Long-term effect of nutritional counseling: a study in family medicine

This paper reports research using data in the Nijmegen Family Practice Monitoring Project. One part of the research is follow-up, after 17 y, of a 1977 trial of dietary advice for patients with hypertension or a family history of premature cardiovascular disease. In the intervention group, 840 patients were given health education every 2 mo by trained practice nurses for 1 y. There were 497 patients with similar coronary risk factors in the control group, who received usual care. One year after the intervention a significant decrease was found (and published) in serum cholesterol concentrations and blood pressure in the intervention group. By the time of the 1995 reexaminations, however, there were no differences in coronary risk factors between the two groups. Blood pressures had come down, more so in the control group, and the percentage of smokers had decreased equally in both groups. There were no significant differences in intake of dietary fat or in type of fat. The lack of difference was still found when the groups were divided into those with serum cholesterol concentrations > and < 6.5 mmol/L. A second part of the research was to investigate in 1995 the relation between patients' stage of change of fat intake and their dietary intake. It was found that those in stage 5 (sustaining desired changes in behavior) had the lowest saturated fat intake. Since 1977 both groups have been treated equally if hypertension was diagnosed. The two groups were not managed differently with regard to dietary advice after 1977.