death in men and women in the USA. Once a patient experiences an acute coronary syndrome (ACS), they are at increased risk for hospital readmission within 30days and 6months after discharge and more importantly, they have worse survival. Hospital readmissions lead to poor clinical outcomes for the patient and also significantly increase healthcare costs due to repeat diagnostic evaluation, imaging, and coronary interventions. The goal after hospital discharge is to modify cardiovascular (CV) risk factors including hypertension, hyperlipidemia, and diabetes to prevent repeat coronary events; however, drug therapy is only one aspect. Several diets have been shown to decrease weight and reduce these risk factors over short durations; however, most people typically cannot sustain their diet and regain the weight. The Intelligent Quisine (IQ) diet is a prepared meal plan that was designed to meet the American Heart Association and American Diabetes Association nutritional guidelines and simplify the daily consumption of a nutritionally complete, calorie conscious meal. The IQ diet has been shown to significantly reduce blood pressure, cholesterol levels, glucose levels, and weight over a 10-week period. Additional studies have shown that patients are able to remain compliant on the diet for a year and maintain the reduction of their CV risk factors. If patients are consistent with a healthy calorie conscious and nutritionally complete diet modifying CV risk factors long term, then food could be as powerful in reducing CV events as evidence-based drug therapy. There is a need to begin conceptualizing food as medicine. To this end, it is time for a randomized control trial implementing the IQ diet versus current standard dietary recommendations in a large number of patients and measuring hard CV endpoints. Many readmissions can be avoided with proper patient education and support emphasizing lifestyle modifications such as eating healthy and smoking cessation on a foundation of optimal medical therapy.

Factors affecting blood pressure responses to diet: the Vanguard study

To study physiologic factors affecting the blood pressure (BP) response to nonpharmacologic maneuvers, fasting blood glucose, insulin, lipid and mineral levels, urinary mineral excretion, and the calcium regulating hormones parathyroid hormone (PTH) and 1,25 dihydroxyvitamin D (1,25 (OH) 2D) were measured in 71 unmedicated hypertensive (26 hypertensive only [HT], 45 hypertensive hyperlipidemic [HTHL]), and 87 normotensive hyperlipidemic (NTHL) control subjects before and during a 10-week multicenter, randomized controlled trial comparing a prepared meal plan (CCNW) with a self-selected diet (SSD) based on nutritionist counseling. Blood pressure fell to a greater extent in hypertensive versus normotensive subjects ( −8 ± 1/ −5 ± 1 v −2 ± 1/ −2 ±1 mm Hg, P < .0001/ P < .0001), and on CCNW versus SSD diets (Δ systolic BP [SBP]/Δ diastolic BP [DBP], P = .033/ P = .002). Diet-induced weight change was the strongest correlate of changes in BP (SBP: r = 0.360, P < .0001; DBP: r = 0.414, P < .0001), which, on multivariate analysis for ΔSBP, could partly be accounted for by diet-induced changes in fasting glucose (r = 0.215, P = .009) and cholesterol (r = 0.219, P = .006) levels. Independently of weight, diet-induced changes in SBP also were significantly related to concomitant changes in urinary excretion of potassium (r = −0.285, P = .001), magnesium (r = −0.254, P = .003), and calcium relative to sodium (r = −0.200, P = .021), but not to sodium per se; and to changes in serum potassium (r = −0.249, P = .002), phosphorus (r = −0.279, P = .001), PTH (r = 0.288, P = .0006), and 1,25 D (r = 0.202, P = .017). We conclude that the ability of diet to lower BP successfully may result from the additive contributions of multiple components. Independently of weight loss and the associated changes in circulating glucose and cholesterol, BP is influenced by the increasing provision of minerals such as potassium, magnesium, and calcium, perhaps by virtue of their suppressive effects on circulating vasoactive calcium regulating hormones.

