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BIBTEX RIS

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

2019; Elsevier BV; Volume: 215; Linguagem: Inglês

10.1016/j.ahj.2019.06.010

1097-6744

Bernardete Weber, Ângela Cristine Bersch-Ferreira, Camila Ragne Torreglosa, Aline Marcadenti, Enilda S. Lara, Jacqueline T. da Silva, Rosana Perim Costa, Renato Hideo Nakagawa Santos, Otávio Berwanger, Rosa Bosquetti, Raira Pagano, Luis G.S. Mota, Juliana D. Oliveira, Rafael Marques Soares, Andrea Galante, Suzana Araujo da Silva, Fernando G. Zampieri, Cristiane Kovacs, Fernanda C. Amparo, Priscila Moreira, Renata A. da Silva, Karina Gama dos Santos, Aline S. Monteiro, Catharina C.J. Paiva, Daniel Magnoni, Annie Seixas Bello Moreira, Daniela Peçanha, Karina C.S. Missias, Lais S. de Paula, Deborah Marotto, P.A.R.S. Souza, Patrícia Regina Thomé Martins, Elisa Maia dos Santos, Michelle R. Santos, Luisa P. Silva, Rosileide S. Torres, Socorro Nazaré Araújo Almeida Barbosa, Priscila Matos de Pinho Costa, Suzi H.A. de Araujo, Adriana O.L. Veríssimo, Aldair S. Guterres, Andrea F.R. Cardoso, Moacyr Magno Palmeira, Bruno Rafael Batista de Ataíde, Lilian P.S. Costa, Helyde Albuquerque Marinho, Celme B.P. de Araújo, Helen M.S. Carvalho, Rebecca O. Maquiné, Alessandra C. Caiado, Cristina Matos, Claiza Barretta, Clarice Maria Specht, Mihaela Onofrei, Renata Torres Abib, Lúcia Rota Borges, Eduardo Gehling Bertoldi, Aline Longo, Bruna Luiza Paulina Ribas, Fernanda Vighi Dobke, Alessandra Doumid Borges Pretto, Nathalia Perleberg Bachettini, Alexandre de Abreu Gastaud, Rodrigo Necchi, Gabriela Corrêa Souza, Priccila Zuchinali, Bianca M. Fracasso, Sara Bobadra, Tamirys D. Sangali, Joyce Y. Y. Salamoni, Luíza M. Garlini, Gabriela S. Shirmann, Mónica Santos, Vera M.S. Bortonili, Cristiano P. dos Santos, Guilherme Cassão Marques Bragança, Cíntia L. Ambrózio, Susi B. e Lima, J.T. Schiavini, Alechandra S. Napparo, Jorge L. Boemo, Francisca Eugênia Zaina Nagano, Paulo V.G. Modanese, Natália Machado da Cunha, Caroline Frehner, Lannay F. da Silva, Franciane Silvana Formentini, María Elena Ramos, Salvador S. Ramos, Marilia C.S. Lucas, Bruna Machado, Karen Brasil Ruschel, Jâniffer R. Beiersdorf, Cristine E. Nunes, Rafael Rech, Mônica Damiani, Marina de Carvalho Berbigier, Soraia Poloni, Izabele Vian, Diana S. Russo, Juliane Araújo Rodrigues, Maria Antonieta Moraes, Laura Maggi da Costa, Mirena Boklis, Raquel Milani El Kik, Elaine F. Adorne, Joise M. Teixeira, Eduardo P. Trescastro, Fernanda L. Chiesa, Cristina T. Telles, Livia Pellegrini, Luisa F. Reis, Roberta G.M. Cardoso, Vera Elizabeth Closs, Naoel H. Feres, Nilma F. da Silva, Neyla E. Silva, Eliane Said Dutra, Marina Ito, Mariana E.P. Lima, Ana P.P.F. Carvalho, Maria I.S. Taboada, Malaine Morais Alves Machado, Marta M. David, Délcio G.S. Júnior, Camila Dourado, Vanessa C.F.O. Fagundes, Rose Mary Uehara, Sandramara Sasso, Jaqueline S.O. Vieira, Bianca A.S. de Oliveira, Juliana Lopes Pereira, Isa Galvão Rodrigues, Cláudia Porto Sabino Pinho, Antônio Carlos Sobral Sousa, Andreza Santos Almeida, Monique Tavares de Jesus, Glauber B. da Silva, Luciana Vieira Sousa Alves, Viviane O.G. Nascimento, Sabrina A. Vieira, Amanda Gonçalves Lopes Coura, Clenise F. Dantas, Neuma M.F.S. Leda, Auriene L. Medeiros, Ana C.L. Andrade, Josilene Maria Ferreira Pinheiro, Luana R.M. Lima, Letícia S. Sabino, Camila V.S. Souza, Sandra Mary Lima Vasconcelos, Francisco A. Costa, Raphaela Costa Ferreira, Isadora B. Cardoso, Laís Nanci Pereira Navarro, Rosielle B. Ferreira, André Eduardo da Silva Júnior, Maria Bárbara Galdino-Silva, Karine Maria Moreira Almeida, Andreza M. Penafort, Ana Paula O. de Queirós, Geysa Maria Nogueira Farias, Daniele M.O. Carlos, Cíntia G.N.C. Cordeiro, Valdiana B. Vasconcelos, Edite M.V.M. C. de Araújo, Viviane Sahade, Carine S.A. Ribeiro, Givaldo A. Araújo, Luciana Brugiolo Gonçalves, Camile S. Teixeira, Lívia M.A.J. Silva, Laís B. da Costa, Tainah S. Souza, Sende O. de Jesus, Adriana Barros Luna, Bárbara Rafaela Santos da Rocha, Maria Augusta B. dos Santos, José Albuquerque de Figueiredo Neto, Luciana Pereira Pinto Dias, Rosângela C.A. Cantanhede, Jadson M. Morais, Rita Duarte, Elza C.B. Barbosa, Janaína Maiana Abreu Barbosa, Rosângela Maria Lopes de Sousa, Alexsandro F. Santos, Adriana Fonseca Teixeira, Emílio Hideyuki Moriguchi, Neide Maria Bruscato, Josiele Kesties, Lilian Vivian, Waldemar de Carli, Marina Shumacher, Maria Cristina de Oliveira Izar, Marina T. Asoo, Juliana T. Kato, Celma M. Martins, Valéria A. Machado, Célia R.O. Bittencourt, Thiago T. de Freitas, Viviane A.R. Sant'Anna, Julia do Carmo Machado kneipp Lopes, Simone Cristina Pinto Matheus Fischer, Sônia Lopes Pinto, Kellen C. Silva, Lúcia Helena Almeida Gratão, Luciana Carla Holzbach, Luciano Marcelo Backes, Milena P. Rodrigues, Keyla L.A.L. Deucher, Maiara Cantarelli, Vanessa Maria Bertoni, Daniela Rampazzo, Josefina Bressan, Helen Hermana Miranda Hermsdorff, Ana Paula Silva Caldas, Matheus Brum Felício, Camila R. Honório, Alessandra da Silva, Simone Raimondi de Souza, Priscila Aparecida Rodrigues, Tatiana M.X. de Meneses, Magali Kumbier, Ana Luiza Oliveira Barreto, Alexandre Biasi Cavalcanti,

Consumer Attitudes and Food Labeling

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.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.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.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.