Effectiveness of Individual Nutritional Guidance with Supervised Cardiac Rehabilitation after Acute Myocardial Infarction
Objective: To evaluate the effectiveness of nutritional guidance with supervised cardiac rehabilitation after acute myocardial infarction (AMI). Method: The subjects were 102 patients (85 males, mean age 67±10 years) who underwent supervised cardiac rehabilitation after AMI between December 2015 and...
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| Published in | Nihon Kanshikkan Gakkaishi Vol. 3; pp. 12 - 17 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
The Japanese Coronary Association
2021
特定非営利活動法人 日本冠疾患学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 2434-2157 |
| DOI | 10.32182/njcoron.21-00005 |
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| Abstract | Objective: To evaluate the effectiveness of nutritional guidance with supervised cardiac rehabilitation after acute myocardial infarction (AMI). Method: The subjects were 102 patients (85 males, mean age 67±10 years) who underwent supervised cardiac rehabilitation after AMI between December 2015 and June 2019. Nutritional guidance was provided 1 and 3 months after discharge, and three individual dietary changes were recommended for each patient. At 3 months after discharge, the rate of implementation of the three recommendations was evaluated. High and low adherence was defined as rates of ≥67% (HA group) and <67% (LA group), respectively. Risk factors for diet adherence were examined in these groups. Result: Nutritional guidance was conducted for 85 patients (83%) at 1 month and for 63 patients (62%) at 3 months. The median implementation rates were 80% at 1 month and 79% at 3 months. Low adherence was found in 12 patients (19%). Patients living alone and drinking excessive alcohol were more frequently observed in the LA group than in the HA group (p=0.04, p=0.03). Body mass index (BMI) had a tendency to be higher at baseline in the LA group (24.6±3.5 vs. 22.9±2.9 kg/m², p = 0.07) and showed a tendency to increase in this group after 5 months (p=0.08). Conclusion: Individual Nutritional guidance with three recommendations may be effective for patients who underwent supervised cardiac rehabilitation. However, particular care may be recommended for patients living alone, drinking excessive alcohol, or with higher BMI. |
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| AbstractList | Objective: To evaluate the effectiveness of nutritional guidance with supervised cardiac rehabilitation after acute myocardial infarction (AMI). Method: The subjects were 102 patients (85 males, mean age 67±10 years) who underwent supervised cardiac rehabilitation after AMI between December 2015 and June 2019. Nutritional guidance was provided 1 and 3 months after discharge, and three individual dietary changes were recommended for each patient. At 3 months after discharge, the rate of implementation of the three recommendations was evaluated. High and low adherence was defined as rates of ≥67% (HA group) and <67% (LA group), respectively. Risk factors for diet adherence were examined in these groups. Result: Nutritional guidance was conducted for 85 patients (83%) at 1 month and for 63 patients (62%) at 3 months. The median implementation rates were 80% at 1 month and 79% at 3 months. Low adherence was found in 12 patients (19%). Patients living alone and drinking excessive alcohol were more frequently observed in the LA group than in the HA group (p=0.04, p=0.03). Body mass index (BMI) had a tendency to be higher at baseline in the LA group (24.6±3.5 vs. 22.9±2.9 kg/m², p = 0.07) and showed a tendency to increase in this group after 5 months (p=0.08). Conclusion: Individual Nutritional guidance with three recommendations may be effective for patients who underwent supervised cardiac rehabilitation. However, particular care may be recommended for patients living alone, drinking excessive alcohol, or with higher BMI. Objective: To evaluate the effectiveness of nutritional guidance with supervised cardiac rehabilitation after acute myocardial infarction (AMI). Method: The subjects were 102 patients (85 males, mean age 67±10 years) who underwent supervised cardiac rehabilitation after AMI between December 2015 and June 2019. Nutritional guidance was provided 1 and 3 months after discharge, and three individual dietary changes