Changing Dietary Patterns in an Ethnically Diverse Group Attending the Imperial Cardiovascular Health Programme
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1 Changing Dietary Patterns in an Ethnically Diverse Group Attending the Imperial Cardiovascular Health Programme Ellis SM, Bovill-Taylor C, Szymula E, Pattni C, Mc Mullen D, and Connolly SB
2 Background Strong evidence supports the use of the Mediterranean Diet in the primary and secondary prevention of CVD (Softi et al 2008, Eustruch et al 2013, De Lorgeril 1999) Diet is included in the BACPR 7 core components
3 Mediterranean Diet Score 1. Is olive oil the main culinary fat used? 14 point assessment tool Developed by Estruch et al for Predimed study Assigned a score of 0 or 1 for according to intake of 14 components Evidence shows a higher score is associated with a lower risk of CVD and all cause mortality (Softi et al 2008) 2. Are 4 tblsp of olive oil used each day? 3. Are 2 servings (of 200g each of vegetables eaten each day? 4. Are 3 servings of fruit (of 80g each) eaten each day? 5. Is < 1 serving ( g) of red meat/hamburgers/ other meat products eaten each day? 6. Is < 1 serving (12g) of butter, margarine or cream eaten each day? 7. Is < 1 serving (330ml) of sweet or sugar sweetened carbonated beverages consumed each day? 8. Are 3 glasses (of 125ml) of wine consumed each week? 9. Are 3 servings (of 150g) of legumes consumed each week? 10. Are 3 servings of fish ( g) or seafood (200g) eaten each week? 11. Is < 3 servings of commercial sweets/pastries eaten each week? 12. Is 1 serving (of 30g) of nuts consumed each week? 13. Is chicken, turkey or rabbit routinely eaten instead of veal, pork, hamburger or sausage? 14. Are pasta, vegetable or rice dishes flavoured with garlic, tomato, leek or onion eaten twice a week?
4 Aim The aim was to assess dietary changes in a diverse ethnic group of patients who attended the Imperial Cardiovascular Health Programme
5 Imperial CV Health Service Programme Multidisciplinary Assessment Dietitian Food Habits MDS BMI WC Nurse Smoking BP, chol, glucose Medications Psychological Health PA Specialist Activity patterns Physical Restrictions Functional Capacity Pedometers Psychologist Behavioural Change Strategy Programme Planning & Individual Goal Setting 8 Week Programme Multidisciplinary Reassessment
6 Activity and Baseline Characteristics No. Patients - Baseline Assessment: n 3232 No. Patients - End of Programme Assessment: n (%) 1521 (47.1) Patients - Male: n (%)* 932 (61.3) Mean Age (SD): years* 64.7 (±9.9) Diagnosis* High CVD Risk (JBS 2 >20%) n (%) Vascular disease: n (%) Ethnicity* White: n (%) S. Asian: n (%) Black: n (%) Arab: n (%) Other: n (%) 970 (63.9) 549 (36.1) 801 (52.7) 186 (12.2) 124 (8.2) 94 (6.2) 316 (20.7) Mean BMI kg/m 2 Mean MDS 7.3 (2.2) * Patients who completed programme
7 Mediterranean Diet Score Mean Mediterranean Diet Score 9 P <0.001 P <0.001 P <0.001 P < Initial Assessment EOP Assessment White S. Asian Black Arab
8 Median Fruit and Vegetables Intake P <0.001 P =0.002 P =0.005 P = ,000 White Asian Black Arab Initial Assessment Final Assessment
9 Median Fish Intake P <0.001 P =0.006 P =0.006 P = White Asian Black Arab Initial Assessment Final Assessment
10 Limitations Data at EOP only Change over short term FU at 1 year shows maintenance of change MDS not validated in ethnic groups (pragmatic approach)
11 Summary A comprehensive cardiovascular health programme that adheres to BACPR Core Components and Minimum Standards can achieve meaningful dietary changes Clinically and statistically significant improvements in MDS, fish and fruit and vegetable in all groups Improvements seen in the 3 principal ethnic groups were in same direction as white patients Key factors were 1. individualised dietary assessment and 2. culturally appropriate tailored advice 3. continuous reinforcement throughout programme (dietician attends the exercise class) and 4. reassessment First data on successful dietary change in a multiethnic cohort of cardiovascular patients in the UK
12 Acknowledgements Judith Edwards - Lead Nurse Imperial Cardiovascular Health Service Imperial Cardiovascular Health Service Team Paul Bassett Statistician Imperial College of London
13 Thanks For Your Attention Any Questions?
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