Nutrition Counseling

NC: Cardiovascular Disease Risk Factors (2007-2008)

Read more about behavior change theory. 

Cognitive-Behavioral Therapy

• Cardiovascular disease risk factors

• Intervention
  What is the evidence that cognitive-behavioral therapy, of short duration (< 6 months) targeted to reduce cardiovascular disease risk factors, results in health/food behavior change in adults counseled in an outpatient/clinic setting?

  • Conclusion

    In two small research studies, one RCT and one non-randomized trial of neutral quality, cognitive-behavioral therapy (CBT) of short duration (eight-weeks) targeted to reduce cardiovascular disease risk factors was shown to produce modest, but significant reductions in a variety of cardiovascular risk factors. In one study, researchers found cognitive-behavioral therapy significantly reduced weight, body fat, and changed regional body composition in both men and women, and reduced leptin level in women, and serum cholesterol in men. In the other study, researchers found CBT reduced serum cholesterol levels in both men and women.

     

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Short Duration Cognitive-Behavioral Therapy for CVD risk factors
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Sebregts E, Falger P, Bär F, Kester A, Appels A. Cholesterol changes in coronary patients after a short behavior modification program. International Journal of Behavioral Medicine. 2003; 10 (4): 315-330.
      • Volek JS, Gómez AL, Love DM, Weyers AM, Hesslink R Jr, Wise JA, Kraemer WJ. Effects of an eight-week weight-loss program on cardiovascular disease risk factors and regional body composition. European Journal of Clinical Nutrition, 2002, 56; 585-592. 
  • Search Plan and Results: NC: Counseling Theories 2007
     
  What is the evidence that cognitive-behavioral therapy of intermediate duration (six to 12 months), targeted to reduce cardiovascular disease risk factors, results in health or food behavior change in adults counseled in an outpatient or clinic setting?

  • Conclusion

    Two positive-quality and one neutral-quality RCT evaluated the effect of weight-reduction programs with a behavioral component on reducing cardiovascular risk factors in middle-aged subjects. These researchers found behavioral therapy was significantly more effective in facilitating weight loss, beneficial change in diet and exercise habits, decreasing triglyceride levels, increasing HDL-cholesterol in men and women and decreasing systolic blood pressure in women. Additional studies with more intense, validated behavioral components should be conducted to assess optimal outcomes achievable.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Intermediate Duration Cognitive-Behavioral Therapy to reduce CVD factors
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Jalkanen L. The effect of a weight reduction program on cardiovascular risk factors among overweight hypertensives in primary health care. Scand J Soc Med. 1991 March; 19 (1): 66-71.
      • Karvetti RL, Hakala P. A seven-year follow-up of a weight reduction programme in Finnish primary health care. Eur J Clin Nutr. 1992; 46 (10): 743-752.
      • Lovibond SH, Birrell PC, Langeluddecke P. Changing coronary heart disease risk-factor status: The effects of three behavioral programs. J Behav. Med. 1986 October; 9 (5): 415-437.
  • Search Plan and Results: NC: Counseling Theories 2007
     
  What is the evidence that cognitive-behavioral therapy conducted over a 12-month or longer time frame, targeted to reduce cardiovascular disease risk factors, results in health or food behavior change in adults counseled in an outpatient or clinic setting?

  • Conclusion

    Four large positive-quality RCTs provide evidence that cognitive-behavioral therapy of greater than 18-months' duration is beneficial in facilitating modification of dietary habits, weight and cardiovascular risk factors.
    

  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Long-Duration Cognitive-Behavioral Therapy for CVD Risk Factors
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Elmer P, Obarzanek E, Vollmer W, Simons-Morton D, Stevens V, Young D, Lin P, Champagne C, Harsha D, Svetkey L, Ard J, Brantley P, Proschan M, Erlinger T, Appel L. Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial. Ann Intern Med. 2006 April 4; 144 (7): 485-495.
      • Howard B, Van Horn L, Hsia J, Manson J, Stefanick M, Wassertheil-Smoller S, Kuller L, LaCroix A, Langer R, Lasser N, Lewis C, Limacher M, Margolis K, Mysiw W, Ockene J, Parker L, Perri M, Phillips L, Prentice R, Robbins J, Rossouw J, Sarto G, Schatz I, Snetselaar L, Stevens V, et al. Low-fat dietary pattern and risk of cardiovascular disease: The Women's Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. 2006 February 8; 295 (6): 655-666.
      • Kuller LH, Simkin-Silverman LR, Wing RR, Meilahn EN, Ives DG. Women's Healthy Lifestyle Project: A randomized clinical trial: results at 54 months. Circulation 2001 Jan 2; 103 (1): 32-37.
      • Stevens VJ, Obarzanek E, Cook NR, Lee IM, Appel LJ, West DS, Milas NC, Mattfeldt-Beman M, Belden L, Bragg C, Millstone M, Racynski J, Brewer A, Singh B, Cohen J. Long-term weight loss and changes in blood pressure: Results of the trials of hypertension prevention, phase II. Annals of Internal Medicine, 2001; 134: 1-11. 
  • Search Plan and Results: NC: Counseling Theories 2007