본문 바로가기
HOME> 논문 > 논문 검색상세

논문 상세정보

임상영양서비스의 효과성 평가 : 체계적 검토와 메타분석을 통하여
Effectiveness of Nutrition Intervention : Systematic Review & Meta-Analysis

이해영   (상지대학교 식품영양학과UU0000668  ); 김현아   (연세대학교 생활과학대학 식품영양전공UU0000936  ); 양일선   (연세대학교 생활과학대학 식품영양전공UU0000936  ); 남정모   (연세대학교 의과대학 예방의학교실UU0000936  ); 박은철   (국립암센터 연구소HH0000021  );
  • 초록

    A systematic review and meta-analysis of the literatures was conducted to evaluate the effectiveness of nutrition intervention by dietitian. The 31 studies that were all randomized controlled trials, were identified from computerized search of published researches on MEDLINE, Embase database until January, 2003 and review of reference lists. The main search terms were the combination “dietitian”, “dietary intervention”, “nutrition intervention” or “nutritional intervention” and “effectiveness”. The subgroup analysis was performed by the publication year, quality score, type of disease, content of intervention, intervention provider, type of intervention (nutritional counseling and education/nutrilion counseling and education + diet modification), method of intervention (individual/group/individual + group) and follow-up period. Two reviewers independently selected trials for inclusion, assessed the quality and extracted the data. The meta-analysis of 31 studies based on the random effect model showed that the medical nutrition therapy was significantly effective in treating the diseases (effect size 0.1715 : 95% confidence interval 0.0938-0.2491). This study showed the clear evidence of the effectiveness of nutrition intervention through the meta-analysis. So the nutrition intervention by dietitian should be recommended and recognized as the effective therapy of treating the diseases. Also the nutrition intervention should be conducted regularly to maintain the effectiveness of the nutrition intervention. The nutrition intervention was significantly effective in treating the diseases on the random effect model (effect size 0.1715 : 95% confidence interval 0.0938-0.2491).


  • 주제어

    nutrition intervention .   dietitian .   effectiveness .   systematic review .   meta-analysis.  

  • 참고문헌 (74)

