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Ryding HG, Mitchell LJ, Rigby RR, Ball L, Hobby J, Williams LT. Effectiveness of dietetic care for cancer survivors in the primary care setting: A systematic review and meta-analysis of randomized controlled trials. J Cancer Surviv 2024:10.1007/s11764-024-01583-6. [PMID: 38710853 DOI: 10.1007/s11764-024-01583-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/01/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE Nutrition plays an important role in cancer survivorship. This systematic review and meta-analysis aim to critically assess and quantify the effectiveness of nutrition care interventions provided by dietitians to survivors who have completed treatment for cancer. METHODS A systematic review of randomized controlled trials (RCTs) published from January 2004 to November 2023 reporting the effectiveness of primary care dietetic interventions with adult cancer survivors was conducted. PubMed, Scopus, CINAHL, Embase, ProQuest and PsycINFO databases were searched for key terms. Meta-analyses were conducted where there were sufficient studies of the same cancer type and outcomes. RESULTS Twelve RCTs representing 1138 cancer survivors (519 breast cancer; 75 prostate cancer; 544 colorectal cancer) were included. Primary outcome measures included weight loss (n = 6), quality of life (n = 2), reducing lymphedema-related arm volume (n = 2), nutritional status (n = 1) and increasing fruit and vegetable intake (n = 1). Weight loss was observed in studies where this was the primary outcome. Results for quality of life varied. Meta-analyses of RCTs with breast cancer survivors showed that dietitian intervention achieved a mean of 3.7 kg greater intentional weight loss and 2.3% greater body fat decrease than control (p < 0.0001). CONCLUSIONS This study provides evidence for the effectiveness of primary care dietetic interventions by dietitians with cancer survivors, particularly with respect to intentional weight and fat loss in breast cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Dietitians can play a key role in managing weight and improving long term health outcomes and prognosis for cancer survivors beyond the acute care setting.
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Affiliation(s)
- Henriette G Ryding
- Griffith University, Brisbane, Australia
- Menzies Health Institute Queensland, Southport, QLD, Australia
| | - Lana J Mitchell
- Griffith University, Brisbane, Australia.
- Menzies Health Institute Queensland, Southport, QLD, Australia.
| | - Roshan R Rigby
- Griffith University, Brisbane, Australia
- Menzies Health Institute Queensland, Southport, QLD, Australia
| | - Lauren Ball
- Griffith University, Brisbane, Australia
- University of Queensland, Brisbane, Australia
| | | | - Lauren T Williams
- Griffith University, Brisbane, Australia
- Menzies Health Institute Queensland, Southport, QLD, Australia
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O'Connor SG, O'Connor LE, Higgins KA, Bell BM, Krueger ES, Rawal R, Hartmuller R, Reedy J, Shams-White MM. Conceptualization and Assessment of 24-H Timing of Eating and Energy Intake: A Methodological Systematic Review of the Chronic Disease Literature. Adv Nutr 2024; 15:100178. [PMID: 38242444 PMCID: PMC10877687 DOI: 10.1016/j.advnut.2024.100178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/29/2023] [Accepted: 01/16/2024] [Indexed: 01/21/2024] Open
Abstract
Timing of eating (TOE) and energy intake (TOEI) has important implications for chronic disease risk beyond diet quality. The 2020 Dietary Guidelines Advisory Committee recommended developing consistent terminology to address the lack of TOE/TOEI standardization. The primary objective of this methodological systematic review was to characterize the conceptualization and assessment of TOE/TOEI within the chronic disease literature (International Prospective Register of Systematic Reviews registration number: CRD42021236621). Literature searches in Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, Embase, PubMed, and Scopus were limited to English language publications from 2000 to August 2022. Eligible studies reported the association between TOE/TOEI and obesity, cardiovascular disease, type 2 diabetes mellitus, cancer, or a related clinical risk factor among adults (≥19 y) in observational and intervention studies. A qualitative synthesis described and compared TOE/TOEI conceptualization, definitions, and assessment methods across studies. Of the 7579 unique publications identified, 259 studies (observational [51.4 %], intervention [47.5 %], or both [1.2 %]) were eligible for inclusion. Key findings indicated that most studies (49.6 %) were conducted in the context of obesity and body weight. TOE/TOEI variables or assigned conditions conceptualized interrelated aspects of time and eating or energy intake in varying ways. Common TOE/TOEI conceptualizations included the following: 1) timepoint (specific time to represent when intake occurs, such as time of breakfast [74.8 %]); 2) duration (length of time or interval when intake does/does not occur, such as "eating window" [56.5 %]); 3) distribution (proportion of daily intake at a given time interval, such as "percentage of energy before noon" [29.8 %]); and 4) cluster (grouping individuals based on temporal ingestive characteristics [5.0 %]). Assessment, definition, and operationalization of 24-h TOE/TOEI variables varied widely across studies. Observational studies most often used surveys or questionnaires (28.9 %), whereas interventions used virtual or in-person meetings (23.8 %) to assess TOE/TOEI adherence. Overall, the diversity of terminology and methods solidifies the need for standardization to guide future research in chrononutrition and to facilitate inter-study comparisons.
