美国预防服务工作组推荐意见声明
遵从与不遵从国家健康饮食和体力活动指南的成人相比，心血管发病率和死亡率较低。所有人，无论其心血管疾病的风险状况如何，均可从健康饮食行为和适当体力活动获益。
2017年7月11日，《美国医学会杂志》正式发表凯萨医疗机构（华盛顿西雅图）卫生研究所、旧金山加利福尼亚大学、爱荷华大学、哈佛医学院、哥伦比亚大学、宾夕法尼亚大学、弗吉尼亚理工学院暨州立大学、杜克大学、弗吉尼亚联邦大学、耶鲁大学、伯明翰阿拉巴马大学、洛杉矶加利福尼亚大学、布朗大学、波士顿大学、西北大学、夏威夷大学、太平洋卫生研究教育研究所起草的美国预防服务工作组（USPSTF）声明，更新了2012年关于行为咨询的推荐意见，以促进健康饮食和体力活动对无心血管风险因素（高血压、高血脂、高血糖或糖尿病）成人的心血管疾病预防作用。
美国预防服务工作组（USPSTF）是由美国卫生部医疗研究与质量管理局任命的初级医疗、流行病学和预防医学专家组，负责对临床预防服务的有效证据进行系统评审并制定推荐意见。USPSTF不考虑成本效益。推荐意见单纯基于患者医疗获益证据，无论成本高低。
凯萨医疗机构是一家综合性管理型医疗集团，总部位于美国加利福尼亚州奥克兰，由实业家亨利·凯萨和医生西德尼·加菲尔德于1945年创立，由三个不同但是相互依赖的实体组成：凯萨基金会医疗保险公司及其区域运营子公司、凯萨基金会医院、区域医生集团（医疗团队执业经纪组织）。截至2014年，凯萨医疗机构在八个州以及哥伦比亚特区经营，是美国最大的管理型医疗集团。
USPSTF对以下证据进行了评审：促进健康饮食和（或）体力活动的初级医疗相关咨询干预措施能否改善成人心血管疾病相关中间结局、健康结局、饮食或体力活动行为；减少久坐行为的干预措施；行为咨询干预是否有害。
结果发现，咨询干预措施可以改善健康行为，并小幅但重要地改善中间结局，包括降低血压和低密度脂蛋白胆固醇水平、改善肥胖程度。这些干预措施总体可以获益，但是幅度较小，潜在危害极小，使USPSTF认为这些干预措施对于无心血管疾病风险因素的肥胖成人而言有少量净获益。
因此，USPSTF推荐初级医疗专业人员对无高血压、高血脂、高血糖水平或糖尿病的无肥胖成人个体化决定是否直接提供或转诊提供行为咨询，以促进健康饮食和体力活动。现有证据表明，行为咨询对于预防该人群心血管疾病有积极而较小获益。有兴趣并准备进行行为改变者最有可能从行为咨询获益（C级推荐意见）。
USPSTF Recommendation: Behavioral Counseling for CVD Prevention.
Interview with Susan J. Curry, PhD, author of Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Cardiovascular Risk Factors: US Preventive Services Task Force Recommendation Statement.
对此，《美国医学会杂志》配发患者单页：无风险因素成人预防心血管疾病的健康生活咨询。
对此，《美国医学会杂志》配发西北大学费恩伯格医学院、纽约西奈山伊坎医学院、西班牙卡洛斯三世国家心血管研究中心、《美国医学会杂志》高级编辑的同期评论：为所有人控制心血管风险因素。
当天，《美国医学会杂志心脏病学分册》在线发表西北大学费恩伯格医学院预防医学专家的评论：推广健康的体力活动和饮食——为了多数人或少数人？
当天，《美国医学会杂志内科学分册》在线发表英国利物浦大学临床流行病学和初级医疗专家的评论：对无已知风险因素成人进行预防心血管疾病的健康饮食和体力活动行为咨询是否必要？
调查投票
JAMA. 2017 Jul 11;318(2):167-174.
Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Cardiovascular Risk Factors: US Preventive Services Task Force Recommendation Statement.
