The effects of 6 months dietary counseling on diet quality and cardiovascular risk profile in patients with cardiovascular disease: A randomized controlled trial

Background & aims: A healthy diet improves cardiovascular disease (CVD) risk factors. However, dietary counseling is not yet widely implemented in health care for patients with CVD. We assessed how dietary counseling by a dietitian, focused on improving diet quality, influenced the cardiovascular risk profile of patients with CVD. Methods: In this 6-month trial, 124 patients with CVD (68.1 ± 9.5 years, 72 % men) were randomly assigned to counseling by a dietitian (n = 63) or usual care (n = 61). Difference in cardiovascular risk profile between groups was assessed with a 10-year composite cardiovascular risk prediction score including changes in blood pressure and low-density lipoprotein cholesterol (LDL-C). Secondary outcomes included adherence to a healthy diet as assessed with the Dutch Healthy Eating Index-2015 (DHD15-index), individual risk factors (LDL-C, blood pressure, body weight, and high-sensitivity C-reactive protein [hs-CRP]) as well as depressive symptoms and optimism scores. Results: DHD15-index at baseline was 103 ± 18 out of 160 and increased 5.7 points more in the dietary counseling group compared to the usual care group (95 % confidence interval (CI): 1.3; 10.1). Multivariate analysis revealed no statistically significant differences in changes over time in 10-year cardiovascular risk score (0.6 %, 95%CI: −4.1 %; 5.3 %), blood pressure (−2 mmHg, 95%CI: −7; 4), LDL-C (0.0 mmol/l, 95%CI: 0.2; 0.2), body weight (−0.7 kg, 95%CI: −2.9; 1.5), hs-CRP (0.71 mg/dl, 95%CI: −1.20; 2.62) or depressive symptoms and optimism scores between groups. Conclusions: Dietary counseling for patients with CVD for 6 months only slightly improved adherence to a healthy diet in patients with established CVD and did not result in substantial improvement in cardiovascular risk profile or depressive symptoms and optimism scores. Clinical trial registration: This trial was registered at www.clinicaltrials.gov/study/NCT05071092.