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Affiliation(s)
- Sydney G O'Connor
- Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD, United States; Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, United States.
| | - Lauren E O'Connor
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, United States; Food Components and Health Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service, United States Department of Agriculture, Beltsville, MD, United States
| | - Kelly A Higgins
- Food Components and Health Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service, United States Department of Agriculture, Beltsville, MD, United States; Exponent Inc., Washington, DC, United States
| | - Brooke M Bell
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States; Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Emily S Krueger
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
| | - Rita Rawal
- Food Components and Health Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service, United States Department of Agriculture, Beltsville, MD, United States
| | - Reiley Hartmuller
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
| | - Jill Reedy
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
| | - Marissa M Shams-White
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
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Silva F, Rodrigues Amorim Adegboye A, Lachat C, Curioni C, Gomes F, Collins GS, Kac G, de Beyer JA, Cook J, Ismail LC, Page M, Khandpur N, Lamb S, Hopewell S, Kirtley S, Durão S, Vorland CJ, Schlussel MM. Completeness of Reporting in Diet- and Nutrition-Related Randomized Controlled Trials and Systematic Reviews With Meta-Analysis: Protocol for 2 Independent Meta-Research Studies. JMIR Res Protoc 2023; 12:e43537. [PMID: 36951931 PMCID: PMC10131600 DOI: 10.2196/43537] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/29/2023] [Accepted: 01/29/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Journal articles describing randomized controlled trials (RCTs) and systematic reviews with meta-analysis of RCTs are not optimally reported and often miss crucial details. This poor reporting makes assessing these studies' risk of bias or reproducing their results difficult. However, the reporting quality of diet- and nutrition-related RCTs and meta-analyses has not been explored. OBJECTIVE We aimed to assess the reporting completeness and identify the main reporting limitations of diet- and nutrition-related RCTs and meta-analyses of RCTs, estimate the frequency of reproducible research practices among these RCTs, and estimate the frequency of distorted presentation or spin among these meta-analyses. METHODS Two independent meta-research studies will be conducted using articles published in PubMed-indexed journals. The first will include a sample of diet- and nutrition-related RCTs; the second will include a sample of systematic reviews with meta-analysis of diet- and nutrition-related RCTs. A validated search strategy will be used to identify RCTs of nutritional interventions and an adapted strategy to identify meta-analyses in PubMed. We will search for RCTs and meta-analyses indexed in 1 calendar year and randomly select 100 RCTs (June 2021 to June 2022) and 100 meta-analyses (July 2021 to July 2022). Two reviewers will independently screen the titles and abstracts of records yielded by the searches, then read the full texts to confirm their eligibility. The general features of these published RCTs and meta-analyses will be extracted into a research electronic data capture database (REDCap; Vanderbilt University). The completeness of reporting of each RCT will be assessed using the items in the CONSORT (Consolidated Standards of Reporting Trials), its extensions, and the TIDieR (Template for Intervention Description and Replication) statements. Information about practices that promote research transparency and reproducibility, such as the publication of protocols and statistical analysis plans will be collected. There will be an assessment of the completeness of reporting of each meta-analysis using the items in the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement and collection of information about spin in the abstracts and full-texts. The results will be presented as descriptive statistics in diagrams or tables. These 2 meta-research studies are registered in the Open Science Framework. RESULTS The literature search for the first meta-research retrieved 20,030 records and 2182 were potentially eligible. The literature search for the second meta-research retrieved 10,918 records and 850 were potentially eligible. Among them, random samples of 100 RCTs and 100 meta-analyses were selected for data extraction. Data extraction is currently in progress, and completion is expected by the beginning of 2023. CONCLUSIONS Our meta-research studies will summarize the main limitation on reporting completeness of nutrition- or diet-related RCTs and meta-analyses and provide comprehensive information regarding the particularities in the reporting of intervention studies in the nutrition field. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/43537.
