Nutritional counselling in primary health care: a randomized comparison of an intervention by general practitioner or dietician

Abstract

Aims: To compare health effects and risk reduction in two different strategies of nutritional counselling in primary health care for patients at high risk of ischaemic heart disease.

Methods: In a cluster-randomized trial 60 general practitioners (GPs) in the Copenhagen County were randomized to give nutritional counselling or to refer patients to a dietician. Patients were included after opportunistically screening (n=503 patients), and received nutritional counselling by GP or dietician over 12 months. Health effects were measured by changes in weight, waist circumference and blood lipids. Risk of cardiovascular disease was calculated by The Copenhagen Risk Score. Data on use of medicine and primary health care was obtained from central registers.

Results: Altogether 339 (67%) patients completed the intervention. Weight loss was larger in the dietician group (mean 4.5 kg vs. 2.4 kg), and increase of HDL-cholesterol was larger in the GP group (mean 0.13 mmol/l vs. 0.03 mmol/l). The reduction of the cardiovascular risk score was significantly larger in the GP group (P=0.0005). Other health outcomes were not significantly different.

Conclusions: GPs were aware of substantial risk factors of cardiovascular disease and addressed these when counselling. The guidance from a GP was of significant importance for risk reduction in relation to IHD. However, a long-term lifestyle intervention by GP was difficult to implement. In the case of obesity it was effective to refer to long-term nutritional counselling by a dietician.