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Nutrition intervention program of the Modification of Diet in Renal Disease Study: a self-management approach
B P Gillis1, A W Caggiula, A T Chiavacci
1Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA 15213, USA.
Objective:
To characterize the Modification of Diet in Renal Disease (MDRD) Study nutrition intervention program by determining the frequency of intervention strategies used by the dietitians and the usefulness of program components as rated by participants.
Design:
Dietitians recorded which of 32 intervention strategies they used at each monthly visit. Participants rated the usefulness of 19 program components.
Subjects:
840 adults with renal insufficiency.
Intervention:
Participants were assigned randomly to usual-, low-, or very-low-protein diet groups. Each eating pattern also specified a phosphorus intake goal. Each participant met monthly with a dietitian for an average of 26 months.
Statistical Analyses:
Analyses of variance and chi 2 analyses.
Results:
Dietitians used the following intervention strategies most often in all groups: providing feedback based on self-monitoring and/or food records, reviewing adherence or biochemistry data, providing low-protein foods, and reviewing graphs of adherence progress. In general, the dietitians used feedback, modeling, and support strategies more often, and knowledge and skills strategies less often, with participants who had to make the greatest reductions in protein intake and those with more advanced disease. In all groups, the dietitians' use of knowledge and skills, feedback, and modeling strategies decreased over time (P < .001), whereas use of support strategies was maintained. The type and frequency of intervention strategies used by dietitians and the usefulness ratings of participants did not vary by educational level of the participant. Both self-monitoring and dietitian support were rated as "very useful" by 88% of the participants.
Conclusions:
Three features were central to the MDRD Study nutrition intervention program: feedback, particularly from self-monitoring and from measures of adherence; modeling, particularly by providing low-protein food products; and dietitian support. We recommend the self-management approach.