A Randomized Trial of Improved Weight Loss With a Prepared Meal Plan in Overweight and Obese Patients

To assess the long-term effects of a prepackaged, nutritionally complete, prepared meal plan compared with a usual-care diet (UCD) on weight loss and cardiovascular risk factors in overweight and obese persons. In this randomized multicenter study, 302 persons with hypertension and dyslipidemia (n = 183) or with type 2 diabetes mellitus (n = 119) were randomized to the nutrient-fortified prepared meal plan (approximately 22% energy from fat, 58% from carbohydrate, and 20% from protein) or to a macronutrient-equivalent UCD. The primary outcome measure was weight change. Secondary measures were changes in blood pressure or plasma lipid, lipoprotein, glucose, or glycosylated hemoglobin levels; quality of life; nutrient intake; and dietary compliance. After 1 year, weight change in the hypertension/dyslipidemia group was -5.8+/-6.8 kg with the prepared meal plan vs -1.7+/-6.5 kg with the UCD plan (P<.001); for the type 2 diabetes mellitus group, the change was -3.0+/-5.4 kg with the prepared meal plan vs -1.0+/-3.8 kg with the UCD plan (P<.001) (data given as mean +/- SD). In both groups, both interventions improved blood pressure, total and low-density lipoprotein cholesterol levels, glycosylated hemoglobin level, and quality of life (P<.02); in the diabetic group, the glucose level was reduced (P<.001). Compared with those in the UCD group, participants with hypertension/dyslipidemia in the prepared meal plan group showed greater improvements in total (P<.01) and high-density lipoprotein (P<.03) cholesterol levels, systolic blood pressure (P<.03), and glucose level (P<.03); in participants with type 2 diabetes mellitus, there were greater improvements in glucose (P =.046) and glycosylated hemoglobin (P<.02) levels. The prepared meal plan group also showed greater improvements in quality of life (P<.05) and compliance (P<.001) than the UCD group. Long-term dietary interventions induced significant weight loss and improved cardiovascular risk in high-risk patients. The prepared meal plan simultaneously provided the simplicity and nutrient composition necessary to maintain long-term compliance and to reduce cardiovascular risk.

Increased dietary micronutrients decrease serum homocysteine concentrations in patients at high risk of cardiovascular disease1-3

Elevated blood homocysteine is a risk factor for cardiovascular disease. A 5-micromol/L increase is associated with an approximately 70% increase in relative risk of cardiovascular disease in adults. For patients with established risk factors, this risk is likely even greater. Effects of increased dietary folate and recommended intakes of vitamins B-12 and B-6 on serum total homocysteine (tHcy) were assessed in individuals at high risk of cardiovascular disease. This trial was conducted at 10 medical research centers in the United States and Canada and included 491 adults with hypertension, dyslipidemia, type 2 diabetes, or a combination thereof. Participants were randomly assigned to follow a prepared meal plan (PMP; n = 244) or a self-selected diet (SSD; n = 247) for 10 wk, which were matched for macronutrient content. The PMP was fortified to provide >/=100% of the recommended dietary allowances for 23 micronutrients, including folate. Mean folate intakes at 10 wk were 601 +/- 143 microgram/d with the PMP and 270 +/- 107 microgram/d with the SSD. With the PMP, serum tHcy concentrations fell from 10.8 +/- 5.8 to 9.3 +/- 4.9 micromol/L (P < 0.0001) between weeks 0 and 10 and the change was associated with increased intakes of folate, vitamin B-12, and vitamin B-6 and with increased serum and red blood cell folate and serum vitamin B-12 concentrations. tHcy concentrations did not change significantly with the SSD. The PMP resulted in increased intakes and serum concentrations of folate and vitamin B-12. These changes were associated with reduced serum tHcy concentrations in persons at high risk of cardiovascular disease.

Nutritionally Complete Prepared Meal Plan to Reduce Cardiovascular Risk Factors: A Randomized Clinical Trial