were recommended for each patient. At 3 months after discharge, the rate of implementation of the three recommendations was evaluated. High and low adherence was defined as rates of ≥67% (HA group) and <67% (LA group), respectively. Risk factors for diet adherence were examined in these groups. Result: Nutritional guidance was conducted for 85 patients (83%) at 1 month and for 63 patients (62%) at 3 months. The median implementation rates were 80% at 1 month and 79% at 3 months. Low adherence was found in 12 patients (19%). Patients living alone and drinking excessive alcohol were more frequently observed in the LA group than in the HA group (p=0.04, p=0.03). Body mass index (BMI) had a tendency to be higher at baseline in the LA group (24.6±3.5 vs. 22.9±2.9 kg/m², p = 0.07) and showed a tendency to increase in this group after 5 months (p=0.08). Conclusion: Individual Nutritional guidance with three recommendations may be effective for patients who underwent supervised cardiac rehabilitation. However, particular care may be recommended for patients living alone, drinking excessive alcohol, or with higher BMI. 【目的】急性心筋梗塞（acute myocardial infarction: AMI）患者の食習慣是正による二次予防は重要であるが，行動変容の維持は困難である．栄養指導による患者の行動変容について検討を行った．【対象・方法】2015年12月～2019年6月，AMIにて入院栄養指導を実施し，その後外来心臓リハビリテーション（心リハ）に参加した102例（男性85例，年齢67±10歳）を対象とした．指導は個々の食習慣に応じて是正項目を3項目程度に絞った個別化指導を実施した．心リハプログラムでの栄養指導は退院1ヵ月，3ヵ月後に実施，退院後3ヵ月の実行率67%以上であった症例を実行群，67%未満を非実行群として比較検討を行った．【結果】冠危険因子の保有率は，肥満36%，高血圧症42%，脂質異常症39%，糖尿病34%，喫煙18%であった．栄養指導実施は1ヵ月後85例（83%），3ヵ月後63例（62%）であった．入院前の食生活上の問題点は塩分過剰78例（76%），菓子類過剰44例（43%），野菜不足29例（28%）であった．退院後の実行率は1ヵ月後80%，3ヵ月後79%であり，各指導項目実行率は塩分制限（1ヵ月後81%，3ヵ月後91%），菓子類制限（1ヵ月後82%，3ヵ月後82%），野菜増加（1ヵ月後72%，3ヵ月後82%）であり良好に維持できた．3ヵ月後に実行率が67%未満であった非実行群は12例（19%）であり，非実行群は独居，アルコール摂取量が有意に多く（p=0.04，p=0.03），入院時のbody mass index（BMI）が大きい傾向にあった（p=0.07）．非実行群で5ヵ月後のBMIは増加傾向にあった（p = 0.08）．【結論】継続的な個別化栄養指導は，食習慣是正への行動変容維持に繋がる可能性がある．実行率の低い独居，肥満患者，アルコール多飲患者に対してはより重点的な介入が必要と考えられた． |
| Author | Honma, Tomoaki Fujiwara, Takashi Morita, Natsumi Kawamoto, Yoshimi Kobayashi, Taira Ueda, Masami |
| Author_FL | 森田 菜津美 本間 智明 小林 平 河本 良美 上田 雅美 藤原 敬士 |
| Author_FL_xml | – sequence: 1 fullname: 森田 菜津美 – sequence: 2 fullname: 河本 良美 – sequence: 3 fullname: 藤原 敬士 – sequence: 4 fullname: 上田 雅美 – sequence: 5 fullname: 本間 智明 – sequence: 6 fullname: 小林 平 |
| Author_xml | – sequence: 1 fullname: Ueda, Masami organization: Department of Rehabilitation in Acute Phase, JA Hiroshima General Hospital – sequence: 1 fullname: Kawamoto, Yoshimi organization: Section of Nutrition, JA Hiroshima General Hospital – sequence: 1 fullname: Honma, Tomoaki organization: Department of Rehabilitation in Acute Phase, JA Hiroshima General Hospital – sequence: 1 fullname: Fujiwara, Takashi organization: Department of Cardiology, JA Hiroshima General Hospital – sequence: 1 fullname: Morita, Natsumi organization: Section of Nutrition, JA Hiroshima General Hospital – sequence: 1 fullname: Kobayashi, Taira organization: Department of Rehabilitation in Acute Phase, JA Hiroshima General Hospital |
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| References | 6) Teramoto T, Sasaki J, Ishibashi S, et al; Japan Atherosclerosis Society: Executive summary of the Japan Atherosclerosis Society (JAS) guidelines for the diagnosis and prevention of artherosclerotic cardiovascular diseases in Japan – 2012 version. J Atheroscler Thromb 2013; 20: 517–523 2) 玉木大輔，寺地順子，長山雅俊，他: アンケート調査による心臓リハビリテーション患者の食事･食行動．心臓リハ2000; 5: 82–86 8) 日本肥満学会編: 肥満症診療ガイドライン2016．ライフサイエンス出版，東京，2016 7) Kanda Y: Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 2013; 48: 452–458 15) Scotto CJ, Waechter DJ, Rosneck J: Adherence to prescribed exercise and diet regimens two months post-cardiac rehabilitation. Can J Cardiovasc Nurs 2011; 21: 11–17 9) Sharp PB, Salyer J: Self-efficacy and barriers to healthy diet in cardiac rehabilitation participant and nonparticipant. J Cardiovasc Nurs 2012; 27: 253–262 13) Huffman JC, Moore SV, DuBois CM, et al: An exploratory mixed methods analysis of adherence predictors following acute coronary syndrome. Psychol Health Med 2015; 20: 541–550 12) American Diabetes Association: 5. Facilitating behavior change and well-being to improve health outcomes: Standards of medical care in diabetes—2020. Diabetes Care 2020; 43 Suppl 1: S48–S65 5) Griffo R, Ambrosetti M, Tramarin R, et al: Effectiveness secondary prevention through cardiac rehabilitation after coronary revascularization and predictors of poor adherence to lifestyle modification and medication. Results of the ICAROS Survey. Int J Cardiol 2013; 167: 1390–1395 10) 野原隆司，安達 仁，石原俊一，他: 心血管疾患におけるリハビリテーションに関するガイドライン（2012年改訂版)．