Preliminary trial of the effect of general practice based nutritional advice. Preventing coronary heart disease in high-risk families. Effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events in men and women with coronary artery disease. The Stanford Coronary Risk Intervention Project (SCRIP). Regular Physical Exercise and Low‐Fat Diet: Effects on Progression of Coronary Artery Disease Effects of alcohol and caloric restrictions on blood pressure and serum lipids in overweight men. An individualized teaching programme following primary uncomplicated myocardial infarction. Five years of physical exercise and low fat diet: effects on progression of coronary artery disease. Lifestyle intervention: results of the Treatment of Mild Hypertension Study (TOMHS). Diet and exercise are equally effective in reducing risk for cardiovascular disease. Results of a randomized controlled study in men with slightly to moderately raised cardiovascular risk factors. The Belgian Heart Disease Prevention Project: Modification of the Coronary Risk Profile in an Industrial Population Predictive value of lipid profile for salutary coronary angiographic changes in patients on a low-fat diet and physical exercise program. Effects of Orem-based nursing intervention on nutritional self-care of myocardial infarction patients. Quantitative changes in dietary fat intake and serum cholesterol in women: results from a randomized, controlled trial. Prospective, randomized, controlled comparison of the effects of low-fat and low-fat plus high-fiber diets on serum lipid concentrations. Change in dietary saturated fat intake is correlated with change in mass of large low-density-lipoprotein particles in men. Acyl pattern of adipose tissue triglycerides, plasma free fatty acids, and diet of a group of men participating in a primary coronary prevention program (the Oslo Study). Effects of varying dietary fat, fish, and fish oils on blood lipids in a randomized controlled trial in men at risk of heart disease. Plasma lipoprotein response to substituting fish for red meat in the diet. Can lifestyle changes reverse coronary heart disease?: The Lifestyle Heart Trial A randomized study of instructional variations in nutrition counseling and their efficacy in the treatment of hyperlipidemia. Improving self-care among older patients with type II diabetes: the "Sixty Something..." Study. Randomised controlled trial evaluating the effectiveness of behavioural interventions to modify cardiovascular risk factors in men and women with impaired glucose tolerance: outcomes at 6 months. Effect of diet and physical exercise intervention programmes on coronary heart disease risk in smoking and non-smoking men in Sweden. Design of the Women's Health Initiative clinical trial and observational study. The Women's Health Initiative Study Group. Treadmill test responses to an early exercise program after myocardial infarction: a randomized study. Nutritional counselling in general practice: a cost effective analysis. Long-term cholesterol-lowering effects of 4 fat-restricted diets in hypercholesterolemic and combined hyperlipidemic men. The Dietary Alternatives Study. A long-term nutrition intervention experience: lipid responses and dietary adherence patterns in the Multiple Risk Factor Intervention Trial. Attenuated progression of coronary artery disease after 6 years of multifactorial risk intervention: role of physical exercise. A randomized controlled trial of dietary fat reduction: the retention of subjects and characteristics of drop outs. Nonpharmacologic intervention to reduce blood pressure in older patients with mild hypertension. Effect of low energy diet and weight loss on major risk factors, central obesity and associated disturbances in patients with essential hypertension. Randomised trial of lipid lowering dietary advice in general practice: the effects on serum lipids, lipoproteins, and antioxidants Individualised multifactorial lifestyle intervention trial for high-risk cardiovascular patients in primary care. Prevention of Type II diabetes in subjects with impaired glucose tolerance: the Diabetes Prevention Study (DPS) in Finland
Study design and 1-year interim report on the feasibility of the lifestyle intervention programme An Economic Evaluation of Four Work Site Based Cardiovascular Risk Factor Interventions Lifestyle intervention in people with insulin-dependent diabetes mellitus (IDDM) Life-style intervention at the worksite--reduction of cardiovascular risk factors in a randomized study. Weight and sodium reduction for the prevention of hypertension: a comparison of group treatment and individual counseling. The Finnish Diabetes Prevention Study. The Tromsø Survey: the Family Intervention study--the effect of intervention on some coronary risk factors and dietary habits, a 6-year follow-up. The cost-effectiveness of a cardiovascular risk reduction program in general practice. Physical activity training for weight loss in Latinas: a controlled trial. Effects of a Brief Office-Based Intervention to Facilitate Diabetes Dietary Self-Management Results of a randomized feasibility study of a low-fat diet. Effectiveness of health checks conducted by nurses in primary care: final results of the OXCHECK study Effect of diet and weight reduction in hypertension. Management of hypercholesterolemia: evaluation of practical clinical approaches in healthy young adults. The efficacy of intensive dietary therapy alone or combined with lovastatin in outpatients with hypercholesterolemia. Use and outcomes of a cholesterol-lowering intervention for rural elderly subjects. Effects on coronary artery disease of lipid-lowering diet, or diet plus cholestyramine, in the St Thomas' Atherosclerosis Regression Study (STARS) Failure of weight reduction to reduce mildly elevated blood pressure: a randomized trial. Mortality rates in treated hypertensive men with additional risk factors are high but can be reduced: a randomized intervention study. Evaluation of a self-help dietary intervention in a primary care setting. Personal and mediated health counseling for sustained dietary reduction of hypercholesterolemia. Primary prevention of hypertension by nutritional-hygienic means. Final report of a randomized, controlled trial. Efficacy of low fat diet in the treatment of benign breast disease. United Kingdom Heart Disease Prevention Project: 12-year follow-up of risk factors. Improved stenosis geometry by quantitative coronary arteriography after vigorous risk factor modification. Characteristics of participating and nonparticipating men in a randomized, controlled diet and exercise intervention trial. Change in cardiovascular risk factors during a 10-year community intervention program. Effects of diet and lifestyle changes on atherosclerotic risk factors after 24 weeks on the Indian Diet Heart Study. The Tromsø Heart Study A controlled trial of a high fibre, low fat and low sodium diet for mild hypertension in type 2 (non-insulin-dependent) diabetic patients The Oslo Diet‐Heart Study: Eleven‐Year Report Long-term effect of nutritional counseling: a study in family medicine. Do tailored behavior change messages enhance the effectiveness of health risk appraisal? Results from a randomized trial. Impact of Mediterranean diet education versus posted leaflet on dietary habits and serum cholesterol in a high risk population for cardiovascular disease. Effect of dietary cholesterol on plasma cholesterol concentration in subjects following reduced fat, high fibre diet. Coeur en santé St-Henri--a heart health promotion programme in Montreal, Canada: design and methods for evaluation. A controlled trial of a low sodium, low fat, high fibre diet in treated hypertensive patients: the efficacy of multiple dietary intervention. The Paris Cardiovascular Risk Factor Prevention Trial. Effects of two years of intervention in a population of young men. Impact of group nutrition education and surplus value of Prochaska-based stage-matched information on health-related cognitions and on Mediterranean nutrition behavior. Brief description of the Multiple Risk Factor Intervention Trial. Changing coronary heart disease risk-factor status: The effects of three behavioral programs Telematic expert system Diabeto: New Tool for Diet Self-Monitoring for Diabetic Patients Changes in lipoprotein subfractions during diet-induced and exercise-induced weight loss in moderately overweight men. Health promotion in couples adapting to a shared lifestyle. Take Heart II: Replication of a Worksite Health Promotion Trial The additive effect of probucol on diet in hyperlipidemia A randomised controlled trial of a dietary advice program for relatives of heart attack victims. Computerized weight loss intervention optimizes staff time: the clinical and cost results of a controlled clinical trial conducted in a managed care setting. Clinical trial of low-fat, high-carbohydrate diet in subjects with mammographic dysplasia: report of early outcomes. Long-term effects and costs of brief behavioural dietary intervention for patients with diabetes delivered from the medical office. The psychological consequences of weight gain prevention in healthy, premenopausal women. Serum insulin response to oral glucose load during a dietary intervention trial in healthy coronary high risk men: the Oslo study. The effectiveness of a low lipid diet and exercise in the management of coronary artery disease. Randomised controlled trial of health promotion in general practice for patients at high cardiovascular risk Effects of a low-intensity worksite-based nutrition intervention. Maintenance of a low-fat diet: follow-up of the Women's Health Trial. Prospective Evaluation of HDL Cholesterol Changes After Diet and Physical Conditioning Programs for Patients with Type II Diabetes Mellitus The Independent and Combined Effects of Aerobic Exercise and Dietary Fish Intake on Serum Lipids and Glycemic Control in NIDDM: A randomized controlled study Multifactorial treatment of hypertensive men at high cardiovascular risk and low-density lipoprotein cholesterol affinity to human arterial proteoglycans. Ebeltoft project: baseline data from a five-year randomized, controlled, prospective health promotion study in a Danish population. The cost-effectiveness of a cardiovascular multiple-risk-factor intervention programme in treated hypertensive men. Diabetes Intervention Study: Multi-Intervention Trial in Newly Diagnosed NIDDM Body weight and blood pressure. Effects of weight reduction on hypertension. Hypercholesterolaemia in treated hypertensives: a controlled trial of intensive dietary advice. A CONTROLLED TRIAL OF NURSE COUNSELLING ON LIFESTYLE CHANGE FOR HYPERTENSIVES TREATED IN GENERAL PRACTICE: PRELIMINARY RESULTS Impact of Intensive Educational Approach to Dietary Change in NIDDM Dietary intervention for cholesterol reduction in public clinic patients. A Controlled Trial on the Effects of Patient Education in the Treatment of Insulin-dependent Diabetes A Randomized Trial of Cardiovascular Risk Factor Reduction: Patterns of Attrition after Randomization and During Follow-Up General guidelines for a low-fat diet effective in the management and prevention of nonmelanoma skin cancer. Heart disease prevention project: a randomised controlled trial in industry. Effect of training and a structured office practice on physician-delivered nutrition counseling: the Worcester-Area Trial for Counseling in Hyperlipidemia (WATCH). Feasibility of a randomized trial of a low-fat diet for the prevention of breast cancer: dietary compliance in the Women's Health Trial Vanguard Study. A Randomized Controlled Trial of Weight Reduction and Exercise for Diabetes Management in Older African-American Subjects Dietary intervention in breast cancer patients: effects on food choice. Impact of cholesterol reduction on peripheral arterial disease in the Program on the Surgical Control of the Hyperlipidemias (POSCH). [Dietary treatment of mild to moderate hypercholesterolemia. Effectiveness of different interventions]. Project Joy: Faith Based Cardiovascular Health Promotion for African American Women Improved plasma cholesterol levels in men after a nutrition education program at the worksite. The cost-effectiveness of telephone vs clinic counseling for hypertensive patients: a pilot study. Independent associations between plasma lipoprotein subfraction levels and the course of coronary artery disease in the St. Thomas' Atherosclerosis Regression Study (STARS). Group Education for Obese Patients with Type 2 Diabetes: Greater Success at Less Cost Long-term mortality after 5-year multifactorial primary prevention of cardiovascular diseases in middle-aged men. The efficacy of multiple risk factor intervention in treated hypertensive men during long-term follow up. Risk Factor Intervention Study Group. Coaching patients with coronary heart disease to achieve the target cholesterol: a method to bridge the gap between evidence-based medicine and the "real world"--randomized controlled trial. Predicting achievement of a low-fat diet: a nutrition intervention for adults with low literacy skills. Quality of life is not negatively affected by diet and exercise intervention in healthy men with cardiovascular risk factors The Oslo Study: diet and antismoking advice. Additional results from a 5-year primary preventive trial in middle-aged men. Results of a Community-Based Low-Literacy Nutrition Education Program Dietary treatment of hypercholesterolemia: do dietitians do it better? A randomized, controlled trial. The impact of a computer-tailored nutrition intervention. Nutrition Education and Social Learning Interventions for Type II Diabetes Behavioral effects of a comprehensive, multifactorial program for lifestyle change after percutaneous transluminal coronary angioplasty: a prospective, randomized controlled study. The Comparison of Four Weight Reduction Strategies Aimed at Overweight Diabetic Patients An experimental evaluation of a prototype public access nutrition information system for supermarkets. Efficacy of dietary instructions in newly diagnosed non-insulin-dependent diabetic patients. Comparison of two different patient education regimens. Modifying Dietary and Tobacco Use Patterns in the Worksite: The Take Heart Project Maintenance of cholesterol reduction using automated telephone calls. Effectiveness of counselling over 1 year on changes in lifestyle and coronary heart disease risk factors. Effects of low-fat diet, calorie restriction, and running on lipoprotein subfraction concentrations in moderately overweight men. Management of type IV hyperlipoproteinemia. Evaluation of practical clinical approaches. Progression of atherosclerosis in middle-aged men: effects of multifactorial intervention. Dietary fat and blood pressure: an intervention study on the effects of a low-fat diet with two levels of polyunsaturated fat. Impact of intensive physical exercise and low-fat diet on collateral vessel formation in stable angina pectoris and angiographically confirmed coronary artery disease. The impact of the Guidelines for a Healthy Diet of The Netherlands Nutrition Council on total and high density lipoprotein cholesterol in hypercholesterolemic free-living men. Effect of a Nutrition Intervention on Macronutrient Intake in a Low English-Proficient Hispanic Sample Lifestyle Intervention in Overweight Individuals With a Family History of Diabetes Improved control of type 2 diabetes mellitus: a practical education/behavior modification program in a primary care clinic. Effects of dietary fat intervention on mental health in women. Cholesterol reduction through low-intensity interventions: results from the Minnesota Heart Health Program. Influence of coronary nursing management follow up on lifestyle after acute myocardial infarction. Nutrient intake and progression of coronary artery disease. The effects of weight loss by exercise or by dieting on plasma high-density lipoprotein (HDL) levels in men with low, intermediate, and normal-to-high HDL at baseline. Worksite Cholesterol and Nutrition: An Intervention Project in Colorado Determinants of compliance in men enrolled in a diet and exercise intervention trial: a randomized, controlled study. A randomized controlled trial of a physician-directed treatment program for low-income patients with high blood cholesterol: the Southeast Cholesterol Project. The Stanford Nutrition Action Program: a dietary fat intervention for low-literacy adults. The effect of a weight reduction program on cardiovascular risk factors among overweight hypertensives in primary health care Evaluation of referral completion after a workplace cholesterol screening program. Coronary heart disease and all-causes mortality in the Multiple Risk Factor Intervention Trial: subgroup findings and comparisons with other trials. Epidemiological Evidence of Relationships between Dietary Polyunsaturated Fatty Acids and Mortality in the Multiple Risk Factor Intervention Trial Effect of dietary manipulation on the lipid abnormalities and urinary protein loss in nephrotic patients. A public health model for cardiovascular risk reduction. Impact of cholesterol screening with brief nonphysician counseling. Long-term effects of a comprehensive rehabilitation programme after myocardial infarction. Clinical and cost outcomes of medical nutrition therapy for hypercholesterolemia: a controlled trial. Intervention in hypercholesterolemic college students: a pilot study. Treatment of coronary heart disease with diet and exercise--problems of compliance. Effects of diet and exercise in men and postmenopausal women with low levels of HDL cholesterol and high levels of LDL cholesterol. Design of a multicenter trial to evaluate long-term life-style intervention in adults with high-normal blood pressure levels. Trials of Hypertension Prevention (phase II). Trials of Hypertension Prevention (TOHP) Collaborative Research Group. Effect of dietary counselling on blood pressure and arterial plasma catecholamines in primary hypertension. Coronary risk factor modification in women after coronary artery bypass surgery. The effects of exercise and weight loss on plasma lipids in young obese men. Cost-effectiveness of medical nutrition therapy provided by dietitians for persons with non-insulin-dependent diabetes mellitus. Family versus individually oriented intervention for weight loss in Mexican American women. The PATHWAYS Church-Based Weight Loss Program for Urban African-American Women at Risk for Diabetes A randomized study of quality of life during multiple risk factor intervention in treated hypertensive men at high cardiovascular risk Long-term effects of participation in a randomized trial of a low-fat, high-carbohydrate diet. Alternative fat-restricted diets for hypercholesterolemia and combined hyperlipidemia: feasibility, design, subject recruitment, and baseline characteristics of the dietary alternatives study. A RANDOMIZED CONTROLLED TRIAL OF WEIGHT REDUCTION AND METOPROLOL IN THE TREATMENT OF HYPERTENSION IN YOUNG OVERWEIGHT PATIENTS Behavior change outcomes in an outpatient cardiac rehabilitation program. The effect of a combination low sodium, low fat, high fibre diet on serum lipids in treated hypertensive patients. Can life-styles of subjects with impaired glucose tolerance be changed? A feasibility study. Comprehensive individualised nonpharmacological treatment programme for hypertension in physician-nurse clinics: two year follow-up. Effects of Diet and Exercise in Preventing NIDDM in People With Impaired Glucose Tolerance: The Da Qing IGT and Diabetes Study Exercise and diet interventions improve perceptions of self in middle-aged adults. A FACTORIAL STUDY OF FAT AND FIBRE CHANGES AND SODIUM RESTRICTION ON BLOOD PRESSURE OF HUMAN HYPERTENSIVE SUBJECTS Oslo Study Diet and Antismoking Trial. Results after 102 months. Cholesterol-lowering intervention program. Effect of the step I diet in community office practices. Teaching dietary counseling skills to residents: patient and physician outcomes. The CADRE Study Group. Short-term treatment of glucose intolerance in middle-aged subjects by diet, exercise and sulfonylurea. Trial of Nonpharmacologic Intervention in the Elderly (TONE). Design and rationale of a blood pressure control trial. Coronary heart disease death, nonfatal acute myocardial infarction and other clinical outcomes in the Multiple Risk Factor Intervention Trial. Multiple Risk Factor Intervention Trial Research Group. Management of coronary risk factors by registered nurses versus usual care in patients with unstable angina pectoris (a chest pain evaluation in the emergency room [CHEER] substudy). New methodologies for studying the prevention of atherosclerosis. The Fasting Hyperglycaemia Study: II. Randomized controlled trial of reinforced healthy-living advice in subjects with increased but not diabetic fasting plasma glucose. Diet and probucol in lowering cholesterol concentrations. Additive effects on plasma cholesterol concentrations in patients with familial type ii hyperlipoproteinemia. In-hospital exercise after myocardial infarction does not improve treadmill performance. A Case-Management System for Coronary Risk Factor Modification after Acute Myocardial Infarction Dietary strategies for risk-factor modification to prevent cardiovascular diseases. Compliance in a randomized clinical trial of dietary fat reduction in patients with breast dysplasia. Effectiveness of medical nutrition therapy provided by dietitians in the management of non-insulin-dependent diabetes mellitus: a randomized, controlled clinical trial. Dietary treatment of patients with mild to moderate hypertension in a general practice: a pilot intervention study (1). The first three months. Effect of a long-term fat-modified diet on serum lipoprotein levels of cholesterol and triglyceride in patients on home haemodialysis. Work-site nutrition intervention and employees' dietary habits: the Treatwell program. Spouse support and long-term adherence to lipid-lowering diets. Health checks and coronary risk: further evidence from a randomised controlled trial Improving dietary behavior: the effectiveness of tailored messages in primary care settings. Partial cost-benefit analysis of two different modes of nonpharmacological control of hypertension in the community. A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. Follow-up care in general practice of patients with myocardial infarction or angina pectoris: initial results of the SHIP trial. Southampton Heart Integrated Care Project. EFFECT OF A LOW-FAT HIGH-CARBOHYDRATE DIET ON SYMPTOMS OF CYCLICAL MASTOPATHY Diet modification in lowering plasma cholesterol levels. A randomised trial of three types of intervention. The costs and effects of two different lipid intervention programmes in primary health care. Development and evaluation of a computer-based system for dietary management of hyperlipidemia. A controlled trial of a behavioral and educational intervention following coronary artery bypass surgery. Effects of a health education programme with telephone follow-up during cardiac rehabilitation. The impact of behavioral counseling on stage of change in fat intake, physical activity, and cigarette smoking in adults at increased risk of coronary heart disease. Effects of two "lipid-lowering" diets on plasma lipid levels of patients with peripheral vascular disease. The Women's Health Trial Feasibility Study in Minority Populations: design and baseline descriptions. Behavioural counselling in general practice for the promotion of healthy behaviour among adults at increased risk of coronary heart disease: randomised trial. A Family Approach to Cardiovascular Risk Reduction: Results from The San Diego Family Health Project The Family Atherosclerosis Risk Intervention Study (FARIS): risk factor profiles of patients and their relatives following an acute cardiac event. One-year community-based education program for hypercholesterolemia in middle-aged Japanese: a long-term outcome at 8-year follow-up. Effects of five years of cardiac rehabilitation after coronary artery bypass grafting on coronary risk factors. Impact on blood pressure control of a six-month intervention project. Effectiveness of two preventive interventions for coronary heart disease in primary care. A feasibility study on weight reduction in obese postmenopausal breast cancer patients. Long-term nopharmacological treatment for mild to moderate hypertension. Factors associated with changes in serum cholesterol during a community-based hypertension programme. Reducing blood cholesterol levels in patients with peripheral vascular disease: dietitian or diet fact sheet? Effects of intervention on compliance to referral and lifestyle recommendations given at cholesterol screening programs. Role of dietary fat in blood pressure control. Weight reduction in obese hypertensive patients. EFFECTS OF CHANGES IN FAT, FISH, AND FIBRE INTAKES ON DEATH AND MYOCARDIAL REINFARCTION: DIET AND REINFARCTION TRIAL (DART) Weight loss intervention in phase 1 of the Trials of Hypertension Prevention. The TOHP Collaborative Research Group. A Telephone-Delivered Intervention for Patients With NIDDM: Effect on coronary risk factors Randomized trial of intake of fat, fiber, and beta carotene to prevent colorectal adenomas. The european multifactorial preventive trial of coronary heart disease: four-year experience. Hypertension Prevention Trial (HPT): food pattern changes resulting from intervention on sodium, potassium, and energy intake. Hypertension Prevention Trial Research Group. Physician training for patient-centered nutrition counseling in a lipid intervention trial. Lipoprotein lipid response to the National Cholesterol Education Program step II diet by hypercholesterolemic and combined hyperlipidemic women and men. A randomized trial to evaluate the effectiveness of dietary advice by practice nurses in lowering diet-related coronary heart disease risk. Changes in plasma lipids and lipoproteins in overweight men during weight loss through dieting as compared with exercise. Determinants of plasma vitamins and lipids: the Working Well Study. EFFECT OF DIET AND SMOKING INTERVENTION ON THE INCIDENCE OF CORONARY HEART DISEASE: Report from the Oslo Study Group of a Randomised Trial in Healthy Men Patient Choice in Diabetes Education Curriculum: Nutritional versus standard content for type 2 diabetes Early lifestyle intervention in patients with non-insulin-dependent diabetes mellitus and impaired glucose tolerance. Diet and exercise intervention have favourable effects on blood pressure in mild hypertensives: the Oslo Diet and Exercise Study (ODES). Changes in cardiovascular risk factors by combined pharmacological and nonpharmacological strategies: the main results of the CELL Study. A comparison of education methods and their impact on behavioral change in patients with hyperlipidemia. Modified-fat dietary management of the young male with coronary disease. A five-year report. Work-site cardiovascular risk reduction: a randomized trial of health risk assessment, education, counseling, and incentives. Coronary heart disease risk factors before and after bypass surgery: results of a controlled trial on multifactorial rehabilitation. Effect of long-term community health education on blood pressure and hypertension control. The Stanford Five-City Project. Work-site cholesterol screening and dietary intervention: the Staff Healthy Heart Project. Steering Committee. A dietary intervention in primary care practice: the Eating Patterns Study. Impact of intensified dietary therapy on energy and nutrient intakes and fatty acid composition of serum lipids in patients with recently diagnosed non-insulin-dependent diabetes mellitus. Association between lipoprotein(a) and progression of coronary artery disease in middle-aged men. Weight reduction in a blood pressure clinic. Long-term effects of four fat-modified diets on blood pressure. Randomised controlled trial of effect of fruit and vegetable consumption on plasma concentrations of lipids and antioxidants Randomized controlled trial of a nonpharmacologic cholesterol reduction program at the worksite. Community-based cholesterol screening and education to prevent heart disease: five-year results of the North Coast Cholesterol Check Campaign. Group office visits change dietary habits of patients with coronary artery disease-the dietary intervention and evaluation trial (D.I.E.T.). The effects of a health promotion-health protection intervention on behavior change: the WellWorks Study. A RANDOMIZED CONTROL TRIAL OF A VEGETARIAN DIET IN THE TREATMENT OF MILD HYPERTENSION A randomized trial of a low-fat dietary intervention in women at high risk for breast cancer. Nutritional therapy for high blood pressure. Final report of a four-year randomized controlled trial--the Hypertension Control Program. The Diabetes Education Study: A Controlled Trial of the Effects of Diabetes Patient Education Dietary intervention in breast cancer patients: effects on dietary habits and nutrient intake. A worksite program for overweight middle-aged men achieves lesser weight loss with exercise than with dietary change. Intensive nutrition counseling enhances outcomes of National Cholesterol Education Program dietary therapy. A cost effective, community based heart health promotion project in England: prospective comparative study A clinical trial of the American Heart Association step one diet for treatment of hypercholesterolemia. Effect of a multidisciplinary intervention on medication compliance in elderly patients with congestive heart failure. Adherence to a dietary fat intake reduction program in postmenopausal women receiving therapy for early breast cancer. The Women's Intervention Nutrition Study. Multiple risk intervention trial in high risk hypertensive men: comparison of ultrasound intima-media thickness and clinical outcome during 6 years of follow-up. Prevention of cardiovascular risk factor elevations in healthy premenopausal women. Study of the Effectiveness of a Health-Risk Reduction Program Take heart: results from the initial phase of a work-site wellness program. Effect of cholesterol-lowering diet on mortality from coronary heart-disease and other causes. A twelve-year clinical trial in men and women. The family heart dietary intervention program: community response and characteristics of joining and nonjoining families. Saturated fat intake is reduced in patients with ischemic heart disease 1 year after comprehensive counseling but not after brief counseling. Effectiveness of health checks conducted by nurses in primary care: results of the OXCHECK study after one year A primary preventive study of Gothenburg, Sweden. A Randomized Clinical Trial Comparing Behavior Modification and Individual Counseling in the Nutritional Therapy of Non-insulin-dependent Diabetes Mellitus: Comparison of the Effect on Blood Sugar, Body Weight, and Serum Lipids Effects of an Obesity Prevention Program on the Eating Behavior of African American Mothers and Daughters Brief assessments of dietary behavior in field settings. The effects of nonpharmacologic interventions on blood pressure of persons with high normal levels. Results of the Trials of Hypertension Prevention, Phase I. Outcomes of a cardiovascular nutrition counseling program in African-Americans with elevated blood pressure or cholesterol level. Trial of antihypertensive intervention and management: greater efficacy with weight reduction than with a sodium-potassium intervention. [One-year effect of health counseling on life style and risk factors of heart disease]. The costs and effects of a nutritional education program following work-site cholesterol screening. A seven-year follow-up of a weight reduction programme in Finnish primary health care. Long-term effects of three fat-modified diets in hypercholesterolemic subjects. Randomised blind controlled trial of a high fibre, low fat and low sodium dietary regimen in mild essential hypertension. Development of new coronary atherosclerotic lesions during a 4-year multifactor risk reduction program: the Stanford Coronary Risk Intervention Project (SCRIP). Secondary prevention after acute myocardial infarction.
Despite formal recommendations for dietary change to reduce the incidence of ischaemic heart disease , the acceptability and effectiveness of the proposed diets have not been well investigated in population based studies . In this preliminary investigation of nutritional advice in a well population , subjects in one group practice were r and omized to receive either dietary instruction or simple follow up without instruction . The dietary recommendations were well received , and a substantial proportion of subjects reported altering their diets in accordance with them . There were modest beneficial changes in plasma lipid levels among men . Thus , using general practice as an avenue for promoting dietary change is feasible , and may be effective among men A preventive nursing intervention to reduce coronary heart disease ( CHD ) risk was tested . The sample was 19 families composed of 58 first-degreed relatives of young ( age 30 - 55 years ) victims of sudden cardiac death . Families were r and omly assigned to control and experimental groups . The intervention at 3 - 5 months postdeath focused on assessment of health history , health behaviors , health beliefs , informing and educating about CHD risk factors , and methods for detecting and reducing these factors . The control group received mailed question naires and no intervention . The subject 's reduction of CHD risk was measured at 7 months by changes in high risk CHD behaviors , changes in health beliefs , and adherence to screening for serum cholesterol and blood pressure determination . Analysis of covariance ( covarying age and pretest scores ) demonstrated no differences between groups for health beliefs ; however , significant differences for health beliefs existed between the sibling subgroups . The intervention was correlated with a significant reduction in alcohol intake . Reductions in high fat meat consumption were in the desired direction . Greater percentages of subjects in the intervention group obtained blood pressure and cholesterol screening BACKGROUND Recent clinical trials have shown that modification of plasma lipoprotein concentrations can favorably alter progression of coronary atherosclerosis , but no data exist on the effects of a comprehensive program of risk reduction involving both changes in lifestyle and medications . This study tested the hypothesis that intensive multiple risk factor reduction over 4 years would significantly reduce the rate of progression of atherosclerosis in the coronary arteries of men and women compared with subjects r and omly assigned to the usual care of their physician .  METHODS AND RESULTS Three hundred men ( n = 259 ) and women ( n = 41 ) ( mean age , 56 + /- 7.4 years ) with angiographically defined coronary atherosclerosis were r and omly assigned to usual care ( n = 155 ) or multifactor risk reduction ( n = 145 ) . Patients assigned to risk reduction were provided individualized programs involving a low-fat and -cholesterol diet , exercise , weight loss , smoking cessation , and medications to favorably alter lipoprotein profiles . Computer-assisted quantitative coronary arteriography was performed at baseline and after 4 years . The main angiographic outcome was the rate of change in the minimal diameter of diseased segments . All subjects underwent medical and risk factor evaluations at baseline and yearly for 4 years , and reasons for all hospitalizations and deaths were documented . Of the 300 subjects r and omized , 274 ( 91.3 % ) completed a follow-up arteriogram , and 246 ( 82 % ) had comparative measurements of segments with visible disease at baseline and follow-up . Intensive risk reduction result ed in highly significant improvements in various risk factors , including low-density lipoprotein cholesterol and apolipoprotein B ( both , 22 % ) , high-density lipoprotein cholesterol ( + 12 % ) , plasma triglycerides ( -20 % ) , body weight ( -4 % ) , exercise capacity ( + 20 % ) , and intake of dietary fat ( -24 % ) and cholesterol ( -40 % ) compared with relatively small changes in the usual-care group . No change was observed in lipoprotein(a ) in either group . The risk-reduction group showed a rate of narrowing of diseased coronary artery segments that was 47 % less than that for subjects in the usual-care group ( change in minimal diameter , -0.024 + /- 0.066 mm/y versus -0.045 + /- 0.073 mm/y ; P < .02 , two-tailed ) . Three deaths occurred in each group . There were 25 hospitalizations in the risk-reduction group initiated by clinical cardiac events compared with 44 in the usual-care group ( rate ratio , 0.61 ; P = .05 ; 95 % confidence interval , 0.4 to 0.9 ) . CONCLUSIONS Intensive multifactor risk reduction conducted over 4 years favorably altered the rate of luminal narrowing in coronary arteries of men and women with coronary artery disease and decreased hospitalizations for clinical cardiac events Background Significant regression of coronary and femoral atherosclerotic lesions has been documented by angiographic studies using aggressive lipid-lowering treatment . This study tested the applicability and effects of intensive physical exercise and low-fat diet on coronary morphology and myocardial perfusion in nonselected patients with stable angina pectoris . Methods and Results Patients were recruited after routine coronary angiography for stable angina pectoris ; they were r and omized to an  intervention group ( n = 56 ) and a  control group on “ usual care ” ( n = 57 ) . Treatment comprised intensive physical exercise in group training sessions ( minimum , 2 hr/wk ) , daily home exercise periods ( 20 min/d ) , and low-fat , low-cholesterol diet ( American Heart Association recommendation , phase 3 ) . No lipid-lowering agents were prescribed . After 12 months of participation , repeat coronary angiography was performed ; relative and minimal diameter reductions of coronary lesions were measured by digital image processing . Change in myocardial perfusion was assessed by 201TI scintigraphy . In patients participating in the intervention group , body weight decreased by 5 % ( p<0.001 ) , total cholesterol by 10 % ( p<0.001 ) , and triglycerides by 24 % ( p<0.001 ) ; high density lipoproteins increased by 3 % ( p = NS ) . Physical work capacity improved by 23 % ( p<0.0001 ) , and myocardial oxygen consumption , as estimated from maximal rate-pressure product , by 10 % , ( p<0.05 ) . Stress-induced myocardial ischemia decreased concurrently , indicating improvement of myocardial perfusion . Based on minimal lesion diameter , progression of coronary lesions was noted in nine patients ( 23 % ) , no change in 18 patients ( 45 % ) , and regression in 13 patients ( 32 % ) . In the control group , metabolic and hemodynamic variables remained essentially unchanged , whereas progression of coronary lesions was noted in 25 patients ( 48 % ) , no change in 18 patients ( 35 % ) , and regression in nine patients ( 17 % ) . These changes were significantly different from the intervention group ( p<0.05 ) . Conclusions In patients participating in regular physical exercise and low-fat diet , coronary artery disease progresses at a slower pace compared with a control group on usual care We have examined the independent and combined effects on blood pressure and blood lipids of alcohol restriction and weight loss in overweight male drinkers with a view to assessing overall effects on cardiovascular risk of two widely promoted nonpharmacological approaches for hypertension . Eighty-six men with a mean age of 44.3 years , a mean regular alcohol intake of 440 ml/wk ( five or six st and ard drinks per day ) , a mean blood pressure of 137.4 mm Hg systolic and 84.8 mm Hg diastolic , and a mean body mass of 92.5 kg entered a controlled two-way factorial study . The subjects were r and omly assigned to four groups for an 18-week intervention in which members of two groups drank only low-alcohol beer , thereby reducing their alcohol intake  by 374 ml/wk , while those of the other two groups continued their normal alcohol intake . Within the low and normal alcohol intake groups subjects either continued their usual diet or reduced their caloric intake by 4,200 - 6,300 kJ/day ( 1,000 - 1,500 kcal/day ) ( with protein , fat , and carbohydrate provided as 15 % , 30 % , and 55 % of total calories , respectively ) . Calorie reduction and alcohol restriction caused weight losses of 7.5 ( p less than 0.001 ) and 2.1 ( p less than 0.01 ) kg , respectively . Calorie reduction and alcohol restriction were associated with decreases in systolic blood pressure of 5.4 ( p less than 0.001 ) and 4.8 ( p less than 0.01 ) mm Hg , respectively , and in diastolic blood pressure of 4.2 ( p less than 0.001 ) and 3.3 ( p less than 0.01 ) mm Hg , respectively . ( ABSTRACT TRUNCATED AT 250 WORDS This paper describes the planning and implementation of an individualized teaching programme for patients and their families following primary uncomplicated myocardial infa rct ion . This preliminary study was design ed and implemented by a senior nurse while working in the clinical area . Patients were r and omly allocated to a control or study group . Both groups of patients were interviewed on the fourth day following admission to hospital and again at 2 and 6 months after discharge . Nurse intervention in the form of individually planned consecutive teaching sessions achieved a reduction in anxiety and modification of identifiable risk factors ( smoking , obesity , diet , exercise ) in the patients included in the teaching programme PURPOSE This study was design ed to assess the long-term effects of low-fat diet and intensive physical exercise . METHODS Long-term efficacy of exercise and diet was assessed in 18 nonselected , fully employed patients with symptomatic coronary artery disease . Results were compared to 18 patients on usual care . RESULTS In the intervention group at 1 year , serum lipoproteins were brought to ideal levels , exercise-induced myocardial ischemia was significantly reduced , and progression in coronary atherosclerosis was retarded . After more than 5 years , patients in the intervention group showed a significant reduction in lipoprotein levels ( total cholesterol , 248 [ 179 - 299 ] vs 214 [ 173 - 272 ] mg/dL , P < .01 ; low density lipoprotein , 146 [ 83 - 216 ] , vs 152 [ 121 - 197 ] mg/dL , P < .005 vs control ; triglycerides ; 151 [ 80 - 303 ] mg/dl , vs 98 [ 46 - 182 ] mg/dL ; P < .005 ) and body mass index ( 26 + /- 2.9 vs 25.4 + /- 3.3 kg/m2 ; P < .05 ) . Exercise induced myocardial ischemia , measured by 201thallium scintigraphy , decreased by 29 % ( 41 degrees + /- 36 degrees vs 29 degrees + /- 29 degrees , P = NS ) and coronary atherosclerosis , assessed by angiography and digital image processing , progressed at a slower pace in light of a 21 % increase in physical work capacity ( 169 + /- 40 vs 205 + /- 50 , P < .01 ) and a 28 % increase in maximal rate pressure product ( 25 + /- 6 vs 32 + /- 4 , P < .004 ) . In contrast , patients in the control group showed only poorly controlled coronary risk factors ( total cholesterol , 243 [ 179 - 306 ] vs 26 [ 178 - 304 ] mg/dL , P = NS ; low density lipoprotein , 151 [ 79 - 229 ] vs 196 [ 107 - 238 ] mg/dL , P < .0005 vs intervention ; body mass index 25.7 + /- 2.5 vs 27.5 + /- 3.5 kg/m2 , P < .01 ) , whereas their physical work capacity tended to deteriorate ( 165 + /- 45 vs 142 + /- 62 Watts , P = not significant ) . CONCLUSIONS These data demonstrate that current usual care is insufficient in controlling risk factors of coronary artery disease . However , intensive physical exercise and low-fat diet remain an effective form of treatment after more than 5 years BACKGROUND Questions regarding the efficacy of nonpharmacologic approaches for the treatment of stage 1 hypertension were addressed as part of the Treatment of Mild Hypertension Study ( TOMHS ) , a 4-year , r and omized clinical trial ( N = 902 ) . This report describes the lifestyle intervention program used in TOMHS , presents data on the lifestyle changes observed , and focuses on the effect of weight loss on blood pressure and blood lipid levels . METHODS Participants were r and omly assigned to receive either placebo or one of five different antihypertensive medications . All took part in a lifestyle intervention program to reduce weight and sodium and alcohol intake  and to increase physical activity .  RESULTS Substantial changes from baseline levels were achieved for all lifestyle intervention variables . Mean weight change was -10.5 lb ( -5.6 % ) at 1 year , -8.5 lb ( -4.5 % ) at 2 years , -7.4 lb ( -4.0 % ) at 3 years , and -5.7 lb ( -3.0 % ) at 4 years . At 4 years , 70 % of participants remained below baseline weight and 34 % maintained a weight loss of 10 lb or greater . Mean change in urinary sodium excretion was -12.5 mmol/8 hr ( -23 % ) at 1 year , -10.7 mmol/8 hr ( -20 % ) at 2 years , -8.4 mmol/8 hr ( -16 % ) at 3 years , and -4.6 mmol/8 hr ( -9 % ) at 4 years . Alcohol intake declined by 1.6 drinks/week among drinkers at 4 years . Reported leisure physical activity increased by 86 % at 1 year and remained 50 % above baseline at 4 years . Beneficial changes in blood pressure and serum lipids were associated with these changes . CONCLUSIONS These results support a role for lifestyle interventions as the initial treatment for stage 1 hypertension and demonstrate that such interventions can be successfully implemented in the clinical setting To study the impact of diet and exercise and the combination thereof on cardiovascular risk factors , 157 healthy men aged 35 - 60 years ( mean + /- S.D. ; 46.2 + /- 5.0 ) with slightly to moderately raised cardiovascular risk factors , were r and omized to 4 groups , diet ( D , n = 40 ) , exercise ( E , n = 39 ) , diet plus exercise ( DE , n = 39 ) , and no active intervention ( controls ( C , n = 39 ) ) , and investigated at baseline and after 6 months . BMI was significantly reduced in Groups E and DE ( mean difference and 95 % confidence intervals ( CI ) , -0.3 ( -0.5 , -0.01 ) and -0.6 ( -0.9 , -0.3 ) kg/m2 , respectively ) . Waist circumference was reduced in all 3 intervention groups ( D , E , and DE ) , -1.3 ( -2.5 , -0.1 ) , -2.2 ( -3.2 , -1.3 ) and -3.0 ( -3.9 , -2.0 ) cm , but not in the control group . Blood pressure ( BP ) was reduced in all 3 intervention groups , systolic BP 4 - 7 mmHg and diastolic BP 2 - 6 mmHg . Serum cholesterol was reduced in Group DE , -0.45 ( -0.77 , -0.13 ) mmol/l . VLDL-cholesterol was reduced in Groups E and DE , -0.14 ( -0.26 , -0.03 ) and -0.09 ( -0.18 , -0.01 ) mmol/l , whereas LDL-cholesterol was reduced in Groups D and DE -0.30 ( -0.54 , -0.06 ) and -0.35 ( -0.64 , -0.05 ) mmol/l . In contrast , neither HDL-cholesterol nor serum triglycerides were influenced by the interventions . According to the coronary risk profile derived from the Framingham study , all 3 intervention groups ( D , E , and DE ) significantly reduced their estimated 10-year risk ( -13 , -12 , and -14 % , respectively ) . We conclude that even with rather moderate changes in diet and exercise , several important cardiovascular risk factors can be affected and that diet and exercise were about equally effective in reducing cardiovascular risk The Belgian Heart Disease Prevention Project is a controlled , multifactorial prevention trial involving 19,390 males aged 40–59 years employed by 30 Belgian industries . These industries were paired and r and omized into a control or intervention unit . In each intervention factory , the subjects from the two highest deciles of a coronary risk-score distribution curve were given individual advice twice a year . A health education campaign was also organized in each intervention factory . In the control group , 10 % of r and omly chosen subjects had the same baseline examination as the whole of the intervention group . After 2 years , high-risk subjects and r and om sample s of the control and intervention group were compared regarding the coronary risk profile by means of a multiple logistic function ( MLF ) . In the intervention high-risk group , the MLF showed a decrease of 20 % , and in the control group there was an increment of 12.5 % ( p < 0.001 ) . Comparing the r and om sample s an increment of 25 % was found in the control group vs a drop of 2.26 in the intervention group ( p < 0.001 ) . The coronary risk profile can be altered in a middle-aged male working population through mass media health education supplemented by face-to-face counseling in high-risk subjects In this study , 113 patients with modestly elevated levels of low-density lipoprotein cholesterol ( < 210 mg/dl ) and coronary artery disease were r and omized to an  intervention group ( n=56 ) or a control group ( n=57 ) . The intervention program consisted of daily exercise and a low-fat diet according to the American Heart Association 's recommendation phase III ; patients in the control group received " usual care " rendered by their private physician . After 1 year , complete data were available for all 92 patients ( intervention : n=40 ; control : n=52 ) who underwent repeat coronary angiography .  During the study course , patients in the intervention group showed an increase in apolipoprotein A-I(123 + /- 18 vs 129 + /- 20 mg/dl ; p < 0.02 ) and apolipoprotein A-I/B ( 1.3 + /- 0.4 vs 1.5 + /- 0.4 ; p < 0.01 ) and a decrease in apolipoprotein B ( 99 + /- 20 vs 89 + /- 18 mg/dl ; p < 0.01 ) , while apolipoprotein A-II remained unchanged ( 38 + /- 6 vs 38 + /- 6 mg/dl ; p = NS ) . In the control group , there were no significant changes ( apolipoprotein A-I , 124 + /- 17 vs 128 + /- 13 mg/dl ; apolipoprotein A-II , 38 + /- 6 vs 39 + /- 6 mg/dl ; apolipoprotein B , 100 + /- 21 vs 99 + /- 16 mg/dl ; apolipoprotein A-I/B , 1.3 + /- 0.3 vs 1.4 + /- 0.5 ; all p = NS ) . As previously reported , there was a significant retardation of progression in patients in the intervention group ( progression 23 % , no change 45 % , regression 32 % ) compared with the control group ( progression 48 % , no change 35 % , regression 17 % ) ( p < 0.05 ) . Although retardation of progression was significantly associated with an increase in apolipoprotein A-I/B and a decrease in apolipoprotein B ( p < 0.05 ) , these gave way in multivariate analysis to changes in total cholesterol/high-density lipoprotein cholesterol , absolute levels of low-density lipoprotein cholesterol , and , in a subgroup of patients , to leisure-time physical activity ( all p < 0.05 ) . These data demonstrate that an intervention based on a low-fat diet and intensive physical exercise is capable of improving apolipoprotein levels , associated with retardation of progression of coronary artery disease . However ,  total cholesterol/high-density lipoprotein cholesterol and low-density lipoprotein cholesterol  appear superior to apolipoproteins as metabolic markers for effective treatment in patients with coronary artery disease The purpose of the study was to investigate the effect of nursing care based on Orem 's nursing theory on nutritional self-care of myocardial infa rct ion patients . Self-efficacy was explored as a disposition which may motivate behavioral change . One hundred and four subjects were r and omly assigned to treatment or  control groups . The nursing intervention , which took place during the first 6 weeks following hospital discharge , was effective in supporting healthy low-fat eating behavior .  Nursing care influenced patients ' self-care agency but lacked impact on self-efficacy for healthy eating We compared observed and predicted changes in serum cholesterol in women with mammographic dysplasia who participated for 12 mo in a r and omized , controlled trial of a low-fat , high-carbohydrate diet , in which total fat intake was reduced from an average of 37 % of calories to 21 % and carbohydrate intake increased from 44 % to 52 % of calories . Changes observed in serum cholesterol were greater than those predicted ( by the formulas of Hegsted and Keys ) for subjects with initial serum cholesterol values in the upper tertile of the population , were not significantly different from those predicted for subjects with baseline values in the middle tertile , and were significantly less than those predicted for subjects with initial values in the lower tertile . These results show that the usefulness of serum cholesterol as a marker of change in dietary fat intake in women depends on the distribution of serum cholesterol values in the population studied Previous studies examining the hypocholesterolemic effects of high-soluble-fiber diets have not been design ed to control for dietary fat intake . Serum cholesterol reductions may therefore be accounted for by differences in consumption of fat . Moderately hypercholesterolemic , nonobese , Caucasian men and women , 30 - 50 y old were r and omly assigned to low-fat , low-fat plus high-fiber , or usual-diet groups and followed for 12 mo . At 12 mo the high-fiber group consumed significantly more  soluble fiber  than both the low-fat and usual-diet groups ( P = 0.0063 and P = 0.0001 ) ; the high-fiber group did not differ from the low-fat group in quantity of dietary fat consumed . The high-fiber group experienced a greater average reduction ( 13 % ) in serum cholesterol than did the low-fat ( 9 % ) and usual-diet ( 7 % ) groups . After adjustment for relevant covariates , the reduction in the high-fiber group was significantly greater than that in the low-fat group ( P = 0.0482 ) . Supplementation with soluble fiber reduces serum cholesterol beyond the reduction observed with low-fat diet alone We tested whether nutrient intakes estimated from 4-d diet records were associated with plasma lipoprotein subclasses in 103 men who were r and omly assigned to a low-fat ( 24 % fat ) and a high-fat ( 46 % fat ) diet for 6 wk each in a crossover design . Postheparin plasma lipoprotein lipase ( LPL ) and hepatic lipase ( HL ) activities were also determined in a subset of 43 men . Changes in intake ( ie , high fat minus low fat ) of total saturated fatty acids , as well as myristic ( 14:0 ) and palmitic ( 16:0 ) acids , were positively correlated ( P < 0.01 ) with increases in mass of large LDL particles [ measured by analytic ultra-centrifugation as mass of lipoproteins of flotation rate ( Sf ) 7 - 12 ] and with LDL peak particle diameter and flotation rate , but not with changes in LDL-cholesterol concentration . Changes in total saturated fatty acids as well as myristic and palmitic acids were also inversely associated with changes in HL activity ( P < 0.05 ) . With the high-fat diet only , variation in dietary total saturated fatty acid intake was inversely correlated ( P < 0.01 ) with concentrations of small , dense LDL of Sf 0 - 5 . This correlation was significant specifically for myristic acid ( P < 0.001 ) . Stearic acid ( 18:0 ) , monounsaturates , and polyunsaturates showed no significant associations with lipoprotein concentrations . These data indicate that a high saturated fat intake ( especially 14:0 and 16:0 ) is associated with increased concentrations of larger , cholesterol-enriched LDL and this occurs in association with decreased HL activity The acyl pattern of adipose tissue triglycerides and of plasma free fatty acids were determined after 7 yr of diet intervention on elevated plasma cholesterol in 42 men taking part in the smoking-lipid trial of the Oslo Study . Twenty-two of the men were advised to change dietary habits ( mainly reduce saturated fat ) whereas the remaining 20 were controls . The adipose tissue from men in the intervention group contained relatively more linoleic and linolenic acids and relatively less saturated and monounsaturated fatty acids compared to men in the control group . There were strong correlations between the relative content of several fatty acids in adipose tissue triglycerides and plasma free fatty acid . Furthermore , there was a close correlation between the intake of polyunsaturated fatty acids found in a dietary survey done 2 to 3 yr before this study and the relative content of polyunsaturated fatty acids in adipose tissue This study aim ed to determine the effects of incorporating fish with 40%- or 30%-fat diets and the differences in response to fish or fish oil omega 3 fats .  Men with high-normal blood pressure and elevated serum cholesterol were r and omly allocated to one of seven diets for 12 wk . Fish or fish oil with a 40%-fat diet increased total cholesterol , HDL cholesterol , HDL2 cholesterol , and LDL cholesterol , and reduced triglycerides . The 30%-fat diet alone reduced cholesterol , LDL cholesterol , and HDL cholesterol , with triglycerides unchanged . Fish with the 30%-fat diet reduced cholesterol , LDL cholesterol , and triglycerides and increased HDL2 cholesterol . This study has shown that plasma lipids are affected similarly by fish or fish oil in men consuming a 40%-fat diet . Adverse effects of omega 3 fats on total and LDL cholesterol are reversed by a 30%-fat diet , whereas one daily fish meal substantially lowers triglycerides and reverses the fall in HDL cholesterol that is usual with a low-fat diet The effect of 6 wk of either red meat ( RM ) or fatty fish ( FF ) intake on plasma lipid concentrations in 28 free-living volunteers ( 12 males , 16 females ) aged 22 - 45 y was investigated in this clinical crossover trial . Dietary intake was estimated by 7-d dietary records , and fasting blood sample s were analyzed for plasma lipid concentrations . Although energy intake did not differ , protein intake was higher ( P less than 0.01 ) in the FF period than in the RM period . There was also a difference ( P less than 0.001 ) in the ratio of dietary polyunsaturated to saturated fatty acids in the RM ( 0.45 ) and FF ( 0.93 ) periods . Mean plasma total cholesterol , low-density-lipoprotein cholesterol , very-low-density-lipoprotein ( VLDL ) cholesterol VLDL-triacylglycerol , and plasma triacylglycerol concentrations were lower ( P less than 0.001 ) in the FF than in the RM period . Positive correlations between animal-protein intake and plasma lipoproteins were observed . Atherogenic plasma lipoprotein concentrations were lower when FF was substituted for RM In a prospect i ve , r and omised , controlled trial to determine whether comprehensive lifestyle changes affect coronary atherosclerosis after 1 year , 28 patients were assigned to an experimental group ( low-fat vegetarian diet , stopping smoking , stress management training , and moderate exercise ) and 20 to a usual-care control group . 195 coronary artery lesions were analysed by quantitative coronary angiography  . The average percentage diameter stenosis regressed from 40.0 ( SD 16.9)% to 37.8 (16.5)% in the experimental group yet progressed from 42.7 (15.5)% to 46.1 (18.5)% in the control group . When only lesions greater than 50 % stenosed were analysed , the average percentage diameter stenosis regressed from 61.1 (8.8)% to 55.8 (11.0)% in the experimental group and progressed from 61.7 (9.5)% to 64.4 (16.3)% in the control group . Overall , 82 % of experimental-group patients had an average change towards regression .  Comprehensive lifestyle changes may be able to bring about regression of even severe coronary atherosclerosis after only 1 year , without use of lipid-lowering drugs The important of the educational diagnosis in instructing patients in a fat modified diet was examined in a double blind study . The educational diagnosis depended upon the assessment of three independent instructional parameters : the amount of structure , the teaching mode , and the language code preferred by the patient . Group I ( 67 patients ) received traditional personalized counseling for 3 months . Group IIa ( 40 patients ) , whose instruction was matched to their preferred education attributes , was r and omized against group IIb ( 36 patients ) , whose instruction was mismatched . Group IIIa ( 33 patients ) , receving matched instruction was r and omized against group IIIb ( 35 patients ) , receiving high structure in the symbolic mode of instruction . The greatest reduction in serum cholesterol was seen in group I. At 3 months , no significant difference in serum cholesterol reduction could be shown between groups IIa and IIb , or IIIa and IIIb . However , the mean cholesterol reduction became significantly greater ( P less than 0.05 ) in IIa than IIb at the 6 month visit . Seven day food diaries showed no significant differences in dietary intake and 1 and 3 months between matched and unmatched groups . The data did suggest that patients preferring high structure in the symbolic mode had a greater serum cholesterol reduction that other diagnostic groups . Analysis of variance showed an interaction between the preferred and instructional level of structure as related to the change in total fat , and saturated fat of the diet after 3 months A 10-session , self-management training program was design ed specifically for persons over 60 years of age having Type II diabetes . It targeted social learning variables , especially problem-solving skills and self-efficacy , found to be related to diabetes self-care in earlier correlational research . One hundred two adults were r and omized to immediate or delayed intervention conditions . At posttest , subjects in the immediate intervention condition showed significantly greater reductions in caloric intake and percent of calories from fat than control subjects . The intervention also produced greater weight reductions and increases in the frequency of glucose testing than did the control condition . Improvements among immediate intervention subjects were generally maintained at a 6-month follow-up . Intervention results from subjects receiving delayed intervention closely replicated those for immediate intervention subjects . We conclude that a relatively short-term program can improve self-management skills of older diabetic adults , and that there is an important need for such interventions AIMS To evaluate the efficacy of interventions to promote a healthy diet and physical activity in people with impaired glucose tolerance ( IGT ) . METHODS A r and omised controlled trial in Newcastle upon Tyne , UK , 1995 - 98 . Participants included 67 adults ( 38 men ; 29 women ) aged 24 - 75 years with IGT . The intervention consisted of regular diet and physical activity counselling based on the stages of change model . Main outcome measures were changes between baseline and 6 months in nutrient intake ; physical activity ; anthropometric and physiological measurements including serum lipids ; glucose tolerance ; insulin sensitivity . RESULTS The difference in change in total fat consumption was significant between intervention and control groups ( difference -21.8 ( 95 % confidence interval ( CI ) -37.8 to -5.8 ) g/day , P=0.008 ) . A significantly larger proportion of intervention participants reported taking up vigorous activity than controls ( difference 30.1 , ( 95 % CI 4.3 - -52.7)% , P=0.021 ) . The change in body mass index was significantly different between groups ( difference -0.95 ( 95 % CI -1.5 to -0.4 ) kg/m(2 ) , P=0.001 ) . There was no significant difference in change in mean 2-h plasma glucose between groups ( difference -0.19 ( 95 % CI -1.1 to 0.71 ) mmol/l , NS ) or in serum cholesterol ( difference 0.02 ( 95 % CI -0.26 to 0.31 ) mmol/l , NS ) . The difference in change in fasting serum insulin between groups was significant ( difference -3.4 ( 95 % CI -5.8 to -1.1 ) mU/l , P=0.005 ) . CONCLUSIONS After 6 months of intensive lifestyle intervention  in participants with IGT , there were changes in diet and physical activity , some cardiovascular risk factors and insulin sensitivity , but not glucose tolerance . Further follow-up is in progress to investigate whether these changes are sustained or augmented over 2 years STUDY OBJECTIVE : To investigate differences between smokers and non-smokers in health behaviour , cardiovascular risk factors , coronary heart disease ( CHD ) risks , health knowledge , health attitudes , and compliance with a CHD prevention programme . DESIGN : Differences between smokers and non-smokers were studied via medical examinations , question naires , physical exercise activity logs , and food record sheets . Data were analysed using univariate and multivariate analyses . The five and 10 year CHD risks were assessed using the Framingham CHD risk estimate . SETTING : The Karolinska Hospital , Stockholm , and Sollentuna Primary Health Centre , Sollentuna , Sweden . PARTICIPANTS : The analyses were based on 158 healthy smoking and non-smoking men aged 35 - 60 years with raised cardiovascular risk factors who enrolled in controlled , r and omised six month diet and exercise programmes .  