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Affiliation(s)
- Flávia Silva
- Nutrition Department, Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA, Porto Alegre, Brazil
| | | | - Carl Lachat
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - Cintia Curioni
- Department of Nutrition in Public Health, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fabio Gomes
- Pan-American Health Organization, World Health Organization, Washington, WA, United States
| | - Gary S Collins
- UK EQUATOR Centre, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jennifer Anne de Beyer
- UK EQUATOR Centre, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Jonathan Cook
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Leila Cheikh Ismail
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Sharjah, United Arab Emirates
| | - Matthew Page
- Methods in Evidence Synthesis Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Neha Khandpur
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Sarah Lamb
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Sally Hopewell
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Shona Kirtley
- UK EQUATOR Centre, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Solange Durão
- Cochrane South Africa, South African Medical Research Council, South Africa, Cape Town, South Africa
| | - Colby J Vorland
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, United States
| | - Michael M Schlussel
- UK EQUATOR Centre, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
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Silva FM, Adegboye ARA, Curioni C, Gomes FS, Collins GS, Kac G, A De Beyer J, Cook JA, Cheikh Ismail L, Page MJ, Khandpur N, Lamb S, Hopewell S, Kirtley S, Durão S, Vorland CJ, M Schlussel M. Protocol for a meta-research study of protocols for diet or nutrition-related trials published in indexed journals: general aspects of study design, rationale and reporting limitations. BMJ Open 2022; 12:e064744. [PMID: 36572499 PMCID: PMC9806013 DOI: 10.1136/bmjopen-2022-064744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 12/01/2022] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) reporting guideline establishes a minimum set of items to be reported in any randomised controlled trial (RCT) protocol. The Template for Intervention Description and Replication (TIDieR) reporting guideline was developed to improve the reporting of interventions in RCT protocols and results papers. Reporting completeness in protocols of diet or nutrition-related RCTs has not been systematically investigated. We aim to identify published protocols of diet or nutrition-related RCTs, assess their reporting completeness and identify the main reporting limitations remaining in this field. METHODS AND ANALYSIS We will conduct a meta-research study of RCT protocols published in journals indexed in at least one of six selected databases between 2012 and 2022. We have run a search in PubMed, Embase, CINAHL, Web of Science, PsycINFO and Global Health using a search strategy designed to identify protocols of diet or nutrition-related RCTs. Two reviewers will independently screen the titles and abstracts of records yielded by the search in Rayyan. The full texts will then be read to confirm protocol eligibility. We will collect general study features (publication information, types of participants, interventions, comparators, outcomes and study design) of all eligible published protocols in this contemporary sample. We will assess reporting completeness in a randomly selected sample of them and identify their main reporting limitations. We will compare this subsample with the items in the SPIRIT and TIDieR statements. For all data collection, we will use data extraction forms in REDCap. This protocol is registered on the Open Science Framework (DOI: 10.17605/OSF.IO/YWEVS). ETHICS AND DISSEMINATION This study will undertake a secondary analysis of published data and does not require ethical approval. The results will be disseminated through journals and conferences targeting stakeholders involved in nutrition research.
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Affiliation(s)
| | - Amanda Rodrigues Amorim Adegboye
- Centre for Healthcare Research, Coventry University, Coventry, UK
- Centre for Agroecology, Water and Resilience, Coventry University, Coventry, UK
| | - Cintia Curioni
- Nutrition Institute, UERJ, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fabio S Gomes
- Pan American Health Organization, Washington, District of Columbia, USA
| | - Gary Stephen Collins
- UK EQUATOR Centre, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics Reumathology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Gilberto Kac
- Josué de Castro Nutrition Institute, UFRJ, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jennifer A De Beyer
- UK EQUATOR Centre, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics Reumathology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jonathan Alistair Cook
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics Rheumathology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Leila Cheikh Ismail
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, UAE
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Matthew J Page
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Neha Khandpur
- Centre for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, USP, Sao Paulo, Brazil
| | - Sarah Lamb
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sally Hopewell
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics Rheumathology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Shona Kirtley
- UK EQUATOR Centre, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics Reumathology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Solange Durão
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Colby J Vorland
- Department of Applied Health Science, Indiana University School of Public Health - Bloomington, Bloomington, Indiana, USA
| | - Michael M Schlussel
- UK EQUATOR Centre, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics Reumathology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Leary M, Pursey K, Verdejo-García A, Skinner J, Whatnall MC, Hay P, Collins C, Baker AL, Burrows T. Designing an online intervention for adults with addictive eating: a qualitative integrated knowledge translation approach. BMJ Open 2022; 12:e060196. [PMID: 35672064 PMCID: PMC9174813 DOI: 10.1136/bmjopen-2021-060196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Codesign is a meaningful end-user engagement in research design. The integrated knowledge translation (IKT) framework involves adopting a collaborative research approach to produce and apply knowledge to address real-world needs, resulting in useful and useable recommendations that will more likely be applied in policy and practice. In the field of food addiction (FA), there are limited treatment options that have been reported to show improvements in FA symptoms. OBJECTIVES The primary aim of this paper is to describe the step-by-step codesign and refinement of a complex intervention delivered via telehealth for adults with FA using an IKT approach. The secondary aim is to describe our intervention in detail according to the TIDieR checklist. DESIGN This study applies the IKT process and describes the codesign and refinement of an intervention through a series of online meetings, workshops and interviews. PARTICIPANTS This study included researchers, clinicians, consumers and health professionals. PRIMARY OUTCOME MEASURE The primary outcome was a refined intervention for use in adults with symptoms of FA for a research trial. RESULTS A total of six female health professionals and five consumers (n=4 female) with lived overeating experience participated in two interviews lasting 60 min each. This process resulted in the identification of eight barriers and three facilitators to providing and receiving treatment for FA, eight components needed or missing from current treatments, telehealth as a feasible delivery platform, and refinement of key elements to ensure the intervention met the needs of both health professionals and possible patients. CONCLUSION Using an IKT approach allowed for a range of viewpoints and enabled multiple professions and disciplines to engage in a semiformalised way to bring expertise to formulate a possible intervention for FA. Mapping the intervention plan to the TIDieR checklist for complex interventions, allowed for detailed description of the intervention and the identification of a number of areas that needed to be refined before development of the finalised intervention protocol.
