The effectiveness of medical nutrition therapy for people at moderate to high risk of cardiovascular disease in an Australian rural primary care setting: 12-month results from a pragmatic cluster randomised controlled trial.

Anna Jansson, M Com Nutr, Penny Milson, Carissa Alderton, John Attia, Clare E Collins, Megan E Rollo, Jennifer May, Andrew Boyle, Shanthi Ramanathan, Leanne J Brown, Tracy L Schumacher, Christopher Oldmeadow, Erin D Clarke, Jaimee Herbert, Annabelle Williams, Michelle Guppy

Journal: BMC health services research 2025;25(1):956

PMID: 40671037

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Abstract

PURPOSE

To reduce risk of cardiovascular disease (CVD) in adults, as assessed by primary care doctors in rural NSW, Australia. Medical nutrition therapy (MNT) was delivered by Accredited Practicing Dietitians (APDs) using telehealth.

METHODS

The study was a 12-month pragmatic cluster randomised controlled trial. All primary care practices (PCPs) within a large rural region were invited to participate, with enrolled practices stratified based on rurality and practice size. Patients at moderate to high CVD risk were recruited via practices. Usual care (UC) was provided by the patient's general practitioner (GP). In addition to UC, the intervention group received two hours of MNT telehealth (video calls) consultations from an APD during five sessions over 6 months. The primary outcome was total serum cholesterol. Secondary outcomes included LDL cholesterol, triglycerides, blood glucose control, blood pressure, weight and waist circumference. Changes were analysed using Bayesian linear mixed models and posterior probability.

FINDINGS

Sixteen PCPs recruited 132 eligible participants (n = 91 intervention, n = 41 UC), with 79% (72/91) and 80% (33/41) respectively completing a primary or secondary outcome. No significant differences were found between groups for total cholesterol, LDL cholesterol or blood pressure at 12-months. However, the intervention group had significant improvements in blood glucose control (HbA1c: -0.16%, 95%CI: -0.32, -0.01) and decreased body weight (-2.46 kg, 95%CI: -4.54, -0.41) compared to UC at 12-months.

CONCLUSIONS

Results indicate that two hours of MNT delivered by an APD via telehealth is a synergistic adjunct therapy to support the usual care provided by GP, with benefits continuing to 12-months.

Address: Department of Rural Health, College of Health Medicine and Wellbeing, University of Newcastle, Tamworth, NSW, 2340, Australia.; Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.; Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.; School of Health Sciences, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia.; Department of Rural Health, College of Health Medicine and Wellbeing, University of Newcastle, Tamworth, NSW, 2340, Australia.; Data Sciences, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.; School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, WA, 6102, Australia.; Hunter New England Central Coast Primary Health Network, Tamworth, 2340, Australia.; School of Rural Medicine, University of New England, Armidale, NSW, 2350, Australia.; School of Medicine and Public Health, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia.; Heart and Stroke Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.; Department of Cardiovascular Medicine, John Hunter Hospital, Locked bag 1, Newcastle, NSW, 2310, Australia.; School of Medicine and Public Health, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia.; Research Impact Platform, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.; Department of Rural Health, College of Health Medicine and Wellbeing, University of Newcastle, Tamworth, NSW, 2340, Australia.; School of Medicine and Public Health, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia.; School of Medicine and Public Health, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia.; Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia. [email protected].; School of Health Sciences, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia. [email protected].

DOI: 10.1186/s12913-025-13096-8

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MeSH Terms: Humans, Female, Male, Cardiovascular Diseases, Primary Health Care, Middle Aged, Aged, Nutrition Therapy, Telemedicine, New South Wales, Adult, Rural Health Services, Cholesterol, Rural Population