    1. Bastow MD, Rawlings J, Allison SP (1983): Benefits of supplementary tube feeding after fractured neck of femur: A randomised controlled trial. Br Med J 287(6405): 1589-1592 
    2. Bloemberg BP, Kromhout D, Goddijn HE, Jansen A, Obermann-de Boer GL (1991): The impact of the Guidelines for a Healthy Diet of The Netherlands Nutrition Council on total and high density lipoprotein cholesterol in hypercholesterolemic free-living men. Am J Epidemiol 134(1): 39-48 
    3. Brunner E, Bristow A, Marmot M (1997): Can dietary intervention change diet and cardiovascular risk factor? A Meta-analysis of Randomized Controlled Trials. Am J Public Health 87(9): 1415-1422 
    4. Burr ML, Fehily AM, Gilbert JF, Rogers S, Holliday RM, Sweetnam PM, Elwood PC, Deadman NM (1989): Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: Diet and reinfarction trial (DART). Lancet 2(8666): 757-761 
    5. Byers T, Mullis R, Anderson J, Dusenbury L, Gorsky R, Kimber C, Krueger K, Kuester S, Kokdad A, Perry G, Smith CA (1995): The costs and effects of a nutritional education program following worksite cholesterol screening. Am J Public Health 85: 650-655 
    6. Delahanty LM, Sonnengerg LM, Hayden D, Nathan DM (2001): Clinical and cost outcomes of medical nutrition therapy for hypercholesterolemia: A controlled trial. J Am Diet Assoc 101(9): 1012-1023 
    7. Ditschuneit HH, Flechtner-Mors M, Johnson TD, Adler G (1999): Metabolic and weight-loss effects of a long-term dietary intervention in obese patients. Am J Clin Nutr 69(2): 198-204 
    8. Dyson PA, Hammersley MS, Moris RJ, Holman RR, Turner RC (1997): The fasting hyperglycaemia study: II. Randomized controlled trail of reinforced healthy-living advice in subjects with increased but not diabetic fasting plama glucose. Metabolism 46(12 suppl 1): 50-55 
    9. Hunninghake DB, Stein EA, Dujovne CA, Harris WS, Feldman EB, Miller VT, Tobert JA, Laskarzewski PM, Quiter E, Held J, Taylor Am, Hopper S, Leonard SB, Brewer BK (1993): The efficacy of intensive dietary therapy alone or combined with lovastatin in outpatients with hypercholesterolemia. N Engl J Med 328(17): 1213-1219 
    10. Jelalian E, Stark LJ, Reynolds L, Seifer R (1998): Nutrition intervention for weight gain in cystic fibrosis: a meta analysis. J Pediatr 132: 486-492 
    11. Kaplan RM, Davis WK (1996): Evaluating the costs and benefits of outpatient diabetes education and nutrition counseling. Diabetes Care 9: 81-86 
    12. Park EC, Kim HA, Lee HY, Lee YE, Yang IS (2002): A review of the Medical Nutrition Therapy (MNT) of th U.S. medicare system. Korean J Community Nutrition 7(6): 852-862 
    13. Retzlaff BM, Walden CE, McNeney WB, Buck BL, McCann BS, Knopp RH (1997): Nutritional intake of women and men on the NCEP Step I and Step II diets. J Am Coll Nutr 16(1): 52-61 
    14. Ridgeway NA, Harvill DR, Harvill LM, Falin TM, Forester GM, Gose OD (1999): Improved control of type 2 diabetes mellitus: a practical education/behavior modification program in a primary care clinic. South Med J 92(7): 667-672 
    15. Rubin RJ, Altman RJ, Mendelson DN (1994): Health care expenditures for people with diabetes mellitus. J clin Endocrinol Metab 78: 809A-809F 
    16. Swinburn BA,Woollard GA, Chang EC, Wilson MR (1999): Effects of reduced-fat diets consumed ad libitum on intake of nutrients, particularly antioxidant vitamins. J Am Diet Assoc 99: 1400-1405 
    17. Cho YY (2002): The needs for sharing of standardized medical nutrition therapy. Proceedings of Korean Dietitian Association Conference pp. 82-95, Seoul, Korea 
    18. Bransome ED (1992): Financing the care of diabetes mellitus in the U.S. Background, problems, and challenges. Diabetes Care 15(Suppl 1): 1-5 
    19. Eriksson KF, Lindgarde F (1991): Prevention of type 2 (non-insulindependent) diabetes mellitus by diet and physical exercise. The 6-year Malmo feasibility study. Diabetologia 34(12): 891-898 
    20. Ashley JM, St Jeor ST, Schrage JP, Perumean-Chaney SE, Gilbertson MC, McCall NL, Bovee V (2001b): Weight control in the physician’s office. Arch Intern Med 161(13): 1599-1604 
    21. Bourn DM, Waldron MA, Mann JI, Wishart JD, McSkimming BJ (1994): Impaired glucose tolerance and NIDDM: Does a lifestyle intervention program have an effect? Diabetes Care 17(11): 1311-1317 
    22. Hursting SD, Thornquist M, Henserson MM (1990): Types of dietary fat and the incidence of cancer at five sites. Prev Med 19: 242-253 
    23. Kasim SE, Martino S, Kim P, Khilnani S, Boomer A, Depper J, Reading BA, Heibrun (1993): Dietary and anthropometric determinants of plasma lipoproteins during a long-term low-fat diet in healthy women. Am J Clin Nutr 57(2): 146-153 
    24. Kim HA, Yang IS, Lee HY, Lee YE, Park EC, Nam CM (2003): Evaluation of cost-effectiveness of medical nutrition therapy: Meta analysis. Korean J Nutritioin 36(5): 515-527 
    25. Lee KY, Park TJ, Kim KJ (1997): The response to a cholesterol-lowering diet insturcted by physicians and dieticians. J Korean Acad Fam Med 18(10): 1042-1053 
