• Intervention
    (2005) What is the optimal duration and frequency of follow-up visits for an adult patient by a registered dietitian using medical nutrition therapy (MNT)?
    • Conclusion

      (2005)The optimal duration and frequency of follow-up MNT visits by a RD 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.
  • Monitoring and Evaluation
    In patients with disorders of lipid metabolism, does medical nutrition therapy (MNT) given by a registered dietitian result in changes in levels of dietary fat, saturated fat, serum cholesterol, and cardiac risk factors?
    • Conclusion

      Available data from studies on Medical Nutrition Therapy provided by a registered dietitian indicate that with 2 to 6 planned visits patients reported 15-22% reduction in total dietary fat (from 32-33% of calories to 25-28% of calories), and 22-36% reduction in saturated fat (from 11-12% of calories to 7-9% of calories). This was accompanied by 6-13% reduction in total plasma cholesterol and 7-14% reduction in LDL-C. Findings further suggest decreases in triglycerides and possibly HDL but results are inconsistent. MNT involved an initial planned visit ranging from 45-90 minutes and a follow-up planned visits ranging from 30-60 minutes over a 6 week to 6 month time period. Data on long-term adherence and sustained lipid response are unavailable.

    • 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.
    In patients with disorders of lipid metabolism, does MNT result in reduced need for lipid lowering medications?
    • Conclusion

      Two small studies comparing cost-benefit of MNT involving retrospective chart review in male VA patients suggested that diet intervention could obviate the need for lipid lowering medications but randomized clinical trial data are needed. None of the studies reviewed for this guideline have deliberately measured whether aggressive MNT can reduce or replace the need for lipid lowering medication.

    • 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 additional medical nutrition therapy (MNT) visits with a registered dietitian (RD) result in further reductions in total and LDL cholesterol in adults?
    • Conclusion

      Data suggests greater decreases in total cholesterol and LDL-C occur as the number of MNT visits and time spent with a dietitian increases.

    • 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.