The effect of brief versus individually tailored dietary advice on change in diet, lipids and blood pressure in patients with inflammatory joint disease
Background: Patients with inflammatory joint diseases (IJD) have an increased risk of cardiovascular disease (CVD) compared to the general population. Nutritional advice has been shown to influence CVD risk factors. Our objective was to evaluate whether an individually tailored dietary counselling versus a brief standardised advice on heart-friendly diet had comparable effect on change in diet, lipids and blood pressure (BP) in patients with IJD.
Methods: Thirty-one patients with IJD aged 40–80 years received a brief standardised advice (4 min) on heartfriendly diet by a physician. Sixteen of the patients were randomised to receive an additional, individually tailored, heart-friendly dietary counselling session (60 min) by a dietitian. Change in dietary habits, measured by a validated questionnaire (SmartDiet), lipids, BP and C-reactive protein (CRP) were assessed after 8 weeks of follow-up.
Results: After 8 weeks, the average increase in SmartDiet score was 5.1 and 5.7 points in the diet group (DG) and the control group (CG), respectively ( p = 0.65). Low-density lipoprotein cholesterol (LDL-c) was reduced by 12.6% in the DG versus 2.4% in the CG ( p = 0.05). There were no significant differences between the two groups regarding change in BP, lipids or CRP.
Conclusion: Individually tailored dietary counselling resulted in more heart-friendly food choices in patients with IJD. However, the change in SmartDiet score was comparable for IJD patients receiving a brief nutritional advice and individually tailored heart-friendly dietary counselling. Further studies evaluating the longitudinal effects of dietary advice on CVD outcome in patients with IJD are warranted.
- Tzoulaki I, Elliott P, Kontis V, Ezzati, M. Worldwide Exposures to Cardiovascular Risk Factors and Associated Health Effects: Current Knowledge and Data Gaps. Circulation. 2016 Jun 7;133(23):2314–33.
- Folkehelseinstituttet. Norgeshelsa statistikkbank norgeshelsa. no: Folkehelseinstituttet; [cited 2016 30.06.16]. Available from: http://norgeshelsa.no/norgeshelsa
- Meune C, Touze E, Trinquart L, Allanore, Y. Trends in cardiovascular mortality in patients with rheumatoid arthritis over 50 years: a systematic review and meta-analysis of cohort studies. Rheumatology (Oxford, England). 2009 Oct;48(10):1309–13.
- Peters MJ, van der Horst-Bruinsma IE, Dijkmans BA, Nurmohamed, M. T. Cardiovascular risk profile of patients with spondylarthropathies, particularly ankylosing spondylitis and psoriatic arthritis. Seminars in arthritis and rheumatism. 2004 Dec;34(3):585–92.
- Agca R, Heslinga SC, van Halm VP, Nurmohamed MT. Atherosclerotic cardiovascular disease in patients with chronic inflammatory joint disorders. Heart (British Cardiac Society). 2016 May 15;102(10):790–5.
- Lindhardsen J, Ahlehoff O, Gislason GH, Madsen OR, Olesen JB, Torp-Pedersen C, et al. The risk of myocardial infarction in rheumatoid arthritis and diabetes mellitus: a Danish nationwide cohort study. Annals of the rheumatic diseases. 2011 Jun;70(6):929–34.
- Haroon NN, Paterson JM, Li P, Inman RD, Haroon N. Patients With Ankylosing Spondylitis Have Increased Cardiovascular and Cerebrovascular Mortality: A Population-Based Study. Annals of internal medicine. 2015 Sep 15;163(6):409–16.
- Semb AG, Rollefstad S, van Riel P, van Riel P, Kitas GD, Matteson EL, Gabriel SE. Cardiovascular disease assessment in rheumatoid arthritis: a guide to translating knowledge of cardiovascular risk into clinical practice. Annals of the rheumatic diseases. 2014 Jul;73(7):1284–8.
- Choy E, Ganeshalingam K, Semb AG, Szekanecz Z, Nurmohamed M. Cardiovascular risk in rheumatoid arthritis: recent advances in the understanding of the pivotal role of inflammation, risk predictors and the impact of treatment. Rheumatology (Oxford, England). 2014 Dec;53(12):2143–54.
- Maradit-Kremers H, Crowson CS, Nicola PJ, Ballman KV, Roger VL, Jacobsen SJ, et al. Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population-based cohort study. Arthritis and rheumatism. 2005 Feb;52(2):402–11.