Objective To compare a nutritionally complete prepared meal plan that meets national dietary guidelines to usual-care dietary therapy for hypertension, dyslipidemia, and glycemic control. Design Randomized, controlled trial. Subjects/setting Outpatients with hypertension, dyslipidemia, or diabetes mellitus (n=251) were recruited at 6 medical centers in the United States and Canada. Intervention The prepared meal plan, which was developed by university-based nutrition and cardiovascular scientists and food technologists at Campbell's Center for Nutrition & Wellness (CCNW), provided the optimal levels of macronutrients and micronutrients recommended for cardiovascular risk reduction in a variety of prepackaged meals and snacks. After a 4-week pretrial period to assess baseline state, participants were randomized to the CCNW plan or “usual-care” diet for 10 weeks. Main outcome measures Blood pressure, carbohydrate metabolism, lipoproteins, homocysteine, weight, nutrient intake, compliance. Statistical analyses performed Repeated measures analysis of variance. Results Lipoproteins, carbohydrate metabolism, blood pressure, and weight improved on both plans. Mean differences (±standard deviation) between baseline and follow-up for the CCNW plan and the usual-care plan, respectively, were total cholesterol, −0.41±0.64 and −0.20±.50 mmol/L (between-group P<.01); plasma glucose, −0.7±1.7 and −0.3±1.3 mmol/L ( P<.05); systolic blood pressure, −5.2±10.0 and −4.7±9.0 mm Hg ( P=.67), diastolic blood pressure, −3.8±5.9 and −2.2±5.5 mm Hg ( P<.05); and homocysteine, −1.3±3.8 and 0.2±3.4 μmol/L ( P<.01). The CCNW plan led to greater weight loss than the usual-care diet (−5.5±3.8 kg vs −3.0±3.2 kg, P<.0001). Applications/conclusion The nutritionally complete CCNW plan offers greater improvements in lipids, blood sugars, homocysteine, and weight loss than usual-care diet therapy. This prepackaged comprehensive nutrition program can augment both the prescription and practice of optimal dietary therapy. J Am Diet Assoc. 1999;99:1077–1083

Blood Pressure Reduction in the Long-Term Cardiovascular Risk Reduction Dietary Intervention Trial

As a follow-up in a series of studies designed to test the effect of a risk-reducing prepared meal plan on CVD endpoints in patients with CVD risk factors, this year-long study was designed to determine the long-term effects on blood pressure (BP) of a prepared meal plan (PMP) compared to a usual care self-selected diet (SSD). In a multi-center trial, 220 participants aged 25-70 with marginally controlled hypertension and dyslipidemia were randomized to either: 1) usual care SSD (n= 110) or 2) nutrient-fortified PMP (n=110). Both plans were designed to provide (as % energy) 22% fat, 17% protein and 61% carbohydrate. Supine systolic (SBP) and diastolic (DBP) blood pressure was measured at baseline (BL), week 12, and at the end of 26 weeks. ANOVA with repeated measures was used to determine changes in BP (mean change ±SD) from BL within and between diets through 6 months of intervention (interim data are shown): PMP SSD week12 week26 week12 week26 SBP −12.4±10.6 −15.0±9.9 −8.1±9.1 −8.8±10.9 DBP −8.0±6.5 −9.3±6.6 −4.9±6.4 −6.5±6.7 Baseline BP was 146/91 and 147/88 for the PMP and SSD respectively (p=ns). Within diets, SBP and DBP were reduced from BL in both groups (p < 0.001). Changes in SBP and DBP from BL were greater in the PMP compared to the SSD after 12 (p < 0.02) and 26 weeks (p < 0.03). Similar changes were noted for sitting SBP (p < 0.03). Within diets, further changes from week 12 to 26 were also observed for SBP (p < 0.04) and DBP (p < 0.007). Long-term dietary interventions to reduce BP can be effective strategies for controlling hypertension. The PMP offers a convenient modality for achieving more favorable long-term changes in BP control compared to usual care self-selected diets.

N005 Effect of a prepared meal plan on trace mineral status in patients with cardiovascular disease risk factors

N005 Effect of a prepared meal plan on trace mineral status in patients with cardiovascular disease risk factors

Predicting Dietary Compliance with Step I and II Dietary Guidelines in Patients With CVD Risk Factors.