US Preventive Services Task Force, Grossman DC, Bibbins-Domingo K, Curry SJ, Barry MJ, Davidson KW, Doubeni CA, Epling JW Jr, Kemper AR, Krist AH, Kurth AE, Landefeld CS, Mangione CM, Phipps MG, Silverstein M, Simon MA, Tseng CW.
Kaiser Permanente Washington Health Research Institute, Seattle; University of California, San Francisco; University of Iowa, Iowa City; Harvard Medical School, Boston, Massachusetts; Columbia University, New York, New York; University of Pennsylvania, Philadelphia; Virginia Tech Carilion School of Medicine, Roanoke; Duke University, Durham, North Carolina; Fairfax Family Practice Residency, Fairfax, Virginia; Virginia Commonwealth University, Richmond; Yale University, New Haven, Connecticut; University of Alabama at Birmingham; University of California, Los Angeles; Brown University, Providence, Rhode Island; Boston University, Boston, Massachusetts; Northwestern University, Evanston, Illinois; University of Hawaii, Honolulu; Pacific Health Research and Education Institute, Honolulu, Hawaii.
IMPORTANCE: Adults who adhere to national guidelines for a healthful diet and physical activity have lower rates of cardiovascular morbidity and mortality than those who do not. All persons, regardless of their risk status for cardiovascular disease (CVD), can gain health benefits from healthy eating behaviors and appropriate physical activity.
OBJECTIVE: To update the 2012 US Preventive Services Task Force (USPSTF) recommendation on behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention among adults without obesity who do not have cardiovascular risk factors (hypertension, dyslipidemia, abnormal blood glucose levels, or diabetes).
EVIDENCE REVIEW: The USPSTF reviewed the evidence on whether primary care-relevant counseling interventions to promote a healthful diet, physical activity, or both improve health outcomes, intermediate outcomes associated with CVD, or dietary or physical activity behaviors in adults; interventions to reduce sedentary behaviors; and the harms of behavioral counseling interventions.
FINDINGS: Counseling interventions result in improvements in healthful behaviors and small but potentially important improvements in intermediate outcomes, including reductions in blood pressure and low-density lipoprotein cholesterol levels and improvements in measures of adiposity. The overall magnitude of benefit related to these interventions is positive but small. The potential harms are at most small, leading the USPSTF to conclude that these interventions have a small net benefit for adults without obesity who do not have CVD risk factors.
CONCLUSIONS AND RECOMMENDATION: The USPSTF recommends that primary care professionals individualize the decision to offer or refer adults without obesity who do not have hypertension, dyslipidemia, abnormal blood glucose levels, or diabetes to behavioral counseling to promote a healthful diet and physical activity. Existing evidence indicates a positive but small benefit of behavioral counseling for the prevention of CVD in this population. Persons who are interested and ready to make behavioral changes may be most likely to benefit from behavioral counseling. (C recommendation).
PMID: 28697260
DOI: 10.1001/jama.2017.7171
JAMA. 2017 Jul 11;318(2):210.
Counseling on Healthy Living to Prevent Cardiovascular Disease in Adults Without Risk Factors.
Jin J.
PMID: 28697255
DOI: 10.1001/jama.2017.8445
JAMA. 2017 Jul 11;318(2):130-131.
Cardiovascular Risk Factor Control for All.
Greenland P, Fuster V.
Northwestern University Feinberg School of Medicine, Chicago, Illinois; Senior Editor, JAMA; Icahn School of Medicine at Mount Sinai, New York, New York; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.
PMID: 28697239
DOI: 10.1001/jama.2017.7648
JAMA Cardiol. 2017 Jul 11. [Epub ahead of print]
Healthful Physical Activity and Diet Promotion-For the Many or the Few?
Spring B.
Northwestern University Feinberg School of Medicine, Preventive Medicine, Chicago, Illinois.
PMID: 28697230
DOI: 10.1001/jamacardio.2017.2568
JAMA Intern Med. 2017 Jul 11. [Epub ahead of print]
Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Risk Factors: Is Behavioral Counselling Necessary?
Capewell S, Dowrick C.
University of Liverpool, United Kingdom.
PMID: 28697229
DOI: 10.1001/jamainternmed.2017.1979