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Participants' willingness to consume soy foods for lowering cholesterol and receive counselling on cardiovascular disease by nutrition professionals

Published online by Cambridge University Press:  02 January 2007

Tamara Schryver
Affiliation:
Department of Food Science & Nutrition, University of Minnesota, 1334 Eckles Avenue, St. Paul, MN 55108, USA
Chery Smith*
Affiliation:
Department of Food Science & Nutrition, University of Minnesota, 1334 Eckles Avenue, St. Paul, MN 55108, USA
*
*corresponding author: Email [email protected]
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Abstract

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Objectives

To determine if participants would be interested in consuming soy foods to lower cholesterol in primary and secondary prevention of heart disease, and to identify the role physicians and registered dietitians have in providing dietary advice, about soy foods or other foods, for participants with elevated cholesterol.

Methodology

Qualitative data from 12 focus groups were gathered from a convenience sample of 74 adults, aged 18–91 years, with and without high cholesterol (total cholesterol >200 mg dl−1). Participants were recruited from Minneapolis/St. Paul mainstream and natural foods grocery stores. Focus group interviews were taped and transcribed verbatim. Common themes were identified, coded and compared using NVivo computer software.

Results

Participants believed diet, lifestyle and genetics were the cause of high cholesterol and cardiovascular disease (CVD). Few participants were aware of the Food and Drug Administration health claim for soy protein, yet many were willing to consume soy as part of lifestyle modification to prevent CVD. They reported preferring food and exercise over medication to treat high cholesterol. Few participants had ever received dietary advice from physicians on treating high cholesterol or CVD, and most doubted the accuracy of such advice. They believed registered dietitians were the most credible source of nutrition counselling and expressed an interest in physician referrals to dietitians.

Conclusions

A collaboration and referral system between physicians and registered dietitians could increase CVD patients' consumption of soy foods as a means potentially leading to a reduced risk of heart disease in participants.

