Maderuelo-Fernandez José A, Recio-Rodríguez José I, Patino-Alonso Maria C, Pérez-Arechaederra Diana, Rodriguez-Sanchez Emiliano, Gomez-Marcos Manuel A, García-Ortiz Luis
Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service, SACYL, Salamanca, Spain. REDIAPP. IBSAL.
Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service, SACYL, Salamanca, Spain. REDIAPP. IBSAL; Statistics Department, University of Salamanca, Salamanca, Spain.
Prev Med. 2015 Jul;76 Suppl:S39-55. doi: 10.1016/j.ypmed.2014.12.011. Epub 2014 Dec 16.
To evaluate the effects on healthy eating or the Mediterranean diet adherence achieved by interventions suitable for implementation in primary care settings.
Medline (PubMed) and The Cochrane Library bibliographic searches retrieved randomized controlled trials published in English or Spanish, January 1990-January 2013. The inclusion criteria were adult population, >3 months follow-up, and interventions suitable for primary care settings. Exclusion resulted if studies focused exclusively on weight loss or did not analyze food intake (fats, fruits and vegetables--F&V, fiber) or Mediterranean diet adherence. Validity (risk of bias) was independently evaluated by two researchers; discrepancies were reviewed until a consensus was reached.
Of the 15 included articles (14 studies), only 3 studies surpassed 12-months follow-up. Ten interventions emphasized healthy nutrition (n = 9948); 4 added activity levels (n = 3816). Six trials included participants with cardiovascular risk; 7 were community-based; 1 focused on women with cancer. Eleven studies showed 9.7% to 59.3% increased F&V intake with counseling interventions, compared to baseline (-13.3% to 27.8% in controls). Seven studies reported significant differences between intervention and control groups.
Nutritional counseling moderately improves nutrition, increases intake of fiber, F&V, reduces dietary saturated fats, and increases physical activity. Studies with longer follow-up are needed to determine long-term effects, cardiovascular morbidity, and mortality.
评估适用于初级保健机构实施的干预措施对健康饮食或地中海饮食依从性的影响。
通过检索Medline（PubMed）和考克兰图书馆，获取1990年1月至2013年1月期间以英文或西班牙文发表的随机对照试验。纳入标准为成年人群、随访时间超过3个月以及适用于初级保健机构的干预措施。若研究仅专注于体重减轻或未分析食物摄入量（脂肪、水果和蔬菜——F&V、纤维）或地中海饮食依从性，则予以排除。由两名研究人员独立评估研究的有效性（偏倚风险）；如有分歧则进行讨论，直至达成共识。
在纳入的15篇文章（14项研究）中，仅有3项研究的随访时间超过12个月。10项干预措施强调健康营养（n = 9948）；4项增加了活动水平（n = 3816）。6项试验纳入了有心血管疾病风险的参与者；7项以社区为基础；1项聚焦于癌症女性患者。与基线相比（对照组为 -13.3%至27.8%），11项研究表明咨询干预使F&V摄入量增加了9.7%至59.3%。7项研究报告了干预组与对照组之间的显著差异。
营养咨询适度改善了营养状况，增加了纤维、F&V的摄入量，减少了饮食中的饱和脂肪，并增加了身体活动。需要进行更长随访时间的研究来确定长期影响、心血管发病率和死亡率。