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Affiliation(s)
- Mark Leary
- College of Health Medicine and Wellbeing, The University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Kirrilly Pursey
- College of Health Medicine and Wellbeing, The University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | | | - Janelle Skinner
- College of Health Medicine and Wellbeing, The University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Megan C Whatnall
- College of Health Medicine and Wellbeing, The University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Phillipa Hay
- Western Sydney University, Penrith South, New South Wales, Australia
| | - Clare Collins
- College of Health Medicine and Wellbeing, The University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Amanda L Baker
- College of Health Medicine and Wellbeing, The University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Tracy Burrows
- College of Health Medicine and Wellbeing, The University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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Kirkegaard A, Ball L, Mitchell L, Brickley B, Williams LT. Quality improvement strategies enhance primary care dietetics: A systematic review and meta-analysis. J Hum Nutr Diet 2021; 35:479-493. [PMID: 34725871 DOI: 10.1111/jhn.12963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/07/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Quality improvement strategies have been widely applied in health care; however, little is known about their use in primary care dietetics. This review aims to describe and evaluate the effectiveness of quality improvement strategies that seek to improve patient outcomes by enhancing dietetic care compared to standard dietetic care. METHODS The study employed a systematic review and meta-analysis design following PRISMA guidelines and included studies up to March 2021. Studies were included if they used a randomised controlled trial (RCT) design to evaluate the effect of a quality improvement strategy applied to care delivered by a dietitian on patient outcomes. A meta-analysis was conducted where there were sufficient studies with homogeneous populations and outcome measures. RESULTS Twelve RCTs (n = 1604) met the inclusion criteria for review and five studies (n = 511) were eligible for meta-analysis for glycated haemoglobin in patients with type 2 diabetes. The most frequently reported quality improvement strategies addressed disease management programs (58%), patient education (67%), group care (42%) and patient self-management (42%). A positive intervention effect was reported in 50% of the included studies. A low grade of evidence supported a positive intervention effect for quality improvement intervention by a dietitian for glycated haemoglobin (pooled mean difference = -0.39% with 95% confidence interval = -0.70 to -0.08, p = 0.01) in n = 511 patients with type 2 diabetes mellitus. CONCLUSIONS Interventions aimed at enhancing quality in primary care dietetic practice support improvements in patient outcomes. Further research on quality improvement interventions for patient outcomes is required to strengthen the evidence base in this important topic.
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Affiliation(s)
- Amy Kirkegaard
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast, Campus, QLD, Australia
| | - Lauren Ball
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast, Campus, QLD, Australia
| | - Lana Mitchell
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast, Campus, QLD, Australia
| | - Bryce Brickley
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast, Campus, QLD, Australia
| | - Lauren T Williams
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast, Campus, QLD, Australia
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Barnes KA, Szewczyk Z, Kelly JT, Campbell KL, Ball LE. How cost-effective is nutrition care delivered in primary healthcare settings? A systematic review of trial-based economic evaluations. Nutr Rev 2021; 80:1480-1496. [PMID: 34605888 DOI: 10.1093/nutrit/nuab082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
CONTEXT Nutrition care is an effective lifestyle intervention for the treatment and prevention of many noncommunicable diseases. Primary care is a high-value setting in which to provide nutrition care. OBJECTIVE The objective of this review was to evaluate the cost-effectiveness of nutrition care interventions provided in primary care settings. DATA SOURCES Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Central Register of Controlled Trials, EconLit, and the National Health Service Economic Evaluation Database (NHS EED) were searched from inception to May 2021. DATA EXTRACTION Data extraction was guided by the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) reporting guidelines. Randomized trials of nutrition interventions in primary care settings were included in the analysis if incremental cost-effectiveness ratios were reported. The main outcome variable incremental cost-effectiveness ratios (ICERs) and reported interpretations were used to categorize interventions by the cost-effectiveness plane quadrant. RESULTS Of 6837 articles identified, 10 were included (representing 9 studies). Eight of the 9 included studies found nutrition care in primary care settings to be more costly and more effective than usual care . High study heterogeneity limited further conclusions. CONCLUSION Nutrition care in primary care settings is effective, though it requires investment; it should, therefore, be considered in primary care planning. Further studies are needed to evaluate the long-term cost-effectiveness of providing nutrition care in primary care settings. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42020201146.
