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Although citing insufficient evidence to recommend for or against routine dietary counseling in the general population of adult patients, the U.S. Preventive Services Task Force has recommended that primary care clinicians provide dietary counseling for adult patients with high cholesterol and other known risk factors for diet-related chronic disease, such as high blood pressure and obesity. These recommendations appear in the January 2003 issue of the American Journal of Preventive Medicine.
The Task Force found that effective counseling for promoting healthy diets among patients at known risk for cardiovascular disease generally requires multi-session group or individual behavioral counseling provided by specially trained physicians and nurse practitioners or by primary care dietitians, nutritionists, or health educators. Effective counseling combines education about healthy diet with specific behavioral counseling that increases patients' motivation, skills, and social support for healthier eating patterns.
The Task Force, an independent panel of experts sponsored by the Agency for Healthcare Research and Quality, found that counseling by specially trained primary care clinicians can help high-risk patients eat less saturated fat and eat more fruits and vegetables and fiber and concluded that the magnitude and duration of diet changes produced were significant enough to have beneficial effects on cardiovascular disease and possibly other health problems such as cancer and diabetes that may be related to unhealthy diets.
In 2002, Medicare began covering nutrition therapy for beneficiaries with diabetes and kidney disease. Four of the ten leading causes of death—coronary heart disease, some types of cancer, stroke, and type 2 diabetes—are associated with unhealthy diets. Most studies show that people who eat diets low in fat, saturated fat, transfatty acids, and cholesterol and high in fruits, vegetables, and whole grain products containing fiber have lower rates of death and disease from coronary heart disease and possibly several forms of cancer. The Task Force noted that counseling that focuses only on reducing fat intake without giving attention to all the components of a healthy diet could have adverse effects if it inadvertently leads to higher carbohydrate and calorie intake, which has been linked to obesity, diabetes, and elevated lipids.
Among the general population of adult patients, brief counseling may prove beneficial, but the existing evidence was insufficient to determine whether such patients would maintain these small changes over time or whether the changes would lead to significant improvements in health outcomes such as lowered risk of heart disease, according to the Task Force.
The Task Force noted two promising strategies for addressing diet problems in average-risk patients. These strategies range from multi-session group or individual treatments delivered by a dietitian, nutritionist, or trained clinician to much briefer (as short as 5 minutes) behavioral counseling supplemented by self-help materials, telephone counseling, and individually tailored health mailings and messages. Further research is needed, however, to determine whether these treatments are consistently effective in the general population.
The Task Force found no controlled research on primary care dietary counseling for children or adolescents. Given the serious and growing national epidemic of youth obesity, reflecting both unhealthy diet and insufficient physical activity, more research on youth-focused interventions is greatly needed, according to the Task Force. One of AHRQ's Practice-Based Research Networks is conducting research about diet and youth obesity.
The Task Force, the leading independent panel of private-sector experts in prevention and primary care, conducts rigorous, impartial assessments of all the scientific evidence for a broad range of preventive services. Its recommendations are considered the gold standard for clinical preventive services. The Task Force based its conclusion on a report from a team led by Michael Pignone, M.D., M.P.H., and Alice Ammerman, Dr.P.H., R.D, from AHRQ's Evidence-based Practice Center at Research Triangle Institute/University of North Carolina at Chapel Hill.
The Task Force grades its recommendations from "A" (strongly recommends) to "D" (recommends against) or "I" (insufficient evidence). The Task Force recommendation is a "B" for high-risk patients and an "I" for adults in the general population. In 1996, the Task Force recommended simply that all patients be advised about a healthy diet. At that time, there was limited evidence about the role of the clinician in dietary counseling. Since then, more studies have been done to examine the benefits of dietary counseling in the primary care setting.
Information for clinicians is available by selecting recommendations and materials.
Previous Task Force recommendations, summaries of the evidence, easy-to-read fact sheets explaining the recommendations, and related materials are available from the AHRQ Publications Clearinghouse.
Select National Guideline Clearinghouse™ for clinical information.
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