DLM: Medical Nutrition Therapy (2005)
To assess the effects of dietary advice given by a dietitian compared with another health professional, or the use of self-help resources, in reducing blood cholesterol in adults.
Randomised trials of dietary advice given by a dietitian compared with another health professional or self-help resources.
Search history: The Cochrane Library (to Issue 3 2002), the EPOC trial register (October 2002), MEDLINE (1966 to September 2002), EMBASE (1980 to September 2002), Cinahl (1982 to August 2002), Human Nutrition (1991 to 1998), Science Citation Index, Social Sciences Citation Index, hand searched conference proceedings on nutrition and heart disease, and contacted experts in the field.
Quality: Two reviewers independently extracted data and assessed study quality.
The main outcome was difference in blood cholesterol between dietitian groups compared with other intervention groups.
12 studies with 13 comparisons were included
4 studies compared dietitian with doctor, 7 with self-help resources, and only 1 study was found for dietitian versus nurse and dietitian versus counsellor comparisons.
Participants receiving advice from dietitians experienced a greater reduction in blood cholesterol than those receiving advice only from doctors (-0.25 mmol/L (95% CI -0.37, -0.12 mmol/L)).
There was no statistically significant difference in change in blood cholesterol between dietitians and self-help resources (-0.10 mmol/L (95% CI -0.22, 0.03 mmol/L)).
No statistically significant differences were detected for secondary outcome measures between any of the comparisons with the exception of dietitian versus nurse for HDLc, where the dietitian group showed a greater reduction (-0.06 mmol/L (95% CI -0.11, -0.01)) and dietitian versus counsellor for body weight, where the dietitian group showed a greater reduction (-5.80 kg (95% CI -8.91, -2.69 kg)).
Dietitians were better than doctors at lowering blood cholesterol in the short to medium term, but there was no evidence that they were better than self-help resources. There was no evidence that dietitians provided better outcomes than nurses.The results should be interpreted with caution as the studies were not of good quality and the analysis was based on a limited number of trials.
| Government: | Institute of Child Health |
1) According to the inclusion/exclusion criteria papers were not examined for MNT versus other types of counseling and our analysis was for MNT, which includes an individualized approach with at least one follow-up visit
2) Studies of nutritionists were included, which is different from our question that address the effectiveness of MNT given by a registered dietitian that has received education via an ADA accredited program and internship
3) Studies included in the cochrane review were in a variety of individuals, including those with normal cholesterol values, and our analysis was of high-risk individuals
4) Conclusions drawn by authors do not accurately reflect the results
5) Per the authors the, analysis was based on a limited number of studies and studies of not good quality and studies may not have met our inclusion criteria on a drop-out £20%.
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Quality Criteria Checklist: Review Articles
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| Relevance Questions | |||
| 1. | Will the answer if true, have a direct bearing on the health of patients? | Yes | |
| 2. | Is the outcome or topic something that patients/clients/population groups would care about? | Yes | |
| 3. | Is the problem addressed in the review one that is relevant to dietetics practice? | Yes | |
| 4. | Will the information, if true, require a change in practice? | Yes | |
| Validity Questions | |||
| 1. | Was the question for the review clearly focused and appropriate? | Yes | |
| 2. | Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? | Yes | |
| 3. | Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? | ??? | |
| 4. | Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? | Yes | |
| 5. | Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? | No | |
| 6. | Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? | Yes | |
| 7. | Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? | ??? | |
| 8. | Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? | Yes | |
| 9. | Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? | No | |
| 10. | Was bias due to the review's funding or sponsorship unlikely? | Yes | |