日本循環器学会．https://www.j-circ.or.jp/old/guideline/pdf/JCS2012_nohara_h.pdf.（アクセス日：2021/02/23） 16) Kinugasa Y, Kato M, Sugihara S, et al: Multidisciplinary intensive education in the hospital improves outcomes for hospitalized heart failure patients in a Japanese rural setting. BMC Health Serv Res 2014; 14: 351 11) 足立香代子: インスリン非依存性糖尿病患者における簡便な栄養食事指導方法と指導継続期間の検討．栄養誌 1998; 56: 159–170 14) Xie Z, Liu K, Or C, et al: An examination of the socio-demographic correlates of patient adherence to self-management behaviors and the mediating roles of health attitudes and self-efficacy among patients with coexisting type 2 diabetes and hypertension. BMC Public Health 2020; 20: 1227 1) 西島ちさと，白土美穂，池上富子，他: 心臓リハビリテーションに参加した患者の栄養摂取量の経時的変化と栄養指導の効果について．心臓リハ2004; 9: 127–130 3) 三間 渉，長谷川靖，賀川尚美，他: 包括的外来心臓リハビリテーションが摂取食塩量に与える影響．心臓リハ2018; 24: 100–105 4) Urbinati S, Olivari Z, Gonzini L, et al: Secondary prevention after acute myocardial infarction: drug adherence, treatment goals, and predictors of health lifestyle habits. The BLITZ-4 Registry. Eur J Prev Cardiol 2015; 22: 1548–1556 |
| References_xml | – reference: 7) Kanda Y: Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 2013; 48: 452–458 – reference: 8) 日本肥満学会編: 肥満症診療ガイドライン2016．ライフサイエンス出版，東京，2016 – reference: 6) Teramoto T, Sasaki J, Ishibashi S, et al; Japan Atherosclerosis Society: Executive summary of the Japan Atherosclerosis Society (JAS) guidelines for the diagnosis and prevention of artherosclerotic cardiovascular diseases in Japan – 2012 version. J Atheroscler Thromb 2013; 20: 517–523 – reference: 2) 玉木大輔，寺地順子，長山雅俊，他: アンケート調査による心臓リハビリテーション患者の食事･食行動．心臓リハ2000; 5: 82–86 – reference: 10) 野原隆司，安達 仁，石原俊一，他: 心血管疾患におけるリハビリテーションに関するガイドライン（2012年改訂版)．日本循環器学会．https://www.j-circ.or.jp/old/guideline/pdf/JCS2012_nohara_h.pdf.（アクセス日：2021/02/23） – reference: 9) Sharp PB, Salyer J: Self-efficacy and barriers to healthy diet in cardiac rehabilitation participant and nonparticipant. J Cardiovasc Nurs 2012; 27: 253–262 – reference: 12) American Diabetes Association: 5. Facilitating behavior change and well-being to improve health outcomes: Standards of medical care in diabetes—2020. Diabetes Care 2020; 43 Suppl 1: S48–S65 – reference: 16) Kinugasa Y, Kato M, Sugihara S, et al: Multidisciplinary intensive education in the hospital improves outcomes for hospitalized heart failure patients in a Japanese rural setting. BMC Health Serv Res 2014; 14: 351 – reference: 13) Huffman JC, Moore SV, DuBois CM, et al: An exploratory mixed methods analysis of adherence predictors following acute coronary syndrome. Psychol Health Med 2015; 20: 541–550 – reference: 5) Griffo R, Ambrosetti M, Tramarin R, et al: Effectiveness secondary prevention through cardiac rehabilitation after coronary revascularization and predictors of poor adherence to lifestyle modification and medication. Results of the ICAROS Survey. Int J Cardiol 2013; 167: 1390–1395 – reference: 3) 三間 渉，長谷川靖，賀川尚美，他: 包括的外来心臓リハビリテーションが摂取食塩量に与える影響．心臓リハ2018; 24: 100–105 – reference: 14) Xie Z, Liu K, Or C, et al: An examination of the socio-demographic correlates of patient adherence to self-management behaviors and the mediating roles of health attitudes and self-efficacy among patients with coexisting type 2 diabetes and hypertension. BMC Public Health 2020; 20: 1227 – reference: 11) 足立香代子: インスリン非依存性糖尿病患者における簡便な栄養食事指導方法と指導継続期間の検討．栄養誌 1998; 56: 159–170 – reference: 1) 西島ちさと，白土美穂，池上富子，他: 心臓リハビリテーションに参加した患者の栄養摂取量の経時的変化と栄養指導の効果について．心臓リハ2004; 9: 127–130 – reference: 15) Scotto CJ, Waechter DJ, Rosneck J: Adherence to prescribed exercise and diet regimens two months post-cardiac rehabilitation. Can J Cardiovasc Nurs 2011; 21: 11–17 – reference: 4) Urbinati S, Olivari Z, Gonzini L, et al: Secondary prevention after acute myocardial infarction: drug adherence, treatment goals, and predictors of health lifestyle habits. The BLITZ-4 Registry. Eur J Prev Cardiol 2015; 22: 1548–1556 |
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| Title | Effectiveness of Individual Nutritional Guidance with Supervised Cardiac Rehabilitation after Acute Myocardial Infarction |
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