MNT: Comparative Effectiveness of MNT Services (2009)

MNT: Comparative Effectiveness of MNT Services (2009)

• Assessment
  What is the evidence to support effectiveness of MNT provided by an RD compared with other healthcare professionals who provide nutrition interventions (doctors, nurses, health coaches, etc.)?

  • Conclusion

    Five studies were reviewed to evaluate the effectiveness of Medical Nutrition Therapy (MNT) provided by a registered dietitian, when compared with other healthcare professionals who provide nutrition interventions in the same study. The only studies comparing providers were in the area of hyperlipidemia: These studies report inconclusive findings due to variations in nature and length of the interventions and outcome measures. Further research utilizing comparable interventions on consistent outcomes over longer time periods is needed, as well as research in other disease states and compared with other healthcare professionals.

  • 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.
  • Evidence Summary: Effectiveness of MNT provided by an RD compared with other healthcare professionals who provide nutrition interventions (doctors, nurses, health coaches, etc.) for Hyperlipidemia
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Caggiula AW, Watson JE, Kuller LH, Olson MB, Milas NC, Berry M, Germanowski J. Cholesterol-lowering intervention program. Effect of the Step I diet in community office practices. Arch Intern Med. 1996; 156: 1205-1213.
      • Neil HAW, Roe L, Godlee RJP, Moore JW, Clark GMG, Brown J, Thorogood M, Stratton IM, Lancaster T, Mant D, Fowler GH.  Randomized trial of lipid lowering dietary advice in general practice: the effects on serum lipids, lipoproteins, and antioxidants. BMJ. 1995; 310 (6979): 569-573.
      • Reid R, Fodor G, Lydon-Hassen K, Slovinec D'Angelo M, McCrea J, Bowlby M, Difrancesco L. Dietary counselling for dyslipidemia in primary care: results of a randomized trial. Can J Diet Prac Res. 2002; 63: 169-175.
      • Timlin MT, Shores KV, Reicks M. Behavior change outcomes in an outpatient cardiac rehabilitation program. J Am Diet Assoc. 2002; 102: 664-671. 
      • Willaing I, Ladelund S, Jorgensen T, Simonsen T, Nielsen LM. Nutritional counselling in primary health care: a randomized comparison of an intervention by general practitioner or dietician. European Journal of Cardiovascular Prevention and Rehabilitation, 2004; 11: 513-520. 
  • Search Plan and Results: Comparative MNT Effectiveness 2008
     
  What is the evidence to support effectiveness of nutrition interventions and counseling provided by an RD when part of a healthcare team?

  • Conclusion

    Nine studies demonstrate that the inclusion of nutrition interventions and counseling, when provided by a registered dietitian as part of a healthcare team, resulted in significant improvements in weight and BMI, A1C, blood pressure and serum lipids. The majority of these studies took place in primary care settings.

  • 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.
  • Evidence Summary: Effectiveness of nutrition interventions and counseling provided by an RD when part of a healthcare team
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Berra K, Ma J, Klieman L, Hyde S, Monti V, Guardado A, Rivera S, Stafford RS. Implementing cardiac risk-factor case management: Lessons learned in a county health system. Critical Pathways in Cardiology. 2007; 6(4): 173-179.
      • Dolecek TA, Bradham KH, Espeland MA, Margitic SE, Byington RP, Hoen H, Kappelle LJ, for the Asymptomatic Carotid Artery Progression Study (ACAPS) Group. Maximizing recruitment efforts in a drug lipid-lowering trial with dietary intervention to lower LDL cholesterol. Controlled Clinical Trials. 1996; 17(1): 33-45.
      • Hebert JR, Ebbeling CB, Ockene IS, Ma Y, Rider L, Merriam PA, Ockene JK, Saperia GM. A dietitian-delivered group nutrition program leads to reductions in dietary fat, serum cholesterol, and body weight: the Worcester Area Trial for Counseling in Hyperlipidemia (WATCH). J Am Diet Assoc. 1999; 99(5): 544-552.
      • Heller SR, Clarke P, Daly H, Davis I, McCulloch DK, Allison SP, Tattersall RB. Group education for obese patients with type 2 diabetes: greater success at less cost. Diabetic Medicine. 1988; 5: 552-556.
      • Holmes AL, Sanderson B, Maisiak R, Brown A, Bittner V. Dietitian services are associated with improved patient outcomes and the MEDFICTS dietary assessment questionnaire is a suitable outcome measure in cardiac rehabilitation. J Am Diet Assoc. 2005; 105(10): 1533-1540.
      • Luepker RV, Smith LK, Rothchild SS, Gillis A, Kochman L, Warbasse JR. Management of hypercholesterolemia: evaluation of practical clinical approaches in healthy young adults. Am J Cardiol. 1978; 41: 590-596.
      • Martin OJ, Wu WC, Taveira TH, Eaton CB, Sharma SC. Multidisciplinary group behavioral and pharmacologic intervention for cardiac risk reduction in diabetes: A pilot study. Diabetes Educ. 2007; 33(1): 118-127. 
      • Pritchard DA, Hyndman J, Taba F. Nutritional counselling in general practice: A cost effective analysis. J Epidemiol Community Health. 1999; 53: 311-316.
      • Smith LK, Luepker RV, Rothchild SS, Gillis A, Kochman L, Warbasse JR.  Management of type IV hyperlipoproteinemia: evaluation of practical clinical approaches. Annals of Internal Medicine. 1976; 84: 22-28.
  • Search Plan and Results: Combined/Additive MNT Effectiveness 2008