Neil H A, Roe L, Godlee R J, Moore J W, Clark G M, Brown J, Thorogood M, Stratton I M, Lancaster T, Mant D
University of Oxford, Department of Public Health and Primary Care, Radcliffe Infirmary.
BMJ. 1995 Mar 4;310(6979):569-73. doi: 10.1136/bmj.310.6979.569.
To determine the relative efficacy in general practice of dietary advice given by a dietitian, a practice nurse, or a diet leaflet alone in reducing total and low density lipoprotein cholesterol concentration.
Randomised six month parallel trial.
A general practice in Oxfordshire.
2004 subjects aged 35-64 years were screened for hypercholesterolaemia; 163 men and 146 women with a repeat total cholesterol concentration of 6.0-8.5 mmol/l entered the trial.
Individual advice provided by a dietitian using a diet history, a practice nurse using a structured food frequency questionnaire, or a detailed diet leaflet sent by post. All three groups were advised to limit the energy provided by fat to 30% or less and to increase carbohydrate and dietary fibre.
Concentrations of total cholesterol and low density and high density lipoprotein cholesterol after six months; antioxidant concentration and body mass index.
No significant differences were found at the end of the trial between groups in mean concentrations of lipids, lipoproteins, and antioxidants or body mass index. After data were pooled from the three groups, the mean total cholesterol concentration fell by 1.9% (0.13 mmol/l, 95% confidence interval 0.06 to 0.22, P < 0.001) to 7.00 mmol/l, and low density lipoprotein cholesterol also fell. The total carotenoid concentration increased by 53 nmol/l (95% confidence interval 3.0 to 103, P = 0.039).
Dietary advice is equally effective when given by a dietitian, a practice nurse, or a diet leaflet alone but results in only a small reduction in total and low density lipoprotein cholesterol. To obtain a better response more intensive intervention than is normally available in primary care is probably necessary.
确定营养师、执业护士提供的饮食建议或仅提供饮食宣传册在全科医疗中降低总胆固醇和低密度脂蛋白胆固醇浓度的相对疗效。
为期六个月的随机平行试验。
牛津郡的一家全科诊所。
对2004名年龄在35 - 64岁的受试者进行高胆固醇血症筛查；163名男性和146名女性，其总胆固醇浓度重复测量值在6.0 - 8.5 mmol/l之间，进入试验。
营养师通过饮食史提供个体化建议，执业护士使用结构化食物频率问卷提供建议，或邮寄详细的饮食宣传册。三组均被建议将脂肪提供的能量限制在30%或更低，并增加碳水化合物和膳食纤维的摄入。
六个月后总胆固醇、低密度和高密度脂蛋白胆固醇的浓度；抗氧化剂浓度和体重指数。
试验结束时，各组在脂质、脂蛋白、抗氧化剂的平均浓度或体重指数方面未发现显著差异。将三组数据合并后，平均总胆固醇浓度下降了1.9%（0.13 mmol/l，95%置信区间0.06至0.22，P < 0.001），降至7.00 mmol/l，低密度脂蛋白胆固醇也有所下降。总类胡萝卜素浓度增加了53 nmol/l（95%置信区间3.0至103，P = 0.039）。
营养师、执业护士提供的饮食建议或仅提供饮食宣传册同样有效，但仅能使总胆固醇和低密度脂蛋白胆固醇略有降低。要获得更好的效果，可能需要比初级保健中通常提供的更强化的干预措施。