Type
Research Article
Copyright
Copyright © The Authors 2006

References

1 American Heart Association (AHA). Heart Disease and Stroke Statistics – 2004 Update. Dallas, TX: AHA, 2004; Also available at http://www.americanheart.org/presenter. jhtml?identifier=3000090. Accessed 29 June 2004.Google Scholar
2Schaefer, EJ. Lipoproteins, nutrition, and heart disease. American Journal of Clinical Nutrition 2002; 75: 191212.CrossRefGoogle ScholarPubMed
3Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Journal of the American Medical Association 2001; 285: 2486–97.CrossRefGoogle Scholar
4Hu, FB, Willett, WC. Optimal diets for prevention of coronary heart disease. Journal of the American Medical Association 2002; 288: 2569–78.CrossRefGoogle ScholarPubMed
5Ornish, D, Scherwitz, LW, Billings, JH, Brown, SE, Gould, KL, Merritt, TA, et al. Intensive lifestyle changes for reversal of coronary heart disease. Journal of the American Medical Association 1998; 280: 2001–7.CrossRefGoogle ScholarPubMed
6National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Final Report. NIH Publication No. 02-5215. Washington, DC: National Cholesterol Education Program, National Heart, Lung, and Blood Institute, National Institutes of Health, 2002.Google Scholar
7Eidelman, RS, Lamas, GA. The new National Cholesterol Education Program guidelines: clinical challenges for more widespread therapy of lipids to treat and prevent coronary heart disease. Archives of Internal Medicine 2002; 162: 2033–6.CrossRefGoogle ScholarPubMed
8McKenney, JM. New cholesterol guidelines, new treatment challenges. Pharmacotherapy 2002; 22: 853–63.CrossRefGoogle ScholarPubMed
9Davidson, MH. Strategies to improve Adult Treatment Panel III guidelines adherence and patient compliance. American Journal of Cardiology 2002; 89: 8C22C.CrossRefGoogle ScholarPubMed
10Grundy, SM, Cleeman, JI, Bairey Merz, CNBrewer, HB Jr, Hunninghake, D, Posternack, RC. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004; 110: 227–39.CrossRefGoogle ScholarPubMed
11Krauss, RM, Eckel, RH, Howard, B, Appel, LJ, Daniels, SR, Deckelbaum, RJ, et al. AHA Dietary Guidelines Revision 2000: a statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation 2000; 102: 2284–99.CrossRefGoogle ScholarPubMed
12Food and Drug Administration. Food Labeling: Health Claims; Soy Protein and Coronary Heart Disease. Washington, DC: US Department of Health and Human Services, 26 10 1999; (64)(206): 57699–7733 [21 CFR Part 101].Google Scholar
13Jenkins, DJA, Kendall, CWC, Marchie, A, Faulkner, DA, Wong, JM, de Souza, R, et al. Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. Journal of the American Medical Association 2003; 290: 502–10.CrossRefGoogle ScholarPubMed
14Schryver, T, Smith, C. Reported attitudes and beliefs toward soy food consumption of soy consumers versus non-consumers in natural foods or mainstream grocery stores. Journal of Nutrition Education and Behavior 2005; 37: 292–9.CrossRefGoogle Scholar
15Wenrich, TR, Cason, KL. Consumptions and perceptions of soy among low-income adults. Journal of Nutrition Education and Behavior 2004; 36: 140–5.CrossRefGoogle ScholarPubMed
16Horn-Ross, PL, Lee, M, John, EM, Koo, J. Sources of phytoestrogen exposure among non-Asian women in California, USA. Cancer Causes&Control 2000; 11: 299302.Google ScholarPubMed
17Lampe, JW, Gustafson, DR, Hutchins, AM, Martini, MC, Li, S, Wahala, K, et al. Urinary isoflavonoid and lignan excretion on a Western diet: relation to soy, vegetable, and fruit intake. Cancer Epidemiology, Biomarkers&Prevention 1999; 8: 699707.Google ScholarPubMed
18de Kleijn, MJJ, van der Schouw, YT, Wilson, PWF, Adlercreutz, H, Mazur, W, Grobbee, DE, et al. Intake of dietary phytoestrogens is low in postmenopausal women in the United States: the Framingham study. Journal of Nutrition 2001; 131: 1826–32.CrossRefGoogle ScholarPubMed
19Goodman-Gruen, D, Kritz-Silverstein, D. Dietary isoflavone intake is associated with cardiovascular disease risk factors in postmenopausal women. Journal of Nutrition 2001; 131: 1202–6.CrossRefGoogle ScholarPubMed
20Gilbert, L. 2001 HealthFocus ® Fast Facts Report: Soyfoods Shoppers 2001: Who They Are, Why They Buy. Atlanta, GA: HealthFocus, Inc., 2001.Google Scholar