MAIN RESULTS : Discriminant analysis suggested that smokers , compared with non-smokers , were characterised by a higher alcohol energy percent , lower HDL cholesterol concentration , lower systolic blood pressure , and a higher plasminogen activator inhibitor-1 ( PAI-1 ) value . Knowledge of the risk factors for CHD was not a discriminating factor . Both smokers and non-smokers increased the exercise taken , improved their diet , and lowered their CHD risk . Before , as well as after the intervention , smokers had a higher CHD risk than non-smokers . CONCLUSIONS : The best CHD prevention action that could be taken by smokers would of course be to quit smoking . Those who can not stop should be encouraged to improve their diet and increase the amount of  physical exercise  they take in order to reduce the health hazards of their smoking behaviour The Women 's Health Initiative ( WHI ) is a large and complex clinical investigation of strategies for the prevention and control of some of the most common causes of morbidity and mortality among postmenopausal women , including cancer , cardiovascular disease , and osteoporotic fractures . The WHI was initiated in 1992 , with a planned completion date of 2007 . Postmenopausal women ranging in age from 50 to 79 are enrolled at one of 40 WHI clinical centers nationwide into either a clinical trial ( CT ) that will include about 64,500 women or an observational study ( OS ) that will include about 100,000 women . The CT is design ed to allow r and omized controlled evaluation of three distinct interventions : a low-fat eating pattern , hypothesized to prevent breast cancer and colorectal cancer and , secondarily , coronary heart disease ; hormone replacement therapy , hypothesized to reduce the risk of coronary heart disease and other cardiovascular diseases and , secondarily , to reduce the risk of hip and other fractures , with increased breast cancer risk as a possible adverse outcome ; and calcium and vitamin D supplementation , hypothesized to prevent hip fractures and , secondarily , other fractures and colorectal cancer . Overall benefit-versus-risk assessment is a central focus in each of the three CT components . Women are screened for participation in one or both of the components -- dietary modification ( DM ) or hormone replacement therapy (HRT)--of the CT , which will r and omize 48,000 and 27,500 women , respectively . Women who prove to be ineligible for , or who are unwilling to enroll in , these CT components are invited to enroll in the OS . At their 1-year anniversary of r and omization , CT women are invited to be further r and omized into the calcium and vitamin D ( CaD ) trial component , which is projected to include 45,000 women . The average follow-up for women in either CT or OS is approximately 9 years . Concerted efforts are made to enroll women of racial and ethnic minority groups , with a target of 20 % of overall enrollment in both the CT and OS . This article gives a brief description of the rationale for the interventions being studied in each of the CT components and for the inclusion of the OS component . Some detail is provided on specific study design choices , including eligibility criteria , recruitment strategy , and sample size , with attention to the partial factorial design of the CT . Some aspects of the CT monitoring approach are also outlined . The scientific and logistic complexity of the WHI implies particular leadership and management challenges . The WHI organization and committee structure employed to respond to these challenges is also briefly described The effects of an exercise program started early after myocardial infraction and the added effects of an outpatient teaching-counseling program were studied . At r and om , 84 patients were allocated to a control group ( A ) , 88 patients to an exercise group ( B1 ) and 86 patients to an exercise and teaching-counseling group ( B2 ) . The same exercise program was prescribed for patients in groups B1 and B2 and was started about 4.5 days after myocardial infa rct ion and continued for 3 months . The outpatient teaching-counseling program consisted of eight group sessions pertaining to risk factor reduction and psychosocial adjustment to myocardial infraction . A low-level treadmill test and an exercise test were performed at 3 months and the exercise test was repeated at 6 months . The clinical , hemodynamic and electrocardiographic responses to these tests were not different among the three groups . However , by the end of 3 months , patients in group B1 and B2 reported walking greater distances than patients in group A. The incidence of morbidity and mortality was not different between the groups . No deleterious or beneficial physiologic effects of an exercise program either by itself or combined with a teaching-counseling program were demonstrated . Routine medical care and our interventions were equally effective in permitting the spontaneous hemodynamics improvements after myocardial infraction . More than 3 months after myocardial infa rct ion , the group as a whole manifested spontaneous recovery in the form of a significant decrease in resting heart rate ( p less than 0.001 ) and a significant increase in systolic and diastolic blood pressure at rest and with submaximal exercise ( p less than 0.001 ) . No further improvements were observed between 3 and 6 months STUDY OBJECTIVE : To study the clinical and cost outcomes of providing nutritional counselling to patients with one or more of the following conditions : overweight , hypertension and type 2 diabetes . DESIGN : The study was design ed as a r and om controlled trial . Consecutive patients were screened opportunistically for one or more of the above conditions and r and omly allocated to one of two intervention groups ( doctor/dietitian or dietitian ) or a control group . Both intervention groups received six counselling sessions over 12 months from a dietitian . However , in the doctor/dietitian group it was the doctor and not the dietitian who invited the patient to join the study and the same doctor also review ed progress at two of the six counselling sessions . SETTING : The study was conducted in a university group general practice set in a lower socioeconomic outer suburb of Perth , Western Australia . PATIENTS : Of the 273 patients r and omly allocated to a study group , 198 were women . Age ranged from 25 to 65 years . Seventy eight per cent of patients resided in the lower two socioecnomic quartiles , 56 per cent described their occupation as home duties and 78 per cent were partnered . RESULTS : Both intervention groups reduced weight and blood pressure compared with the control group . Patients in the doctor/dietitian group were more likely to complete the 12 month programme than those in the dietitian group . Patients in the doctor/dietitian group lost an average of 6.7 kg at a cost of $ A9.76 per kilogram , while the dietitian group lost 5.6 kg at a cost of $ A7.30 per kilogram . CONCLUSION : General practitioners , in conjunction with a dietitian , can produce significant weight and blood pressure improvement by health promotion methods CONTEXT The long-term effect of aggressively vs moderately fat-restricted diets has not been studied extensively in free-living subjects with different types of hyperlipidemia . OBJECTIVE To compare the cholesterol-lowering effects of 4 levels of dietary fat intake restriction after 1 year . DESIGN R and omized , parallel , comparison trial . SETTING Male employees of a large industry . PARTICIPANTS A total of 444 men had low-density lipoprotein cholesterol ( LDL-C ) levels above the 75th age-specific percentile . Subjects with triglyceride  ( TG ) levels less than the 75th age-specific percentile were defined as hypercholesterolemic ( HC ) and those with TG levels at or above the 75th age-specific percentile were defined as combined hyperlipidemic ( CHL ) . INTERVENTIONS Hypercholesterolemic subjects were r and omized to diets 1 , 2 , 3 , and 4 taught to contain 30 % , 26 % , 22 % , and 18 % fat , and the CHL subjects were r and omized to diets 1 , 2 , and 3 . All 4 diets were taught to subjects and spouses or partners in 8 weekly 2-hour classes . MAIN OUTCOME MEASURES Plasma lipoprotein levels after 1 year . RESULTS Fat intake after 1 year declined from a mean of 34 % to 36 % of energy to 27 % , 26 % , 25 % , and 22 % in the 4 HC diet groups and 28 % , 26 % , and 25 % in the 3 CHL diet groups . Mean+/-SD percent LDL-C reductions were 5.3%+/-16.2 % , 13.4%+/-12.6 % , 8.4%+/-11.2 % , and 13.0%+/-15.7 % in the HC diet groups and 7.0%+/-16.2 % , 2.8%+/-15.8 % , and 4.6%+/-13.5 % in the CHL diet groups ( P<.01 in all but 1 instance ) . Apoprotein B levels decreased 8.6 % , 10.7 % , 4.3 % , and 5.3 % in the HC groups and 14.6 % , 11.4 % , and 9.9 % in the CHL groups ( P<.05-.01 in each instance ) . Triglyceride levels increased significantly in subjects following HC diets 3 and 4 , 21.7 % and 38.7 % ( P<.05 and .01 ) , but not in any CHL subjects . High-density lipoprotein cholesterol decreased 2.8 % and 3.2 % in subjects on HC diets 3 and 4 , respectively ( P<.05 in both cases ) . CONCLUSIONS After 1 year , moderate restriction of dietary fat intake attains meaningful and sustained LDL-C reductions in HC subjects and apoprotein B reductions in both HC and CHL subjects . More extreme restriction of fat intake offers little further advantage in HC or CHL subjects and potentially undesirable effects in HC subjects Nutrition counselors in the Multiple Risk Factor Intervention Trial ( MRFIT ) were able to help middle-aged men who were at high risk for coronary heart disease change their dietary habits , maintain those changes over time , and decrease their serum cholesterol levels . Most of a 7.5 % mean serum cholesterol reduction achieved after 6 years of nutrition intervention occurred during the first year of the trial and was thereafter sustained . Total cholesterol and low-density lipoprotein cholesterol fraction decreases indicated improvement in terms of coronary heart disease risk . The food record rating , a numerical , semi- objective adherence technique that assesses a 3-day food record with respect to lipid-lowering potential , was used throughout the trial to measure adherence to recommended food patterns . Participants with lower food record rating scores , which indicate better adherence , demonstrated greater reductions in serum total cholesterol , plasma total cholesterol , and low-density lipoprotein fraction cholesterol determinations on a group basis . Subjective evaluations of the suitability of home and working environments , evidence of deviation from the MRFIT food patterns , and overall nutrition program motivation also showed that as ratings in each category became more favorable , lower food record rating scores and greater blood lipid reductions were consistently observed . The subgroup of participants who were non-smokers and not hypertensive demonstrated greater lipid responses and better dietary adherence . Continued smoking and antihypertensive medications appeared to adversely influence dietary adherence and /or lipid reductions . The MRFIT experience , however , demonstrated for the first time that dietary changes and blood lipid reductions can be achieved after the initial intervention effect , despite a continued emphasis on high blood pressure management and smoking cessation BACKGROUND It was the aim of this study to assess the long-term effects of physical exercise and low-fat diet on the progression of coronary artery disease . At the beginning of the study , 113 male patients with coronary artery disease were r and omized to an intervention group ( n=56 ) or a control group ( n=57 ) ; 90 patients ( 80 % ) could be reevaluated after 6 years . METHODS AND RESULTS Patients in the intervention group ( n=40 ) showed a reduction in total serum cholesterol ( 6.03+/-1.03 versus 5.67+/-1.01 mmol/L ; P<.03 ) and triglyceride levels ( 1.94+/-0.8 versus 1.6+/-0.89 mmol/L ; P<.005 ) and maintained their initial body mass index ( 26+/-2 versus 27+/-2 kg/m2 ; P = NS ) , but results were not statistically different from the control group ( n=50 ) ( total serum cholesterol , 6.05+/-1.02 versus 5.79+/-0.88 mmol/L ; triglycerides , 2.25+/-1.28 versus 1.85+/-0.96 mmol/L [ both P = NS ] ; body mass index , 26+/-2 versus 28+/-3 kg/m2 [ P<.0001 ] ) . In the intervention group , there was a significant 28 % increase in physical work capacity ( 166+/-59 versus 212+/-89 W ; P<.001 ) , whereas values remained essentially unchanged in the control group ( 165+/-51 versus 170+/-60 W ; P = NS ; between groups , P<.05 ) . In the intervention group , coronary stenoses progressed at a significantly slower rate than in the control group ( P<.0001 ) . Energy expenditure during exercise was assessed in a subgroup ; patients with regression of coronary stenoses spent an average of 1784+/-384 kcal/wk ( approximately 4 hours of moderate aerobic exercise per week ) . Multivariate regression analysis identified only physical work capacity as independently contributing to angiographic changes . CONCLUSIONS After 6 years of multifactorial risk intervention , there is significant and persistent improvement in lipoprotein levels and physical work capacity , which results in a significant retardation of disease progression . These beneficial effects appear to be largely due to chronic physical exercise We have examined the feasibility of carrying out a r and omized controlled trial of dietary fat reduction in women at increased risk for breast cancer . The r and omization was either to a control group who were taught the principles of balanced nutrition , but were not counselled to change their fat intake , or to an intervention group who were taught to reduce their dietary fat intake to 15 % of total calories from a baseline average of 35 % of calories .  Potentially eligible subjects were women attending a breast diagnostic clinic who had the mammographic pattern of dysplasia . Subjects were recruited by letter from their referring surgeon followed by a telephone call . Subjects interested in participating in the study then entered by one of two phases . In Phase I , the study was explained , informed consent sought and willing subjects r and omized to the intervention or control group . Using this procedure 227 subjects were r and omized and 48 ( 21 % ) dropped out of the study in the 12 months following r and omization . ( A drop out was defined as a subject who persistently failed to keep appointments and provide nutrient data . ) Of these drop outs , 30 ( 63 % ) occurred at or soon after r and omization . A modified procedure of entry was then adopted in which subjects interested in the study were first taught the procedures involved , including keeping food records and clinic appointments , and were then asked to provide consent and r and omized . Two hundred and eighty subjects were enrolled using this modified procedure and 25 ( 9 % ) have dropped out in the 12 months following r and omization . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND Although nonpharmacologic interventions are widely recommended in the therapy of high blood pressure in older adults , surprisingly little data exist to confirm the efficacy of these interventions in older persons . METHODS We conducted a r and omized , controlled clinical trial in persons aged 60 to 85 years with a diastolic blood pressure of 85 to 100 mm Hg . The experimental arm was a nonpharmacologic intervention combining weight reduction , sodium restriction , and increased physical activity . The nonpharmacologic intervention consisted of eight weekly group and two individual sessions during the intensive phase , followed by four monthly group sessions during the maintenance phase . The control group received no treatment during the study .  Blood pressure was assessed by certified technicians ( blinded to group assignment ) using r and om zero sphygmomanometers . RESULTS Of 56 participants r and omized , 47 completed the entire 6-month trial ( 21 in the intervention group and 26 in the control group ) . Attendance at the intervention sessions was excellent . The intervention group lost more weight ( -2.1 kg ) over 6 months than the control group ( + 0.3 kg ) . Trends for decreasing 24-hour urine sodium excretion in both the intervention and control groups , with greater trend in the intervention group , were not statistically significant . The intervention group experienced more reduction in systolic and diastolic blood pressure than did the control group ( mean differences between groups at 6 months , 4.2/4.9 mm Hg , respectively ) . CONCLUSIONS Our data indicate that a nonpharmacologic intervention will lower systolic and diastolic blood pressure levels in older people with borderline or mild elevations of diastolic blood pressure Obesity , especially central , increases the risk of hypertension , hypertriglyceridaemia and diabetes to a significant extent . To determine whether dietary weight reduction can reduce blood pressure ( BP ) and other cardiovascular risk factors , 217 hypertensives were r and omised to receive either 1600 Kcal/day diet ( group A , n = 108 ) or the usual 2100 Kcal/day diet ( group B , n = 109 ) . Sodium intake and physical activity were kept similar in both groups . After 16 weeks of follow-up , patients in group A received significantly less energy leading to a 2.8 kg net reduction in mean weight in association with a significant net decrease in mean SBP and DBP ( 7.5/6.5 mm Hg ) compared with nonsignificant changes in group B. There was a significant net decrease in mean total cholesterol ( 7.0 % ) , low-density lipoprotein (LDL)-cholesterol ( 7.9 % ) and triglycerides ( 8.0 % ) , with a significant net increase in high-density lipoprotein (HDL)-cholesterol ( 4.0 % ) in group A compared with group B. New risk factors such as glucose intolerance ( 8.0 % ) and central obesity ( waist-hip girth ratio , 0.021 ) showed a significant net reduction compared with group B. Patients with central obesity and other associated disturbances showed maximal reduction in BP and other cardiovascular risk factors with a significantly greater increase in HDL-cholesterol . Mean doses of drugs were similar at entry to the study as well as after 16 weeks in both groups . It is possible that weight reduction due to a low caloric diet can moderate central obesity and associated disturbances in hypertensive subjects Abstract Objective : To determine the relative efficacy in general practice of dietary advice given by a dietitian , a practice nurse , or a diet leaflet alone in reducing total and low density lipoprotein cholesterol concentration . Design : R and omised six month parallel trial . Setting : A general practice in Oxfordshire . Subjects : 2004 subjects aged 35 - 64 years were screened for hypercholesterolaemia ; 163 men and 146 women with a repeat total cholesterol concentration of 6.0 - 8.5 mmol/l entered the trial . Interventions : Individual advice provided by a dietitian using a diet history , a practice nurse using a structured food frequency question naire , or a detailed diet leaflet sent by post . All three groups were advised to limit the energy provided by fat to 30 % or less and to increase carbohydrate and dietary fibre . Main outcome measures : Concentrations of total cholesterol and low density and high density lipoprotein cholesterol after six months ; antioxidant concentration and body mass index . Results : No significant differences were found at the end of the trial between groups in mean concentrations of lipids , lipoproteins , and antioxidants or body mass index . After data were pooled from the three groups , the mean total cholesterol concentration fell by 1.9 % ( 0.13 mmol/l , 95 % confidence interval 0.06 to 0.22 , P<0.001 ) to 7.00 mmol/l , and low density lipoprotein cholesterol also fell . The total carotenoid concentration increased by 53 nmol/l ( 95 % confidence interval 3.0 to 103 , P=0.039 ) . Conclusions : Dietary advice is equally effective when given by a dietitian , a practice nurse , or a diet leaflet alone but results in only a small reduction in total and low density lipoprotein cholesterol . To obtain a better response more intensive intervention than is normally available in primary care is probably necessary . Key messages Key messages In this study dietary advice had only a modest effect on lipid and lipoprotein concentrations Personalised advice from a nurse or dietitian was no more effective than a detailed diet leaflet Antioxidant concentrations increased slightly , but this requires further study A mass approach to dietary change is needed to produce significant BACKGROUND The multiprofessional teams in Finnish health centres are well placed to carry out interventions aim ed at the prevention of cardiovascular diseases . AIM To evaluate the effectiveness of an individually tailored multifactorial lifestyle intervention in primary care for individuals at high risk for cardiovascular disease . DESIGN OF STUDY A r and omised controlled trial was conducted over 24 months with interim assessment s at six and 12 months . SETTING A health centre in Finl and with a patient population of 11,000 . METHOD One hundred and fifty adults aged 18 to 65 years old with existing cardiovascular disease or multiple risk factors were r and omised to active multiprofessional risk factor intervention or to st and ard care . The main outcome measure was a change in cardiovascular risk-factor score . Secondary outcomes were changes in blood pressure , weight , body-mass index , serum cholesterol , blood glucose , smoking cessation , and exercise habits . RESULTS The cardiovascular risk score decreased by 28 % in the intervention group ( 23 % in the control group ) , body weight decreased by 3.7 % ( 2 % ) and total cholesterol decreased by 10.8 % ( 6.5 % ) , while time engaged in exercise increased by 39 % ( 43 % ) . Differences were not significant . CONCLUSIONS Cardiovascular risk levels of high-risk individuals decreased in both intervention and control groups . Primary care prevention should be targeted to high-risk persons . Long-term follow-up studies are needed Aims /hypothesis . The aim of the Diabetes Prevention Study is to assess the efficacy of an intensive diet-exercise programme in preventing or delaying  Type II ( non-insulin-dependent ) diabetes mellitus in subjects with impaired glucose tolerance , to evaluate the effects of the intervention programme on cardiovascular risk factors and to assess the determinants for the progression to diabetes in persons with impaired glucose tolerance . Methods . A total of 523 overweight subjects with impaired glucose tolerance ascertained by two oral glucose tolerance tests were r and omised to either a control or intervention group . The control subjects received general information at the start of the trial about the lifestyle changes necessary to prevent diabetes and about annual follow-up visits . The intervention subjects had seven sessions with a nutritionist during the first year and a visit every 3 months thereafter aim ed at reducing weight , the intake of saturated fat and increasing the intake of dietary fibre . Intervention subjects were also guided individually to increase their physical activity .  Results . During the first year , weight loss in the first 212 study subjects was 4.7 ± 5.5 vs 0.9 ± 4.1 kg in the intervention and control group , respectively ( p < 0.001 ) . The plasma glucose concentrations ( fasting : 5.9 ± 0.7 vs 6.4 ± 0.8 mmol/l , p < 0.001 ; and 2-h 7.8 ± 1.8 vs 8.5 ± 2.3 mmol/l , p < 0.05 ) were significantly lower in the intervention group after the first year of intervention . Favourable changes were also found in blood pressure , serum lipids and anthropometric indices in the intervention group . Conclusion /interpretation . The interim results show the efficacy and feasibility of the lifestyle intervention programme . [ Diabetologia ( 1999 ) 42 : 793–801 We used outcome data from a r and omized work site intervention trial to examine the cost-effectiveness of four cardiovascular disease ( CVD ) risk reduction programs : health risk assessment ( HRA ) , risk factor education ( RFE ) , behavioral counseling ( BC ) , and behavioral counseling plus incentives ( BCI ) . Composite CVD risk scores were derived from measures of serum total cholesterol , blood pressure , number of cigarettes smoked , body mass index , and aerobic capacity . The economic evaluation of the programs focused on the subset of costs most sensitive to the differences between the interventions , and a sensitivity analysis examined some of the relevant cost variations . At the 6-month follow-up ( i.e. , the " action " or initiation stage of lifestyle change ) , the RFE , BC , and BCI interventions produced a significant reduction in cardiovascular risk . Incremental analyses demonstrated RFE to be more cost-effective , but not as clinical ly effective as BC ; BC was more cost-effective than RFE when assessment costs were included , and BCI was judged to be the least cost-effective . At the 12-month follow-up ( i.e. , the " maintenance " stage of lifestyle of change ) , BC was the only program found to produce a significant reduction in CVD risk .  Individualized behavioral counseling was found to be a cost-effective strategy for the initiation and maintenance of CVD risk factor reduction Objective : To investigate the impact of intensive lifestyle education on dietary practice s , exercise and metabolic measurements in people with insulin-dependent diabetes mellitus ( IDDM ) . Design : Sixty-one volunteer subjects with IDDM were r and omised to intensive ( Group 1 ) or st and ard ( Group 2 ) education programmes for six months . During a second six month period of observation Group 1 subjects received routine surveillance for their condition and those in Group 2 were given intensive advice ( phase 2 ) . Current insulin regimens were modified to optimise glycaemic control before the start of the intervention phase . Nutrient intakes , weight , blood pressure , glycated haemoglobin ( HbA ) , plasma lipids , lipoproteins and maximal oxygen consumption ( VO max ) were measured at the time of recruitment and at three monthly intervals during the trial and phase 2 . Setting : Department of Human Nutrition at the University of Otago . Results : Glycated haemoglobin decreased significantly in both groups between recruitment and r and omisation , the improvement being sustained during the six months of the r and omised trial and for group 1 during the six months of post trial observation . A further decrease was seen in Group 2 during the second six month period when they were given intensive advice . Comparable changes were seen with total and low density lipoprotein ( LDL ) cholesterol in Group 1 during the trial , but significant decreases were only seen in Group 2 in association with intensive intervention ( phase 2 ) . These changes occurred in parallel with increases in intakes of carbohydrate and monounsaturated fatty acids , a reduction in intakes of total and saturated fat , and an improvement in maximum oxygen consumption . Conclusions : A lifestyle programme for people with IDDM results in modest changes in diet and exercise habits sufficient to improve measures of glycaemic control and lipoprotein mediated risk of coronary heart disease independent of changes in insulin regime . More innovative approaches to achieve lifestyle changes are required to meet current recommendations which in turn are likely to produce even greater beneficial changes than those observed here . Sponsorship : This study was supported by the Eli Lilly Research Grant ( Eli Lilly and Company ( New Zeal and ) Ltd ) , The Deans Research Grant ( Otago Medical School , New Zeal and ) and The New Zeal and Dietetic Association ( Abbott Award ) OBJECTIVES This study tested a feasible method for screening for cardiovascular risk at the worksite and investigated the effects of a long-term comprehensive program of life-style intervention to prevent cardiovascular disease . METHODS Employees in the public sector filled out a self-administered question naire with questions on social , medical , and work-related factors . The respondents numbered 454 ( 80 % ) . A score sum for cardiovascular risk was calculated ( range 1 - 20 , median 7.0 ) , and the 128 subjects with a sum above 8 were invited to a health examination including blood sampling . Thereafter the subjects were invited to participate , following r and omization , in a comprehensive , 18-month , life-style intervention program to improve cardiovascular risk or in a control group . RESULTS The intervention group significantly decreased body mass index , diastolic blood pressure , heart rate , low-density lipoprotein ( LDL ) cholesterol , and smoking habits during the intervention . The initially elevated serum cortisol , as a marker of stress reaction , normalized in the intervention group . In the control group LDL cholesterol also decreased , but the glucose and triglyceride levels increased , and smoking habits were unchanged . Sick days for a given period decreased after 1 year in the intervention group but not in the control group . CONCLUSIONS Several cardiovascular risk factors can be improved and morning serum cortisol normalized during a long-term life-style intervention program with a r and omized design using a worksite population of middle-aged subjects . The use of a 2-step screening program , with an initial question naire followed by a health check of subjects with elevated risk , is feasible for worksite setting Ninety-three overweight adult males with labile blood pressure elevation participated in a 20-week dietary intervention program to achieve a 10 per cent reduction in body weight and a reduction in dietary sodium intake to 70 milliequivalents per day . By r and om assignment , half were treated with intensive group treatment procedures and half with individual counseling . Written h and outs and assignments were identical , as was the schedule of treatment visits . Both techniques produced significant decreases in weight , sodium intake , calorie intake , and blood pressure . Calorie and sodium knowledge also increased significantly with both intervention approaches . The two treatment modalities did not differ in effectiveness The aim of the Finnish Diabetes Prevention Study is to assess the efficacy of an intensive diet-exercise programme in preventing or delaying  type 2 diabetes in individuals with impaired glucose tolerance ( IGT ) and to evaluate the effect of the programme on the risk factors of atherosclerotic vascular diseases and the incidence of cardiovascular events . In this ongoing study , a total of 523 overweight subjects with IGT based on two oral glucose tolerance tests were r and omized to either an intervention group or a control group . The main measure in the intervention group is individual dietary advice aim ed at reducing weight and intake of saturated fat and increasing intake of dietary fibre . The intervention subjects are individually guided to increase their level of physical activity .  The control group receives general information about the benefits of weight reduction , physical activity and healthy diet in the prevention of diabetes . A pilot study began in 1993 , and recruitment ended in 1998 . By the end of April 1999 there were 65 new cases of diabetes , 34 drop-outs and one death . The weight reduction was greater ( -4.6 kg ) at 1 year in the intervention group ( n = 152 ) than in the control group ( n = 143 , -0.9 kg , P < 0.0001 ) , and this difference was sustained in the second year of follow-up . At 1 year 43.4 % and at 2 years 41.8 % of the intervention subjects had achieved a weight reduction of at least 5 kg , while the corresponding figures for the control subjects were 14.0 and 12.0 % ( P < 0.001 between the groups ) . At 1 year the intervention group showed significantly greater reductions in 2 h glucose , fasting and 2 h insulin , systolic and diastolic blood pressure , and serum triglycerides . Most of the beneficial changes in cardiovascular risk factors were sustained for 2 years . These interim results of the ongoing Finnish Diabetes Prevention Study demonstrate the efficacy and feasibility of the lifestyle intervention programme While most intervention studies on coronary heart disease have focused on the high-risk person only , the present study used the family as the unit of intervention . In the study 1373 high-risk men , ages 30 - 54 years , were identified on the basis of high total cholesterol ( TC ) and /or low relative high-density lipoprotein cholesterol ( HDL-C ) ( HDL-C/TC ) following the 1979/1980 survey in Tromsø . The men and their families were r and omly allocated to a control or intervention condition . The intervention families were given advice on diet , smoking , and exercise . At rescreening in 1986/1987 , significantly lower risk factor levels were found in both the intervention men and their spouses compared with those in the control group . For children , the differences were small and mostly nonsignificant . Men , spouses , and children in the intervention group reported more favorable dietary habits than those in the control group . No differences were found in smoking or leisure time physical activity An economic evaluation was conducted alongside a r and omised controlled trial of two lifestyle interventions and a routine care ( control ) group to assess the cost-effectiveness of a general practice -based lifestyle change program for patients with risk factors for cardiovascular disease . Routine care was the base case comparator because it represents ' current therapy ' for cardiovascular disease ( CVD ) . A ' no care ' control group was not considered a clinical ly acceptable alternative to lifestyle interventions . The interventions consisted of an education guide and video for GPs to assess individual patient risk factors and plan a program for risk factor behavior change . Each patient received a risk factor assessment , education material s , a series of videos to watch on lifestyle behaviors and some patients received a self-help booklet .  Eighty-two general practitioners were r and omised from 75 general practice s in Sydney 's Western Metropolitan Region to ( i ) routine care ( n = 25 ) , ( ii ) video group ( n = 29 ) or ( iii ) video + self help group ( n = 28 ) . GPs enrolled patients into the trial who met selection criteria for being at risk of CVD . There were 255 patients in the routine care ( control ) group , 270 in the video ( intervention ) group and 232 in the video + self help ( intervention ) group enrolled in the trial . Outcome measures included patient risk factor status : blood pressure , body mass index , cholesterol and smoking status at entry to trial and after 1 year . Changes in risk factors were used to estimate quality adjusted life years ( QALYs ) gained . One hundred and thirty patients in the routine care group , 199 in the video group and 155 in the video + self help group remained in the trial at the 12-month review and had complete data . The cost per QALY for males ranged from $ AUD152,000 to 204,000 . Further analysis suggests that a program targeted at ' high risk ' males would cost approximately $ 30,000 per QALY . The lifestyle interventions had no significant effect on cardiovascular risk factors when compared to routine patient care . There remains insufficient evidence that lifestyle programs conducted in general practice s are effective . Re sources for general practice -based lifestyle programs may be better spent on high risk patients who are contemplating changes in risk factor behaviours This study tested the effects of an exercise and diet modification training program for weight loss  among Latinas . Forty four obese women were assigned to an experimental training group ( n = 22 ) or a control ( n = 22 ) , at r and om . One session per week for eight weeks included instruction for diet modification and walking for exercise , and all women were led in 20 min of walking during each session . Instruction was provided by a bi-cultural Spanish-speaking physician . Statistically significant ( P < 0.05 ) decreases , relative to controls , were obtained for Body Mass Index , waist to hip ratio , and serum cholesterol . Significant increases were obtained for fitness , exercise rate and frequency , and diet/exercise knowledge . Results suggest that the training was effective for decreasing obesity and increasing fitness among Low SES , Mexican-American women . Implication s for weight control and disease prevention among under-served population s are discussed OBJECTIVE There is a pressing need for brief practical interventions that address diabetes management . Using a r and omized design , we evaluated a medical office-based intervention focused on behavioral issues relevant to dietary self-management . RESEARCH DESIGN AND METHODS There were 206 adult diabetes patients r and omized to usual care or brief intervention  , which consisted of touchscreen computer-assisted assessment to provide immediate feedback on key barriers to dietary self-management , and goal setting and problem-solving counseling for patients . Follow-up components to the single session intervention included phone calls and interactive video or videotape instruction as needed . RESULTS Multivariate analyses of covariance revealed that the brief intervention produced greater improvements than usual care on a number of measures of dietary behavior ( e.g. , fewer calories from saturated fat , fewer high-fat eating habits and behaviors ) at the 3-month follow-up . There were also significant differences favoring intervention on changes in serum cholesterol levels and patient satisfaction but not on glycosylated hemoglobin . The intervention effects were relatively robust across a variety of patient characteristics , the two participating physicians , and intervention staff members . CONCLUSIONS If the long-term results are equally positive and generalize to other setting , this intervention could provide a prototype for a feasible cost-effective way to integrate patient views and behavioral management into office-based care for diabetes A 2-year r and omized clinical trial was conducted to test whether free-living women aged 45 to 69 years can reduce the fat content of their diet from the typical US level of approximately 39 % to 20 % of energy from fat , using readily available foods , when given nutritional and behavioral counseling and social support . Three clinical units r and omized 303 selected volunteers into intervention ( low-fat eating plan ) or control ( customary diet ) groups . The two groups were comparable at baseline . The intervention group received nutrition instruction and behavioral counseling largely in permanent groups of 12 to 15 participants meeting weekly , then biweekly , and finally monthly . At 6 months , they had substantially reduced the mean proportion of total energy from fat from 39.1 % to 20.9 % , compared with the control group 's nonsignificant reduction from 39.0 % to 38.1 % . At 12 and 24 months , they sustained the reduction of energy from fat . Weight loss and plasma cholesterol level changes in the intervention group supported the self-recorded dietary intake changes . Attendance at intervention sessions averaged 75 % during the first 6 months and , subsequently , 60 % to 70 % . Four-day food records for the r and omized women were obtained at 6 and 12 months from approximately 95 % and at 24 months from 87 % . A clinical trial of a low-fat diet is feasible in women Abstract Objective : To determine the effectiveness of health checks , performed by nurses in primary care , in reducing risk factors for cardiovascular disease and cancer . Design : R and omised controlled trial . Setting : Five urban general practice s in Bedfordshire . Subjects : 2205 men and women who were r and omly allocated a first health check in 1989 - 90 and a re-examination in 1992 - 3 ( the intervention group ) ; 1916 men and women who were r and omly allocated an initial health check in 1992 - 3 ( the control group ) . All subjects were aged 35 - 64 at recruitment in 1989 . Main outcome measures : Serum total cholesterol concentration , blood pressure , body mass index , and smoking prevalence ( with biochemical validation of cessation ) ; self reported dietary , exercise , and alcohol habits . Results : Mean serum total cholesterol was 3.1 % lower in the intervention group than controls ( difference 0.19 mmol/l ( 95 % confidence interval 0.12 to 0.26 ) ; in women it was 4.5 % lower ( P<0.0001 ) and in men 1.6 % ( P<0.05 ) , a significant difference between the sexes ( P<0.01 ) . Self reported saturated fat intake was also significantly lower in the intervention group . Systolic and diastolic blood pressures and body mass index were respectively 1.9 % , 1.9 % , and 1.4 % lower in the intervention group ( P<0.005 in all cases ) . There was a 3.9 % ( 2.4 to 5.3 ) difference in the percentage of subjects with a cholesterol concentration > /=8 mmol/l , but no significant differences in the number with diastolic blood pressure > /=100 mm Hg or body mass index > /=30 kg/m2 . There was no significant difference between the two groups in prevalence of smoking or excessive alcohol use . Annual rechecks were no more effective than a single recheck at three years , but health checks led to a significant increase in visits to the nurse according to patients ' degree of cardiovascular risk . Conclusions : The benefits of health checks were sustained over three years . The main effects were to promote dietary change and reduce cholesterol concentrations ; small differences in blood pressure may have been attributable to accommodation to measurement . The benefits of systematic health promotion in primary care are real , but must be weighed against the costs in relation to other priorities . Key messages Key messages There is little effect on smoking or alcohol use , and more targeted approaches to modifying these behaviours may be appropriate Systematic implementation of health checks might lead to a reduction in risk of myocardial infa rct ion among those who attend of about 5 - 15 % ; men , who are at higher risk , show less change than women Health checks consume substantial re sources , and their effect is attenuated by non-attendance The benefits of health promotion through primary care must be weighed against their costs and in relation to other Weight reduction by a low-energy diet and a high-polyunsaturates- , fiber- and potassium-rich diet may be independently useful to hypertensives . To study the effect of such diets , 416 hypertensives were r and omized to either a low-energy cardiovasoprotective ( CVP ) diet ( Group A ; n = 106 ) , a low-energy usual diet ( Group B ; n = 104 ) , an optimal-energy CVP diet ( Group C ; n = 104 ) , or an optimal-energy , usual pre-experimental diet ( Group D ; n = 102 ) plus drug therapy in a single-blind and controlled fashion . Groups A and B received significant ( p less than 0.02 ) fewer calories per day than Groups C and D. Groups A and C also received significantly ( p less than 0.02 ) more calories per amount of complex carbohydrates , polyunsaturates , potassium , and magnesium than did Groups B and D. Dietary compliance and drug intake was checked weekly . After 3 months , there was a significant fall in mean serum cholesterol ( p less than 0.01 ) and mean serum triglycerides ( p less than 0.05 ) in Group A compared with Group D. Group A and B patients had a loss of around 10 kg of mean body weight , with no weight change seen in Group D. Weight loss was associated with a significant fall in systolic and diastolic pressures in both Group A ( 22/18mmHg ) and Group B ( 16/13mmHg ) compared with Group D at the end of the study . Group C patients also showed a significant fall in pressure ( 13/10mmHg ) compared with Group D. Drug therapy , exercise , and salt intake were similar in all the groups . ( ABSTRACT TRUNCATED AT 250 WORDS A work site-located clinic screened 6,000 employees ( 91 percent participation ) and identified 146 hypercholesterolemic subjects ( 100 percent initial participation , 12 percent subsequent dropout rate ) . The subjects , aged 20 to 50 years , were r and omly classified into four groups : Group A , treatment in a lipid intervention clinic with diet for 6 weeks , then diet plus clofibrate for the subsequent 18 weeks ; Group B , diet treatment from a clinic nutritionist with the cooperation of the subject 's private physician ; Group C , referral for treatment by a private physician ; and Group D , no intervention .  Initial mean cholesterol was 294 mg/100 ml . At 24 weeks , all intervention groups had decreases in serum cholesterol ( Group A , 12 percent ; Group B , 15 percent ; Group C , 17 percent ; P less than 0.001 ) . The control group ( D ) had a small decrease in cholesterol ( 4 percent ) . Decreases in cholesterol were correlated with weight loss and decrease in fasting serum triglycerides but not with the use of clofibrate .  Serum cholesterol can be reduced in healthy young adults by several practical methods BACKGROUND A diet low in saturated fat and cholesterol is the st and ard initial treatment for hypercholesterolemia . However , little quantitative information is available about the efficacy of dietary therapy in clinical practice or about the combined effects of diet and drug therapy . METHODS One hundred eleven out patients with moderate hypercholesterolemia were treated at five lipid clinics with the National Cholesterol Education Program Step 2 diet ( which is low in fat and cholesterol ) and lovastatin ( 20 mg once daily ) , both alone and together . A diet high in fat and cholesterol and a placebo identical in appearance to the lovastatin were used as the respective controls . Each of the 97 patients completing the study ( 58 men and 39 women ) underwent four consecutive nine-week periods of treatment according to a r and omized , balanced design : a high-fat diet-placebo period , a low-fat diet-placebo period , a high-fat diet-lovastatin period , and a low-fat diet-lovastatin period . RESULTS The level of low-density lipoprotein ( LDL ) cholesterol was a mean of 5 percent ( 95 percent confidence interval , 3 to 7 percent ) lower during the low-fat diet than during the high-fat diet ( P < 0.001 ) . With lovastatin therapy as compared with placebo , the reduction was 27 percent . Together , the low-fat diet and lovastatin led to a mean reduction of 32 percent in the level of LDL cholesterol . The level of high-density lipoprotein ( HDL ) cholesterol fell by 6 percent ( 95 percent confidence interval , 4 to 8 percent ) during the low-fat diet ( P < 0.001 ) and rose by 4 percent during treatment with lovastatin ( P < 0.001 ) . The ratio of LDL to HDL cholesterol and the level of total triglycerides were reduced by lovastatin ( P < 0.001 ) , but not by the low-fat diet . CONCLUSIONS The effects of the low-fat-low-cholesterol diet and lovastatin on lipoprotein levels were independent and additive . However , the reduction in LDL cholesterol produced by the diet was small , and its benefit was possibly offset by the accompanying reduction in the level of HDL cholesterol Few studies have evaluated the efficacy of cholesterol-lowering interventions in a community setting and have included a control or comparison group . As part of a preventive health demonstration project in rural Pennsylvania , Medicare beneficiaries underwent cholesterol screening to identify high-risk individuals with serum cholesterol levels > or = 240 mg/dL. These high-risk individuals were r and omized to a  cholesterol-lowering intervention  through either local hospitals or physicians ' offices or to a control group . Baseline and follow-up serum cholesterol levels collected two to three years later were compared according to service location ( hospital versus physician 's office ) , intervention attendance , degree of participation , baseline heart disease history , and cholesterol-lowering medication use at follow-up . Serum cholesterol levels decreased between 5.7 % and 6.6 % in the hospital-based and physician-based groups , as well as in a control group not offered the intervention .  Participation rates did not differ between treatment groups , nor did participation affect serum cholesterol levels . Attendance level and heart disease history were not associated with a greater decrease in serum cholesterol levels . Individuals reporting cholesterol-lowering drug use at follow-up had significantly higher baseline serum cholesterol levels and a significantly greater decrease in total serum cholesterol ( P < .0001 ) than those not on medication . Both nonpharmacological ( diet ) and pharmacological ( drug ) interventions will reduce serum cholesterol levels and heart attack risk . The study results suggest that , at least for older individuals , the impact of nonpharmacological interventions on the community is minimal . We conclude that only very aggressive treatment will significantly loser serum cholesterol levels in older individuals at risk for heart attack To assess the effect of dietary reduction of plasma cholesterol concentrations on coronary atherosclerosis , we set up a r and omised , controlled , end-point-blinded trial based on quantitative image analysis of coronary angiograms in patients with angina or past myocardial infa rct ion . Another intervention group received diet and cholestyramine , to determine the effect of a greater reduction in circulating cholesterol concentrations . 90 men with coronary heart disease ( CHD ) , who had a mean ( SD ) plasma cholesterol of 7.23 ( 0.77 ) mmol/l were r and omised to receive usual care ( U , controls ) , dietary intervention ( D ) , or diet plus cholestyramine ( DC ) , with angiography at baseline and at 39 ( SD 3.5 ) months . Mean plasma cholesterol during the trial period was 6.93 ( U ) , 6.17 ( D ) , and 5.56 ( DC ) mmol/l . The proportion of patients who showed overall progression of coronary narrowing was significantly reduced by both interventions ( U 46 % , D 15 % , DC 12 % ) , whereas the proportion who showed an increase in luminal diameter rose significantly ( U 4 % , D 38 % , DC 33 % ) . The mean absolute width of the coronary segments ( MAWS ) studied decreased by 0.201 mm in controls , increased by 0.003 mm in group D , and increased by 0.103 mm in group DC ( p less than 0.05 ) , with improvement also seen in the minimum width of segments , percentage diameter stenosis , and edge-irregularity index in intervention groups . The change in MAWS was independently and significantly correlated with LDL cholesterol concentration and LDL/HDL cholesterol ratio during the trial period . Both interventions significantly reduced the frequency of total cardiovascular events . Dietary change alone retarded overall progression and increased overall regression of coronary artery disease , and diet plus cholestyramine was additionally associated with a net increase in coronary lumen diameter . These findings support the use of a lipid-lowering diet , and if necessary of appropriate drug treatment , in men with CHD who have even mildly raised serum cholesterol concentrations To determine the value of weight reduction on blood pressure , we r and omly allocated 60 untreated , mildly hypertensive , obese individuals to a no-treatment control group or  to  a behaviourly-oriented weight loss ( ' diet ' ) programme administered by professional dietitians . Behavioural techniques included self-monitoring , shaping , reinforcement and modelling . Subjects were reassessed after six months by an observer who was unaware of their study group . Fifty-four subjects ( 90 % ) completed the study .  Diet subjects lost 4.1 kg and controls only 0.8 kg ( P = 0.018 ) . However , neither systolic nor diastolic blood pressures differed . The chance that we missed a clinical ly important diastolic difference of 6 mmHg ( our pre- study target ) is less than 1 % . We conclude that our weight loss programme was successful in reducing weight but that weight loss is not useful in lowering blood pressure in mild , otherwise untreated hypertensives The aim was to examine the feasibility and efficacy of a multifactorial risk factor intervention program in hypertensive patients at high cardiovascular risk . Treated hypertensive men , aged 50 to 72 years , with at least one of the following : serum cholesterol concentration > or = 6.5 mmol/L , diabetes mellitus , or smoking were r and omized to multifactorial risk factor intervention ( n = 253 ) or usual care ( n = 255 ) . The specific intervention was based on group meetings to encourage a lipid lowering diet and smoking cessation . Cholestyramine , nicotinic acid , fibrates , and later statins were used either as single drug therapy or in combination , following agreed guidelines in patients in whom the nonpharmacological intervention was judged to be insufficient . Usual care was given according to clinical practice . The median follow-up time was 6.6 years . Sixty-four patients ( 25.1 % ) died in the usual care group , compared with 41 patients ( 16.2 % ) in the intervention group ( P = .016 ; 95 % confidence interval , relative risk 0.42 to 0.92 ) . The overall risk for fatal and nonfatal cardiovascular events was 29 % lower in the intervention group than in the usual care group ( P = .041 ) . Relative to usual care , the intervention program lowered mean in-trial serum concentrations of total cholesterol ( 6.3 % , P < .0001 ) , LDL cholesterol ( 9.1 % , P < .0001 ) , and blood glucose ( 0.2 mmol/L , P < .05 ) . Among smokers , at entry , cotinine-adjusted quit rates were 28 % in the intervention group and 11 % in the usual care group ( P = .012 ) after 3 years . This study illustrates the very high cardiovascular risk in hypertensive patients 50 to 72 years of age with additional risk factors . The results indicate , however , that the gloomy prognosis may be improved by a dedicated risk factor intervention program BACKGROUND Dietary intervention to reduce fat consumption and increase fiber consumption has been recommended by the National Cancer Institute , but there is little evidence concerning the effectiveness of self-help material s. The purpose of this study was to evaluate such self-help material s , introduced by a nurse in a primary care setting . METHODS A r and omized controlled trial involving 242 subjects was conducted in two primary care clinics in Chapel Hill , NC , in 1987 .  Changes in fat and fiber consumption in the intervention and control groups during the 3-month interval between interviews were compared using analysis of covariance . RESULTS The estimated reduction in fat was 3.8 g larger for the intervention group than for the control group , but the confidence interval included zero . For those individuals who had some responsibility for meal preparation there was a larger difference ( -6.9 g ) in favor of the intervention group , although the difference using calorie-adjusted values was -3.8 g with a 95 % confidence interval ( -7.1 , -0.4 ) . The differences for fiber change were smaller . CONCLUSIONS We found significant small but consistent differential changes associated with a minimal self-help intervention , but we can not rule out the possibility of some response bias . Nonetheless , this study demonstrates that the use of self-help material s for dietary change is feasible , and may be effective Methods of effective cardiovascular risk reduction that are suitable for use in clinical setting s are needed . Several behavioral interventions were design ed to be compatible with office-based medical practice , to be delivered by paraprofessional counselors , and to be of low intensity and low cost . Eighty-three hypercholesterolemic volunteers were assigned to one of three experimental conditions ( face-to-face counseling , mail and telephone counseling , initial session only ) . Twenty-six nonr and omized subjects served as a no-contact group and were followed for 1 year . Participants in the first three groups received risk factor education , behavioral recommendations , and a packet of material s , while those in the face-to-face and mail/telephone counseling groups were contacted for five brief follow-up sessions over a 4-month period . At the 1-year follow-up evaluation , subjects in the face-to-face and mail/telephone counseling conditions showed decreases in plasma cholesterol of 6.2 and 4.6 % , respectively ( P less than 0.01 ) , while the other two groups evidence d small increases . There were no differences by condition for plasma triglycerides , systolic or diastolic blood pressure , or weight . Low-intensity , low-cost behavioral interventions delivered by paraprofessionals can produce long-term decreases in a major cardiovascular risk factor . Physicians are encouraged to incorporate similar interventions into their practice A 5-year trial involving 201 men and women with high-normal blood pressure at baseline demonstrated the ability to reduce the incidence of hypertension in participants r and omized to nutritional-hygienic intervention compared with a control group . The incidence of hypertension was 8.8 % among 102 intervention group participants vs 19.2 % among 99 control group members . The odds ratio for the incidence of hypertension in the control group was 2.4 . Mean trial blood pressure also was lower in the intervention compared with the control group ( -1.2 and -1.9 mm Hg , respectively , for diastolic blood pressure at work-site and office visits and -1.3 and -2.0 mm Hg , respectively , for systolic blood pressure at the two sites ) . Net weight loss in the intervention group averaged 2.7 kg during the trial ; sodium intake was reduced by 25 % and reported alcohol intake decreased by 30 % . The majority of intervention participants also reported an increase in physical activity . Effect on blood pressure was related particularly to degree of weight loss . Results indicate that even a moderate reduction in risk factors for hypertension among hypertension-prone individuals contributes to the primary prevention of the disease BACKGROUND Previous studies have shown that lipid abnormalities have a role in the pathogenesis of benign breast disease . However , few investigators have tried to reduce dietary fat to treat this disorder . METHODS Between 1990 and 1993 , we conducted a prospect i ve cohort study to find out the efficacy of a low fat diet ( less than 15 % fat-derived calories ) in the treatment of benign breast disease in patients who had been symptomatic for 6 months or more . The study was conducted in two phases . In the first phase 36 patients were alternately assigned to control and treatment groups for 6 months and in the second phase 121 patients ( including all those in phase I ) were given treatment ( median follow up 25 months , range 3 to 39 months ) . Detailed lipid profiles were studied at the time of presentation and at 4 and 5 months . RESULTS Phase I results showed that after 6 months none of the patients in the control group had experienced any alteration in their symptoms and signs but in the treatment group 12 out of 17 improved . In phase II improvement in pain ( 68 out of 97 ; 70 % ) , nodularity ( 51 out of 79 ; 64 % ) and discharge ( 15 out of 19 ; 80 % ) was seen . There was a significant decline in the mean values of total cholesterol and high-density lipoproteins at the end of 5 months of treatment . CONCLUSION A low fat diet improves the symptoms as well as the lipid profile in patients with benign breast disease Ten of the original 24 factories from the United Kingdom Heart Disease Prevention Project were resurveyed in 1983 to assess the long-term ( 12-year ) effects of an education program on  diet , smoking , and exercise .  These 10 factories had previously been grouped into five pairs matched for size , location , and nature of industry , with one of each pair r and omly chosen for intervention . Men in intervention factories were given advice on reduction of cholesterol in diet , stopping smoking , weight reduction , and regular exercise .  High-risk workers ( 13 % ) received personal counseling in addition to the factory-wide education program . A total of 1,204 workers r and omly selected from those still employed in 1978 were surveyed . There were significant differences observed in cigarette consumption , butter use , and several other dietary behaviors ; however , the differences were small and insignificant for the proportion smoking and leisure-time exercise . The largest effects were in the high-risk group who had received personal counseling . This education program appears to have some lasting effects on behavior associated with coronary disease risk factors . Similarly design ed programs may serve as models for community-wide coronary disease prevention programs This study is a r and omized , controlled , blinded , arteriographic trial to determine the effects of a low-cholesterol , low-fat , vegetarian diet , stress management and moderate aerobic exercise on geometric dimensions , shape and fluid dynamic characteristics of coronary artery stenoses in humans . Complex changes of different primary stenosis dimensions in opposite directions or to different degrees cause stenosis shape change with profound effects on fluid dynamic severity , not accounted for by simple percent narrowing . Accordingly , all stenosis dimensions were analyzed , including proximal , minimal , distal diameter , integrated length , exit angles and exit effects , determining stenosis shape and a single integrated measure of stenosis severity , stenosis flow reserve reflecting functional severity . In the control group , complex shape change and a stenosis-molding characteristic of statistically significant progressing severity occurred with worsening of stenosis flow reserve . In the treated group , complex shape change and stenosis molding characteristic of significant regressing severity was observed with improved stenosis flow reserve , thereby documenting the multidimensional characteristics of regressing coronary artery disease in humans OBJECTIVE To study characteristics of importance for participation in a diet and physical exercise prevention programme . SETTING Primary Health Care , Sollentuna , and the Karolinska Hospital , Stockholm , Sweden . SUBJECTS A sample of 187 men , aged 35 - 60 , with increased risk factors for CHD , were invited to a 6-month  prevention programme .  