    26. Fishbein HA (1995): Precipitants of hospitalization in insulin-dependent diabetes mellitus (IDDM): a state-wide perspective. Diabetes Care 8(Suppl 1): 61-64 
    27. Park DS (2001): The theory on the educational research method. pp. 253, Moon-Eum Sa, Seoul 
    28. Sheppard L, Kristal AR, Kushi LH (1991): Weight loss in women participating in a randomized trial of low-fat diets. Am J Clin Nutr 54(5): 821-828 
    29. Gillman MW, Cupples LA, Gagnon D, Posner BM, Ellison RC, Castelli WP, Wolf PA (1995): Protective effect of fruits and vegetables on development of stroke in men. JAMA 273: 1113-1117 
    30. Henderson MM, Kushi LH, Thompson DJ, Gorbach SL, Clifford CK, Insull W Jr, Moskowitz M, Thompson RS (1990): Feasibility of a randomized trial of a low-fat diet for the prevention of breast cancer: Dietary compliance in the Women’s Health Trial Vanguard Study. Prev Med 19(2): 115-133 
    31. Koopman H, Spreeuwenberg C, Westerman RF, Donker AJ (1990): Dietary treatment of patients with mild to moderate hypertension in a general practice: A pilot intervention study. (1) The first three months. J Hum Hypertens 4(4): 368-371 
    32. Elixhauser A (1999): The cost-effectiveness of preventive care for diabetes mellitus. Diabetes Spectrum 2: 349-353 
    33. Paul O, Arnold CB, Mandriota R, Ames RP, Ruff Eisenbach J, Bohm E. (1982): Multiple risk factor intervention trial: risk factor changes and mortality results. JAMA 248(12): 1465-1477 
    34. Schaefer EJ, Lichtenstein AH, Lamon-Fava S, McNamara JR, Schaefer MM, Rasmussen H, Ordovas JM (1995): Body weight and lowdensity lipoprotein cholesterol changes after consumption of a lowfat ad libitum diet. JAMA 274: 1450-1455 
    35. Stamler R, Stamler J, Grimin R, Gosch FC, Elmer P, Dyer A, Berman R, Fishman J, Van Heel N, Civinelli J (1987): Nutritional therapy for high blood pressure. Final report of a four-year randomized controlled trial- The Hypertension Control Program. JAMA 257: 1484-1491 
    36. Wing RR, Venditti E, Jakicic JM, Polley BA, Lang W (1998): Lifestyle intervention in overweight individual with a family history of diabetes. Diabetes Care 21(3): 350-359 
    37. Delmi M, Rapin CH, Bengoa JM, Delmas PD, Vasey H, Bonjour JP (1990): Dietary supplementation in elderly patients with gractured neck of the femur. Lancet 335(8696): 1013-1016 
    38. Schectman G, Wolff N, Byrd JC, Hiatt JG, Hartz A (1996): Physician extenders for cost-effectiveness management of hypercholesterolemia. J Gen Intern Med 11(5): 277-286 
    39. American Diabetes Association (1986): Task Force on financing quality health care for persons with diabetes, American Diabetes Association, Diabetes Outpatient Education: The Evidence of Cost Savings. Alexandria, Va 
    40. Boyd NF, Martin LJ, Beaton M, Cousins M, Kriukov V (1996): Longterm effects of participation in a randomized trial of a low-fat, highcarbohydrate diet. Cancer Epidemiology Biomarkers and Prevention 5(3): 217-222 
    41. Ferreira I, Brooks D, Lacasse Y, Goldstein R (2001): Nutritional intervention in COPD: a systematic overview. Chest 119(2): 353-363 
    42. Yoo SY, Lee TW, Choue R (2002): Individualized medical nutrition therapy improved nutritional status and quality of life in hemodialysis patients. Nutritional Sciences 5(2): 77-83 
    43. Brown SA, Garcia AA, Kouzekanani K, Hanis CL (2002): Culturally competent diabetes self-management education for Mexican Americas: The Starr County border health initiative. Diabetes Care 25(2): 259-268 
    44. Cappucio FP, Elliott P, Allender PS, Pryer J, Follman DA, Cutler JA (1995): Epidemiologic Association between dietary calcium intake and blood pressure: a meta-analysis of published data. Am J Epidemiol 142(9): 935-945 
    45. Daley H, Kennedy CM (2000): Meta analysis: Effects of interventions on premature infants feeding. Journal of Perinatal & Neonatal Nursing 14(3): 62-77 
    46. Goodman C, Cascade E, Savage K, Sheils J (1996): A review of the literature and data in the cost effectiveness of dietitian services. The Lewin Study Group, Washington DC 
    47. Lee KY, Park TJ, Kwon ER, Kim KJ (2000): The effect of diet education provided by physicians and dieticians on serum lipid profiles during more that 1 year. J Korean Acad Fam Med 21(12): 1523-1533 
    48. Hjermann I, Velve Byre K, Holme I, Leren P (1981): Effect of diet and smoking intervention on the incidence of coronary heart disease. Report from the Oslo Study Group of a randomised trial in healthy men. Lancet 2(8259): 1303-1310 
    49. Whelton PK, Appel L, Charleston J, Dalcin AT, Ewart C, Fried L, Kaidy E, Klag MJ, Kumanyka S, Steffen L, Walker WG, et al (1992): The effects of nonpharmacologic inteventions on blood pressure of persons with high normal levels. JAMA 267(9): 1213-1220 
    50. Barratt A, Reznik R, Irwig L, Cuff A, Simpson JM, Oldenburg B, Horvath J, Sullivan D (1994): Work-site cholesterol screening and dietary intervention: the Staff Health Heart Project. Steering Committee. Am J Public Health 84(5): 779-782 