21Rice, MM, LaCroix, AZ, Lampe, JW, van Belle, G, Kestin, M, Sumitani, M, et al. Dietary soy isoflavone intake in older Japanese American women. Public Health Nutrition 2001; 4: 943–52.CrossRefGoogle ScholarPubMed
22Maskarinec, G, Singh, S, Meng, L, Franke, AA. Dietary soy intake and urinary isoflavone excretion among women from a multiethnic population. Cancer Epidemiology, Biomarkers&Prevention 1998; 7: 613–9.Google ScholarPubMed
23Resnicow, K, Barone, J, Engle, A, Miller, S, Haley, N, Fleming, DWE. Diet and serum lipids in vegan vegetarians: a model for risk reduction. Journal of the American Dietetic Association 1991; 91: 447–53.CrossRefGoogle Scholar
24Morgan, DL, Krueger, RA. The Focus Group Kit. Volumes 1–6. Thousand Oakes, CA: Sage, 1997.Google Scholar
25Lisk, CJ, Grau, L. Perceptions of women living with coronary heart disease: an overview of study findings. American Journal of Geriatric Cardiology 1999; 8: 157–61.Google ScholarPubMed
26Gettleman, L, Winkleby, MA. Using focus groups to develop a heart disease prevention program for ethnically diverse, low-income women. Journal of Community Health 2000; 25: 439–53.CrossRefGoogle ScholarPubMed
27Krummel, DA, Humphries, D, Tessaro, I. Focus groups on cardiovascular health in rural women: implications for practice. Journal of Nutrition Education and Behavior 2002; 34: 3846.CrossRefGoogle ScholarPubMed
28Covello, VT, Peters, RG. Women's perceptions of the risks of age-related diseases, including breast cancer: reports from a 3-year research study. Health Communication 2002; 14: 377–95.CrossRefGoogle ScholarPubMed
29Nic Gabhainn, S, Kelleher, CC, Naughton, AM, Carter, F, Flanagan, M, McGrath, MJ. Socio-demographic variations in perspectives on cardiovascular disease and associated risk factors. Health Education Research 1999; 14: 619–28.CrossRefGoogle ScholarPubMed
30 Dietary Guidelines Advisory Committee. The Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans [online], 2000. Available at http://www.health.gov/dietaryguidelines/dgac. Accessed 22 July 2004.Google Scholar
31US Department of Health and Human Services. A Public Health Action Plan to Prevent Heart Disease and Stroke: Executive Summary and Overview. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, 2003.Google Scholar
32Krueger, R, Casey, MA. Preventing Heart Disease and Stroke: Summary of Focus Groups with People Living in Minnesota. St. Paul, MN: Krueger & Associates, 2002.Google Scholar
33Green, JS, Grant, M, Hill, KL, Brizzolara, J, Belmont, B. Heart disease risk perception in college men and women. Journal of the American College of Health 2003; 51: 207–11.CrossRefGoogle ScholarPubMed
34Shepherd, R. Social determinants of food choice. Proceedings of the Nutrition Society 1999; 58: 807–12.CrossRefGoogle ScholarPubMed
35Montgomery, GH, Erblich, J, DiLorenzo, T, Bovbjerg, DH. Family and friends with disease: their impact on perceived risk. Preventive Medicine 2003; 37: 242–9.CrossRefGoogle ScholarPubMed
36Thomas, RJ, Kottke, TE, Brekke, MJ, Brekke, LN, Brandel, CL, Aase, LA, et al. Attempts at changing dietary and exercise habits to reduce risk of cardiovascular disease: who's doing what in the community?. Preventive Cardiology 2002; 5: 102–8.CrossRefGoogle ScholarPubMed
37Aubin, M, Godin, G, Vezina, L, Maziade, J, Desharnias, R. Hypercholesterolemia screening. Does knowledge of blood cholesterol level affect dietary fat intake?. Canadian Family Physician 1998; 44: 1289–97.Google ScholarPubMed
38Karner, A. Coronary heart disease: causes and drug treatment–spouses' conceptions. Journal of Clinical Nursing 2004; 13: 167–76.CrossRefGoogle ScholarPubMed
39Troein, M, Rastam, L, Selander, S, Widlund, M, Uden, G. Understanding the unperceivable: ideas about cholesterol expressed by middle-aged men with recently discovered hypercholesterolaemia. Family Practitioner 1997; 14: 376–81.CrossRefGoogle ScholarPubMed
40Borra, S, Kelly, L, Tuttle, M, Neville, K. Developing actionable dietary guidance messages: dietary fat as a case study. Journal of the American Dietetic Association 2001; 101: 678–84.CrossRefGoogle ScholarPubMed
41Karner, A, Goransson, A, Bergdahl, B. Conceptions on treatment and lifestyle in patients with coronary heart disease – a phenomenographic analysis. Patient Education and Counseling 2002; 47: 137–43.CrossRefGoogle ScholarPubMed