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Affiliation(s)
- Katelyn A Barnes
- Healthy Primary Care, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
| | - Zoe Szewczyk
- Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, Australia.,School of Medicine and Public Health, the University of Newcastle, Callaghan, NSW, Australia
| | - Jaimon T Kelly
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia.,Centre for Online Health, the University of Queensland, Brisbane, QLD, Australia.,Centre for Health Services Research, the University of Queensland, Brisbane, QLD, Australia
| | - Katrina L Campbell
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia.,Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, Australia
| | - Lauren E Ball
- Healthy Primary Care, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
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Abstract
BACKGROUND Despite broad efforts to improve the reporting of biomedical research, no reporting guideline exists for primary care (PC) research. Little is known about current reporting practices or how well reports meet the needs of varied users in PC. OBJECTIVE To map the published literature on PC research reporting: quality, strengths and weaknesses, recommendations and efforts to improve reporting. METHODS Scoping review of literature across seven major databases and search engines to identify all articles on PC research reporting published in English, 2000-20. An additional secondary search of references of these 25 articles and consideration of expert panel suggestions. Structured data extraction by multiple reviewers using a predetermined form. RESULTS Search yielded 2847 unique titles, of which 126 underwent full-text review and 25 met inclusion criteria. Publications included opinion pieces (9), systematic reviews (5), methods articles (2), literature reviews (4), qualitative studies (4) and surveys (1). Studies focussed on a variety of topics and research methods. All publications identified the need for improved reporting and recommended items to include in reports. Most commonly, publications cited the need for more detailed reporting on the context of study interventions, clinical settings and health care systems. Most publications endorsed the use of reporting guidelines and recognized the unique needs of PC research reporting. CONCLUSIONS Published research and opinion identify unique needs for PC research reports and support new guidance to improve the validity, generalizability and application of study findings.
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Mirmiran P, Bahadoran Z, Gaeini Z. Common Limitations and Challenges of Dietary Clinical Trials for Translation into Clinical Practices. Int J Endocrinol Metab 2021; 19:e108170. [PMID: 34567133 PMCID: PMC8453651 DOI: 10.5812/ijem.108170] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 03/01/2021] [Accepted: 03/29/2021] [Indexed: 01/31/2023] Open
Abstract
The progressive development of clinical and public health nutrition has long relied on dietary clinical trials (DCTs), investigating the causal relationship between diet and multiple risk factors of non-communicable and chronic diseases. DCTs are also hallmarks for establishing dietary requirements and promoting overall nutritional health among the population. Despite their critical importance in translation into public health strategies and practices, DCTs have several limitations and challenges for study design, implementation and finding interpretation. The complex nature of nutrition interventions, collinearity between diet components, multi-target effects of the interventions, diverse dietary behaviors, and food culture are the most challenging issues. Furthermore, baseline exposure and dietary status, appropriate control groups, blinding, randomization, and poor adherence undermine the effectiveness of DCTs in translation into practices. Disruptive factors will be minimized if researchers are committed to following good clinical practice (GCP) standards available for common designs of clinical trials. Planning DCTs, however, needs careful considerations for hypothesis generation, study design development, the definition of primary and secondary outcome measures, and target population.
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Affiliation(s)
- Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Bahadoran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P. O. Box: 1985717413, Tehran, Iran. Tel: +98-2122432500,
| | - Zahra Gaeini
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Zacharia K, Patterson AJ, English C, Ramage E, Galloway M, Burke M, Gray R, MacDonald-Wicks L. i-Rebound after Stroke-Eat for Health: Mediterranean Dietary Intervention Co-Design Using an Integrated Knowledge Translation Approach and the TIDieR Checklist. Nutrients 2021; 13:1058. [PMID: 33805076 DOI: 10.3390/nu13041058] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/11/2021] [Accepted: 03/21/2021] [Indexed: 02/07/2023] Open
Abstract
Lifestyle interventions to reduce second stroke risk are complex. For effective translation into practice, interventions must be specific to end-user needs and described in detail for replication. This study used an Integrated Knowledge Translation (IKT) approach and the Template for Intervention Description and Replication (TIDieR) checklist to co-design and describe a telehealth-delivered diet program for stroke survivors. Stroke survivors and carers (n = 6), specialist dietitians (n = 6) and an IKT research team (n = 8) participated in a 4-phase co-design process. Phase 1: the IKT team developed the research questions, and identified essential program elements and workshop strategies for effective co-design. Phase 2: Participant co-design workshops used persona and journey mapping to create user profiles to identify barriers and essential program elements. Phase 3: The IKT team mapped Phase 2 data to the TIDieR checklist and developed the intervention prototype. Phase 4: Co-design workshops were conducted to refine the prototype for trial. Rigorous IKT co-design fundamentally influenced intervention development. Modifications to the protocol based on participant input included ensuring that all resources were accessible to people with aphasia, an additional support framework and resources specific to outcome of stroke. The feasibility and safety of this intervention is currently being pilot tested (randomised controlled trial; 2019/ETH11533, ACTRN12620000189921).
