Behavioral Counseling Promotes Diet Quality and Reduces Cardiovascular Risk Factors in Residents of Rural Appalachia

Introduction: Kentucky consistently ranks in the top ten for worst health outcomes in the U.S. Fifty four Kentucky counties are in Appalachia, the region with the nation’s worst social, environmental and health conditions. U.S. Preventive Services Task Force recommends that adults who are overweight or obese and have additional cardiovascular disease (CVD) risk factors be offered intensive behavioral counseling that includes a healthy diet to promote CVD prevention.

Purpose: To investigate whether an intensive self-management intervention for CVD risk reduction (HeartHealth) improved diet quality and risk factors in persons living in rural Appalachian Kentucky.

Methods: A sample of 719 adults (age 53±14 years, 74% female, 43±19 years living in Kentucky, 87% overweight or obese) with two or more CVD risk were enrolled in the 12-week HeartHealth intervention that included strategies to improve diet to promote CVD risk reduction. Diet quality was measured by healthy eating index (HEI) calculated from food frequency questionnaires with higher HEI score indicating more healthy diets. The intervention was delivered in small groups using culturally appropriate approaches. Paired t-tests were used to compare HEI scores and CVD risk factors pre- and post-intervention.

Results: HEI total score increased 8% from 63.3±11.6 to 68.5±11.4 (p<0.005). HEI scores for total fruit; whole fruit; total vegetable; legumes, orange and dark green vegetables; whole grain; and milk increased by 31%, 28%, 7%, 20%, 15%, and 3% ,respectively, post intervention when compared to the baseline (p<0.05). Diet quality for saturated fat; and calories from solid fats, alcoholic beverages and added sugar also improved by 28% and 12%, respectively (p<0.005). Total cholesterol, systolic blood pressure, and hemoglobin A1C levels decreased from 191.8±37.8 to 187.5±36.9 mg/dL, 128.7±16.4 to 125.2±15.6 mmHg, and 5.77±0.96 to 5.70±0.90 %, respectively (p<0.005).

Conclusion: An intensive behavioral counseling intervention promoted a healthy diet and reduced CVD risk in overweight or obese adults living in a rural socioeconomically distressed environment.