• Assessment
    What is the optimal duration and frequency of follow-up visits for hypercholesterolemia by a Registered Dietitian (RD) using medical nutrition therapy (MNT)?
    • Conclusion

      No new studies were identified in the 2010 update. The optimal duration and frequency of follow-up medical nutrition therapy visits by a Registered Dietitian is not known.

    • Grade: V
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
  • Intervention
    Does medical nutrition therapy (MNT) given by a Registered Dietitian (RD) result in changes in adult patients' levels of dietary fat, saturated fat, serum cholesterol and cardiac risk factors?
    • Conclusion

      Medical Nutrition Therapy (MNT) provided by Registered Dietitians (RDs) promotes changes in dietary intake of fat and saturated fat and positively impacts changes in serum lipid levels. When patients attended two to four MNT sessions over six to twelve weeks, they reduced daily dietary fat (5% to 8% saturated fat (2% to 4%) and energy intake (232-710kcal per day). Serum total cholesterol (TC) was lowered by 7% to 21% and low-density lipoprotein cholesterol (LDL-C) was lowered by 7% to 22%. Triglycerides (TG)were lowered from 11% to 31%.
       

    • Grade: I
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    Does medical nutrition therapy (MNT) by a Registered Dietitian (RD) result in reduced need for lipid lowering medications in adults?
    • Conclusion

      Medical nutrition therapy (MNT) may reduce need for lipid-lowering drugs. Three studies prior to ATP III were reviewed for this question. These included one randomized controlled trial (RCT) and two cost-benefit analyses. All three studies reported reduced need for lipid-lowering drugs and significant potential cost savings when patients attend two to four MNT sessions in six to eight weeks.

      In the 2010 update, there were no new papers identified for this question. It should be noted that the guidelines for optimal blood lipid levels were lowered after these studies were completed.

       

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    Do multiple medical nutrition therapy (MNT) visits by a Registered Dietitian (RD) result in further reductions in total- and LDL-cholesterol in adults?
    • Conclusion

      When patients attend more than two medical nutrition therapy (MNT) sessions (three to six visits) provided by Registered Dietitians (RDs), further reductions in total cholesterol  (TC) (cumulative reduction as much as 19%) and low-density lipoprotein cholesterol (LDL-C) (cumulative reduction as much as 22%) were observed beyond the first two sessions.

    • Grade: II
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.