OBJECTIVE:The purpose of this study was to develop, implement, and evaluate the efficacy of an intensive intervention program (IIP) based on motivational interviewing to motivate participants within the dietary study of the Women's Health Initiative (WHI) to meet the study's nutritional goals. SUBJECTS/DESIGN:WHI dietary intervention participants (n=175) from 3 clinical centers were randomly assigned to either intervention or control status. Participants assigned to IIP intervention received 3 individual motivational interviewing contacts from a dietitian, plus the usual WHI Dietary Intervention. Participants randomly assigned to IIP control received the usual WHI dietary modification (DM) Intervention. Percent of energy from fat was estimated at study baseline and at follow-up (1 year later) using the WHI Food Frequency Questionnaire. RESULTS:The change in percent energy from fat between IIP baseline and IIP 1-year follow-up was -1.2% for IIP intervention participants and +1.4% for IIP control participants, giving an overall difference of 2.6% (P<.001). Participants having the highest IIP baseline fat intake (>30% energy) showed the largest overall change in percent energy from fat between IIP baseline and IIP follow-up. CONCLUSIONS:The results of this study indicate that a protocol based on motivational interviewing and delivered through contacts with trained dietitians is an efficacious way to further lower dietary fat intake among participants exposed to ongoing intervention. These data will be useful in future intervention situations when there is a need to increase motivation to change.

Background. The relationship between the protein-energy nutritional status and renal function was assessed in 1785 clinically stable patients with moderate to advanced chronic renal failure who were evaluated during the baseline phase of the Modification of Diet in Renal Disease Study. Their mean +/- SD glomerular filtration rate (GFR) was 39.8 +/- 21.1 mL/min/ 1.73 m(2).Methods. The GFR was determined by I-121-iothalamate clearance and was correlated with dietary and nutritional parameters estimated from diet records. biochemistry measurements, and anthropometry.Results. The following parameters correlated directly with the GFR in both men and women: dietary protein intake estimated from the urea nitrogen appearance, dietary protein and energy intake estimated from dietary diaries, serum albumin, transferrin. percentage body fat, skinfold thickness, and urine creatinine excretion. Serum total cholesterol, actual and relative body weights, body mass index, and arm muscle area also correlated with the GFR in men. The relationships generally persisted after statistically controlling for reported efforts to restrict diets. Compared with patients with GFR > 37 mL/min/ 1.73 m(2), the means of several nutritional parameters were significantly lower for GFR between 21 and 37 mL/min/1.73 m(2), and lower still for GFRs under 21 mL/min/1.73 m(2). In multivariable regression analyses, the association of GFR with several of the anthropometric and biochemical nutritional parameters was either attenuated or eliminated completely after controlling for protein and energy intakes. which were themselves strongly associated with many of the nutritional parameters. On the other hand, few patients showed evidence for actual protein-energy malnutrition.Conclusions. These cross-sectional findings suggest that in patients with chronic renal disease, dietary protein and energy intakes and serum and anthropometric measures of protein-energy nutritional status progressively decline as the GFR decreases. The reduced protein and energy intakes, as GFR falls, may contribute to the decline in many of the nutritional measures.