Cholesterol-related counseling by registered dietitians in Northern California

Hyman, David J.; Clark, Mia; Houston-Miller, Nancy; Johannsson, Mark; Ghandour, Ghassan; Shah, Raksha; DeBusk, Robert F.

doi:10.1016/0091-7435(92)90081-r

Cited by 5 publications

(3 citation statements)

References 14 publications

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“…In a previous study, postpartum depression was shown to increase the odds of early breastfeeding cessation 28 ; however, early recognition of depressive symptoms and provision of appropriate treatment have been shown to reduce the risk of adverse maternal health outcomes 29 and to increase the likelihood that affected mothers will continue breastfeeding. 30 In addition to the necessary treatment by a physician, other sources of emotional and mental support can help counteract mothers' feelings of frustration and isolation and increase the likelihood that they will continue to breastfeed.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With Exclusive Breastfeeding in the United States

et al. 2011

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OBJECTIVES: To estimate the proportions of US infants who were breastfed exclusively for 6 months, according to characteristics of the mother, child, and household environment, and to compare associations between those characteristics and exclusive breastfeeding with associations between those characteristics and breastfeeding initiation. METHODS: Data were obtained from the 2007 National Survey of Children's Health, a nationally representative, cross-sectional survey. Multivariate logistic regression was used to calculate the adjusted odds ratios for breastfeeding among all infants and for breastfeeding exclusively for 6 months among infants who had initiated breastfeeding. All analyses were limited to children aged 6 months through 5 years for whom breastfeeding data were available (N = 25 197). RESULTS: Of the nearly 75% of children in the study who had ever been breastfed, 16.8% had been breastfed exclusively for 6 months. Non-Hispanic black children were significantly less likely to have ever been breastfed compared with their non-Hispanic white counterparts (adjusted odds ratio: 0.54 [95% confidence interval: 0.44–0.66]). However, no significant differences in the odds of exclusive breastfeeding according to race were observed. Children with birth weights of <1500 g were most likely to have ever been breastfed and least likely to have been breastfed exclusively. Maternal age was significantly associated with exclusive breastfeeding; however, maternal age was not associated with breastfeeding initiation. CONCLUSIONS: In the United States, the prevalence of exclusive breastfeeding for 6 months remains low among those who initiate breastfeeding. Factors associated with breastfeeding exclusively for 6 months differ from those associated with breastfeeding initiation.

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Section: Discussionmentioning

confidence: 99%

Factors Associated With Exclusive Breastfeeding in the United States

et al. 2011

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“…It is estimated that approximately 52 million Americans should receive dietary education, according to the ATP II recommendations 39 . However, physicians often do not counsel or refer patients to dietitians, 9,11,28,40 and when they do, contact with patients is often brief and limited to a single visit 10,30 . It appears to be the norm that physicians have insufficient time to spend on nutrition counseling.…”

Section: Discussionmentioning

confidence: 99%

“…The relative effectiveness of dietary counseling by dietitians, nurses, and physicians remains unclear 6–9 . Studies have demonstrated that only a minority of hypercholesterolemic patients are referred to dietitians by physicians and that most physicians are unable to provide intensive dietary counseling themselves 10–13 . Given that the number of available dietitians is small relative to that of nurses, and that physicians alone may not be able to concentrate on dietary counseling in clinical encounters, the purpose of this study was to determine whether a registered nurse, trained in dietary intervention, could effectively counsel high‐risk individuals to lower their total fat and cholesterol intake.…”

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confidence: 99%

Dietary Counseling for High Blood Cholesterol in Families at Risk of Coronary Disease

Moy

Yanek

Raqueño

et al. 2001

Preventive Cardiology

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A positive family history of coronary heart disease alone confers an increased risk, which may be affected by untreated hypercholesterolemia. Dietary counseling is a first-line treatment approach. To determine whether nurse counseling can provide additional benefits over usual physician efforts to lower dietary fat in high-risk persons, 117 apparently healthy adult siblings of persons with premature coronary heart disease were counseled by a registered nurse using adapted national guidelines. Reductions in total fat, saturated fat, and cholesterol were significantly greater in the nurse group compared to those in the usual care group. Total fat intake decreased by 14 g in the nurse group, compared with an increase of 5 g in the usual care group (p=0.0001). Assignment to the nurse group was also a significant predictor of a greater reduction in the percentage of total fat calories (p=0. H ealthy brothers and sisters of individuals with premature coronary heart disease (CHD) are at a markedly increased risk for developing premature CHD themselves. 1 Clustering of highly prevalent and modifiable CHD risk factors has also been shown in these brothers and sisters, 2-3 as have unhealthy eating behaviors. 4 The National Cholesterol Education Program Adult Treatment Panel II (ATP II) guidelines 5 recommend dietary intervention as the first-line approach in the treatment of hypercholesterolemia. The new ATP III guidelines will probably again place emphasis on the use of dietary interventions as an adjunct to pharmacologic treatment. Physicians are encouraged to provide initial dietary counseling. The guidelines suggest that registered dietitians and qualified nutritionists serve as consultants if initial attempts by primary care providers to alter diet are unsuccessful. The relative effectiveness of dietary counseling by dietitians, nurses, and physicians remains unclear. [6][7][8][9] Studies have demonstrated that only a minority of hypercholesterolemic patients are referred to dietitians by physicians and that most physicians are unable to provide intensive dietary counseling themselves. [10][11][12][13] Given that the number of available dietitians is small relative to that of nurses, and that physicians alone may not be able to concentrate on dietary counseling in clinical encounters, the purpose of this study was to determine whether a registered nurse, trained in dietary intervention, could effectively counsel high-risk individuals to lower their total fat and cholesterol intake. This is important both because of the primary impact of diet and because of the role diet may play in augmenting the efficacy of the statin drugs. In an era when drugs are being increasingly used, effective ways to implement dietary intervention remain important. Thus, we compared nurse counseling with usual care by a physician in healthy, free-living brothers and sisters of persons with premature CHD. This was part of a larger prospective study of coronary disease risk factors in persons with familial-aggregated premature CHD. From 1991Fr...

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