title: Dietary compliance and cardiovascular risk reduction with a prepared meal plan compared with a self-selected diet.
abstract: Noncompliance with therapeutic diets remains a major obstacle to achieving improvements in cardiovascular disease (CVD) morbidity and mortality. This study compared dietary compliance and CVD risk factor response to two dietary interventions designed to treat hypertension, dyslipidemia, and diabetes mellitus. In a multicenter trial, 560 adults were randomly assigned to either a self-selected, mixed-food plan (n = 277), or a nutrient-fortified prepared meal plan (n = 283); each was designed to provide 15-20% of energy from fat, 55-60% from carbohydrate, and 15-20% from protein. Nutrient intake was estimated from 3-d food records collected biweekly throughout the 10-wk intervention. Compliance was determined by evaluating the participants' ability to meet specific criteria for energy intake [+/-420 kJ (100 kcal) from the midpoint of the prescribed energy range], fat intake (< 20%, < 25%, or < 30% of energy from total fat), and the National Cholesterol Education Program/American Heart Association Step 1 and 2 diet recommendations. Compliance with energy, fat, and Step 1 and 2 criteria was better in participants who followed the prepared meal plan than in those who followed the self-selected diet (P < 0.0001). Compliant participants in both groups achieved greater reductions in body weight, systolic and diastolic blood pressure, and total and low-density-lipoprotein cholesterol than noncompliant participants (P < 0.05). In general, better endpoint responses were observed with lower fat intakes regardless of group assignment. The prepared meal plan is a simple and effective strategy for meeting the many nutrient recommendations for CVD risk reduction and improving dietary compliance and CVD endpoints.
authors.affiliation: Department of Medicine, Oregon Health Sciences University, Portland 97201, USA. metzj@ohsu.edu
authors.forename: J A
authors.initials: JA
authors.lastname: Metz
authors.forename: P M
authors.initials: PM
authors.lastname: Kris-Etherton
authors.forename: C D
authors.initials: CD
authors.lastname: Morris
authors.forename: V A
authors.initials: VA
authors.lastname: Mustad
authors.forename: J S
authors.initials: JS
authors.lastname: Stern
authors.forename: S
authors.initials: S
authors.lastname: Oparil
authors.forename: A
authors.initials: A
authors.lastname: Chait
authors.forename: R B
authors.initials: RB
authors.lastname: Haynes
authors.forename: L M
authors.initials: LM
authors.lastname: Resnick
authors.forename: S
authors.initials: S
authors.lastname: Clark
authors.forename: D C
authors.initials: DC
authors.lastname: Hatton
authors.forename: M
authors.initials: M
authors.lastname: McMahon
authors.forename: S
authors.initials: S
authors.lastname: Holcomb
authors.forename: G W
authors.initials: GW
authors.lastname: Snyder
authors.forename: F X
authors.initials: FX
authors.lastname: Pi-Sunyer
authors.forename: D A
authors.initials: DA
authors.lastname: McCarron
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D050260:Carbohydrate Metabolism; D002318:Cardiovascular Diseases / Q000178:diet therapy / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy / Q000517:prevention & control; D004032:Diet; D015930:Diet Records; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000178:diet therapy / Q000517:prevention & control; D008074:Lipoproteins / Q000097:blood; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D012307:Risk Factors
chemical_list: D008074:Lipoproteins