LEARNING OUTCOME: To identify factors predictive of dietary compliance in patients with CVD risk factors. The goal of this study was to identify factors predictive of dietary compliance in individuals with marginally controlled hypertension, dyslipidemia or NIDDM following two therapeutic dietary interventions. In a multicenter trial, 560 participants aged 25-70 were randomized to either: 1) a nutritionist-guided self-selected mixed-food plan (SSD; n=277) or 2) a nutrient-fortified prepared meal plan (PMP; n=283). Both plans provided (as % energy) 17% fat, 21% protein and 62% carbohydrate. Dietary intake and compliance with Step I and II guidelines was estimated with 3-day food records throughout the 10-week trial. Compliance with Step I was achieved by 97% of the PMP group compared to 73% of SSD, whereas Step II compliance was 81% vs. 41% respectively. Logistic regression was used to compute odds of compliance for each variable in the model. Treatment group was the strongest predictor of compliance, with the PMP 15.3 times as likely to achieve STEP I and 7.5 times as likely to achieve Step II compliance compared to the SSD (p<0.0001). Men were half as likely to be compliant compared to women (p<0.003), and diabetics were half as likely to be compliant with Step I and II compliance compared to all other diagnostic groups (p<0.007). Each unit increase in BMI was associated with a 5% increase in noncompliance with Step II guidelines (p<0.036). Age was not a significant predictor of compliance. In this study, dietary compliance is significantly enhanced with the PMP, in women, in non-diabetics and with decreasing BMI. The PMP provides a viable option for enhancing compliance in participants with CVD risk factors.

Dietary compliance and cardiovascular risk reduction with a prepared meal plan compared with a self-selected diet

Noncompliance with therapeutic diets remains a major obstacle to achieving improvements in cardiovascular disease (CVD) morbidity and mortality. This study compared dietary compliance and CVD risk factor response to two dietary interventions designed to treat hypertension, dyslipidemia, and diabetes mellitus. In a multicenter trial, 560 adults were randomly assigned to either a self-selected, mixed-food plan (n = 277), or a nutrient-fortified prepared meal plan (n = 283); each was designed to provide 15-20% of energy from fat, 55-60% from carbohydrate, and 15-20% from protein. Nutrient intake was estimated from 3-d food records collected biweekly throughout the 10-wk intervention. Compliance was determined by evaluating the participants' ability to meet specific criteria for energy intake [+/-420 kJ (100 kcal) from the midpoint of the prescribed energy range], fat intake (< 20%, < 25%, or < 30% of energy from total fat), and the National Cholesterol Education Program/American Heart Association Step 1 and 2 diet recommendations. Compliance with energy, fat, and Step 1 and 2 criteria was better in participants who followed the prepared meal plan than in those who followed the self-selected diet (P < 0.0001). Compliant participants in both groups achieved greater reductions in body weight, systolic and diastolic blood pressure, and total and low-density-lipoprotein cholesterol than noncompliant participants (P < 0.05). In general, better endpoint responses were observed with lower fat intakes regardless of group assignment. The prepared meal plan is a simple and effective strategy for meeting the many nutrient recommendations for CVD risk reduction and improving dietary compliance and CVD endpoints.

Nutritional Management of Cardiovascular Risk Factors

Adherence to dietary recommendations for disease management is often hindered by the complexity of incorporating them into the daily diet. Nutrition and cardiovascular scientists and food technologists collaborated to develop a prepared meal plan that meets national dietary guidelines for cardiovascular risk reduction. To assess the clinical effects of this plan, which incorporates all National Academy of Sciences National Research Council recommended dietary allowances for vitamins, minerals, and macronutrients, compared with a patient-selected American Heart Association Step I and Step II diet plan. This multicenter, randomized, parallel-intervention trial was conducted at 10 medical centers in the United States and Canada and involved 560 men and women with hypertension, dyslipidemia, or diabetes. Following calculation of prescriptions to meet individual nutritional requirements based on the Harris-Benedict equation, participants were randomized to the Campbell's Center for Nutrition and Wellness (CCNW) plan, which is composed of prepackaged breakfast, lunch, and dinner meals provided to participants, or a nutritionist-guided American Heart Association Step I and Step II diet, in which participants self-selected foods to meet their nutrition prescription for 10 weeks. Blood pressure (BP); lipid, glucose, glycosylated hemoglobin (HbA1c), and insulin levels; body weight; dietary intake; and quality of life. Patients' BP, lipid levels, carbohydrate metabolism, weight, and quality of life (P < or = .001 for all findings except low-density lipoprotein-high-density lipoprotein ratio, P = .25) all improved on both nutrition plans. Mean differences (+/-SD) between baseline and treatment clinical values for the CCNW and the self-selected diet groups (between-group P values), respectively, were as follows: systolic BP, -6.4 +/- 9.2 mm Hg and -4.6 +/- 9.0 mm Hg (P = .02); diastolic BP, -4.2 +/- 5.7 mm Hg and -3.0 +/- 5.1 mm Hg (P = .006); cholesterol, -0.32 +/- 0.58 mmol/L and -0.27 +/- 0.56 mmol/L (-12.4 +/- 22.5 mg/dL and -10.4 +/- 21.9 mg/dL) (P = .30); glucose, -0.65 +/- 1.88 mmol/L and -0.75 +/- 2.03 mmol/L (-11.7 +/- 34.0 mg/dL and -13.5 +/- 36.6 mg/dL) (P = .10); and HbA1c, -0.4% +/- 0.8% and -0.3% +/- 0.7% (P = .66). Weight loss with the CCNW and self-selected plans, respectively, was as follows: men, -4.5 +/- 3.6 kg and -3.5 +/- 3.3 kg; and women, -4.8 +/- 3.0 kg and -2.8 +/- 2.8 kg. Quality of life was significantly improved for daily and work activities (P < .05) and nutritional health perceptions (P < .05) with the CCNW plan relative to the self-selected group. Overall nutrient intake and compliance were both significantly (P < .001) better with the CCNW plan. Nutritionally balanced meals that meet the recommendations of national health organizations improved multiple risk factors for patients with cardiovascular disease. The CCNW plan resulted in greater clinical benefits, nutritional completeness, and compliance than the self-selected diet. The CCNW is a comprehensive nutrition plan, convenient for both prescription and practice, and appears viable for effecting favorable dietary changes in patients at high risk for cardiovascular disease.

