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Background • A high nutrient density (HND) vegetable-based
diet offers a dietary model extremely low in saturated fat as well
as refi ned carbohydrates and emphasizes a liberal intake of fresh
fruits, vegetables, beans, and nuts. We conducted a retrospective
chart review of patients who came to a family practice offi ce seeking
nutritional counseling for weight loss. All of these patients
were prescribed an HND diet in an extended counseling session
with a family physician.
Methods • A convenience sample (N=56) of all patients seeking
dietary counseling for weight loss from a family practice physician
in a 3-year period was included in the chart review. No personal
identifying data were recorded. The initial counseling sessions
averaged 1 hour in length. Patients were provided with a
sample HND daily meal plan and recipes and with verbal and
written information about the rationale for the diet. Data recorded
from patients’ charts at 6-month intervals for up to 2 years of
follow-up (when available) included weight, blood pressure, total
cholesterol, high-density lipoprotein (HDL) cholesterol, lowdensity
lipoprotein (LDL) cholesterol, triglycerides, and<
cholesterol:HDL ratio. Non-parametric statistical testing using
the Friedman rank order (exact) test for k-related samples was
conducted. A follow-up survey on adherence and medication use
was completed by 38 patients.
Results • Of the 33 patients who returned for follow-up after 1 year, the mean weight loss was 31 lbs(P=.000). Of the 19 patients
who returned
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after 2 years, the mean weight loss was 53 lbs
(P=.000), mean cholesterol fell by 13 points, LDL by 15 points,
triglycerides by 17 points, and cardiac risk ratio dropped from
4.5 to 3.8. Changes in systolic and diastolic blood pressure were
highly signifi cant at all follow-up time intervals (P≤.001). There
was a signifi cant correlation between adherence and degree of
weight loss (P=.011).
Conclusions • Weight loss was sustained in patients who
returned for follow-up and was more substantial in those who
reported good adherence to the recommendations. However,
many patients were lost to follow-up. Favorable changes in lipid
profi le and blood pressure were noted. An HND diet has the
potential to provide sustainable, signifi cant, long-term weight
loss and may provide substantial lowering of cardiac risk in
patients who are motivated and provided with extended one-onone
counseling and follow-up visits. Development of tools to aid
in patient retention is an area for possible further study. Clinical
trials with long-term follow-up are needed to further test the
therapeutic potential and to examine adherence and follow-up
issues related to this dietary approach. An HND diet as demonstrated
with this group may be the most health-favorable and
effective way to lose weight for appropriately motivated patients.
(Altern Ther Health Med. 2008;14(3):48-53.)
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