Participants ( n = 158 ) were r and omized into a  diet group , a physical exercise group , a diet and physical exercise group , and a control group . Twenty-seven men , who declined participation , formed the group of non participants . DESIGN Participants and non participants were compared with respect to health beliefs , health knowledge , CHD risk factors , demographic and personality factors . MAIN OUTCOME MEASURES Characteristics of men participating and not participating in the intervention trial . RESULTS Non participants , compared with participants , believed less in the benefits of dietary change  and perceived the health threat of stroke and myocardial infa rct ion as less serious . Non participants had a better knowledge of a number of risk factors for cardiovascular disease . CONCLUSION Belief in treatment efficacy and perceived health threat , rather than health knowledge , predicted initial participation in a non-pharmacological intervention trial The study describes changes in cardiovascular risk factors during 10 years of a  community intervention program  conducted in a rural area in Central Italy . Two areas were involved , one for treatment and one for reference . In 1983 - 84 , 739 men and 859 women in the treatment area and 942 men and 1045 women in the control area , aged 20 - 69 years , were screened ; total and HDL cholesterol , systolic and diastolic blood pressure , fasting blood glucose , smoking habit , weight and height were measured . Between 1983 and 1993 several intervention activities based on community medicine were carried out in the treatment area . They were based on interaction with the local socio-sanitary institutions and school system in order to influence individual persons , small groups and entire community . Major effort was addressed to mass health education , nutrition education , antismoking-propag and a and detection and treatment of hypertension , diabetes and hyperlipidemia In a r and omized , single-blind , controlled trial , 621 patients were assigned either intervention diet A ( group A , 310 patients ) or control diet B  ( group B , 311 patients ) for a period of 24 weeks . After 24 weeks as revealed by dietary question naires , group A patients received : ( 1 ) a diet with a higher percentage of calories from fruits and vegetables and complex carbohydrates ; ( 2 ) a higher polyunsaturated/saturated fat ratio diet ; and ( 3 ) a larger amount of soluble dietary fiber , antioxidant vitamins and minerals and low saturated fat and cholesterol than group B. Group A patients also did more physical and yogic exercises than group B. Adherence to diet and exercise was obtained through question naires and information obtained was quantified into a formula . After 24 weeks , the overall score of diet and exercises  was significantly higher in group A than in group B. There was a significant decrease in serum total cholesterol ( 13.3 % ) , low-density lipoprotein cholesterol ( 16.9 % ) , triglycerides ( 19.2 % ) , fasting blood glucose ( 19.5 % ) and blood pressures ( 11.5/6.2 mm Hg ) in the intervention group compared with initial levels and changes in group B. The effect of  exercise  on the decrease in risk factors was additive . Within group A , overall score for diet and exercise  was greater in 1 subset of 116 patients in the intervention group which had maximal lifestyle changes . A separate analysis of data in this subgroup revealed a greater decrease in risk factors compared with risk factor changes in the remaining 194 patients with less higher overall score ; this indicated that the relation of lifestyle changes with reduction in risk factors may be of causal nature . ( ABSTRACT TRUNCATED AT 250 WORDS Intervention on high risk persons for CHD has shown varying results depending on the effectiveness of the intervention . Most studies have concentrated on the high-risk person only . The present study focuses on the high-risk family as an entity . 1373 high-risk men , 30 - 55 years , were identified on the basis of high total cholesterol and /or low relative HDL ( HDL-cholesterol/tot . cholesterol ) in the Tromsø II screening in 1979/80 , and r and omly allocated to intervention or control group . The 673 men in the intervention group and their families , were offered advice to reduce their risk during two home visits and later by quarterly newsletters . Follow-up blood sample s drawn 1.5 years following the home-visit , show a small reduction in total cholesterol and an increase in the ratio of HDL cholesterol/total cholesterol . Both the intervention and control group were invited to the examination in connection with the Tromsø III screening in 1986/87 and are being followed for 10 years on cardiovascular morbidity and mortality Summary Fifty hypertensive Type 2 ( non-insulin-dependent ) diabetic patients were allocated , in a controlled trial , to a treatment diet of high fibre , low fat and low sodium composition , or to a control diet by the hospital dietitian . After 3 months treatment , the modified diet-treated group showed a highly significant reduction in mean systolic ( 180.5±19.0 to 165.0±20.7 mmHg ) and diastolic blood pressure ( 96.6±9.3 to 88.0±10.5 mmHg ) , accompanied by significant reductions in urinary sodium excretion ( 183.0±62.1 to 121.7 + 65.8 mmol/day ) glycosylated haemoglobin ( 12.4±3.1 to 10.5±2.9 % ) , weight ( 74.6s±13.5 to 71.7±12.1 kg ) and serum triglyceride levels ( p<0.05 ) . The mean values of diastolic pressure ( p<0.01 ) , urinary sodium/potassium ratio ( p < 0.001 ) , urinary potassium ( p<0.01 ) was significantly reduced at 3 months compared to control . No changes in serum HDL-cholesterol levels were observed . The number of patients with normal blood pressure at 3 months was greater in the modified diet-treated group ( ten versus five ) . Treatment of mild hypertension in diabetic subjects with this form of dietary regimen has a hypotensive response , with improvement in glycaemic control and no side effects . This modified diet may be an attractive alternative to anti-hypertensive drug therapy as a first line treatment The study deals with 412 men , aged 30 to 64 years , r and omized 1 to 2 years after a first myocardial infa rct ion . For the experimental group a diet low in saturated fats and cholesterol , and high in polyunsaturated fats was recommended . After 5 years , as reported previously , the incidence of fatal and nonfatal myocardial reinfa rct ion was found to be significantly reduced . “ Sudden death ” was uninfluenced . Major coronary heart disease ( CHD ) relapses , including fatal and nonfatal events ( MI ) , were significantly reduced ( P = 0.05).After 11 years , death from all causes had occurred in 101 of the original dieters and 108 controls . A significantly reduced myocardial infa rct ion mortality in the original diet group was found ( 32 versus 57 , P = 0.004 ) . The total number of coronary deaths ( fatal myocardial infa rct ion and sudden death ) was 79 in the diet group and 94 in the control group ( P = 0.097).The CHD mortality was correlated with age , serum cholesterol level , blood pressure , body weight , smoking habits , and a combination of these risk factors This paper reports research using data in the Nijmegen Family Practice Monitoring Project . One part of the research is follow-up , after 17 y , of a 1977 trial of dietary advice for patients with hypertension or a family history of premature cardiovascular disease . In the intervention group , 840 patients were given health education every 2 mo by trained practice nurses  for 1 y. There were 497 patients with similar coronary risk factors in the control group , who received usual care .  One year after the intervention a significant decrease was found ( and published ) in serum cholesterol concentrations and blood pressure in the intervention group . By the time of the 1995 reexaminations , however , there were no differences in coronary risk factors between the two groups . Blood pressures had come down , more so in the control group , and the percentage of smokers had decreased equally in both groups . There were no significant differences in intake of dietary fat or in type of fat . The lack of difference was still found when the groups were divided into those with serum cholesterol concentrations > and < 6.5 mmol/L. A second part of the research was to investigate in 1995 the relation between patients ' stage of change of fat intake and their dietary intake . It was found that those in stage 5 ( sustaining desired changes in behavior ) had the lowest saturated fat intake . Since 1977 both groups have been treated equally if hypertension was diagnosed . The two groups were not managed differently with regard to dietary advice after 1977 Health risk appraisal ( HRA ) remains one of the most widely used health promotion tools despite only equivocal evidence for its effectiveness . Theories of behavior change predict conventional HRA 's ineffectiveness because risk information alone is seldom sufficient to change complex behaviors . In this study , a r and omized trial compared the effects of feedback from an enhanced HRA with a typical HRA and a control group among adult patients from eight family medicine practice s. The enhanced HRA assessed behavior-specific psychosocial factors and provided patients with computer-generated , individually-tailored behavior change information in addition to typical HRA risk feedback . Changes in seven behaviors were assessed at a 6 month follow-up . Overall , patients receiving enhanced HRA feedback were 18 % more likely to change at least one risk behavior than were patients receiving typical HRA feedback or no feedback ( OR = 1.18 , 95 % CI = 1.00 , 1.39 ) . The enhanced HRA feedback appeared to promote changes in cholesterol screening , dietary fat consumption and physical activity , but not in smoking , seat belt use , mammography and Pap smears . We conclude that the addition of theory-based , individually-tailored behavior change information may improve the effectiveness of HRA OBJECTIVE To investigate the impact of intensive group education on the Mediterranean diet on  dietary intake and serum total cholesterol after 16 and 52 weeks , compared to a posted leaflet with the Dutch nutritional guidelines , in the context of primary prevention of cardiovascular disease ( CVD ) . DESIGN Controlled comparison study of an  intervention group  given intensive group education about the Mediterranean diet and a  control group of hypercholesterolaemic persons  given usual care by general practitioners ( GPs ) . SETTING A socioeconomically deprived area in the Netherl and s with an elevated coronary heart disease ( CHD ) mortality ratio . SUBJECTS Two hundred and sixty-six hypercholesterolaemic persons with at least two other CVD risk factors . RESULTS After 52 weeks , the intervention group decreased total and saturated fat intake more than the control group ( net differences were 1.8 en% ( 95%CI 0.2 - 3.4 ) and 1.1 en% ( 95%CI 0 . 4 - 1.9 ) , respectively ) . According to the Mediterranean diet guidelines the intake of fish , fruit , poultry and bread increased in the intervention group , more than in the control group . Within the intervention group , intake of fish ( + 100 % ) , poultry ( + 28 % ) and bread ( + 6 % ) was significantly increased after 1 year ( P < 0.05 ) . The intensive programme on dietary education did not significantly lower serum cholesterol level more ( -3 % ) than the posted leaflet ( -2 % ) ( net difference 0.06 mmol l-1 , 95%CI -0.10 to 0.22 ) . Initially , the body mass index ( BMI ) decreased more in the intervention group , but after 1 year the intervention and control group gained weight equally ( + 1 % ) . CONCLUSIONS Despite beneficial changes in dietary habits in the intervention group compared with the control group , after 1 year BMI increased and total fat and saturated fat intake were still too high One hundred and sixty eight subjects participated in a r and omised crossover study to determine whether halving or doubling the present dietary cholesterol intake from eggs had any influence on  blood cholesterol concentration in people following current dietary recommendations . During the first eight weeks all participants were advised to follow a reduced fat diet ( 26 % total energy for hyperlipidaemic patients , 35 % total energy for normolipidaemic volunteers ) with an increased ratio of polyunsaturated to saturated fatty acids . This background diet was continued throughout the 16 week experimental period , during which participants ate either two or seven eggs a week . A small but significant increase in total cholesterol was seen after four weeks in the group eating seven eggs a week compared with that in the group eating two eggs a week , but this was no longer apparent after eight weeks . Previous studies suggesting that dietary cholesterol has a greater effect on the serum cholesterol concentration either have been carried out against a background of a higher fat intake or have contrasted extreme cholesterol intakes . A further reduction in dietary cholesterol  seems to be unnecessary in those people who have already reduced their intake of saturated fat and increased the ratio of polyunsaturated to saturated fatty acids and fibre rich carbohydrate STUDY OBJECTIVE --This paper describes the objectives , design , and methods of evaluation of the impact of the coeur en santé St-Henri programme , as well as selected results from the evaluation to date . It discusses the possible effects of study design choices made to maintain the impact evaluation within budget . DESIGN --The impact of the programme is evaluated in a community trial which compares the prevalence of cardiovascular disease behavioural risk factors before and after programme implementation in the intervention and a matched comparison community , in both longitudinal cohort and independent sample surveys . In addition , repeated independent sample surveys are conducted in the intervention community to monitor awareness of and participation in the programme . PARTICIPANTS --The baseline sample for both the longitudinal cohort and independent sample surveys included 849 subjects from the intervention community ( 79.3 % of 1071 eligible subjects--8.0 % could not be contacted and 12.6 % refused ) and 825 subjects from the comparison community ( 77.8 % of 1066 eligible subjects--6.6 % could not be contacted and 15.6 % refused ) . The two surveys on awareness and participation conducted to date , included 461 ( 71.0 % of 649 eligible subjects ) and 387 ( 67.9 % of 570 eligible subjects ) subjects respectively from the intervention community . MEASUREMENTS --Baseline data for the longitudinal cohort and independent sample surveys on behavioural risk factor outcomes including use of tobacco , physical activity behaviour , high fat diet , and behaviours related to blood pressure and cholesterol control were collected in 35 minute telephone interviews in both the intervention and comparison communities . Data on awareness of and participation in the programme were collected in 10 minute interviews in the intervention community only in two independent sample surveys conducted seven and 22 months respectively after the baseline survey . RESULTS --With the exception of smoking , the intervention and comparison communities were similar at baseline with regard to the prevalence of behavioural risk factors studied . Awareness of the coeur en santé programme increased from 64.1 % in January 1993 to 72.9 % 15 months later . Participation in the programme increased from 21.3 % to 33.7 % . CONCLUSIONS --This paper presents background information on the evaluation of the impact of the coeur en santé programme , as a reference for future publications An 8-week combination low sodium , low fat , high fibre diet was compared to the individual components of this diet in a controlled trial using 193 patients already on treatment for essential hypertension . No significant changes were observed in the high fibre group . The low sodium group showed a decrease in systolic blood pressure which was close to significance . The low fat group showed a small but significant decrease in seated diastolic blood pressure and weight . The combination group showed larger and highly significant decreases in seated and st and ing systolic blood pressures , seated diastolic blood pressure and weight , as well as a significant reduction in st and ing diastolic blood pressure . We conclude that multiple dietary intervention in this case in the form of a low sodium , low fat , high fibre diet , is more effective than any single dietary intervention and is useful in patients already on medication The Paris Cardiovascular Risk Factor Prevention Trial was design ed to determine whether individualised intervention could induce a reduction in the coronary risk factor levels in young men . Three thous and three hundred and thirty-six men aged 25 to 35 , working in the 160 sections of a large Parisian administration , were examined . The section were r and omly allocated to a control and an intervention group . Advice concerning diet , cigarette smoking , and physical activity was provided repeatedly to the subjects in the intervention group . Two years after the first intervention , the first 1292 subjects who entered the study , whether from the intervention or the control group , were recalled ; 86 % of the intervention group and 84 % of the control group responded . The changes in weight , blood pressure , and cigarette smoking in the intervention group , corrected for changes in the control group , were respectively -0.4 kg ( p = 0.06 ) , -1.4 mm Hg ( p less than 0.05 ) , and -1.2 cigarettes ( p less than 0.01 ) . There was no difference between the two groups in serum cholesterol change . Most of these results concerning young men are in agreement with recently reported results of community intervention programmes in middle-aged men This study compares the effect of two interventions focussed on the promotion of Mediterranean nutrition behavior .  The target groups are persons with three risk factors for development of cardiovascular disease . The study region is a socio-economically deprived area in the Netherl and s. The first intervention consisted of three meetings in which the positive health effects of a Mediterranean diet were discussed in group sessions . In the additional intervention stage-matched information based on the Transtheoretical Model of behavior change was given . Both intervention groups were compared with a control group , which received only a printed leaflet with the Dutch nutritional guidelines . At baseline the three subgroups were comparable and after 16 weeks both intervention strategies result ed in significant changes in comparison with the control condition . For fish consumption , both strategies result ed in more positive attitudes , social norms , stronger intentions , more progress in stage of change and better nutritional intake . For fruit/vegetables consumption , the effects of both strategies were limited to stage of change and nutritional intake . Additional individually stage-matched tailored letters did not result in more progress on any of the dependent variables . We conclude that substantial nutritional behavior change can be achieved by interactive group education in socio-economically deprived population groups The Multiple Risk Factor Intervention Trial ( MRFIT ) was one of the coronary heart disease prevention trials recommended to the National Heart and Lung Institute in 1971 as an alternative to a national single-factor dietary trial , which was judged to be infeasible . MRFIT was a r and omized , primary prevention trial , conducted at 22 US clinical centers from 1973 to 1982 to test whether lowering elevated serum cholesterol and diastolic blood pressure and ceasing cigarette smoking would reduce coronary heart disease mortality .  Men 35 - 57 y of age ( n = 12,866 ) with one or more of these risk factors were r and omly assigned to the special intervention ( SI ) or usual care ( UC ) group and followed for 6 - 8 y. UC men were given information on risk factors , referred to their usual sources of care , and reexamined annually . SI participants received group and individual counseling on a fat-modified diet , a stepped-care drug treatment program for diastolic hypertension ( after an initial attempt at  blood pressure control by weight reduction , if indicated ) , and , for cigarette smokers , counseling aim ed at cessation . SI men had risk factor assessment s every 4 mo and annual examinations that were generally identical to those given to UC men and that always included measurement of blood cholesterol concentration . A listing of variables measured at each visit along with the design and major mortality results of MRFIT are included in this chapter Seventy-five persons ( 57 male and 18 female ) with a high risk of coronary heart disease ( CHD ) were r and omly assigned in equal numbers to three 8-week behavioral treatment programs . All three treatments were design ed to alter simultaneously a number of risk-elevating behavior patterns , in the expectation that change in any one behavior pattern would reinforce change in others . Weight , blood pressure , and aerobic fitness were regularly assessed in all subjects . Serum lipids were also measured , but less frequently . All three interventions produced significant beneficial changes in the major objective measures , and the changes were well maintained after 12 months . The most improved group exhibited the following mean changes : weight loss of 9.2 kg , reductions in blood pressure of 12.9/8.8 mm Hg , improvement in aerobic capacity of 33 % , reduction in serum cholesterol of 0.45 mmol/liter , and reduction in current overall CHD risk of 41 % . The effectiveness of the interventions was positively related to the degree to which the programs emphasized training in , and detailed application of , behavioral change principles Objective — To evaluate Diabeto , a computer-assisted diet education system . Research Design And Methods — One hundred five patients with insulin-dependent diabetes mellitus ( IDDM ) or non-insulin-dependent diabetes mellitus ( NIDDM ) were divided into two r and omized groups to participate in the evaluation of Diabeto . With free access through Minitel , the French public videotex network , Diabeto helps diabetic patients self-monitor their diets and balance their meals with personalized counseling . Results — During the first 6-mo study , group A ( 54 patients ) used Diabeto , whereas group B ( 51 patients ) were control subjects . For the second 6-mo study , group B used the system . Evaluation was based on patients ' dietetic knowledge , dietary habits , and metabolic balance . Conclusions –Diabeto led to a significant improvement of dietetic , knowledge in group A ( P < 0.0005 ) and also to improved dietary habits ; decreased caloric intake in patients initially overeating ( P < 0.05 ) , increase of dietary carbohydrate from 39.7 ± 0.7 to 42.9 ± 0.9 % in patients with an initial intake < 45 % carbohydrate , and decrease of fat intake from 41.9 ± 0.9 to 37.4 ± 1.1 % in patients with an initial intake of > 35 % fat ( P < 0.0005 ) . In the second study , in addition to similar improvements to those observed in the first study , HbA1 decreased from 11.0 ± 0.4 to 9.9 ± 0.4 % ( P < 0.005 ) and fructosamine from 5.00 ± 0.17 to 4.57 ± 0.17 % ( P < 0.001 ) . Diabeto appears to be an effective therapeutic tool in the control of metabolic diseases We studied separately the effects of weight loss by calorie restriction ( dieting ) and by calorie expenditure ( primarily , running ) on lipoprotein subfraction concentrations in sedentary , moderately overweight men assigned at r and om into three groups as follows : exercise without calorie restriction ( n = 46 ) , calorie restriction without exercise ( n = 42 ) , and control ( n = 42 ) . Plasma lipoprotein mass concentrations were measured by analytic ultracentrifugation for flotation rates ( F0(1.20 ) , S0f ) within high density lipoprotein ( HDL ) ( F0(1.20 ) 0 - 9 ) , low density lipoprotein ( LDL ) ( S0f 0 - 12 ) , intermediate density lipoprotein ( IDL ) ( S0f 12 - 20 ) , and very low density lipoprotein ( VLDL ) ( S0f 20 - 400 ) particle distributions . Particle diameter and flotation rate of the most abundant LDL species were determined by nondenaturing polyacrylamide gradient gel electrophoresis and analytic ultracentrifugation , respectively . During the 1-year trial , the exercisers ran ( mean + /- SD ) 15.6 + /- 9.1 km/wk , and the dieters ate 340 + /- 71 fewer kilocalories per day than at baseline . Total body weight was reduced significantly more in dieters ( -7.2 + /- 4.1 kg ) and exercisers ( -4.0 + /- 3.9 kg ) than controls ( 0.6 + /- 3.7 kg ) . As compared with mean changes in controls , the exercisers and dieters significantly increased HDL2 mass ( 48.6 % and 47.1 % , respectively ) , decreased VLDL mass ( -23.9 % and -25.5 % ) , and increased LDL peak particle diameter ( 2.4 and 3.2 A ) . When adjusted to an equivalent change in body mass index by analysis of covariance , 1 ) exercise-induced and diet-induced weight loss produced comparable mean changes in the mass of small LDL and VLDL , and in LDL peak particle diameter ; 2 ) the exercisers versus control group difference in HDL2 was attributed to the exercisers ' reduced body mass index ; and 3 ) HDL2 increased significantly less in dieters than in exercisers . In dieters , low calorie intake might mitigate the effects of weight loss on HDL2 In a pilot health promotion program for couples , we aim ed to build on re-evaluation of attitudes to health occurring early in marriage , and social support provided by partners , to address the weight gain and physical inactivity which may follow marriage . A r and omized controlled trial lasting 16 weeks used six modules focusing on nutrition and physical activity but including information about alcohol and smoking . Thirty-four of 39 couples enrolled completed the study .  Self-efficacy for diet and physical activity increased significantly in the program group while ranking of barriers to healthy behaviours decreased and ranking of beliefs about the benefits of health behaviours increased relative to controls . Intake of fat , take-away foods and alcohol decreased , and consumption of fruit , vegetables and reduced-fat foods increased significantly in the program group .  Physical activity  in the program group increased by the equivalent of 50 min of brisk walking weekly but did not differ significantly from controls . Cholesterol fell significantly by 6 % more in the program group than controls . In focus groups , participants unanimously found the program valuable . Health promotion programs design ed for couples can achieve short-term changes in behaviour and risk factors . Larger trials with longer-term monitoring , incorporating feedback from focus groups and cost-benefit analysis , are in progress The purpose of this study was to evaluate the effects of a revised worksite health promotion program that featured an employee steering committee/menu approach to intervention . The “ Take Heart II ” program was evaluated using a quasi-experimental matched-pair design with worksite as the unit of analysis . Experimental and control worksites did not differ on baseline organizational or employee demographic variables or on baseline levels of dependent variables . Outcome and process results revealed consistent , but modest effects favoring intervention worksites on most measures . Cross-sectional analyses generally failed to produce statistically significant intervention effects , but cohort analyses revealed significant beneficial effects of the Take Heart II intervention on eating patterns , behavior change attempts , and perceived social support . Neither analysis detected a beneficial effect of intervention on cholesterol levels The effect of probucol , a hypocholesteremic drug , in reducing blood lipids below the level achieved with diet alone , was studied in 19 free‐living hyperlipidemic patients ( 13 type IIA , 4 type VI [ IIB ] , 1 type III , 1 type V ) . Diet prescriptions were a4justed to lipid type . The study consisted of a 4 week adjustment period with patients on their usual diet , a 3 month period with fat‐modified diet and placebo , and a 3 month period with the same diet and 500 mg probucol twice a day . The mean serum cholesterol level of type IIA patients was the same for the placebo and probucol periods , but there were large differences among individual patients . One type IIA patient had an increase of 19.2 % with probucol , 5 had no change , and 7 had an additional reduction of 8.1 % . There was a mean reduction of serum cholesterol level of 8.8 % in 4 type VI , 1 type III , and 1 type V patient ; serum triglyceride levels in these 6 patients were reduced by 22 % . Lipoprotein patterns were unchanged . There were no side effects from probucol OBJECTIVE To compare two interventions for reducing dietary fat intake in first degree relatives of recent heart attack victims . DESIGN A r and omised controlled trial comparing a low cost mail-out advice program ; referral to a general practitioner ( GP ) ; and no intervention ( control group ) . PARTICIPANTS Adult children or siblings , aged less than 70 years , of survivors of definite or suspected heart attack who had been admitted to hospitals in the Lower Hunter Region of New South Wales . MAIN OUTCOME MEASURES  Dietary fat intake ( evaluated with a vali date d short question naire ) and measurement of blood cholesterol levels at six months . RESULTS Of the 342 relatives who participated ( 36 % of those invited ) , 109 , 120 and 113 , respectively , were r and omly assigned to receive a mail-out intervention , advice from their GP or to be part of a control group . The six-month follow-up question naire was completed by only 59 % of those in the mail-out intervention group compared with 71 % of the GP group and 77 % of the control group . Younger participants , cigarette smokers and children ( compared with siblings ) were less likely to return a follow-up question naire . The mail-out group showed a statistically significant 20 % reduction in self-reported dietary fat intake , but this was not seen in either the GP group or the controls . The low response rate meant the study had insufficient power to detect hypothesised changes in blood cholesterol . CONCLUSION Because of the poor response rate and possible biases from a differential response to follow-up , we conclude that this low intensity intervention for relatives of people with recent heart attack produces only a modest improvement in reported dietary fat intake . Alternative strategies may be more effective in reducing the risk of heart disease OBJECTIVE To evaluate the costs and effects of incremental components of a weight-loss program . DESIGN A 3-arm , 12-month r and omized controlled clinical trial to evaluate 3 incremental levels of intervention intensity . SUBJECTS/ SETTING The study included 588 individuals ( BMI > 25 kg/m2 ) in a freest and ing health maintenance organizalion and achieved an 81 % completion rate . INTERVENTION Using a cognitive behavioral approach for tailoring lifestyle modification goals , the incremental levels of intervention included a ) a workbook alone , b ) the addition of computerized tailoring using onsite computer kiosks with touch screen monitors , and c ) the addition of both computers and staff consultation . MAIN OUTCOME MEASURES Endpoints included weight parameters , lipid profile , plasma glucose , blood pressure , intervention costs , dietary intake , and physical activity . STATISTICAL ANALYSIS PERFORMED Study endpoints were analyzed using analysis of variance for normally distributed variables and analysis of covariance to control for any baseline differences . Regression and correlation analysis assessed the relationship between weight loss and other variables . RESULTS For the increasing levels of intervention intensity , the mean 12-month weight losses were 2.2 , 4.7 , and 7.4 pounds , with the respective cost per participant being $ 12.33 , $ 41.99 , and $ 133.74 . The decreases in mean BMI s for these respective intervelation levels were 0.4 , 0.9 and 1.2 . All groups reported a decrease in energy and fat intake and an increase in blocks walked ( P<.01 ) . Intervention variables that correlated with weight loss included more computer log-ons , achieving computer-selected goals , more self-monitoring , increased walking , and decreased energy and fat intake , as well as higher attendance in staff consultation group sessions for that treatment condition . Weight loss correlated with decreases in fasting glucose and blood pressure . APPLICATIONS/ CONCLUSIONS In a weight-loss program , computers can facilitate selecting behavioral change goals . More frequent usage result ed in greater weight loss . Staff counseling to augment the computer intervention achieved the most weight loss Despite evidence that dietary fat intake may influence breast cancer risk , there is little information about the effects of dietary fat on the human breast . We have studied the effects of dietary fat on the breast by examining the influence of dietary fat reduction on mammographic dysplasia ( nodular or sheetlike areas of radiological density ) . Subjects with mammographic dysplasia were r and omly allocated to a control group , in which they received advice about maintaining a balanced diet ( 36 % of calories as fat ) , or an intervention group , in which they were taught to reduce dietary fat to a target of 15 % of calories . A total of 295 patients consented to r and omization , and after 1 year , 20 % of the intervention group and 5 % of the control group had dropped out ( failed to keep appointments and provide nutrient data ) . The remaining patients closely adhered to the dietary goals of the study as assessed by food records , chemical analysis of duplicate meals , and serum cholesterol measurements . Comparison of mammograms before and after 1 year of dietary fat reduction shows no significant influence on the extent or density of mammographic dysplasia . Surgical biopsies performed in subjects after entry in the study showed five cancers in the control group and two cancers in the intervention group ; this total of seven cancers is four times the number expected . These data show that clinical trials of the effects of  dietary fat reduction  on breast cancer risk are feasible and that long-term compliance with a low-fat diet can be achieved , and they confirm that the patients selected because they had mammographic dysplasia had increased risk of breast cancer This study evaluated the 12-month follow-up results and costs of a personalized , medical office-based intervention focused on behavioral issues related to dietary self-management . Two hundred and six adults having diabetes attending an internal medicine outpatient clinic visit were r and omized to either Usual Care or to Brief Intervention . The single session intervention involved touchscreen computer-assisted assessment that provided immediate feedback on key barriers to dietary self-management , goal setting and problem-solving counselling . Follow-up components included phone calls and videotape intervention relevant to each participant . Brief Intervention produced significantly greater improvement than Usual Care on multiple measures of change in dietary behaviour ( e.g. , covariate adjusted difference of 2.2 % of calories from fat ; p = 0.023 ) and on serum cholesterol levels ( covariate adjusted difference of 15 mg/dl ; p = 0.002 ) at 12-month follow-up . There were also significant differences favouring intervention on patient satisfaction ( p < 0.02 ) but not on HbA1c levels . The costs of intervention ( $ 137 per patient ) were modest relative to many commonly used practice OBJECTIVE This study examined the psychological consequences of a modest weight loss in a sample of healthy women aged 44 to 50 . METHOD Five hundred and thirty-five women , with body mass indices ( BMI s ) ranging from 20 to 34 , were r and omly assigned either to an intensive behavioral lifestyle intervention or to a no-treatment control group . Women in the lifestyle intervention received weight loss goals of 5 to 15 lb , depending on baseline BMI , and attended 20 weekly group meetings during which they received information on lowering dietary fat intake and increasing physical activity levels . Psychological measures administered at baseline and at a 6-month examination assessed perceived stress , mood , dietary restraint , and binge eating behaviors . RESULTS Intervention subjects showed significant decreases in depressive symptoms over time , relative to control subjects , and this effect was observed for normal-weight , as well as heavier , subjects . Binge eating scores for all subjects declined significantly over time , with heavier subjects in the intervention showing the greatest decrease in scores . DISCUSSION The current study found no evidence of negative psychological sequelae of participation in a behavioral lifestyle change program , regardless of weight status . Results further suggest that participation in these types of programs may exert a positive influence on the psychological status of both normal-weight and heavier women The effect of an ordinary lipid-lowering diet on serum insulin response to oral glucose load was investigated in a r and omized , primary preventive trial of the Oslo Study of coronary heart disease in healthy high risk middle aged men . After 3 years intervention the treated group showed a significantly lower insulin response curve , a lower serum total cholesterol , a higher cholesterol ratio ( defined as the ratio between high density lipoprotein cholesterol and low density + very low density lipoprotein cholesterol ) , lower fasting triglycerides and lower relative body weight than the control group . Increased levels of serum insulin and elevated insulin response to oral glucose load has been shown in earlier studies to be associated with increased susceptibility for atherosclerotic diseases . Therefore , it might be of importance , that lipid-lowering diet induce a lowering of serum insulin response in healthy , coronary prone men . As a contrast to the two high risk groups , the very low response curve of serum insulin and glucose in a group of coronary low risk men is also presented , and it is suggested that serum insulin levels should be added to the coronary prone syndrome of hyperlipidemia , obesity and physical inactivity To evaluate the effects of a high complex carbohydrate , low lipid diet on the management of coronary artery disease , we review ed data on 32 patients , who had participated in a diet and exercise program , and compared the results with 40 patients who had been managed only with exercise .  After a follow-up period of 10 to 16 weeks the patients on the diet-exercise program showed significant reduction in body weight ( -6 + /- 2 kg mean + /- st and ard deviation ) , serum cholesterol ( -43 + /- 41 mg/dl ) , and triglycerides ( -51 + /- 70 mg/dl ) , while patients who were managed only with exercise had no significant changes in weight or serum lipids . Both the diet-exercise and the exercise groups showed significant improvement in working capacity and reduction in resting systolic blood pressure . Patients on the diet-exercise program had significantly less angina ( 21.9 % ) occurring on the exercise test after the program compared to before , even though the same double product was reached . Multiple logistic regression analysis of the data for patients with angina on the exercise test demonstrated that the only significant ( p = 0.004 ) contributor for reduction in angina was the dietary intervention . Beta-blocking drugs did not affect the results . Although r and omized controlled trials must be run in order to ascertain the significance of this finding , this study strongly suggests that a low lipid , high carbohydrate diet is a useful addition to exercise in the management of patients with coronary disease Abstract Objective : To assess the value of health education for patients with angina in reducing risk factors for cardiovascular disease and lessening the effect of angina on everyday activities . Design : R and omised controlled trial of personal health education given every four months . Setting : 18 general practice s in the greater Belfast area . Subjects : 688 patients aged less than 75 years and known to have had angina for at least six months ; 342 r and omised to receive education and 346 to no education .  Main outcome measures : Restriction of everyday activities , dietary habit , smoking habit , frequency of physical exercise ; blood pressure , body mass index , and serum total cholesterol concentration at entry to trial and after two years . Results : 317 in the intervention group and 300 in the control group completed the trial . At the two year review more of the intervention group ( 140 , 44 % ) reported taking daily physical exercise than the control group ( 70 , 24 % ) . The intervention group also reported eating a healthier diet than the control group and less restriction by angina in any everyday activity . No significant differences were found between the groups in smoking habit , systolic or diastolic blood pressure , cholesterol concentration , or body mass index . Conclusion : Despite having no significant effect on objective cardiovascular risk factors , personal health education of patients with angina seems to increase exercise and improve dietary habits and is effective in lessening the restriction of everyday activities Male employees from four local worksites were recruited to participate in a short-term and low-intensity nutrition intervention which focused on promoting low-fat dietary habits . The sites were r and omized to control conditions or to the intervention programme that consisted of an individualized health risk appraisal , group sessions , mass media activities and environmental changes . Participants were seen before and three months after intervention to measure blood lipids , nutrition knowledge and dietary changes .  Eighty-three per cent of all eligible subjects were screened ( n = 770 ) and follow-up measures were obtained for 82 % . The score for nutrition knowledge improved significantly in the intervention group . There was also a net reduction in the intake of total calories and in the percentage of energy from total fat . Reported intake of carbohydrates and proteins increased . For all employees assessed , there were no changes in mean total cholesterol level or fatty acid composition . Only among participants with hypercholesterolemia was a significant reduction in blood cholesterol observed . This low-intensity intervention programme achieved some self-reported dietary changes and was successful ( at least in part because statistical regression needs to be considered ) in obtaining a more short-term beneficial cholesterol level in employees at higher cardiovascular risk This report examines the maintenance of a low-fat diet  1 year on average after the completion of intervention sessions among participants in the Women 's Health Trial ( WHT ) . The WHT was a r and omized controlled trial of the feasibility of adoption of a  low-fat diet among women of moderate or increased risk of breast cancer , conduced in Seattle , Houston , and Cincinnati in 1985 - 1988 . The women r and omized to the low-fat diet attended an intensive dietary intervention program for 5 - 37 months . Intervention women were highly successful in reducing their dietary fat intake from 40.0 % of energy intake at baseline to 26.3 % by the end of the trial , based on a food frequency question naire ( or an estimated 24 % adjusted for the inaccuracies of a food frequency question naire versus a 4-day diet record ) . During 1989 , 1 year on average after the WHT ended , 448 intervention women and 457 control women ( 87 % of eligibles ) completed a follow-up survey to determine the degree of maintenance of the diet . The intervention women maintained the low-fat diet  with an increase of only 1.4 percentage points of energy from fat , despite the fact that they had attended no further intervention sessions and had made no commitment to maintain the diet beyond the end of the WHT . Furthermore , the degree of maintenance of the low-fat diet was not dependent on the length of time in the intervention , which suggests that intervention led to a sustained change in eating habits after as little as 5 - 9 months ( 8 - 13 classes ) . ( ABSTRACT TRUNCATED AT 250 WORDS High-density lipoprotein ( HDL ) cholesterol is known to be low in patients with diabetes mellitus . Low HDL levels are correlated with premature cardiovascular mortality in several major epidemiologic studies and many investigators believe increases in HDL cholesterol may reduce the risk of coronary heart disease . We evaluated dietary and exercise interventions in relation to HDL cholesterol in patients with type II diabetes mellitus . Sixty-five volunteers were r and omly assigned to one of four experimental conditions : diet , exercise , diet plus exercise , or education control . Three months after entering the program , those exposed to the dietary intervention had significant increases in HDL cholesterol . HDL increases for the other two treatment groups did not differ significantly from the education control OBJECTIVE The triglyceride-lowering effects of ω-3 fats and HDL cholesterol-raising effects of exercise may be appropriate management for dyslipidemia in NIDDM . However , fish oil may impair glycemic control in NIDDM . The present study examined the effects of moderate aerobic exercise and the incorporation of fish into a low-fat ( 30 % total energy ) diet on serum lipids and glycemic control in dyslipidemic NIDDM patients . RESEARCH DESIGN AND METHODS In a controlled , 8-week intervention , 55 sedentary NIDDM subjects with serum triglycerides > 1.8 mmol/l and /or HDL cholesterol < 1.0 mmol/l were r and omly assigned to a low-fat diet ( 30 % daily energy intake ) with or without one fish meal daily ( 3.6 g ω-3/day ) and further r and omized to a moderate ( 55–65 % VO2max ) or light ( heart rate < 100 bpm ) exercise program .  An oral glucose tolerance test ( 75 g ) , fasting serum glucose , insulin , lipids , and GHb were measured before and after intervention . Self-monitoring of blood glucose was performed throughout . RESULTS In the 49 subjects who completed the study , moderate exercise  improved aerobic fitness ( VO2max ) by 12 % ( from 1.87 to 2.07 l/min , P = 0.0001 ) . Fish consumption  reduced triglycerides ( 0.80 mmol/l , P = 0.03 ) and HDL3 cholesterol ( 0.05 mmol/l , P = 0.02 ) and increased HDL2 cholesterol ( 0.06 mmol/l , P = 0.01 ) . After adjustment for age , sex , and changes in body weight , fish diets were associated with increases in GHb ( 0.50 % , P = 0.05 ) and self-monitored glucose ( 0.57 mmol/l , P = 0.0002 ) , which were prevented by moderate exercise . CONCLUSIONS A reduced fat diet incorporating one daily fish meal reduces serum triglycerides and increases HDL2 cholesterol in dyslipidemic NIDDM patients . Associated deterioration in glycemic control can be prevented by a concomitant program of moderate exercise The purpose of this work was to examine in an open , r and omized parallel-group study whether an intervention programme directed towards hypercholesterolaemia , smoking and diabetes mellitus in treated hypertensive men was associated with less complex formation between low-density lipoprotein ( LDL ) and human arterial proteoglycans than was the case with usual care . The intervention consisted mainly of non-pharmacological treatment , but drug therapy could be instituted to achieve the treatment goals in the intervention group . The intervention programme was associated with a significant reduction in body mass index , and 46 % of the patients were on lipid-lowering medication at the follow-up examination . The net differences were ( intervention -- usual care ) : change in serum LDL-cholesterol , -0.48 mmol L-1 ( 95 % confidence interval -0.84 to -0.11 mmol L-1 ) , precipitated LDL-cholesterol , -5.5 micrograms ( 95 % CI -9.0 to -1.1 micrograms ) . The latter remained after adjustment for the difference in serum LDL-cholesterol between groups . Our conclusion is that the multifactorial risk factor treatment programme was associated with a reduced tendency of LDL to form complexes with human arterial proteoglycans BACKGROUND There is increasing political pressure on the medical profession to approach welfare diseases , such as coronary heart disease and diabetes , through prevention . General practitioners are required to offer regular health checks to healthy people  , in spite of the lack of scientific evidence for the universal need , usefulness and side effects of such an intervention . R and omized controlled trials are needed . AIM A study was carried out to investigate people 's interest in participating in health checks and in discussion s about health with their own general practitioner , participants ' health status , the proportion who received health advice following health checks , and the lifestyle goals they set following discussion with their general practitioner . This study reports the baseline data from a five-year r and omized , controlled , prospect i ve , population -based study in general practice s in Ebeltoft , Denmark . METHOD All general practitioners from the four practice s in Ebeltoft and a r and om sample of 2000 people aged between 30 and 50 years were invited to participate . Participants were r and omly divided into three groups -- one control group and two intervention groups . One intervention group were given a health check which included being screened for cardiovascular risk factors , lung and liver function , fitness , sight and hearing and an optional test for the human immunodeficiency virus ( HIV ) ; this group received written feedback from the general practitioner . The other intervention group were also given a health check and written feedback ; in addition , they were given the opportunity to attend their general practitioner to discuss preventive health . RESULTS A total of 1370 people participated in the study ( 69 % response rate ) . Health advice was given to 76 % of 905 participants following health checks . Almost all of the 456 participants ( 96 % ) who were offered the opportunity of discussing their health with their general practitioner took up the offer ; 64 % of the 456 participants reported that they had decided to undertake lifestyle changes . Eleven of those who discussed their health with the doctor were referred to a specialist ( 2 % ) . CONCLUSION There was considerable interest in participating in health promotion . Three out of four of those having a health check were given health advice . Two out of three of those offered a health talk with the general practitioner appeared willing to make relevant lifestyle changes . Long-term follow up is needed to determine effects and side effects of health checks and health talks OBJECTIVES The aim of this study was to carry out a cost-effectiveness analysis of a multifactorial intervention programme in treated hypertensive patients . DESIGN A cost-effectiveness analysis based on 3 years of follow-up in an open , r and omized , parallel-group study with allocation either to a comprehensive , multiple-risk factor modification programme or to conventional treatment . SETTING An outpatient clinic of a city hospital . SUBJECTS Inclusion criteria were : male sex , age 50 - 72 ( mean 66.4 ) years , treated hypertension and at least one of the following : serum cholesterol > or = 6.5 mmol L-1 , and /or smoking and /or diabetes mellitus . A total of 508 patients were included in the study . INTERVENTIONS Advice given to individuals , and group meetings based on nutritional advice and behavioural treatment principles . If necessary , drug therapy could be instituted to achieve the treatment goals in the intervention group : serum total cholesterol of < 6.0 mmol L-1 , no smoking , HbAlc < 6.0 % and diastolic blood pressure < 90 mmHg in both groups . MAIN OUTCOME MEASURE Incremental cost per life-year gained of the intervention programme . RESULTS The cost per life-year gained was SEK 4000 in an estimation based on the observed risk reduction and ranged between SEK 62,000 and SEK 163,000 in three estimations based on the risk factor changes . CONCLUSIONS The analysis indicates that the intervention programme is cost-effective in the studied patient population Objective In a r and omized 5-yr multi-intervention trial , we tested the efficacy of intensified health education ( IHE ) in improving metabolic control and reducing the level of coronary risk factors and incidence of ischemic heart disease ( IHD ) . Research Design and Methods Within the intervention group , the benefit of clofibric acid was evaluated in a double-blind study . One thous and one hundred thirty-nine newly diagnosed middle-aged ( 30- to 55-yr-old ) patients with non-insulindependent diabetes mellitus ( NIDDM ) entered the study . They were classified as diet controlled after a 6- wk screening phase with conventional dietary treatment . During the follow-up , the control group ( n = 378 ) was cared for at different diabetes outpatient clinics with a st and ardized surveillance . The intervention group ( n = 761 ) had a structured IHE that included dietary advice , antismoking and antialcohol education , and ways to enhance physical activity . Results R and omly , 379 of the IHE patients received 1.6 g clofibric acid/day , and the others received placebo . IHE result ed in improved glucose control ( adjusted fasting blood glucose ) levels after 5 yr ( control subjects 9.27 mM , IHE group 8.71 mM , and IHE plus clofibric acid group 8.60 mM , P < 0.01 ) . The better glycemic control was achieved with fewer antidiabetic drugs . After 5 yr , antidiabetic drugs were prescribed to 47 % of the control subjects , 28 % of the IHE group , and 34 % of the IHE plus clofibric acid group ( cutoff limit for drug application was postpr and ial blood glucose of ≥13.87 mM ) . The ratio of polyunsaturated to saturated fatty acids ( 0.26 vs. 0.40 , P < 0.01 ) and physical activity ( 174 vs. 327 scores , P < 0.01 ) were increased , and blood pressure , tobacco , and alcohol consumption were significantly reduced by IHE . However , IHE had no effect on calorie intake , percentage of fat in the diet ( 45 % ) , and body weight . The most important finding was the significant increase of blood cholesterol in all three groups ( + 0.47 , + 0.36 , and + 0.34 mM , respectively ) . Clofibric acid only prevented the increase of triglyceride levels ( + 0.56 , + 0.24 , and + 0.05 mM , respectively ) . The incidence rate per 1000 for myocardial infa rct ion was 30.3 for control subjects , 53.6 for the IHE group , and 55.6 for the IHE plus clofibric acid group . The corresponding rates for IHD incidence were 90.9 , 97.8 , and 98.8 , respectively . Men suffered more frequently from myocardial infa rct ion , whereas women developed ECG criteria for IHD more frequently . Among the 35 cases of death , besides cardiovascular diseases , liver cirrhosis and neoplasia were the predominant causes . The death rate per 1000 in control subjects was 46.2 , 30.6 in the IHE group , and 27 among patients with IHE plus clofibric acid . Conclusions IHE was of substantial benefit for the control of glycemia , significantly diminished the need for antidiabetic drugs , and reduced a cluster of risk factors but had no effect on the control of blood lipids . This could be one major reason for the failure of IHE , effective lowering of blood pressure , and clofibric acid to prevent cardiovascular complications .  Clofibric acid was only effective in reducing triglycerides A sub study of the Hypertension Optimal Treatment study , conducted in the Jackson Mississippi Center , set out to determine the link between obesity and hypertension and to determine the effects of weight loss in hypertensive individuals . An analysis of the relationship between body mass index and diastolic blood pressure for another study showed that increasing body mass indices were associated with increases in blood pressure . This indicates that not only is there a strong relationship between obesity and hypertension , but that there is also a close association between the continuous variables of body mass index and blood pressure . The purpose of the present study was to determine the effectiveness of a weight loss regimen in reducing the amount of medication required to achieve the target blood pressure in 228 patients at the Jackson center . Subjects were r and omized to a dietary intervention group or to a control group .  Preliminary 3 month observational data showed that subjects who lost the appropriate amount of weight were three times more likely to achieve their target blood pressure at 3 months . These observations suggest that weight reduction regimens can reduce elevated blood pressure and can probably promote further blood pressure reductions when combined with drug therapy in the treatment of hypertension We evaluated dietary counselling by dietitians in hypercholesterolaemic hypertensives over 6 months . A total of 141 patients were r and omly assigned to intensive advice or usual care .  Body weight fell significantly in the intervention group , but did not in the controls . There was a modest but significant fall in total cholesterol from 7.1 to 6.8 and 7.1 to 6.9 mmol/l in the diet and the control groups , respectively ( 4 and 3 % ) . A similar pattern emerged from the triglyceride measurements . Low-density lipoprotein fell in both groups , but only achieved significance ( P less than 0.05 ) in the intervention group . High-density lipoprotein did not change . There was a more marked change in cholesterol when serum levels during the study were compared with the previous annual review . These falls occurred after selection for the study but before r and om allocation to groups . They are unlikely to reflect regression to the mean as the lipids were stable for 2 or more years before the study , but may reflect spontaneous changes in diet after the patients were labelled hypercholesterolaemic . Dietary advice can lower total cholesterol but the magnitude of this decrease is small . Additional approaches are likely to be required to reduce plasma cholesterol to a normal range 1 . We assessed whether a lifestyle modification programme implemented by nurse counsellors in a general practice setting would improve blood pressure ( BP ) control in treated hypertensive patients The aim of this study was to compare the effects of an intensive educational approach incorporating longer time , greater simplicity , repetition , and cognitive motivational techniques with a conventional one in subjects with established non-insulin-dependent diabetes mellitus ( NIDDM ) whose weight , glycemic control , and diet were not optimal . Subjects were r and omly allocated to intensive or conventional education .  Of 350 subjects , 70 met the study criteria , which included established NIDDM ( ≥3 mo ) , suboptimal recent glycemic control , dietary fat intake ≥35 % of total energy intake , and body massindex ≥25 kg/m2 . The intensive approach was associated with significantly greater improvements in dietary compliance , dietary intake ( complex carbohydrate , [ P = 0.013 ] , legumes [ P < 0.0001 ] , fiber [ P < 0.0001 ] , total fat [ P < 0.004 ] , saturated fat [ P < 0.004 ] ) , and total cholesterol level ( P = 0.007 ) . The transient improvement in glycemic control was similar in both groups . An intensive education program can improve dietary compliance in established NIDDM subjects more than a conventional one . These recommended dietary improvements achieve better improvement in total cholesterol but do not necessarily improve glycemic control OBJECTIVES To test the feasibility and effectiveness of a diet intervention ( consisting of interactive mailings , computer-generated phone calls , and classes ) in hypercholesterolemic low-income public clinic patients . METHODS Clinic patients with serum cholesterol > 200 mg/dl , referred by their primary care physician were r and omized to a 6-month special intervention ( SI ) or usual care ( UC ) .  The intervention included mailings , computer phone calls , and four 1-hour classes .  