Nutritional management of cardiovascular risk factors. A randomized clinical trial

Adherence to dietary recommendations for disease management is often hindered by the complexity of incorporating them into the daily diet. Nutrition and cardiovascular scientists and food technologists collaborated to develop a prepared meal plan that meets national dietary guidelines for cardiovascular risk reduction.To assess the clinical effects of this plan, which incorporates all National Academy of Sciences National Research Council recommended dietary allowances for vitamins, minerals, and macronutrients, compared with a patient-selected American Heart Association Step I and Step II diet plan.This multicenter, randomized, parallel-intervention trial was conducted at 10 medical centers in the United States and Canada and involved 560 men and women with hypertension, dyslipidemia, or diabetes. Following calculation of prescriptions to meet individual nutritional requirements based on the Harris-Benedict equation, participants were randomized to the Campbell's Center for Nutrition and Wellness (CCNW) plan, which is composed of prepackaged breakfast, lunch, and dinner meals provided to participants, or a nutritionist-guided American Heart Association Step I and Step II diet, in which participants self-selected foods to meet their nutrition prescription for 10 weeks.Blood pressure (BP); lipid, glucose, glycosylated hemoglobin (HbA1c), and insulin levels; body weight; dietary intake; and quality of life.Patients' BP, lipid levels, carbohydrate metabolism, weight, and quality of life (P < or = .001 for all findings except low-density lipoprotein-high-density lipoprotein ratio, P = .25) all improved on both nutrition plans. Mean differences (+/-SD) between baseline and treatment clinical values for the CCNW and the self-selected diet groups (between-group P values), respectively, were as follows: systolic BP, -6.4 +/- 9.2 mm Hg and -4.6 +/- 9.0 mm Hg (P = .02); diastolic BP, -4.2 +/- 5.7 mm Hg and -3.0 +/- 5.1 mm Hg (P = .006); cholesterol, -0.32 +/- 0.58 mmol/L and -0.27 +/- 0.56 mmol/L (-12.4 +/- 22.5 mg/dL and -10.4 +/- 21.9 mg/dL) (P = .30); glucose, -0.65 +/- 1.88 mmol/L and -0.75 +/- 2.03 mmol/L (-11.7 +/- 34.0 mg/dL and -13.5 +/- 36.6 mg/dL) (P = .10); and HbA1c, -0.4% +/- 0.8% and -0.3% +/- 0.7% (P = .66). Weight loss with the CCNW and self-selected plans, respectively, was as follows: men, -4.5 +/- 3.6 kg and -3.5 +/- 3.3 kg; and women, -4.8 +/- 3.0 kg and -2.8 +/- 2.8 kg. Quality of life was significantly improved for daily and work activities (P < .05) and nutritional health perceptions (P < .05) with the CCNW plan relative to the self-selected group. Overall nutrient intake and compliance were both significantly (P < .001) better with the CCNW plan.Nutritionally balanced meals that meet the recommendations of national health organizations improved multiple risk factors for patients with cardiovascular disease. The CCNW plan resulted in greater clinical benefits, nutritional completeness, and compliance than the self-selected diet. The CCNW is a comprehensive nutrition plan, convenient for both prescription and practice, and appears viable for effecting favorable dietary changes in patients at high risk for cardiovascular disease.

