Outcomes of a cardiovascular nutrition counseling program in African-Americans with elevated blood pressure or cholesterol level

Objective To evaluate a cardiovascular nutrition education package designed for African-American adults with a nide range of Literacy skills. Design Comparison of a self-help group and a full-instruction group; each g roup received nutrition counseling and clinical monitoring every 4 months. Subjects Three hundred thirty African-American adults, aged 40 to 70 years, with elevated cholesterol level or high blood pressure were randomly assig ned to the self-help or full-instruction group; 255 completed the 12-month follow-up. Interventions Counseling to reduce intake of dietary fat, cholesterol, and sodium was based on Cardiovascular Dietary Education System (CARDES) materi als, which included food-picture cards, a nutrition guide (self-help and fu ll-instruction group), a video and audiotape series, and 4 classes (full-in struction group only). Main outcome measures Changes in Lipid levels and blood pressure after 12 m onths. Statistical analyses performed Primary analyses consisted of repeated-measu res analysis of variance to examine effects of time and randomization group on outcomes. Results Total cholesterol and low-density lipoprotein cholesterol level dec reased by 7% to 8% in the self-help and full-instruction groups of men and women (P<.01). The ratio of total cholesterol to high-density Lipoprotein c holesterol (HDL-C) decreased in both groups of women and in the men in the full-instruction group (P<.01). In full-instruction and self-help participa nts with elevated blood pressure at baseline, systolic blood pressure decre ased by 7 to 11 mm Hg and diastolic blood pressure decreased by 4 to 7 mm H g (P<.01). Outcomes did not differ by literacy scores but were positively r elated to the reported initial frequency of using CARDES materials. Applications/conclusions These results suggest that periodic nutrition coun seling based on CARDES materials used for home study can enhance management of lipid levels and blood pressure in African-American outpatients.