Medical Nutrition Therapy

MNT: Disorders of Lipid Metabolism (2015)

Please visit the MNT Effectiveness: Dyslipidemia (2022) review for updated information. 

• Intervention
  In outpatient adults, what is the effectiveness of MNT provided by a Registered Dietitian Nutritionist (RDN) to improve disorders of lipid metabolism outcomes?

  • Conclusion
    Strong evidence supports the effectiveness of multiple visits (two to 12 visits; 60-minute initial visit and 20- to 45-minute follow-ups) for Medical Nutrition Therapy (MNT) by a nutrition professional (registered dietitian nutritionist or equivalent) in adults with disorders of lipid metabolism. Evidence showed improved total cholesterol (-2.3mg to -47.9mg per dL), LDL-cholesterol (-6.0mg to -21.7mg per dL), triglycerides (-12mg to -175mg/dL), HLD-cholesterol (+2.0mg to +4.0mg per dL), weight (-4.3kg to -12.6kg), waist circumference (-0.6cm to -9.3cm) and BMI (-0.2kg/m² to -2.6kg/m²). MNT may also result in reductions in need for lipid-lowering medications.
  • 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: In outpatient adults, what is the effectiveness of MNT provided by a registered dietitian nutritionist (RDN) to improve disorders of lipid metabolism outcomes?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
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      • Al-Shookri A, Khor GL, Chan YM, Loke SC, Al-Maskari M. Effectiveness of medical nutrition treatment delivered by dietitians on glycaemic outcomes and lipid profiles of Arab, Omani patients with type 2 diabetes. Diabet Med. 2012; 29(2): 236-244.
      • Barakatun Nisak MY, Ruzita AT, Norimah AK, Kamaruddin NA. Medical nutrition therapy administered by a dietitian yields favourable diabetes outcomes in individuals with type 2 diabetes mellitus. Med J Malaysia. 2013; 68(1): 18-23.
      • Batista MdCR and Franceschini SdCC. Impact of nutritional counseling in reducing serum cholesterol in public health service patients. Arq Bras Cardiol. 2003; 80 (2):167-170.  
      • Bray P, Cummings DM, Morrissey S, Thompson D, Holbert D, Wilson K, Lukosius E, Tanenberg R. Improved outcomes in diabetes care for rural African Americans. Annals of Family Medicine. 2013; 11 (2): 145-150. 
      • Daubert H, Ferko-Adams D, Rheinheimer D, Brecht C. Metabolic risk factor reduction through a worksite health campaign: A case study design. Online J Public Heal Informatics. 2012 ;4(2).
      • Goulet J, Lamarche B, Charest A, Nadeau G, Lapointe A, Desroches S, Lemieux S. Effect of a nutritional intervention promoting the Mediterranean food pattern on electrophoretic characteristics of low-density lipoprotein particles in healthy women from the Quebec City metropolitan area. Br J Nutr. 2004; 92 (2): 285-293.
      • Goulet J, Lapointe A, Lamarche B, Lemieux S. Effect of a nutritional intervention promoting the Mediterranean food pattern on anthropometric profile in healthy women from Quebec city metropolitan area. Eur J Clin Nutr. 2007; 61: 1,293-1,300.
      • 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.
      • Imai S, Kozai H, Naruse Y, Watanabe K, Fukui M, Hasegawa G, Obayashi H, Nakamura N, Naito Y, Yoshikawa T, Kajiyama S. Randomized controlled trial of two forms of self-management group education in Japanese people with impaired glucose tolerance. J Clin Biochem Nutr. 2008; 43: 82-87.
      • Jensen GL, Roy M, Buchanan AE, Berg MB. Weight loss intervention for obese older women: I mprovements in performance and function. Obes Res. 2004; 12(11): 1,814-1,820.
      • Kim HJ, Hong JI, Mok HJ, Lee KM. Effect of workplace-visiting nutrition education on anthropometric and clinical measures in male workers. Clin Nutr Res. 2012; 1 (1): 49-57. doi: 10.7762/cnr.2012.1.1.49.
      • Lee IS, Shin G, Choue R. A 12-week regimen of caloric restriction improves levels of adipokine and pro-inflammatory cytokines in Korean women with BMIs greater than 23 kg/m². Inflammation Research, 2010; 59: 399-405.
      • Lim H, Son JY, Choue R. Effects of medical nutrition therapy on body fat and metabolic syndrom components in premenopausal overweight women. Ann Nutr Metab. 2012; 61: 47-56.
      • Majumdar SR, Guirguis LM, Toth EL, Lewanczuk RZ, Lee TK, Johnson JA. Controlled trial of a multifaceted intervention for improving quality of care for rural patients with type 2 diabetes. Diabetes Care, 2003; 26 (11): 3,061-3,066.
      • Makrilakis K, Grammatikou S, Liatis S, Kontogianni M, Perrea D, Dimosthenopoulos C, Poulia KA, Katsilambros N. The effect of a non-intensive community-based lifestyle intervention on the prevalence of metabolic syndrome. The DEPLAN study in Greece. Hormones. 2012; 11(3): 316-324. 
      • 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. 
      • McCoin M, Sikand G, Johnson E, Kris-Etherton P, Burke F, Carson JAS, Champagne CM, Karmally W, Van Horn L. The effectiveness of medical nutrition therapy deliverd by registred dietitians for disorders of lipid metabolism: a call for further research. JADA. 2008; 108 (2): 233-239.
      • Morita-Suzuki S, Fujioka Y, Mitsuoka H, Tashiro M, Harada M. Adding diet and exercise counseling to the health promotion plan alleviates anthropometric and metabolic complications in patients with metabolic syndrome. Nutr Metab Insights. 2012; 5: 49-58. doi: 10.4137/NMI.S9683.
      • Nagashima J, Musha H, Takada H, Takagi K, Mochida T, Yoshihisa T, Imagawa Y, Matsumoto N, Ishige N, Fujimaki R, Nakajima H, Murayama M. Three-month exercise and weight loss program improves heart rate recovery in obese persons along with cardiopulmonary function. Journal of Cardiology. 2010; 56: 79-84.
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      • Parker AR, Byham-Gray L, Denmark R, Winkle PJ. The Effect of Medical Nutrition Therapy by a Registered Dietitian Nutritionist in Patients with Prediabetes Participating in a Randomized Controlled Clinical Research Trial. J Acad Nutr Diet. 2014. doi:10.1016/j.jand.2014.07.020.
      • Patel M, Patel IM, Patel YM, Rathi, SK. Factors associated with consumption of diabetic diet among type 2 diabetic subjects from Ahmedabad, Western India. Journal of Health, Population and Nutrition, 2012; 30 (4): 447-455.
      • Thomson CA, Stopeck AT, Bea JW, Cussler E, Nardi E, Frey G, Thompson PA. Changes in body weight and metabolic indexes in overweight breast cancer survivors enrolled in a randomized trial of low-fat vs. reduced-carbohydrate diets. Nutr Cancer. 2010; 62 (8): 1,142-1,152.
      • van de Laar FA, van de Lisdonk EH, Lucassen PL, Tigchelaar JM, Meyboom S, Mulder J, van den Hoogen JM, Rutten GE, van Weel, C. Fat intake in patients newly diagnosed with type 2 diabets: A four-year follow-up study in general practice. Br J Gen Prac. 2001; 54: 177-182.
      • Welty FK, Nasca MM, Lew NS, Gregoire S, Ruan Y. Effect of onsite dietitian counseling on weight loss and lipid levels in an outpatient physician office. Am J Cardiol. 2007; 100(1): 73-75.
      • Wong V, Chan R, Wong G, Cheung B, Chu W, Yeung D, Chim A, Lai J, Li L, Sea M, Chan F, Sung J, Woo J, Chan H. Community-based lifestyle modification programme for non-alcoholic fatty liver disease: a randomized controlled trial. Journal of Hepatology, 2013; 59: 536-542.
      • Woo J, Sea MMM, Tong P, et al. Effectiveness of a lifestyle modification programme in weight maintenance in obese subjects after cessation of treatment with Orlistat. J Eval Clin Pract. 2007; 13 (6): 853-859. doi:10.1111/j.1365-2753.2006.00758.x.
      • Yamada Y, Uchida J, Izumi H, Tsukamoto Y, Inoue G, Watanbe Y, Irie J, Yamada S. A non-calorie-restricted low-carbohydrate diet is effective as an alternative therapy for patients with type 2 diabetes. Internal Medicine. 2014; 53: 13-19.
      • Yim JE, Kim YS, Cho MR, Choue R. Ratio of fat to energy intake independently associated with the duration of diabetes and total cholesterol levels in type 2 diabetes. Nutrition Research and Practice. 2011; 5 (2): 157-162.
      • Zazpe I, Sanchez-Tainta A, Estruch R, Lamuela-Raventos RM, Schroder H, Salas-Salvado J, Corella D, Fiol M, Gomez-Gracia E, Aros F, Ros E, Ruiz-Gutierrez V, Iglesias P, Conde-Herrera M, Martinez-Gonzalez MA. A large randomized individual and group intervention conducted by registered dietitians increased adherence to Mediterranean-type diets: The PREDIMED study. J Am Diet Assoc. 2008; 108 (7): 1,134-1,144.
  • Search Plan and Results: MNT: Effectiveness of MNT by RDN - DLM (2015)
     