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Seddon N, Chapple LAS, Tatucu-Babet OA, Ridley EJ. Reporting of Randomized Controlled Trials Investigating an Enteral or Parenteral Nutrition Intervention in Critical Illness According to the CONSORT Statement: A Systematic Review and Recommendation of Minimum Standard Reporting Criteria. JPEN J Parenter Enteral Nutr 2020; 45:465-478. [PMID: 33119130 DOI: 10.1002/jpen.2038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/06/2020] [Accepted: 10/16/2020] [Indexed: 12/28/2022]
Abstract
Lack of reporting consistency is common in randomized controlled trials (RCTs) in critical care nutrition. This impacts synthesis and interpretation and may misinform clinical practice. The objective was to evaluate reporting of parallel-group RCTs of enteral or parenteral nutrition interventions in critically ill adults against the recommendations in the Consolidated Standards of Reporting Trials (CONSORT) 2010 guidelines and a priori-defined nutrition criteria. A systematic search of CENTRAL, MEDLINE, EMBASE, and CINAHL was conducted to identify RCTs published from January 2011 to February 14, 2020. The primary outcome was the percentage of CONSORT criteria "completely met" (a score of 1) from all included studies (out of a total possible score of 37). Secondary outcomes included the percentage of CONSORT criteria that were "partially" or "not met" and the percentage of a priori-defined nutrition criteria that were "completely," "partially," or "not met" (adjusted to reflect criteria applicable to the paper). Data are presented as mean (standard deviation). Comparisons of normally distributed continuous data were made using a t-test (P < .05). Of 18,969 articles identified, 56 studies met inclusion criteria. Of these, 60% (19%) of the eligible CONSORT criteria were "completely met," 20% (9%) "partially met," and 20% (15%) "not met." For the nutrition criteria, 41% (20%) of the eligible criteria were "completely met," 25% (14%) "partially met," and 34% (17%) "not met." Reporting against CONSORT guidelines was variable and often incomplete in relation to important a priori-defined nutrition variables.
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Affiliation(s)
- Nathan Seddon
- Riverland Community Health Service, Berri, Australia
| | - Lee-Anne S Chapple
- Intensive Care Research, Royal Adelaide Hospital, Adelaide, Australia.,Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
| | - Oana A Tatucu-Babet
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University Melbourne, Melbourne, Australia
| | - Emma J Ridley
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University Melbourne, Melbourne, Australia.,Nutrition Department, Alfred Health, Melbourne, Australia
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Rigby RR, Mitchell LJ, Hamilton K, Williams LT. The Use of Behavior Change Theories in Dietetics Practice in Primary Health Care: A Systematic Review of Randomized Controlled Trials. J Acad Nutr Diet 2020; 120:1172-1197. [PMID: 32444328 DOI: 10.1016/j.jand.2020.03.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 03/24/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Behavior change theories frameworks provide the theoretical underpinning for effective health care. The extent to which they are applied in contemporary dietetics interventions has not been explored. OBJECTIVE To systematically review the evidence of behavior change theory-based interventions delivered by credentialed nutrition and dietetics practitioners in primary health care settings. METHODS Medline, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Embase, and Cochrane databases were searched for English language, randomized controlled trials before August 2019. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. Eligible interventions included adults (aged ≥18 years) receiving face-to-face dietetics care underpinned by behavior change theories in primary health care settings with outcome measures targeting changes in health behaviors or health outcomes. Screening was conducted independently in duplicate and data were extracted using predefined categories. The quality of each study was assessed using the Cochrane Risk of Bias tool. The body of evidence was assessed using the Academy of Nutrition and Dietetics Evidence Analysis Manual Conclusion Grading Table. RESULTS Thirty articles reporting on 19 randomized controlled trials met the eligibility criteria, representing 5,172 adults. Thirteen studies (68%) showed significant improvements for the primary outcome measured. Social cognitive theory was the behavior change theory most commonly applied in interventions (n=15) with 11 finding significant intervention effects. Goal setting, problem solving, social support, and self-monitoring were the most commonly reported techniques (n=15, n=14, n=11, and n=11, respectively). Most studies had a high (n=11) or unclear (n=8) risk of bias. There was fair evidence (Grade II) supporting the use of behavior change theories to inform development of dietetics interventions. CONCLUSIONS Interventions delivered by credentialed nutrition and dietetics practitioners that were underpinned by behavior change theories and utilizing various behavior change techniques were found to have potential to be more effective at improving patient health outcomes than dietary interventions without theoretical underpinnings. Findings from this review should inform future primary health care research in the area of dietary behavior change. In addition, findings from this review highlight the need for stronger documentation of use of behavior change theory and techniques that map on to the theory within dietetics practice.
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Odgers-Jewell K, Ball LE, Reidlinger DP, Isenring EA, Thomas R, Kelly JT. Replicating group-based education interventions for the management of type 2 diabetes: a review of intervention reporting. Diabet Med 2020; 37:768-778. [PMID: 31646673 DOI: 10.1111/dme.14158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2019] [Indexed: 11/27/2022]
Abstract
AIMS To assess the completeness of reporting of group-based education interventions for the management of type 2 diabetes. METHODS A previous systematic review of group-based education programmes for adults with type 2 diabetes identified eligible intervention studies. Data were extracted and assessed using the Template for Intervention Description and Replication ('TIDieR') checklist. Missing data were sourced from other published material, or by contacting authors. RESULTS Fifty-three publications describing 47 studies were included. No publications sufficiently described all items. Authors of 43 of the 47 included studies (91%) were contacted via e-mail to obtain missing data in order to complete the TIDieR checklist. Seven (16%) did not respond. Additional data were obtained for 33/47 studies (70%). Most studies (45/47, 96%) described the intervention duration and frequency, detailed the procedures and rationale (40/47, 85%), provided a brief intervention name and explained any individual tailoring (38/47, 81%), defined whether providers received training and adequately described how the programme was delivered (37/47, 79%). However, few described any modifications (28/47, 60%), whether the intervention was delivered as planned (27/47, 57%), where it was delivered (21/47, 45%), whether materials were provided (19/47, 40%), and who delivered the intervention (13/47, 28%). CONCLUSIONS Group-based education interventions for the management of type 2 diabetes are poorly reported. To translate effective research into practice, practitioners need sufficient detail to implement evidence-based interventions. Researcher adoption of the TIDieR checklist will assist the translation and replication of published interventions.