Serum total cholesterol ( TC ) was measured before and after intervention , and participation was monitored . RESULTS One hundred sixty-five of the 212 patients referred ( 77.8 % ) agreed to participate . A medical records review revealed 123 ( 74.5 % ) met eligibility criteria . Eligible subjects had a mean age of 56.7 years , 80.0 % were African American , 74.8 % were female , 33.6 % were married , and 89.4 % had a high school or lower education . Subjects were r and omized with 80.5 % ( 99 ) completing follow-up cholesterol measures . SI subjects were encouraged to use all three components , with 84.6 % ( 55 of 65 ) actively participating in at least one component . Seventy-two percent ( 47 of 65 ) returned at least one mailing , 49.1 % ( 28 of 57 ) of those with touch-tone phones accessed the computer system , and 43.1 % ( 28 of 65 ) attended classes . The TC in SI decreased from 273.2 mg/dl to 265.0 mg/dl ( P = 0.05 ) and in UC 272.4 mg/dl to 267.6 mg/dl ( P = 0.32 ) . The net reduction in SI compared with UC was 3.4 mg/dl ( P = 0.58 ) . CONCLUSIONS ( 1 ) Low-income public clinic patients will participate in diet interventions , ( 2 ) computer-generated interactive phone calls are feasible in this population , and ( 3 ) clinical ly meaningful decreases in serum cholesterol are difficult to achieve with interventions of practical intensity The effect of patient education on diabetic control in insulin-treated diabetic adults was studied in 77 subjects r and omized into two groups : intensive patient education ( group A ) and control ( group B ) . The subjects in group A received intensive patient instruction , both individually and in small groups , from a team of physicians , teaching nurses , and a dietitian . The patients in group B received a short instruction course consisting mainly of printed material . A highly significant improvement in diabetic control was observed in both groups immediately after the education programs , with gradual return to the original level during the following 3–6 mo . No difference was observed between the two groups in any of the measured parameters during the 18-mo investigation . Factors related to good control during the study included the length of school education , the quality of the control at the beginning of the study , and the high degree of self-confidence and lack of signs of anxiety in the psychological tests . The results demonstrate that the effects of educational programs are of limited value if they do not lead to permanent changes in attitudes and motivation , which are critical factors affecting long-term diabetic control Background The Preventive Cardiology Center compared two intensities of behavior modification for cardiovascular disease ( CVD ) risk factors in persons at risk and their families . Characteristics of drop-outs both before and after intervention were compared with subjects who completed the 6-month trial . Methods A total of 333 individuals of all ages were enrolled in the study and r and omly assigned by family to a single-session ( ‘ skills ’ group — low-intensity ) or a five-session ( ‘ practice ’ group — high intensity ) intervention . Baseline and follow-up assessment s included a personal and family health question naire , nutritional intake survey , and clinic visit to obtain blood pressure , lipids , and height and weight data . Results Two hundred and forty adults over 18 years of age were r and omly assigned to one of the two intervention groups , Of these , 68 subjects ( 28.3 % ) did not participate in the intervention . Multivariate analysis revealed that these ‘ early drop-outs ’ were significantly more likely to be non-white and to have had a lower LDL cholesterol . Of the 172 subjects attending the intervention , 70 ( 40.7 % ) did not attend the 6-month follow-up ( ‘ late drop-outs ’ ) , Multivariate analysis revealed that , compared with follow-up attendees , non-attendees were significantly more likely to be white and to be current smokers . Conclusions Both early and late drop-outs in a r and omized trial of CVD risk reduction were significantly different than continuing participants in several key factors . These differences suggest the use of caution in both interpreting and making generalizations about behavioral trials of risk factor reduction when attrition is high A dietary intervention trial has shown a significant reduction in occurrence of actinic keratosis and nonmelanoma skin cancer in skin cancer patients who adopt diets in which the percentage of calories from fat is markedly lowered . The purpose of this study was to examine the dietary parameters of a low-fat diet found to be effective in reducing occurrence of skin cancer .  Skin cancer patients were taught fat reduction strategies to complement their individual food preferences and life-styles . Diet composition was calculated using st and ard dietary assessment and nutrient analysis techniques . The dietary intervention was effective in reducing the percentage of calories from fat to 21 % by Month 4 and maintaining that level for the remainder of the two-year study . Practical dietary advice with respect to reduction of percentage of calories from fat , along with an increase in the intake of grains , fruits , and vegetables , could make an important contribution to the management and prevention of skin cancer Twenty-four factories or other occupational groups , employing 18 210 men aged 40 to 59 , were formed into matched pairs . One of each pair was allocated r and omly to receive a five to six year programme of medical examinations and intervention to reduce the levels of the main coronary risk factors . Men at factories in the intervention group were given advice on dietary reduction of plasma cholesterol concentrations , stopping or reducing cigarette smoking , regular exercies for the sedentary and reduced energy intake for the overweight , and hypertension was treated . The programme was delivered mainly through existing occupational medical services , helped by a small central staff . Personal consultations were largely confined to men with a high risk of developing coronary heart disease . Changes in risk factors were assessed by regular st and ardised examinations of r and om sample s of men . The spread of information by general propag and a proved easy , but a change in habits seemed to require personal contact . Small but significant reductions occurred , mainly in the high-risk group , but these were not sustained when pressure was relaxed We examined the effectiveness of a training program for physician-delivered nutrition counseling , alone and in combination with a structured office practice environment for nutrition management , on physicians ' counseling practice s. Forty-five primary care internists and 1,278 of their patients in the top quarter of the cholesterol distribution at a central Massachusetts health maintenance organization ( the Fallon Clinic ) were enrolled into a r and omized controlled trial . Physicians were r and omized by site into three conditions : ( 1 ) usual care , ( 2 ) physician nutrition counseling training , and ( 3 ) physician nutrition counseling training plus a structured office practice environment for nutrition management ( prompts and the provision of lipid results and counseling algorithms ) . A r and omly selected 325 patients were given a 10-item patient exit interview ( PEI ) assessing whether the physician provided advice ; assessed past changes , barriers , and re sources ; negotiated specific plans and goals ; provided patient material s ; referred the patient to a dietitian ; and developed plans for follow-up . Condition 3 physicians demonstrated significantly greater implementation of the nutrition counseling sequence than did physicians in either of the other two conditions ( P < .0001 ) . Referrals to nutrition services were markedly reduced in condition 2 , despite PEI scores no different than those in condition 1 . Higher PEI scores for patients seen by physicians in condition 3 were stable for as long as two years beyond training . Primary care internists , when provided with both training in counseling techniques and a supportive office environment , will carry out patient counseling appropriately . Training alone , however , is not sufficient and may be counterproductive . Medical Subject Headings ( MeSH ) : hypercholesterolemia , diet therapy , coronary disease , health behavior , primary health care , medical education , managed care programs The Women 's Health Trial Vanguard Study was conducted to examine the feasibility of a nationwide , r and omized multicenter intervention trial to test the hypothesis that a low-fat diet followed for a period of 10 years will reduce breast cancer risk . Women ages 45 - 69 years at increased risk of breast cancer were r and omized into  intervention ( low-fat diet , n = 184 ) and control ( usual diet , n = 119 ) groups . On the basis of 4-day food records , baseline fat intakes were comparable in the two groups , averaging 1,718 kcal with 39 % of energy as fat . Intervention women reported substantially lower fat intake at 6 ( 20.9 % kcal ) , 12 ( 21.6 % ) , and 24 months ( 22.6 % kcal ) . In contrast , control women reported only slight reductions in fat intake ( 37.3 % kcal at 12 months and 36.8 % kcal at 24 months ) . Evidence that these women were indeed complying with the low-fat dietary intervention comes from ( a ) the reasonable nature of reported nutrient changes within food groups in the intervention women and ( b ) agreement between observed and expected differences in plasma total cholesterol between the control and the intervention groups . At 12 months , the observed control - intervention plasma cholesterol difference was 13.1 + /- 4.6 mg/dl while the expected difference based on the Keys equation was 15.1 + /- 1.1 mg/dl ; at 24 months , the observed difference was 15.5 + /- 4.3 mg/dl and the expected difference was 12.0 + /- 1.2 mg/dl . These analyses indicate that the intervention women made substantial dietary changes and have successfully maintained these changes over a 2-year period . This study thus demonstrates the feasibility of a r and omized trial with an intensive low-fat dietary intervention OBJECTIVE To evaluate a weight loss and exercise program design ed to improve diabetes management in older African-Americans . RESEARCH DESIGN AND METHODS Overweight African-Americans ( n = 64 ) ages 55–79 years with NIDDM were r and omized to either an intervention ( 12 weekly group sessions , 1 individual session , and 6 biweekly group sessions ) or usual care ( 1 class and 2 informational mailings ) . Clinical and behavioral variables were assessed at 0 , 3 , and 6 months of treatment . RESULTS Significant net differences in the intervention versus usual care were observed for weight ( −2.0 kg , P = 0.006 ) , physical activity , and dietary intake of fat , saturated fat , cholesterol , and nutrition knowledge at 3 months ( all P < 0.05 ) and for weight at 6 months ( −2.4 kg ; P = 0.006 ) and mean HbA1c values at 3 and 6 months ( respectively , −1.6 and −2.4 % , both P < 0.01 ) . After the adjustment for changes in weight and activity , the intervention participants were ∼ twice as likely to have a one unit decrease in HbA1c value as those in usual care . Blood pressure increase sin usual care participants result ed in net differences ( intervention minus control ) at 3 and 6 months of −3.3 ( P = 0.09 ) and −4.0 ( P = 0.05 ) mmHg diastolic , respectively , and −8.4 ( P = 0.06 ) and −5.9 ( P > 0.10 ) mmHg systolic , respectively . Blood lipid profiles improved more in intervention than usual care participants , but not significantly . CONCLUSIONS The intervention program was effective in improving glycemic and blood pressure control . The decrease in HbA1c values was generally independent of the relatively modest changes in dietary intake , weight , and activity and may reflect indirect program effects on other aspects of self-care Effects of dietary intervention on food choice were studied in 240 women aged 50 - 65 years who had been operated for a stage I-II breast cancer . Following surgery , the women participated in a dietary history interview and were then r and omized to one of two groups . The intervention group ( n = 121 ) received individual dietary counselling aim ed at reducing dietary fat intake to 20 - 25 % energy ( E% ) , whereas no dietary advice was given to women in the control group ( n = 119 ) . For the 52 % of the women in the intervention group that completed the study the total fat intake decreased from 36 to 23 E% ( P less than or equal to 0.01 ) and from 37 to 34 E% ( P less than or equal to 0.01 ) for the control group . There were significant reductions in the intake of table fat , high-fat milk products , pork and sausages  ( containing greater than 11 % fat ) ,  eggs , rice , pasta , cakes and chocolate for the intervention group . Concurrently the intake of vegetables , fruits , potatoes , bread , cereals , low-fat milk products , low-fat meat , sausages and fish increased significantly . For the control group there was a significant decrease in the consumption of total milk products , total meats , rice , pasta , cakes , and butter intake while the consumption of vegetables , fruits , cereals and fish increased ( P less than or equal to 0.01 ) . Reduction of high-fat foods and increases of carbohydrate-rich foods were more pronounced for the intervention group than for the control group . Formal education influenced dietary changes , and dietary counselling should therefore ideally be adapted to education level . This study showed that dietary counselling can bring about significant changes in consumption of high-fat foods for at least a 2-year period for women operated for breast cancer BACKGROUND Few lipid/atherosclerosis intervention trials have assessed the impact of cholesterol reduction on peripheral arterial disease .  The 838 patients evaluated in the Program on the Surgical Control of the Hyperlipidemias ( POSCH ) trial represent more than the total number of patients in the seven previously reported studies . METHODS Peripheral arterial disease in POSCH was assessed by progression of clinical disease , serial changes in the systolic blood pressure ankle/brachial index ( ABI ) , and changes on sequential peripheral arteriograms . RESULTS At the time of formal closure of the POSCH trial on July 19 , 1990 , claudication or limb-threatening ischemia was exhibited in 72 of 417 control group ( CG ) patients and in 54 of 421 intervention group ( IG ) patients ( IG relative risk [ RR ] 0.702 , 95 % confidence interval [ CI ] 0.169 to 1.000 , p = 0.049 ) . With additional follow-up evaluation to September 30 , 1994 , clinical peripheral arterial disease was evident in 91 CG patients and 64 IG patients ( RR 0.656 , 95 % CI 0.200 to 0.903 , p = 0.009 ) . At the 5-year follow-up evaluation , an ABI of less than 0.95 was present in 41 of 120 CG patients and in 24 of 126 IG patients , all of whom had an ABI of 0.95 or greater at baseline ( RR in the IG of 0.557 , 95 % CI 0.360 to 0.863 , p < 0.01 ) . No appreciable differences were noted in the progression or regression of arteriographic peripheral arterial disease between the two groups . CONCLUSIONS Effective cholesterol reduction in POSCH led to statistically significant differences between the control and the intervention groups in the development of clinical ly evident peripheral arterial disease and in the ABI values , but not in the peripheral arteriograms . Additional studies need to assess the correlation between peripheral arterial changes and coronary arterial changes and clinical atherosclerosis events . Intervention trials that study peripheral arterial disease have intrinsic value in the evaluation of the impact of risk factor modification on progression of atherosclerotic peripheral arterial disease OBJECTIVE To compare the efficacy of brief dietary intervention by family physicians in their daily practice and in group sessions to st and ard dietetic treatment in mild to moderate hypercholesterolemia . DESIGN R and omised clinical trial . SETTING Family practice clinic in a remote community . PARTICIPANTS Between September 1 , 1991 and September 30 , 1992 , 135 men and women between 20 and 60 years old with mild to moderate hypercholesterolemia were recruited and r and omly assigned to three treatment groups to be taught the American Heart Association low fat diet . Each participant had an LDL-C reading higher than the desirable level set by the Canadian Consensus Conference on Cholesterol . INTERVENTIONS The three treatment groups received different interventions : individual consultations with a family physician in his office ( phase I ) ; group sessions with a physician and a dietician ( phase II ) ; and individual consultations with a dietician ( phase II ) . Participants were followed for 6 months with visits and blood tests every 2 months . MAIN OUTCOME MEASURES Reduction in serum levels of total cholesterol , LDL-C , HDL-C , and triglycerides was measured after 2 , 4 , and 6 months of dietary treatment .  Changes in risk factors ( smoking , weight , level of physical activity ) and patients ' cholesterol/saturated fat index were also measured . RESULTS Ninety-nine subjects completed the 6-month regimen . The mean reduction in serum LDL-C was 0.08 mmol/L ( 1.8 % ) in Group I , 0.07 mmol/L ( 1.6 % ) in Group II , and 0.28 mmol/L ( 6.3 % ) in Group III ( P = 0.94 ) . An LDL-C reduction of 10 % or more relative to initial level was observed in 27 % of participants in Group I and approximately 40 % of subjects in the other two groups ( P = 0.41 ) . Counseling result ed in a decrease in body weight , smoking , and dietary fat consumption and an increase in physical activity . CONCLUSIONS Treatment by a dietician achieved better results and should remain the st and ard . Physicians should focus on the detection and control of other heart disease risk factors Objective . The authors tested the impact on cardiovascular risk profiles of African American women ages 40 years and older after one year of participation in one of three church-based nutrition and physical activity strategies : a st and ard behavioral group intervention , the st and ard intervention supplemented with spiritual strategies , or self-help strategies . Methods . Women were screened at baseline and after one year of participation . The authors analyzed intention-to-treat within group and between groups using a generalized estimating equations adjustment for intra-church clustering . Because spiritual strategies were added to the st and ard intervention by participants themselves , the results from both active groups were similar and , thus , combined for comparisons with the self-help group . Results . A total of 529 women from 16 churches enrolled . Intervention participants exhibited significant improvements in body weight ( −1.1 lbs ) , waist circumference ( −0.66 inches ) , systolic blood pressure ( −1.6 mmHg ) , dietary energy ( −117 kcal ) , dietary total fat ( −8 g ) , and sodium intake ( −145 mg ) . The self-help group did not . In the active intervention group , women in the top decile for weight loss at one year had even larger , clinical ly meaningful changes in risk outcomes ( −19.8 lbs ) . Conclusions . Intervention participants achieved clinical ly important improvements in cardiovascular disease risk profiles one year after program initiation , which did not occur in the self-help group . Church-based interventions can significantly benefit the cardiovascular health of African American women Eighty management-level male employees participated in a company-sponsored comprehensive physical that included determination of plasma total cholesterol , low-density lipoprotein cholesterol , high-density lipoprotein cholesterol , and triglyceride levels and percentage of body fat . After the lipid screening , each employee met with a registered dietitian who explained the results of the lipid analysis and discussed risk factors for coronary heart disease with an emphasis on diet .  Seventy employees had a triglyceride level above 5.17 mmol/L and were invited to participate in a nutrition education program . Thirty-three ( mean age = 44 years ) chose to participate ( intervention group ) ; the other 37 ( mean age = 35 years ) served as controls ( control group ) . Thus , the design of the study was not r and om . All subjects completed 3-day dietary records before and after the nutrition education program . Nutrition intervention consisted of ( a ) individualized instruction about the step 1 diet ; ( b ) group sessions ( 1 hour every 3 months ) on eating out , dietary fiber , and maintaining heart healthy behaviors ; and ( c ) individualized follow-up by telephone ( one call per month ) . The results of the year-long program revealed that men in the intervention group decreased dietary intake of energy ( 2,546 + /- 162 kcal to 2,246 + /- 125 kcal ) and cholesterol ( 444 + /- 5.3 mg to 304 + /- 1.6 mg ) and percentage of energy from total fat ( 38 + /- 3.4 % to 31 + /- 2.6 % ) and protein ( 24 + /- 3.5 % to 20 + /- 2.2 % ) . Their consumption of carbohydrate and dietary fiber increased ( 38 + /- 2.1 % to 45 + /- 2.5 % and 8.0 + /- 2.3 g to 23.0 + /- 3.5 g , respectively ) . ( ABSTRACT TRUNCATED AT 250 WORDS The cost-effectiveness of counseling by telephone and by clinic visit contacts were compared in 40 hypertensive patients each of whom received counseling and reinforcement every three weeks for six months regarding diet , exercise , smoking , and coping with stress . Blood pressure declined significantly in both counseling groups ( N : 10 each ) but not in a control group ( N : 20 ) . The cost per patient under control was $ 82 for the clinic counseling and $ 39 for the telephone counseling strategy , suggesting that telephone counseling was a cost-effective technique Associations between plasma lipoprotein subfractions and changes in coronary artery diseases ( CAD ) were examined in 74 men who completed the St. Thomas ' Atherosclerosis Regression Study ( STARS ) .  Plasma lipoproteins were isolated by stepwise , preparative ultracentrifugation at repeated intervals during the 38-month trial . Paired coronary angiograms were quantitatively analyzed by a computerized method . In univariate linear regression analysis , changes in mean absolute width ( delta MAWS ) and minimum absolute with ( delta MinAWS ) of coronary segments were significantly correlated with in-trial concentrations of cholesterol in intermediate-density lipoprotein ( [ IDL ] d = 1.006 to 1.019 kg/L ) , low-density lipoprotein ( [ LDL2 ] d = 1.019 to 1.040 kg/L ; LDL3 , d = 1.040 to 1.063 kg/L ) , and high-density lipoprotein ( [ HDL3 ] d = 1.125 to 1.210 kg/L ) subfractions ; no significant associations were found with other lipoproteins . IDL , LDL3 , and HDL3 cholesterol were then selected for multiple linear regression analysis because these variables were not co-correlated and because they attained a significance of P less than or equal to .1 in univariate regression . In this analysis , only LDL3 cholesterol level was a significant negative predictor ( P < .05 ) of both delta MAWS and delta MinAWS ; a positive association between delta MinAWS and HDL3 cholesterol level just failed to reach conventional statistical significance ( P = .066 ) . Correlations between changes in coronary luminal dimensions and LDL3 cholesterol level were independent of age , smoking , weight , and blood pressure . Most patients showing regression of coronary atherosclerosis had an LDL3 cholesterol level of less than 1.8 mmol/L. The findings suggest that LDL3 is the plasma lipoprotein subfraction that exerts the single most powerful effect on the course of CAD in middle-aged men with hypercholesterolemia It has been suggested that much effort expended in teaching diabetic diets is ineffective and wasteful . We have tested a different system by r and omly allocating 75 newly diagnosed obese Type 2 diabetic patients to usual ‘ unstructured ’ clinic care or to group education by diabetes specialist nurses and a dietitian . Patients allocated to group education attended five 90‐min group sessions during the first 6 months . Six months after diagnosis they had lost more weight ( median ( 95 % CI ) , 7 ( 5.5–9 ) vs 2 ( 1–5 ) kg , p<0.002 ) and were better controlled ( HbA1 : 7.5 ( 7.0–8.1 ) vs 9.5 ( 8.7–10.4 ) % , p<0.001 ) than those r and omized to the usual clinic system . At 1 year ( after no further visits ) the difference in weight loss was less ( 5.5 ( 4–6.5 ) vs 3 ( 2–4 ) kg , p<0.05 ) and diabetic control was similar ( HbA1:9.0 ( 8.2–9.8 ) vs 9.9 ( 8.9–10.9 ) % . At 1 year only 14 ( 39 % ) of the education group and 9 ( 23 % ) of those attending the clinic had a fasting blood glucose less than 7.0 mmol l−1 OBJECTIVE To investigate the long-term effects of multifactorial primary prevention of cardiovascular diseases ( CVD ) . DESIGN The 5-year r and omized , controlled trial was performed between 1974 and 1980 . The subjects and their risk factors were reevaluated in 1985 . Posttrial mortality follow-up was continued up to December 31 , 1989 . SETTING Institute of Occupational Health , Helsinki , Finl and , and Second Department of Medicine , University of Helsinki . PARTICIPANTS In all , 3490 business executives born during 1919 through 1934 participated in health checkups in the late 1960s . In 1974 , 1222 of these men who were clinical ly healthy , but with CVD risk factors , were entered into the primary prevention trial ; 612 were r and omized to an intervention and 610 to a control group . INTERVENTIONS During the 5-year trial , the subjects of the intervention group visited the investigators every fourth month . They were treated with intensive dietetic-hygienic measures and frequently with hypolipidemic ( mainly clofibrate and /or probucol ) and antihypertensive ( mainly beta-blockers and /or diuretics ) drugs . The control group was not treated by the investigators . MAIN OUTCOME MEASURES Total mortality , cardiac mortality , mortality due to other causes . RESULTS Total coronary heart disease risk was reduced by 46 % in the intervention group as compared with the control group at end-trial . During 5 posttrial years , the risk factor and medication differences were largely leveled off between the groups . Between 1974 and 1989 the total number of deaths was 67 in the intervention group and 46 in the control group ( relative risk [ RR ] , 1.45 ; 95 % confidence interval [ CI ] , 1.01 to 2.08 ; P = .048 ) ; there were 34 and 14 cardiac deaths ( RR , 2.42 ; 95 % CI , 1.31 to 4.46 ; P = .001 ) , two and four deaths due to other CVD ( not significant ) , 13 and 21 deaths due to cancer ( RR , 0.62 ; 95 % CI , 0.31 to 1.22 ; P = .15 ) , and 13 and one deaths due to violence ( RR , 13.0 ; 95 % CI , 1.70 to 98.7 ; P = .002 ) , respectively . Multiple logistic regression analysis of treatments in the intervention group did not explain the 15-year excess cardiac mortality . CONCLUSION These unexpected results may not question multifactorial prevention as such but do support the need for research on the selection and interaction(s ) of methods used in the primary prevention of cardiovascular diseases OBJECTIVE To examine the feasibility and efficacy of a multifactorial intervention programme directed towards hypercholesterolaemia , smoking , and diabetes mellitus in treated hypertensive patients after more than 3 years ' follow-up and to describe the incidence of cardiovascular complications . DESIGN Open , r and omized , parallel-group study with allocation either to a comprehensive multiple risk factor modification programme or to usual care . SETTING Outpatient clinic in a city hospital . PATIENTS A total of 508 male patients with treated hypertension , aged 50 - 72 years , with at least one of the following : serum cholesterol > or = 6.5 mmol L-1 , smoking or diabetes mellitus . INTERVENTION Individually given advice and group meetings based on nutritional advice and behavioral treatment principles . Drug therapy could be instituted to achieve the treatment goals in the intervention group : serum total cholesterol below 6.0 mmol L-1 , no smoking , and HbA1c below 6.0 % . Diastolic blood pressure below 90 mmHg was the treatment goal in both groups . MAIN OUTCOME MEASUREMENTS Serum cholesterol , HbA1c , diastolic blood pressure , smoking . Cardiovascular end-points were recorded . RESULTS The net changes were ( change intervention -- change usual care ) : serum cholesterol -5.0 % ( 95 % confidence interval , -7.6 to -2.3 % ) , 17.6 % more stopped smoking ( P = 0.04 ) ; diastolic blood pressure and HbA1c remained unchanged . The incidence of stroke was lower in the intervention group compared with the usual-care group : 2.0 and 6.7 % , respectively ( P = 0.017 ) . CONCLUSION The intervention programme was comparatively successful with regards to the effects on hypercholesterolaemia and smoking habits . An unexpected decrease in the stroke incidence was observed in the intervention group compared with the usual-care group Community studies have demonstrated suboptimal achievement of lipid targets in the management of patients with coronary heart disease ( CHD ) . An effective strategy is required for the application of evidence -based prevention therapy for CHD . The objective of this study was to test coaching as a technique to assist patients in achieving the target cholesterol level of < 4.5 mmol/L. Patients with established CHD ( n = 245 ) underwent a stratified r and omization by cardiac procedure ( coronary artery bypass graft surgery or percutaneous coronary intervention ) to receive either the coaching intervention ( n = 121 ) or usual medical care ( n = 124 ) . The primary outcome measure was fasting serum total cholesterol ( TC ) , serum triglyceride ( TG ) , high-density lipoprotein cholesterol ( HDL-C ) , and calculated low-density lipoprotein cholesterol ( LDL-C ) level , measured at 6 months post-r and omization . At 6 months , the serum TC and LDL-C levels were significantly lower in the coaching intervention group ( n = 107 ) than the usual care group ( n = 112 ) : mean TC ( 95%CI ) 5.00 ( 4.82 - 5.17 ) mmol/L versus 5.54 ( 5.36 - 5.72 ) mmol/L ( P < .0001 ) ; mean LDL-C ( 95%CI ) 3.11 ( 2.94 - 3.29 ) mmol/L versus 3.57 ( 3.39 - 3.75 ) mmol/L ( P < .0004 ) , respectively . Coaching had no impact on TG or on HDL-C levels . Multivariate analysis showed that being coached ( P < .001 ) had an effect of equal magnitude to being prescribed lipid-lowering drug therapy ( P < .001 ) . The effectiveness of the coaching intervention is best explained by both adherence to drug therapy and to dietary advice given . Coaching may be an appropriate method to reduce the treatment gap in applying evidence -based medicine to the " real world . BACKGROUND This paper identifies factors that predict achievement of a low-fat diet among 242 California adults with low literacy skills , following their participation in the Stanford Nutrition Action Program ( SNAP ) , a r and omized classroom-based nutrition intervention trial ( 1993 - 1994 ) . METHODS The intervention classes received a newly developed curriculum that focuses on reducing dietary fat intake ( SNAP ) ; the control classes received an existing general nutrition ( GN ) curriculum . Data were collected at baseline and 3 months postintervention . This hypothesis-generating analysis uses a signal detection method to identify mutually exclusive groups that met the goal of a low fat diet , defined as < 30 % of calories from total fat , at 3 months postintervention . RESULTS Three mutually exclusive groups were identified . Twenty-three percent of Group 1 , participants with high baseline dietary fat ( > 60 g ) who received either the GN or the SNAP curriculum , met the postintervention goal of < 30 % of calories from total fat . Thirty-four percent of Group 2 , participants with moderate baseline dietary fat ( < or = 60 g ) who received the GN curriculum , were successful . Sixty percent of Group 3 , participants with moderate baseline dietary fat who received the SNAP curriculum , were successful . Members of Group 3 also significantly increased their intake of vegetables , grains , and fiber . CONCLUSIONS Within this population of adults with low literacy skills , a large proportion of those with moderate baseline dietary fat who participated in the SNAP classes met the postintervention criteria for a low-fat diet . A much smaller proportion of those with high baseline dietary fat were successful , suggesting that this group may benefit from different , more intensive , or longer-term interventions Health-related quality of life was assessed in a diet and exercise intervention study among 157 healthy men aged 35–60 years ( mean ± s.d . ; 46.2 ± 5.0 ) with moderately raised cardiovascular risk factors . The men were r and omized to four groups , diet ( D , n=40 ) , exercise ( E , n=39 ) , diet plus exercise ( DE , n=39 ) , and no active intervention ( controls ( C ) n=39 ) . Quality of life was measured with two self-administered question naires ; Subjective Symptoms Assessment Profile and Minor Symptom Evaluation Profile , at baseline and after 1.5 , 3 and 6 months . Cardiovascular risk factors were investigated at baseline and after 6 months . As a result of changes in dietary habits and physical exercise in the three intervention groups , several important cardiovascular risk factors were significantly reduced . The quality of life/well-being did not differ between the four groups and did not change significantly in any of the groups during the study . There was , however , a tendency towards fewer gastrointestinal symptoms in group D and fewer cardiac symptoms in group DE . We conclude that advice on lifestyle changes in the form of diet and exercise reduce risk factors in middle-aged men without negative effects on their quality of life In this r and omized , primary prevention trial of 1,232 high-risk , middle-aged Oslo men , advice during 5 years about diet and smoking brought about a significant reduction ( 47 % ) in incidence of first major coronary heart disease ( CHD ) events in the intervention group compared with controls . Data are presented indicating that the net difference of 10 % in serum cholesterol between groups was the main cause for this achievement and that the antismoking factor , due to a rather small net difference in quit rates ( 17 and 24 % in control and intervention groups , respectively ) , contributed to a lesser degree . Analysis of social class reveals that the favorable results in the intervention group were present in all social strata , despite the unexpected finding that lower class men experienced a lower CHD incidence than men of higher socioeconomic status . Antismoking advice was especially effective in lower class intervention group men . Among cigarette quitters , lower social class men reduced their serum cholesterol more than higher social class men . However , for the total intervention group , higher status men had at least as great a reduction in serum cholesterol as did lower status men . With endpoint follow-up extended to 8.5 - 10 years , additional cases of CHD ( nonfatal and fatal myocardial infa rct ion and sudden death ) numbered 7 and 10 in the intervention and control groups , respectively ; CHD cases throughout the trial totaled 25 and 45 ( P approximately equal to 0.02 ) . Total deaths numbered 19 and 31 , respectively ( P approximately equal to 0.05 ) A nutrition intervention focused on low-fat eating pattern changes was conducted among low-literacy participants in a Twin Cities Metropolitan area Exp and ed Food and Nutrition Education Program ( EFNEP ) . A total of 134 EFNEP participants who participated in the intervention were compared to 70 comparison participants who received EFNEP nutrition education material s.  Associations between changes in outcome variables specific to the intervention were evaluated using mixed-model regression analyses . The principal effects seen for this program were related to changes in eating pattern scales . More modest effects were seen in scales related to attitudes of low-fat eating , and although changes in dietary fat intake as measured by 24-hour dietary interviews suggested a positive intervention effect , this did not approach statistical significance PURPOSE Current guidelines of the National Cholesterol Education Program ( NCEP ) recommend initial dietary counseling by physicians for most patients with hypercholesterolemia ; referral to a registered dietitian and lipid-lowering drugs are recommended only for patients who remain hypercholesterolemic . We evaluated the incremental value of detailed nutritional counseling by dietitians when added to general nutritional advice provided by physicians . SUBJECTS AND METHODS Hypercholesterolemic patients detected during a cholesterol screening project were r and omly assigned to receive dietary counseling by a physician only ( 70 patients ) or by a physician and a registered dietitian ( 66 patients ) . Patients were observed for 1 year to determine compliance with NCEP guidelines . RESULTS At 3 months , the mean ( + /- SD ) decrease in the serum low-density lipoprotein ( LDL ) cholesterol level was 7 % + /- 11 % in the physician group and 12 % + /- 10 % in the dietitian group ( P < 0.004 ) . A decrease of 10 % or more in the LDL cholesterol level was seen in 25 patients ( 36 % ) in the physician group and 43 patients ( 65 % ) in the dietitian group ( P < 0.001 ) . Only 40 ( 29 % ) of the patients in both groups achieved their NCEP target goals at 3 months . The majority of these were low-risk patients with an LDL cholesterol target goal of 160 mg/dL. At 12 months , both groups lost about half of the beneficial effects on LDL cholesterol levels , and the difference between the two groups diminished . CONCLUSIONS The short-term reduction in LDL cholesterol level achieved after counseling by dietitians is superior to that achieved by physicians . However , long-term compliance remains inadequate . For patients at high risk , consideration should be given to a more aggressive dietary approach and possibly earlier introduction of lipid-lowering medications BACKGROUND Nutrition education tailored to individual characteristics of people might be more effective than general nutrition education . Nowadays , the use of computers makes individualized feedback available for larger groups . METHODS The impact of tailored nutrition information on changes in fat , vegetable , and fruit consumption was tested in a r and omized trial among 347 employees of a major oil company . Respondents in the experimental group received computer-generated feedback letters tailored to their personal dietary behavior , attitudes , perceived social influences , self-efficacy expectations , and awareness levels . Respondents in the control group received general nutrition information . RESULTS Respondents in the experimental group decreased their fat consumption significantly more than the control group between baseline and posttest . A significant effect of tailoring was also found for changes in attitudes and intentions toward reducing fat intake and increasing fruit and vegetable consumption . Furthermore , respondents in the experimental group were more satisfied with the nutrition information they received and more often reported changing their diet or intention as a result of the information . CONCLUSIONS It is concluded that computer-tailored nutrition information is a promising means of stimulating people to change their diet toward dietary recommendations Two diabetes education programs were compared to a control condition . Seventy-eight type II ( non-insulindependent ) diabetic out patients were r and omly assigned to nutrition education , nutrition education plus social learning intervention , or wait-list control conditions . Both interventions involved five weekly meetings that focused on reducing calorie intake , increasing dietary fiber , and decreasing fat consumption . The social learning condition also included individualized goal setting and feedback and training in problem-solving and relapse prevention . Within-group analyses and between-group comparisons generally revealed greater improvement in targeted goals ( e.g. , calorie intake , fat reduction ) among intervention conditions than the control condition . There were few differences in more distal measures of outcome such as weight or glycosylated hemoglobin . The social learning component did not improve outcome more than the nutrition education program . Possible reasons for the observed findings and the advantages and limitations of focused time-limited diabetes education efforts are discussed A group of 93 coronary patients recently treated with percutaneous transluminal coronary angioplasty ( PTCA ) were r and omly assigned to either an intervention or a control group . Subjects in the intervention group participated in a comprehensive behaviorally oriented program aim ed at achieving significant long-term changes in risk factor-related lifestyle behavior . Assessment s of lifestyle behaviors , psychological factors , biological risk factors , and rehabilitation as well as secondary prevention endpoints were carried out , at inclusion and after 12 months . Results showed that the intervention patients , as compared with controls , improved significantly on measures assessing smoking , exercise , and diet habits . These self-rated changes were confirmed by weight reductions and improved exercise capacity , as well as by between-group differences in sub clinical chest pain during an exercise test . However , few effects were found on the different psychological variables , as well as on morbidity or return to work Four weight reduction strategies were investigated in a diabetic population who previously had shown little motivation to lose weight . Some 409 patients , body mass index 28–45 were invited to participate . Only 51 % replied , although 22 patients ( 5.4 % ) lost > 3 kg by invitation alone . The study comprised 159 patients , r and omly allotted to either regular clinic visits , behavioural group therapy , dexfenfluramine ( 30 mg d−1 for initial 3 months ) or combined home and clinic visits . A further 58 patients were monitored as controls . At 3 months the best weight loss ( intention to treat ) was achieved using dexfenfluramine with mean weight losses of 1.6 , 1.2 , 3.4 , and 1.7 kg , respectively , in each group . At 1 year weight losses were similar ( 1.2 , 1.8 , 2.8 , 1.2 kg , respectively ) but contrasted with a mean 1.2 kg weight gain in the controls . Some 38 % lost > 3 kg  on dexfenfluramine compared to 19–23 % for the others . In those who completed the study , weight loss was similar with behavioural therapy ( 3 kg ) or dexfenfluramine ( 3.2 kg ) . We conclude that intensive dietetic efforts can reverse the weight increase in the diabetic population although weight loss is minimal . Dexfenfluramine was most effective in the short term , behavioural therapy useful long term but only in those who remained within the group ; home visits offered no advantage Located the Nutrition for a Lifetime System ( NLS-1 ) , a prototype interactive information system , in a large supermarket to help users decrease  high-fat food purchases  and increase  high-fiber food purchases .  Study participants were r and omly assigned to  control ( n = 23 ; used the NLS-1 to enter food purchases only ) or experimental ( n = 26 ;  viewed videodisc instructional programs , received prompts , made commitments , received feedback from the NLS-1 ) conditions . According to data entered in the NLS-1 and actual food shopping receipts , experimental participants significantly reduced higher fat purchases . Increases in higher fiber purchases favored the experimental group but were not significant Eighty consecutive newly diagnosed non-insulin-dependent diabetic patients were r and omly allocated into two groups to compare two different patient education regimens . One group received individual dietary instructions by a nurse and the other a short , written leaflet given by a doctor . The principal aim of the dietary instructions was weight reduction . A significant weight loss and improvement in the control of diabetes occurred in both groups , and these changes were similar in the two groups . At the end of one year 's follow-up , however , only 25 % of the patients were satisfactorily controlled ( fasting blood glucose less than or equal to 6.0 mmol/l ) . The degree of weight loss correlated only weakly with the improvement in the metabolic control . The degree of obesity and insulin secretion capacity as measured at the beginning of the study did not predict the improvement of glycaemic control during the study . At the end of the study a significant improvement was observed in serum lipids of patients with good control ( fasting blood glucose less than or equal to 6.0 mmol/l ) or weight loss ( greater than 5 kg ) . In conclusion , both brief , written and individual dietary instructions induced a significant weight loss as well as improved glucose and lipid metabolism in newly diagnosed non-insulin-dependent diabetic patients , but satisfactory metabolic control was achieved only in a minority of the patients This article describes the conceptual basis , design , and intervention approach for a worksite-based heart disease risk reduction project . Baseline characteristics of the 26 moderate size worksites participating in the Take Heart Project are also described . The trial is design ed to produce changes at both the organization and employee level on tobacco use , dietary fat intake , and serum cholesterol . A key feature of the intervention is creation of employee steering committees to enhance ownership and involvement . From a menu of brief , low-intensity health education and environmental change activities , these committees select activities best suited to their worksite . The baseline characteristics of ogranizations r and omized to intervention and control conditions were similar , and indicated a relatively high level of worksite activity related to cholesterol and smoking A critical problem in the dietary treatment of hypercholesterolemia is the long-term maintenance of cholesterol reduction . A system to maintain contact and provide feedback through a computer-interactive phone system was used with 115 subjects who completed a four-week diet and behavioral cholesterol reduction program . The subjects , mean age 48 years , were 87 % non-Hispanic Caucasian and 74.8 % were female . They were r and omized to a control or maintenance group . The maintenance group received calls twice a month for six months . Total cholesterol ( TC ) and weight ( lb ) were obtained before and after a four-week program and after the six-month maintenance period . Neither group of subjects with all cholesterol measurements fully maintained initial cholesterol reductions ( mean TC : in maintenance [ n = 48 ) 248 , 221 , 231 versus control [ n = 43 ] 243 , 224 , 232 mg/dL ) . All ( n = 59 ) of the maintenance subjects used the phone system , with 83.3 % of a subset evaluating it indicating the phone messages were helpful . Patients ( n = 25 ) with > or = 5 lb weight loss and 10 % TC decrease from baseline had a better maintenance of TC reduction in the maintenance versus control group ( 273,208,231 versus 259,205,246 mg/dL ) ( P < .05 ) . We conclude that ( 1 ) maintenance remains a problem for cholesterol-lowering diet interventions , (2)automated phone calls are capable of maintaining contact and providing patient feedback , and ( 3 ) this system may help in the maintenance of TC levels for patients who made greater changes Many have studied the effects of different lifestyles on disease , mortality or risk factors for a disease , but little is known about how behaviour is changed in the population . We studied the need for counselling and its effect on willingness and ability to change lifestyle , and subsequent changes in CHD risk factors .  All 152 male employees in a computer company , 25 - 45 years of age , were invited to participate . Subjects were r and omized into an intervention group ( I-group ) and a control group . The I-group was divided into subgroups based on baseline behaviour and risk factor status . Changes were evaluated after 1 year . After an initial health examination , participants from the I-group were counselled at baseline and after 5 months . Eighty-five ( 56 % ) males participated . Twenty-nine were assigned to a control group and 56 to an intervention group ( I-group ) ( dropout = 8) . An exercise group ( E-group ) was advised to exercise aerobically three times/week , a diet group to reduce the intake of saturated fat and increase fish products , and smokers to quit smoking . Forty subjects were recommended one or more behavioural changes and eight had no need . Thirty-four were willing to make behavioural changes . Compared to the control group , the fitness level increased ( P < 0.01 ) and body weight decreased in the I-group ( P < 0.05 ) . It may be concluded that individual counselling promotes regular exercise with subsequent improvements in CHD risk factors . The diet- and smoking counselling models were less successful in terms of adherence We studied the effects of exercise ( primarily running ) , calorie restriction ( dieting ) , and a low-fat , high-carbohydrate diet on changes in lipoprotein subfractions in moderately overweight men in a r and omized controlled clinical trial . After 1 year , complete data were obtained for 39 men assigned to lose weight through dieting without exercise , 37 men assigned to lose weight through dieting with exercise ( primarily running ) , and 40 nondieting sedentary controls .  We instructed both diet groups to consume no more than 30 % total fat , 10 % saturated fat , and 300 mg/d of cholesterol , and at least 55 % carbohydrates , and the controls were instructed to maintain their usual food choices . Analytic ultracentrifugation was used to measure changes in plasma lipoprotein mass concentrations . In addition , the absorbance of protein-stained polyacrylamide gradient gels was used as an index of concentrations for five high-density lipoprotein ( HDL ) subclasses that have been identified by their particle sizes , ie , HDL3c ( 7.2 to 7.8 nm ) , HDL3b ( 7.8 to 8.2 nm ) , HDL3a ( 8.2 to 8.8 nm ) , HDL2a ( 8.8 to 9.7 nm ) , and HDL2b ( 9.7 to 12 nm ) . Relative to controls , weight decreased significantly in men who dieted with exercise ( net difference + /- SE , -3.3 + /- 0.4 kg/m2 ) and in men who dieted without exercise ( -2.0 + /- 0.4 kg/m2 ) . Dieting with exercise significantly decreased very-low-density lipoprotein (VLDL)-mass concentrations and significantly increased plasma HDL2-mass , HDL3a , HDL2a , and HDL2b relative to both control and dieting without exercise . There were no significant changes in lipoprotein mass and HDL protein for dieters who did not run . ( ABSTRACT TRUNCATED AT 250 WORDS A lipid intervention clinic screened 4000 employees ( 89 % participation ) and identified 150 type IV subjects ( top 5 percentile triglyceride values , 100 % initial participation , 6 % drop out ) . The 150 healthy type IV subjects , ages 20 to 49 , were r and omly divided into treatment subgroups : A , treatment by clinic nutritionist and physician with the National Heart and Lung Institute 's type IV diet for 6 weeks , then diet plus clofibrate for 18 weeks ; B , same treatment by private physician ; C , no intervention for 24 weeks , subjects advised of abnormality . The group A mean fasting serum triglyceride of 407 mg/dl declined 50 % at 6 weeks , 61 % at 12 weeks , and was unchanged at 24 weeks ( P less than 0.0005 at 6 , 12 , 24 weeks ) . Group B triglyceride decreased 42 % , 50 % , 41 % ( P less than 0.0005 at 6 , 12 , 24 weeks ) . Group C triglyceride declined 20 % , 1st to 24th week . Body weight decreased 8 % ( A ) and 4 % ( B ) at 6 weeks ( P less than 0.0005 ) and was unchanged at 24 weeks . The maximum cholesterol decrease ( A ) was 11 % ( P less than 0.0005 ) . Type IV hyperlipoproteinemia can readily be identified in a working population ; treatment by clinic or private physician will markedly lower fasting serum triglyceride values in apparently healthy type IV subjects for at least 24 weeks OBJECTIVE To determine the effect of multifactorial intervention against cardiovascular risk factors on ultrasound-determined progression of atherosclerosis in healthy middle-aged men . DESIGN One hundred and forty-nine healthy middle-aged men were assigned to an intervention group ( IG ) or a control group ( CG ) . SUBJECTS The participants had moderately increased risk-factor scores for cardiovascular disease . They were recruited from a health screening programme at the Preventive Medicine Section , Department of Medicine , Lund University , University Hospital , Malmö . During the study period , 32 of the subjects were lost to follow-up , leaving 59 in the IG and 58 in the CG . INTERVENTION The IG subjects underwent multifactorial intervention for 2 years , the goal being to help them stop smoking and to reduce their blood lipids and blood pressure . MAIN OUTCOME MEASURES Intima-media thickness and plaque score in the right carotid artery were ultrasonographically determined initially and after 2 years . Blood lipids and blood pressure were measured at the same time , and in the IG also after 3 , 6 , 12 and 18 months after entry into the study . RESULTS At the entry into the study , there were no significant differences in major risk factors or ultrasound variables between IG and CG . Blood lipids and smoking decreased significantly during the 2 years of intervention in the IG , whilst these factors remained unchanged in the CG . Intima-media thickness and plaque scores increased significantly in both groups . CONCLUSIONS No effects on ultrasound variables could be detected after 2 years of multifactorial intervention . A more aggressive intervention programme , possibly more dependent on pharmacological treatment , may be required to obtain reduced progression or regression of atherosclerosis The role of dietary fat in human blood pressure control was studied among 84 middle-aged subjects ( mainly couples ) in two semirural communities in North Karelia , Finl and . The families were r and omly allocated into two groups that , after a baseline period of 2 weeks , changed their diet for a 12-week intervention period so that the proportion of energy derived from fats was similarly reduced in both groups , from 38 to 24 % , but the polyunsaturated/saturated fatty acid ( P/S ) ratio was increased -- from 0.2 to 0.9 in group I and to 0.4 in group II . After the intervention period , both groups switched back to their usual diet for a period of 5 weeks . During the intervention period , total serum cholesterol was reduced by 16 % in group I and 14 % in group II . Mean body weight and urinary sodium , potassium , calcium , and magnesium excretion changes were small or nonexistent . Mean systolic blood pressure decreased 4 mm Hg in group I ( P less than 0.01 ) and 3 mm Hg in group II ( P less than 0.01 ) , and mean diastolic blood pressure decreased 5 mm Hg ( P less than 0.001 ) and 4 mm Hg ( P less than 0.01 ) , respectively . The reductions were reversed during the switch-back period ( P less than 0.01 ) . These results confirm previous findings of the blood-pressure-reducing effect of a low-fat/high-P/S diet . Although a number of possible confounding factors can be ruled out , the dietary constituent accounting for the blood pressure change can not be ascertained definitely . The results showed no significant further blood pressure reduction with more than a moderately increased P/S ratio when the saturated fat intake was markedly reduced This r and omized study was performed to assess the effects of > 3 hours of physical exercise per week and low-fat diet on collateral formation in nonselected patients with coronary artery disease ( intervention group , n = 56 ) . Results were compared with those of patients in a control group ( n = 57 ) , who received usual care by their private physicians .  Coronary lesions were assessed by quantitative coronary angiography at the beginning and after 1 year of study ( n = 92 ) . As previously reported , after 1 year there was a significant retardation of progression of coronary artery disease in the intervention group as compared with the control group . In this study , evaluation of collateral formation revealed no significant difference between both groups , and changes in hemodynamic and metabolic variables or leisure time physical activity were not related to changes in collateral formation . Although progression of the disease was significantly related to an increase in collateral formation , regression was significantly related to a decrease in collateral formation ( p < 0.00001 ) . Because patients in the intervention group exercised for > 3 hours/week , and patients with regression of coronary artery disease even dedicated 5 to 6 hours to leisure time physical activity per week , these findings question whether an exercise program within the safety tolerance of patients will be able to induce coronary collateralization in the presence of regression of coronary artery disease To study the impact of dietary intervention on the plasma total and high density lipoprotein cholesterol ( HDL cholesterol ) levels in hypercholesterolemic men , the authors selected 80 male participants in a monitoring risk factor project carried out in Amsterdam , The Netherl and s. These men had plasma total cholesterol levels of between 6.5 and 10.0 mmol/liter ( between 251 and 387 mg/dl ) and were r and omly assigned to either the intervention ( n = 39 ) or the control ( n = 41 ) group . At the start of the intervention period , after 5 weeks , and after 26 weeks , both the intervention and the control groups were examined . This examination consisted of a measurement of height , weight , plasma total and HDL cholesterol , and a dietary interview . The intervention program consisted of a personalized dietary advice to the respondent , based on the report of the Netherl and s Nutrition Council . The study took place between September 1987 and November 1988 . Because of this intervention program , the plasma total and HDL cholesterol levels decreased . The difference in change in plasma total cholesterol between the intervention and control groups was 0.47 mmol/liter ( 18 mg/dl ) after 5 weeks and 0.30 mmol/liter ( 12 mg/dl ) after 26 weeks . For HDL cholesterol , a significant difference in change after 5 weeks disappeared after 26 weeks . The public health implication s of the decrease in plasma total cholesterol are discussed Currently , heart disease is the number one cause of death in the Hispanic population . 4 The age-adjusted mortality rate for heart disease in Hispanic Axnericans ( 181 per 100,000 persons ) is greater than that found in White Americans ( 177 per 100,000 persons ) , Asian/Pacific Isl and ers ( 94 per 100,000 persons ) , and American Indian/ Alaska Natives ( 104 per 100,000 persons ) , but equivalent to rates found in African-Americans ( 181 per 100,000 persons ) .5 The relatively high prevalence of heart disease within this population illustrates the importance of targeting this group in health promotion programs . Nader et al. ( 1992 ) conducted a family-based cardiovascular disease ( CVD ) risk reduction study in which intervention OBJECTIVE To assess the effect of lifestyle intervention over 2 years on changes in weight , coronary heart disease ( CHD ) risk factors , and incidence of diabetes in overweight individuals with a parental history of diabetes . RESEARCH DESIGN AND METHODS Participants ( n = 154 ) , who were 30–100 % over ideal body weight , had one or both parents with diabetes , and were currently nondiabetic , were r and omly assigned to 2-year treatments focused on diet ( decreasing calories and fat intake ) , exercise ( goal of 1,500 kcal/week of moderate activity ) , or the combination of diet plus exercise or to a no-treatment control group . Subjects were reassessed at 6 months , 1 year , and 2 years . RESULTS At 6 months , the groups differed significantly on measures of eating , exercise , and fitness ; weight losses in the diet and diet-plus-exercise groups were significantly > in the exercise and control conditions . Weight losses were associated with positive changes in CHD risk factors . After 6 months , there was gradual deterioration of behavioral and physiological changes , so that at 2 years , almost no between-group differences were maintained . Differences between groups in risk of developing diabetes were of borderline significance ( P = 0.08 ) . Strongest predictors were impaired glucose tolerance at baseline , which was positively related to risk of developing diabetes , and weight loss from baseline to 2 years , which was negatively related ; in all treatment groups , a modest weight loss of 4.5 kg reduced the risk of type 2 diabetes by ∼ 30 % compared with no weight loss . CONCLUSIONS Although initially successful , the interventions studied here were not effective in producing long-term changes in behavior , weight , or physiological parameters . However , weight loss from 0 to 2 years reduced the risk of developing type 2 diabetes . Since modest weight loss significantly reduced risk of type 2 diabetes , further research is needed to determine how best to increase the percentage of subjects achieving at least a modest weight loss BACKGROUND This study was done to determine the efficacy and ease of administration of education/behavior modification classes , provided by a nurse and a dietitian in a primary care clinic for improving control of type 2 diabetes mellitus .  METHODS Patients were divided r and omly into two groups . Eighteen patients completed 6 months of structured , office-based classes , and 20 similar patients served as control subjects . All were patients of the same group practice and had their usual office visits .  