  In outpatient adults, what is the cost benefit of MNT provided by a Registered Dietitian Nutritionist (RDN) to improve disorders of lipid metabolism outcomes?

  • Conclusion
    Consistent evidence supports the cost-effectiveness, cost benefit and economic savings of outpatient Medical Nutrition Therapy (MNT) provided by a nutrition professional (registered dietitian nutritionist or equivalent) in patients with disorders of lipid metabolism (three or more MNT visits over six weeks to three months). Using a variety of cost-effectiveness analyses, the studies affirm that MNT resulted in improved clinical outcomes (total cholesterol and LDL-cholesterol, -6% to -13%; triglycerides, -11% to -22%; HDL-cholesterol, ­+4%; BMI, -4%; quality adjusted life years, +0.75 years to 0.78 years) and lower medication use (savings of $638 to $1,456 per year) in patients with disorders of lipid metabolism. Increased time spent with a nutrition professional resulted in greater improvements. Continued research is needed on the cost-effectiveness, cost benefit and economic savings of outpatient MNT for disorders of lipid metabolism.
  • 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: In outpatient adults, what is the cost benefit of MNT provided by a registered dietitian nutritionist (RDN) to improve disorders of lipid metabolism outcomes?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Olsen J, Willaing I, Ladelund S, Jorgensen T, Gundgaard J, Sorensen J. Cost-effectivenss of nutritional counseling for obese patients and patients at risk of ischemic heart diease. Int J Technol Assess Health Care. 2005; 21(2): 194-202.
      • Troyer JL, McAuley WJ, McCutcheon ME. Cost-effectiveness of medical nutrition therapy and therapeutically designed meals for older adults with cardiovascular disease. J Am Diet Assoc. 2010; 110: 1840-1851.  
  • Search Plan and Results: MNT: Cost Benefit - MNT by RDN - DLM (2015)