Abstract
PURPOSE: This study educated cardiac rehabilitation patients about the potential health benefits obtained from specific "heart healthy" functional foods and evaluated whether a targeted education program about these foods leads to their increased consumption or positive attitude changes.
METHODS: The targeted audience was 69 cardiac rehabilitation patients (phases 2 and 3). Four foods (soy, oats, sterol/stanol ester-enhanced margarine, and nuts) were discussed in two 90-minute education sessions conducted 2 months apart. These sessions provided scientific information about each food, allowed participants to sample products, and collected data using both preeducation and follow-up surveys.
RESULTS: The findings showed a significant increase in the reported consumption of all four functional foods (soy in particular), and several positive attitude changes concerning the relation between diet and heart health. Most of the participants (88%) either agreed or strongly agreed that they intended to continue incorporating functional foods into their diet to improve heart health.
CONCLUSION: According to the reported attitudinal and behavioral intentions, the education of cardiac rehabilitation patients may lead to beneficial dietary changes conducive to the reduction of cardiovascular disease risk.
Functional foods are those providing a health benefit that goes beyond basic nutrition. 1 According to the American Dietetic Association, functional foods may be whole, fortified, enriched, or enhanced foods that must be consumed as part of a varied diet on a regular basis at effective levels. 2 A variety of functional foods or food ingredients have been shown to improve cardiovascular health. 3 Furthermore, a number of foods or food categories are eligible to bear a Food and Drug Administration (FDA)-approved health claim related to a reduced risk of coronary heart disease, 4 including oat soluble fiber (3 g of beta-glucan per day), 5,6 soy protein (25g/day), 7-9 and plant sterol (0.65 g/day), 10,11 and stanol esters (1.7g/day). 10,11
In addition, a growing body of epidemiologic and clinical evidence indicates that tree nuts, consumed in moderate amounts as a substitution for saturated fat, significantly decreases total and low-density lipoprotein (LDL) cholesterol. 12 In August 2002, the International Tree Nut Council petitioned the FDA to authorize a health claim linking consumption of all edible nuts (1 oz/day) to a reduced risk of coronary heart disease. 13
The current study was designed both to educate cardiac rehabilitation patients about the potential health benefits obtained from specific "heart healthy" functional foods and to evaluate whether a targeted education program about these foods leads to their increased consumption. The four "heart healthy" functional foods discussed in the education sessions, along with their primary physiologically active component, were oat products (beta-glucan soluble fiber), cholesterol-lowering margarines (sterol/stanol esters), nuts (monounsaturated fatty acids), and soy products (protein).
The objectives of the heart health education session were (1) to introduce the concept of functional foods to the participants, (2) to provide examples of functional foods shown to help prevent and treat cardiovascular disease and educate participants concerning their practical uses, (4) to inform the participants about the recommended amounts for each food and the frequency of consumption required to obtain the purported health benefits; and (4) to obtain pre- and posteducation data for comparing attitudes, knowledge, and consumption frequency before and after the education program.
These objectives of the heart health education session were aligned with the cardiac rehabilitation guidelines that promote intensive nutrition education, counseling, and behavioral interventions to improve dietary fat and cholesterol intake. 14 Education, counseling, and behavioral interventions concerning nutrition, with and without pharmacologic lipid-lowering therapy, have been shown to result in significantly improved blood lipid levels. These interventions are recommended as a component of cardiac rehabilitation. 15