Effect of the Brazilian Cardioprotective Nutritional Program on the Quality of Life of Atherosclerotic Disease Patients

Abstract Background Cardiovascular diseases (CVD) accounted for 27% of deaths in Brazil in 2017. Most of the recorded deaths caused by CVD would be preventable if patients controlled risk factors including inadequate diet. The Brazilian Cardioprotective Nutritional Program (Dica Br) adapted the Mediterranean diet pattern to Brazilian typical foods and evaluated the effectiveness of a nutritional program based on cardioprotective foods on cardiovascular events and death of patients with cardiovascular diseases. Objectives To evaluate the effect of Dica Br on the QoL of patients with atherosclerotic disease from two health centers in the city of Rio de Janeiro. Method Randomized clinical trial with 273 participants of both sexes, over 45 years old, followed for four years. The intervention group (IG) received individualized dietary prescription, educational program, individual and group consultations, and phone calls. The control group (CG) received general dietary guidance. The SF-36 was used to assess QoL. The Student’s t-test and the Mann-Whitney test was used to compare means between the groups. The mixed model test was used to compare the course of variables over time between the groups. Statistical significance was set at 5%. Result Most patients were male, with an average age of 64.2 ± 8.2 years in the IG and 65±9.5 years in the CG. Most were physically inactive, overweight, and had incomplete elementary school. The most prevalent comorbidity was systemic arterial hypertension, followed by dyslipidemia. QoL improved in both groups at four years. Waist circumference decreased in both groups over time, and low-density lipoprotein cholesterol (LDL-C) levels decreased in the IG but not in the CG after four years of follow-up. Conclusion The cardioprotective diet was effective in reducing LDL-C in the IG, and an improvement in QoL was observed in both intervention and control groups.

摘要 背景
2017年，心血管疾病（Cardiovascular Diseases, CVD）在巴西的死亡构成中占比达27%。若患者能够对包括饮食不当在内的各类危险因素进行有效管控，绝大多数已记录在案的心血管疾病相关死亡本可避免。巴西心脏保护营养计划（Dica Br）将地中海饮食模式适配至巴西本土常见食物，并评估了基于心脏保护食物的营养干预方案对心血管疾病患者心血管事件及死亡结局的影响。

研究目标
本研究旨在评估Dica Br计划对里约热内卢市两家医疗中心动脉粥样硬化疾病患者生存质量（Quality of Life, QoL）的干预效果。

研究方法
本研究为随机对照临床试验，共纳入273名男女受试者，年龄均≥45岁，随访周期为四年。干预组（IG）接受个体化饮食处方、健康教育项目、个体与集体咨询及电话随访指导；对照组（CG）仅获得一般性饮食指导。本研究采用健康调查简表（SF-36）评估受试者的生存质量。组间均数比较采用t检验与曼-惠特尼U检验，组间变量随时间变化的趋势比较则采用混合效应模型检验，设定统计学显著性水平为5%。

研究结果
受试者中多数为男性，干预组（IG）受试者平均年龄为64.2±8.2岁，对照组（CG）为65±9.5岁。多数受试者存在体力活动不足、超重情况，且未完成初等教育。最常见的合并症为系统性动脉高血压，其次为血脂异常。随访四年后，两组受试者的生存质量均有所提升。两组受试者的腰围均随时间呈下降趋势；干预组受试者的低密度脂蛋白胆固醇（Low-Density Lipoprotein Cholesterol, LDL-C）水平在随访四年后显著降低，而对照组受试者该指标未出现明显变化。

研究结论
心脏保护饮食方案可有效降低干预组受试者的低密度脂蛋白胆固醇水平；同时，干预组与对照组患者的生存质量均得到了改善。