Structured advice provided by a dietitian increases
adherence of consumers to diet and lifestyle changes and
lowers blood low-density lipoprotein (LDL)-cholesterol: the
Increasing Adherence of Consumers to Diet & Lifestyle
Changes to Lower (LDL) Cholesterol (ACT) randomised
T. E. Sialvera,
S. P. Efstathiou,
E. A. Trautwein,
R. T. Ras,
& A. Zampelas
Department of Food Science and Human Nutrition, School of Food, Biotechnology and Development, Agricultural University of Athens, Athens,
Center for Cardiovascular Disease Prevention, Hygeias Melathron Inﬁrmary, Athens, Greece
Unilever R&D, Vlaardingen, The Netherlands
Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
Department of Cardiology, Euroclinic, Athens, Greece
Errikos Dunant, Hospital Centre, Athens, Greece
dietary advice, adherence, lifestyle behaviours,
blood cholesterol, plant sterols.
A. Zampelas, Department of Food Science and
Human Nutrition, School of Food, Biotechnology
and Development, Agricultural University of
Athens, Athens, Greece.
Tel.: +30 210 529 4701
Fax: +30 210 529 4701
How to cite this article
Sialvera T.E., Papadopoulou A., Efstathiou S.P.,
Trautwein E.A., Ras R.T., Kollia N., Farajian P.,
Goumas G., Dimakopoulos I., Papavasiliou K.,
Koutsouri A. & Zampelas A. (2018) Structured
advice provided by a dietitian increases adherence
of consumers to diet and lifestyle changes and
lowers blood low-density lipoprotein (LDL)-
cholesterol: the Increasing Adherence of
Consumers to Diet & Lifestyle Changes to Lower
(LDL) Cholesterol (ACT) randomised controlled
trial. J Hum Nutr Diet. 31, 197–208
Background: Evidence from healthcare professionals suggest that consumer
compliance to healthy diet and lifestyle changes is often poor. The present
study investigated the effect of advice provided by a physician or dietitian
on consumer adherence to these measures combined with consuming foods
with added plant sterols (PS) with the aim of lowering low-density lipopro-
tein cholesterol (LDL-C).
Methods: One hundred mildly-to-moderately hypercholesterolaemic indi-
viduals were enrolled into a parallel, randomised, placebo-controlled study.
Dietitians (dietitian group; DG) advised 50 individuals in six weekly face-
to-face behavioural therapy sessions, whereas the other 50 received standard
advice from physicians (physician group, PG). Both groups consumed foods
with added PS (three servings a day) for 6 weeks. Subsequently, all individ-
uals were followed-up for another 6 weeks under real-life conditions. Blood
lipids were measured at baseline and weeks 6 and 12 and 3-day diet diaries
were taken at weeks 1, 6 and 12.
Results: Individuals in the DG signiﬁcantly improved their dietary habits,
physical activity and increased PS intake compared to the PG. After
6 weeks, LDL-C decreased in both groups compared to baseline without
any signiﬁcant differences between groups. At week 12, LDL-C was further
signiﬁcantly improved only in the DG (P = 0.006) compared to week 6.
Total cholesterol, LDL-C and triglycerides were signiﬁcantly lower in the
DG compared to the PG at week 12 after adjusting for levels at week 6
(P < 0.001, P < 0.001 and P = 0.009, respectively).
Conclusions: Although structured counselling by dietitians and common
standard advice by physicians were equally effective with respect to
ª 2017 The British Dietetic Association Ltd.
Journal of Human Nutrition and Dietetics