Glycemic control , lipid levels , body weight , knowledge about diabetes , medication requirements , and symptoms were monitored during the 6 months , with follow-up at 12 months . RESULTS At the end of 6 months , the intervention group had significant reductions in mean fasting blood glucose , glycosylated hemoglobin , total cholesterol , and low-density lipoprotein cholesterol ( LDL-C ) values . Their mean body weight was significantly reduced at 12 months , and their knowledge of diabetes was improved . Control patients had significant improvement only in glycosylated hemoglobin and body weight at 6 months . Minimal physician time was required . CONCLUSION The education/behavior modification program was clinical ly worthwhile , and it was easy to administer Several studies have identified potential detrimental sequelae of cholesterol and fat-lowering interventions in r and omized trial . Little research has been published to document changes in mental health in women as a result of fat and cholesterol lowering interventions to prevent chronic disease . This paper examines the relationships among changes in dietary fat consumption and mental health in the Women 's Health Trial , a r and omized , controlled trial to determine whether lowering fat consumption to 20 % of daily calories could reduce the incidence of breast cancer in women ages 45 - 69 years . Assessment s were made at baseline and at the 12-month follow-up of several aspects of quality of life , including negative and positive affect and past , present , and future perceptions of health . Mental health variables were measured by the Mental Health Inventory , a st and ardized scale used in the Medical Outcomes study . Dietary intake was assessed for all subjects with the use of semiquantitative food frequency question naires . The change in mental health values ( follow-up minus baseline ) was significantly different between intervention and control groups for three of the four psychological variables : ( a ) anxiety ; ( b ) depression ; and ( c ) vigor . In all three cases , the direction of the change for intervention women was positive . Neither r and omization assignment nor percent of calories from fat at the follow-up visit were significant predictors of mental health at the 1-year follow-up . Cholesterol changes were not related to levels of mental health variables in a sample of the women . These data indicate that lowering fat in the diets of healthy women does not produce overall lowering of any mental health variables . ( ABSTRACT TRUNCATED AT 250 WORDS The National Cholesterol Education Program has underscored the need for health professionals to work together to promote dietary changes and reduce blood cholesterol levels across the population . This article reports the results of an evaluation of several low-intensity intervention programs design ed for the general public that could be offered on a larger scale , either through traditional outlets for short courses or on an outpatient basis after physician referral . The interventions were design ed as classes , required approximately 8 hr of contact time with the participants , cost approximately $ 20 per participant , and were taught by nutritionists and dietitians recruited from the community and trained for this program . Results indicated that similar net reductions in total cholesterol of about 4 % were achieved at 1-yr follow-up either from a course which focused on changing eating patterns or from one which focused on weight loss and weight-loss management . These results support the hypothesis that cholesterol reduction is possible with inexpensive and simple methods in healthy , low-risk population OBJECTIVE : To examine the ability of a secondary prevention programme to improve the lifestyle in myocardial infa rct ion patients aged 50 - 70 years . DESIGN : Habitual physical activity , food habits , and smoking habits were assessed from question naires at admission to hospital and at the one year follow up . Initially , all patients were invited to join an exercise programme and were informed about cardiovascular risk factors . Four weeks after discharge from the hospital , 87 patients were r and omised to follow up at the coronary prevention unit by a special trained nurse ( the intervention group )  , and 81 to follow up by their general practitioners (  the  usual care group ) . After r and omisation , the intervention group was educated about the effects of smoking cessation , dietary management , and regular physical activity . The intervention group also participated in a physical training programme two to three times weekly for 10 - 12 weeks . MAIN RESULTS : 89 % of the patients referred to the intervention group improved their food habits compared with 62 % of the patients referred to the usual care group ( P = 0.008 ) . Furthermore , 50 % of the smokers referred to the intervention group stopped smoking compared to 29 % in the usual care group ( P = 0.09 ) . Changes in physical activity did not differ between the groups . CONCLUSIONS : This secondary prevention programme based on a nurse rehabilitator was successful in improving food habits in patients with acute myocardial infa rct ion . Initiating the smoking cessation programme during the hospital stay followed by repeated counselling during follow up might have improved the results . The exercise programme had no advantage in supporting physical activity compared to usual care The relation between nutrient intake and progression of coronary artery disease was examined in 50 men receiving a lipid-lowering diet or usual care in the St. Thomas ' Atherosclerosis Regression Study . Nutrient intake was assessed by diet history . Changes in coronary angiograms were measured by quantitative image analysis . In univariate linear regression analysis progression of disease over 39 months , as measured by decrease in minimum absolute width of coronary segments , was directly related to dietary energy ( p < 0.001 ) and to the absolute intakes of total fat ( p < 0.001 ) , saturated fat ( p < 0.001 ) , monounsaturated fat ( p = 0.016 ) and cholesterol ( p = 0.06 ) . No significant associations were seen with polyunsaturated fat , carbohydrate , protein , fiber , alcohol or with the ratio of intakes of polyunsaturated fatty acids to saturated fatty acids . In multiple linear regression analysis the associations of change in minimum absolute width of coronary segments with total or saturated fat persisted when adjusted for plasma low-density lipoprotein cholesterol concentration , age , weight , blood pressure , smoking or treatment group assignment . The findings suggest that in middle-aged men , progression of CAD is strongly influenced by intake of saturated fatty acids , an effect mediated in part by mechanisms other than the influence of this nutrient on plasma cholesterol and low-density lipoprotein cholesterol To assess whether baseline plasma high-density lipoprotein ( HDL ) cholesterol levels affected the HDL response to weight loss , we examined lipoprotein changes in overweight men aged 30 to 59 years who were r and omized to lose weight by exercise training ( primarily running , n = 46 ) or by caloric restriction ( ie , dieting , n = 42 ) or to remain sedentary , nondieting controls ( n = 42 ) in a 1-year study . In exercisers , absolute increases in HDL ( mg/dL ) were greatest in men with normal-to-high baseline HDL and least in men with low baseline HDL . Specifically , when divided into groups of low ( < or = 37 mg/dL ) , intermediate ( 38 to 47 mg/dL ) , and normal-to-high HDL cholesterol ( > or = 48 mg/dL ) at baseline , the exercisers increased HDL cholesterol by 2.3 + /- 1.9 , 4.9 + /- 1.1 , and 7.0 + /- 1.3 mg/dL , respectively ; HDL2 cholesterol by 0.8 + /- 1.6 , 2.3 + /- 1.2 , and 5.1 + /- 1.3 mg/dL ; and HDL2 mass by 2.8 + /- 5.1 , 9.5 + /- 8.9 , and 31.7 + /- 11.0 mg/dL. Relative increases in HDL cholesterol were more similar in the low ( 7.1 % + /- 6.1 % ) , intermediate ( 12.4 % + /- 3.9 % ) , and normal-to-high men ( 13.2 % + /- 4.0 % ) . Regression analyses were performed to assess whether baseline HDL cholesterol was related to the amount of absolute HDL change per unit of weight loss . In exercisers , the increase in HDL3 cholesterol concentrations was significantly greater in men with low HDL than in those with normal-to-high HDL at entry ( 2.0 + /- 0.8 v 0.2 + /- 0.8 mg/dL per kg/m2 lost ) . ( ABSTRACT TRUNCATED AT 250 WORDS The study purpose was to determine whether group intervention or an individual self help program proved to be more effective at lowering heart disease risk factors  among employees in different worksites . Eight worksites and 502 employees in the Denver metropolitan area were selected for the project , with four r and omized to Usual Care and four to the Special Intervention . Most worksites had < 200 employees . Employees were r and omly assigned to either a control group receiving usual nutrition education or one of two special intervention groups in which employees selected to attend group nutrition education classes or complete an individual self paced nutrition education program . Results indicated that offering a choice of methods for the special nutrition education intervention was valuable , and both approaches modified behavior and certain physiological outcomes . Results suggested that enhanced nutrition education efforts in worksites may be effective and will realize greater benefits than a pamphlet or brief discussion following a worksite screening Determinants of compliance with a 6-month diet and exercise program were studied among 118 healthy middle-aged men with risk factors for coronary heart disease ( CHD ) . Data were gathered via medical examinations , interviews and question naires . Smoking , high levels of hostility , perception of barriers to diet change and low knowledge of risk factors for CHD were linked to poor compliance with increased intake of dietary fiber . Poor compliance with low fat diet  was linked with smoking , younger age and not having relatives or friends afflicted with CHD . Poor compliance with the exercise program  tended to be associated with younger age and having children at home . Practice implication s for health professionals who provide clinical and educational services for middle-aged men with slightly elevated CHD risk factors are discussed OBJECTIVE To assess the effectiveness of a cholesterol-lowering intervention design ed to facilitate the management of hypercholesterolemia by primary care clinicians . DESIGN R and omized controlled trial , with r and omization of clinician-patient groups . SETTING Twenty-one community and rural health centers in North Carolina and Virginia . PARTICIPANTS Primary care clinicians ( n = 42 , 71 % physicians ) and the patients they enrolled with high cholesterol ( n = 372 ) . Twenty-two clinicians were r and omized to give the special intervention ( 184 patients ) and 20 to give usual care ( 188 patients ) . Two thirds of participating patients were women , 40 % were African American , and 11 % were Native American . INTERVENTION A 90-minute tutorial to train clinicians how to use a structured assessment and treatment program ( Food for Heart Program ) consisting of a brief dietary assessment and three 5- to 10-minute dietary counseling sessions given by the primary care clinician , referral to a local dietitian if the  low-density lipoprotein cholesterol ( LDL-C ) remained elevated at 4-month follow-up , and a prompt for the clinician to consider lipid-lowering medication based on the LDL-C at 7-month follow-up . MAIN OUTCOME MEASURES Changes in total and LDL cholesterol at 4-month follow-up and averaged over a 1-year follow-up period ( 4- , 7- , and 12-month follow-up ) . RESULTS At 4-month follow-up , total cholesterol decreased 0.33 mmol/L ( 12.6 mg/dL ) in the intervention group and 0.21 mmol/L ( 8.3 mg/dL ) in the control group : the difference was 0.11 mmol/L ( 4.2 mg/dL ) ( 90 % confidence interval [ CI ] , -0.02 to 0.24 mmol/L [ -0.7 to 9.1 mg/dL ] ) . The average reduction during the 1-year follow-up period was 0.09 mmol/L ( 3.6 mg/dL ) greater in the intervention group ( 90 % CI , -0.01 to 0.19 mmol/L [ -0.3 to 7.5 mg/dL ] ) . Eight percent of intervention patients were taking lipid-lowering medication at follow-up visits compared with 15 % of control patients . In a subgroup analysis restricted to the 89 % of returnees who were not taking lipid-lowering medication , the reduction in total cholesterol at 4-month follow-up was 0.14 mmol/L ( 5.5 mg/dL ) greater in the intervention group ( 95 % CI , 0.01 to 0.28 mmol/L [ 0.3 to 10.7 mg/dL ] ) ; averaged over 1 year , it was 0.14 mmol/L ( 5.3 mg/dL ) greater ( 95 % CI , 0.03 to 0.24 mmol/L [ 1.2 to 9.4 mg/dL ] ) . Changes in LDL-C were similar . CONCLUSIONS Total cholesterol and LDL-C decreased more in the intervention group than in the control group . Overall , the difference in lipid reduction between groups was modest and of borderline statistical significance ; among participants who did not take lipid-lowering medication during follow-up , the difference in lipid reduction between groups was larger . We conclude that primary care clinicians can be trained to give a cholesterol-lowering intervention to low-income patients that results in modest , short-term reductions in total cholesterol and OBJECTIVES This study was undertaken to test the effectiveness of the Stanford Nutrition Action Program , an experimental trial to reduce dietary fat intake among low-literacy , low-income adults . METHODS Twenty-four paired adult education classes ( 351 participants , 85 % women , mean age = 31 years ) were r and omly assigned to receive a newly developed dietary fat curriculum ( the Stanford Nutrition Action Program ) or an existing general nutrition curriculum .  Food frequency and nutrition-related data , body mass index , and capillary blood cholesterol were collected at baseline and at two postintervention follow-ups . RESULTS The Stanford Nutrition Action Program classes showed significantly greater net improvements in nutrition knowledge ( + 7.7 ) , attitudes ( /0.2 ) , and self-efficacy ( -0.2 ) than the general nutrition classes ; they also showed significantly greater reductions in the percentage of calories from total ( -2.3 % ) and saturated ( -0.9 % ) fat . There were no significant differences in body mass index or blood cholesterol . All positive intervention effects were maintained for 3 months postintervention . CONCLUSIONS The Stanford Nutrition Action Program curriculum , tailored to the cultural , economic , and learning needs of low-literacy , low-income adults , was significantly more effective in achieving fat-related nutritional changes than the general nutrition curriculum The aim of the study was to test the effect of a non-pharmacological weight reduction program on cardiovascular risk factors among overweight hypertensives in a primary health care setting . Forty-nine overweight hypertensive patients completed the 12-month program . The patients were r and omly allocated into either intervention or control groups . The examinations included interviews by a nutritionist , pertinent laboratory tests , and a medical examination . The intervention involved an individually planned energy-restricted diet of 1000 - 1500 kcal per day , weekly discussion s , and various leaflets on diet modification and on increase of physical activity . The mean body weight was reduced by 5 kg in the intervention group , but remained unchanged in the control group . The intervention group reduced their fat intake by 14 g/day while the control group increased it by 9 g/day on the average . In the intervention group , the total serum cholesterol decreased , HDL-cholesterol increased and triglycerides decreased significantly . The systolic blood pressure fell by 8 mm Hg and 15 mm Hg in the intervention and control groups , respectively . The diastolic blood pressure fell on average by 11 mm Hg in both groups . The results demonstrate the comprehensive weight reduction program to be effective in the control of cardiovascular risk factors We design ed a r and omized clinical trial to examine effectiveness of a follow-up educational mailing to improve referral completion following a workplace cholesterol screening program . Of 836 employees who participated in a cholesterol screening program at Blue Cross and Blue Shield of Maryl and , 313 ( 37 % ) had a total cholesterol greater than or equal to 200 mg/dL and were referred to their physician for remeasurement and evaluation . Individuals with elevated cholesterol who agreed to a telephone interview two months after screening ( n = 272 ) were r and omized to a control or intervention group . The intervention consisted of a booster mailing two weeks after screening design ed to encourage further physician follow-up and to increase knowledge about cholesterol and its dietary control and about risk factors for coronary heart disease ( CHD ) . No statistically significant differences appeared between the control and intervention groups in rate of referral completion . However , a blood cholesterol level of greater than or equal to 240 mg/dL at the time of screening was the most significant predictor of referral completion ( P less than .0001 ) . Of those r and omized , the association between the number of other additional risk factors for CHD and referral completion was not statistically significant . There was , however , a trend toward reported changes in lifestyle behavior as a result of screening , particularly in diet modification The Multiple Risk Factor Intervention Trial ( MRFIT ) was a r and omized primary prevention trial to test whether a special intervention ( SI ) program to reduce high blood pressure , elevated blood cholesterol , and /or cigarette smoking could lower  coronary heart disease ( CHD ) mortality in middle-aged men at above average risk . After an average follow-up period of 7 years , risk factor levels were reduced substantially more in SI than in usual-care ( UC ) men ; however , SI-UC differences in CHD mortality ( 7.1 % ) and total mortality ( -2.1 % ) were not statistically significant . Subgroup analysis showed 35 % fewer SI than UC CHD deaths ( P = 0.14 ) but no all-causes mortality difference in men comparable to the cohort having dietary and smoking intervention in Oslo ( the " Oslo-like " cohort ) . Among the subgroup hypertensive at entry , SI-UC differences in CHD and total mortality appeared to be heterogeneous : CHD mortality was 24 % lower in SI than UC men with a normal resting ECG at baseline , but 67 % higher if baseline ECG abnormalities were present ( nominal P = 0.02 , for difference in relative risk estimates ) . These findings were supported by within-group analyses and are generally consistent with results of other CHD/cardiovascular disease prevention trials . They pose a new hypothesis about possible adverse effects of diuretic therapy in a minority of the hypertensive population Abstract This evaluation of the Multiple Risk Factor Intervention Trial data base investigated the effects of dietary PUFA on disease outcomes that may relate to polyunsaturated fatty acid ( PUFA ) biochemistry . The Multiple Risk Factor Intervention Trial was a r and omized clinical trial in coronary heart disease ( CHD ) primary prevention involving 12,866 middle-aged men determined to be at high risk of CHD . They were assigned to either a special intervention group or a usual care group and returned to clinics on an annual basis for assessment of risk factor status . Only data on the usual care men ( n = 6,250 ) are presented , since the multi-intervention effects on the special intervention group introduce considerable analytic complexities . Mean PUFA intake estimates were calculated from four dietary recall interviews at baseline and follow-up Years 1 , 2 , and 3 and estimates for PUFA were established using absolute grams , percentage of total kilocalories , and ratios . Proportional hazards regression analysis controlling for age , race and baseline diastolic blood pressure , smoking , high and low density lipoprotein cholesterol levels , and alcohol was used to analyze dietary PUFA intakes on 10.5-year mortality rates . Results were more significant when PUFA were expressed as percentage of total kilocalories . No significant associations with mortality were detected for linoleic acid ( 18:2n-6 ) , the predominant dietary PUFA . Significant inverse associations were observed for linolenic acid ( 18:3n-3 ) on mortality from CHD ( P < 0.04 ) , all cardiovascular diseases ( CVD ) ( P < 0.03 ) , and all cause mortality ( P < 0.02 ) ; the sum of fatty acids primarily derived from fish oils ( 20:5n-3 + 22:5n-3 + 22:6n-3 ) on CHD ( P < 0.02 ) , CVD ( P < 0.006 ) , and all cause ( P < 0.02 ) mortality ; and , the ratio of 18:3n-3 to 18:2n-6 on cancer mortality ( P < 0.05 ) . Analysis using the total n-3 ( 18:3 + 20:5 + 22:5 + 22:6 ) to total n-6 ( 18:2 + 18:4 + 20:4 ) ratio was also significant on cancer mortality ( P < 0.04 ) . These findings support reports that n-3 fatty acids are protective against CVD and suggest that composition of dietary PUFA may influence CVD and cancer rates We performed two trials . The former was a multicentric trial on 24 untreated patients with nephrotic syndrome due to membranous nephropathy to ascertain whether or not a long-term reduction of protein intake reduces urinary protein loss . In a r and omized cross-over design the patients ate sequentially each for 3 months a normal protein diet ( 1.1 + /- 0.3 g/kg/day of proteins ) and a low-protein diet ( 0.7 + /- 0.1 g/kg/day ) . Both diets were low in fat ( < 30 % of total calories ) . Neither urinary protein excretion nor serum albumin concentration were significantly different at the end of the low protein diet period or the normal protein diet period . We found that after 6 months of dietary manipulation serum total and LDL-cholesterol were reduced by 24 and 27 % from the values at the beginning of the run-in period , also the mean 24 h proteinuria was significantly lower . In the later trial , after a baseline control period of 2 months on free diet , 20 untreated nephrotic patients were fed for two months a vegetarian soy diet , low in fat ( 28 % of total calories ) and in proteins ( 0.71 + /- 0.36 g/kg ideal body weight/day ) . At the end of the diet period all patients ate the same free diet as in the baseline period for 2 more months . The soy diet induced highly significant decreases in total serum cholesterol ( 28 % ) . LDL-cholesterol ( 33 % ) , apolipoprotein B ( 19 % ) , urinary protein excretion ( 32 % ) , that reversed on discontinuation of the diet . ( ABSTRACT TRUNCATED AT 250 WORDS To examine the impact of cholesterol screening with brief nonphysician counseling on cardiovascular risk factors , 886 employees at a large financial services firm underwent  fingerstick screening followed by brief ( 3- to 5-minute ) counseling by a registered nurse . At the 6-month follow-up , there were significant declines in total cholesterol levels ( 5.9 to 5.5 mmol/L [ 228 to 213 mg/dL ] ) , weight ( 78 to 75 kg ) , blood pressure ( 119/78 to 115/75 mm Hg ) , and number of people reporting smoking ( 16.8 % to 14.5 % ) among participants with a baseline cholesterol value of 5.2 mmol/L ( 200 mg/dL ) or greater . A r and omized experiment was conducted on 137 participants initially classified as having a " borderline-high blood cholesterol " level ( 5.2 to 6.2 mmol/L [ 200 to 239 mg/dL ] ) to test the impact of frequency of follow-up . Those receiving frequent follow-up ( cholesterol measurement and brief counseling at 2 , 4 , and 6 months ) reported significantly greater dietary change and demonstrated a trend toward greater declines in total cholesterol compared with those receiving follow-up at 6 months only . The results of this study support the feasibility and efficacy of cholesterol screening utilizing brief nonphysician counseling on multiple cardiovascular risk factors and suggest an enhanced effect when patients receive more frequent follow-up The aim of this study was to determine the long-term effects on myocardial infa rct ion ( MI ) patients of a six-month comprehensive rehabilitation programme ( CRP ) conducted by an interdisciplinary team regarding cardiac events , physical and psychological conditions , life habits , and cardiac health knowledge . The results of a multivariate analysis carried out five years after the MI showed that cardiac events and psychological condition were not significantly influenced by the CRP . However , it was found that the physical condition of the patients benefited from the CRP ;  self-reported physical fitness ( p < 0.002 ) and physical exercise test ( p < 0.007 ) . CRP participation was linked to significant modifications of life habits ( diet change ; p < 0.04 , sexual activity ; p < 0.000 ) . The cardiac health knowledge was significantly improved by participation in the CRP ( basic cardiac knowledge ; p < 0.005 ; knowledge about misconceptions ; p < 0.04 ) . In conclusion , CRPs have had positive long-term effects on physical condition , life habits and cardiac health knowledge . No such effects , however , were found regarding either cardiac events or psychological condition OBJECTIVE To compare the results and cost-effectiveness of a cholesterol lowering protocol implemented by registered dietitians with cholesterol lowering advice by physicians . DESIGN Six month r and omized controlled trial , cost-effectiveness analysis . Subjects included 90 ambulatory care patients ( 60 men , 30 women ) , age range 21 to 65 years , with hypercholesterolemia and not taking hypolipidemic drugs . Patients were r and omly assigned to receive medical nutrition therapy ( MNT ) from dietitians using a NCEP based lowering protocol or usual care ( UC ) from physicians . Outcome measures were plasma lipid profiles , dietary intake , weight , activity , patient satisfaction , and costs of MNT . Changes from baseline for each variable of interest were compared between treatment groups using analysis of covariance controlling for baseline value of the variable and gender . RESULTS MNT achieved a 6 % decrease in total and LDL cholesterol levels at 3 and 6 months compared with a 1 % increase and a 2 % decrease in both values at 3 and 6 months with UC ( P<.001 and P<.05 , respectively ) . Weight loss ( 1.9 vs 0 kg , P<.001 ) and dietary intake of saturated fat ( 7 % of energy vs 10 % , P<.001 ) were better in the MNT than the UC group . The additional costs of MNT were $ 217 per patient to achieve a 6 % reduction in cholesterol and $ 98 per patient to sustain the reduction . The cost-effectiveness ratio for MNT was $ 36 per 1 % decrease in cholesterol and LDL level . APPLICATIONS/ CONCLUSIONS MNT from registered dietitians is a reasonable investment of re sources because it results in significantly better lipid , diet , activity , weight , and patient satisfaction outcomes than UC PURPOSE Since atherosclerosis begins in childhood and cholesterol levels can track from adolescence to adulthood , early intervention to lower elevated levels may be important . Our objective was to test the effectiveness of a health education intervention in hypercholesterolemic college students . METHODS Thirty-nine university students with plasma low-density lipoprotein cholesterol ( LDL-C ) levels > or = 75th percentile ( 2.84 mmol/L , 110 mg/dL ) were r and omized into two study groups . The control group ( n = 19 ) attended a lecture and viewed a brief video on diet and cholesterol . The intervention group ( n = 20 ) participated in 7 weekly sessions on nutrition and behavior modification . At baseline and 8 weeks later , all subjects completed st and ardized tests assessing knowledge and attitudes regarding cholesterol , saturated fat , fiber , and heart-healthy lifestyles . Lipid profiles were analyzed at baseline , 8 weeks , and 8 months after study initiation . RESULTS The groups did not differ at baseline in terms of knowledge , attitudes or lipid profiles . At the 8-week post-test , the intervention group 's knowledge was superior to that of the control group ( p = < 0.001 ) . Both groups showed improvement in their attitude toward a heart-healthy diet . At the 8-week follow-up , the intervention group lowered their mean plasma LDL-C by 0.21 mmol/L ( 8 mg/dL ) whereas the control group 's level fell by an average of 0.05 mmol/L ( 3 mg/dL ) ( p = 0.40 ) . At the 8-month follow-up , LDL-C levels increased from baseline in both groups , but the control group levels rose significantly more than the intervention group ( 0.34 mmol/L vs. 0.05 mmol/L , p = 0.045 ) . Students whose baseline LDL-C was > or = 95 % ( 3.36 mmol/L , 130 mg/dL ) benefitted more from the intervention than those with levels > or = 75 % but < 95 % . CONCLUSIONS We conclude that a 7-week intervention results in significant improvement in nutritional knowledge and protects hyperlipidemic college students with levels > or = 95 % from significant increases in The effects of low fat diet and intensive physical exercise were examined in a r and omized prospect i ve study in patients with angiographically documented coronary heart disease . In addition to supervised regular physical exercise , patients of the intervention group ( n = 18 ) were subjected to intensive dietary counselling with the aim of a low fat , low cholesterol diet to be maintained for at least 12 months . The control group ( n = 27 ) received relevant advise only and usual care by private physicians . In the intervention group there was significant lowering of plasma triglycerides ( 202 + /- 82/141 + /- 74 mg/dl ) and body weight ( 78.2 + /- 9.5/73.7 + /- 10.4 kg ) while total and LDL cholesterol did not change significantly . There was a tendency for a rise of HDL-cholesterol ( 35.6 + /- 9.0/40.4 + /- 14.8 mg/dl , p = 0.07 ) . According to 24-hour diet protocol s there was a significant lowering of energy intake ( 2.298 + /- 697/1.602 + /- 758 kcal/day ) , of fat intake ( 111.7 + /- 44.4/52.0 + /- 23.9 g/day ) and of intake of dietary cholesterol  ( 402.8 + /- 186/161.3 + /- 100.3 mg/day ) as well as of saturated fatty acids ( 42.5 + /- 20.4/14.3 + /- 8.1 g/day ) . Fatty acid composition of adipose tissue was not correlated with the patients ' 24-hour dietary protocol s. In the control group there were no changes of plasma lipids , body weight or diet composition according to 24-hour protocol s after 1 year compared to data at the beginning of the study . There was , however , a marked correlation of adipose tissue composition and dietary information given by the patients . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND Guidelines established by the National Cholesterol Education Program ( NCEP ) promote exercise and weight loss for the treatment of abnormal lipoprotein levels . Little is known , however , about the effects of exercise or the NCEP diet , which is moderately low in fat and cholesterol , in persons with lipoprotein levels that place them at high risk for coronary heart disease . METHODS We studied plasma lipoprotein levels in 180 postmenopausal women , 45 through 64 years of age , and 197 men , 30 through 64 years of age , who had low high-density lipoprotein ( HDL ) cholesterol levels ( < or = 59 mg per deciliter in women and < or = 44 mg per deciliter in men ) and moderately elevated levels of low-density lipoprotein ( LDL ) cholesterol ( > 125 mg per deciliter but < 210 mg per deciliter in women and > 125 mg per deciliter but < 190 mg per deciliter in men ) . The subjects were r and omly assigned to aerobic exercise , the NCEP Step 2 diet , or diet plus exercise , or to a control group , which received no intervention . RESULTS Dietary intake of fat and cholesterol decreased during the one-year study ( P<0.001 ) , as did body weight , in women and men in either the diet group or the diet-plus-exercise group , as compared with the controls ( P<0.001 ) and the exercise group ( P<0.05 ) , in which dietary intake and body weight were unchanged . Changes in HDL cholesterol and triglyceride levels and the ratio of total to HDL cholesterol did not differ significantly among the treatment groups , for subjects of either sex . The serum level of LDL cholesterol was significantly reduced among women ( a decrease of 14.5+/-22.2 mg per deciliter ) and men ( a decrease of 20.0+/-17.3 mg per deciliter ) in the diet-plus-exercise group , as compared with the control group ( women had a decrease of 2.5+/-16.6 mg per deciliter , P<0.05 ; men had a decrease of 4.6+/-21.1 mg per deciliter , P<0.001 ) . The reduction in LDL cholesterol in men in the diet-plus-exercise group was also significant as compared with that among the men in the exercise group ( 3.6+/-18.8 mg per deciliter , P<0.001 ) . In contrast , changes in LDL cholesterol levels were not significant among the women ( a decrease of 7.3+/-18.9 mg per deciliter ) or the men ( 10.8+/-18.8 mg per deciliter ) in the diet group , as compared with the controls . CONCLUSIONS The NCEP Step 2 diet failed to lower LDL cholesterol levels in men or women with high-risk lipoprotein levels who did not engage in aerobic exercise . This finding highlights the importance of physical activity in the treatment of elevated LDL cholesterol levels Phase II of the Trials of Hypertension Prevention ( TOHP ) is a multicenter , r and omized trial sponsored by the National Heart , Lung , and Blood Institute design ed to test whether weight loss alone , sodium reduction alone , or the combination of weight loss and sodium reduction will decrease diastolic ( DBP ) and systolic blood pressure ( SBP ) as well as the incidence of hypertension ( DBP > or = 90 mm Hg , SBP > or = 140 mm Hg , and /or use of antihypertensive medications ) in subjects with high-normal DBP ( 83 to 89 mm Hg ) and SBP less than 140 mm Hg at entry . These interventions were chosen for longer-term testing with end points including hypertension prevention as well as blood pressure ( BP ) change based on their demonstrated short-term efficacy in reducing BP in phase I of TOHP . The phase II study population is comprised of 2382 participants ( 1566 men and 816 women ) who are 110 to 165 % of desirable body weight , allocated at r and om to the four treatment arms using a 2 x 2 factorial design . The trial has 80 % power to detect an overall treatment effect on DBP of 1.2 mm Hg for weight loss or sodium reduction and a difference of 1.6 mm Hg between the combined intervention and placebo groups . BP observers are blinded to participant treatment assignments . Participants will be followed for 3 to 4 years . This trial may have important public policy implication s concerning the ability of life-style modifications to reduce BP and prevent the development of hypertension over the long term , thereby avoiding the need for drug therapy which while effective is costly and may have side effects There is still a need of support for nonpharmacologic treatment of uncomplicated , mild-to-moderate essential hypertension . We investigated whether a low sodium-based diet implemented by a nutritionist could lower blood pressure and affect sympathetic activity .  Middle-aged , otherwise healthy men with never-treated essential hypertension ( n = 95 ) were r and omized to an intervention group , a blood pressure control group , and a time control group . The intervention group was advised to use less sodium chloride in their diet , and if necessary , less saturated fat and decrease body weight .  They attended regular clinic visits as did the blood pressure control group . After 1 year , the intervention group had achieved on average 72 mmol/24 h lower urinary sodium excretion ( P < .001 ) and a decrease in body weight of 2.7 + /- 0.5 kg ( P < .001 ) . Both supine and st and ing mean blood pressure were on average 8 to 10 mm Hg lower after intervention compared with the two control groups ( P < .001 ) . Arterial plasma epinephrine , measured in all 40-year-old subjects ( n = 30 ) , decreased in parallel in all three groups ( P < .05 ) , indicating some habituation to the invasive procedure and clinic visits . However , the decrease in norepinephrine was significant ( P < .001 ) only in the intervention group ; it correlated with the weight loss ( r = 0.76 , P < .05 ) and was significantly higher ( P < .05 ) than in both control groups . These results suggest that broad dietary advice ( ie , low intake of sodium chloride , saturated fat and energy ) , implemented by a nutritionist , may have a significant blood pressure lowering effect and a favorable sympathicolytic effect in uncomplicated , mild-to-moderate essential hypertension In a trial to evaluate the effectiveness of a nurse-directed intervention design ed to help patients decrease dietary intake of fat , quit or decrease smoking , and increase exercise , 138 women who underwent coronary artery bypass surgery were r and omized to receive special intervention ( SI ) or usual care ( UC ) . The SI group received a behavioral program based on self-efficacy theory in the home 2 weeks after discharge with regular follow-up . The UC group received routine medical care .  Risk factors and lifestyle behaviors were measured at baseline and 1 year after surgery in 116 ( 84 % ) women ( SI = 59 , UC = 57 ) . The SI group decreased their total fat intake from a mean of 38 % of calories at baseline to 35 % at 1 year , while the UC group increased it from 36 % to 38 % . The prevalence of smoking decreased from 24 % at baseline to 8 % at 1 year in the SI group and from 19 % to 14 % in the UC group . At follow-up , the quit rate in those smoking at baseline was 64 % in the SI group , with no new smokers , and 55 % in the UC group , with three new smokers . Both groups reported improvement in exercise , with the proportion of women reporting participation in some form of regular exercise slightly higher in the SI group than in the UC group , 54 % and 51 % , respectively We studied the independent and combined effects of exercise training and weight loss on blood lipids under fixed diet and exercise conditions . Twenty-one obese sedentary men were r and omly allocated to one of four treatment groups : ( 1 ) inactive and constant weight ( control ) , ( 2 ) exercise training and constant weight , ( 3 ) inactive and weight loss , and ( 4 ) exercise training and weight loss . There were three study periods : a 3 week baseline period inactive and on an isocaloric diet , a 12 week treatment period , and a 3 week weight stabilization period . Exercise consisted of treadmill walking at an energy cost of 3500 kcal/wk for groups 2 and 4 with replacement caloric intake only in group 2 . Group 3 reduced caloric intake by 3500 kcal/wk during the treatment period . Weight loss for groups 3 and 4 were 13.4 pounds and 13.7 pounds , respectively . Maximal oxygen uptake ( mL/min ) increased 6 % in both exercise groups ( 2 and 4 ) , and percent body fat decreased only in these groups . Regression analysis by group assignment on HDL cholesterol ( HDL-C ) showed that the inactivity-weight loss modality ( group 3 ) and the exercise-constant weight modality ( group 2 ) each significantly increased HDL-C , with an additive effect of exercise and weight loss ( group 4 ) . The rate of HDL-C change differed significantly between groups ( P = 0.01 ) . HDL-C increased 0.63 , 0.61 , and 1.89 mg/dL per 3 weeks or 2 % , 2.4 % , and 5.5 % above baseline levels in groups 2 , 3 , and 4 , respectively , while the control group decreased 0.11 mg/dL. Plasma triglycerides and very low-density lipoprotein ( VLDL ) cholesterol increased with exercise at constant weight ( group 2 ) and decreased with exercise associated with weight loss ( group 4 ) . In conclusion , exercise and weight loss separately and independently increase HDL-C , and their effects are additive OBJECTIVE To conduct a cost analysis and cost-effectiveness study based on a r and omized clinical trial of basic nutrition care ( BC ) and practice guidelines nutrition care ( PGC ) provided by dietitians in outpatient clinics . DESIGN Subjects with non-insulin-dependent diabetes mellitus ( NIDDM ) from three states ( Minnesota , Florida , Colorado ) were r and omly assigned to a group receiving BC or a group receiving PGC for a 6-month clinical trial . Along with data about medical and clinical outcomes , data about cost re sources were collected . The cost-effectiveness of PGC compared with BC was calculated using per-patient costs and glycemic outcomes for the 6 months of the study . A net cost-effectiveness ratio comparing BC and PGC , including the cost savings result ing from changes in medical therapy , was also calculated . SUBJECTS The study reports on a sample of 179 subjects with NIDDM between the ages of 38 and 76 years who completed the clinical trial . RESULTS Patients in the PGC group experienced a mean 1.1 + /- 2.8 mmol/L decrease in fasting plasma glucose level 6 months after entry to the study , for a total per-patient cost of $ 112 .  PGC costs included one glycated hemoglobin assay used by the dietitian to evaluate nutrition outcomes . Patients in the BC group experienced a mean 0.4 + /- 2.7 mmol/L decrease , for a total per-patient cost of $ 42 . In the PGC group , 17 persons had changes in therapy , which yielded an average 12-month cost savings prorated for all patients of $ 31.49 . In contrast , in the BC group , 9 persons had changes in therapy , for an average 12-month prorated cost savings of $ 3.13 . Each unit of change in fasting plasma glucose level from entry to the 6-month follow-up can be achieved with an investment of $ 5.75 by implementing BC or of $ 5.84 by implementing PGC . If net costs are considered ( per-patient costs -- cost savings due to therapy changes ) , the cost-effectiveness ratios become $ 5.32 for BC and $ 4.20 for PGC , assuming the medical changes in therapy were maintained for 12 months . APPLICATIONS These findings suggest that individualized nutrition interventions can be delivered by experienced dietitians with a reasonable investment of re sources . Cost-effectiveness is enhanced when dietitians are engaged in active decision making about intervention alternatives based on the patient 's needs Mexican Americans are more likely to be obese than non-Hispanic whites , yet little research has been conducted on the treatment of obesity in Mexican Americans . The purpose of this study was to compare a family-based intervention with a traditional program oriented to the individual for achieving weight loss by obese Mexican American women . A total of 168 obese women were r and omly assigned to one of three groups . Group 1 served as a comparison group and received only printed material s on nutrition , exercise , and behavioral principles for weight loss . Subjects in the individual group ( group 2 ) received the same printed information , but they also attended classes led by bilingual registered dietitians . Subjects in the family group ( group 3 ) received material s and attended classes that emphasized a family-oriented approach to making changes in eating habits and exercise behavior . Spouses and children attended classes with subjects in this group . Results revealed a significant linear trend in both body mass index and weight reduction across the groups , with losses greatest in the family group , followed by the individual group , and least in the comparison group . Both the individual and the family groups lost significantly more weight than the comparison group , although the difference between these two groups was not statistically significant . The results suggest that a culturally and linguistically appropriate program can achieve significant weight reduction among Mexican Americans . More research should be conducted on the effects of family and other types of social support on weight loss by Mexican Americans OBJECTIVE This study was carried out to test the effectiveness of PATHWAYS , a weight loss program design ed specifically for urban African-American women , when administered in urban churches by trained lay facilitators . RESEARCH DESIGN AND METHODS Thirty-nine obese women were recruited from three urban African-American churches . After r and omization and the collection of baseline data on weight and lifestyle practice s , subjects in the experimental group ( n = 19 ) were assigned to receive a 14-week weight loss program ( PATHWAYS ) conducted by trained lay volunteers ; control group subjects ( n = 20 ) were put on a waiting list to receive the program at the conclusion of the study period . RESULTS Of the 39 women enrolled , 15 experimental group subjects and 18 control group subjects were available for posttreatment data collection . After completing the program , PATHWAYS participants lost an average of 10.0 lb , and the control group subjects gained an average of 1.9 lb . Posttreatment difference in weight loss between the groups was statistically significant ( P < 0.0001 ) . Waist circumference among PATHWAYS participants decreased 2.5 inches , while waist circumference among control group subjects remained relatively the same . This difference between the groups was statistically significant ( P < 0.05 ) . CONCLUSIONS A weight loss program administered by trained lay volunteers was effective in producing significant and clinical ly meaningful weight loss among African-American women who often do not benefit from typical weight loss programs . Ongoing research is focusing on whether the weight loss can be maintained or enhanced through monthly reinforcement sessions Objective To examine the effect on quality of life in hypertensive men of a multiple risk factor intervention programme  compared with that of usual care .  Design A prospect i ve , open , r and omized , parallel-group study with allocation either to a comprehensive multiple risk factor modification programme or to usual care . Setting An outpatient clinic in a city hospital . Patients : Five hundred and eight treated hypertensive men , aged 50–72 years , with at least one of the following : serum cholesterol ≥ 6.5 mmol/l , smoking habit or diabetes mellitus . Intervention Nutritional advice , behavioural treatment principles and drug therapy . Main outcome measures : Minor symptoms evaluation profile ( MSEP ) was used to measure change in quality of life . Results The intervention programme led to sustained effects on lifestyle-related variables such as hypercholesterolaemia , body mass index and smoking habits , whereas diastolic blood pressure and HbA1c remained unchanged . The change in the MSEP during follow-up did not differ between the intervention and the usual care groups . There was a close relationship between the measurements of the three MSEP dimensions at baseline and at follow-up ( P < 0.0001 ) . None of the potential risk factors measured at entry was significantly associated with change in the three MSEP dimensions during follow-up . Conclusion The multiple risk factor intervention programme directed towards smoking habits , hypercholesterolaemia and the metabolic control of diabetes mellitus in treated hypertensive men at high cardiovascular risk was not associated with an impaired quality of life compared with that in a control group . The method used , the MSEP , has previously been found to be a reliable method with good validity , and this study 's results provide further evidence of its validity In 1982 we started a series of pilot studies to examine the feasibility of dietary intervention with a low-fat , high-carbohydrate diet in women with extensive mammographic densities . The purpose of the present paper is to examine the long-term effects of participation in these studies by assessing nutrient intake and other variables several years after active participation had stopped . Two hundred sixteen women were eligible for the follow-up study and were invited to attend and interview with a dietician . Data were collected by food frequency question naire from 157 subjects ( 73 % ) , and blood was obtained from 115 subjects .  Total energy intake was slightly lower in the intervention group . Total fat and percent energy from fat were significantly lower in the intervention group . The intake of all types of fat ( saturated fat , linoleic acid , and oleic acid ) and dietary cholesterol was lower in the in the intervention group ; however , the polyunsaturated/saturated fat ratio did not differ between the groups . Total cholesterol and apoprotein B levels were lower in the intervention group compared to the control group . Follicle-stimulating hormone was 29 % higher in postmenopausal members of the intervention group than in controls , but there was no difference in levels of estradiol . A total of 19 women enrolled in pilot studies had developed breast cancer , 5.7 times the number expected , confirming that the selection of women with extensive mammographic densities does identify a high-risk group . These data suggest that even quite short periods of intensive dietary counselling may have prolonged effects on diet , and that once subjects have adopted new dietary habits , the habits may persist even in the absence of continued counselling UNLABELLED Dietary recommendations for the treatment of hypercholesterolemia ( HC ) emphasize stepwise reductions in fat intake , but there is no agreement on what lower limit is desirable or achievable . These recommendations have applied broadly to persons with HC alone , as well as to those with a combined elevation in triglyceride ( TG ) and cholesterol , even though they may differ in pathophysiological mechanisms and response . In this paper , we describe the design and feasibility of recruiting and r and omizing subjects with HC or combined hyperlipidemia ( CHL ) to an outpatient dietary intervention study of progressively fat-restricted diets . Diets were design ed to contain 30 , 26 , 22 , and 18 % of calories from fat ; 300 , 200 , 100 , and 100 mg cholesterol/day ; and a polyunsaturated/saturated fat ratio of approximately 1.0 . Triglyceride and low-density-lipoprotein cholesterol ( LDL-C ) cutpoints were based on the age-specific 75th percentile value . Over 18 months , 8372 men were screened , yielding 320 HC subjects r and omized to the four diets and 211 CHL subjects r and omized to the first three diets ( because of fewer CHL subjects ) . At baseline , HC and CHL subjects were similar in age , education , lifestyle , dietary intake , and LDL-C , but CHL subjects were heavier , more hyperglycemic , hyperinsulinemic , and hypertensive . CONCLUSIONS Recruiting a large cohort of HC and CHL subjects from an industrial workforce is feasible in a restricted time frame . CHL subjects demonstrate features of the insulin resistance/hypertension syndrome , differing from HC subjects . CHL is sufficiently common relative to HC ( 2:3 ) to permit a comparison of dietary responses between the two conditions . Finally , the r and omization of HC and CHL subjects to the diets yielded statistically indistinguishable groups , permitting a test of the efficacy of the alternative diets within each hyperlipidemic ( HL ) category 1 . The effects of weight reduction and metoprolol ( 100 mg , b.d . ) in the treatment of hypertension ( diastolic blood pressure 90–109 mmHg ) in 56 young , overweight patients were investigated in a r and omized placebo controlled trial . After a 4‐week baseline , subjects were followed up for 21 weeks OBJECTIVE To evaluate the effectiveness of nutrition education within an outpatient cardiac rehabilitation program . DESIGN Subjects were assigned , according to participation in cardiac rehabilitation programs in two community hospitals within an integrated healthcare system , to either a treatment ( n=54 ) , or a control group ( n=50 ) . SUBJECTS/ SETTING One hundred four men and women , age range 35 to 85 years , participating in a 6-week cardiac rehabilitation program . Most were men ( 80 % ) and overweight . The majority presented with the diagnosis of myocardial infa rct ion followed by coronary artery bypass surgery or percutaneous transluminal coronary angiography procedure . INTERVENTION Subjects in the control group received usual nonindividualized nutrition education from cardiac rehabilitation therapists . Subjects in the treatment group attended two group nutrition education classes and one individual diet counseling session , all led by the same dietitian . MAIN OUTCOME MEASURES Changes in fat , saturated fat , cholesterol , and carbohydrate intake , and restaurant eating habits as assessed by the Diet Habit Survey ; changes in cardiac diet self-efficacy ; and changes in health-related quality of life . Statistical analyses performed Group-by-time analysis of variance with repeated measures , chi2 test . RESULTS The treatment group had greater improvement in Restaurant and Recipes scores on the Diet Habit Survey ( 2.6 vs 1.0 ) and a greater cardiac diet self-efficacy mean score ( 4.3 ) compared with the control group ( 3.8 ) , with the greatest change in items related to eating in restaurants , away from home , or when alone . From entry into the program to discharge , the cholesterol-saturated fat index decreased significantly in the control group ( from 57 to 48 ) , and in the treatment group ( from 51 to 42 ) . The percent of energy from carbohydrate increased significantly in the control group ( from 51 % to 55 % ) and in the treatment group ( from 53 % to 57 % ) . There were no differences between groups over the 3 time periods ( baseline , 6 weeks , and 3-month follow-up ) ( n=39 for control group and n=47 for treatment group for all 3 time periods ) . APPLICATIONS/ CONCLUSIONS Nutrition education within an outpatient cardiac rehabilitation program can improve dietary choices at restaurants and boost self confidence in the ability to adhere to a lipid-lowering diet The effect of a combination low sodium , low fat , high fibre diet on serum lipids in 184 treated hypertensive patients was analysed in a controlled trial . The combination diet caused a small but significant reduction in serum triglyceride and total cholesterol . This was apparently due to the low fat component of the diet , since a low fat diet alone also caused a similar reduction in total cholesterol , whereas a high fibre diet or a low sodium diet alone caused no significant changes in serum lipids . Analysis of the medication subgroups suggests that diuretics may allow more favourable changes in lipid profile than betablockers . The combination diet and the low fat diet both caused a significant reduction in HDL cholesterol . Thus there was no significant change in the HDL ratio for the combination group and a significant decrease in this ratio for the low fat group . Furthermore the magnitude of changes in total and LDL cholesterol in the low fat and combination groups was much smaller compared to previously observed changes in untreated patients . The overall limited benefit of the combination diet , and possibly adverse effect of the low fat diet , may contribute to the limited effect of therapeutic intervention on mortality from ischaemic heart disease seen in previous studies Thirty-one subjects with impaired glucose tolerance were r and omly allocated to a group receiving advice to improve their diet and physical activity levels over 6 months ( n = 23 ) or to a control group ( n = 8) . At 6 months , 18 of the 23 subjects receiving ' healthy living ' advice  were re-examined ( five subjects had withdrawn ) . Fourteen of the 18 subjects showed an alteration in diet or an increase in exercise . The 18 subjects re-evaluated showed a reduction in systolic blood pressure ( 118 + /- 15 vs 124 + /- 15 mmHg , p less than 0.05 ) and decrease in total plasma cholesterol ( 4.5 + /- 1 vs 5.2 + /- 1 mmol l-1 , p less than 0.01 ) and LDL-cholesterol levels ( 2.8 + /- 0.9 vs 3.2 + /- 0.9 mmol l-1 , p less than 0.05 ) . Plasma glucose levels were unchanged . One subject withdrew from the control group . At 6 months , the seven control subjects examined showed no significant change in metabolic parameters , with little measurable change in diet or exercise . At 2 years , 17 of the 23 ' healthy living ' subjects were reassessed . Nine of the subjects had continued to exercise or maintained a decreased weight compared to baseline . Fasting plasma glucose levels had increased ( 6.0 + /- 1.2 vs 5.5 + /- 0.6 mmol l-1 , p less than 0.05 ) , with the only continued improvement being a reduced LDL level ( 2.8 + /- 0.7 vs 3.1 + /- 0.9 mmol l-1 , p less than 0.05 ) . At 2 years , a similar proportion of the control group were taking regular exercise compared with the ' healthy living ' group . ( ABSTRACT TRUNCATED AT 250 WORDS A comprehensive programme of nonpharmacological control of hypertension ( balanced nutrition , satisfactory weight , enhanced physical activity , relaxation technique , smoking cessation ) by primary care physician-nurse ( PN ) teams  who were instructed and routinely advised by a paramedical professional ( PP ) team ( psychologist , nutritionist and physical activity instructor ) was developed with the aim of increasing long-term compliance . To evaluate effectiveness , 52 mild and moderate hypertensives without target organ damage were r and omly allocated to six weekly meetings of individual intensive instruction by PN teams alone , or direct group instructions by PP teams ( 24 and 28 patients , respectively ) . The respective results at 11 months and 24 months follow-up compared with baseline were : ( 1 ) 56.9 % and 58.8 % showed minimal satisfactory reduction of weight , ( 2 ) 49 % and 58.8 % showed minimal satisfactory increase in physical activity , ( 3 ) the reported increase in physical activity at 11 months follow-up was vali date d by significantly correlated improved performance in ergometry , ( 4 ) 75 % and 40 % of the patients performed relaxation vs. 2 % at baseline and ( 5 ) 71 % and 59 % needed no medication or reduced dose to control BP , and these changes were significantly ( P < 0.02 ) correlated with weight reduction and increased physical activity . As no differences were found between the two modes of treatment , we conclude that our programme can be successfully applied by the PN primary care teams to increase adherence to nonpharmacological measures in the control of hypertension OBJECTIVE Individuals with impaired glucose tolerance ( IGT ) have a high risk of developing NIDDM . The purpose of this study was to determine whether diet and exercise interventions in those with IGT may delay the development of NIDDM , i.e. , reduce the incidence of NIDDM , and thereby reduce the overall incidence of diabetic complications , such as cardiovascular , renal , and retinal disease , and the excess mortality attributable to these complications . RESEARCH DESIGN AND METHODS In 1986 , 110,660 men and women from 33 health care clinics in the city of Da Qing , China , were screened for IGT and NIDDM . Of these individuals , 577 were classified ( using World Health Organization criteria ) as having IGT . Subjects were r and omized by clinic into a clinical trial , either to a control group or to one of three active treatment groups : diet only , exercise only , or diet plus exercise . Follow-up evaluation examinations were conducted at 2-year intervals over a 6-year period to identify subjects who developed NIDDM . Cox 's proportional hazard analysis was used to determine if the incidence of NIDDM varied by treatment assignment . RESULTS The cumulative incidence of diabetes at 6 years was 67.7 % ( 95 % CI , 59.8–75.2 ) in the control group compared with 43.8 % ( 95 % CI , 35.5–52.3 ) in the diet group , 41.1 % ( 95 % CI , 33.4–49.4 ) in the exercise group , and 46.0 % ( 95 % CI , 37.3–54.7 ) in the diet-plus-exercise group ( P < 0.05 ) . When analyzed by clinic , each of the active intervention groups differed significantly from the control clinics ( P < 0.05 ) . The relative decrease in rate of development of diabetes in the active treatment groups was similar when subjects were stratified as lean or overweight ( BMI < or ≥ 25 kg/m2 ) . In a proportional hazards analysis adjusted for differences in baseline BMI and fasting glucose , the diet , exercise , and diet-plus-exercise interventions were associated with 31 % ( P < 0.03 ) , 46 % ( P < 0.0005 ) , and 42 % ( P < 0.005 ) reductions in risk of developing diabetes , respectively . CONCLUSIONS Diet and /or exercise interventions led to a significant decrease in the incidence of diabetes over a 6-year period among those with IGT The effect of a 1-year exercise and diet intervention program on global self-concept , perceptions of the body , physical competence , exercise mastery , social competence , social comfort , and fitness was examined with 208 healthy individuals ( 191 males , 17 females ) aged 39 - 49 years ( mean age 44.9 ) with elevated risk factors for cardiovascular disease . The relative utility of the skill development versus the self-enhancement model of the self-concept/behaviour relationship was tested . The participants were r and omized into four groups : diet ( n = 53 ) , diet and exercise ( n = 64 ) , exercise ( n = 48 ) and no active intervention ( n = 43 ) . Measurements were made by the Harter adult self perception profile ( HASPP ) and the self-perception in exercise question naire ( SPEQ ) . Two-way ANOVA analyses revealed that exercise participation , with or without diet , enhanced self-perceptions of physical mastery and ability , body perception , fitness and social comfort . The unique contribution of diet indicated enhanced body perception . No effect was found of diet or exercise on global self-concept . Exercise participation had a positive effect on perceptions of the self , and the higher the compliance with the exercise program , the stronger were the effects on the self-perceptions . This supported the skill development model of the self-concept/behaviour relationship . As the pretest self-concept scores did not predict exercise compliance , the self-enhancement model of the self-concept/behaviour relationship was not supported 1 . Diets used to reduce sodium intake often involve changes in fats and fibre which might themselves affect blood pressure and /or lipid metabolism . To evaluate the relative importance of these dietary changes for the management of hypertension we have studied the independent and additive effects of sodium restriction ( 60 mmol/day ) and a low fat ( 30 % energy ) , high P/S ratio ( 1.0 ) , high fibre ( 30–50 g/day ) ‘ cholesterol lowering ’ diet The five year ( 60-month ) results from the Oslo Study Diet and Antismoking Trial were published in the Lancet in December 1981 . The trial involved 1,232 healthy men , aged 40 to 49 years , at high risk for coronary heart disease , with serum cholesterol values in the range of 7.5 to 9.8 mmol/liter ( enzymatic method : 6.9 to 9.0 , mean value 7.8 mmol/liter ) . Eighty percent of the men were daily cigarette smokers at the start of the study , and all participants were normotensive , i.e. , systolic blood pressure was less than 150 mm Hg . Subjects were r and omly assigned to either a control or intervention group . Follow-up visits were scheduled every six months for the intervention group and yearly for the control group . Once the trial was completed , the regular six-month follow-up visits were discontinued , but eight to nine years ( 96 to 108 months ) after the start of the trial , participants were called for a new follow-up . Risk factors were recorded , and clinical events were diagnosed according to the same procedure as during the trial . The mean serum cholesterol levels in the intervention group remained unchanged three years after the end of the trial , but the cholesterol levels in the control group declined . Daily cigarette smoking increased in the intervention group but remained stable in the control group . At the new follow-up , the difference in incidence of fatal and nonfatal myocardial infa rct ion and sudden coronary death was the same as at the end of the trial three years earlier , yielding significant differences between the two groups for sudden death , total coronary death , and total coronary events . Although the study was not design ed to show differences in total mortality , this difference became marginally significant , with 19 deaths in the intervention group and 31 in the control group . It is concluded that although net differences in risk factors between the two groups had been reduced during the three years after the regular intervention period , the significant difference in coronary events and sudden death was maintained BACKGROUND A r and omized study was conducted to test the feasibility of cholesterol lowering in physician office practice s using the National Cholesterol Education Program Adult Treatment Panel 1 guidelines . METHODS Twenty-two physician practice s in phase 1 and 23 in phase 2 were recruited from communities in Western Pennsylvania and West Virginia . These physicians treated a total of 450 adults in phase 1 ( 190 men and 260 women ) and 480 adults in phase 2 ( 184 men and 296 women ) with hypercholesterolemia . Three models ( Usual Care [ phase 1 ] , Office Assisted [ phase 2 ] , and Nutrition Center [ phase 2 ] ) for implementing the National Cholesterol Education Program Adult Treatment Panel 1 guidelines were tested over an 18-month period . The baseline serum cholesterol levels were as follows : 6.51 mmol/L ( 252 mg/dL ) in the Usual Care Model ; 6.80 mmol/L ( 262 mg/dL ) in the Office Assisted Model ; and 6.96 mmol/L ( 269 mg/dL ) in the Nutrition Center Model . RESULTS In the patients who were not taking lipid-lowering medication , the mean cholesterol response was significantly different between the 3 models ( P < .01 ) . Serum cholesterol levels declined by 0.14 mmol/L ( 5.4 mg/dL ) in the Usual Care Model ; by 0.31 mmol/L ( 12 mg/dL ) in the Office Assisted Model ; and by 0.54 mmol/L ( 20.9 mg/dL ) in the Nutrition Center Model . Two factors-length of time to follow-up measurement and change in weight-were independently related to cholesterol response across all models . African Americans demonstrated a significantly smaller response than whites in the Usual Care Model , while men demonstrated greater declines in serum cholesterol levels than women in the Office Assisted Model . Patient satisfaction was very favorable in both enhanced conditions ; however , those treated in the the Nutrition Center Model were more satisfied ( P < .05 ) with program components . CONCLUSIONS The impact of nutrition intervention delivered through physician practice s on serum cholesterol levels is less than clinical ly desirable , and new approaches with more aggressive therapy should be tested and implemented Our objective was to determine whether an educational intervention and prompting intervention for physicians improved dietary counseling of patients with high blood cholesterol and result ed in beneficial changes in patients ' diets and cholesterol levels . We instituted a factorial design , multicenter , r and omized , placebo-controlled trial to test two interventions . We tested the trial at continuity care clinics of internal medicine residents at seven community and university medical centers in the northern and eastern United States . Our participants were 130 internal medicine residents and 254 adult out patients with blood cholesterol levels of 240 - 300 mg/dL. Interventions included an educational program for resident physicians design ed to improve their skills and confidence in dietary counseling ( two one-hour sessions with specially prepared printed material s for use in counseling ) and a prompting intervention , which was a fingerstick blood cholesterol determination prior to the patient 's clinic visit . Resident physicians ' knowledge , attitudes , and self-reported behaviors were assessed prior to the intervention and 10 months later using chart audits and question naires . Residents ' behaviors were also assessed by exit interviews with patients . Patients ' knowledge , attitudes , behaviors , and fingerstick blood cholesterol levels were measured at baseline and 10 months later . The educational program increased the percentage of physicians who were confident in providing effective dietary counseling ( baseline of 26 % to 67%-78 % ; P < .01 ) . The prompting intervention approximately doubled the frequency of physician counseling ( P = .0005 ) and increased the likelihood that patients would try to change their diets . When both interventions were combined , most outcomes were better , although not statistically significant . Cholesterol levels , however , decreased only marginally and were no different among groups at 10-month follow-up . Despite success in changing physicians ' attitudes and behaviors and increasing patients ' willingness to change their diets , there was no significant change in patients ' cholesterol levels . Medical Subject Headings ( MeSH ) : r and omized controlled trial ; cholesterol ; patient education ; behavior therapy ; education , medical ; diet In a screening survey of women and men 47 - 54 years old for detection of glucose intolerance ( GI ) , with 75 g oral glucose tolerance tests ( OGTT ) , 25 subjects with GI were r and omly selected for a therapeutic trial for normalization of the GI . A control group of 18 GI subjects was chosen r and omly from the same health survey and given no treatment for 5 - 10 months ; no significant changes in OGTT variables , body mass index , blood pressure or blood lipids were found in this group during follow-up . The treatment group was given advice concerning a low-sucrose , low-fat , high-fiber and energy-restricted ( when overweight ) diet and also concerning exercise - single-h and ed ( 16 subjects ) or in an exercise group ( 9 subjects ) . The GI improved in the 25 treated subjects after 6 months of this therapy . Thus the total area under the glucose curve and the 1-h and the 2-h glucose values had decreased , the mean 2-h glucose value was restored to normal ( less than 7.0 mmol X l-1 ) and 48 % of the treated subjects had a normal 2-h glucose value . Body mass index , systolic blood pressure , serum cholesterol and serum triglycerides were also reduced at the follow-up . The 6-month result was similar in the subgroup of nine GI subjects who followed the dietary advice and exercised in a group for at least one hour per week during at least three months . Physical working capacity was increased , although non-significantly . Glipizide , 1.25 mg daily , was added at breakfast to ten GI-subjects who still had pathological 2-h glucose values after 6 months of dietary and exercise treatment . After a further 6 months of treatment of these 10 subjects , the total glucose area and the 2-h glucose value were reduced , while the mean 2-h glucose value had not required the normal level . Body mass index was unchanged . Another four subjects in this subgroup now showed a normal 2-h glucose value . In conclusion , the 2-h glucose value was restored to normal in totally 64 % of all treated GI subjects after short-term treatment with a diet , exercise and , in some cases , added glipizide National and international policy-making organizations advocate nonpharmacologic therapies to reduce blood pressure ( BP ) . However , data to support such recommendations in older persons are virtually nonexistent . The Trials of Nonpharmacologic Intervention in the Elderly ( TONE ) is a r and omized , controlled trial that will test whether weight loss or a reduced sodium ( Na ) intake or both can maintain satisfactory BP control , without unacceptable side effects , after withdrawal of antihypertensive drug therapy . Medication-treated hypertensives ( aged 60 to 80 years ) with a systolic BP less than 145 mm Hg and a diastolic BP less than 85 mm Hg who are taking one antihypertensive medication are r and omly assigned to one of four groups : ( 1 ) weight loss alone , ( 2 ) reduced Na intake alone , ( 3 ) combined weight loss and reduced Na intake , or ( 4 ) usual life-style ( control group ) .  