Outcomes of a cardiovascular nutrition counseling program in African- Americans with elevated blood pressure or cholesterol level

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Objective: To evaluate a cardiovascular nutrition education package designed for African-American adults with a wide range of literacy skills. Design: Comparison of a self-help group and a full-instruction group; each group received nutrition counseling and clinical monitoring every 4 months. Subjects: Three hundred thirty African-American adults, aged 40 to 70 years, with elevated cholesterol level or high blood pressure were randomly assigned to the self-help or full-instruction group; 255 completed the 12-month follow-up. Interventions: Counseling to reduce intake of dietary fat, cholesterol, and sodium was based on Cardiovascular Dietary Education System (CARDES) materials, which included food-picture cards, a nutrition guide (self-help and full-instruction group), a video and audiotape series, and 4 classes (full-instruction group only). Main outcome measures: Changes in lipid levels and blood pressure after 12 months. Statistical analyses performed: Primary analyses consisted of repeated-measures analysis of variance to examine effects of time and randomization group on outcomes. Results: Total cholesterol and low-density lipoprotein cholesterol level decreased by 7% to 8% in the self-help and full-instruction groups of men and women (P<.01). The ratio of total cholesterol to high-density lipoprotein cholesterol (HDL-C) decreased in both groups of women and in the men in the full-instruction group (P<.01). In full-instruction and self-help participants with elevated blood pressure at baseline, systolic blood pressure decreased by 7 to 11 mm Hg and diastolic blood pressure decreased by 4 to 7 mm Hg (P<.01). Outcomes did not differ by literacy scores but were positively related to the reported initial frequency of using CARDES materials. Applications/conclusions: These results suggest that periodic nutrition counseling based on CARDES materials used for home study can enhance management of lipid levels and blood pressure in African-American outpatients.

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