Disorders of Lipid Metabolism

Disorders of Lipid Metabolism

Welcome to the Disorders of Lipid Metabolism (DLM) Guideline and Supporting Systematic Review

This EAL project was first published in 2005 and updated between 2007 and 2011. The objective of the DLM guideline is to provide Medical Nutrition Therapy (MNT) recommendations that support improvement in lipid levels and risk factor management of cardiovascular disease (CVD). The focus of the guideline is on the treatment of lipid metabolism disorders - patients with elevated low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), or triglyceride (TG) levels, and low-high density lipoprotein cholesterol (HDL-C) levels, as well as coronary health issues such as metabolic syndrome and hypertension (HTN).

The systematic review topics include:

  • Corollary Health Issues, Macronutrients, Medical Nutrition Therapy, Micronutrients, Physical Activity, and Specific Foods
The evidence-based nutrition practice guideline incudes eighteen (18) recommendations. Topic areas include:
  • Medical Nutrition Therapy
  • Nutrition Assessment
  • Nutrition Intervention
    • Cardioprotective Diet and Macronutrients
    • Cardioprotective Diet and Other Dietary Components
    • Micronutrients
    • Behavior/Physical Activity
    • Corollary Health Issues
    • Triglycerides
  • Nutrition Monitoring and Evaluation
Use the links on the left to access the content. Expand the Project Team section below for information on the expert workgroup, workgroup disclosures and project funding information.

About the Archive:  The EAL is designed so that the most current information is available at the top of the left navigation bar. The older content remains accessible as a resource. Click on the tab titled  DLM Archive to access all of the archived content.

Dietary Cholesterol and Fat Intake Update

While the Academy does not have an official consensus on this topic, the EAL is reviewing current literature and will publish and update when complete. In addition, the Academy's Nutrition Care Manual Disorders of Lipid Metabolism section is being updated with an anticipated publication date of fall 2020..

The USDA Dietary Guidelines for Americans (DGAs), National Lipid Association (NLA) and the American Heart Association (AHA) have guidelines on this topic. However, these guidelines focus on varying populations (download a review of recommendations).

Neither the current DGA or AHA guidelines discuss dietary cholesterol. The AHA guideline has recommendations pertaining to saturated fat. The most recent NLA guideline includes recommendations on dietary cholesterol as does the EAL's DLM 2011 guideline.

From the published guidelines on dietary cholesterol and fat intake thus far, when dealing with a population with dyslipidemia, recommending dietary cholesterol restriction may be warranted. Practitioner judgment is important when the evidence is dated and mixed, as is currently the case with dietary cholesterol.
  • Project Team
    The following individuals contributed their valuable time and expertise on this project;

    Workgroup Members
    • Wahida Karmally, DrPH, RD, CDE, Chair (until 2008)
    • Jo Ann S. Carson, PhD, RD, LD, Chair (starting 2008)
    • France M. Burke, MS, RD
    • Catherine Champagne, PhD, RD, LDN, FADA
    • Elvira Johnson, MS, RD, CDE, LDN
    • Penny Kris-Etherton, PhD, RD
    • Mikelle C. McCoin, MPH, RD
    • Geeta Sikand, MA, RD, CDE, CLS, FADA
    • Linda Van Horn, PhD, RD
    Project Manager
    • Tami Piemonte, MS, RD, LDN
    Lead Analysts
    • Joanne Spahn, MS, RD, FADA (until March 2009)
    • Patti Landers, PhD, RD, LD (starting March 2009)
    • Julieann Anderson, MPH, RD, LD
    • Kimberly Bandelier, MPH, RD
    • Lori Brizee, MS, RD, LD, CSP
    • Josh Brown, MS, RD, LD
    • Lisa Davis, MS, D
    • Joy Dubost, PhD, RD
    • Mary Tiffany Graham, MPH, RD, LD
    • Mary Katherine 'Kathy' Joy, EdD, RD, CDE
    • Carly Gustafson Leon, MS, RD, CD, LDN
    • Mary Harris, PhD, RD
    • Heather Hoffhines, MS, RD, LD
    • Vijaya Juturu, PhD, FACN
    • Kimberly Larson, RD
    • Sharon McWhinney, PhD, RD, LD
    • Lori Neighbors, PhD, RD
    • Jen Nicholson, PhD, RD
    • Elizabeth Palmer-Reed, MPH, RD
    • Joan Pleuss, MS, CDE, CD, RD
    • Judy Poracri, MBA, MS, RD
    • Jennifer Shoemaker, MS, RD, LD
    • Jennifer Spilotro, MS, RD, LDN
    • Angela Thayer, MS, RD, LDN
    • Patricia Weber, MS,RD, CDE
    Guideline Reviewers
    • Sonya Angelone, MS, RD, CLD
    • Linda Arpino, MA, RD, CDN
    • Christina Biesemeier, MS, RD, LDN,FADA
    • Kathryn Camp, MS, RD, CSP
    • Sonja Conner, MS, RD, LD
    • Erica Gradwell, MS, RD
    • Heather Holden, RD, LD, CDE
    • Jennifer A. Johanek, MS, RD LD, CNSC
    • Ainsley Malone, MS, RD, LD, CNSD
    • Beverly J. McCabe-Sellers, PhD, RD, LD
    • Susan G. Rodder, MS, RD, LD
    • Sharon Smalling, MPH, RD, LD
    • Pat Splett, PhD, MPH, RD, FADA
    • Marsha R. Stieber, MSA, RD, CNSC
    • Peter Talbot, BSc, MScMed
    • Mara Z. Vitolins, DrPH, MPH, RD
    • Judith Wsylei-Rosett, EdD, RD
    Academy Staff
    • Deborah Cummins, PhD
    • Kari Kren, MPH, RD
    • Esther Myers, PhD, RD
    • Joan Schwaba, MS, RD
    Financial Contributors
    • Evidence Analysis
      • Academy of Nutrition and Dietetics
      • The Almond Board
    • Guideline
      • Academy of Nutrition and Dietetics