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Affiliation(s)
- K Odgers-Jewell
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - L E Ball
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - D P Reidlinger
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - E A Isenring
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - R Thomas
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - J T Kelly
- School of Public Health, University of Queensland, Brisbane, Australia
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Alston L, Partridge SR. Limited dietary interventions in rural Australian communities: A systematic review. Nutr Diet 2020; 78:57-68. [PMID: 32160401 DOI: 10.1111/1747-0080.12612] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/14/2020] [Accepted: 02/17/2020] [Indexed: 01/13/2023]
Abstract
AIM This review aimed to synthesise the evidence on the effectiveness of dietary interventions targeting adolescents (>13 years) and adults living in rural or remote Australia. METHODS Six electronic databases were searched to identify dietary interventions undertaken in rural or remote communities. Studies were included if they utilised intervention and control comparisons or pre and post assessment of diet-related outcomes. If studies included metropolitan populations, dietary outcome measures had to be provided separately for rural data. RESULTS In total, 14 articles from 12 unique studies met the criteria for inclusion and together provided incomplete coverage across all states of Australia, included intervention studies targeted diet to address obesity, cardiovascular disease, and high blood pressure or diabetes. No studies were focussed on reducing community malnutrition. All studies, with one exception, focussed specifically on rural adults, no interventions specifically targeted adolescents in rural areas. Only two studies documented the involvement of a dietitian in intervention development or delivery. All studies produced a significant outcome for either dietary intake, body mass index, waist circumference, or diet related biomedical risk factors for individuals located in rural or remote areas of Australia. CONCLUSION Dietary interventions in rural Australia are under-studied, especially among the adolescent population. This is despite the high level of preventable diet-related disease burden in rural and remote Australia. Existing evidence shows promise in improving dietary intakes, but further, large scale intervention research, with the involvement of dietitians, is urgently needed to improve the health of rural communities.
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Affiliation(s)
- Laura Alston
- The Global Obesity Centre, Deakin University, Institute for Health Transformation, Geelong, Victoria, Australia.,Faculty of Health, Deakin Rural Health, Deakin University, Warrnambool, Victoria, Australia.,Research Department, Colac Area Health, Colac, Victoria, Australia
| | - Stephanie R Partridge
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Prevention Research Collaboration, Charles Perkins Centre, Sydney School Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Cadogan CA, Dharamshi R, Fitzgerald S, Corish CA, Castro PD, Ryan C. A systematic scoping review of interventions to improve appropriate prescribing of oral nutritional supplements in primary care. Clin Nutr 2020; 39:654-63. [DOI: 10.1016/j.clnu.2019.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/07/2019] [Accepted: 03/05/2019] [Indexed: 02/03/2023]
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Ross LJ, Barnes KA, Ball LE, Mitchell LJ, Sladdin I, Lee P, Williams LT. Effectiveness of dietetic consultation for lowering blood lipid levels in the management of cardiovascular disease risk: A systematic review and meta-analysis of randomised controlled trials. Nutr Diet 2019; 76:199-210. [PMID: 30714668 PMCID: PMC6850486 DOI: 10.1111/1747-0080.12509] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/06/2018] [Accepted: 11/19/2018] [Indexed: 11/30/2022]
Abstract
AIM 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Lynda J Ross
- Menzies Health Institute Queensland, Queensland, Australia.,Griffith University, Gold Coast, Brisbane, Queensland, Australia
| | - Katelyn A Barnes
- Griffith University, Gold Coast, Brisbane, Queensland, Australia
| | - Lauren E Ball
- Menzies Health Institute Queensland, Queensland, Australia.,Griffith University, Gold Coast, Brisbane, Queensland, Australia
| | - Lana J Mitchell
- Menzies Health Institute Queensland, Queensland, Australia.,Griffith University, Gold Coast, Brisbane, Queensland, Australia
| | - Ishtar Sladdin
- Menzies Health Institute Queensland, Queensland, Australia.,Griffith University, Gold Coast, Brisbane, Queensland, Australia
| | - Patricia Lee
- Griffith University, Gold Coast, Brisbane, Queensland, Australia
| | - Lauren T Williams
- Menzies Health Institute Queensland, Queensland, Australia.,Griffith University, Gold Coast, Brisbane, Queensland, Australia
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Williams LT, Barnes K, Ball L, Ross LJ, Sladdin I, Mitchell LJ. How Effective Are Dietitians in Weight Management? A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Healthcare (Basel) 2019; 7:E20. [PMID: 30717197 DOI: 10.3390/healthcare7010020] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/24/2019] [Accepted: 01/30/2019] [Indexed: 12/18/2022] Open
Abstract