Overweight participants are r and omized to one of these four groups , while nonoverweight individuals are assigned to either the reduced Na intake or the usual life-style group . The interventions , tailored to the needs of older persons , use behavioral approaches to accomplish intervention-specific goals ( weight loss > or = 10 lb , daily Na intake < or = 80 mEqa ) . Three months after the start of intervention , antihypertensive drug therapy is withdrawn . The primary trial end point is a BP of 150/90 mm Hg or higher , resumption of antihypertensive drug therapy , or the occurrence of a BP-related clinical complication during 2 to 3 years of follow-up . It is anticipated that TONE findings may identify an effective and acceptable nonpharmacologic approach to control hypertension in the increasingly large number of older persons treated with antihypertensive drug therapy The Multiple Risk Factor Intervention Trial was a r and omized clinical study to test whether a special-intervention ( SI ) program aim ed at reducing serum cholesterol levels , blood pressure and cigarette smoking would prevent coronary heart disease ( CHD ) in middle-aged men . The main endpoint reported here is the percentage of participants experiencing first major CHD events ( either nonfatal acute myocardial infa rct ion [ AMI ] or CHD death ) during 7 years of follow-up . This outcome was slightly less frequent in the 6,428 SI men than in the 6,438 men assigned to their usual source of care ( UC ) . However , the relative difference -- either 1 % ( 95 % confidence interval -17 % to 16 % ) or 8 % ( 95 % confidence interval -5 % to 20 % ) , depending on how AMI was classified -- was not statistically significant . Regression analyses within the SI and UC groups suggested that the cholesterol and cigarette smoking interventions reduced the number of first major CHD events : the associations between lowering the levels of these 2 factors and reductions in CHD rates were significant ( p less than 0.001 ) and of the anticipated magnitude . A similar analysis of antihypertensive treatment in the SI group revealed no favorable association between lowering blood pressure and CHD rate , and other subgroup comparisons suggested that a mixture of beneficial and adverse effects may underlie this finding . Thus , the nonsignificant overall UC/SI contrast in CHD rates may reflect a combination of the expected beneficial effects of the cholesterol and smoking interventions with unexpected heterogeneous effects of the antihypertensive intervention . Seven of 8 other prespecified cardiovascular endpoints occurred less frequently among SI than among UC men , the difference being nominally significant ( p less than 0.05 ) for angina pectoris , congestive heart failure and peripheral arterial disease This study examined whether  nurses  could manage coronary risk factors in patients with unstable angina more effectively than physicians practicing usual care . Three hundred twenty-six patients were r and omized in the emergency room to a 6-month program of risk factor management by a registered nurse versus participation in usual care . The nurse intervention consisted of a 30-minute counseling visit at 6 to 10 days after the chest pain episode and a second 30-minute session 1 month later . Multiple risk factors were assessed and addressed : smoking , blood lipids , blood pressure , blood glucose , physical inactivity , weight , psychological stress , and social isolation . Compared with usual care , nurse intervention patients significantly reduced both triglycerides ( -29 + /- 8 vs 5 + /- 6 mg/dl ; p < 0.0004 ) and weight ( -0.9 + /- 3.3 vs + 0.1 + /- 2.1 kg ; p = 0.0071 ) , and had corresponding improvements in self-reported diet compliance and exercise ( + 34 + /- 106 vs + 9 + /- 98 minutes , p = 0.0491 ) . No significant differences between groups were observed in terms of 6-month changes in total , high-density lipoprotein , or low-density lipoprotein cholesterol , blood pressure , fasting blood glucose , percent body fat or waist-hip ratio , or psychological distress scores . The 6-month rate of recurrent events ( cardiac death , out-of-hospital cardiac arrest , myocardial infa rct ion ) and /or revascularizations ( coronary artery bypass surgery or coronary angioplasty ) was lower in the nurse intervention group ( 1 % vs 9 % ; p = 0.002 ) . We conclude that a nurse-delivered risk factor intervention program for patients with chest pain is feasible and more effective than usual care in terms of fostering lifestyle changes that may lower coronary risk To determine if multiple risk factor modification favorably alters the rate of progression of coronary atherosclerosis , 300 patients with established atherosclerosis have been r and omized into a clinical trial ; 155 to usual care and 145 to special intervention .  All patients have medical/risk examinations at baseline and annually for 4 years . The special intervention patients undergo aggressive risk factor management with emphasis on lipoprotein modification , dietary management , smoking abatement , blood pressure control , weight loss and increased physical activity . To measure progression of atherosclerosis , a quantitative , computer-assisted coronary arteriographic system was developed to analyze the baseline and 4-year follow-up arteriograms . This procedure uses a catheter with a metallic calibration cylinder at its tip to determine absolute artery size and automated computer edge detection techniques to define the internal border of the artery . The analysis system detects artery borders using changes in cine film density and measures distances between these borders . For each segment the minimum , maximum and mean diameters are measured and percent stenosis and atheroma area calculated . This system provides precise and reproducible measures of coronary artery segment diameter . Using this technique , we estimate a 33 % reduction in the rate of coronary artery progression over 4 years , defined as mean segment diameter , can be detected at a power of 0.80 and an alpha of 0.05 ( one tailed test ) with a sample size of 120 in each of 2 groups Self-referred subjects ( N = 227 ) thought to be at risk of developing non-insulin-dependent diabetes mellitus ( NIDDM ) and with fasting plasma glucose ( FPG ) in the range of 5.5 to 7.7 mmol . L-1 on two consecutive tests 2 weeks apart were r and omized to reinforced or basic healthy-living advice . They were simultaneously allocated either to a sulfonylurea group or a control group in a two-by-two factorial design . A total of 201 subjects in three English and two French centers completed 1 year 's follow-up study .  Reinforced advice recommending dietary modification and increased exercise was given every 3 months , and basic advice was given once at the initial visit . Glycemia was monitored by FPG , dietary compliance by body weight and food diaries , and fitness compliance by bicycle ergometer assessment and exercise diaries . Both reinforced and basic advice groups had a significant mean reduction in body weight ( 1.5 kg ) at 3 months , although the weight subsequently returned to baseline . After 1 year , subjects allocated to reinforced advice versus basic advice ( 1 ) reported a lower fat intake ( 34.1 % v 35.8 % , P = .04 ) with no difference in lipid profiles , ( 2 ) had improved fitness as shown by increased calculated maximal oxygen uptake ( [ Vo2max ] 2.39 v 2.18 L.min-1 , P = .007 ) with no change in insulin sensitivity , ( 3 ) showed no change in FPG , glucose tolerance , or hemoglobin A1c ( HbA1c ) , and ( 4 ) showed a greater tendency to withdraw from the study ( 16 % v 7 % , P = .03 ) . In conclusion , reinforced healthy-living advice given to self-referred subjects with increased FPG did not encourage sufficiently pronounced life-style changes for significantly greater effects on body weight and glycemia in a 1-year study than basic healthy-living advice Probucol [ 4,4-(isopropylidendithio bis)(2,6-di-t-butylphenol ) ] , as as an adjunct to diet , was evaluated for its effect on lowering the plasma cholesterol level in patients with familial hypercholesterolemia ( type II ) . The trial had a double-blind , placebo-controlled , crossover design . About half of the 30 patients responded to a low-cholesterol modified-fat diet with a decrease in the plasma cholesterol level of approximately 13 % . When probucol was added to the diet of the responders , their plasma cholesterol level was lowered a further 13 % . Patients who did not respond to the diet did show reduced plasma cholesterol concentrations when receiving probucol plus the diet . Analysis of the cholesterol content of the various lipoprotein fractions showed that the low-density lipoproteins accounted for most of the total plasma cholesterol level decrease . There was , as expected , no effect on plasma triglyceride concentrations . Neither the 7-dehydrocholesterol nor the desmosterol level was increased in the plasma of patients treated with probucol for three months . Probucol is useful as an adjunct to diet in lowering plasma cholesterol levels in patients with familial hypercholesterolemia . The drug was well tolerated by all patients Prolonged bed rest after myocardial infa rct ion is thought to result in deconditioning , manifested by increased heart-rate and blood-pressure responses to exercise and decreased functional capacity . We studied the effects of early , supervised exercises in preventing deconditioning after acute myocardial infa rct ion . Eighty-four patients were r and omized to a control group and 174 to an exercise group .  Enrollment in the exercise program occurred an average of 4.5 days after admission ( range , one to nine ) . Discharge from the hospital occurred an average of 10.3 days after admission in the control group and 10.4 days in the exercise group . Most patients had a low-level treadmill test on the day before hospital discharge . There were no differences between the two groups in the clinical , hemodynamic , or electrocardiographic responses to the treadmill test . Incidences of complications and deaths ( one death in each group ) during hospitalization were not significantly different in the two groups , although six patients ( 3 per cent , all in the exercise group ) required cardiac surgery -- four because of recurrent chest pain and two because of rupture of heart muscle . Thus , we were unable to demonstrate any significant beneficial or deleterious effects of an early , in-hospital exercise program Table . SI Units Systematic modification of coronary risk factors is not integrated into the medical care provided to most of the more than 1 million patients treated annually in the United States for acute myocardial infa rct ion by percutaneous transluminal coronary angioplasty or coronary artery surgery .  Most of such patients have lipoprotein abnormalities [ 1 ] , and nearly one half smoke [ 2 ] . These risk factors , which contribute to subsequent morbidity and mortality , remain highly prevalent after acute cardiac events . Failure to integrate comprehensive risk factor modification into the st and ard medical care provided to patients after acute cardiac events primarily reflects the lack of an organizational framework or system . This deficiency in re source allocation for preventive and rehabilitative aspects of care in turn reflects the predominant orientation of the U.S. health care system to the management of acute illness [ 3 ] . Several clinical research studies have shown the effectiveness of risk factor modification , especially treatment of lipoprotein abnormalities [ 4 - 7 ] , in achieving regression of coronary artery lesions and reducing the clinical consequences of coronary artery disease [ 6 , 7 ] . However , risk factor interventions shown to be effective in clinical trials may not prove equally effective in clinical practice because of a paucity of re sources , especially nonphysician personnel . The lack of effective management systems limits the expected reduction in morbidity and mortality and the corresponding reduction in medical care costs that motivates current efforts to orient the priorities of the American health care system toward preventive and rehabilitative care . This r and omized , controlled trial compared the effectiveness of a physician-directed , nurse-managed , home-based case-management system for coronary risk factor modification with that of usual medical care . Outcomes were measured in both groups immediately after the end of the first year after acute myocardial infa rct ion . The term case-management system has been used in various context s. As used here , it refers to a system in which a nurse case-manager , working with different health care specialists ( a psychiatrist , a cardiologist , a lipid specialist , a nutritionist , and a nurse coordinator ) , managed coronary risk factors . Methods Enrollment and Orientation Program nurses enlisted patients on hospital day 3 or as soon as their medical condition stabilized . Study participants gave written informed consent to be r and omly assigned to a treatment group . Immediately after r and omization , program nurses introduced patients to the special intervention with the aid of a videotape . Usual Care The 585 patients in our study were cared for by 215 internists and 34 cardiologists in the five participating medical centers who were organized into practice groups of 5 to 10 physicians each . Cardiology consultation was often provided during hospitalization , but primary responsibility for follow-up care was generally assumed by internists . The usual care offered by the Kaiser Permanente Medical Care Program included physician counseling on smoking cessation and nutritionist counseling on dietary change during hospitalization and physician-managed , lipid-lowering drug therapy after hospital discharge . Group outpatient smoking cessation programs were available for a $ 50 fee . Group exercise rehabilitation , not generally provided by the Kaiser Permanente Medical Care Program during this study , was available to patients at various community facilities at an average cost of $ 1800 to $ 2700 for 3 months ' participation . Special Intervention The behavioral interventions in our case-management system , which were offered to the 293 patients in the intervention group in addition to usual care , were derived from social learning theory [ 8 , 9 ] and modified for medical problems [ 10 ] . In this model , persons must learn how to monitor the health habits they seek to change , set attainable sub goals to motivate and direct their efforts , use feedback of progress in ways that promote health , and enlist incentives and social support to sustain the effort needed to succeed [ 8 , 9 ] . In the hospital , patients were instructed on how to complete  self-reports [ status reports ] of smoking , dietary intake , and exercise .  Scheduled interactions between case managers and patients after discharge took three forms : 1 ) nurse-initiated telephone contacts ; 2 ) computer-generated progress reports mailed to patients based on question naires completed by patients and mailed to the nurses ; and 3 ) visits to the program nurse for treadmill exercise testing , initiation of lipid-lowering drug therapy , if indicated , and a single counseling session after a smoking relapse . The maximum number of treatment contacts during the year , including outcome measurement at 6 and 12 months , was as follows : 14 nurse-initiated telephone contacts , 8 patient visits to the blood chemistry laboratory , and 4 patient visits to the nurse case manager . Smoking Intervention Smoking was defined as the use of cigarettes , cigars , cigarillos , pipe tobacco , or any other form of tobacco in the 6 months before admission . Forty-three percent of patients were smokers . Patients who had smoked during the 6 months before hospitalization received the same intensive smoking cessation intervention during hospitalization ; this intervention has been described previously [ 11 ] . Physicians used a written script that enabled them to provide st and ardized counseling in less than 2 minutes . The hospital-based smoking cessation counseling focused on relapse prevention . Nurses conducted a st and ardized smoking history to evaluate patients ' addiction to smoking . Patients ' reported self-efficacy or confidence to resist smoking in each of 28 potentially high-risk situations was measured ; patients were then counseled on how to manage the situations in which they reported less than 70 % confidence . Patients also received a relapse prevention manual and a relaxation audiotape . They were advised that the nurse would telephone them 48 hours and 1 week after hospital discharge and at monthly intervals for as long as 6 months . Patients who relapsed were offered one additional visit with the nurse for further counseling . Nicotine polacrilex or transdermal nicotine patches were reserved for highly addicted patients who relapsed after hospital discharge . Nutritional Counseling A computer-based expert system developed by the investigators was used to provide nutritional counseling on a National Cholesterol Education Program [ 12 ] Step 2 diet that was low in cholesterol and saturated fat . A food frequency question naire design ed by the investigators was scored using the Cholesterol and Saturated Fat Index developed by Connor and colleagues [ 13 ] . Calculations of cholesterol and saturated fat totals were based on weekly rather than daily average food intakes . Data from the food frequency question naires , mailed by patients to the Stanford coordinating center and entered into a microcomputer , were used to generate progress reports that characterized patients ' dietary patterns , prioritized dietary change goals , and provided guides for managing difficult situations by directing patients to relevant sections of a nutrition workbook entitled Good Eating for Good Health developed by the program nutritionist . Patients in the intervention group completed a food frequency question naire during hospitalization that described their eating habits in the previous month . Patients also completed food frequency question naires 6 , 11 , and 26 weeks after admission . Progress reports were mailed to patients within 48 to 72 hours after the food frequency question naires were received . Detailed strategies for maintenance of dietary change were incorporated into the 26-week progress report . Question naires to evaluate outcomes were also completed at 36 and 52 weeks . Lipid-Lowering Drug Therapy The therapeutic goal of a plasma low-density lipoprotein (LDL)-cholesterol value of 2.46 mmol/L ( 95 mg/dL ) adopted for this trial was based on the mean post-treatment level of LDL cholesterol found in patients in the study by Blankenhorn and colleagues [ 4 ] . Patients with mean plasma LDL cholesterol values ( based on measurements in two separate blood sample s drawn 75 and 90 days after infa rct ion ) that exceeded this value were given initial drug therapy according to the four algorithms shown in Table 1 . Patients unable to tolerate bile acid-binding resin or nicotinic acid because of comorbid conditions or potentially adverse interactions with these agents received lovastatin or gemfibrozil . During a visit 90 days after discharge , the nurses did a brief physical examination and obtained a history relevant to hyperlipidemia . They provided detailed counseling to patients regarding the rationale for lipid-lowering drug therapy and ways to maximize drug efficacy and minimize drug side effects , and they advised patients on the schedule of laboratory visits and nurse-initiated follow-up telephone contacts . Table 1 . Initial Drug Therapy * Changes in drug therapy at 120 , 150 , and 180 days , which were coordinated by nurse-initiated telephone contacts , were based on three types of responses to initial therapy : 1 ) if lipoprotein levels returned to normal , the effective drug therapy was continued ; 2 ) if the response was incomplete , the dose of the effective medication was increased or another drug was added , or both ; and 3 ) if comorbid conditions worsened or blood chemistry abnormalities or intolerable side effects occurred , drug dosage was reduced or the patient was switched to another agent or both . A physician lipid specialist and a Stanford-based senior nurse-coordinator provided telephone consultation to the case managers . Before initiating lipid-lowering drug therapy at 90 days and at each subsequent step , nurses review ed the patients ' blood chemistry and lipoprotein values and elicited any symptoms requiring a change in therapy . The To study the role of diet in cardiovascular risk-factor intervention , 458 high-risk individuals were asked to eat for either a cardiovasoprotective diet ( group A , n = 228 ) or their usual diet ( group B , n = 230 ) in a r and omized single-blind fashion . Ages varied between 25 and 63 yr , and 414 were men . Group A received significantly more calories in relation to the amount of complex carbohydrates , vegetable proteins , polyunsaturated fats , fiber , potassium , magnesium , and vitamin C and fewer calories in saturated fat and cholesterol compared with group B. Age , risk factors , nutritional factors , complications , and laboratory data were similar at entry to the study . Dietary adherence was obtained by question naire . After 1 yr , there was a significant ( P less than 0.02 ) decrease in total risk factors ( 32.0 % ) in group A compared with group B , and 1-yr mean serum cholesterol was significantly lower than the initial mean cholesterol in group A. There was a significant ( P less than 0.02 ) decrease in total complications ( 38.3 % ) in group A compared with group B in association with a significant ( P less than 0.02 ) decrease in cardiovascular end points ( 38.3 % ) , including postexercise electrocardiographic changes , fatal and nonfatal myocardial infa rct ion , and sudden death . Overall mortality and mortality due to ischemic heart disease was less in group A ( 8 and 3.5 % ) than group B ( 11 and 4.8 % ) . However , because of the few cases , differences were insignificant . It is possible that diet causes a significant reduction in blood cholesterol and modification of other risk factors leading to a decrease in complications and cardiovascular end points in patients with risk factors of coronary heart disease Dietary compliance was studied in 57 women participating for 1 y in a r and omized clinical trial of dietary fat reduction .  Nutrient analysis of food records , collected at 0 , 6 , and 12 mo , was compared with changes observed in lipid profiles and with chemical analysis of duplicate diets . Both food records and duplicate meals showed a significant decrease in fat intake ( from 36 to 23 % of total calories , p less than 0.0001 ) and a significant increase in carbohydrate ( from 43 to 56 % of total calories , p less than 0.0001 ) in the intervention group . The calculated nutrient intake from food records tended to overestimate the intake of protein , fat , and carbohydrate compared with the chemically analyzed method . The mean level of plasma cholesterol in the intervention group was significantly reduced ( 7.3 % , p less than 0.01 ) in the first 6 mo after a reduction in dietary fat but the levels observed did not differ significantly between the groups at any time OBJECTIVE To assess the effect of medical nutrition therapy ( MNT ) provided by dietitians on medical and clinical outcomes for adults with non-insulin-dependent diabetes mellitus ( NIDDM ) , and to compare MNT administered according to practice guidelines nutrition care ( PGC ) to MNT administered with basic nutrition care ( BC ) . DESIGN A prospect i ve , r and omized , controlled clinical trial of two levels of MNT on metabolic control in persons newly diagnosed with or currently under treatment for NIDDM was conducted at diabetes centers in three states ( Minnesota , Florida , and Colorado ) .  BC consisted of a single visit with a dietitian ; PGC involved an initial visit with a dietitian followed by two visits during the first 6 weeks of the study period . Data were collected at entry to the study and at 3 and 6 months . SUBJECTS Results are reported for 179 men and women aged 38 to 76 years : 85 assigned r and omly to BC and 94 to PGC . This represents 72 % of the 247 subjects enrolled . An additional 62 adults with NIDDM at one site who had no contact with a dietitian were identified as a nonr and om comparison group . OUTCOMES Medical outcome measures included fasting plasma glucose ( FPG ) , glycated hemoglobin ( HbA1c ) , and serum lipid levels . Clinical outcomes included weight , body mass index , waist-to-hip ratio , and changes in medical therapy . STATISTICAL ANALYSES Initial analysis of the discrete variables was done using the chi 2 statistic with Yates ' correction . Initial analysis of continuous variables was done by analysis of variance . The changes in variables between time periods were analyzed by paired t test , and comparisons between groups were analyzed using a t test for independent groups . RESULTS At 6 months , PGC result ed in significant improvements in blood glucose control as indicated by FPG and HbA1c levels and BC result ed in significant improvements in HbA1c level . Participants assigned to the PGC group had a mean FPG level at 6 months that was 10.5 % lower than the level at entry , and those in the BC group had a 5.3 % lower value . Among subjects who had diabetes for longer than 6 months , those who received PGC had a significantly better HbA1c level at 3 months compared with those receiving BC . The comparison group showed no improvement in glycemic control over a comparable 6 months . PGC subjects had significant improvements in cholesterol values at 6 months , and subjects in both the PGC and the BC groups had significant weight loss . CONCLUSIONS MNT provided by dietitians result ed in significant improvements in medical and clinical outcomes in both the BC and PGC groups and is beneficial to persons with NIDDM . Persons with a duration of diabetes longer than 6 months tended to do better with PGC than with BC . Because of the upward trend in glucose levels after 3 months , ongoing MNT by dietitians is important for long-term metabolic control Thirty-five patients with mild to moderate hypertension were r and omised into a three months ' dietary advised and a three months ' control group . The diet was of a composition currently considered to be appropriate , and was monitored by a dietitian . Statistically significant decreases in diastolic blood pressure , mean arterial pressure , sodium excretion , and low density lipoprotein (LDL)-cholesterol occurred in the intervention group , although differences in change between the intervention and the control group were , except for LDL-cholesterol , not statistically significant . Thus , it did not become clear whether and to what extent change in diet was responsible for the lowering of the blood pressure in the intervention group 1 . Changes in serum total and lipoprotein fraction triglyceride and cholesterol levels were studied in 24 adults on home haemodialysis . Half the patients were r and omly allocated to a low cholesterol ( mean 200 mg/day ) , fat-modified diet ( mean polyunsaturated/saturated fat ratio of 1.0 with a mean of 43 % of the total energy content derived from fat ) . 2 . Before dietary manipulation , triglyceride levels in all lipoprotein fractions were significantly higher ( P less than 0.02 ) than in a control group of age and sex matched normal subjects . Total cholesterol , very-low-density-lipoprotein ( VLDL ) and low-density-lipoprotein ( LDL ) cholesterol were also significantly raised ( P less than 0.02 ) , but high-density-lipoprotein ( HDL ) cholesterol was normal . In the patients on a fat-modified diet  triglyceride levels did not alter in any of the lipoprotein fractions . Total cholesterol and LDL cholesterol levels fell significantly into the normal range ( P less than 0.002 and less tha 0.001 respectively ) but VLDL and HDL cholesterol levels did not change . 3 . Hypertriglyceridaemia is the most common lipid abnormality in patients with renal failure and a long-term fat-modified diet is , therefore , of limited therapeutic importance in these patients unless there is a low HDL/LDL cholesterol ratio In a r and omized , controlled study of the Treatwell work-site nutrition intervention program , which focused on promoting eating patterns low in fat and high in fiber , 16 work sites from Massachusetts and Rhode Isl and were recruited to participate and r and omly assigned to either an intervention or a control condition . The intervention included direct education and environmental programming tailored to each work site ; control work sites received no intervention .  A cohort of workers r and omly sample d from each site was surveyed both prior to and following the intervention . Dietary patterns were assessed using a semiquantitative food frequency question naire . Adjusting for work site , the decrease in mean dietary fat intake was 1.1 % of total calories more in intervention sites than in control sites ( P less than .005 ) . Mean changes in dietary fiber intake between intervention and control sites did not differ . This study provides evidence that a work-site nutrition intervention program can effectively influence the dietary habits of workers Social support is inversely associated with heart disease risk . Support may influence heart disease by encouraging health behavior change in high-risk individuals . This study examined the association between spouse support and maintenance of low-fat diets in men with hypercholesterolemia . Participants were 254 men enrolled in a 24-month r and omized trial of lipid-lowering diets initiated in 1985 in Seattle , Washington . The Evaluation of Spouse Support , which assesses the extent to which spouses supported maintenance of  lipid-lowering diets  , was administered after the last of eight dietary classes and at 3 , 12 , and 24 months postinstruction . Attainment of dietary goals was determined from food records completed at the end of the class and at 3 , 12 , and 24 months . Compared with those in the lowest quartile , those in the highest quartile of support were more likely to attain dietary goals at 3 months ( odds ratio ( OR ) = 4.5 , 95 % confidence interval ( CI ) 1.9 - 10.4 ) , 12 months ( OR = 5.5 , 95 % CI 2.4 - 12.5 ) , and 24 months ( OR = 3.9 , 95 % CI 1.7 - 9.3 ) . Support was not associated with end-of-class dietary goal achievement . Social support may be an important factor in the maintenance of low-fat diets Abstract Objectives : To determine the effectiveness of a health check and assess any particular benefits result ing from feedback of plasma cholesterol concentration or coronary risk score , or both Design : R and omised controlled trial in two Glasgow work sites Subjects:1632 employees ( 89 % male ) aged 20 to 65 years . Interventions : At the larger work site , ( a ) health education ; ( b ) health education and feedback on cholesterol concentration ; ( c ) health education and feedback on risk score ; ( d ) health education with feedback on cholesterol concentration and risk score ( full health check ) ; ( e ) no health intervention ( internal control ) . At the other work site there was no health intervention ( external control ) . Main outcome measures Changes in Dundee risk score , plasma cholesterol concentration , diastolic blood pressure , body mass index , and self reported behaviours ( smoking , exercise , alcohol intake , and diet ) in comparison with internal and external control groups Results : Comparisons between the full health check and the internal control groups showed a small difference ( 0.13 mmol/l ) in the change in mean cholesterol concentration ( 95 % confidence interval 0.02 to 0.22 , P=0.02 ) but no significant differences for changes in Dundee risk score ( P=0.21 ) , diastolic blood pressure ( P=0.71 ) , body mass index ( P=0.16 ) , smoking ( P=1.00 ) , or exercise ( P=0.41 ) . Significant differences between the two groups were detected for changes in self reported consumption of alcohol ( 41 % in group with full health check v 17 % in internal control group , P=0.001 ) , fruit and vegetables ( 24 % v 12 % , P<0.001 ) , and fat ( 30 % v 9 % , P<0.001 ) . Comparison of all groups showed no advantage from feedback of cholesterol concentration or risk score , or both . Conclusions : The health check only had a small effect on reversible coronary risk . It was effective in influencing self reported alcohol consumption and diet . Feedback on cholesterol concentration and on risk score did not provide additional motivation for a change in behaviour OBJECTIVES To achieve the Healthy People 2000 objectives , public health professionals must develop effective dietary interventions that address psychosocial and behavioral components of change . This study tested the effect of individually computer-tailored messages design ed to decrease fat intake and increase fruit and vegetable intake . METHODS Adult patients from four North Carolina family practice s were surveyed at baseline and then r and omly assigned to one of two interventions or to a control group . The first intervention consisted of individually computer-tailored nutrition messages ; the second consisted of nontailored nutrition information based on the 1990 Dietary Guidelines for Americans . Patients were resurveyed 4 months postintervention . RESULTS The tailored intervention produced significant decreases in total fat and saturated fat scores compared with those of the control group ( P < .05 ) . Total fat was decreased in the tailored group by 23 % , in the nontailored group by 9 % , and in the control group by 3 % . Fruit and vegetable consumption did not increase in any study group . Seventy-three percent of the tailored intervention group recalled receiving a message , compared with 33 % of the nontailored intervention group . CONCLUSIONS Tailored nutrition messages are effective in promoting dietary fat reduction for disease prevention In the Dan and Ashkelon areas of Israel , 28 male and 24 female mild to moderate hypertensives without target organ damage aged 35 - 65 years were r and omly assigned to treatment programmes ( based on nutritional management , exercise and stress management techniques ) either on an individual basis administered by physician-nurse teams ( PN ) or on a group basis from a team of paramedical professionals ( PP ) consisting of a psychologist , nutritionist and physical activity instructor . At 11 and 24 months follow-up , there were similar significant improvements in both treatment modes for such risk factors as body mass index , caloric intake and physical activity levels . There was a significant decrease in drug use from $ 36.28 a month at baseline to $ 18.94 a month at 11 month follow-up ( P = 0.01 ) and to an estimated $ 20.48 at 24 months . Mean BP remained unchanged , despite the reduction in drug use , indicating a reduction in the underlying BP . The net present value ( NPV ) of the reduction in drug utilisation totalled $ 740 per person over a five year time horizon and a 7.5 % discount rate . The total extra costs of treatment , training , case-note writing , travelling and follow-up booster sessions , amounted to $ 95 per patient for the PN mode and $ 234 per patient for the PP mode , yielding benefit to cost ratios of 7.79/1 and 3.16/l , respectively . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND Congestive heart failure is the most common indication for admission to the hospital among older adults . Behavioral factors , such as poor compliance with treatment , frequently contribute to exacerbations of heart failure , a fact suggesting that many admissions could be prevented . METHODS We conducted a prospect i ve , r and omized trial of the effect of a nurse-directed , multidisciplinary intervention on rates of readmission within 90 days of hospital discharge , quality of life , and costs of care for high-risk patients 70 years of age or older who were hospitalized with congestive heart failure . The intervention consisted of comprehensive education of the patient and family , a prescribed diet , social-service consultation and planning for an early discharge , a review of medications , and intensive follow-up . RESULTS Survival for 90 days without readmission , the primary outcome measure , was achieved in 91 of the 142 patients in the treatment group , as compared with 75 of the 140 patients in the control group , who received conventional care ( P = 0.09 ) . There were 94 readmissions in the control group and 53 in the treatment group ( risk ratio , 0.56 ; P = 0.02 ) . The number of readmissions for heart failure was reduced by 56.2 percent in the treatment group ( 54 vs. 24 , P = 0.04 ) , whereas the number of readmissions for other causes was reduced by 28.5 percent ( 40 vs. 29 , P not significant ) . In the control group , 23 patients ( 16.4 percent ) had more than one readmission , as compared with 9 patients ( 6.3 percent ) in the treatment group ( risk ratio , 0.39 ; P = 0.01 ) . In a subgroup of 126 patients , quality -of-life scores at 90 days improved more from base line for patients in the treatment group ( P = 0.001 ) . Because of the reduction in hospital admissions , the overall cost of care was $ 460 less per patient in the treatment group . CONCLUSIONS A nurse-directed , multidisciplinary intervention can improve quality of life and reduce hospital use and medical costs for elderly patients with congestive heart failure OBJECTIVE We aim ed to assess the effectiveness of a nurse-led programme to ensure that follow-up care is provided in general practice after hospital diagnosis of myocardial infa rct ion ( MI ) or angina pectoris . METHODS We conducted a r and omized controlled trial with stratified r and om allocation of practice s to intervention and control groups within all 67 practice s in Southampton and South-West Hampshire , Engl and . The subjects were 422 adult patients with a MI and 175 patients with a new diagnosis of angina recruited during hospital admission or chest pain clinic attendance between April 1995 and September 1996 . Intervention involved a programme of secondary preventive care led by specialist liaison nurses in which we sought to improve communication between hospital and general practice and to encourage general practice nurses to provide structured follow-up . The main outcome measures were : extent of general practice follow-up ; attendance for cardiac rehabilitation ; medication prescribed at hospital discharge ; self-reported smoking , diet and exercise ; and symptoms of chest pain and shortness of breath . Follow-ups of 90.1 % of subjects at 1 month and 80.6 % at 4 months were carried out . RESULTS Median attendance for nurse follow-up in the 4 months following diagnosis was 3 ( IQR 2 - 5 ) in intervention practice s and 0 ( IQR 0 - 1 ) in control practice s ; the median number of visits to a doctor was the same in both groups . At hospital discharge , levels of prescribing of preventive medication were low in both intervention and control groups : aspirin 77 versus 74 % ( P = 0.32 ) , cholesterol lowering agents 9 versus 10 % ( P = 0.8 ) . Conversely , 1 month after diagnosis , the vast majority of patients in both groups reported healthy lifestyles : 90 versus 84 % reported eating healthy food ( P = 0.53 ) ; 73 versus 67 % taking regular exercise ( P = 0.13 ) ; 89 versus 92 % not smoking ( P = 0.77 ) . Take up of cardiac rehabilitation was 37 % in the intervention group and 22 % in the control group ( P = 0.001 ) ; the median number of sessions attended was also higher ( 5 versus 3 out of 6 ) . CONCLUSIONS The intervention of a liaison nurse is effective in ensuring that general practice nurses follow-up patients after hospital discharge . It does not alter the number of follow-up visits made by the patient to the doctor . Levels of prescribing and reported changes in behaviour at hospital discharge indicate that the main tasks facing practice nurses during follow-up are to help patients to sustain changes in behaviour , to encourage doctors to prescribe appropriate medication and to encourage patients to adhere to medication while returning to an active life . These are very different tasks to those traditionally undertaken by practice nurses in relation to primary prevention , where the emphasis has been on identifying risk and motivating change . Assessment of the effectiveness of practice nurses in undertaking these new tasks requires a longer follow-up 21 patients with severe persistent cyclical mastopathy of at least 5 years ' duration were r and omised  to a control group who received general dietary advice or to an intervention group who were taught how to reduce the fat content of their diet to 15 % of calories while increasing complex carbohydrate consumption to maintain caloric intake . Both groups were followed for 6 months with food records and measurement of  plasma hormone and lipid levels .  Severity of symptoms was recorded with daily diaries and patients were assessed at the beginning and end of the study by a physician who was unaware of their dietary regimen . After 6 months there was a significant reduction in the intervention group in the severity of premenstrual breast tenderness and swelling . Physical examination showed reduced breast swelling , tenderness , and nodularity in 6 of 10 patients in the intervention group and 2 of 9 patients in the control group OBJECTIVE To compare the efficacy of three types of diet and lifestyle interventions for lowering plasma lipid levels . DESIGN R and omised parallel-group trial . SUBJECTS AND SETTING Adults with plasma cholesterol levels of 5.5 - 8.0 mmol/L attending two Sydney community health screening clinics were asked to participate : 179 agreed and 131 completed the study . INTERVENTIONS A pamphlet with brief advice ; group dietary counselling ; or individual counselling . Counselling included three sessions with a dietitian/nutritionist over six months . MAIN OUTCOME MEASURES Plasma total cholesterol levels measured by Reflotron analyser ; fasting serum lipid levels measured by st and ard laboratory methods ; and calculated low-density lipoprotein cholesterol levels . RESULTS Significantly lower plasma total cholesterol levels ( Reflotron ) were observed at two months and at six months with each of the three interventions . Additionally , both types of dietitian-based counselling result ed in small but significant decreases in plasma low-density lipoprotein cholesterol levels at six months in a subset of subjects . CONCLUSION Although there were no statistically significant differences in efficacy between the three types of intervention , dietitians have a role to play in setting up such counselling programs OBJECTIVE To compare the costs and effects of two different intervention strategies for the nonpharmacological treatment of hypercholesterolaemia . DESIGN R and omized , controlled trial . Subjects were r and omly allocated to one of two intervention models and followed up for 1 year . SETTING Vårby Health Centre , a primary care practice located in a suburb of Stockholm . SUBJECTS Subjects with a total serum cholesterol in the range 7.0 - 7.8 mmol L-1 and no signs of ischaemic heart disease or diabetes mellitus , r and omized to a low-intensity ( n = 35 ) or medium-intensity ( n = 41 ) intervention . INTERVENTION Two strategies were used , one labelled medium-intensity strategy which followed national current guidelines for nonpharmacological treatment of hypercholesterolaemia , the other was a low-intensity strategy . MAIN OUTCOME MEASURES Total serum cholesterol and intervention costs . RESULTS Both intervention strategies result ed in small ( mean 3.5 % ) decreases in total cholesterol with no significant difference between the groups . The cost per subject in the low-intensity group was SEK 753 and in the medium-intensity group SEK 3614 . CONCLUSIONS Because the effect of the two intervention programmes did not differ , the low-intensity programme is to be preferred from a cost-effectiveness point of view . If only one-third of the population in Stockholm county with cholesterol levels > or = 6.5 mmol L-1 are discovered by the primary health care system , and follow the treatment advice , the net savings in the low-intensity model compared to the current guidelines here presented as the moderate-intensity model , would be SEK 93 million OBJECTIVE To describe the development of a computer-based system for dietary management of hyperlipidemia and to evaluate its efficacy for lowering plasma cholesterol level . DESIGN Using a stepwise approach , we developed and tested a three-part self-management system in five consecutive clinical studies . Each study assessed plasma cholesterol levels before and after dietary intervention using the system . These studies enabled progressive refinement of ( a ) a food frequency question naire used to assess food intake in the preceding month ; ( b ) computer-generated progress reports , based on question naire responses , offering dietary change sub goals and strategies for change ; and ( c ) a dietary workbook providing detailed information on how to achieve goals . SUBJECTS/ SETTING Persons with hyperlipidemia ( n=814 ) were enrolled from worksite and clinical setting s in the San Francisco Bay area of California . The attrition rate after r and omization was 5 % . INTERVENTION Elements of the dietary intervention evolved in response to the results of five clinical studies . In each study , patients underwent a form of baseline assessment of dietary intake followed by counseling/instruction by various means . Follow-up dietary assessment s were provided at specific intervals to facilitate subjects ' progress toward their dietary goals . A dietary workbook provided the detailed instruction required to implement the recommendations contained in the periodic progress reports . STATISTICAL ANALYSES PERFORMED Changes in plasma cholesterol level were measured by paired and unpaired t tests . The relationship between the reported reduction in dietary fat and cholesterol level assessed by food frequency question naires and the directly measured change in plasma cholesterol level was measured by multiple linear regression . RESULTS The three major elements of the final computerized system ( food frequency question naires , computer-generated progress reports , and dietary workbook ) were developed and refined in the course of the five clinical studies . Reductions in total plasma cholesterol level of 5.0 % to 6.5 % achieved by participants in all five studies were consistent with self-reported reductions in intake of dietary saturated fat and cholesterol . Therefore , the computerized self-management system appears to be an effective tool for reducing plasma cholesterol levels . APPLICATIONS/ CONCLUSIONS A computer-based system for dietary self-management of hyperlipidemia , implemented by mail , was effective in short-term studies . This self-management system can potentially provide health-promoting services to large numbers of people at low cost PURPOSE Patients who have undergone coronary artery bypass graft surgery ( CABG ) are obvious c and i date s for rehabilitation programs because of the potential for progression of disease . Such programs have been shown to foster risk-factor modification , improve quality of life , and prolong survival among post-myocardial infa rct ion ( MI ) patients . However , the efficacy of these programs has not been established among patients who have undergone CABG . METHODS A r and omized controlled trial was employed to evaluate whether a behavioral and educational cardiac rehabilitation program was effective in modifying cardiovascular disease risk factors and improving quality of life in a cohort of 86 patients after CABG . Patients were recruited from the cardiac ward of a large teaching hospital and were block-r and omized to either an intervention group or routine care . Subjects in the intervention group attended 6 weekly group sessions following hospital discharge , and booster sessions at 8 months and 1 year . They also received a personalized behavior modification program based on their baseline risk factors . Risk factor and quality of life measures were recorded at baseline ( 6 weeks after surgery ) , 4 months , 8 months , and 1 year . RESULTS The results indicated few differences between the study groups . However , the intervention group 's aerobic capacity ( VO2max ) improved over that of the routine care group . With regard to the quality of life variables , all patients tended to improve steadily over time . CONCLUSIONS The relatively moderate success of this intervention program compared with various post-MI studies may be indicative of differences between the treatment needs of patients after acute myocardial infa rct ion or CABG . Future post-CABG rehabilitation research should explore these patients ' unique treatment needs , and investigate a variety of program strategies A health education and counselling programme was offered to myocardial infa rct ion patients during and after hospitalization . A r and omized pre-test-post-test control group design was used to evaluate the effects of the experimental intervention . During hospitalization the intervention consisted of two individual counselling sessions and two group health education sessions focusing on medication , healthy habits , anxiety and depression . On completion of these sessions , weekly telephone calls were made to patients for a period of six weeks after discharge from hospital . The intervention was offered to 30 myocardial infa rct ion patients and their partners ( the experimental group ) in addition to  st and ard medical care . Thirty control patients received st and ard medical care only . Two months after myocardial infa rct ion , patients in the experimental condition reported a significantly greater increase in physical activity , and a significantly greater decrease in unhealthy eating habits . No effects were found regarding smoking cessation , anxiety and depression . Twelve months after discharge from hospital patients in the experimental condition reported a significantly greater decrease in unhealthy eating habits . No effects were found regarding smoking cessation , physical activity , anxiety and depression . In addition , two months after myocardial infa rct ion , it was found that patients whose partners participated in the health education sessions showed a significantly greater decrease in smoking and unhealthy eating habits and a significantly greater increase in physical activity than patients with no partner participating . Twelve months after discharge the only significant result favouring the patients whose partner participated in the health education sessions concerned smoking cessation OBJECTIVES This study assessed stages of change in fat intake , physical activity , and cigarette smoking during a r and omized controlled trial of behavioral counseling . METHODS Twenty general practice s ( primary health care centers ) were r and omized to lifestyle counseling by behavioral methods or to usual health promotion . A total of 883 patients were selected for the presence of 1 or more of the following risk factors : cigarette smoking , high cholesterol , or a combination of a high body mass index and low physical activity . Stage of change ( precontemplation , contemplation , preparation , and action/maintenance ) was assessed at baseline and after 4 and 12 months . RESULTS The odds of moving to action/maintenance for behavioral intervention vs control patients at 4 months were 2.15 ( 95 % confidence interval [ CI ] = 1.30 , 3.56 ) for fat reduction , 1.89 ( 95 % CI = 1.07 , 3.36 ) for increased physical activity , and 1.77 ( 95 % CI = 0.76 , 4.14 ) for smoking cessation . The likelihood of achieving action/maintenance was related to baseline stage for all 3 behaviors . CONCLUSIONS Brief behavioral counseling based on advice matched to stage of readiness for change may be valuable in encouraging healthy lifestyles among patients in primary care at raised risk of cardiovascular disease Fifty subjects with peripheral vascular disease were r and omly assigned to either the American Heart Association Hyperlipidemia Diet C ( AHA , N = 23 ) or a higher fiber , low fat diet based on the Pritikin maintenance diet ( HFD , N = 27 ) and studied for a 12-month period . Diet counseling was provided , and the subjects were encouraged to exercise regularly , to decrease their consumption of salt , alcohol , and caffeine , and to restrict cigarettes as much as possible . Dietary intake data showed that energy distribution was approximately 49 % and 64 % carbohydrate , 20 % and 22 % protein , and 31 % and 14 % fat for the AHA and HFD groups , respectively . Cholesterol and dietary fiber intakes averaged 201 mg and 23 gm per day , respectively , for the AHA group and 108 mg and 43 gm per day , respectively , for the HFD group . Generally , both groups showed tendencies toward decreased serum triglycerides , cholesterol , and LDL cholesterol and increased HDL cholesterol . The HFD group achieved a significant decrease in serum cholesterol ( at month 12 ) ( p less than .01 ) . The only significant between-group difference was in serum cholesterol at 4 months ( p less than .01 ) , with the lower value in the HFD group . There was a consistent negative correlation between dietary fiber and serum cholesterol levels ( p less than .01 ) . Average weight loss was 4.1 kg for the AHA group and 6 kg for the HFD group . We concluded that both dietary regimens , combined with exercise , can be of benefit to patients with peripheral vascular disease The Women 's Health Trial : Feasibility Study in Minority Population s ( WHT : FSMP ) , a r and omized trial of 2208 women , was conducted to investigate three questions . First , can women from minority and low-socioeconomic-status population s be recruited in numbers sufficient to evaluate a dietary intervention design ed to lower fat intake . Second , the efficacy of a low fat , increased fruit/vegetable/ grain product intervention for reducing fat consumption . Third , will participation in the intervention lower plasma cholesterol and estradiol levels relative to the controls . The baseline results showed that an adequate number of minority and low SES women could be recruited to test the study hypotheses . A diverse study population of postmenopausal women consuming a high fat diet was recruited : 28 % of participants were Black , 16 % were Hispanic , 11 % had less than a high school level of education , and 15.5 % had household incomes of < $ 15,000 Abstract Objective : To measure the effect of behaviourally oriented counselling in general practice on healthy behaviour and biological risk factors in patients at increased risk of coronary heart disease . Design : Cluster r and omised controlled trial . Participants : 883 men and women selected for the presence of one or more modifiable risk factors : regular cigarette smoking , high serum cholesterol concentration ( 6.5 - 9.0 mmol/l ) , and high body mass index ( 25 - 35 ) combined with low physical activity . Intervention : Brief behavioural counselling , on the basis of the stage of change model , carried out by practice nurses to reduce smoking and dietary fat intake and to increase regular physical activity . Main outcome measures : Question naire measures of diet , exercise , and smoking habits , and blood pressure , serum total cholesterol concentration , weight , body mass index , and smoking cessation ( with biochemical validation ) at 4 and 12 months . Results : Favourable differences were recorded in the intervention group for dietary fat intake , regular exercise , and cigarettes smoked per day at 4 and 12 months . Systolic blood pressure was reduced to a greater extent in the intervention group at 4 but not at 12 months No differences were found between groups in changes in total serum cholesterol concentration , weight , body mass index , diastolic pressure , or smoking cessation . Conclusions : Brief behavioural counselling by practice nurses led to improvements in healthy behaviour . More extended counselling to help patients sustain and build on behaviour changes may be required before differences in biological risk factors emerge The effectiveness of a family-based cardiovascular disease risk reduction intervention was evaluated in two ethnic groups . Participants were 206 healthy , volunteer low-to-middle-income Mexican-American and non-Hispanic white ( Anglo-American ) families ( 623 individuals ) , each with a fifth or a sixth- grade child . Families were recruited through elementary schools . Half of the families were r and omized to a year-long educational intervention design ed to decrease the whole family 's intake of high salt , high fat foods , and to increase their regular physical activity . Eighty-nine percent of the enrolled families were measured at the 24-month follow-up . Both Mexican- and Anglo-American families in the experimental groups gained significantly more knowledge of the skills required to change dietary and exercise habits than did those in the control groups . Experimental families in both ethnic groups reported improved eating habits on a food frequency index . Anglo families reported lower total fat and sodium intake . There were no significant group differences in reported physical activity or in tested cardiovascular fitness levels . Significant differences for Anglo-American experimental vs. control adult subjects were found for LDL cholesterol . Significant intervention-control differences ranging from 2.2 to 3.4 mmHg systolic and /or diastolic blood pressure were found in all subgroups . Direct observation of diet and physical activity behaviors in a structured environment suggested generalization of behavior changes . There was evidence that behavior change persisted one year beyond the completion of the intervention program . It is concluded that involvement of families utilizing school based re sources is feasible and effective . Future studies should focus on the most cost-effective methods of family involvement , and the potential for additive effects when family strategies are combined with other school health education programs BACKGROUND Relatives of patients with coronary heart disease have a heightened risk of cardiovascular disease . Attendance at a family-based screening clinic after an acute cardiac event could motivate patients and relatives to modify their lifestyles . AIMS The Family Atherosclerosis Risk Intervention Study ( FARIS ) aim ed to determine ( i ) whether a high proportion of patients and relatives would attend a special screening and prevention programme ; ( ii ) whether the risk factor profiles of relatives would be worse than those in the general community ; and ( iii ) whether ongoing management of patients and families together in a special clinic would improve risk factor profiles . METHODS Consecutive patients , together with spouse , siblings and offspring , aged 18 to 69 years , were r and omly allocated three months after an acute cardiac event to attend a special outpatient clinic , a screening and advice group , or a control group . Risk factor measures were total cholesterol , HDL cholesterol ( HDLC ) , systolic blood pressure ( SBP ) , body mass index ( BMI ) and smoking behaviour . This paper presents the risk factor profiles of all FARIS attenders and compares those of family members , age adjusted , with risk factors measured in a multicentre urban cross-sectional survey conducted in the same period . Differences between groups were compared using t-tests for numerical variables and ANOVA and chi-square for categorical variables . RESULTS Six hundred and twenty-eight patients and 1723 family members were enrolled , representing 85.9 % and 82.7 % of eligible patients and relatives respectively . Risk factors were significantly worse amongst family members than among those in the population survey To examine a long-term effect of community-based education program for  hypercholesterolemia  and an effect modification by apolipoprotein E polymorphism , we conducted a 1-year r and omized clinical trial with 8 year-follow-up . One hundred four persons aged 40 - 64 years who had serum total cholesterol levels between 6.21 and 7.73 mmol/l ( 240 and 299 mg/dl ) in 1988 - 89 cardiovascular risk surveys were enrolled in the trial . The intervention group ( n=51 , 82 % for women ) attended eight education classes in 1 year , while the control group ( n=53 , 85 % for women ) attended only two classes . Both groups were invited to the subsequent annual surveys . The mean serum cholesterol was 0.24 - 0.26 mmol/l less in the intervention than in the control group at both 6 month and 1 year ( P=0.03 , each ) while the proportion of subjects using hypolipidemic agents was 0 and 6 % in both groups , respectively . During 8-year follow-up , the probability of using hypolipidemic agents and /or total cholesterol > or = 7.76 mmol/l was 51 % in the education group and 69 % in the control group ; the risk ratio in the intervention vs control groups was 0.62 ( 95 % CI : 0.36 - 1.06 ) . When stratified by the apolipoprotein E polymorphism examined for 78 % of the subjects , the risk ratio was 0.61 ( 0.31 - 1.18 ) among subjects without e4 allele ( n=59 ) and 0.55 ( 0.14 - 2.14 ) among those with e4 allele ( n=22 ) . The intervention group had reduced intake of egg , fish egg , butter , mayonnaise and fatty meat compared to the control group at 6-month , 1- and 8-year follow-up . In conclusion , our community-based program was effective in reducing serum total cholesterol levels non-pharmacologically during the first year , and also reduced the likelihood of progressive worsening of hypercholesterolemia during the subsequent 8 years , regardless of the apolipoprotein E polymorphism Coronary risk factors were studied in 119 patients r and omly assigned to cardiac rehabilitation and compared with 109 patients receiving st and ard care alone after coronary artery bypass grafting .  