    51. Hooper L, Summerbell CD, Higgins JP, Thompson RL, Capps NE, Smith GDm Riemersma RA, Ebrahim S (2001): Dietary fat intake and prevention of cardiovascular disease: systematic review. BMJ 322(31): 757-763 
    52. Lim JK (2003): The legalization of the nutrition education and counseling fee. Proceedings of Korean Dietitian Association Conference pp. 89-93, Seoul, Korea 
    53. Moon SJ, Sohn CY, Kim JH, Kim HS, Lim HS, Lee HC, Huh KB. Measurement of nutrition counseling effects for diabetes mellitus patients. Korean J Nutrition 27(10): 1071-1077 
    54. Rhodes KS, Bookstein LC, Aaronoson LS, Mercer NM, Orringer CE (1996): Intensive nutritional counseling enhances outcomes of National Cholesterol Education Program dietary therapy. J Am Diet Assoc 96(10): 1003-1010 
    55. Walter HJ, Hofman A, Connelly PA, Barrett LT, Kost KL(1985): Primary prevention of chronic disease in childhood: Changes in risk factors after one year of intervention. Am J Epidemiol 112(5): 772-781 
    56. Mhurchu CN, Margetts BM, Speller V (1998): Randomized clinical trial comparing the effectiveness of two dietary interventions for patients with hyperlipidaemia. Clinical Science 95: 479-487 
    57. Oldroyd JC, Unwin NC, White M, Imrie K, Mathers JC, Alberti KGMM (2001): Randomised controlled trial evaluating the effectiveness of behavioural interventions to modify cardiovascular risk factors in men and women with impaired glucose tolerance: outcomes at 6 months. Diabetes Research and Clinical Practice 52: 29-43 
    58. Evans WK, Nixon DW, Daly JM, Ellenberg SS, Gardner L, Wolfe E, Shepherd FA, Feld R, Gralla R, Fine S, Kemeny N, Jeejeebhoy KN, Heymsfield S, Hoffman FA (1987): A randomized study of oral nutritional support versus ad lib nutritional intake during chemotherapy for advanced colorectal and non-small-cell lung cancer. J Clin Oncol 5(1): 113-124 
    59. Korea Health Industry Development Institute (2000): The report on the status of clinical nutrition and foodservice for the improvement of medical nutrition quality in hospitals 
    60. Gambera PJ, Schneeman BO, Davis PA (1995): Use of the Food Guide Pyramid and US Dietary Guidelines to improve dietary intake and reduce cardiovascular risk in active-duty Air Force members. J Am Diet Assoc 95(11): 1268-1273 
    61. Greenwood CM (1999): Statistical issues in a metaregression analysis of randomized trials: impact on the dietary sodium intake and blood pressure relationship. Biometrics 55(2): 630-636 
    62. Jadad J A, Moore A, Carroll D, Jenkinson C, Reynolds J M, Gavaghan D J, McQuay H J (1996): Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clinical Trials 17: 1-12 
    63. Pritchard DA, Hyndman J, Taba F (1999): Nutritional counselling in general practice: A cost- effective analysis. J Epidemiol Community Health 53(5): 311-316 
    64. Widga AC, Lewis NM (1999): Defined, in-home, prenatal nutrition intervention for low-income women. J Am Diet Assoc 99(9): 1058-1062 
    65. Cohen J(1977): Statistical Power Analysis for the Behavior Science. Academic Press, San Diego 
    66. Ashley JM, St Jeor ST, Peruman-Chaney S, Schrage J, Bovee V (2001a): Meal replacements in weight intervention. Obes Res 9(suppl 4): 312S-320S 
    67. Swinburn BA, Metcalf PA, Ley SJ (2001): Logn-term (5-Year) effects of a reduced-fat diet intervention in individuals with glucose intolerance. Diabetes Care 24(4): 619-624 
    68. Tang JL, Armitage JM, Lancaster T, Silagy CA, Fowler GH, Neil HA (1998): Systematic review of dietary intervention trials to lower blood total cholesterol in free-living subjects. BMJ 316(7139): 1213-1220 
    69. Yu-Poth S, Zhao G, Etherton T, Naglak M, Jonnalagadda S, Kris-etherton PM (1999): Effects of the National Choloesterol Education Program’s Step I and Step II dietary intervention programs in cardiovascular disease risk factors: a meta-analysis. Am J Clin Nutr 69: 632-646 
    70. Chang UJ, Lim KA, Han YB (1999): Effect of nutrition education on weight control program. Korean J Food & Nutr 12(2): 177-183 
    71. Chun MS, Kang SH, Kweon HK, Oh YT, Kim JR, Lee HJ, Lee SY. Choi SJ (1998): Effect of oral nutritional support during radiation therapy in patients with thoracic and head/neck cancer. J Korean Cancer Assoc 30(4): 781-789 
    72. Goertz CH, Grimm RH, Svendsen K, Grandits G (2002): Treatment of hypertension with alternative therpies (THAT) study: A randomized clinical trial. Journal of Hypertention 20(20): 2063-2068 
    73. McKenzie J, Dixon LB, Smiciklas-Wright H, Mitchell D, Shannon B, Tershakovec A (1996): Change in nutrient intakes, number of servings, and contributions of total fat from food groups in 4- to 10-year-old children enrolled in a nutrition education study. J Am Diet Assoc 96(9): 865-873 
    74. Ovesen L, Allingstrup L, Hannibal J, Mortensen EL, Hansen OP (1993): Effect of dietary counseling on food intake, body weight, response rate, survival, and quality of life in cancer patients undergoing chemotherapy: A prospective, randomized study. J Clin Oncol 11(10): 2043-2049 
  • 이 논문을 인용한 문헌 (6)

