Appendix G
U.S. Preventive Services Task Force Rating of Professionals to Deliver Dietary Counseling

COUNSELING TO PROMOTE A HEALTHY DIET

Intervention

Level of Evidencea

Strength of Recommendationb

Efficacy of Risk Reduction in the General Population

Limiting intake of dietary fat (especially saturated fat)

I, II-2, II-3

A

Limiting intake of dietary cholesterol

II-2

B

Emphasizing fruits, vegetables and grain products containing fiber

II-2, II-3

B

Maintaining caloric balance through diet and exercise

II-2

B

Maintaining adequate intake of dietary calcium in women

I, II-I, II-2, II-3

B

Reducing intake of dietary sodium

II-3

C

Increasing intake of dietary iron

II-2, II-3, III

C

Increasing intake of beta-carotene and other antioxidants

II-2, II-2

C

Breastfeeding infants

I, II-2

A

Effectiveness of Counseling

Counseling to change dietary habits Specially trained educators

Ic

B

Primary care clinicians

III

C

a Quality of evidence: I = evidence obtained from at least one properly randomized



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OCR for page 355
The Role of Nutrition in Maintaining Health in the Nation’s Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population Appendix G U.S. Preventive Services Task Force Rating of Professionals to Deliver Dietary Counseling COUNSELING TO PROMOTE A HEALTHY DIET Intervention Level of Evidencea Strength of Recommendationb Efficacy of Risk Reduction in the General Population Limiting intake of dietary fat (especially saturated fat) I, II-2, II-3 A Limiting intake of dietary cholesterol II-2 B Emphasizing fruits, vegetables and grain products containing fiber II-2, II-3 B Maintaining caloric balance through diet and exercise II-2 B Maintaining adequate intake of dietary calcium in women I, II-I, II-2, II-3 B Reducing intake of dietary sodium II-3 C Increasing intake of dietary iron II-2, II-3, III C Increasing intake of beta-carotene and other antioxidants II-2, II-2 C Breastfeeding infants I, II-2 A Effectiveness of Counseling Counseling to change dietary habits Specially trained educators Ic B Primary care clinicians III C a Quality of evidence: I = evidence obtained from at least one properly randomized

OCR for page 355
The Role of Nutrition in Maintaining Health in the Nation’s Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population controlled trial; II-1 = Evidence obtained from well-designed controlled trials without randomization. II-2 = Evidence obtained from well-designed cohort or case-control analytic studies, perferably from more than one center or research group; II-3 = Evidence obtained from multiple time series with or without the intervention, dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatment in the 1940s) could also be regarded as this type of evidence. III = Opinions of respected authorities, based on clinical experience; descriptive studies and case reports; or reports of expert committees. b Strength of Recommendations: A = There is good evidence to support the recommendation that the condition be specifically considered in a periodic health examination; B = There is fair evidence to support the recommendation that the condition be specifically considered in a periodic health examination; C = There is insufficient evidence to recommend for or against the inclusion of the condition in a periodic health examination, but recommendations may be made on other grounds; D = There is fair evidence to support the recommendation that the condition be excluded from consideration in a periodic health examination; E = There is good evidence to support the recommendation that the condition be excluded from consideration in a periodic health examination. c These trials generally involved specially trained educators such as dietitians delivering intensive interventions (e.g., multiple sessions, tailored materials) to selected patients with known risk factors. SOURCE: USPSTF (U.S. Preventive Services Task Force). 1995. Guide to Clinical Preventive Services, 2nd ed. Report of the U.S. Preventive Services Task Force. Washington, D.C.: U.S. Department of Health and Human Services, Office of Public Health, Office of Health Promotion and Disease Prevention.