title: Counseling to promote a healthy diet in adults: a summary of the evidence for the U.S. Preventive Services Task Force.
abstract: OBJECTIVE
  The purpose of this study was to examine the effectiveness of counseling to promote a healthy diet among patients in primary care settings.
  
  
  METHODS
  We conducted a MEDLINE search from 1966 to December 2001.
  
  
  METHODS
  We included randomized controlled trials of at least 3 months' duration with measures of dietary behavior that were conducted in patient populations similar to those found in primary care practices. We excluded studies that reported only biochemical or anthropomorphic endpoints, had dropout rates greater than 50%, or enrolled patients based on the presence of a chronic disease.
  
  
  METHODS
  One author extracted relevant data from each included article into evidence tables. Using definitions developed by the research team, two authors independently rated each study in terms of its effect size, the intensity of its intervention, the patient risk level, and the use of well-proven counseling techniques.
  
  
  RESULTS
  We identified 21 trials for use in this review. Dietary counseling produces modest changes in self-reported consumption of saturated fat, fruits and vegetables, and possibly dietary fiber. More-intensive interventions were more likely to produce important changes than brief interventions, but they may be more difficult to apply to typical primary care patients. Interventions using interactive health communications, including computer-generated telephone or mail messages, can also produce moderate dietary changes.
  
  
  CONCLUSIONS
  Moderate- or high-intensity counseling interventions, including use of interactive health communication tools, can reduce consumption of saturated fat and increase intake of fruit and vegetable. Brief counseling of unselected patients by primary care providers appears to produce small changes in dietary behavior, but its effect on health outcomes is unclear.
authors.affiliation: Division of General Internal Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina 27599, USA. pignone@med.unc.edu
authors.forename: Michael P
authors.initials: MP
authors.lastname: Pignone
authors.forename: Alice
authors.initials: A
authors.lastname: Ammerman
authors.forename: Louise
authors.initials: L
authors.lastname: Fernandez
authors.forename: C Tracy
authors.initials: CT
authors.lastname: Orleans
authors.forename: Nola
authors.initials: N
authors.lastname: Pender
authors.forename: Steven
authors.initials: S
authors.lastname: Woolf
authors.forename: Kathleen N
authors.initials: KN
authors.lastname: Lohr
authors.forename: Sonya
authors.initials: S
authors.lastname: Sutton
mesh_terms: D000328:Adult; D003376:Counseling; D004041:Dietary Fats / Q000008:administration & dosage; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D011314:Preventive Health Services / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D014481:United States
chemical_list: D004041:Dietary Fats