Introduction Cardiovascular disease (CVD) continues to be the main cause of death in Europe. Culture strongly influences attitudes and behaviours towards diet and evidence suggests that lifestyle counselling is a greater challenge when there are cultural differences.
Null hypothesis Baseline cultural dietary habits have no effect on the attainment of preventive cardiovascular dietary targets in patients with coronary heart disease who receive usual care (UC) or an intervention programme (INT).
Methods This post-hoc analysis of the EUROACTION study used data obtained from patients with coronary heart disease in six matched, cluster-randomised hospitals in six European countries. This particular study looked at the impact of having a trained dietician delivering culturally adapted health promotion interventions. Data from 1,751 UC patients and 1,587 INT patients were analysed using Stata 13. The proportion of participants achieving particular dietary targets and outcomes at one year was compared to baseline data.
Results Countries which had a low proportion meeting targets for cardioprotective foods appeared to do less well, particularly in the context of UC. Poland, Spain and Sweden had a low median intake of fruit at baseline. In UC, only 35%, 18%, and 29% of participants attained the target. None of these three usual care hospitals had a statistically significant increase in the proportion achieving the target intake.
Countries with a high proportion consuming foods likely to have a deleterious effect on cardiovascular risk profile did less well, particularly in the context of UC. Spain had the highest consumption of sugar-sweetened beverages i.e. 67% in UC and 54% in INT. Consumption fell by just 5% in UC (p = 0.2969). In contrast, consumption fell by 44% in INT (p = 0.0001).
Conclusions It is possible to reject the null hypothesis. The use of a culturally sensitive approach to changing behaviour is likely to partly explain why INT was more effective than UC in changing behaviour. Moreover, this is particularly true in the context of changing behaviour in populations with high levels of specific refractory cultural dietary patterns.
- dietary intervetion
- secondary prevention
- euroaction study
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