The George Institute for Global Health, Sydney, Australia.
Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Int J Behav Nutr Phys Act. 2018 May 23;15(1):45. doi: 10.1186/s12966-018-0677-1.
A healthy diet is an important component of secondary prevention of coronary heart disease (CHD). The TEXT ME study was a randomised clinical trial of people with CHD that were randomised into standard care or a text-message programme in addition to standard care. This analysis aimed to: 1) assess the effects of the intervention onadherence to the dietary guideline recommendations; 2) assess the consistency of effect across sub-groups; and 3) assess whether adherence to the dietary guideline recommendations mediated the improvements in objective clinical outcomes.
Dietary data were collected using a self-report questionnaire to evaluate adherence to eight dietary guideline recommendations in Australia, including consumption of vegetables, fruits, fish, type of fat used for cooking and in spreads, takeaway food, salt and standard alcohol drinks. The primary outcome of this analysis was the proportion of patients adhering to ≥ 4 dietary guideline recommendations concomitantly and each recommendation was assessed individually as secondary outcomes. Data were analysed using log-binomial regression for categorical variables and analysis of covariance for continuous variables.
Among 710 patients, 54% were adhering to ≥ 4 dietary guideline recommendations (intervention 53% vs control 56%, p = 0.376) at baseline. At six months, the intervention group had a significantly higher proportion of patients adhering to ≥ 4 recommendations (314, 93%) compared to the control group (264, 75%, RR 1.23, 95% CI 1.15-1.31, p < 0.001). In addition, the intervention patients reported consuming higher amounts of vegetables, fruits, and fish per week; less takeaway foods per week; and greater salt intake control. The intervention had a similar effect in all sub-groups tested. There were significant mediational effects of the increase in adherence to the recommendations for the association between the intervention and LDL-cholesterol (p < 0.001) and body mass index (BMI) at six months follow-up (p = 0.005).
A lifestyle-focused text-message programme improved adherence to the dietary guideline recommendations, and specifically improved self-reported consumption of vegetables, fruits, fish, takeaway foods and salt intake. Importantly, these improvements partially mediated improvements in LDL-cholesterol and BMI. This simple and scalable text-messaging intervention could be used as a strategy to improve diet in people with CHD.
Australia and New Zealand Clinical Trials Registry ACTRN12611000161921 . Registered on 10 February 2011.
健康的饮食是冠心病二级预防的重要组成部分。TEXT ME 研究是一项针对冠心病患者的随机临床试验，将患者随机分为标准护理组或在标准护理基础上加用短信项目组。本分析旨在：1）评估干预对饮食指南推荐的依从性的影响；2）评估亚组间效果的一致性；3）评估对饮食指南推荐的依从性是否可作为改善客观临床结局的中介因素。
采用自报告问卷收集饮食数据，以评估澳大利亚八项饮食指南推荐的依从性，包括蔬菜、水果、鱼、烹饪和涂抹用脂肪类型、外卖食品、盐和标准酒精饮料的摄入。本分析的主要结局是同时依从≥4 项饮食指南推荐的患者比例，每项推荐均单独评估为次要结局。采用二项式回归分析分类变量，采用协方差分析连续变量。
在 710 例患者中，54%（干预组 53%，对照组 56%，p=0.376）在基线时符合≥4 项饮食指南推荐。6 个月时，干预组依从≥4 项推荐的患者比例明显更高（314 例，93%），而对照组为 264 例（75%，RR 1.23，95%CI 1.15-1.31，p<0.001）。此外，干预组患者报告每周摄入更多的蔬菜、水果和鱼，每周摄入更少的外卖食品，以及更好的盐摄入控制。该干预在所有测试的亚组中均有相似的效果。在干预与 LDL-胆固醇（p<0.001）和 6 个月随访时 BMI（p=0.005）之间的关联中，对推荐的依从性增加存在显著的中介作用。
以生活方式为重点的短信项目提高了对饮食指南推荐的依从性，特别是提高了蔬菜、水果、鱼、外卖食品和盐摄入的自我报告量。重要的是，这些改善部分解释了 LDL-胆固醇和 BMI 的改善。这种简单且可扩展的短信干预措施可作为改善冠心病患者饮食的一种策略。
澳大利亚和新西兰临床试验注册 ACTRN12611000161921 。2011 年 2 月 10 日注册。
