Original paper

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

  • Dietitian delivered structured advice increases adherence to recommended diet and lifestyle changes and lowers low-density lipoprotein (LDL)-cholesterol.
  • Structured advice from a dietitian resulted in the consumption of more servings of foods with added plant sterols both during the study and afterwards when no longer provided.
  • This study demonstrates a beneficial effect on blood lipids of dietary advice including use of food with added plant sterols when individuals are followed up after the intervention has ended.

Although it is well known that a healthy diet and regular exercise are important for cardiovascular health, consumer adherence to lifestyle and dietary change is poor.  A parallel, randomised, placebo-controlled study, set in Athens, Greece, enrolled one hundred participants with hypercholesterolaemia and allocated 50 to a standard physician advice group and 50 to a dietitian group for a structured programme of behavioural change. Both groups were given food with added plant sterols (three servings a day).

At baseline, all individuals had EAS/ESC1 defined borderline to mildly elevated total cholesterol levels of 200-239 mg dL-1 (5.18-6.19 mmol L-1) and were not on any cholesterol-lowering medication nor consuming plant sterols or stanols.

The intervention phase of the study lasted for six weeks and those in the dietitian group benefited from weekly, face-to-face behavioural advice. The physician group received one face-to-face meeting with brief information on cholesterol, plant sterols and information on which foods to avoid or increase.  An additional follow up period of six weeks was included in the study in order to observe any difference between the groups under real-life conditions.  Blood cholesterol levels were measured at baseline, 6 and 12 weeks and 3-day diet diaries were kept at weeks 1, 6 and 12.

Plant sterols were provided to all the study participants for the 6 week intervention period only. They were able to choose from a combination of spreads, milk and yoghurt.

A significant difference in dietary habits, physical activity and increased plant sterols consumption was observed in the group that received structured advice from a dietitian. It is of interest that although at week 6 both groups showed a comparable decrease in LDL-cholesterol levels from baseline it was the dietitian intervention arm only which demonstrated a further significant improvement in LDL-cholesterol (P=0.006) at 12 weeks when compared with the 6 week measure.  Similar results were seen for total cholesterol and triglycerides at week 12. Participants in the dietitian group consumed more plant sterols during the study and purchased more plant sterols for themselves in the follow up period. This indicates that the structured advice delivered by a dietitian was more effective for sustaining a healthy behavioural change and a cholesterol lowering effect.

The dietitian led behavioural intervention sessions included education about:

  • Healthy diet e.g. Mediterranean style diet
  • Understanding food labels
  • Diet and lifestyle plans
  • Goal setting
  • Advice on; dietary fat intake, reducing salt and alcohol, fruit and vegetable consumption, whole grain products and plant sterols/stanols
  • Advice about increasing physical activity
  • General information about cholesterol



  1. Catapano AL, Graham I, De Backer G et al. (2016) 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J 37, 2999-3058.