Dietary advice given by a dietitian versus other health professional or self-help resources to reduce blood cholesterol.
BACKGROUND
The average level of blood cholesterol is an important determinant of the risk of coronary heart disease. Blood cholesterol can be reduced by dietary means. Although dietitians are trained to provide dietary advice, for practical reasons it is also given by other health professionals and occasionally through the use of self-help resources.


OBJECTIVE
To assess the effects of dietary advice given by a dietitian compared with another health professional, or the use of self-help resources, in reducing blood cholesterol in adults.


METHODS
We searched The Cochrane Library (to Issue 2 1999), MEDLINE (1966 to January 1999), EMBASE (1980 to December 1998), Cinahl (1982 to December 1998), Human Nutrition (1991 to 1998), Science Citation Index, Social Sciences Citation Index, hand searched conference proceedings on nutrition and heart disease, and contacted experts in the field.


METHODS
Randomised trials of dietary advice given by a dietitian compared with another health professional or self-help resources. The main outcome was difference in blood cholesterol between dietitian groups compared with other intervention groups.


METHODS
Two reviewers independently extracted data and assessed study quality.


RESULTS
Eleven studies with 12 comparisons were included, involving 704 people receiving advice from dietitians, 486 from other health professionals and 551 people using self-help leaflets. Four studies compared dietitian with doctor, seven with self-help resources, and one compared dietitian with nurse. Participants receiving advice from dietitians experienced a greater reduction in blood cholesterol than those receiving advice only from doctors (-0.25 mmol/L (95% CI -0.37, -0.12 mmol/L)). There was no statistically significant difference in change in blood cholesterol between dietitians and self-help resources (-0.10 mmol/L (95% CI -0.22, 0.03 mmol/L)). No statistically significant differences were detected for secondary outcome measures between any of the comparisons with the exception of dietitian versus nurse for HDLc, where the dietitian groups showed a greater reduction (-0.06 mmol/L (95% CI -0.11, -0.01)). No significant heterogeneity between the studies was detected.


CONCLUSIONS
Dietitians were better than doctors at lowering blood cholesterol in the short to medium term, but there was no evidence that they were better than self-help resources. The results should be interpreted with caution as the studies were not of good quality and the analysis was based on a limited number of trials. More evidence is required to assess whether change can be maintained in the longer term. There was no evidence that dietitians provided better outcomes than nurses.
Thompson
R L
RL
Institute of Human Nutrition, University of Southampton, Level B, South Academic Block, Southampton General Hospital, Southampton, Hampshire, UK, SO16 6YD. R.L.Thompson@soton.ac.uk
Summerbell
C D
CD
Hooper
L
L
Higgins
J P
JP
Little
P S
PS
Talbot
D
D
Ebrahim
S
S
D002784:Cholesterol / Q000097:blood*; D004032:Diet; D004046:Dietetics; D006282:Health Personnel; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000517:prevention & control; D009726:Nurses; D010353:Patient Education as Topic / Q000379:methods; D010358:Patient Participation; D010820:Physicians; D016032:Randomized Controlled Trials as Topic
D002784:Cholesterol