title: Long term adherence to dietary recommendations after inpatient rehabilitation: prospective follow up study of patients with coronary heart disease.
abstract: OBJECTIVE
  To evaluate the adherence to nutritional recommendations in inpatient rehabilitation and the long term maintenance of dietary changes among patients with coronary heart disease.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Two rehabilitation clinics in Germany.
  
  
  METHODS
  A cohort of 1206 patients undergoing inpatient rehabilitation after an acute manifestation of coronary heart disease.
  
  
  METHODS
  Self reported dietary intake before, during, and one and three years after rehabilitation measured with a semiquantitative food frequency questionnaire and summarised to a nutritional index, which was used to categorise patients as having a poor, fair, or good diet.
  
  
  RESULTS
  During rehabilitation the proportion of patients whose dietary intake was categorised as good increased strongly from 30% to 91%. One and three years after rehabilitation a still increased proportion of 49% and 42%, respectively, in the good category was observed. The strong increase in intake of low fat and wholemeal products that was achieved during rehabilitation was followed after rehabilitation discharge by a backslide to the intake observed before rehabilitation admission. The avoidance of unfavourable food items, such as French fries or eggs, was at least partly maintained during the follow up period.
  
  
  CONCLUSIONS
  During inpatient rehabilitation most patients do have to make major changes in their dietary intake to comply with recommendations. Although some proportion of patients continue to adhere to dietary recommendations in the long run, further research into strategies to improve maintenance of dietary changes is needed to enhance further the long term benefits from cardiac rehabilitation.
authors.affiliation: Department of Epidemiology, The German Centre for Research on Aging, Heidelberg, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Twardella
authors.forename: H
authors.initials: H
authors.lastname: Merx
authors.forename: H
authors.initials: H
authors.lastname: Hahmann
authors.forename: B
authors.initials: B
authors.lastname: Wüsten
authors.forename: D
authors.initials: D
authors.lastname: Rothenbacher
authors.forename: H
authors.initials: H
authors.lastname: Brenner
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003327:Coronary Disease / Q000178:diet therapy* / Q000534:rehabilitation; D018752:Diet, Fat-Restricted; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D010349:Patient Compliance; D011446:Prospective Studies