42 United Soybean Board. National Report 2004–2005: Consumer Attitudes about Nutrition. Insights into Nutrition, Healthy and Soyfoods. St. Louis, MO: United Soybean Board, 2004. Also available at http://www.talksoy.com/pdfs/ConsumerAttitudes2004.pdf. Accessed 9 August 2004.Google Scholar
43 International Food Information Council Foundation (IFIC), Cogent Research. Impact of Trans Fat Label Information on Consumer Food Choices. Washington, DC: IFIC, 2003. Also available at http://www.ific.org/research/transres.cfm. Accessed 21 July 2004.Google Scholar
44Pelletier, S, Kundrat, S, Hasler, CM. Effects of a functional foods nutrition education program with cardiac rehabilitation patients. Journal of Cardiopulmonary Rehabilitation 2003; 23: 334–40.CrossRefGoogle ScholarPubMed
45Lappalainen, R, Koikkalainen, M, Julkunen, J, Saarinen, T, Mykkanen, H. Association of demographic factors with barriers reported by patients receiving nutrition counseling as part of cardiac rehabilitation. Journal of the American Dietetic Association 1998; 98: 1026–9.CrossRefGoogle Scholar
46Stilley, CS, Sereika, S, Muldoon, MF, Ryan, CM, Dunbar-Jacob, J. Psychological and cognitive function: predictors of adherence with cholesterol lowering treatment. Annals of Behavioral Medicine 2004; 27: 117–24.CrossRefGoogle ScholarPubMed
47Pearson, TA, Laurora, I, Chu, H, Kafonek, S. The lipid treatment assessment project (L-TAP). Archives of Internal Medicine 2000; 160: 459–67.CrossRefGoogle ScholarPubMed
48Pearson, T, Kopin, L. Bridging the treatment gap: improving compliance with lipid-modifying agents and Therapeutic Lifestyle Changes. Preventive Cardiology 2003; 6: 204–13.CrossRefGoogle ScholarPubMed
49Anderson, JW. Diet first, then medication for hypercholesterolemia. Journal of the American Medical Association 2003; 290: 531–3.CrossRefGoogle ScholarPubMed
50Kedward, J, Dakin, L. A qualitative study of barriers to the use of statins and the implementation of coronary heart disease prevention in primary care. British Journal of General Practice 2003; 53: 684–9.Google Scholar
51Honda, K. Factors underlying variation in receipt of physician advice on diet and exercise: applications of the behavioral model of health care utilization. American Journal of Health Promotion 2004; 18: 370–7.CrossRefGoogle ScholarPubMed
52Gale Group. Physician advice and individual behaviors about cardiovascular disease risk reduction: seven states and Puerto Rico, 1997. Morbidity&Mortality Weekly Report 1999; 48: 74–5.Google Scholar
53Nawaz, H, Adams, ML, Katz, DL. Physician–patient interactions regarding diet, exercise, and smoking. Preventive Medicine 2000; 31: 652–7.CrossRefGoogle ScholarPubMed
54Yarzebski, J, Bujor, CF, Goldberg, RJ, Spencer, F, Lessard, D, Gore, JM. A community-wide survey of physician practices and attitudes toward cholesterol management in patients with recent acute myocardial infarction. Archives of Internal Medicine 2002; 162: 797804.CrossRefGoogle ScholarPubMed
55Kushner, RF. Barriers to providing nutrition counseling by physicians: a survey of primary care practitioners. Preventive Medicine 1995; 24: 546–52.CrossRefGoogle ScholarPubMed
56Sikand, G, Kashyap, ML, Wong, ND, Hsu, JC. Dietitian intervention improves lipid values and saves medication costs in men with combined hyperlipidemia and a history of niacin noncompliance. Journal of the American Dietetic Association 2000; 100: 218–24.CrossRefGoogle Scholar
57Dalgard, C, Thuroe, A, Haastrup, B, Haghfelt, T, Stender, S. Saturated fat intake in patients with ischemic heart disease 1 year after comprehensive counseling but not after brief counseling. Journal of the American Dietetic Association 2001; 101: 1420–9.CrossRefGoogle Scholar
58Vale, MJ, Jelinek, MV, Best, JD, Santamaria, JD. Coaching patients with coronary heart disease to achieve the target cholesterol: a method to bridge the gap between evidence-based medicine and the ‘real world’ – randomized controlled trial. Journal of Clinical Epidemiology 2002; 55: 245–52.CrossRefGoogle Scholar
59 The Vegetarian Resource Group. How Many Vegetarians are There? [online], 2004. Available at http://www.vrg.org/journal/vj2003issue3/vj2003issue3poll.htm. Accessed 16 October 2005.Google Scholar
60National Center for Health Statistics. Health, United States, 2004, With Chartbook on Trends in the Health of Americans. Hyattsville, MD: National Center for Health Statistics, 2004.Google Scholar