Stage-matched nutrition guidance: stages of change and fat consumption in Dutch patients at elevated cardiovascular risk

Abstract

Objective: To assess the effects of stage-matched nutrition counseling on stages of change and fat intake.

Design: Controlled clinical trial.

Setting: 9 family practices in a family medicine practice network.

Participants: 143 patients at elevated cardiovascular risk, aged 40 to 70 years.

Intervention: Intervention patients received stage-matched counseling from their family physician and a dietitian. Control patients received usual care.

Main outcome measures: Stages of change and fat intake were measured at baseline and after 6 and 12 months.

Analysis: Chi-squared tests, t tests, and regression analyses (alpha = .05) were conducted.

Results: More patients in the intervention group than in the control group were in the postpreparation stage after 6 months (70% vs 35%; P < .01) but not after 12 months (70% vs 55%; P = .10). Between 0 and 12 months, the reduction in total fat intake (-5.6% kcal vs -2.4% kcal) was largest in the intervention group.

Conclusions and implications: Stage-matched nutrition counseling promotes movement through stages of change, resulting in a reduced fat intake. Our results partly support stages of change as a tool for behavior change. Movement across stages of change was not an intermediating factor in the intervention effects. Research should focus on feasible ways to keep patients in the postpreparation stage.