    1. Yang Il-Sun ; Kim Hye-Young ; Lee Hae-Young ; Kang Yeo-Hwa 2004. "Effectiveness of Web-Based Nutritional Education Program for Junior and Senior High School Students" 韓國營養學會誌 = The Korean journal of nutrition., 37(7): 576~584     
    2. Shim, Jae-Hun 2009. "Effectiveness of Exercise Therapy on Physical Function in Patients With Ankylosing Spondylitis: Systemic Review and Meta-Analysis" 한국전문물리치료학회지 = Physical Therapy Korea, 16(3): 50~59     
    3. Kim, Hye-Jin ; Kim, Eun-Mi ; Lee, Geum-Ju ; Lee, Jung-Joo ; Lim, Jung-Hyun ; Lee, Jung-Min ; Jeon, Hyun-Jung ; Lee, Hae-Young 2011. "Clinical Nutrition Service at Medical Centers in Seoul" 대한영양사협회 학술지 = Journal of the Korean dietetic association, 17(2): 176~189     
    4. Cha, Jin-A ; Kim, Kang-Eun ; Kim, Eun-Mi ; Park, Mi-Sun ; Park, Yoo-Kyoung ; Baek, Hee-Joon ; Lee, Song-Mi ; Choi, Soo-Kyong ; Seo, Jung-Sook 2013. "Development of Job Description of Clinical Dietitians in Hospitals by the DACUM Method" 대한영양사협회 학술지 = Journal of the Korean dietetic association, 19(3): 265~286     
    5. Jang, Eun Hee ; Lyu, Eun Soon ; Lee, Song Mi ; Park, Yoo Kyung ; Lee, Eun ; Cha, Jin A ; Park, Mi Sun ; Lee, Ho Sun ; Rha, Mi Young ; Lee, Seung Min 2014. "Job Satisfaction Level and Related Factors among Korean Hospital Dietitians" 대한영양사협회 학술지 = Journal of the Korean dietetic association, 20(4): 257~274     
    6. Gwon, Su-Jin ; Woo, Mi-Hye ; Ju, Dal Lae ; Kim, Eun Mi ; Park, Mi-Sun ; Sohn, Cheongmin ; Wie, Gyung-Ah ; Lee, Song-Mi ; Cha, Jin-A ; Seo, Jung-Sook 2015. "Development of Job Standards for Clinical Dietitians Administering Clinical Nutrition Therapy to Diabetic Patients in Hospitals" 대한영양사협회 학술지 = Journal of the Korean dietetic association, 21(1): 37~56     

