Evid Based Nurs 9:48 doi:10.1136/ebn.9.2.48
  • Treatment

Review: dietary advice improves dietary intake and reduces cardiovascular risk factors

 Q Does dietary advice achieve sustained dietary changes and reduce cardiovascular risk factors in healthy adults?


GraphicData sources:

Medline, EMBASE/Excerpta Medica, Cochrane Library, Cardiovascular Randomized Clinical Trial Registry, INST ED-Bibliomap, INST ED-EPPI-Centre, Current Controlled Trials (to 2000), SIGLE (to June 2000), CAB Health (to 1999), relevant Cochrane Review Groups, reference lists of systematic reviews, and experts in the field.

GraphicStudy selection and assessment:

randomised and quasi-randomised controlled trials (RCTs) in any language that compared verbal or written dietary advice (delivered in person or by telephone to individuals or small groups for the purpose of reducing risk of chronic diseases) with no or minimal advice in healthy adults. RCTs were required to have ⩾3 months of follow up in ⩾80% of participants, <25% of participants with cardiovascular disease at enrolment, and ⩽10% of participants taking lipid lowering drugs. RCTs involving interventions in addition to dietary advice or diets for weight reduction were excluded.


included change in cardiovascular risk factors (blood pressure, blood lipid concentrations, folate), biomarkers of dietary intake (urinary sodium, β carotene), and self reported measures of dietary intake (fat, fibre, fruits and vegetables).


23 RCTs (n = 24 443) met the selection criteria. Mean age of participants ranged from 27 to 61 years, and the proportion of men ranged from 0% to 100%. The intensity of the intervention ranged from 1 contact to 50 hours of individual counselling. The most common duration of follow up was 6 months (range 3–48 mo). Dietary advice reduced systolic and diastolic blood pressure, total and low density lipoprotein cholesterol concentrations, urinary sodium output, and total dietary fat more than no or minimal advice (table). The groups did not differ for change in high density lipoprotein cholesterol concentrations. Dietary advice increased self reported intake of fruits and vegetables and intake of fibre more than no or minimal advice (table). There was insufficient evidence to evaluate the effect of dietary advice on triglycerides, plasma β carotene, and red cell folate concentrations (1 study each).


Dietary advice promotes beneficial changes in diet and reduces cardiovascular risk factors in healthy adults.


  1. Catherine Goetz-Perry, RN, MN
  1. Victorian Order of Nurses, Grey Bruce, Owen Sound, Ontario, Canada

      Few reviews have studied the effect of dietary advice given to healthy adults on sustained dietary changes and resulting reductions in cardiovascular risk factors. Recent reviews have focused on single dietary changes, such as reduction of dietary fat1 or salt,2 or single outcomes, such as blood cholesterol concentrations.3 The review by Brunner et al is important because it considers the effects of intensity, mode, and duration of dietary advice and the intervention setting on cardiovascular risk factors and dietary intake measures as primary and secondary outcomes.

      Generalisability of the results may be limited to developed nations. Most included studies were from the US, and the findings may not apply to populations with different dietary patterns. There was significant heterogeneity among the effects, which may have been caused by differences in intensity, duration, mode, or setting of the intervention, or population characteristics. Results on self reported measures (eg, fibre intake) may be overstated.

      The results of the review by Brunner et al are relevant to public health nurses involved in population health strategies, advanced practitioners in primary health care working with adults in health promotion and chronic disease prevention, and nurses practising in various community settings, given that there was little difference in results between community/workplace and healthcare settings. The extent of change is influenced by the intensity and duration of the interventions, as well as an individual’s perceived risk. Although high intensity, long term interventions are not cost efficient, small dietary changes will result in health gains for healthy adults. The methods by which dietary change can be sustained over time remain to be addressed.


      Dietary advice v no or minimal advice to improve diet and reduce cardiovascular risk factors in healthy adults*

 Q Does dietary advice achieve sustained dietary changes and reduce cardiovascular risk factors in healthy adults?


      • For correspondence: Dr E Brunner, University College London, London, UK. e.brunner{at}

      • Source of funding: Coronary Prevention Group, UK.

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