Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
PLoS Med. 2020 Nov 5;17(11):e1003385. doi: 10.1371/journal.pmed.1003385. eCollection 2020 Nov.
Guidelines recommend reducing saturated fat (SFA) intake to decrease cardiovascular disease (CVD) risk, but there is limited evidence on scalable and effective approaches to change dietary intake, given the large proportion of the population exceeding SFA recommendations. We aimed to develop a system to provide monthly personalized feedback and healthier swaps based on nutritional analysis of loyalty card data from the largest United Kingdom grocery store together with brief advice and support from a healthcare professional (HCP) in the primary care practice. Following a hybrid effectiveness-feasibility design, we tested the effects of the intervention on SFA intake and low-density lipoprotein (LDL) cholesterol as well as the feasibility and acceptability of providing nutritional advice using loyalty card data.
The Primary Care Shopping Intervention for Cardiovascular Disease Prevention (PC-SHOP) study is a parallel randomized controlled trial with a 3 month follow-up conducted between 21 March 2018 to 16 January2019. Adults ≥18 years with LDL cholesterol >3 mmol/L (n = 113) were recruited from general practitioner (GP) practices in Oxfordshire and randomly allocated to "Brief Support" (BS, n = 48), "Brief Support + Shopping Feedback" (SF, n = 48) or "Control" (n = 17). BS consisted of a 10-minute consultation with an HCP to motivate participants to reduce their SFA intake. Shopping feedback comprised a personalized report on the SFA content of grocery purchases and suggestions for lower SFA swaps. The primary outcome was the between-group difference in change in SFA intake (% total energy intake) at 3 months adjusted for baseline SFA and GP practice using intention-to-treat analysis. Secondary outcomes included %SFA in purchases, LDL cholesterol, and feasibility outcomes. The trial was powered to detect an absolute reduction in SFA of 3% (SD3). Neither participants nor the study team were blinded to group allocation. A total of 106 (94%) participants completed the study: 68% women, 95% white ethnicity, average age 62.4 years (SD 10.8), body mass index (BMI) 27.1 kg/m2 (SD 4.7). There were small decreases in SFA intake at 3 months: control = -0.1% (95% CI -1.8 to 1.7), BS = -0.7% (95% CI -1.8 to 0.3), SF = -0.9% (95% CI -2.0 to 0.2); but no evidence of a significant effect of either intervention compared with control (difference adjusted for GP practice and baseline: BS versus control = -0.33% [95% CI -2.11 to 1.44], p = 0.709; SF versus control = -0.11% [95% CI -1.92 to 1.69], p = 0.901). There were similar trends in %SFA based on supermarket purchases: control = -0.5% (95% CI -2.3 to 1.2), BS = -1.3% (95% CI -2.3 to -0.3), SF = -1.5% (95% CI -2.5 to -0.5) from baseline to follow-up, but these were not significantly different: BS versus control p = 0.379; SF versus control p = 0.411. There were small reductions in LDL from baseline to follow-up (control = -0.14 mmol/L [95% CI -0.48, 0.19), BS: -0.39 mmol/L [95% CI -0.59, -0.19], SF: -0.14 mmol/L [95% CI -0.34, 0.07]), but these were not significantly different: BS versus control p = 0.338; SF versus control p = 0.790. Limitations of this study include the small sample of participants recruited, which limits the power to detect smaller differences, and the low response rate (3%), which may limit the generalisability of these findings.
In this study, we have shown it is feasible to deliver brief advice in primary care to encourage reductions in SFA intake and to provide personalized advice to encourage healthier choices using supermarket loyalty card data. There was no evidence of large reductions in SFA, but we are unable to exclude more modest benefits. The feasibility, acceptability, and scalability of these interventions suggest they have potential to encourage small changes in diet, which could be beneficial at the population level.
ISRCTN14279335.
指南建议减少饱和脂肪（SFA）的摄入量，以降低心血管疾病（CVD）的风险，但鉴于超过 SFA 建议摄入量的人群比例很大，对于可扩展且有效的改变饮食摄入的方法，证据有限。我们旨在开发一种系统，该系统根据最大的英国杂货店的会员卡数据进行营养分析，为个人医疗保健专业人员（HCP）提供每月个性化反馈和更健康的替代品，并提供简短的建议和支持。采用混合有效性-可行性设计，我们测试了干预措施对 SFA 摄入量和低密度脂蛋白（LDL）胆固醇的影响，以及使用会员卡数据提供营养建议的可行性和可接受性。
初级保健预防心血管疾病购物干预（PC-SHOP）研究是一项平行随机对照试验，随访期为 2018 年 3 月 21 日至 2019 年 1 月 16 日。从牛津郡的全科医生（GP）诊所招募了 LDL 胆固醇>3mmol/L 的≥18 岁成年人（n=113），并随机分配到“简要支持”（BS，n=48）、“简要支持+购物反馈”（SF，n=48）或“对照”（n=17）。BS 包括与 HCP 进行 10 分钟的咨询，以促使参与者减少 SFA 的摄入量。购物反馈包括有关杂货店购买的 SFA 含量的个性化报告和更低 SFA 替代品的建议。主要结果是通过意向治疗分析，调整基线 SFA 和 GP 实践后，3 个月时 SFA 摄入量（总能量摄入的百分比）的组间差异。次要结果包括购买的 SFA 百分比、LDL 胆固醇和可行性结果。该试验的目的是检测 SFA 摄入量绝对减少 3%（SD3）的效果。参与者和研究小组均未对分组分配进行盲法。共有 106 名（94%）参与者完成了研究：68%为女性，95%为白种人，平均年龄 62.4 岁（标准差 10.8），体重指数（BMI）27.1kg/m2（标准差 4.7）。3 个月时 SFA 摄入量略有下降：对照组=-0.1%（95%置信区间-1.8 至 1.7），BS=-0.7%（95%置信区间-1.8 至 0.3），SF=-0.9%（95%置信区间-2.0 至 0.2）；但没有证据表明任何干预措施与对照组相比有显著效果（调整 GP 实践和基线后的差异：BS 与对照组=-0.33%[95%置信区间-2.11 至 1.44]，p=0.709；SF 与对照组=-0.11%[95%置信区间-1.92 至 1.69]，p=0.901）。基于超市购买的 SFA%也有类似的趋势：对照组=-0.5%（95%置信区间-2.3 至 1.2），BS=-1.3%（95%置信区间-2.3 至-0.3），SF=-1.5%（95%置信区间-2.5 至-0.5），但这些差异均无统计学意义：BS 与对照组相比，p=0.379；SF 与对照组相比，p=0.411。从基线到随访，LDL 略有下降（对照组=-0.14mmol/L[95%置信区间-0.48，0.19]，BS：-0.39mmol/L[95%置信区间-0.59，-0.19]，SF：-0.14mmol/L[95%置信区间-0.34，0.07]），但这些差异均无统计学意义：BS 与对照组相比，p=0.338；SF 与对照组相比，p=0.790。本研究的局限性包括招募的参与者人数较少，这限制了检测较小差异的能力，以及低反应率（3%），这可能限制了这些发现的普遍性。
在这项研究中，我们已经证明，在初级保健中提供简短建议以鼓励减少 SFA 摄入量并使用超市会员卡数据提供个性化建议以鼓励更健康的选择是可行的。没有证据表明 SFA 大量减少，但我们不能排除更适度的益处。这些干预措施的可行性、可接受性和可扩展性表明，它们有可能鼓励饮食的微小变化，这可能对人群水平有益。
ISRCTN83131759。
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