Medical nutrition therapy provided by a dietitian improves outcomes in adults with prehypertension or hypertension: a systematic review and meta-analysis.
Am J Clin Nutr
; 119(6): 1417-1442, 2024 06.
Article
en En
| MEDLINE
| ID: mdl-38641320
ABSTRACT
BACKGROUND:
Hypertension is an important risk factor for cardiovascular disease (CVD). Interventions with dietitians can help modify dietary intake and reduce hypertension risk.OBJECTIVES:
We aimed to examine the following research question In adults with prehypertension or hypertension, what is the effect of medical nutrition therapy (MNT) provided by a dietitian on blood pressure (BP), CVD risk and events, and anthropometrics compared with standard care or no intervention?METHODS:
MEDLINE, CINAHL, and Cochrane Central databases were searched for randomized controlled trials (RCTs) published in peer-reviewed journals from 1985-2022. Risk of bias was assessed using version 2 of the Cochrane tool for RCTs. Meta-analyses were conducted using the DerSimonian-Laird random-effects model. Certainty of evidence (COE) was assessed for each outcome using the Grading of Recommendations, Assessment and Evaluation method.RESULTS:
Forty articles representing 31 RCTs were included and analyzed. MNT provided by a dietitian may reduce systolic [mean difference (MD) -3.63 mmHg; 95% confidence interval (CI) -4.35, -2.91 mmHg] and diastolic (MD -2.02 mmHg; 95% CI -2.56, -1.49 mmHg) BP (P < 0.001) and body weight (MD -1.84 kg; 95% CI -2.72, -0.96 kg; P < 0.001) and improve antihypertensive medication usage, relative risk of stroke (MD 0.34; 95% CI 0.14, 0.81; P = 0.02), and CVD risk score [standardized mean difference (SMD) -0.20; 95% CI -0.30, -0.09; P < 0.001] compared with control participants, and COE was moderate. Additionally, MNT may reduce arterial stiffness (SMD -0.45; 95% CI -0.71, -0.19; P = 0.008) and waist circumference (SMD -1.18 cm; 95% CI -2.00, -0.36; P = 0.04), and COE was low. There was no significant difference in risk of myocardial infarction between groups. Dietitian interventions reduced BP and related cardiovascular outcomes for adults with prehypertension or hypertension.CONCLUSIONS:
Dietitians play a critical role in improving cardiometabolic risk factors for adults with elevated BP; thus, improved payment for and access to MNT services has the potential to significantly impact public health. This review was registered at PROSPERO as CRD42022351693.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Terapia Nutricional
/
Prehipertensión
/
Nutricionistas
/
Hipertensión
Límite:
Adult
/
Humans
Idioma:
En
Revista:
Am J Clin Nutr
Año:
2024
Tipo del documento:
Article
País de afiliación:
Estados Unidos
Pais de publicación:
Estados Unidos