Counseling to Promote a Healthy Diet in Adults: Summary of the Evidence

Table 2. Counseling to Increase Intake of Fruit or Vegetables: Study Descriptions

Author Year	Sample Population	Level of Risk	Baseline Patient Numbers	Retention Rate	Setting	Intervention and Control Group Counseling Provider and Resources	Intensity
Campbell et al., 1994¹² Tailored msg vs. control	Adult men and women of family practices: 2 urban and 2 rural in North Carolina, USA	Unselected	Intv: NR Cont: NR	82%	Mailings and computer-generated messages	Intv: Self-administered surveys in office delivered by staff; messages mailed home Cont: self-administered surveys only; no messages	Low
Coates et al., 1999¹³	Post-menopausal in research clinics of Women's Health Trial 28% black, 16% Hispanic	At risk	Intv: 1,324 Cont: 883	75% to 85%	Research clinic	Intv: RD-delivered group sessions weekly x 6 weeks, biweekly x 6 weeks, monthly x 9 months Cont: given Dietary Guidelines for Americans; no counseling	High
Delichatsios, Friedman et al., 2001¹⁴	Adult men and women in a large multisite, multi-specialty group practice—Harvard Vanguard Medical Associates in Massachusetts, USA; 72% women, 45% white, 45% black	Unselected	NR	NR	Mailings and computer-generated messages: home	Intv: weekly diet-related educational feedback, advice, and behavioral counseling for 5-7 minutes by a totally automated, telephone-linked computer-based voice communication system Cont: weekly physical activity-related educational feedback, advice, and behavioral counseling for 5-7 minutes by a totally automated, telephone-linked computer-based voice communication system	Medium
Delichatsios, Hunt et al., 2001¹⁵	Adult men and women patients from 6 group HMO practices in the primary care research network of Harvard Pilgrim HealthCare, Massachusetts, USA	Unselected	Intv: 230 Cont: 274	Intv: 85% Cont: 92%	Mailings and computer-generated messages	Intv: mailed personalized dietary recommendations and 2 educational booklets; endorsement by 1 hour-trained MD or NP; 2 motivational phone counseling sessions by trained MPH student telephone counselors. RD consultation if needed. Cont: NR	Medium
Knutsen and Knutsen, 1991²¹	Adult men at increased risk for CVD and their families Tromso, Norway	At risk	2,838	39%	Research clinic	Intv: MD or RD each made 1 home visit for CHD risk factor counseling and diet assessment and counseling Cont: NR	Medium
Kristal et al., 2000²²	Adult men and women enrollees of Group Health Cooperative of Puget Sound HMO, Washington, USA	Unselected	Intv: 729 Cont: 730	86.5%	Mailings and computer-generated messages	Intv: self-help materials, dietary analysis with behavioral feedback, and semi-monthly newsletters mailed home; trained health educator-delivered motivational phone call Cont: usual care - no intervention	Medium
Lutz et al., 1999³¹ Tailored msg w/ goal vs. control	Adult men and women	Unselected	Intv: 177 Cont: 180	81%	Mailings and computer-generated messages	Intv: self-administered assessment mailed home; tailored messages were mailed home Cont: no newsletter	Low
Maskarinec et al., 1999³²	Healthy adult women over age 35 consuming less than 5 servings of fruit and vegetables daily in a study center Hawaii, USA	Unselected	Intv: 13 Cont: 16	88%	Research clinic	Intv: RD delivered monthly counseling sessions (1st 2 individual, next 3 group) with phone F/U as needed to increase fruits and vegetables Cont: RD delivered general healthy eating counseling based on the USDA Dietary Guidelines	High
Roderick et al., 1997²⁸	Adult men and women with hypercholesterolemia in general practice from 4 regions, United Kingdom	Unselected	Intv: 473 Cont: 483	Intv: 86% Cont: 74%	Primary care	Intv: RNs on-site (trained for intv by RD) delivered dietary assessment, advice and F/U Cont: standard health education materials	Small
Siero et al., 2000³³ Group education and tailored msg vs. control	Low income adult men and women at increased risk for CVD in primary care practices and at home, The Netherlands	At risk	Intv: NR Cont: NR	NR	Research clinic	Intv: messages were mailed home; group sessions 2 hr each led by group instructor, not otherwise specified Cont: received printed leaflet with the Dutch nutritional guidelines	High

Note: Cont indicates control; F/U, followup; Intv, intervention; msg, message; NP, nurse practitioner; NR, not reported; RD, registered dietician; RN, registered nurse.