- Zegkos T, Kitas G, Dimitroulas T. Cardiovascular risk in rheumatoid arthritis: assessment, management and next steps. Therapeutic advances in musculoskeletal disease. 2016 Jun;8(3):86–101.
- Baghdadi LR, Woodman RJ, Shanahan EM, Mangoni AA. The Impact of Traditional Cardiovascular Risk Factors on Cardiovascular Outcomes in Patients with Rheumatoid Arthritis: A Systematic Review and Meta-Analysis. PLoS ONE. 2015;10(2):1–18.
- Martin RH. The role of nutrition and diet in rheumatoid arthritis. The Proceedings of the Nutrition Society. 1998 May;57(2):231–4.
- Pattison DJ, Symmons DP, Young A. Does diet have a role in the aetiology of rheumatoid arthritis? The Proceedings of the Nutrition Society. 2004 Feb;63(1):137–43.
- Choi HK. Dietary risk factors for rheumatic diseases. Current opinion in rheumatology. 2005 Mar;17(2):141–6.
- Tedeschi SK, Costenbader KH. Is There a Role for Diet in the Therapy of Rheumatoid Arthritis? Current rheumatology reports. 2016 May;18(5):23.
- Smedslund G, Byfuglien MG, Olsen SU, Hagen KB. Effectiveness and safety of dietary interventions for rheumatoid arthritis: a systematic review of randomized controlled trials. Journal of the American Dietetic Association. 2010 May;110(5):727–35.
- Subhan FB, Chan CB. Review of Dietary Practices of the 21st Century: Facts and Fallacies. Canadian journal of diabetes. 2016 Aug;40(4):348–54.
- National Center for Chronic Disease P, Health Promotion Office on S, Health. Reports of the Surgeon General. The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2014.
- World Health Organization (WHO). Obesity: preventing and managing the global epidemic: Report of a WHO consultation. Geneva: WHO; 2000. (World Health Organization technical report series; 894).
- Kostråd for å fremme folkehelsen og forebygge kroniske sykdommer Metodologi og vitenskapelig kunnskapsgrunnlag Nasjonalt råd for ernæring 2011. [Dietary advice to promote public health and Prevent chronic diseases Methodology and fundation of scientific knowledge National Nutrition Council 2011]. Oslo: Helsedirektoratet [The Norwegian Directorate of Health]; 2011. Chapter 19, Kosthold og forebygging av hjerte- og karsykdom. [Diet and prevention of cardiovascular disease]; p. 254–262. Norwegian.ogi og vitenskapelig kunnskapsgrunnlag. Oslo: Helsedirektoratet; 2011. p. 254–262.
- Nordic nutrition recommendations 2012: integrating nutrition and physical activity. 5th ed. Copenhagen: Nordic Council of Ministers; 2014. Chapter 9, Physical activity; p. 203–207.
- Henkin Y, Shai I, Zuk R, Brickner D, Zuilli I, Neumann L, et al. Dietary treatment of hypercholesterolemia: do dietitians do it better? A randomized, controlled trial. The American journal of medicine. 2000 Nov;109(7):549–55.
- Svilaas A, Strom EC, Svilaas T, Borgejordet A, Thoresen M, Ose L. Reproducibility and validity of a short food questionnaire for the assessment of dietary habits. Nutrition, metabolism, and cardiovascular diseases : NMCD. 2002 Apr;12(2):60–70.
- Liao KP, Solomon DH. Traditional cardiovascular risk factors, inflammation and cardiovascular risk in rheumatoid arthritis. Rheumatology (Oxford, England). 2013 Jan;52(1):45–52.
- Rollefstad S, Kvien TK, Holme I, Eirheim AS, Pedersen TR, Semb AG. Treatment to lipid targets in patients with inflammatory joint diseases in a preventive cardio-rheuma clinic. Annals of the rheumatic diseases. 2013 Dec;72(12):1968–74.
- World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. Jama. 2013 Nov 27;310(20):2191–4.
- Johnson RK, Kennedy E. The 2000 Dietary Guidelines for Americans: What Are The Changes and Why Were They Made? Journal of the American Dietetic Association. 2000; 100(7):769–774.
- Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr. 2010 Mar;91(3):535–46.
- Skeaff CM, Miller J. Dietary fat and coronary heart disease: summary of evidence from prospective cohort and randomised controlled trials. Annals of nutrition & metabolism. 2009;55(1-3):173–201.
