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| Author/Association: | Patnode CD, Redmond N, Iacocca MO, Henninger M |
| Title: | Behavioral counseling interventions to promote a healthy diet and physical activity for cardiovascular disease prevention in adults without known cardiovascular disease risk factors: updated evidence report and systematic review for the US Preventive Services Task Force [with consumer summary] |
| Source: | JAMA 2022 Jul 26;328(4):375-388 |
| Method: | systematic review |
| Method Score: | This is a systematic review. Systematic reviews are not rated. |
| Consumer Summary: | The US Preventive Services Task Force (USPSTF) has recently published recommendations on behavioral counseling interventions to promote a healthy diet and physical activity to prevent cardiovascular disease (CVD) in adults without CVD risk factors. Cardiovascular disease refers to the buildup of plaque, which causes blockages inside important blood vessels in the body, including the arteries of the heart (coronary heart disease) and brain (cerebrovascular disease). Cardiovascular disease can cause heart attacks and strokes and is the leading cause of death in the US. Modifiable risk factors for CVD include smoking, high blood pressure, being overweight or obese, diabetes, high cholesterol, lack of physical activity, and an unhealthy diet. WHAT DOES COUNSELING ON HEALTH DIET AND PHYSICAL ACTIVITY INVOLVE: A healthy diet is defined as a balance of foods and beverages that help a person achieve and maintain a healthy weight, support health, and prevent disease. Behavioral counseling to promote a healthy diet focuses on (1) increased consumption of fruits, vegetables, whole grains, fat-free or low-fat dairy, lean proteins, and plant-based oils; (2) decreased consumption of foods or beverages that are high in added sugars, saturated or trans fats, and salt (sodium); and (3) moderation of alcohol intake. Physical activity enhances or maintains overall health and physical fitness. It is recommended that adults engage in at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic physical activity per week in addition to strength-training activity at least twice per week. Behavioral counseling involves behavior change techniques such as goal setting, active use of self-monitoring, and addressing barriers related to diet and physical activity. Dietary counseling can provide patient-tailored approaches such as advice about appropriate portion sizes and how to read food labels and prepare healthy meals. Counseling about physical activity typically involves tailored advice about how to gradually increase aerobic activity. Counseling can be done by primary care clinicians as well as other trained professionals, including nurses, registered dietitians, nutritionists, exercise specialists, psychologists, and lifestyle coaches. Counseling sessions can be performed in person or remotely and may be done individually or in group sessions. WHAT IS THE PATIENT POPULATION UNDER CONSIDERATION FOR COUNSELING ABOUT HEALTHY DIET AND PHYSICAL ACTIVITY: This USPSTF recommendation applies to adults without known CVD risk factors. There is a separate USPSTF recommendation for counseling about healthy diet and physical activity for adults who have CVD risk factors. WHAT ARE THE POTENTIAL BENEFITS AND HARMS OF COUNSELING ABOUT HEALTHY DIET AND PHYSICAL ACTIVITY: There is some evidence that counseling about healthy diet and physical activity leads to improvements in body weight, blood pressure, and cholesterol levels. However, there is less direct evidence linking behavioral counseling to CVD outcomes such as heart attacks, strokes, or death from CVD. Any harms from counseling about healthy diet and physical activity are likely to be small. HOW STRONG IS THE RECOMMENDATION TO CONSEL ABOUT HEALTHY DIET AND PHYSICAL ACTIVITY: Based on the current evidence, the USPSTF concludes with moderate certainty that behavioral counseling interventions have a small net benefit on CVD risk in adults without CVD risk factors. Individuals who are interested in and ready to make behavioral changes may be most likely to benefit from counseling. |
| Abstract: | IMPORTANCE: Unhealthful dietary patterns, low levels of physical activity, and high sedentary time increase the risk of cardiovascular disease. OBJECTIVE: To synthesize the evidence on benefits and harms of behavioral counseling interventions to promote a healthy diet and physical activity in adults without known cardiovascular disease (CVD) risk factors to inform a US Preventive Services Task Force recommendation. DATA SOURCES: Medline, PsycINFO, and the Cochrane Central Register of Controlled Trials through February 2021, with ongoing surveillance through February 2022. STUDY SELECTION: Randomized clinical trials (RCTs) of behavioral counseling interventions targeting improved diet, increased physical activity, or decreased sedentary time among adults without known elevated blood pressure, elevated lipid levels, or impaired fasting glucose. DATA EXTRACTION AND SYNTHESIS: Independent data abstraction and study quality rating and random effects meta-analysis. MAIN OUTCOME MEASURES: CVD events, CVD risk factors, diet and physical activity measures, and harms. RESULTS: One-hundred thirteen RCTs were included (N = 129,993). Three RCTs reported CVD-related outcomes: 1 study (n = 47,179) found no significant differences between groups on any CVD outcome at up to 13.4 years of follow-up; a combined analysis of the other 2 RCTs (n = 1,203) found a statistically significant association of the intervention with nonfatal CVD events (hazard ratio 0.27 (95% CI 0.08 to 0.88)) and fatal CVD events (hazard ratio 0.31 (95% CI 0.11 to 0.93)) at 4 years. Diet and physical activity behavioral counseling interventions were associated with small, statistically significant reductions in continuous measures of blood pressure (systolic mean difference -0.8 (95% CI -1.3 to -0.3); 23 RCTs (n = 57,079); diastolic mean difference -0.4 (95% CI -0.8 to -0.0); 24 RCTs (n = 57,148)), low-density lipoprotein cholesterol level (mean difference 2.2 mg/dL (95% CI -3.8 to -0.6); 15 RCTs (n = 6,350)), adiposity-related outcomes (body mass index mean difference -0.3 (95% CI -0.5 to -0.1); 27 RCTs (n = 59,239)), dietary outcomes, and physical activity at 6 months to 1.5 years of follow-up vs control conditions. There was no evidence of greater harm among intervention versus control groups. CONCLUSIONS AND RELEVANCE: Healthy diet and physical activity behavioral counseling interventions for persons without a known risk of CVD were associated with small but statistically significant benefits across a variety of important intermediate health outcomes and small to moderate effects on dietary and physical activity behaviors. There was limited evidence regarding the long-term health outcomes or harmful effects of these interventions. Full text (sometimes free) may be available at these link(s):  help |
