Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

• Autor(a) principal: Weber, Bernardete
• Data de Publicação: 2019
• Outros Autores: Bersch-Ferreira, Ângela Cristine, Torreglosa, Camila Ragne, Marcadenti, Aline, Lara, Enilda de Sousa, Silva, Jacqueline Tereza da, Costa, Rosana Perim, Santos, Renato Hideo Nakagawa, Berwanger, Otávio, Bosquetti, Rosa, Pagano, Raira, Rodrigues, Juliane Araujo, Moraes, Maria Antonieta Pereira de, Costa, Laura Maggi da, Boklis, Mirena, El Kik, Raquel Milani, Adorne, Elaine F., Teixeira, Joise M., Trescastro, Eduardo P., Chiesa, Fernanda L., Telles, Cristina T., Mota, Luis G.S., Pellegrini, Lívia A., Reis, Luisa F., Cardoso, Roberta G.M., Closs, Vera Elizabeth, Feres, Naoel Hassan, Silva, Nilma F. da, Silva, Neyla E., Dutra, Eliane S., Ito, Marina K., Lima, Mariana E.P., Oliveira, Juliana Dantas de, Carvalho, Ana P.P.F., Taboada, Maria I.S., Machado, Malaine M.A., David, Marta M., Júnior, Délcio G.S., Dourado, Camila, Fagundes, Vanessa C.F.O., Uehara, Rose M., Sasso, Sandramara, Vieira, Jaqueline S.O., Soares, Rafael Marques, Oliveira, Bianca A.S. de, Pereira, Juliana L., Rodrigues, Isa Galvão, Pinho, Cláudia Porto Sabino, Sousa, Antônio Carlos Sobral, Almeida, Andreza S., Jesus, Monique T. de, Silva, Glauber B. da, Alves, Luciana V.S., Nascimento, Viviane O.G., Galante, Andrea Polo, Vieira, Sabrina A., Coura, Amanda G.L., Dantas, Clenise F., Leda, Neuma M.F.S., Medeiros, Auriene L., Andrade, Ana C.L., Pinheiro, Josilene Maria Ferreira, Lima, Luana R.M. de, Sabino, Letícia S., Souza, Camila V.S. de, Silva, Suzana A. da, Vasconcelos, Sandra Mary Lima, Costa, Francisco A., Ferreira, Raphaela Costa, Cardoso, Isadora B., Navarro, Laís N.P., Ferreira, Rosielle Batista, Júnior, André E.S., Silva, Maria B.G., Almeida, Karine M.M., Penafort, Andreza M., Zampieri, Fernando G., Queirós, Ana Paula O. de, Farias, Geysa Maria Nogueira, Carlos, Daniele M.O., Cordeiro, Cíntia G.N.C., Vasconcelos, Valdiana B., Araújo, Edite M.V.M.C. de, Sahade, Viviane, Ribeiro, Carine S.A., Araújo, Givaldo A., Gonçalves, Luciana B., Kovacs, Cristiane, Teixeira, Camile S., Silva, Lívia M.A.J., Costa, Laís B. da, Souza, Tainah S., Jesus, Sende O. de, Luna, Adriana B., Rocha, Barbara R.S. da, Santos, Maria A., Neto, José Albuquerque de Figueiredo, Dias, Luciana Pereira P., Amparo, Fernanda Cassulo, Cantanhede, Rosângela C.A., Morais, Jadson M., Duarte, Rita C.L., Barbosa, Elza C.B., Barbosa, Janaina M.A., Sousa, Rosângela Maria Lopes de, dos Santos, Alexsandro Ferreira, Teixeira, Adriana Fonseca, Moriguchi, Emilio Hideyuki, Bruscato, Neide Maria, Moreira, Priscila, Kesties, Josiele, Vivian, Lilian, Carli, Waldemar de, Shumacher, Marina, Izar, Maria Cristina de Oliveira, Asoo, Marina T., Kato, Juliana T., Martins, Celma Muniz G., MacHado, Valéria Arruda, Bittencourt, Célia R.O., Silva, Renata A. da, Freitas, Thiago T. de, Sant'Anna, Viviane A.R., Lopes, Júlia D., Fischer, Simone Cristina Matheus, Pinto, Sônia Lopes, Silva, Kellen Cristine, Gratão, Lúcia Helena Almeida, Holzbach, Luciana Carla, Backes, Luciano Marcelo, Rodrigues, Milena Pozzatto, dos Santos, Karina G., Deucher, Keyla L.A.L., Cantarelli, Maiara, Bertoni, Vanessa Maria, Rampazzo, Daniela, Bressan, Josefina, Hermsdorff, H. H., Caldas, Ana Paula Silva, Felício, Matheus B., Honório, Camila R., Silva, Alessandra da, Monteiro, Aline S., Souza, Simone R., Rodrigues, Priscila A., Meneses, Tatiana M.X. de, Kumbier, Magali C.C., Barreto, Ana L., Cavalcanti, Alexandre Biasi, Paiva, Catharina C.J., Magnoni, Carlos Daniel, Moreira, Annie Seixas Bello, Peçanha, Daniela O., Missias, Karina