ADHERENCE TO DIETARY RECOMMENDATIONS IN THE SPECIAL INTERVENTION GROUP IN THE MULTIPLE RISK FACTOR INTERVENTION TRIAL

This chapter presents findings on adherence to the Multiple Risk Facto r Intervention Trial eating pattern by special intervention participan ts, on the basis of measures other than the 24-h dietary recall and bl ood cholesterol concentrations. These additional assessments included subjective ratings by a nutritionist, used during follow-up years 1 an d 2, and a food record rating that was calculated from a 3-d food reco rd, used during years 3-6. An additional tool used during the latter p art of the trial was a checklist for evaluating degree of shortfall of the participant's diet from recommendations, level of motivation towa rd adherence, and factors in the social environment potentially influe ncing dietary behavior. Subjective ratings and food record ratings ind icated that approximate to 40-65% of participants were good or excelle nt adherers, with declines in these percentages over time. There were consistent strong relations between these ratings and change in serum cholesterol. Checklist evaluations gave similar overall findings, with about one-half to three-quarters of participants rated positively on infrequency of deviation from the eating pattern, motivation, and cond ucive environment. Several baseline traits predicted adherence. Adhere nce was better in older participants, in white than in black men, in n ondrinkers, in those with fewer stressful life events, in those eating away from home less often, in less overweight men (although heavier p articipants exhibited greater changes in serum cholesterol, perhaps re flecting their poorer baseline diets), in those with higher serum chol esterol and diastolic blood pressure, and in nonsmokers.