NUTRITION INTERVENTION PROGRAM OF THE MODIFICATION OF DIET IN RENAL-DISEASE STUDY - A SELF-MANAGEMENT APPROACH

Objective To characterize the Modification of Diet in Renal Disease (M DRD) Study nutrition intervention program by determining the frequency of intervention strategies used by the dietitians and the usefulness of program components as rated by participants. Design Dietitians reco rded which of 32 intervention strategies they used at each monthly vis it. Participants rated the usefulness of 19 program components. Subjec ts 840 adults with renal insufficiency. Intervention Participants were assigned randomly to usual-, low-, or very-low-protein diet groups. E ach eating pattern also specified a phosphorus intake goal. Each parti cipant met monthly with a dietitian for an average of 26 months.Statis tical analyses Analyses of variance and chi(2) analyses. Results Dieti tians used the following intervention strategies most often in all gro ups: providing feedback based on self-monitoring and/or food records, reviewing adherence or biochemistry data, providing low-protein foods, and reviewing graphs of adherence progress. In general, the dietitian s used feedback, modeling, and support strategies more often, and know ledge and skills strategies less often, with participants who had to m ake the greatest reductions in protein intake and those with more adva nced disease. In all groups, the dietitians' use of knowledge and skil ls, feedback, and modeling strategies decreased over time (P < .001), whereas use of support strategies was maintained. The type and frequen cy of intervention strategies used by dietitians and the usefulness ra tings of participants did not vary by educational level of the partici pant. Both self-monitoring and dietitian support were rated as ''very useful'' by 88% of the participants. Conclusions Three features were c entral to the MDRD Study nutrition intervention program: feedback, par ticularly from self-monitoring and from measures of adherence; modelin g, particularly by providing low-protein food products; and dietitian support. We recommend the self-management approach.