Telehealth methods to deliver dietary interventions in adults with chronic disease: A systematic review and meta-analysis

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Kelly, J. T., Reidlinger, D. P., Hoffmann, T. C., & Campbell, K. L. (2016, in press). Telehealth methods to deliver dietary interventions in adults with chronic disease: A systematic review and meta-analysis. American Journal of Clinical Nutrition.

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Copyright © 2016 American Society for Nutrition


Online: 1938-3207; Print: 0002-9165



The long-term management of chronic disease requires the adoption of complex dietary recommendations, which can be facilitated by regular coaching to support behavioral changes. Telehealth interventions can overcome patient-centered barriers to accessing face-to-face programs and provide feasible delivery methods, accessible regardless of geographic location.


This systematic review assessed the effectiveness of telehealth dietary interventions at facilitating dietary change in chronic disease.


A structured systematic search was conducted for all randomized controlled trials evaluating multifactorial dietary interventions in adults with chronic disease that provided diet education in an intervention longer than 4 wk. Meta-analyses that used the random-effects model were performed on diet quality, dietary adherence, fruit and vegetables, sodium intake, energy, and dietary fat intake.


A total of 25 studies were included, involving 7384 participants. The telehealth dietary intervention was effective at improving diet quality [standardized mean difference (SMD): 0.22 (95% CI: 0.09, 0.34), P = 0.0007], fruit and vegetable intake [mean difference (MD) 1.04 servings/d (95% CI: 0.46, 1.62 servings/d), P = 0.0004], and dietary sodium intake [SMD: −0.39 (−0.58, −0.20), P = 0.0001]. Single nutrients (total fat and energy consumption) were not improved by telehealth intervention; however, after a telehealth intervention, important clinical outcomes were improved, such as systolic blood pressure [MD: −2.97 mm Hg (95% CI: −5.72, −0.22 mm Hg), P = 0.05], total cholesterol [MD: −0.08 mmol/L (95% CI: −0.16, −0.00 mmol/L), P = 0.04], triglycerides [MD: −0.10 mmol/L (95% CI: −0.19, −0.01 mmol/L), P = 0.04], weight [MD: −0.80 kg (95% CI: −1.61, 0 kg), P = 0.05], and waist circumference [MD: −2.08 cm (95% CI: −3.97, −0.20 cm), P = 0.03].


Telehealth-delivered dietary interventions targeting whole foods and/or dietary patterns can improve diet quality, fruit and vegetable intake, and dietary sodium intake. When applicable, they should be incorporated into health care services for people with chronic conditions.

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