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Meta-Analysis
. 2024 Feb 16:26:e49178.
doi: 10.2196/49178.

Effectiveness and Feasibility of Telehealth-Based Dietary Interventions Targeting Cardiovascular Disease Risk Factors: Systematic Review and Meta-Analysis

Rupal Trivedi  1 , Shaimaa Elshafie  1 , Randall Tackett  1 , Henry Young  1 , Elisabeth Lilian Pia Sattler  1   2
Affiliations
Meta-Analysis

Effectiveness and Feasibility of Telehealth-Based Dietary Interventions Targeting Cardiovascular Disease Risk Factors: Systematic Review and Meta-Analysis

Rupal Trivedi et al. J Med Internet Res. .

Abstract

Background: Telehealth-based dietary interventions were recommended for cardiovascular disease (CVD) management during the COVID-19 pandemic; however, data regarding their effectiveness and feasibility are limited.

Objective: We aimed to examine (1) the effectiveness of telehealth-based dietary interventions in improving clinical CVD risk factors and (2) the feasibility of these interventions among individuals with CVD.

Methods: To conduct this systematic review and meta-analysis of randomized controlled trials (RCTs), 2 investigators searched PubMed, Cochrane Library, Web of Science, and ClinicalTrials.gov databases based on predetermined search terms and included English-language RCTs published between January 2000 and July 2022. The Cochrane Risk of Bias tool was used to assess RCT quality. To evaluate intervention effectiveness, weight, BMI, systolic and diastolic blood pressure, and levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, or blood glucose were compared postintervention in telehealth and usual care (UC) groups. Feasibility was determined through the number of participants retained in intervention and UC groups. Pooled data for each CVD outcome were analyzed using a random effects model. Mean difference (MD), standardized MD, or risk ratio were calculated using R software.

Results: A total of 13 RCTs with 3013 participants were included in the analysis to assess the effectiveness and feasibility of telehealth-based dietary interventions among individuals with CVD. Participants had a mean age of 61.0 (SD 3.7) years, and 18.5% (n=559) were women. Approximately one-third of RCTs were conducted in the United States (n=4, 31%). Included studies used telephone, app, text, audio-visual media, or website-based interventions. Of the 13 included studies, 3 were of high quality, 9 were of moderate quality, and only 1 was of low quality. Pooled estimates showed systolic blood pressure (MD -2.74, 95% CI -4.93 to -0.56) and low-density lipoprotein cholesterol (standardized MD -0.11, 95% CI -0.19 to -0.03) to be significantly improved among individuals with CVD as a result of telehealth-based dietary interventions compared to UC. No significant difference in effectiveness was detected for weight, BMI, and levels of diastolic blood pressure, total cholesterol, high-density lipoprotein, and triglycerides between telehealth-based dietary interventions and UC among those with CVD. There was no significant difference between the feasibility of telehealth-based dietary interventions versus UC. Significant I2 indicated moderate to considerable heterogeneity.

Conclusions: Telehealth-based dietary interventions show promise in addressing CVD risk factors.

Keywords: cardiovascular diseases; dietary interventions; risk factors; self-management; systematic review and meta-analysis; telehealth.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
PRISMA flow diagram of screened and selected studies.
Figure 2
Figure 2
Forest plot of standardized mean differences in weight for telehealth-based dietary intervention (Int) and usual care (UC) groups [38-40,44].
Figure 3
Figure 3
Forest plot of standardized mean differences in body mass index for telehealth-based dietary intervention (Int) and usual care (UC) groups [35,36,38-40,43].
Figure 4
Figure 4
Forest plot of mean differences in systolic blood pressure for telehealth-based dietary intervention (Int) and usual care (UC) groups [34-37,39-43,45].
Figure 5
Figure 5
Forest plot of mean differences in diastolic blood pressure levels for telehealth-based dietary intervention (Int) and usual care (UC) groups [35,36,39-42,45].
Figure 6
Figure 6
Forest plot of standardized mean differences in total cholesterol levels for telehealth-based dietary intervention (Int) and usual care (UC) groups [35,36,39,40,45,46].
Figure 7
Figure 7
Forest plot of standardized mean differences in low-density lipoprotein cholesterol levels for telehealth-based dietary intervention (Int) and usual care (UC) groups [35,36,39,40,43,45].
Figure 8
Figure 8
Forest plot of standardized mean differences in high-density lipoprotein cholesterol levels for telehealth-based dietary intervention (Int) and usual care (UC) groups [35,36,39,40,44].
Figure 9
Figure 9
Forest plot of standardized mean differences in triglyceride levels for telehealth-based dietary intervention (Int) and usual care (UC) groups [35,39,40].
Figure 10
Figure 10
Forest plot of risk ratio (RR) for feasibility [34-46].
See this image and copyright information in PMC

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