    Disclosures of Potential Conflicts of Interest: In the interest of full disclosure, the Academy has adopted the policy of revealing relationships workgroup members have with companies that sell products or services that are relevant to this topic. Workgroup members are required to disclose potential conflicts of interest by completing the Academy Conflict of Interest Form. It should not be assumed that these financial interests will have an adverse impact on the content, but they are noted here to fully inform readers.
    • None of the workgroup members listed above disclosed potential conflicts.
  • Project Resources
    The following resources were developed:
    • Disorders of Lipid Metabolism Toolkit - this toolkit is designed to assist the registered dietitian in applying the Academy 2005 Disorders of Lipid Metabolism Evidence-Based Nutrition Practice Guidelines. It includes resources such as the MNT protocol, sample documentation forms, client education materials and outcomes monitoring forms. It also incorporates the Academy Nutrition Care Process and Standardized Language for patient/client care. Click to purchase.
    • DLM (2011) Guideline Presentation - This 57-slides include all of the recommendations and ratings of the updated DLM Guideline. Ideal for use in meetings, in-service presentation/training, and classes. Click to purchase.
    • Educator Module on Disorders of Lipid Metabolism - This resources is designed tp save the educator time. It includes Word documents and PowerPoint files with DLM project content overview and instructions for navigating the EAL; student assignments including case studies and questions for classroom discussion or take-home exam; graduate or advanced assignment on evaluating a research article using the Academy evidence analysis process; grading key for both assignments; 3 weeks access to the EAL for 30 students. Click to purchase.
    • Publications - the following articles were published:
      • Linda Van Horn, PhD, RD; Mikelle McCoin, MPH, RD; Penny M. Kris-Etherton, PhD, RD; Frances Burke, MS, RD; Jo Ann S. Carson, PhD, RD; Catherine M. Champagne, PhD, RD; Wahida Karmally, DrPH, RD; Geeta Sikand, MA, RD. Review: The Evidence for Dietary Prevention and Treatment of Cardiovascular Disease. Journal of the American Dietetic Association. 2008; 108: 287-331. (PDF)
      • Mikelle McCoin, MPH, RD; Geeta Sikand, MA, RD; Elvira Q. Johnson, MS, RD; Penny M. Kris-Etherton, PhD, RD; Frances Burke, MS, RD; Jo Ann S. Carson, PhD, RD; Catherine M. Champagne, PhD, RD; Wahida Karmally, DrPH, RD; Linda Van Horn, PhD, RD. Commentary: The Effectiveness of Medical Nutrition Therapy Delivered by Registered Dietitians for Disorders of Lipid Metabolism: A Call for Further Research. Journal of the American Dietetic Association. 2008; 108:233-239.(PDF)