Improved quality of life in patients with generalized cardiovascular metabolic disease on a prepared diet

Current dietary recommendation for cardiovascular disease risk reduction and recommended dietary allowances (RDAs) were used to develop a nutritionally complete prepackaged prepared meal plan specifically designed to reduce the risk of cardiovascular disease. In the current study we tested patient acceptance of the diet as defined by measures of quality of life. In a randomized, parallel-design, multicenter clinical trial, 77 persons with hypertension, diabetes mellitus, dyslipidemia, or a combination of two or more of these conditions were recruited and randomly assigned to either a prepared meal plan (n = 39) or a comparable self-selected diet (n = 38) for 10 wk. The prepared meal plan met both the RDAs for all essential micronutrients and the dietary recommendations of national health organizations for macronutrients, cholesterol, sodium, and fiber. The prescribed self-selected diet was matched for macronutrients. Quality of life, as measured by a battery of instruments, was the major endpoint. Individuals consuming the prepared meal plan had significant improvements in mental health (P < 0.01), general perceived health (P < 0.005), daily activities (P < 0.05), work performance (P < 0.005), affect (P < 0.01), and nutritional health perceptions (P < 0.001), and reductions in nutrition hassles based on a standardized questionnaire (P < 0.001). The self-selected-diet group had significant improvements in nutritional health perceptions (P < 0.001) and affect (P < 0.001). There were significant improvements in weight (P < 0.001), blood pressure (P < 0.001), cholesterol (P < 0.002), low-density lipoproteins (P < 0.001), glucose (P < 0.014), and glycated hemoglobin (Hb A(1c) (P < 0.004) that were comparable in both groups. In summary, this study shows that a nutritionally complete diet, whether prepackaged or self-selected, improves multiple risk factors for cardiovascular disease. The prepackaged prepared meal plan had the added benefit of a greater improvement in quality of life.

A Strategy for Improving Nutrition-related Quality of Life in Patients With Generalized Cardiovascular Metabolic Disease

LEARNING OUTCOME: To assess the quality of life outcomes from two methods for achieving the NCEP/AHA Step 1/2 dietary guidelines.Health professionals frequently advise patients with cardiovascular diseases to modify their diets but often find that patients do not follow their advice because of difficulties encountered altering food-intake patterns. Finding ways of reducing the difficulties associated with dietary change is of critical importance to successful nutritional therapy. The objective of this study was to provide a complete-prepared food plan as a means of reducing diet-related difficulties. Success in meeting this objective was measured by improvements in quality of life (QOL). The prepared food plan was compared to an intensive dietitian-guided, self-selected diet. Both meal plans provided as %Kcal <20% fat, 15–20% protein and 55–60% carbohydrate. Subjects (n=560) from 10 medical centers met entry criteria for marginally controlled hypertension, dyslipidemia or NIDDM and were randomly assigned to the two diet groups. The study consisted of a 4-week-phase of usual diet followed by a 10 week diet intervention phase. Quality of life was measured at weeks -2, 0, 4 and 10. Repeated measures ANOVA showed that both groups had significant improvement over weeks for mental health (p < .001), general health perceptions (p < .001), daily and work activities (p < .001), social function (p < .001), nutritional health perceptions (p < .001), nutritional hassles (p < .001), affect (p < .001) and diet satisfaction (p < .001). Improvements were greater for individuals in the prepared meal plan for daily and work activities (p < .05) and nutritional health perceptions (p < .01). We conclude that improving nutrition patterns enhances QOL in patients with generalized cardiovascular metabolic disease. Reducing the demands on the patient by providing a complete prepared meal plan resulted in the greatest improvement in QOL.