Table 2. Counseling to Increase Intake of Fruit or Vegetables: Study Outcomes

Author Year	Main Outcome	Baseline Values	Duration of Followup	Final Followup Values	Change from Baseline to Final Followup	Net Difference in Change^a or Difference at Final Followup	P-value	Relative Change^b	Effect Size
Campbell et al., 1994¹² Tailored msg vs. control	Servings of fruit and vegetables per day	Intv: 3.6 Cont: 3.6	4 mo	Intv: 3.3 Cont: 3.3	Intv: -0.3 Cont: -0.3	0 servings	P = 0. 817	0%	Small
Coates et al., 1999¹³	Servings of fruit per day	Intv: 1.53 Cont: 1.52	18 mo	NR	Intv: +0.54 Cont: +0.02	0.53 servings	NR	35%	Medium
Coates et al., 1999¹³	Servings of vegetables per day	Intv: 1.62 Cont: 1.65	18 mo	NR	Intv: +0.35 Cont: +0.08	0.27 servings	NR	16%	Medium
Delichatsios, Friedman et al., 2001¹⁴	Combined fruits and vegetables	Intv: 6.6 Cont: 5.9	6 mo	Intv: 7.7 Cont: 5.6	Intv: +1.1 Cont: -0.3	1.4 servings	NR	24%	Large
Delichatsios, Hunt et al., 2001¹⁵	Servings of fruit and vegetables per day	Intv: 2.9 Cont: 3.3	Intv: 2.9 Cont: 3.3	Intv: 4.0 Cont: 3.7	Intv: +1.1 Cont: +0.4	0.7 servings	NR	21%	Medium
Knutsen and Knutsen, 1991²¹	% of subjects eating > 4 fruits per week	NR	6 yrs	Intv: 43% Cont: 39%	NR	4%	NR	NA	Small
Knutsen and Knutsen, 1991²¹	% of subjects eating vegetables with dinner	NR	NR	Intv: 51% Cont: 53%	NR	2%	NR	NA	Small
Kristal et al., 2000²²	Servings of fruit and vegetables per day	Intv: 3.62 Cont: 3.47	12 mo	Intv: 4.09 Cont: 3.61	Intv: +0.47 Cont: +0.14	0.33 servings	P < 0.001	10%	Medium
Lutz et al., 1999³¹ Tailored msg w/ goal vs. control	Mean servings of fruits and vegetables per day	Intv: 3.5 Cont: 3.5	6 mo	Intv: 4.4 Cont: 3.6	Intv: +0.9 Cont: +0.1	0.8 servings	P < 0.002	23%	Medium
Maskarinec et al., 1999³²	Servings of fruit and vegetables per day	Intv: 3.2 Cont: 3.3	6 mo	Intv: 7.4 Cont: 4.1	Intv: 4.2 Cont: 0.8	3.4 servings	P = 0.0001	100%	Large
Roderick et al., 1997²⁸	Servings of fruit and vegetables per week	NR	12 mo	NR	Intv: 1.09 Cont: 0.03	0.94 servings	NR	NA	Medium
Siero et al., 2000³³ Group education and tailored msg vs. control	Fruits and vegetables grams/day	Intv: 426 g Cont: 416 g	16 wks	Intv: 494 g Cont: 395 g	Intv: +68g Cont: -21 g	+99 g	NR	24%	Medium

^aBaseline minus followup value for the intervention group minus baseline minus followup value for the control group.
^bAbsolute change in the intervention group from baseline to followup divided by the baseline value of the control group.

Note: Cont indicates control; Intv, intervention; msg, message; NA, not available; NR, not reported.

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