The long-term impact of rehabilitation on risk factors was modest in patients undergoing elective coronary surgery The aim of this study is to evaluate the impact of a six-month structured education programme on blood pressure ( BP ) control in patients with uncontrolled hypertension . All patients attending the Specialist Hypertension Clinic , University Hospital of the West Indies ( UHWI ) , between January 4 and March 29 , 1999 , with blood pressure > 140/90 mmHg ( n = 80 ) , were r and omly divided into Group 1 , cases ( n = 42 ) and Group 2 , controls ( n = 38 ) . A 40-item pretested question naire , administered at the baseline and final visits of both groups , elicited demographic , lifestyle and knowledge data . Group 1 attended monthly structured interventions for six months . Except for diastolic blood pressure among male controls , diastolic blood pressure and systolic blood pressure were significantly reduced at the end of the intervention period ( p < 0.01 ) . Knowledge improved among the male patients ( p < 0.01 ) . Among the female patients , activity scores were significantly increased ( p < 0.01 ) , weight ( p < 0.05 ) and BMI ( p < 0.05 ) were significantly reduced . There were no differences in these variables among the controls . This intervention had a benefit in blood pressure control OBJECTIVES 1 . To compare a patient-centred , self-directive intervention with conventional care ; 2 . To evaluate longitudinal within-group changes of coronary heart disease risk . METHODS Risk factor changes were evaluated in 110 men with high coronary heart disease risk attending a one year intervention study in general practice . The 22 participating general practice centres were r and omly allocated to follow either a patient-centred , self-directive intervention or a conventional approach . RESULTS No significant between-group differences were found in any single risk factor or in the combined risk of coronary heart disease . The improvement of total risk from screening time to conclusion of the study corresponded with changes of relative risks of CHD to 0.64 ( 95 % CI : 0.54 - 0.77 ) and 0.65 ( 0.54 - 0.77 ) in the patient-centred , self-directive and the conventional care group respectively ( p < 0.0001 in both groups ) . CONCLUSION Everyday general practice clinical work seems as efficacious as a specific intervention method based on currently advocated behaviour change principles An attempt was made to undertake a r and omized clinical trial of weight reduction in obese postmenopausal breast cancer patients as an adjuvant to primary surgical and radiotherapeutic treatment . The rationale was to improve prognosis which has been shown to be worse in the obese ( probably because of its effect on extra-ovarian oestrogen production ) . Difficulties in recruiting a sufficient number of patients and the introduction of tamoxifen as anti-oestrogenic adjuvant therapy led to the decision to modify the aim of the study by limiting it to a feasibility study in 102 patients . In three hospitals in The Netherl and s and in two hospitals in Poznan , Pol and these patients were r and omized in intervention and control groups according to a 3:2 ratio . Weight reduction in the intervention group was achieved by dietary means , ie caloric restriction was adapted to personal needs and behaviour of the patients . After 1 year a median weight loss of 6 kg was reached in both countries . In the Netherl and s further follow-up indicated that this result could be maintained for another 2 years Ninety-one middle-aged men and women with untreated mild hypertension were allocated to a nopharmacological treatment group or to a control group . Members of the treatment group were instructed to reduce daily sodium intake to less than 70 mmol , to reduce the intake of saturated fat , to lose weight if necessary and to perform regular physical exercise and relaxation training . Adherence to and effects of the programme on blood pressure and serum lipids were monitored for 12 months . In the treatment group , daily sodium excretion decreased to and remained at 50 % of its original level ( P less than 0.001 ) , and there was a significant reduction in saturated fat intake . The average weight reduction was modest . Adherence to physical exercise and relaxation training regimens was poor . The net decreases ( difference in changes between treatment and control group ) in blood pressure were greatest during the first 3 months : in men the decrease in systolic blood pressure was 11.3 mmHg ( P less than 0.001 ) and in diastolic blood pressure 8.3 mmHg ( P less than 0.001 ) ; in women the decrease in systolic blood pressure was 10.8 mmHg ( P less than 0.01 ) and in diastolic blood pressure 6.4 mmHg ( P less than 0.01 ) . However , this decrease diminished during the last 3 months to approximately one half owing to blood pressure reduction in controls . Low density lipoprotein cholesterol levels decreased significantly in treated men and women A cohort of 1019 male and 1232 female hypertensives , aged 25 - 59 years , based on a r and om population sample , was followed for five years during a community-based cardiovascular prevention programme . A small mean reduction in serum cholesterol level was found . The observed changes in casual serum cholesterol values were partly due to the regression to the mean . The reductions were most marked in elderly people and in those with high baseline serum cholesterol values . The partial regressions of the cholesterol change were computed in subgroups by age , sex and baseline serum cholesterol level . Changes in weight in men and in age in women were the strongest independent predictors of the change in serum cholesterol . Changes in dietary fat intake were also associated with the change in serum cholesterol . Only a small part of the total variation in the change in serum cholesterol was explained by the regression models . The results indicate that reduction of the serum cholesterol level among hypertensive persons , especially men , was caused by changes in their dietary habits A r and omized trial was performed to test the hypothesis that , among patients with peripheral vascular disease , no difference is achieved in the magnitude of the reduction in blood cholesterol levels as a result of advice which is provided by a dietitian and that which is provided by a diet fact sheet .  Fifty-nine patients were allocated at r and om either to a " dietitian " group ( n = 31 ) or to a " diet fact sheet " group ( n = 28 ) . Dietary advice which was provided by a dietitian involved two personal interviews ; the diet fact sheet was prepared by the NSW Department of Health . Twenty-two and 23 members of each group , respectively , returned for follow-up at three months . The mean cholesterol level fell by 8.5 % among the " dietitian " group but only by 1.9 % among the " diet fact sheet " group . The difference of 0.47 mmol/L in the total cholesterol level reduction between the two groups was statistically significant ( P = 0.02 ; 95 % confidence interval , -0.88 to -0.07 mmol/L ) . It appears that individual advice which is provided by a dietitian is more successful in leading to a reduction in blood cholesterol levels than is the administration of a diet fact sheet , even though this particular diet fact sheet appears to be excellent and is used widely . In view of the large numbers of patients and of persons in the population as a whole who would benefit from a reduction in blood cholesterol levels , and the expense of individual advice to be provided by a dietitian , explorations of cost-effective methods of providing dietary advice are needed To enhance compliance to physician referral as well as dietary and other lifestyle recommendations given at blood cholesterol ( BC ) screening programs , we r and omized Pawtucket Heart Health Program SCORE ( screening , counseling , referral event ) participants with elevated BC levels into one of four groups :  usual care group ; a participant intervention group ( mailed reminder letter and refrigerator magnet ) ; a physician intervention group ( mailed packet to participant 's physician including letter , National Cholesterol Education Program [ NCEP ] guidelines , and preaddressed postcard to mail to patient ) ; and a group that received both interventions . Beginning four months after the screening , we surveyed study subjects by phone . The participant intervention increased recall of physician referral and dietary recommendations ; however , neither intervention successfully improved compliance to referral or dietary and lifestyle recommendations . Overall , 58 % , 67 % and 34 % of subjects reported complying to physician referral , dietary recommendations , and lifestyle recommendations , respectively . Referral compliance was associated with a longer time interval between screening and survey ( relative risk [ RR ] = 1.3 , 95 % confidence interval [ CI [ = 1.0 , 1.7 ) , possession of medical insurance that covered physician visits ( RR = 2.1 , 95 % CI = 0.98 , 4.4 ) , and history of hypertension ( RR = 2.6 , 95 % CI = 1.1 , 5.8 ) . Dietary compliance was positively associated with baseline BC levels > or = 240 mg/dL ( RR = 3.3 , 95 % CI = 1.4 , 7.3 ) and negatively associated with increasing age ; each one year increase in age corresponded to a 3 % decrease in compliance ( RR = 0.97 , 95 % CI = 0.9 . 1.0 ) . ( ABSTRACT TRUNCATED AT 250 WORDS Three controlled intervention studies were carried out in North Karelia to study the possible role of dietary fat in the control of human blood pressure .  All studies included middle-aged free-living couples ( families ) and a baseline ( BS , 2 weeks ) , an intervention ( IN , 6 - 12 weeks ) and a switch-back ( SB , 4 - 6 weeks ) period . During IN the families were instructed to eat low fat ( less than 25 en% instead of 39 en% ) , high P/S ratio diet ( 0.4 - 1.1 instead of 0.2 ) . Salt and energy intake and other lifestyles were kept constant . In the first study the P/S ratio of the IN diet was 1.1 . Both systolic and diastolic blood pressures decreased significantly during IN and increased back again during SB . The same results were obtained in the second study at P/S level 0.9 when a r and omized group with 60 % salt reduction and a control had little change in their blood pressure levels . In the third study the blood pressure reduction was again repeated during a 12 week IN period . The reduction was similar in two r and omized groups with P/S 0.4 and 0.9 , when both group had less than 25 en% of total fat . The results strongly support the hypothesis that dietary fat is related to human blood pressure , and that modification of dietary fat should be considered in the non-pharmacological prevention and management of hypertension This study tested the feasibility of a low-technology office-based approach to weight reduction in obese hypertensive patients . Family practice residents were r and omly assigned to either an experimental or a control group . Physicians in the experimental group were instructed in methods of weight reduction , which they then passed on to their patients . Patients of experimental physicians were seen monthly , their diets were discussed , and improvements were suggested . The control group patients received their usual care . After six months the experimental patients had lost significantly more weight than the controls and had significantly reduced the number of antihypertensive drugs while maintaining blood pressure control . After 12 months there was no significant difference between the two groups with respect to weight loss , blood pressure , or number of antihypertensive drugs . Experimental and control patients who lost weight had visited their physicians more frequently than those who did not and had reduced the number of antihypertensive medications they were taking . This educationally oriented intervention trial is an example of the type of research that is practical to perform in a family practice center and is applicable in family physicians ' offices A r and omised controlled trial with a factorial design was done to examine the effects of dietary intervention in the secondary prevention of myocardial infa rct ion ( MI ) . 2033 men who had recovered from MI were allocated to receive or not to receive advice on each of three dietary factors : a reduction in fat intake and an increase in the ratio of polyunsaturated to saturated fat , an increase in fatty fish intake , and an increase in cereal fibre intake . The advice on fat was not associated with any difference in mortality , perhaps because it produced only a small reduction ( 3 - 4 % ) in serum cholesterol . The subjects advised to eat fatty fish had a 29 % reduction in 2 year all-cause mortality compared with those not so advised . This effect , which was significant , was not altered by adjusting for ten potential confounding factors . Subjects given fibre advice had a slightly higher mortality than other subjects ( not significant ) . The 2 year incidence of reinfa rct ion plus death from ischaemic heart disease was not significantly affected by any of the dietary regimens . A modest intake of fatty fish ( two or three portions per week ) may reduce mortality in men who have recovered from MI BACKGROUND Phase 1 of the Trials of Hypertension Prevention was a collaborative , r and omized controlled clinical trial design ed to determine the feasibility and efficacy of selected nonpharmacologic interventions in reducing or preventing an increase in diastolic blood pressure . METHODS Participants aged 30 to 54 years who had a high-normal diastolic blood pressure ( 80 to 89 mm Hg ) , and were between 115 % and 165 % of their desirable body weight , were r and omly assigned to either an 18-month weight loss intervention ( n = 308 ) or a usual-care control condition ( N = 256 ) . Intervention consisted of 14 weekly group meetings followed by monthly maintenance sessions . Intervention participants received training in behavioral self-management technique and were asked to make life-style changes aim ed at achieving a moderate reduction in energy intake and an increase in physical activity .  RESULTS The average weight losses in the intervention group at 6 , 12 , and 18 months of follow-up were 6.5 , 5.6 , and 4.7 kg for men and 3.7 , 2.7 , and 1.6 kg for women . The mean ( + /- SE ) change in diastolic blood pressure for intervention participants compared with controls at termination was -2.8 + /- 0.6 mm Hg for men and -1.1 + /- 0.9 mm Hg for women . For systolic blood pressure , the corresponding change was -3.1 + /- 0.7 mm Hg for men and -2.0 + /- 1.3 mm Hg for women . Blood pressure reductions were greater for those who lost larger amounts of weight . Sex-related differences in blood pressure response were largely due to the smaller amount of weight lost by women , and sex differences in weight loss could be accounted for by differences in baseline body weight . CONCLUSIONS During an 18-month follow-up period , this weight reduction program was shown to be an effective nonpharmacologic intervention for reducing blood pressure in overweight adults with high-normal blood pressure OBJECTIVE To examine whether a telephone-delivered intervention ( TDI ) , design ed to improve glycemie control in patients with non-insulin-dependent diabetes mellitus ( N1DDM ) , improved coronary risk factors in high-risk patients . RESEARCH DESIGN AND METHODS This r and omized controlled trial involved 275 veterans with N1DDM followed in a general medical clinic .  Intervention ( TDI ) patients were telephoned at least monthly by a nurse . Calls emphasized compliance with the medical regimen ( diet , medications , and exercise ) , encouraged behavioral changes , and facilitated referrals to a dietitian or smoking cessation clinic .  Control patients received no such calls . Baseline and 12-month follow-up measurements included fasting lipid profiles , weight , smoking status ( self-reported ; cessation verified by measurement of exhaled CO ) , adherence to diet and exercise ( self-reported ) , appointments , and medications ( hospital computerized data base ) . RESULTS After 12 months , equal numbers of obese patients in the two groups reported adhering to a diabetic diet and exercising  , although more obese TDI patients had seen a dietitian ( 30 vs. 7 % , P = 0.003 ) . Weight loss was not seen in either group ( —0.9 ± 5.3 vs. —0.1 ± 3.6 kg , P = 0.202 ) . Hyperlipidemic TDI patients were more likely to see a dietitian ( 31 vs. 6 % , P = 0.003 ) and receive lipid-lowering medications ( 22 vs. 9 % , P = 0.096 ) , but serum cholesterol reduction was similar between groups ( –11.7 ± 33.4 vs. –4.3 ± 32.7 mg/dl , P = 0.270 ) ; comparable results were seen for high-density lipoprotein , low-density lipoprotein , and triglyceride levels . More TDI group smokers reported quitting ( 26 vs. 0 % , P = 0.033 ) , but the difference was not significant for CO-verified abstention ( 10 vs. 0 % , P = 0.231 ) . CONCLUSIONS The TDI improved self-reported adherence to regimens that might reduce coronary risk , but had little effect on objective measures of risk BACKGROUND Epidemiologic evidence of associations between the high intake of fat and low intake of dietary fiber , beta carotene , and other dietary constituents and the risk of colorectal neoplasia has been inconsistent and has not provided a sufficient basis for recommendations concerning the dietary prevention of large-bowel cancer in humans . PURPOSE We conducted a clinical trial to assess the effects on the incidence of adenomas of reducing dietary fat to 25 % of total calories and supplementing the diet with 25 g of wheat bran daily and a capsule of beta carotene ( 20 mg daily ) . METHODS We performed a r and omized , partially double-blinded , placebo-controlled factorial trial in which half the patients were assigned to each intervention , result ing in seven  intervention  groups and one control group . Eligibility criteria included histologic confirmation of at least one colorectal adenoma and confidence expressed by the colonoscopist that all polyps had been removed . Dietary changes were individually initiated and monitored by dietitians and research nurses . At surveillance colonoscopy , the size and location of all polyps were recorded , and their histology was later central ly review ed . Among 424 patients who were r and omly assigned in the trial , 13 were found to be ineligible upon histologic review . Among the remaining 411 , complete outcome data were collected from 390 at 24 months and from 306 at 48 months . All P values are from two-sided tests of statistical significance . RESULTS There was no statistically significant prevention of total new adenomas with any of the interventions . We found a statistically non-significant reduced risk of large adenomas ( > or = 10 mm ) with the low-fat intervention : At 24 months , the odds ratio ( OR ) adjusted for potential confounders = 0.4 and 95 % confidence interval ( CI ) = 0.1 - 1.1 ; at 48 months , OR = 0.3 and 95 % CI = 0.1 - 1.0 . Less and statistically nonsignificant reductions in the risk of large adenomas were found with wheat bran : At 24 months , OR = 0.8 and 95 % CI = 0.3 - 2.2 ; at 48 months , OR = 0.8 and 95 % CI = 0.3 - 2.5 . Patients on the combined intervention of low fat and added wheat bran had zero large adenomas at both 24 and 48 months , a statistically significant finding ( P = .03 ) . CONCLUSIONS Because only small numbers of patients were studied , our finding that the combination of fat reduction and a supplement of wheat bran reduced the incidence of large adenomas in this r and omized , controlled trial must be treated with caution . The results do suggest , however , that these interventions may reduce the transition from smaller to larger adenomas , a step that may critically define those adenomas most likely to progress to malignancy The European Multifactorial Preventive Trial of Coronary Heart Disease operates in five centers in Belgium , Italy , Pol and , Spain , and Great Britain with a total of 44 pairs of factories employing over 63,000 men aged 40 - 59 . Pairs of factories were r and omly allocated to either treatment or control . An entry screening for risk factors was offered to all men in treatment factories and to r and om sample s of men in control factories . Those identified as relatively high-risk in treatment factories ( upper 15 - 20 % ) were individually treated with advice for cholesterol lowering diet , smoking cessation , regular exercise , weight reduction , and drug control of hypertension , whereas mass education on the same subjects was given to non-high-risk individuals . R and om sample s of men were reexamined after 2 and 4 years in order to assess risk factor changes , with control groups serving as reference for naturally occurring trends . Changes of main risk factors recorded in different centers varied considerably . Pooled data showed a net reduction of 2.5 % r and om sample ( RS ) and 5.8 % high-risk ( HR ) for serum cholesterol ; of 1.3 % ( RS ) and 2.6 % ( HR ) for systolic blood pressure ; of 0.5 % ( RS ) and 0.9 % ( HR ) for body weight ; and 8.8 % ( RS ) and 15.2 % ( HR ) for cigarette consumption . The net reduction of coronary risk estimated by the multiple logistic equation was 12 % in RS and 17 % in HR The Hypertension Prevention Trial ( HPT ) was a multicenter r and omized trial design ed to assess the effects of long-term dietary changes on  blood pressure  in a normotensive population ( diastolic blood pressure greater than or equal to 78 but less than 90 mm Hg ) for a period of 3 years . The dietary treatments were reduction of sodium intake , increase of potassium intake , and decrease of energy intake . Estimates of changes in food intake were made by comparing 24-hour food records of the treatment and control participants . The participants in the treatment groups reported sodium intakes that were 30 % to 40 % lower than those of the controls . The restriction was achieved mainly by reducing intake of salt , meats , and grain products . Meats and grain products were still a major source of total sodium intake after treatment ( 41 % to 47 % ) , perhaps because of continued use of processed foods . Potassium intake was reported to be 16 % to 25 % higher in the treatment groups than in the controls , the increase achieved largely through increased consumption of fruits , with a lesser contribution from vegetables . Participants with higher initial body weights reported smaller increases in fruit and vegetable consumption than participants of normal weight , perhaps because of concerns about weight gain . Energy intake in the weight loss groups was 8 % to 11 % less than that of the controls . Men reported success in restricting calories from meats , dairy products , fats , beverages , and sugars . Women were less successful in restricting calories from most food groups . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND We examined the effect of a 3-hr training program on physicians ' lipid intervention knowledge , attitudes , and skills . The program teaches physicians skills to conduct a brief dietary risk assessment and provide patient-centered counseling to enable patients with elevated lipids to change their dietary patterns . METHOD The training is part of a r and omized trial of lipid-lowering interventions , the Worcester Area Trial for Counseling in Hyperlipidemia . Primary care internists practicing in a health maintenance organization ( HMO ) were assessed , before and after training using question naires and audiotapes to document changes in knowledge about diet , attitudes about intervention , reported nutrition intervention practice s , and counseling and assessment skills . Physicians also rated the value that they thought the training program had to them . RESULTS After completion of the program the physicians ' use of dietary counseling steps , as assessed by blinded evaluation of audiotaped physician-patient interactions , significantly increased ( mean pre = 5.4 , mean post = 9.2 ; t = 9.9 ; P < or = 0.001 ) . In this regard , there were instances in the use of 7 of the 14 specific counseling steps . Physicians also demonstrated increases in self-perceived preparedness as measured by a 5-point scale ( mean pre = 3.2 , mean post = 4.0 ; t = 4.25 ; P < 0.001 ) , confidence in having an effect ( mean pre = 3.3 , mean post = 3.9 ; t = 3.16 ; P < 0.01 ) , perception that material s were available to aid intervention ( mean pre = 2.7 , mean post = 4.0 ; t = 5.29 ; P < 0.001 ) , and perception that they have access to a nutritionist ( mean pre = 3.5 , mean post = 4.0 ; t = 2.63 ; P < 0.01 ) . They rated the value of the program between very good and excellent . CONCLUSION Results of this 3-hr educational program indicate that physicians in an HMO are responsive to the teaching of specialized skills deemed important for promoting health behavior change in their patients The beFIT study tested whether teaching the NCEP step II diet ( < 30 % of calories from total fat and < 7 % from saturated fat ) is an effective therapy in hypercholesterolemic women and men with or without elevated triglycerides after 6 months . Hypercholesterolemic subjects had two LDL cholesterol measurements  above the age- and sex-specific 75th percentile , and combined hyperlipidemic subjects additionally had similarly elevated triglyceride . Subjects were r and omized to receive dietary intervention ( eight weekly classes ) immediately or 6 months later . Follow-up visits were quarterly , with lipid measurements and 4-day food records . Subjects r and omized to delayed intervention did not report diet changes or experience lipid changes ; the immediate intervention group significantly reduced fat and cholesterol intake , result ing in significant LDL cholesterol lowering . Six months after diet instruction , 178 women and 231 men reported total and saturated fat intakes of approximately 25 % and 7.5 % kcal LDL cholesterol was significantly reduced in women ( 7.6 % and 8.1 % ) and men ( 8.8 % and 8.1 % ) with hypercholesterolemia and combined hyperlipidemia , respectively , but was not different by sex or lipid disorder . C and i date s for drug therapy were reduced from between 27 % and 37 % to 20 % . HDL cholesterol was significantly decreased in women ( -6.4 % and -4.7 % ) but not in men ( -1.3 % and -2.7 % ) . The 6.4 % reduction in hypercholesterolemic women was significantly different from that of men . The significance of the HDL cholesterol reduction in women is unknown . LDL cholesterol response was similar between women and men and between hypercholesterolemic and combined hyperlipidemic subjects . LDL cholesterol lowering by diet can significantly reduce the number of  hyperlipidemic persons requiring drug therapy BACKGROUND Dietary factors are an important contribution to the high rates of coronary heart disease in the UK . One approach to achieving change is health-promoting advice in primary care . AIM To compare the effectiveness of structured dietary advice by practice nurses with st and ard health education in changing serum cholesterol , weight and diet . METHOD R and omized , controlled trial within eight general practice s in Engl and and Wales allocated within matched geographical pairs to ' dietary advice ' or ' usual care ' .  Men and women aged 35 - 59 years , recruited opportunistically by their GPs , underwent health checks . In ' dietary advice ' practice s , subjects received dietary advice from specially trained nurses based on negotiated change principles , reinforced at follow up . In ' usual care ' practice s , subjects were only given st and ard health education material s. RESULTS A total of 956 patients were recruited : 473 in ' dietary advice ' practice s and 483 in ' usual care ' practice s. Compliance with annual follow up was 80 % . Compared with ' usual care ' practice s , there was a mean 0.20 mmol/l lower serum cholesterol ( 95 % CI -0.38 to -0.03 at 1 year ) in ' dietary advice ' practice s. There was a small fall in weight of 0.56 kg ( 95 % CI -1.04 to -0.07 ) and reductions in total and saturated fat . Factor VII coagulant activity fell by a mean of 6.7 % of the st and ard ( 95 % CI -15.4 to + 2.0 ) . CONCLUSION Provision of st and ard health education material alone as part of a health check had no effect on coronary heart disease risk factors . There were modest changes in diet and associated risk factors when a more intensive and individual approach to dietary advice was given by practice nurses . This is , however , probably an ineffective use of re sources , except in those at high risk of coronary heart disease . Whole- population strategies to achieve dietary change are required We studied separately the influence of two methods for losing fat weight on the levels of plasma lipids and lipoproteins in overweight sedentary men --  decreasing energy intake without increasing exercise ( diet ) , and increasing energy expenditure without altering energy intake ( exercise , primarily running)--in a one-year r and omized controlled trial . As compared with controls ( n = 42 ) ,  dieters ( n = 42 ) had significant loss of total body weight ( -7.8 + /- 0.9 kg [ mean + /- SE ] ) , fat weight ( -5.6 + /- 0.8 kg ) , and lean ( non-fat ) weight ( -2.1 + /- 0.5 kg ) ( P less than 0.001 for each variable ) , and  exercisers ( n = 47 ) had significant loss of total body weight ( -4.6 + /- 0.8 kg ) and fat weight ( -3.8 + /- 0.7 kg ) ( P less than 0.001 for both variables ) but not lean weight ( -0.7 + /- 0.4 kg ) . Fat-weight loss did not differ significantly between dieters and exercisers . All subjects were discouraged from altering their diet composition ; however , dieters and exercisers had slight reductions in the percentage of kilojoules derived from fat . As compared with the control group , both weight-loss groups had significant increases ( P less than 0.01 ) in plasma concentrations of high-density lipoprotein ( HDL ) cholesterol ( diet vs. exercise , 0.13 + /- 0.03 vs. 0.12 + /- 0.03 mmol per liter ) , HDL2 cholesterol ( 0.07 + /- 0.02 vs. 0.07 + /- 0.02 mmol per liter ) , and HDL3 cholesterol ( 0.07 + /- 0.02 vs. 0.06 + /- 0.02 mmol per liter ) and significant decreases ( P less than 0.05 ) in triglyceride levels ( diet vs. exercise , -0.35 + /- 0.14 vs. -0.24 + /- 0.12 mmol per liter ) . Levels of total and low-density lipoprotein cholesterol were not significantly changed , relative to values in controls . None of these changes were significantly different between dieters and exercisers . Thus , we conclude that fat loss through dieting or exercising produces comparable and favorable changes in plasma lipoprotein concentrations This study was conducted to assess the determinants of plasma concentrations of alpha-tocopherol , beta-carotene , retinol , and cholesterol fractions in a r and omly selected subset of 203 workers participating in a worksite-based health intervention trial . Workers were from four companies in eastern and central Massachusetts , and all completed an 84-item semiquantitative food frequency question naire as part of baseline ( preintervention ) self- assessment instruments . At the time of fasting blood sampling , each participant also completed a short screening question naire for assessment of changes in  dietary habits and tobacco exposure and for collection of data on use of vitamins and nutritional supplements . On the basis of the self-reported data , the authors found that they could explain 35 % of the variability in plasma beta-carotene , 73 % of the variability in alpha-tocopherol , 36 % of the variability in retinol , and 19 % of the variability in cholesterol . Plasma beta-carotene levels appeared to be affected by the use of supplements that did not contain carotene , indicating a beta-carotene sparing capability of other agents contained in these preparations . Plasma alpha-tocopherol levels were not similarly affected . These results compare favorably with those from studies that used more intensive dietary assessment techniques as the comparison criterion . Results are discussed in terms of implication s for use of self-reported data in epidemiologic study analyses 16 202 men , aged 40 - 49 years , were screened for coronary risk factors , Of these , 1232 healthy , normotensive men at high risk of coronary heart disease ( CHD ) were selected for a 5-year r and omised trial to show whether lowering of serum lipids and cessation of smoking could reduce the incidence of CHD . Men were admitted to the trial if they had serum cholesterol levels of 7.5 - 9.8 mmol/l ( 290 - 380 ) mg/dl ) , coronary risk scores ( based on cholesterol levels , smoking habits , and blood pressure ) in the upper quartile of the distribution , and systolic blood pressures below 150 mm Hg ( mean of two measurements ) . The men in the intervention group were recommended to lower their blood lipids by change of diet and to stop smoking .  Mean serum cholesterol concentrations were approximately 13 % lower in the intervention group than in the control group during the trial ( based on the difference between the mean of 3 prer and omisation values and the mean of yearly values during the trial ) . Mean fasting serum triglycerides fell by 20 % in the intervention group compared with controls . 80 % of the men in both groups smoked tobacco daily at the start of the study . The mean tobacco consumption per man decreased by 45 % more in the intervention group than in the control group . However , only 25 % of the smokers in the intervention group completely stopped smoking compared with 17 % in the control group . Diagnosis of events of cardiovascular disease during the study was made blindly according to predefined criteria by two cardiologists not involved in the study . At the end of the observation period the incidence of myocardial infa rct ion ( fatal and non-fatal ) and sudden death was 47 % lower in the intervention group than in the controls ( p = 0.028 , two-tailed log rank test ) . When the incidence of strokes was added , the difference between the groups was still significant . It is concluded that in healthy middle-aged men at high risk of CHD advice to change eating habits and to stop smoking significantly reduced the incidence of the first event of myocardial infa rct ion and sudden death . Statistical analysis , by Cox 's proportional hazards model shows that the reduction in incidence in the intervention group is correlated with the reduction in total cholesterol and to a lesser extent with smoking reduction OBJECTIVE To examine the effects of patient choice between two education curriculums that emphasized either the st and ard or nutritional management of type 2 diabetes on class attendance and other outcomes among a mostly Hispanic patient population . RESEARCH DESIGN AND METHODS A total of 596 patients with type 2 diabetes were r and omly assigned to either a choice or no choice condition . Patients in the choice condition were allowed to choose their curriculum , while patients in the no choice condition were r and omly assigned to one of the two curriculums . Outcomes were assessed at baseline and at a 6-month follow-up . RESULTS When given a choice , patients chose the nutrition curriculum almost four times more frequently than the st and ard curriculum . Contrary to our hypothesis , however , patients who had a choice did not significantly increase their attendance rates or demonstrate improvements in other diabetes outcomes compared with patients who were r and omly assigned to the two curriculums . Patients in the nutrition curriculum had significantly lower serum cholesterol at a 6-month follow-up , whereas patients in the st and ard curriculum had significant improvements in glycemic control . Of the r and omized patients , 30 % never attended any classes ; the most frequently cited reasons for nonattendance were socioeconomic . Hispanic patients , however , were just as likely as non-Hispanic patients to attend classes and participate at the follow-up . Patients who attended all five classes of either curriculum significantly increased their diabetes knowledge , gained less weight , and reported improved physical functioning compared with patients who did not attend any classes . CONCLUSIONS Although providing patients with a choice in curriculums at the introductory level did not improve outcomes , differential improvements were noted between patients who attended curriculums with different content emphasis . We suggest that diabetes education programs should provide the opportunity for long-term , repetitive contacts to exp and on the modest gains achieved at the introductory level , as well as provide more options to match individual needs and interests and to address socioeconomic barriers to participation Non-insulin-dependent diabetes mellitus ( NIDDM ) is preceded by impaired glucose tolerance ( IGT ) lasting for years before manifesting as overt hyperglycaemia . Both genetic and environmental factors contribute to the development of IGT and NIDDM . Obesity , physical inactivity and high-fat diet have been found to predict IGT and NIDDM . Therefore , a diet and exercise intervention from diagnosis of NIDDM could improve the treatment outcome and prognosis of patients with NIDDM . Furthermore , because subjects with IGT are at increased risk for diabetes and atherosclerotic vascular disease , it is reasonable to assume that in terms of reducing the incidence and longterm consequences of NIDDM an intervention at this phase is more effective than in overt diabetes . Although the nonpharmacological approach is generally accepted as the first-line treatment of NIDDM its efficacy has often been question ed . Therefore , it is important to carry out long-term controlled studies to find out to what extent lifestyle modification could improve the metabolic control and level of major cardiovascular risk factors known to be associated with poor outcome in NIDDM . This kind of study also gave relevant experience in planning studies aim ing at primary prevention of NIDDM . One-year dietary and exercise intervention on newly diagnosed NIDDM patients in Kuopio , Finl and result ed in a better metabolic control and a moderate reduction in cardiovascular risk factors as compared to the conventional treatment group . After the second year of follow-up only 12.5 % in the intervention group were receiving  oral antidiabetic drugs  vs. 34.8 % in the conventional treatment group . Weight reduction and a reduced use of saturated fats appeared to be the main determinants of successful treatment results . Good aerobic capacity was associated with an increase in HDL cholesterol . A multicentre primary prevention study on IGT patients is continuing in Finl and applying the same principles of intervention as used in the study on newly diagnosed NIDDM patients . Pilot results show that glucose tolerance can be improved by lifestyle changes The purpose of this study was to investigate the effect of 1-year diet intervention , exercise intervention and both combined on blood pressure ( BP ) in normotensives and mild hypertensives . Two hundred and nineteen sedentary middle aged men and women with slightly deranged coronary heart disease ( CHD ) risk factors were r and omised to a control , a diet , an exercise and a diet + exercise group . Based on baseline diastolic BP , participants were divided into tertiles , giving baseline average BP of 141.4/96.7 in tertile 1 , 130.7/87.6 in tertile 2 and 121.9/79.0 in tertile 3 . The 1-year net-difference in BP between the intervention groups and the control group decreased across the tertiles ; in tertile 1 being -11.2/-6.7 ( p < 0.05 ) , -11.3/-6.7 ( p < 0.05 for systolic BP only ) and -7.0/-5.1 ( NS ) in the combined , diet and exercise group respectively . Triglycerides , HDL cholesterol , and insulin variables were significantly and favourably changed , the changes being most marked in the combined group . The results show that diet and diet + exercise are about equally effective in reducing BP , and the effects may be dependent on the baseline level . Within the upper tertile of baseline BP , the decline in BP in the combined intervention and the diet group are almost comparable to those obtained with drug treatment . In addition , other important CHD risk factors were all changed in a beneficial direction OBJECTIVE The objectives of the Cost Effectiveness of Lipid Lowering ( CELL ) study were twofold : ( i ) to evaluate the effect on overall cardiovascular risk of two types of health care advice ( " usual ' and " intensive ' ) given in primary care , with or without pharmacological medication , with the target being to attain a moderate decrease in cholesterol ; ( ii ) to evaluate the ritual of daily medication on compliance with the health care advice . DESIGN A prospect i ve , double-blind , r and omized , controlled trial of 18 months ' duration . SETTING The study was carried out in 32 health centres ( out of a total of approximately 850 ) in Sweden . SUBJECTS In all , 681 subjects , aged 30 - 59 years , were r and omized . They had at least two cardiovascular risk factors in addition to moderate primary hyperlipidaemia ( total cholesterol of at least 6.50 mmol L-1 on three occasions measured by Reflotron triglycerides less than 4.0 mmol L-1 and an LDL : HDL cholesterol ratio of more than 4.0 ) . Most ( 87 % ) of the subjects were males ; 626 subjects ( 92 % ) completed the 18-month follow-up . INTERVENTION Half the subjects were r and omized to ' intensive advice ' given in group sessions led by doctors and nurses in primary care . The other half received ' usual advice ' . In each of the two advice groups , one-third received an active lipid-lowering drug ( pravastatin ) , one-third placebo , and one-third no drug at all . The tablets were titrated to achieve a 15 % reduction in cholesterol . MAIN OUTCOME MEASURES Changes in the overall Framingham risk score , and the development of adverse events in each group . RESULTS The change in Framingham risk score was significantly reduced only in subjects taking lipid-lowering medication ( together with intensive advice -0.13 ; 95 % CI-0.20 , -0.06 , and together with usual advice -0.16 ; 95 % CI -0.23 , -0.09 ) . The other subjects receiving intensive advice tended to fare better than those on usual advice . Lifestyle was not influenced significantly over the study period . The ritual of daily medication did not affect the outcome . CONCLUSION As expected , lipid-lowering medication reduced serum cholesterol as well as overall cardiovascular risk in subjects with several risk factors for cardiovascular disease . There was no additive effect of intensive advice to these subjects . However , there was a meagre but significant effect of intensive advice in subjects not receiving active lipid-lowering drugs . One explanation for this difference may be that those on active lipid-lowering medication who had substantial drops in cholesterol might have felt less inclined to change their lifestyle compared with those on other treatment regimens who had less successful drops in cholesterol . There was no benefit from the ritual of taking daily medication We sought to determine the efficacy of a hospital-based , professionally-taught program emphasizing cardiovascular health . Similar programs are in existence throughout the country without documentation of their long-term benefits . Thirty-six hyperlipidemic individuals were treated as a control group or participated in one of two intensive educational interventions . The educational program was based on information obtained from focus group methodology to elicit attitudes about dietary change and learning style preferences . Behavioral changes in smoking , dietary salt and saturated fat intake , stress and tension , physical activity , and departure from ideal body weight were documented using health question naires and Lifestyle Risk Indices . At three months of follow-up , there was no change in serum lipids , total fat intake , or cardiovascular risk behavior in either the control or intervention group . We conclude that a one-day program , whether design ed by the target population or experts , did not improve cardiovascular risk behaviors , suggesting that more innovative methods are required to address health behaviors in this high risk group One hundred young male out patients with coronary disease who were under dietary management with a 28 % fat diet were group-matched to a non-dietary-managed group in regard to age , age at infa rct ion , number of infa rct ions , prevalence of hypertension , degree of angina , and value of serum cholesterol , among other factors . The diet-managed group experienced a significant reduction in serum cholesterol value , while the non-dietary-managed group did not . No significant differences were noted between the two groups in levels for serum total lipids , phospholipids , and triglycerides . Under the experimental conditions employed , the degree of unsaturation of the diet did not appear to influence serum cholesterol value or mortality . The non-dietary-managed group had a 160 % higher recurrent infa rct ion rate and a 233 % higher mortality rate than did the dietary-managed group during the first five years of observation OBJECTIVES This study reports an efficacy trial of four work-site health promotion programs . It was predicted that strategies making use of behavioral counseling would produce a greater reduction in cardiovascular disease risk factors than screening and educational strategies . METHODS Twenty-eight work sites were r and omly allocated to a health risk assessment , risk factor education , behavioral counseling , or behavioral counseling plus incentives intervention . Participants were assessed before the intervention and at 3 , 6 , and 12 months . RESULTS Compared with the average of the health risk assessment and risk factor education conditions , there were significantly higher vali date d continuous smoking cessation rates and smaller increases in body mass index and estimated percentage of body fat in the two behavioral counseling conditions . The behavioral counseling condition was associated with a greater reduction in mean blood pressure than was the behavioral counseling plus incentives condition . On average among all groups , there was a short-term increase in aerobic capacity followed by a return to baseline levels . CONCLUSIONS Work-site interventions that use behavioral approaches can produce lasting changes in some cardiovascular risk factors and , if implemented routinely , can have a significant public health impact The effect of a three-phase multifactorial institution-based rehabilitation programme on coronary heart disease ( CHD ) risk factors was studied in an open r and omised trial comprising 228 patients undergoing coronary artery bypass surgery allocated into a rehabilitation ( R ) group ( n = 119 ) and a hospital ( H = control ) group ( n = 109 ) . Follow-up examinations were performed at 6 and 12 months . Serum total cholesterol and triglyceride levels decreased significantly in both groups during follow-up . These decreases were not significantly different between the R and H groups . Serum high density lipoprotein ( HDL ) cholesterol level increased significantly at 6 and 12 months in the R group , but not in the H group . The differences in the changes between the groups were not significant . The ratio of serum HDL cholesterol to total cholesterol increased significantly in the R group from the preoperative value of 0.154 to 0.179 ( P less than 0.001 ) at 6 months and to 0.180 ( P less than 0.001 ) at 12 months . In the H group these values were 0.152 , 0.166 ( P less than 0.001 ) and 0.168 ( P less than 0.001 ) , respectively . The significance of the differences in the changes between the groups were P = 0.01 at 6 months and 0.06 at 12 months . These differences were more obvious in patients aged 55 years or under . There was a significant decrease ( P = 0.005 ) in the proportion of smokers in the R group and a significant increase in the proportion of patients taking regular exercise in both groups as assessed by question naire . ( ABSTRACT TRUNCATED AT 250 WORDS The Stanford Five-City Project was initiated in 1978 to evaluate the effects of a community-wide health education program on  cardiovascular risk factors , including blood pressure . Two treatment cities received an education program , which used the mass media , various community-based programs , and health professionals , design ed to encourage  individuals  to learn their blood pressure levels , stay in the care of a physician if hypertensive , achieve ideal weight , exercise regularly , and reduce dietary sodium .  Physicians were encouraged to follow national hypertension treatment guidelines and were provided with a range of patient education material s. To evaluate the effect of the intervention on cardiovascular risk factors , four independent cross-sectional surveys of r and omly selected households and four repeated surveys of a cohort were conducted in both treatment cities and in two of the three control cities . After 5 - 1/3 years of intervention , blood pressure in the treatment cities exhibited an overall decline of 7.4 and 5.5 mmHg systolic and 5.0 and 3.7 mmHg diastolic in the cohort and independent surveys , respectively . These declines produced net changes between the treatment and control cities ranging from -1.1 to -3.8 mmHg . While the magnitude of these changes is not large , the results are significant from a public health perspective because they reflect changes in the overall community OBJECTIVES The Staff Healthy Heart Project was established to run a work-site cholesterol screening project and a r and omized controlled trial of dietary interventions . METHODS Screening was offered to all staff at six Australian hospitals . Participants with blood cholesterol of 5.2 mmol/L ( 200 mg/dL ) or above were r and omly allocated to receive screening only ( control group ) , a self-help package , or a nutrition course . Participants were seen 3 and 6 months after intervention to measure blood cholesterol and dietary changes . RESULTS Eighty percent of available staff ( n = 2638 ) were screened . Of those eligible , 67 % ( n = 683 ) entered the trial . Follow-up measures of blood cholesterol and dietary intake were obtained for 63 % and 38 % of trial participants , respectively . A reduction in reported dietary fat was found for all groups , but there were no significant differences between groups . Reported dietary fiber rose by 0.6 g/MJ/day for those in the nutrition course . There were no changes in total blood or high-density lipoprotein cholesterol . CONCLUSIONS Cholesterol reduction was not demonstrated , but this result is difficult to interpret given the poor ongoing participation rates . Strategies to improve ongoing participation in work-site projects are needed to achieve adequate assessment of dietary interventions used in cholesterol screening OBJECTIVES This study evaluated the effectiveness of a low-intensity dietary intervention in primary care practice in lowering dietary fat intake and raising dietary fiber intake . METHODS A r and omized controlled trial of 28 physician practice s in six primary care clinics enrolled , by telephone , adult patients who had appointments for nonurgent nonacute visits . Of 3490 eligible patients contacted , 2111 completed baseline interview ; 86.1 % also completed a 12-month follow-up . Physicians gave intervention participants a self-help booklet and a brief motivational message . Changes in fat and fiber from baseline to 12-month follow-up were evaluated . RESULTS Intervention and control groups both reported a decrease in fat intake and an increase in fiber intake . The differential change and 95 % confidence interval ( CI ) for the percentage of energy obtained from fat was -1.2 ( CI = -0.71 , -1.7 ) ( P = .0015 ) , for grams fiber/1000 kcal 0.32 ( CI = -0.066 , 0.71 ) ( P = .086 ) , for fat score -0.044 ( CI = -0.016 , -0.072 ) ( P = .010 ) , and for fiber score 0.036 ( CI = 0.011 , 0.061 ) ( P = .014 ) , with greater reductions in fat and greater increase in fiber in the intervention group . CONCLUSIONS This low-intensity intervention was effective in dietary behavior change Compliance with dietary recommendations and the effect of intensified dietary therapy on energy and nutrient intakes and fatty acid composition of serum lipids were studied in 86 obese subjects ( aged 40 to 64 years ) with recently diagnosed non-insulin-dependent diabetes mellitus ( NIDDM ) . After three months of basic education , the subjects were r and omly separated into an intervention group ( n = 40 ) and a conventional treatment group ( n = 46 ) . Members of the intervention group participated in 12 months of intensified education ; those in the conventional group visited local health centers . Compliance with dietary instructions was monitored through food records . Intensified dietary therapy result ed in greater weight loss , better metabolic control , and a less atherogenic lipid profile than conventional treatment . Intake of energy and saturated fatty acids tended to decline in the intervention group . A higher percentage of patients in the intervention group had a total fat intake of 30 % of energy or less after 15 months ( 32.5 % [ 12 of 38 ] vs 17.4 % [ 8 of 46 ] ) . Similarly , more patients in the intervention group had a saturated fatty acid intake of 10 % or less of total energy intake at the end of the study ( 35.0 % [ 13 of 38 ] vs 8.7 % [ 4 of 46 ] ) . The mean dietary cholesterol intake was within recommendations in both groups at the end of the study . The relative percentage of linoleic acid of serum lipids increased significantly and the relative percentage of palmitic acid of serum triglycerides , phospholipids , and cholesterol esters decreased in the intervention group . These changes indicate that intensified dietary therapy improved the quality of fat in the diet of patients with NIDDM The association between lipoprotein(a ) ( Lp[a ] ) and progression of coronary artery disease ( CAD ) compared with other serum lipids was evaluated in 104 patients with angiographically proven coronary atherosclerosis . Patients were r and omized to either an intervention or a control group . The 12-month intervention program consisted of a low-fat diet and daily physical exercise . Patients in the control group received " usual care " by their private physician . Eighty-three patients ( 36 in the intervention and 47 in the control group ) underwent repeat angiography after 1 year . Angiographically documented net regression was seen in 13 patients ( 8 in the intervention and 5 in the control group ) , no change was seen in 40 patients ( 21 in the intervention and 19 in the control group ) and progression was noted in 30 patients ( 7 in the intervention and 23 in the control group ) . No correlation could be shown between Lp(a ) and angiographically documented progression of the disease . In a multivariate analysis including metabolic variables , group assignment , age and smoking habits , only assignment to the intervention group ( p = 0.0075 ) and a decrease in total cholesterol ( p = 0.0167 ) were independently associated with the course of the disease . Patients with or without previous myocardial infa rct ion ( 70 vs 34 ) did not differ in Lp(a ) levels ( median 9.15 vs 14.25 mg/dl ) . Patients with  Lp(a ) > 25 mg/dl were younger than patients with Lp(a ) < or = 25 mg/dl ( 52 vs 55 years ; p < 0.03 ) , indicating a connection between Lp(a ) and the development of premature CAD . ( ABSTRACT TRUNCATED AT 250 WORDS Forty-nine hypertensive patients who were overweight were r and omly allocated to one of three strategies for attaining weight reduction and were followed for one year . Those referred to a dietitian  lost more weight ( mean 5.1 kg ) than those given a diet sheet ( mean 2.64 kg ) or simply advised by the doctor to reduce weight ( mean 2.15 kg ) . One-third of all the patients lost 6 kg or more . Successful weight loss was associated with a highly significant and substantial improvement in blood pressure control and with less frequent increases in antihypertensive treatment The purpose of the present study was to examine the effects of four fat-modified diets on BP in 160 middle-aged subjects most of whom had mildly to moderately elevated serum total cholesterol levels and to analyse the relationship of BP to fatty acid composition of serum cholesterol esters . After screening , the subjects ( 74 men and 85 women ) were r and omised for the next six months into one of the four experimental diets : control diet ( high in saturated fats ) ( 35/14:10:4 , indicating 35 % of energy from total fat/14 % from saturated , 10 % from monoenes and 4 % from polyenes in the actual diet ) , AHA ( American Heart Association ) type diet ( 32/10:8:8 ) , monoene-enriched diet ( 34/11:11:5 ) and low-fat diet ( 30/12:8:3 ) . Serum total cholesterol decreased significantly during the AHA type diet and monoene-enriched diet in both men and women . No significant changes were found in BP levels in any of the groups in the long-term when both sexes were analysed together but in men the AHA type diet result ed in a significant decline in SBP ( -4.5 -7.9 mmHg , mean + /- SD ) and a consistent reduction was also found in DBP ( -2.1 + /- 8.4 mmHg ) . In contrast , control diet induced a significant rise ( + 5.5 + /- 14.3 mmHg ) in both SBP and DBP ( + 3.4 + /- 8.4 mmHg ) in men . In women , no persistent significant changes in BP levels were observed . An increase in the sum of proportions of myristic ( C14:0 ) , palmitic ( C16:0 ) and palmitoleic acids ( C16:1 ) of serum cholesterol esters was associated with the elevation of BP in men of the control group . Furthermore , at baseline , BP had significant positive correlations with C14:0 , C16:0 and C16:1 of serum cholesterol esters in the entire study population whereas linoleic acid had an opposite effect on BP even after adjustment for body mass index and age Abstract Objectives : To determine the extent to which plasma antioxidant concentrations in people with habitual low intake of fruit and vegetables respond to increased intakes of these foods . To examine whether advice to increase fruit and vegetables will result in reduction of concentrations of total and low density lipoprotein cholesterol . Design : R and omised controlled trial in which intervention and control groups were followed up for eight weeks . The intervention group was asked to consume eight servings of fruit and vegetables a day . Setting : Dunedin , New Zeal and . Subjects : Eighty seven subjects with normal lipid concentrations who ate three or fewer servings of fruit and vegetables daily . Main outcome measures : Plasma concentrations of vitamin C , retinol , α and ß carotene , α tocopherol , lipids , and lipoproteins . Dietary intake assessed with diet records over four days . Results : The mean plasma vitamin C , α carotene , and ß carotene concentrations increased in parallel with increased dietary intake of fruit and vegetables in the intervention group . Concentrations of retinol , α tocopherol , lipids , and lipoproteins remained unchanged despite some increase in dietary vitamin E and a small reduction in saturated fat intake . Conclusions : Following a recommendation to increase fruit and vegetable consumption produces change in plasma concentrations of vitamin C , α carotene , and ß carotene likely to reduce incidence of cancer . More specific dietary advice to modify fat intake may be necessary to reduce the risk of cardiovascular disease mediated by lipoprotein and vitamin E. Key messages Increasing intake of fruit and vegetables raises plasma concentrations of vitamin C and α and ß carotene These changes in plasma concentrations of antioxidants are probably associated with reduced risk of cancer A simple recommendation to increase fruit and vegetable intake has little effect on plasma concentrations of α tocopherol , lipids , and lipoproteins More specific dietary advice to modify fat intake may be necessary to reduce risk of cardiovascular disease associated with lipoproteins and vitamin Under experimental clinical conditions diet modification has been shown to reduce serum cholesterol levels . This paper reports such a positive response to a nonpharmacologic , behavioral education program at the worksite . Employees at the New York Telephone Company corporate headquarters were assigned r and omly to treatment and control groups . Treatment consisted of an 8-week group cholesterol reduction program conducted during employee lunch hours . It comprised a multiple-treatment approach -- food behavior change techniques combined with nutrition education , physical activity planning , and self-management skills . The treatment group showed substantial change compared with the control group at the program 's completion . Those treated displayed a significant 6.4 % reduction in total serum cholesterol ( 266 mg% average at baseline ) as compared with control subjects with a corresponding decrease in high-density lipoprotein levels . A significant increase in nutrition knowledge and moderate weight loss were also documented for this group . The magnitudes of a participant 's baseline serum cholesterol level and his/her reduction in percentage of ideal body weight were positively and independently correlated with percentage changes in serum cholesterol levels . Over the same period , decreases in high-density lipoprotein levels and no changes in serum cholesterol , weight , and nutrition knowledge were observed for the control group . Overall , participants in the treatment program successfully reduced the coronary heart disease risk factors of elevated cholesterol and weight . Directions for future study are suggested A cardiovascular disease screening and education campaign was conducted throughout the North Coast Region of New South Wales from 1987 to 1991 . Objectives were : to screen 20 per cent of the adult population for blood cholesterol and other heart disease risk factors ; to raise awareness of the risks associated with a high-fat diet ; to provide nutrition counselling and referral advice for those with elevated cholesterol ; and to monitor these participants ' cholesterol levels with a follow-up test at three months . During the five years , 42,869 individuals or 18 per cent of North Coast adults participated , with some overrepresentation of women aged 40 to 60 years . Initially , 65 per cent of participants had elevated cholesterol levels ( > or = 5.5 mmol/L ) and 46 per cent were overweight ( body mass index over 25 ) . A three-month retest was offered to all participants with elevated cholesterol , of whom 53 per cent attended . Participants who received nutrition counselling generally reported dietary changes which were reflected in significant cholesterol and weight reductions . Of participants who attended retest , 63 to 87 per cent had reduced cholesterol levels and 57 to 71 per cent reduced weight . A stratified r and om sample of participants was retested at one and three years . Reductions in cholesterol were well maintained for one year but showed signs of relapse after three years . There was a tendency for initially lower cholesterol levels to increase over a three-year period . Contributing factors included aging , regression to the mean and complacency . Maintenance may be enhanced by regular reinforcement of nutrition changes and development of more supportive environments BACKGROUND We evaluated the effectiveness of a low-cost group visit intervention for changing the dietary intake and lipid levels of patients with known coronary artery disease ( CAD ) . METHODS We performed a controlled r and om group assignment trial in 4 community outpatient clinics . The Dietary Intervention and Evaluation Trial r and omized 97 patients with CAD to either a control group that followed the National Cholesterol Education Program 's Step II-III diet plan ( n=48 ) or an experimental group that received meal plans , recipes , and nutritional information during monthly group office sessions ( n=49 ) . Both groups received lipid-lowering medications and were followed-up over 12 months . We assessed dietary intake , fasting lipid profiles , hemoglobin A1C levels , and per member per month ( PMPM ) expense data . RESULTS Food frequency data showed that eating fruits and vegetables and cooking with monounsaturated fat increased significantly in the experimental group compared with the control group at 1 year ( P=.0072 ; P=.0001 ; P=.0004 ) . The total PMPM expenses decreased for both groups ( 38 % for the experimental group and 10 % for the control group ) , but the cost difference was statistically nonsignificant ( P=.2975 ) . Both groups noted low-density lipoprotein reductions , significant only in the experimental group ( P=.0035 ) . CONCLUSIONS Our study suggests that using group office visits for patients with CAD was an effective method for helping subjects make dietary changes and for improving lipid levels .  