Effective, evidence-based strategies to prevent and treat obesity are urgently required. Dietitians have provided individualized weight management counselling for decades, yet evidence of the effectiveness of this intervention has never been synthesized. The aim of this study was to examine the effectiveness of individualized nutrition care for weight management provided by dietitians to adults in comparison to minimal or no intervention. Databases (Cochrane, CINAHL plus, MedLine ovid, ProQuest family health, PubMed, Scopus) were searched for terms analogous with patient, dietetics and consultation with no date restrictions. The search yielded 5796 unique articles, with 14 randomized controlled trials meeting inclusion criteria. The risk of bias for the included studies ranged from unclear to high. Six studies found a significant intervention effect for the dietitian consultation, and a further four found significant positive change for both the intervention and control groups. Data were synthesized through random effects meta-analysis from five studies (n = 1598) with weight loss as the outcome, and from four studies (n = 1224) with Body Mass Index (BMI) decrease as the outcome. Groups receiving the dietitian intervention lost an additional 1.03 kg (95% CI:−1.40; −0.66, p < 0.0001) of weight and 0.43 kg/m2 (95% CI:−0.59, −0.26; p < 0.0001) of BMI than those receiving usual care. Heterogeneity was low for both weight loss and BMI, with the pooled means varying from 1.26 to −0.93 kg and −0.4 kg/m2 for weight and BMI, respectively, with the removal of single studies. This study is the first to synthesize evidence on the effectiveness of individualized nutrition care delivered by a dietitian. Well-controlled studies that include cost-effectiveness measures are needed to strengthen the evidence base.
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Solmi M, Köhler CA, Stubbs B, Koyanagi A, Bortolato B, Monaco F, Vancampfort D, Machado MO, Maes M, Tzoulaki I, Firth J, Ioannidis JPA, Carvalho AF. Environmental risk factors and nonpharmacological and nonsurgical interventions for obesity: An umbrella review of meta-analyses of cohort studies and randomized controlled trials. Eur J Clin Invest 2018; 48:e12982. [PMID: 29923186 DOI: 10.1111/eci.12982] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/18/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Multiple environmental factors have been implicated in obesity, and multiple interventions, besides drugs and surgery, have been assessed in obese patients. Results are scattered across many studies and meta-analyses, and they often mix obese and overweight individuals. MATERIALS AND METHODS PubMed and Cochrane Database of Systematic Reviews were searched through 21 January 2017 for meta-analyses of cohort studies assessing environmental risk factors for obesity, and randomized controlled trials investigating nonpharmacological and nonsurgical therapeutic interventions for obesity. We excluded data on overweight participants. Evidence from observational studies was graded according to criteria that included the statistical significance of the random-effects summary estimate and of the largest study in a meta-analysis, the number of obesity cases, heterogeneity between studies, 95% prediction intervals, small-study effects and excess significance. The evidence of intervention studies for obesity was assessed with the GRADE framework. RESULTS Fifty-four articles met eligibility criteria, including 26 meta-analyses of environmental risk factors (166 studies) and 46 meta-analyses of nondrug, nonsurgical interventions (206 trials). In adults, the only risk factor with convincing evidence was depression, and childhood obesity, adolescent obesity, childhood abuse and short sleep duration had highly suggestive evidence. Infancy weight gain during the first year of life, depression and low maternal education had convincing evidence for association with paediatric obesity. All interventions had low or very-low-quality evidence with one exception of moderate-quality evidence for one comparison (no differences in efficacy between brief lifestyle primary care interventions and other interventions for paediatric obesity). Summary effect sizes were mostly small across compared interventions (maximum 5.1 kg in adults and 1.78 kg in children) and even these estimates may be inflated. CONCLUSIONS Depression, obesity in earlier age groups, short sleep duration, childhood abuse and low maternal education have the strongest support among proposed risk factors for obesity. Furthermore, there is no high-quality evidence to recommend treating obesity with a specific nonpharmacological and nonsurgical intervention among many available, and whatever benefits in terms of magnitude of weight loss appear small.
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Affiliation(s)
- Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Cristiano A Köhler
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.,Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Francesco Monaco
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium.,University Psychiatric Centre, KU Leuven, University of Leuven, Leuven-Kortenberg, Belgium
| | - Myrela O Machado
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,IMPACT Strategic Research Center, Deakin University, Geelong, Vic., Australia
| | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.,MRC-PHE Centre for Environment, School of Public Health, Imperial College London, London, UK.,Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Joseph Firth
- NICM, School of Science and Health, University of Western Sydney, Sydney, NSW, Australia.,Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - John P A Ioannidis
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California.,Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California.,Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California.,Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, California
| | - André F Carvalho
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Addiction & Mental Health (CAMH), Toronto, ON, Canada
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