Cholesterol: dietitian advice is not clearly better than self-help resources

Clinical bottom line (level 1a)

  1. Patients who receive dietary advice from dietitians as compared with physicians alone have a small fall in cholesterol levels (on average 0.25 mmol/l)
  2. Dietitian advice is not clearly more effective than nurse advice or self-help resources at lowering cholesterol levels.
Thompson et al: Cochrane Library 2001; 1 : -
Expires February 2004

The study

Systematic review of all randomised controlled trials of
  • Patients: elevated cholesterol
  • Intervention: dietitian advice compared with advice from another health professional or from selp-help resources
  • Outcome: fall in cholesterol

Articles found in ?all languages using Cochrane Library, Medline, Embase, Cinahl, Human Nutrition, Science Citation Index, Social Sciences Citation Index, 1966 to January 1999 (search terms: ) and and hand-searching conference proceedings on nutrition and heart disease, and contacting experts in the field

Selection criteria: by 2 independent reviewers: see above and below
Appraisal criteria: by 2 independent reviewers: detailed in text, including concealment of randomisation, follow-up > 80%, blinding
Articles excluded if:
  • lipid-lowering medication given
  • followed for < 6 weeks
  • patients aged < 18
11 studies with 12 comparisons involving 1741 patients
  • 4 compared dietitian with doctor
  • 7 with self-help resources
  • 1 with nurse

The evidence

  • Dietician v. doctor: fall in serum cholesterol: 0.25 mmol/l (95% CI: 0.18 to 0.37)
  • Dietician v. nurse: fall in blood cholesterol: -0.08 mmol/l (95% CI: -0.27 to 0.11)
  • Dietician v. self-help resources: fall in blood cholesterol: 0.08 mmol/l (95% CI: -0.02 to 0.17)

Comments

  1. 6 studies enrolled fewer than 50 patients. Most had follow-up of only a few months. Consequently it is unclear whether the small benefits observed were sustained, and whether this led to any impact on clinical outcomes.

Citation

  1. Thompson RL, Summerbell CD, Hooper L, et al: dietary advice given by a dietician versus other health profressional or self-help resources to reduce blood cholesterol. Cochrane Library 2001; 1 : -
Search Terms: from ACP Journal Club other articles noted
Contributor: Chris Ball, February 2002
Reviewer:

Clinical Question.
Patient elevated serum cholesterol
Intervention or Exposure dietary advice from dietitians
Comparison advice from doctors, nurses, self-help resources
Outcome fall in serum cholesterol