 저자의 다른 논문

  • 이해영 (52)

    1. 2003 "재가노인을 위한 식사배달서비스 제공기관의 실태분석" 대한지역사회영양학회지 = Korean journal of community nutrition 8 (5): 736~743    
    2. 2003 "서울 시내 중.고등학생의 인터넷 영양정보관련 실태분석" 韓國營養學會誌 = The Korean journal of nutrition. 36 (9): 960~965    
    3. 2003 "경로식당 급식서비스 운영관리 실태분석" 대한지역사회영양학회지 = Korean journal of community nutrition 8 (6): 919~926    
    4. 2004 "푸드코트형 산업체 급식소에서의 고객의 메뉴 선택 속성 규명" 대한지역사회영양학회지 = Korean journal of community nutrition 9 (2): 183~190    
    5. 2004 "위탁급식전문업체의 운영관리 인프라 시스템에 대한 본사와 업장 측면에서의 중요도, 지원도, 활용도 탐색" 대한지역사회영양학회지 = Korean journal of community nutrition 9 (2): 233~240    
    6. 2004 "직무 유형에 따른 특급호텔 조리ㆍ식음료 종사원의 직무만족도가 이직의사 견해에 미치는 영향 분석" 한국조리과학회지 = Korean Journal of Food and Cookery Science 20 (2): 151~157    
    7. 2004 "웹기반 영양교육 프로그램의 질 평가도구 개발 및 활용가능성 탐색" 韓國營養學會誌 = The Korean journal of nutrition. 37 (4): 310~315    
    8. 2004 "고객지향적 병원 급식서비스 운영을 위한 질 평가 도구 개발 및 적용" 韓國營養學會誌 = The Korean journal of nutrition. 37 (4): 329~338    
    9. 2004 "중ㆍ고등학생 대상 영양교육 내용 및 성취 목표 선정을 위한 교수분석과 출발점 행동 및 학습자 특성분석" 대한지역사회영양학회지 = Korean journal of community nutrition 9 (4): 464~471    
    10. 2004 "위탁급식전문업체 종사자와 직무만족도 분석" 대한지역사회영양학회지 = Korean journal of community nutrition 9 (4): 519~527    
  • 양일선 (174)

  • 남정모 (65)

  • 박은철 (137)

 활용도 분석

  • 상세보기

    amChart 영역
  • 원문보기

    amChart 영역

원문보기

무료다운로드
유료다운로드

유료 다운로드의 경우 해당 사이트의 정책에 따라 신규 회원가입, 로그인, 유료 구매 등이 필요할 수 있습니다. 해당 사이트에서 발생하는 귀하의 모든 정보활동은 NDSL의 서비스 정책과 무관합니다.

원문복사신청을 하시면, 일부 해외 인쇄학술지의 경우 외국학술지지원센터(FRIC)에서
무료 원문복사 서비스를 제공합니다.

NDSL에서는 해당 원문을 복사서비스하고 있습니다. 위의 원문복사신청 또는 장바구니 담기를 통하여 원문복사서비스 이용이 가능합니다.

이 논문과 함께 이용한 콘텐츠
이 논문과 함께 출판된 논문 + 더보기