Patients with known CAD and elevated lipid levels were willing to make significant lifestyle changes when offered a program that emphasizes healthy foods in a group visit format OBJECTIVES This study assessed the effects of a 2-year integrated health promotion-health protection work-site intervention on changes in dietary habits and cigarette smoking . METHODS A r and omized , controlled intervention study used the work site as the unit of intervention and analysis ; it included 24 predominantly manufacturing work sites in Massachusetts ( 250 - 2500 workers per site ) . Behaviors were assessed in self-administered surveys ( n = 2386 ; completion rates = 61 % at baseline , 62 % at final ) . Three key intervention elements targeted health behavior change : ( 1 ) joint worker-management participation in program planning and implementation , ( 2 ) consultation with management on work-site environmental changes , and ( 3 ) health education programs . RESULTS Significant differences between intervention and control work sites included reductions in the percentage of calories consumed as fat ( 2.3 % vs 1.5 % kcal ) and increases in servings of fruit and vegetables ( 10 % vs 4 % increase ) . The intervention had a significant effect on fiber consumption among skilled and unskilled laborers . No significant effects were observed for smoking cessation . CONCLUSIONS Although the size of the effects of this intervention are modest , on a population wide basis effects of this size could have a large impact on cancer-related and coronary heart disease end points 1 . The effect of an ovo‐lacto‐vegetarian ( OLV ) diet on blood pressure was assessed in a r and omized , controlled , crossover trial in 58 mild untreated hypertensive subjects recruited from the Perth Centre for the 1983 NHF Risk Factor Prevalence Survey A r and omized intervention trial of dietary fat reduction to 15 % of total calories was initiated in 1987 for women at high risk for breast cancer to determine the feasibility of recruiting and maintaining them on a low-fat diet . The study has enrolled 194 women between the ages of 18 and 67 years who met at least one of three eligibility criteria : 1 ) a first-degree relative with breast cancer , 2 ) a P2 or DY Wolfe mammographic pattern , and 3 ) a prior breast biopsy demonstrating epithelial hyperplasia with or without atypia . Eligible women must also have had diets that contained > or = 30 % of calories from fat at entry . Women were r and omized to a nonintervention usual diet vs. a 15 % low-fat diet . Recruitment was sought through physicians , personal mailings , breast cancer patients , and the news media . Two study sites participated : a large urban hospital affiliated with a university medical center and a community oncology private practice . The results from both institutions were similar and demonstrated that a low-fat dietary plan could be effectively conducted in private as well as academic setting s with recruitment tailored to the community where the trial is being conducted . Reduction in dietary fat intake was maximal during the first three months of the dietary intervention and remained stable throughout 12 months of follow-up . Reductions in total calories , weight loss , and percent body fat were minimal . The nonintervention group experienced no major change in their diet . We conclude that it is feasible to recruit women who are at high risk for breast cancer into a dietary intervention trial and with sufficient dietary counseling and motivation on the part of participants , reduction in dietary fat intake can be achieved and maintained . More in-depth analyses of these data will be presented in subsequent reports A four-year trial assessed whether less severe hypertensives could discontinue antihypertensive drug therapy , using nutritional means to control blood pressure . R and omization was to three groups : group 1 - -discontinue drug therapy and reduce overweight , excess salt , and alcohol ; group 2 - -discontinue drug therapy , with no nutritional program ; or group 3 - -continue drug therapy , with no nutritional program . In groups 1 and 2 patients resumed drug therapy if pressure rose to hypertensive levels . Loss of at least 4.5 kg ( 10 + lb ) was maintained by 30 % of group 1 , with a group mean loss of 1.8 kg ( 4 lb ) ; sodium intake fell 36 % and modest alcohol intake reduction was reported . At four years , 39 % in group 1 remained normotensive without drug therapy , compared with 5 % in group 2 . Study findings demonstrated that nutritional therapy may substitute for drugs in a sizable proportion of hypertensives or , if drugs are still needed , can lessen some unwanted biochemical effects of drug treatment The Diabetes Education Study ( DIABEDS ) was a r and omized , controlled trial of the effects of patient and physician education . This article describes a systematic education program for diabetes patients and its effects on patient knowledge , skills , self-care behaviors , and relevant physiologic outcomes . The original sample consisted of 532 diabetes patients from the general medicine clinic at an urban medical center . Patients were predominantly elderly , black women with non-insulin-dependent diabetes mellitus of long duration . Patients r and omly assigned to experimental groups ( N = 263 ) were offered up to seven modules of patient education . Each content area module contained didactic instruction ( lecture , discussion , audio-visual presentation ) , skill exercises ( demonstration , practice , feedback ) , and behavioral modification techniques ( goal setting , contracting , regular follow-up ) .  Two hundred seventy-five patients remained in the study throughout baseline , intervention , and postintervention periods ( August 1978 to July 1982 ) . Despite the requirement that patients demonstrate mastery of educational objectives for each module , postintervention assessment 11–14 mo after instruction showed only rare differences between experimental and control patients in diabetes knowledge . However , statistically significant group differences in self-care skills and compliance behaviors were relatively more numerous . Experimental group patients experienced significantly greater reductions in fasting blood glucose ( −27.5 mg/dl versus −2.8 mg/dl , P < 0.05 ) and glycosylated hemoglobin ( −0.43 % versus + 0.35 % , P < 0.05 ) as compared with control subjects . Patient education also had similar effects on body weight , blood pressure , and serum creatinine . Continued follow-up is planned for DIABEDS patients to determine the longevity of effects and subsequent impact on emergency room visits and hospitalization Effects of dietary intervention on dietary habits and nutrient levels were studied in 240 women aged 50 - 65 years who had been operated for a stage I-II breast cancer . Following surgery the women who had participated in a dietary history interview were r and omly assigned to one of two groups . The intervention group ( n = 121 ) received individual dietary counselling aim ed at reducing dietary fat intake to 20 - 25 per cent of energy ( E per cent ) while increasing intake of carbohydrates . No dietary advice was given to women assigned to the control group ( n = 119 ) . There was no significant difference between the groups in terms of base-line nutrient intake except for a higher energy intake in the control group ( P less than 0.05 ) . Sixty-three ( 52 per cent ) of the women in the intervention group and 106 ( 89 per cent ) of the women in the control group completed the 2-year follow-up . Energy intake decreased after 2 years in both groups and the difference between the groups remained ( P less than 0.01 ) . Total fat intake decreased in the intervention group by 12.9 - 23.3 E per cent after 2 years and by 3.1 E per cent in the control group . The intake of carbohydrates increased from 46.2 to 57.2 E per cent in the intervention group and from 46.2 to 48.9 E per cent in the control group . The study shows that dietary habits and intake of nutrients can be altered through dietary counselling  to breast cancer patients , and that such changes are long lasting OBJECTIVE To compare changes in total and regional body composition using dual energy X-ray absorptiometry ( DEXA ) after subjects lost weight through change in diet or exercise .  DESIGN A 12-month , r and omized , controlled study of two weight-loss interventions -low-fat diet ad libitum or moderate , unsupervised exercise-in  free-living , middle-aged men . Compliance was determined at monthly measurement sessions through food records and activity logs ; DEXA scans were performed every 3 months . SUBJECTS/ SETTING Fifty-eight overweight men ( mean body mass index = 29.0 + /- 2.6 ; mean age = 43.4 + /- 5.7 years ) recruited from a national corporation were assigned r and omly to diet , exercise , or control groups . INTERVENTIONS One group reduced dietary fat to 26.4 % of energy intake but kept activity unchanged ; another group self-selected aerobic exercise ( three sessions per week at 65 % to 75 % maximum heart rate ) but kept diet unchanged . A control group maintained weight . MAIN OUTCOME MEASURES At 12 months , measurements of weight , total and regional fat mass and lean mass , energy intake , and percentage dietary fat ; physical activity indexes . STATISTICAL ANALYSES Results were analyzed using paired t tests and analysis of variance . RESULTS Mean weight loss was 6.4 + /- 3.3 kg in dieters and 2.6 + /- 3.0 kg in exercisers ; control subjects maintained weight . DEXA scans revealed that 40 % of dieters ' weight loss was lean tissue ; more than 80 % of weight lost by exercisers was fat . Exercisers maintained limb lean tissue and lost fat mass . CONCLUSIONS Greater total weight and lean tissue loss occurred when subjects lost weight through a low-fat diet consumed ad libitum than when subjects participated in unsupervised aerobic exercise . Use of DEXA enabled identification of progressive total and regional changes in fat and lean tissue OBJECTIVE To compare the effect of the addition of medical nutrition therapy administered by a registered dietitian with the usual physician counseling on nutrition knowledge , attitudes regarding dietary change , body mass index , dietary intake , and lipid and lipoprotein concentrations during initial management of persons at risk for cardiovascular disease . DESIGN A 3-month prospect i ve , r and omized trial of subjects stratified by sex and assigned to one of four nested treatment groups , which were subsequently collapsed into two groups . SUBJECTS Fifty-two men and 52 women classified at risk for cardiovascular disease . INTERVENTION Two groups of subjects received dietary counseling from a physician or nurse ; in one group the Grocery Shopping Guide was used . Two other groups received medical nutrition therapy from a registered dietitian ( one or three visits ) in addition to the instruction from a physician or nurse and the information provided by the Grocery Shopping Guide . STATISTICAL ANALYSES Analyses of covariance were performed to determine differences between the groups . Paired t tests were performed to study changes within the groups . RESULTS The group receiving medical nutrition therapy from a registered dietitian gained statistically significantly more nutrition knowledge ; had significantly greater perceptions of the benefits and efficacy of following a cholesterol-lowering diet ; consumed a significantly lower percentage of fat , higher percentage of carbohydrate , and less dietary cholesterol than subjects counseled only by a physician or nurse . They also had significantly greater improvement in body mass index . Both groups of subjects achieved statistically significant reductions in serum lipid levels . APPLICATIONS Increased knowledge , benefits , and efficacy and lower-fat eating behaviors associated with additional nutrition therapy may have significant implication s on the ability of persons to follow low-fat eating plans long term , which could reduce the need for costly medication intervention Abstract Objective : To determine whether a community based coronary heart disease health promotion project , undertaken over four years , was associated with changes in the prevalence in adults of lifestyle risk factors known to affect the development of coronary heart disease , and to estimate whether such an approach was cost effective . Design : Prospect i ve , comparative study of the effects of a health promotion intervention on coronary heart disease lifestyle risk factors , assessed by postal question naire sent to a r and omly chosen sample , both at baseline and after four years . Subjects : Intervention and control population s of adults aged 18 - 64 in Rotherham , both from areas with a high incidence of coronary heart disease and similar socioeconomic composition . Main outcome measures : Changes in prevalence of lifestyle risk factors between the control and intervention communities from 1991 to 1995 . The effect of the intervention on certain lifestyle behaviours was evaluated using multiple logistic regression to model the proportion with a particular behaviour in the study communities as a function of age ( 18 - 40 or 41 - 64 years ) , sex , the year of observation ( 1991 or 1995 ) , and area ( intervention or control ) . Results : 6.9 % fewer people smoked and 8.7 % more drank low fat milk in the intervention area , but no other statistically significant changes between the areas were detected . The estimated cost per life year gained was £ 31 . Conclusions : It is possible to have a cost effective impact on coronary heart disease lifestyle risk factors in a population of adults over four years using only modest re sources . Key messages Little is known about the cost effectiveness of focused , heart disease health promotion projects in reducing cardiovascular risk factors over a short period in small population s of adults Research was undertaken to estimate the impact of a heart disease health promotion project — Action Heart— and relate the cost to estimates of health gain Major differences were observed in changes in prevalence of active smoking and consumption of low fat milk between the intervention and control areas over four years The estimated cost per life year gained was £ 31 Further research is required to ascertain whether the changes in risk factors will be sustained after the end of Action BACKGROUND Although diet therapy is the primary treatment for hypercholesterolemia , a trial to determine the effectiveness of the new American Heart Association Step One Diet ( AHA diet ) in lowering cholesterol has to our knowledge never been carried out . METHODS A clinical trial was conducted to assess the plasma lipids response and adherence to the AHA diet in 120 men and women with hypercholesterolemia . All subjects were advised to follow the AHA diet for 18 weeks . RESULTS After 6 weeks of the AHA diet intervention , there were modest but significant reductions in plasma total cholesterol ( -2.6 % ) and low-density lipoprotein ( LDL ) cholesterol ( -3.5 % ) , but no further significant reductions were observed thereafter . Rather , there was a tendency to return to and even exceed baseline levels of total cholesterol and LDL cholesterol over the subsequent 12 weeks , in spite of the subjects ' reported continued adherence to the AHA diet and maintenance of weight loss throughout the entire study period . Nevertheless , 51 % of the subjects had experienced improvement ( -0.2 % to -26.3 % ) in their plasma LDL cholesterol levels by the end of the study . CONCLUSIONS A probable reason for the limited response of the diet was low baseline levels in intake of saturated fat and cholesterol by participants . The subjects who were older and had higher levels of plasma LDL cholesterol and total fat intake at baseline experienced better plasma LDL cholesterol response to the AHA diet . Thus , practicing physicians should consider assessing the baseline dietary fat and cholesterol intake of patients with hypercholesterolemia before starting the AHA diet , since patients may already be following a relatively prudent self-selected diet . Additional dietary gains in lipid management might well require a more severe restriction of dietary fats and cholesterol . Long-term efficacy of the AHA diet should also be evaluated clinical ly with periodic lipid profiles PURPOSE The objectives of this investigation were to prospect ively assess medication compliance rates in elderly patients with congestive heart failure , to identify factors associated with reduced compliance , and to evaluate the effect of a multidisciplinary treatment approach on medication adherence . PATIENTS AND METHODS A total of 156 patients > or = 70 years of age ( mean , 79.4 + /- 6.0 ; 67 % female , 65 % nonwhite ) hospitalized with congestive heart failure were evaluated prospect ively . Prior to discharge , patients were r and omized to the study intervention ( n = 80 ) or conventional care ( n = 76 ) . The intervention consisted of comprehensive patient education , dietary and social service consultations , medication review , and intensive postdischarge follow-up . Detailed data were collected on all prescribed medications at the time of discharge , and compliance was assessed by pill counts 30 + /- 2 days later . RESULTS The overall compliance rate during the first 30 days after discharge was 84.6 + /- 15.1 % ( range , 23.1 - 100 % ) . Compliance was 87.9 + /- 12.0 % in patients r and omized to the study intervention , compared with 81.1 + /- 17.2 % in the control group ( P = 0.003 ) . A compliance rate of > or = 80 % was achieved by 85.0 % of the treatment group versus 69.7 % of the control group ( P = 0.036 ) . By multivariate analysis , assignment to the treatment group was the strongest independent predictor of compliance ( P = 0.008 ) . Other variables included in the model were Caucasian race ( P = 0.044 ) and not living alone ( P = 0.09 ) . CONCLUSIONS A multidisciplinary treatment strategy is associated with improved medication compliance during the first 30 days following hospital discharge in elderly patients with congestive heart failure . Improved compliance may contribute to improved outcomes in these patients PURPOSE To evaluate the feasibility of integrating a program based on dietary fat intake reduction into adjuvant treatment strategies for postmenopausal women receiving therapy for early breast cancer . PATIENTS AND METHODS Two hundred ninety postmenopausal women with localized ( stage I to IIIa ) breast cancer receiving conventional systemic therapy provided informed consent and were r and omized in a multicenter trial to either a dietary intervention group receiving a program of individualized instruction for reducing total fat intake or a dietary control group with minimal dietary counseling . RESULTS Significantly reduced ( P < .001 ) fat intake ( in terms of percent calories derived from fat ) was observed in the intervention group versus the control group at 3 months ( 20.3 % + /- 2.4 % v 31.5 % + /- 2.6 % , mean + /- SD , respectively ) and maintained throughout 24 months of observation . The 50 % reduction in daily fat-gram intake ( from 66 + /- 23 to 33 + /- 14 g , P < .001 ) seen at 6 months was associated with reduced saturated fat , monounsaturated fat , polyunsaturated fat , and linoleic acid ( P < .001 ) . Significantly lower body weight was also seen in intervention compared with control patients at all observation periods , result ing in a 3.3-kg weight difference 18 months after r and omization ( P < .001 ) . CONCLUSION Substantial and sustained  dietary fat reduction  with associated weight change can be achieved at relatively low cost within the context of conventional multimodality clinical management of postmenopausal women with localized breast cancer . This result supports the feasibility of conducting a full-scale evaluation of the influence of dietary fat intake reduction on the clinical outcome of breast cancer patients OBJECTIVES The objective was to analyse whether a favourable change in risk factors , caused by a comprehensive risk factor modification programme , affected intima-media thickness ( IMT ) in the common carotid artery , and whether any such change was associated with a change in cardiovascular events during a 6-year follow-up . DESIGN Patients were r and omized 1 : 1 to special intervention or usual care .  SETTING Hypertension Unit at university hospital . SUBJECTS A total of 164 patients were r and omized . Inclusion criteria were male , aged 50 - 72 years ( at r and omization ) and one or more of the following : Serum cholesterol level > 6.5 mmol L(-1 ) , smoking or diabetes mellitus . All patients were prescribed antihypertensive treatment since many years . In 142 men good quality ultrasound recording of the common carotid IMT were achieved at baseline , 119 were re-examined after 3.3 years , and 97 patients were available for examination after mean follow-up time of 6.2 years . Cardiovascular events were available for all r and omized patients . INTERVENTIONS The nonpharmacological special intervention programme was based on one information meeting followed by five weekly 2-h sessions with participation of patients and spouses . The diet recommendations were similar to established guidelines . Overweight patients were instructed to lose weight , and diabetic patients were systematic ally taught self-monitoring of blood glucose . Smokers were invited to a smoking cessation programme with five weekly meetings . Follow-up visits were thereafter scheduled every 6 months . Lipid lowering drugs were recommended in the intervention group if the treatment goals using nonpharmacological measures were not achieved . Patients in the usual care group were told to quit smoking and to lower their consumption of fat and glucose . Antihypertensive treatment ( i.e. , selection of drugs ) was on purpose kept similar in the two groups . MAIN OUTCOME MEASURES The IMT of the common carotid artery as measured by ultrasound . Cardiovascular events during follow-up . RESULTS Significant net reductions were seen for serum cholesterol , triglycerides , fasting glucose and smoking . No difference in change in IMT was observed during follow-up between the two r and omization groups . The explanation was that patients with positive plaque status at baseline had a much larger increase in IMT over time than patients with negative plaque status , and that patients with positive plaque status more often survived and were available for re-examination after 6 years in the intervention group than in the usual care group .  Total mortality was lower in the intervention group , compared with the usual care group , 13 and 29 % , respectively ( P=0.028 ) . CONCLUSIONS In high risk population s , long-term studies with surrogate endpoints may be misleading because of missing data in patients where a large increase in IMT would have been observed , had they been re-examined . Another important conclusion from our study was that the gloomy prognosis for this patient category may be improved by a dedicated risk factor intervention programme . The improved prognosis was observed mainly in those patients at highest risk judged from history of cardiovascular disease or positive ultrasound plaque status at baseline BACKGROUND A number of factors contribute to increased risk of coronary heart disease ( CHD ) among postmenopausal women , including atherogenic changes in serum cholesterol profiles , weight gain , and decreases in physical activity during the menopause . To date , no study has attempted to prevent elevations in primary CHD risk factors as women experience menopause . METHODS A sample of 535 healthy premenopausal women , ages 44 - 50 , were recruited for an ongoing 5-year r and omized prevention trial testing whether increases in low-density lipoprotein cholesterol ( LDL-C ) and body weight can be prevented during the menopause with a dietary and behavioral intervention . The aim was to reduce total dietary and saturated fat and cholesterol , prevent weight gain , and increase physical activity levels . Changes in CHD risk factors after the first 6 months of treatment were analyzed comparing 253 intervention and 267 assessment -only control participants . RESULTS The intervention group showed significant reductions in total cholesterol ( -0.34 mmol/liter ) , LDL-C ( -0.28 mmol/liter ) , triglycerides ( -0.04 mmol/liter ) , weight ( -4.8 kg ) , waist-hip ratio ( -0.008 ) , systolic blood pressure ( -3.5 mm Hg ) , diastolic blood pressure ( -2.2 mm Hg ) , serum glucose levels ( -0.06 mmol/liter ) , and HDL-C ( -0.06 mmol/liter ) and significant increases in physical activity ( + 383 kcal ) . No significant changes were observed in the control group . CONCLUSION Six-month results suggested that participants were receptive to the preventive approach to CHD risk reduction and were successful in making initial positive lifestyle changes . Follow-up data will evaluate long-term adherence to the intervention and the interaction between adherence and physiological changes during menopause A program titled Contemporary Concerns about Food and Health ( CCFH ) was developed by the Florida Cooperative Extension Service after research in five counties showed 30%-74 % of 2,308 middle-aged citizens to have three or more characteristics that placed them at above-average risk for developing diseases such as cardiovascular disease , adult-onset diabetes , and cirrhosis . CCFH addressed the effects of dietary and other practice s that contribute to such lifestyle-related diseases . This article describes the test of the effectiveness of this program in increasing participant knowledge about the causes and preventions of health risk and in motivating them to make healthful risk-reducing changes in their lifestyles . A comparison , four-group , quasi-experimental design was used to study the program in five counties . The four groups included ( a )  those who participated only in CCFH lessons ; ( b ) lesson participants who had also completed a computerized healthrisk profile ; ( c ) a r and om sample of persons who completed only the health profile ;  and ( d )  a control group r and omly  selected to match both groups of lesson participants closely in age , sex , race , and county of residence . Results showed that lesson participants knew the answers to a significantly greater number of knowledge items than did the comparison groups , and they reported making more , and more important , changes in their lifestyles for reducing their risks of developing health problems OBJECTIVES The purpose of this study was to evaluate the short-term effects of a low-intensity work-site heart disease risk reduction program using a matched pair design with work site as the unit of analysis . METHODS Twenty-six heterogeneous work sites with between 125 and 750 employees were matched on key organization characteristics and then r and omly assigned to early or delayed intervention conditions . Early intervention consisted of an 18-month multifaceted program that featured an employee steering committee and a menu approach to conducting key intervention activities tailored to each site . RESULTS Cross-sectional and cohort analyses produced consistent results . At the conclusion of the intervention , early and delayed intervention conditions did not differ on changes in smoking rates , dietary intake , or cholesterol levels . There was considerable variability in outcomes among work sites within each condition . CONCLUSIONS Despite documented implementation of key intervention activities and organization-level changes in terms of perceived support for health promotion , this intervention did not produce short-term improvements beyond secular trends observed in control work sites . Research is needed to underst and determinants of variability between work sites Abstract The  mortality  from coronary heart-disease ( C.H.D. ) and other causes was studied in two mental hospitals during a long-term ( twelve-year ) controlled preventive trial . The trial was cross-over in design . In one of the hospitals a serum-cholesterol-lowering diet was introduced and the other hospital using a normal diet served as the control . After six years the diets were reversed , and the trial was continued for six more years . In men , the use of the cholesterol-lowering diet was associated with considerably and significantly reduced mortality from C.H.D. Total mortality also was consistently lower on this diet , although the differences were too small for statistical significance . In women , the mortality from C.H.D. also appeared to be lower during the diet period , but the differences were small and not significant . In  female total mortality no appreciable differences were found A r and om sample of 501 eligible families was selected from a design ated neighborhood in Portl and , Oregon , and given the opportunity to join a 5-year intervention program promoting a low-fat and low-cholesterol eating pattern design ed to reduce risk for coronary heart disease . Participation entailed three baseline assessment s of clinical , dietary , and psychological indices , periodic follow-up measurements , and monthly small group meetings led by psychologists and nutritionists . A prior home health survey allowed comparisons of respondents from joining and nonjoining families in terms of reported health status , health beliefs , health locus of control , knowledge about health and nutrition , and demographic characteristics . Almost half ( 47 % ) of all invited families agreed to join this long-term nutrition intervention program and completed the necessary baseline assessment s. Factors discriminating joiners and nonjoiners were not generally consistent with the health belief model of preventive health behavior . Joiners were similar to nonjoiners in terms of perceived susceptibility to disease , family health histories , and reports of elevated plasma cholesterol levels in the family . However , families with hypertensive members were less likely to join this heart disease prevention program . Positive predictors of participation included higher occupational status , greater knowledge about heart disease , a more internal health locus of control , and the belief that there are few barriers preventing the adoption of a healthier low-fat eating pattern . These findings indicate that there is widespread community interest in optimal nutrition , and they also provide suggestions as to what motivates the general public to take preventive health actions OBJECTIVE To examine the dietary habits of patients with ischemic heart disease 1 year after they received either  dietary advice on using the Plate Model and how to increase intakes of fruits and vegetables in a 10-minute session ( brief counseling group , BCG ) or dietary advice primarily based on the National Cholesterol Education Program Step I diet provided in 2 individually tailored 50-minute sessions held 3 months apart ( comprehensive counseling group , CCG ) . DESIGN A r and omized study that included dietary intake evaluation on basis of 7-day weighed food records completed at 3 occasions : immediately before counseling ( week zero ) , 12 weeks after counseling , and 52 weeks after counseling . SUBJECTS BCG was composed of 15 men and 2 women and CCG was composed of 16 men and 3 women with ischemic heart disease age 70 years or younger recruited from the Department of Cardiology , Odense University Hospital , Odense , Denmark . STATISTICAL ANALYSES PERFORMED ANOVA , unpaired t tests , and multiple regression analysis , as well as nonparametric statistical analyses were carried out . RESULTS The comprehensive counseling result ed in significant improvements from week 0 to 52 in the percent of energy from fat ( 33 % to 28 % ) , saturated fat ( 12 % to 9 % ) and carbohydrate ( 51 % to 54 % ) consumed by the subjects . The corresponding values in BCG did not differ significantly ( 31 % to 32 % , 11 % to 12 % , 53 % to 52 % respectively ) . Differences from week 0 to 52 between groups were significant for fat , saturated fat , and carbohydrate intake . In CCG , median intakes of fish , fruits , and vegetables were 44 g/day , 172 g/day , and 315 g/day , respectively , at week 52 . The corresponding values in BCG were 44 g/day , 129 g/day , and 224 g/day . There was no significant difference either within or between the groups . CONCLUSION This study suggests that sustained improvements in dietary behavior require individualized and reinforced counseling in patients with ischemic heart disease . Changes in intakes of fish , fruits , and vegetables need to be specifically targeted Abstract Objective : To assess the effectiveness of health checks by  nurses in reducing risk factors for cardiovascular disease in patients from general practice . Design : R and omised controlled trial . Setting : Five urban general practice s in Bedfordshire . Subjects : 2136 patients receiving an initial health check in 1989 - 91 and scheduled to be re-examined one year later in 1990 - 2 ( intervention group ) ; 3988 patients receiving an initial health check in 1990 - 2 ( control group ) . All patients were aged 35 - 64 years at recruitment in 1989 . Main outcome measures : Serum total cholesterol concentration , blood pressure , body mass index , confirmed smoking cessation . Results : Mean serum total cholesterol was 2.3 % lower in the intervention group than in the controls ( difference 0.14 mmol/l ( 95 % confidence interval 0.08 to 0.20 ) ) ; the difference was greater in women ( 3.2 % , P<0.0001 ) than men ( 1.0 % , P=0.18 ) . There was no significant difference in smoking prevalence , quit rates , or body mass index . Systolic and diastolic blood pressure were 2.5 % and 2.4 % lower respectively in the intervention group . The proportion of patients with diastolic blood pressure > = 100 mm Hg was 2.6 % ( 55/2131 ) in the intervention group and 3.4 % ( 137/3987 ) in the controls ( difference 0.9 % ( 0.0 to 1.7 ) ; the proportion with total cholesterol concentration > = 8 mmol/l 4.8 % ( 100/2068 ) and 7.6 % ( 295/3905 ) ( difference 2.7 % ( 1.5 to 4.0 ) ) ; and that with body mass index > = 30 12.4 % ( 264/2125 ) and 14.0 % ( 559/3984 ) ( difference 1.6 % ( -0.2 to 3.4 ) ) . Conclusion : General health checks by nurses are ineffective in helping smokers to stop smoking , but they help patients to modify their diet and total cholesterol concentration . The public health importance of this dietary change depends on whether it is sustained Abstract A preventive trial aim ing at treatment of the risk factors hypertension , raised serum cholesterol , smoking , and , to some degree , low physical activity is described . The study population comprises all men in the city born in 1915–1925 ; around 30,000 men . They were r and omly divided into one treatment group and two control groups . A follow-up examination 4 years after the first examination is planned . The endpoints are deaths , all causes and cause-specific ; nonfatal myocardial infa rct ion ; and nonfatal stroke , and these are continuously followed by special registers . Some cross-sectional results from three age groups , hitherto examined , are given . The problems of making people aware of their health problems and treatment of risk factors in a community are discussed To determine whether a group behavior modification approach might be preferable to individual counseling in the nutritional therapy of non-insulin-dependent diabetes mellitus , 40 adults younger than 65 yr of age with diabetes mellitus who were not receiving insulin were r and omized to either a program of individualized dietary review and recommendations or a program of group meetings aim ed at controlling the signals leading to overeating and noncompliance with a diabetic dietary regimen . Statistically significant ( P < 0.05 ) decreases in body weight , sum skin-fold thickness , fasting serum glucose , and serum triglycerides but not LDL-C or HDL-C were observed . The individual counseling group had a greater amount of weight loss than the behavior modification group . There were no significant ( P < 0.05 ) differences between the two groups with respect to the biochemical outcome variables . Patient characteristics assessed at entry — namely anxiety , internal versus external locus of control and perceived disease severity , and compliance with advice — were significantly associated with weight loss in the behavior modification group while only the latter index was of value in the individual counseling group . Thus , our use of these programs does not identify a clear advantage of either approach in the nutritional therapy of non-insulin-dependent diabetic patients Cardiovascular disease ( CVD ) is the number one cause of death in the United States . Obesity is highly related to CVD risk , especially in African American women . This study explored the efficacy of a culturally specific obesity prevention program . Design ed for low-income , inner-city African American girls and their mothers , the program addressed the importance of eating a low-fat , low-cholesterol diet and increasing activity .  Mother-daughter dyads were r and omly assigned to a 12-week treatment or an attention placebo group . Participants were assessed at pre- and posttreatment on dietary intake , including daily fat intake , daily saturated fat intake , percentage of daily calories from fat , and daily cholesterol intake . Results showed significant differences between the treatment and control mothers for daily saturated fat intake and percentage of calories from fat . Differences among treatment and control groups were also noted for the daughters on percentage of daily calories from fat . Implication s of the findings for developing culturally specific health risk reduction programs are discussed Our research team is involved in ongoing research in both worksites and medical office setting s. These setting s offer great potential for reaching individuals who would not otherwise participate in health promotion , but they also place considerable constraints on assessment time and efforts , especially if one 's goal is to attract a high and representative proportion of employees or patients . This paper reports on our experience with measures of dietary behavior  in these two setting s. We found it problematic to collect detailed assessment s such as 4-day food records or comprehensive food frequency/history checklists in worksites or medical office setting s using population -based sample s. Instead , we recommend and provide data on the utility of a  dietary-fat screening instrument , and on the  Food Habits Question naire  ( FHQ-Kristal , Shattuck , & Henry , 1990 ) , a brief measure of dietary behaviors associated with high-fat eating patterns . The FHQ , in particular , was found to correlate well with other more costly and time-consuming methods of assessment , to be reliable and responsive to intervention effects , and to provide behavioral targets for intervention . The strengths and limitations of these measures for tailoring intervention and assessing outcomes are discussed OBJECTIVE To test the short-term feasibility and efficacy of seven nonpharmacologic interventions in persons with high normal diastolic blood pressure . DESIGN R and omized control multicenter trials . SETTING Volunteers recruited from the community , treated and followed up at special clinics . PARTICIPANTS Of 16,821 screenees , 2182 men and women , aged 30 through 54 years , with diastolic blood pressure from 80 through 89 mm Hg were selected . Of these , 50 did not return for follow-up blood pressure measurements . INTERVENTIONS Three life-style change groups ( weight reduction , sodium reduction , and stress management ) were each compared with unmasked nonintervention controls over 18 months . Four nutritional supplement groups ( calcium , magnesium , potassium , and fish oil ) were each compared singly , in double-blind fashion , with placebo controls over 6 months . MAIN OUTCOME MEASURES Primary : change in diastolic blood pressure from baseline to final follow-up , measured by blinded observers . Secondary : changes in systolic blood pressure and intervention compliance measures . RESULTS Weight reduction intervention produced weight loss of 3.9 kg ( P less than .01 ) , diastolic blood pressure change of -2.3 mm Hg ( P less than .01 ) , and systolic blood pressure change of -2.9 mm Hg ( P less than .01 ) . Sodium reduction interventions lowered urinary sodium excretion by 44 mmol/24 h ( P less than .01 ) , diastolic blood pressure by 0.9 mm Hg ( P less than .05 ) , and systolic blood pressure by 1.7 mm Hg ( P less than .01 ) . Despite good compliance , neither stress management nor nutritional supplements reduced diastolic blood pressure or systolic blood pressure significantly ( P greater than .05 ) . CONCLUSIONS Weight reduction is the most effective of the strategies tested for reducing blood pressure in normotensive persons . Sodium reduction is also effective . The long-term effects of weight reduction and sodium reduction , alone and in combination , require further evaluation OBJECTIVE To evaluate a cardiovascular nutrition education package design ed for African-American adults with a wide range of literacy skills . DESIGN Comparison of a self-help group and a full-instruction group ; each group received nutrition counseling and clinical monitoring every 4 months . SUBJECTS Three hundred thirty African-American adults , aged 40 to 70 years , with elevated cholesterol level or high blood pressure were r and omly assigned to the self-help or full-instruction group ; 255 completed the 12-month follow-up . INTERVENTIONS Counseling to reduce intake of dietary fat , cholesterol , and sodium was based on Cardiovascular Dietary Education System ( CARDES ) material s , which included food-picture cards , a nutrition guide ( self-help and full-instruction group ) , a video and audiotape series , and 4 classes ( full-instruction group only ) . MAIN OUTCOME MEASURES Changes in lipid levels and blood pressure after 12 months . STATISTICAL ANALYSES PERFORMED Primary analyses consisted of repeated- measures analysis of variance to examine effects of time and r and omization group on outcomes . RESULTS Total cholesterol and low-density lipoprotein cholesterol level decreased by 7 % to 8 % in the self-help and full-instruction groups of men and women ( P < .01 ) . The ratio of total cholesterol to high-density lipoprotein cholesterol ( HDL-C ) decreased in both groups of women and in the men in the full-instruction group ( P < .01 ) . In full-instruction and self-help participants with elevated blood pressure at baseline , systolic blood pressure decreased by 7 to 11 mm Hg and diastolic blood pressure decreased by 4 to 7 mm Hg ( P < .01 ) . Outcomes did not differ by literacy scores but were positively related to the reported initial frequency of using CARDES material s. APPLICATIONS/ CONCLUSIONS These results suggest that periodic nutrition counseling based on CARDES material s used for home study can enhance management of lipid levels and blood pressure in African-American out patients The Trial of Antihypertensive Intervention and Management evaluated nine diet-drug combinations in 878 mildly hypertensive , moderately obese participants using a 3 x 3 factorial design . Drugs evaluated were placebo , diuretic ( chlorthalidone ) , and beta-blocker ( atenolol ) ; diets were usual ( no intervention ) , weight reduction , and low sodium/high potassium ( Na/K ) . This article reports 6-month dietary changes and the effect of dietary change on blood pressure . Six-month mean weight change was -4.7 kg in the weight reduction group , -0.3 kg in the Na/K group , and -0.5 kg in the usual-diet group . At 6 months , daily electrolyte excretion had changed in the Na/K intervention group . Daily sodium excretion decreased from 138.0 to 112.0 mmol in the Na/K group and increased from 134.1 to 138.4 mmol in the weight reduction group and from 129.1 to 137.0 mmol in the usual-diet group . Daily potassium output increased from 58.7 to 71.4 mmol in the Na/K group , from 57.0 to 60.5 mmol in the weight reduction group , and from 55.3 to 59.1 mmol in the usual diet group . Analysis of 3-day food records indicated that sodium intake decreased from 141.1 to 85.8 mmol and potassium intake increased from 76.4 to 90.5 mmol . Our results indicate that the goal for weight reduction was more easily achieved than the goal for electrolyte modification INTRODUCTION We examined the need for counselling and the effect on willingness and ability to change life-style , and subsequent changes in risk factors for CHD . MATERIAL AND METHODS All 152 male employees in a computer company , 25 - 45 years of age , were invited to participate in a controlled intervention study over one year . The subjects were r and omised to an intervention group ( I group ) and a control group . The I group was divided into subgroups based on baseline behaviour and risk factor status . Changes were evaluated after one year . After an initial health examination , participants in the I group were counselled at baseline and at 5 months . RESULTS Eighty-five ( 56 % ) men participated . Twenty-nine were assigned to a control group and 56 to an intervention group ( I group ) ( dropouts = 8) . An exercise group ( E group ) was advised to take up aerobics exercise three times/week , a diet group to reduce the intake of saturated fat and increase fish products , and smokers to stop smoking . Forty were recommended one or more behavioural changes and eight had no need . Thirty-four were willing to make behavioural changes . Compared to the control group , the fitness level increased ( p < 0.01 ) and body weight decreased in the I group ( p < 0.05 ) . DISCUSSION Individual counselling promotes regular exercise with subsequent improvements in CHD risk factors . The diet and smoking counselling models were less successful in terms of compliance OBJECTIVES The purpose of this study was to assess the costs and impact of a nutrition education program following a cholesterol screening . METHODS Forty work-sites were r and omly assigned to one of two educational interventions : a " usual " intervention of 5 minutes of counseling , or a " special " intervention of 2 hours of behaviorally based education on dietary changes to lower serum cholesterol .  Costs were monitored , and cholesterol levels were retested 6 and 12 months later . RESULTS The total per-person cost for screening and the educational intervention was about $ 50 . Cholesterol levels differed little between the two intervention groups 6 months after screening , but after 12 months those in the special intervention worksites showed a 6.5 % drop in cholesterol , whereas those at the usual intervention worksites showed a drop of only 3.0 % . Hence a 3.5 % cholesterol reduction was attributable to the special intervention . CONCLUSIONS A behaviorally based nutrition education program following cholesterol screening can have a meaningful impact on long-term cholesterol levels at a low cost . Nutrition education in work-sites may therefore be a useful way to lower the risk of heart disease in communities The study was carried out to assess the short- and long-term effects of a Finnish Social Insurance Institution ( SII ) weight reduction programme in overweight primary health care clients and the suitability of the programme for use in health centres . The treatment group consisted of 22 men and 71 women , mean body mass index ( BMI ) 34.3 , divided into 8 subgroups . These subjects participated in a 6-week weight reduction course led by public health nurses . Afterwards , there were six follow-up sessions and weight measurements at about 2-month intervals . A control group of 20 men and 76 women , mean BMI 33.5 , received no weight reduction instruction during the 1 year that they served as controls . The weights , serum and high-density lipoprotein ( HDL ) cholesterol levels as well as blood pressures of the subjects in both groups were measured at entry to the study and at the end of the 1-year period . At that time the treatment group showed a weight reduction of 10.9 kg in men and 5.4 kg in women . The control group showed a mean weight gain of 0.9 kg in men and 0.2 kg in women . HDL cholesterol increased in the treatment group . The blood pressure decreased significantly in the category of subjects with a weight loss exceeding 4 kg weight . At the end of the 7-year follow-up period the mean weight reduction in the treatment group was 8.7 kg in men and 3.5 kg in women . Of men 53 % and of women 21 % still weighed over 10 kg less than at baseline . Both the clients and public health nurses found the weight reduction programme useful and applicable to health centres , preferably with extended time . The programme has now been adopted nationwide in the Finnish primary health care system Altogether 160 free living subjects ( aged 30 - 60 years ) most of whom had moderate hypercholesterolemia were r and omised into the following diet groups to find out long-term effects of different fat-modified diets : ( 1 ) control diet 35/14:10:4 ( energy percents from fat/saturated : monounsaturated : polyunsaturated fatty acids in actual diets ) ; ( 2 ) AHA type diet 32/10:8:8 ; ( 3 ) monoene-enriched diet 34/11:11:5 ; ( 4 ) reduced-fat diet 30/12:8:3 .  LDL cholesterol fell equally with the AHA type diet ( 4.54 + /- 0.97 vs. 4.21 + /- 0.89 mmol/l ( mean + /- S.D. , 0 vs. 6 months ) , P = 0.001 ) and with the monoene-enriched diet ( 4.55 + /- 0.95 vs. 4.25 + /- 0.95 mmol/l , P = 0.004 ) during the 6-month study . Moderate amounts of polyenes or monoenes as part of natural diets did not decrease HDL cholesterol level in the long term . Serum lipid values remained unchanged with the reduced-fat diet . Analysis by apolipoprotein E phenotypes showed a decrease in LDL cholesterol only in subjects with phenotype 3/3 in the monoene-enriched group ( -8.6 + /- 8.7 vs. + 1.3 + /- 15.4 , percent change in LDL cholesterol E 3/3 vs. E 4/3 + 4/4 ) , but in the AHA type group LDL cholesterol decreased similarly in phenotypes E 3/3 and E 4/3 + 4/4 ( -6.9 + /- 10.1 vs -6.9 + /- 16.5 ) Thirty-four patients with essential hypertension were allocated , in a controlled trial , to a treatment diet of high fibre , low fat and low sodium composition , or to a control diet by the hospital dietitian . Clinical observations were made by a separate ' blinded ' nursing sister . After three months treatment , the modified diet-treated group showed a significant reduction in mean systolic ( 169.4 + /- 23.4 to 150.6 + /- 16.1 mmHg ) and diastolic blood pressure ( 101.5 + /- 7.3 to 89.4 + /- 6.8 mmHg ) , accompanied by significant reductions in urinary sodium excretion ( 140.4 + /- 34.6 to 93.7 + /- 44 mmol/day ) and weight ( 73.1 + /- 10 to 71.2 + /- 8.4 kg ) . The changes in control were ; systolic 171.2 + /- 14.1 to 162.1 + /- 19.5 mmHg and diastolic pressure 97.2 + /- 10.8 to 91.7 + /- 9.7 mmHg . The mean differences in reductions between treated and control were 8.8 mmHg Systolic ( 95 % confidence intervals : -2.6 to 21.2 mmHg ) and 7.0 mmHg diastolic blood pressure ( 95 % confidence intervals : 0.4 to 14.4 mmHg ) . The number of patients with normal blood pressure in the diet treated group at three months was double that in the control ( eleven versus five ) . No relationships were shown between blood pressure changes and those of weight or urinary sodium excretion during the trial . The findings in this study are broadly in agreement with similar ones in essential hypertension and suggest that this form of dietary regimen has a clinical ly worthwhile hypotensive effect and this should be readily achievable in routine clinical practice OBJECTIVES This study attempted to determine whether an intensive multifactor risk reduction program conducted over 4 years would reduce the rate of development of new coronary artery lesions . BACKGROUND Recent angiographic trials have generally demonstrated that normalization of plasma lipoprotein profiles reduces the rate of progression of established coronary lesions , but limited data exist on how these treatments influence the development of new lesions . METHODS Three hundred men and women with coronary artery disease were r and omized to  multifactor risk reduction or usual care . Highly significant improvements in risk factors were achieved by the risk reduction group compared with minimal changes by the usual care group . Quantitative coronary angiography was performed on entry and after 4 years under identical conditions . A decrement in the minimal diameter of visually normal segments > 0.2 mm was considered to indicate new lesion formation . RESULTS A total of 1,605 segments , representing 257 patients , were considered normal at baseline , with 804 and 801 disease-free segments in the usual care and risk reduction groups , respectively . Ninety-nine segments ( 6.1 % ) were identified by follow-up quantitative angiography and two angiographic observers as having new lesion formation ( usual care 7.6 % , risk reduction 4.7 % , p = 0.05 ) . New lesion formation was observed in 41 ( 31 % ) of 131 patients in the usual care group and in 29 ( 23 % ) of 126 patients in the risk reduction group ( p = 0.16 ) , with a mean number of new lesions/patient of 0.47 in the usual care group and 0.30 in the risk reduction group ( p = 0.06 ) . Multiple regression analysis identified on- study dietary fat intake as the best correlate with new lesion formation . CONCLUSIONS These data indicate that intensive multifactor risk reduction tends to diminish the frequency of new coronary lesion formation The hypothesis that 6 months after acute myocardial infa rct ion , adoption of secondary prevention activities would be higher , quality of life better , and blood cholesterol lower in patients r and omly allocated to a mail-out intervention program  than in those receiving usual care was tested . Patients were aged < 70 years , admitted to hospitals in and around Newcastle , Australia with a suspected heart attack and discharged alive from the hospital . Cluster r and omization , based on the patient 's family practitioner , was used to allocate consenting patients to an intervention or usual care group . A low-cost mail-out program was design ed to help patients reduce dietary fat , obtain regular exercise by walking and ( for smokers only ) to quit smoking . Supplementary telephone contact was also used . In addition , a letter was sent to the family doctor regarding the benefit of aspirin and beta blockers for secondary prevention . Of eligible patients , 71 % participated , and 79 % of the 213 intervention subjects and 87 % of the 237 usual care ones returned a 6-month follow-up question naire . Self-reported fat intake was significantly lower , an " emotional " score obtained from a quality -of-life question naire was significantly higher in the intervention than in the usual care group , and " physical " and " social " scores for quality of life were slightly higher . Blood cholesterol level and other variables were not different between the groups at 6 months . Simple low-cost programs providing support and advice on lifestyle change may be beneficial , particularly in improving patients ' perceived quality of life
BACKGROUND The average level of blood cholesterol is an important determinant of the risk of coronary heart disease .
Blood cholesterol can be reduced by dietary means .
Although dietitians are trained to provide dietary advice , for practical reasons it is also given by other health professionals and occasionally through the use of self-help re sources .
OBJECTIVES To assess the effects of dietary advice given by a dietitian compared with another health professional , or the use of self-help re sources , in reducing  blood cholesterol in adults .