- Hannan EL. Randomized Clinical Trials and Observational Studies: Guidelines for Assessing Respective Strengths and Limitations. JACC: Cardiovascular Interventions. 2008; 1(3):211–217.
- Guasch-Ferre M, Babio N, Martinez-Gonzalez MA, Corella D, Ros E, Martin-Pelaez S, et al. Dietary fat intake and risk of cardiovascular disease and all-cause mortality in a population at high risk of cardiovascular disease. Am J Clin Nutr. 2015 Dec;102(6):1563–73.
- Hu FB, Manson JE, Willett WC. Types of dietary fat and risk of coronary heart disease: a critical review. Journal of the American College of Nutrition. 2001 Feb;20(1):5–19.
- Brown L, Rosner B, Willett WW, Sacks FM. Cholesterol-lowering effects of dietary fiber: a meta-analysis. Am J Clin Nutr. 1999 Jan;69(1):30–42.
- Ripsin CM, Keenan JM, Jacobs DR, Jr., et al. Oat products and lipid lowering. A meta-analysis. Jama. 1992 Jun 24;267(24):3317–25.
- Khaw KT, Barrett-Connor E. Dietary fiber and reduced ischemic heart disease mortality rates in men and women: a 12-year prospective study. Am J Epidemiol. 1987 Dec;126(6):1093–102.
- Wolk A, Manson JE, Stampfer MJ, Colditz GA, Hu FB, Speizer FE, et al. Long-term intake of dietary fiber and decreased risk of coronary heart disease among women. Jama. 1999 Jun 2;281(21):1998–2004.
- Helsedirektoratet [The Norwegian Directorate of Health]. Utviklingen i norsk kosthold 2015. [The development in the Norwegian diet]. Oslo: Helsedirektoratet; 2015. p. 8.
- Avina-Zubieta JA, Choi HK, Sadatsafavi M, Etminan M, Esdaile JM, Lacaille D. Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis and rheumatism. 2008 Dec 15;59(12):1690–7.
- Cornelis MC, El-Sohemy A. Coffee, caffeine, and coronary heart disease. Current opinion in clinical nutrition and metabolic care. 2007 Nov;10(6):745–51.
- Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clinical chemistry. 1972 Jun;18(6):499–502.
- Schumacher TL, Burrows TL, Rollo ME, Spratt NJ, Callister R, Collins CE. Effectiveness of a Brief Dietetic Intervention for Hyperlipidaemic Adults Using Individually-Tailored Dietary Feedback. Healthcare (Basel, Switzerland). 2016 Oct 11;4(4).
- Jenkins DJ, Josse AR, Wong JM, Nguyen TH, Kendall CW. The portfolio diet for cardiovascular risk reduction. Current atherosclerosis reports. 2007 Dec;9(6):501–7.
- Hjermann I, Velve Byre K, Holme I, Leren P. 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. Lancet (London, England). 1981 Dec 12;2(8259):1303–10.
- Ellingsen I, Hjerkinn EM, Arnesen H, Seljeflot I, Hjermann I, Tonstad S. Follow-up of diet and cardiovascular risk factors 20 years after cessation of intervention in the Oslo Diet and Antismoking Study. European journal of clinical nutrition. 2006 Mar;60(3):378–85.
- LeFevre ML. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: U.S. Preventive Services Task Force Recommendation Statement. Annals of internal medicine. 2014 Oct 21;161(8):587–93.
- Krauss RM, Eckel RH, Howard B, Appel LJ, Daniels SR, Deckelbaum RJ, et al. AHA Dietary Guidelines: revision 2000: A statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation. 2000 Oct 31;102(18):2284–99.
- Fulcher J, O’Connell R, Voysey M, Emberson J, Blackwell L, Mihaylova B, et al. Efficacy and safety of LDL-lowering therapy among men and women: meta-analysis of individual data from 174,000 participants in 27 randomised trials. Lancet (London, England). 2015 Apr 11;385(9976):1397–405.
- Semb AG, Kvien TK, DeMicco DA, Fayyad R, Wun CC, LaRosa JC, et al. Effect of intensive lipid-lowering therapy on cardiovascular outcome in patients with and those without inflammatory joint disease. Arthritis and rheumatism. 2012 Sep;64(9):2836–46.
- Li Y, Hruby A, Bernstein AM, Ley SH, Wang DD, Chiuve SE, et al. Saturated Fats Compared With Unsaturated Fats and Sources of Carbohydrates in Relation to Risk of Coronary Heart Disease: A Prospective Cohort Study. Journal of the American College of Cardiology. 2015 Oct 6;66(14):1538–48.
- Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias: The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) Developed with the special contribution of the European Assocciation for Cardiovascular Prevention & Rehabilitation (EACPR). Atherosclerosis. 2011 Jul;217(1):3–46.
- Stanhope KL, Medici V, Bremer AA, Lee V, Lam HD, Nunez MV, et al. A dose-response study of consuming high-fructose corn syrup-sweetened beverages on lipid/lipoprotein risk factors for cardiovascular disease in young adults. Am J Clin Nutr. 2015 Jun;101(6):1144–54.
- Rimm EB, Williams P, Fosher K, Criqui M, Stampfer MJ. Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effects on lipids and haemostatic factors. BMJ (Clinical research ed). 1999 Dec 11;319(7224):1523–8.
- Cook NR, Cutler JA, Obarzanek E, Buring JE, Rexrode KM, Kumanyika SK, et al. Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP). BMJ (Clinical research ed). 2007 Apr 28;334(7599):885–8.
- He FJ, Li J, Macgregor GA. Effect of longer-term modest salt reduction on blood pressure. Cochrane Database Syst Rev. 2013 Apr 30(4):Cd004937.
- Kelly J, Khalesi S, Dickinson K, Hines S, Coombes JS, Todd AS. The effect of dietary sodium modification on blood pressure in adults with systolic blood pressure less than 140 mmHg: a systematic review. JBI database of systematic reviews and implementation reports. 2016 Jun;14(6):196–237.
- World Health Organization (WHO). Diet, nutrition and the prevention of chronic diseases: Report of the joint WHO/FAO expert consultation. Geneva: WHO; 2003. (WHO Technical Report Series; 916).
- Kostråd for å fremme folkehelsen og forebygge kroniske sykdommer Metodologi og vitenskapelig kunnskapsgrunnlag Nasjonalt råd for ernæring 2011. [Dietary advice to promote public health and Prevent chronic diseases Methodology and fundation of scientific knowledge National Nutrition Council 2011]. Oslo: Helsedirektoratet [The Norwegian Directorate of Health]; 2011. Chapter 4, Prinsipper og metodologi som ligger til grunn for de norske kostrådene [Principles and methodology underpinning the Norwegian dietary guidelines]; p. 29–49. Norwegian.
- Conlin PR, Chow D, Miller ER, 3rd, et al. The effect of dietary patterns on blood pressure control in hypertensive patients: results from the Dietary Approaches to Stop Hypertension (DASH) trial. American journal of hypertension. 2000 Sep;13(9):949–55.
- Collart F, de Timary P, Dom G, Dor BD, Duprez D, Lengele JP, et al. Alcohol-induced hypertension: an important healthcare target in Belgium. Acta clinica Belgica. 2015 Dec;70(6):389–95.
- Due A, Toubro S, Stender S, Skov AR, Astrup A. The effect of diets high in protein or carbohydrate on inflammatory markers in overweight subjects. Diabetes, obesity & metabolism. 2005 May;7(3):223–9.
- Pedersen JI, Anderssen S, Hjartåker A. Kostdata, innsamling, bearbeiding og kvalitet. [Dietary data, collection, processing and quality]. In: Pedersen JI, Anderssen S, Hjartåker A, editors. Grunnleggende ernæringslære. [Basic knowledge of nutrition]. 2. ed. Oslo: Gyldendal akademisk; 2012. p. 22–43. Norwegian.
- Molven I, Retterstol K, Andersen LF, Veierod MB, Narverud I, Ose L, et al. Children and young adults with familial hypercholesterolaemia (FH) have healthier food choices particularly with respect to dietary fat sources compared with non-FH children. Journal of nutritional science. 2013;2:e32.
- Hansen-Krone IJ, Enga KF, Njolstad I, Hansen JB, Braekkan SK. Heart healthy diet and risk of myocardial infarction and venous thromboembolism. The Tromso Study. Thrombosis and haemostasis. 2012 Sep;108(3):554–60.
- Wiens L, Schulzer M, Chen C, Parinas K. Reliability and validity of the SmartDiet Canadian version questionnaire. Journal of the American Dietetic Association. 2010 Jan;110(1):101–5.
- Lin JS, O’Connor EA, Evans CV, Senger CA, Rowland MG, Groom HC. U.S. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews. Behavioral Counseling to Promote a Healthy Lifestyle for Cardiovascular Disease Prevention in Persons With Cardiovascular Risk Factors: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014.
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