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Recommendations Summary

DLM: Referral to a Registered Dietitian for Medical Nutrition Therapy (MNT) 2005

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    DLM: MNT and Referral to a Registered Dietitian

    Referral to a registered dietitian for Medical Nutrition Therapy (MNT) is recommended whenever an individual has an abnormal lipid profile, based on ATPIII Risk category and LDL-C goals, or has CHD. A planned initial visit lasting from 45-90 minutes and at least two to six planned follow-up visits (30-60 minutes each, with an RD) can lead to improved dietary pattern; improved lipid profile; reduced plasma total cholesterol, LDL-C, and triglycerides; and improved weight status.

    Rating: Strong
    Conditional

    DLM: MNT Number and Duration of Visits

    The number and duration of visits in the course of Medical Nutrition Therapy will need to be greater if the client is in a higher risk category, if there is a large number of Therapeutic Lifestyle Changes (TLC) that need to be made, and if the individual is not motivated to make TLC changes. Increasing the number of visits and length of time spent with a dietitian can improve serum lipid levels and CVD risk.

    Rating: Fair
    Conditional

    DLM: Lipid-Lowering Medication Re-evaluation

    Re-evaluate the dosage and necessity of lipid-lowering medications throughout the course of Medical Nutrition Therapy. Medical Nutrition Therapy may successfully improve the lipid levels to the point where medication doses can be lowered or discontinued.

    Rating: Fair
    Imperative

    • Risks/Harms of Implementing This Recommendation

      None.

    • Conditions of Application

      None specified.

    • Potential Costs Associated with Application

      None specified.

    • Recommendation Narrative

      • Seven studies (four RCT, two retrospective chart reviews, and one nonrandomized trial with use of historic controls) describe individualized Medical Nutrition Therapy that results in improved cardioprotective dietary pattern changes and/or subsequent plasma lipid changes, thereby decreasing cardiac heart disease risks. Reductions in total fat and saturated fat intake were seen in three studies (two high- and one neutral-quality). Decreases in TC and LDL-C were reported in five studies (three high- and two neutral-quality). Three of these studies found reductions in body weight. Four studies looked at the impact on TG and HDL-C and found varying results.
      • Two studies (one neutral-quality retrospective chart review and one neutral-quality RCT) found that decreases in total cholesterol correlated with time spent with a dietitian. A third high-quality RCT found that individuals who went to three or four MNT sessions had lower LDL-C compared to those that attended fewer than three sessions.
      • Two retrospective chart reviews (one high- and one neutral-quality) found that MNT obviated the need for lipid-lowering medications in some patients
      • One study identified a trend that the dietitian group had lower attrition compared to the control group (MD counseling), possibly indicating preferences for services provided by a dietitian.

    • Recommendation Strength Rationale

      • Studies were of a variety of populations. Studies represented individuals (21-75 years of age) who had ischemic heart disease, hypercholesterolemia, hyperlipidemia (high LDL-C), combined hyperlipidemia (high LDL-C and TG), or hypertriglyceridemia; but excluded familial hypertriglyceridemia (FH).
      • Sufficient time was provided to see outcomes (six weeks was the shortest intervention, with the longest intervention lasting more than six months).
      • Consistent findings across a variety of study designs.
      • Conclusion statements were Grade I, III and V.