COMPUTER-ASSISTED DIETARY MANAGEMENT OF HYPERLIPIDEMIA

4千万美国人的最佳营养管理 严重的高脂血症需要有效、廉价和广泛的治疗， 可用的方法。 调查人员先前已经证明， 计算机辅助营养干预（Computer-Assisted Nutrition Intervention） 学习系统，CALS）降低血浆胆固醇。 拟议 研究比较了3种不同强度干预措施的效果： 1)一本营养手册，2）手册加CALS和3）手册 加CALS加补充营养咨询和随访电话 联系人. 在随机化之前，所有3组均接受简短， 初级保健医生关于临床的标准化指导 高脂血症营养管理重要性 CALS使用数据 从基线时完成的食物频率问卷（FFQ）获得 在第3周和第7周。FFQ响应直接计算机生成 在第4周和第8周打印个性化进度报告， 营养目标和实现这些目标的进展的明确反馈。 FFQ和进度报告通过邮件发送;患者不 与电脑互动。 30-69岁男女共750人 在两个旧金山弗朗西斯科湾接受护理的是凯撒永久（K- P）血浆胆固醇值对多相健康的医学中心 评估需要NCEP标准的医疗监督营养 干预将被随机化，3组各250人。 主 结果测量是血浆LDL胆固醇，在12、24和48 周 血浆LDL胆固醇降低10 mg/dl或更高， 被认为具有临床重要性。 样本量设定为足以产生 检测任何一对干预之间的这种差异的能力。 的 研究的主要目的是确定CALS的疗效， 通常的照顾。医生咨询加阅读疗法（第1组与 2)以及CALS的功效进一步增强的程度B 营养师介导的咨询（第2组与第3组）。 CALS可以帮助 将患者分为三组：1.那些血浆低密度脂蛋白胆固醇 2.减少对营养变化的反应;那些血浆低密度脂蛋白 胆固醇不会因营养变化而降低; 3. 那些没有明显改变饮食的人。取决于其他 冠状动脉危险因素，这三组患者可能需要无 进一步治疗，降脂药物或营养学家介导 咨询，分别。 人均费用低， 可用性和便利性可能会刺激数百万人采用它 高脂血症的美国人目前没有接受， 不太可能接受营养师的咨询。 此外，CALS 可以帮助确定最需要营养师介导的患者 辅导 使用CALS的未来研究可以解决以下问题的有效性： 不同患者人群和医疗保健提供环境中的CALS 以及长期维持营养变化。

Optimal nutritional management of the 40 million Americans with significant hyperlipidemia requires efficient, inexpensive and widely available methods. The investigators have previously demonstrated the efficacy of a computerized nutritional intervention, (Computer-Assisted Learning System, CALS) in reducing plasma cholesterol. The proposed research compared the efficacy of 3 interventions of graded intensity: 1) a nutritional manual alone, 2) the manual plus CALS and 3) the manual plus CALS plus supplemental nutritional counseling and followup telephone contacts. Prior to randomization, all 3 groups received brief, standardized instruction from primary care physicians about the clinical importance of nutritional management of hyperlipidemia. CALS uses data obtained form food frequency questionnaire (FFQ) , completed at baseline and at 3 and 7 weeks. FFQ responses direct the computer generation of printed individualized progress reports at 4 and 8 weeks that provide nutritional goals and explicit feedback of progress toward these goals. FFQ and progress reports are sent through the mail; patients do not interact with the computer. A total of 750 men and women aged 30-69 receiving care in two San Francisco Bay are Kaiser-Permanente (K- P)Medical Center whose plasma cholesterol values on multiphasic health evaluation need NCEP criteria for medically-supervised nutritional intervention will be randomized, 250 to each of 3 groups. The primary outcome measure is plasma LDL cholesterol, measured at 12, 24 and 48 weeks. A 10 mg/dl or greater reduction in plasma LDL cholesterol is considered clinically important. Sample size is set to yield sufficient power to detect such a difference between any pair of interventions. The primary aim of the study is to determine the efficacy of CALS compared to usual care ie. physician counseling plus bibliotherapy (group 1 versus 2) and the extent to which the efficacy of CALS is further enhanced b nutritionist-mediated counseling (group 2 versus 3). CALS could help to triage patients into three groups: 1. those whose plasma LDL cholesterol decreases in response to nutritional change, 2. those whose plasma LDL cholesterol does not decrease in response to nutritional change and 3. those who have not changed their diets significantly. Depending on other coronary risk factors, patients in these three groups may required no further therapy, lipid-lowering drugs or nutritionist-mediated counseling, respectively. CALS; low cost of $ per person and its wide availability and convenience could spur its adoption by millions of hyperlipidemia Americans who are not presently receiving, and are unlikely to receive, nutritionist-mediated counseling. Moreover, CALS could help to identify patients most in need of nutritionist-mediated counseling. Future studies using CALS can address the effectiveness of CALS in different patient populations and health care delivery settings and the long-term maintenance of nutritional change.