Menzies Health Institute Queensland, Queensland, Australia.
Griffith University, Gold Coast, Brisbane, Queensland, Australia.
Nutr Diet. 2019 Apr;76(2):199-210. doi: 10.1111/1747-0080.12509. Epub 2019 Feb 4.
Evidence of the effectiveness of dietetic consultation for the management of cardiovascular disease (CVD) risk factors has not been previously synthesised. A systematic review and four meta-analyses evaluated the effectiveness of dietetic consultation for lowering blood lipid levels in high-risk individuals in primary health-care settings.
Of the 4860 records identified, 10 eligible randomised controlled trials (RCTs, n = 1530) were evaluated for reporting blood lipid outcomes following dietetic consultation (DN)-defined as at least one exclusive individual face-to-face consultation with a dietitian and comparators (C)-defined as no nutrition intervention or usual or minimal care provided by physicians and/or nurses.
DN groups were effective for lowering blood lipid levels across nine studies reporting total cholesterol (TC) and LDL; and across five of six studies reporting triglycerides (TG). Between-group differences were not consistently assessed, with significance levels reported in four studies all in favour of DN, P < 0.05. Meta-analyses for TC and LDL (seven studies) confirmed DN and C groups were equally effective, P > 0.05; and for TG (six studies) DN groups were significantly more effective than C groups, P < 0.05).
This review provides RCT evidence that dietetic counselling is effective for lowering TG levels and at least as effective as usual and minimal care for improving cholesterol levels in high-risk individuals in primary health care. However, more adequate reporting of methods and greater consistency in timing interventions and data collection will enhance the quality of the evidence and increase confidence in the health benefits of dietetic counselling for the management of CVD risk.
以前尚未综合饮食咨询对管理心血管疾病（CVD）风险因素的有效性的证据。一项系统评价和四项荟萃分析评估了在初级保健环境中对高危人群进行饮食咨询以降低血脂水平的有效性。
在确定的 4860 条记录中，评估了 10 项符合条件的随机对照试验（RCT，n=1530），以报告饮食咨询（DN）后的血脂结果-定义为与营养师进行至少一次单独的面对面咨询，对照组（C）定义为没有营养干预或医生和/或护士提供的常规或最低护理。
DN 组在九项报告总胆固醇（TC）和 LDL 的研究中以及在五项报告三酰甘油（TG）的研究中的血脂水平均有效。组间差异未得到一致评估，四项研究均报告了有利于 DN 的显著性水平，P<0.05。TC 和 LDL 的荟萃分析（七项研究）证实 DN 和 C 组同样有效，P>0.05；对于 TG（六项研究），DN 组明显比 C 组更有效，P<0.05）。
本综述提供了 RCT 证据，表明饮食咨询对降低 TG 水平有效，并且至少与常规和最低护理一样有效，可改善初级保健中高危人群的胆固醇水平。然而，更充分地报告方法并在干预和数据收集的时间上更加一致，将提高证据的质量，并增加对饮食咨询在 CVD 风险管理中的健康益处的信心。
