Effectiveness of a dietary intervention strategy in general practice: effects on blood lipids, health and well-being.

OBJECTIVES

To evaluate the effect of a dietary treatment programme on blood cholesterol concentration in hypercholesterolaemic patients in general practice and to analyse subjectively experienced side-effects.

DESIGN

A 1-year parallel trial comparing a new treatment programme with conventional treatment.

SETTING

General practitioners in Roskilde county, Denmark.

SUBJECTS

355 men and women, aged 20-60 years, with a persistent blood cholesterol concentration above age- and gender-specific cut-off points (265 in an intervention group and 90 in a control group).

INTERVENTION

A treatment strategy based on collaboration between doctor and dietitian using individual dietary advice and feedback from measured biological parameters.

MAIN OUTCOME MEASURES

Serum lipids, body weight, blood pressure, dietary behaviour, health parameters, quality of life parameters and acceptance by patients and general practitioners.

RESULTS

Total blood cholesterol concentration decreased by 14% (1.07 mmol l(-1), P < 0.0001) in 159 patients in the intervention group, not having any lipid altering drug during treatment, in addition to 3% from screening to start of treatment. In 65 patients in the control group, without any lipid altering drug, the reduction of cholesterol concentration was 4% (0.27 mmol l(-1), P < 0.01; intervention vs. control P < 0.001). In the intervention group overweight subjects (body mass index > 30) reduced body weight by 6% (P < 0.0001). Systolic blood pressure was reduced by 11% (P < 0.0001) and diastolic blood pressure by 10% (P < 0.0001) and 19% (P < 0.003) for intervals 90-110 mmHg and > 110 mmHg, respectively. Risk score decreased and self-assessed health, physical and psychological well-being improved.

CONCLUSIONS

The treatment strategy tested proved to be efficient, without side-effects and well accepted by patients and general practitioners. The results strongly suggest that hypercholesterolaemia can efficiently be treated non-pharmacologically in general practice.