C.S., Paula, Lais S. de, Marotto, Deborah, Souza, Paula, Martins, Patrícia R.T., dos Santos, Elisa Maia, Santos, Michelle R., Silva, Luisa P., Torres, Rosileide S., Barbosa, Socorro N.A.A., Pinho, Priscila M. de, Araujo, Suzi H.A. de, Veríssimo, Adriana O.L., Guterres, Aldair S., Cardoso, Andrea F.R., Palmeira, Moacyr M., Ataíde, Bruno R.B. de, Costa, Lilian P.S., Marinho, Helyde Albuquerque, Araújo, Celme B.P. de, Carvalho, Helen M.S., Maquiné, Rebecca O., Caiado, Alessandra C., Matos, Cristina Henschel de, Barretta, Claiza, Specht, Clarice M., Onofrei, Mihaela, Bertacco, Renata T.A., Borges, Lúcia Rota, Bertoldi, Eduardo Gehling, Longo, Aline, Ribas, Bruna L.P., Dobke, Fernanda, Pretto, Alessandra Doumid Borges, Bachettini, Nathalia Perleberg, Gastaud, Alexandre, Necchi, Rodrigo, Souza, Gabriela Corrêa, Zuchinali, Priccila, Fracasso, Bianca M., Bobadra, Sara, Sangali, Tamirys D., Salamoni, Joyce, Garlini, Luíza M., Shirmann, Gabriela S., Los Santos, Mônica L.P. de, Bortonili, Vera M.S., dos Santos, Cristiano P., Bragança, Guilherme Cassão Marques, Ambrózio, Cíntia Lima, e Lima, Susi B., Schiavini, Jéssica, Napparo, Alechandra S., Boemo, Jorge L., Nagano, Francisca E.Z., Modanese, Paulo V.G., Cunha, Natalia Morais, Frehner, Caroline, Silva, Lannay F. da, Formentini, Franciane Silvana, Ramos, Maria E.M., Ramos, Salvador S., Lucas, Marilia C.S., Machado, Bruna G., Ruschel, Karen Brasil, Beiersdorf, Jâniffer R., Nunes, Cristine E., Rech, Rafael Luiz, Damiani, Mônica, Berbigier, Marina Carvalho, Poloni, Soraia, Vian, Izabele, Russo, Diana S.
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional do INPA
• DOI: 10.1016/j.ahj.2019.06.010
• Texto Completo: https://repositorio.inpa.gov.br/handle/1/15505
• topic: Adult; Age; Alcohol Consumption; All Cause Mortality; Amputation; Body Mass; Brasil; Cardiovascular Disease; Cardiovascular Risk; Cerebrovascular Accident; Controlled Study; Diet Therapy; Family Income; Female; Follow Up; Fruit; Heart Arrest; Heart Infarction; Hospitalization; Human; Major Clinical Study; Male; Multicenter Study; Nutrition Education; Nutritional Counseling; Practice Guideline; Prescription; Priority Journal; Randomized Controlled Trial; Secondary Prevention; Sex Difference; Study Design; Total Quality Management; Unstable Angina Pectoris; Vegetable; Whole Grain; Cardiovascular Disease; Cause Of Death; Clinical Trial; Diet; Incidence; Middle Aged; Nutritional Assessment; Nutritional Status; Procedures; Program Development; Public Health; Risk Factor; Secondary Prevention; Survival Rate; Brasil; Cardiovascular Diseases; Cause Of Death; Diet; Female; Humans; Incidence; Male; Middle Aged; National Health Programs; Nutrition Assessment; Nutritional Status; Program Development; Risk Factors; Secondary Prevention; Survival Rate

Background: Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD. Methods: In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels. Results: From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ± 8.4 vs 24.7 ± 8.6, P <.01), mainly due to a 0.5-serving/d greater intake of fruits and of vegetables in the BALANCE group. Primary end point events occurred in 236 participants (18.8%) in the BALANCE group and in 207 participants (16.4%) in the control group (hazard ratio, 1.15; 95% CI 0.95-1.38; P =.15). Secondary end points did not differ between groups after follow-up. Conclusions: The BALANCE Program only slightly improved adherence to a healthy diet in patients with established CVD and had no significant effect on the incidence of cardiovascular events or death. © 2019 The Authors