Disorders of Lipid Metabolism

DLM: Medical Nutrition Therapy (2010)

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

• Assessment
  What is the optimal duration and frequency of follow-up visits for hypercholesterolemia by a Registered Dietitian (RD) using medical nutrition therapy (MNT)?

  • Conclusion

    No new studies were identified in the 2010 update. The optimal duration and frequency of follow-up medical nutrition therapy visits by a Registered Dietitian 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.
  • Search Plan and Results: DLM: Medical Nutrition Therapy 2010
     
• Intervention
  Does medical nutrition therapy (MNT) given by a Registered Dietitian (RD) result in changes in adult patients' levels of dietary fat, saturated fat, serum cholesterol and cardiac risk factors?

  • Conclusion

    Medical Nutrition Therapy (MNT) provided by Registered Dietitians (RDs) promotes changes in dietary intake of fat and saturated fat and positively impacts changes in serum lipid levels. When patients attended two to four MNT sessions over six to twelve weeks, they reduced daily dietary fat (5% to 8% saturated fat (2% to 4%) and energy intake (232-710kcal per day). Serum total cholesterol (TC) was lowered by 7% to 21% and low-density lipoprotein cholesterol (LDL-C) was lowered by 7% to 22%. Triglycerides (TG)were lowered from 11% to 31%.
     

  • 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: Does medical nutrition therapy (MNT) given by a Registered Dietitian (RD) result in changes in patients' levels of dietary fat, saturated fat, serum cholesterol and cardiac risk factors?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Dalgard et. al. Saturated fat intake is reduced in patients with ischemic heart disease 1 year after comprehensive counseling but not after brief counseling. J Am Diet Assoc.. 2001;101:1420-1424, 1429.
      • Delahanty LM, Sonnenberg LM, Hayden D, Nathan DM. Clinical and cost outcomes of medical nutrition therapy for hypercholesterolemia: A controlled trial. J Am Diet Assoc. 2001 Sep; 101(9): 1,012-1,023.
      • Geil P, Anderson JW, Gustafson NJ. Women and men with hypercholesterolemia respond similarly to an American Heart Association step 1 diet. JADA. 1995; 95: 436-441.
      • Hebert JR, Ebbeling CB, Ockene IS, Ma Y, Rider L, Merriam PA, Ockene JK, Saperia G. 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: 544-552.
      • Henkin Y, Shai I, Zuk R, Brickner D, Zuilli I, Neumann L, Shany S. Dietary treatment of hypercholesterolemia: Do dietitians do it better? Am J Med. 2000: 109: 549-555.
      • Lim HJ, Choi YM, Choue R. Dietary intervention with emphasis on folate intake reduces serum lipids but not plasma homocysteine levels in hyperlipidemic patients. Nutr Res. 2008 Nov; 28(11): 767-774.
      • McGehee MM, Johnson EQ, Rasmussen HM, Salryoun N, Lynch MM, Carey M. Benefits and costs of medical nutrition therapy by registered dietitians for patients with hypercholesterolemia. JADA. 1995; 95: 1,041-1,043.
      • Sikand G, Kashyap ML, Yang I. Medical nutrition therapy lowers serum cholesterol and saves medication costs in men with hypercholesterolemia. JADA. 1998; 98: 889-894.
      • Sikand G, Kashyap ML, Wong ND, Hsu JC. Dietitian intervention improves lipid values and saves medication costs in men with combined hyperlipidemia and a history of niacin noncompliance. JADA. 2000; 100: 218-224.
  • Search Plan and Results: DLM: Medical Nutrition Therapy 2010
     
  Does medical nutrition therapy (MNT) by a Registered Dietitian (RD) result in reduced need for lipid lowering medications in adults?

  • Conclusion

    Medical nutrition therapy (MNT) may reduce need for lipid-lowering drugs. Three studies prior to ATP III were reviewed for this question. These included one randomized controlled trial (RCT) and two cost-benefit analyses. All three studies reported reduced need for lipid-lowering drugs and significant potential cost savings when patients attend two to four MNT sessions in six to eight weeks.

    In the 2010 update, there were no new papers identified for this question. It should be noted that the guidelines for optimal blood lipid levels were lowered after these studies were completed.

     

  • 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: Does medical nutrition therapy (MNT) by a Registered Dietitian (RD) result in reduced need for lipid lowering medications?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Delahanty LM, Sonnenberg LM, Hayden D, Nathan DM. Clinical and cost outcomes of medical nutrition therapy for hypercholesterolemia: A controlled trial. J Am Diet Assoc. 2001 Sep; 101(9): 1,012-1,023.
      • Sikand G, Kashyap ML, Yang I. Medical nutrition therapy lowers serum cholesterol and saves medication costs in men with hypercholesterolemia. JADA. 1998; 98: 889-894.
      • Sikand G, Kashyap ML, Wong ND, Hsu JC. Dietitian intervention improves lipid values and saves medication costs in men with combined hyperlipidemia and a history of niacin noncompliance. JADA. 2000; 100: 218-224.
  • Search Plan and Results: DLM: Medical Nutrition Therapy 2010
     
  Do multiple medical nutrition therapy (MNT) visits by a Registered Dietitian (RD) result in further reductions in total- and LDL-cholesterol in adults?

  • Conclusion

    When patients attend more than two medical nutrition therapy (MNT) sessions (three to six visits) provided by Registered Dietitians (RDs), further reductions in total cholesterol  (TC) (cumulative reduction as much as 19%) and low-density lipoprotein cholesterol (LDL-C) (cumulative reduction as much as 22%) were observed beyond the first two sessions.

  • Grade: II
    • 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: Do multiple medical nutrition therapy (MNT) visits by a Registered Dietitian (RD) result in further reductions in total- and LDL-cholesterol?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Dalgard et. al. Saturated fat intake is reduced in patients with ischemic heart disease 1 year after comprehensive counseling but not after brief counseling. J Am Diet Assoc.. 2001;101:1420-1424, 1429.
      • Delahanty LM, Sonnenberg LM, Hayden D, Nathan DM. Clinical and cost outcomes of medical nutrition therapy for hypercholesterolemia: A controlled trial. J Am Diet Assoc. 2001 Sep; 101(9): 1,012-1,023.
      • Geil P, Anderson JW, Gustafson NJ. Women and men with hypercholesterolemia respond similarly to an American Heart Association step 1 diet. JADA. 1995; 95: 436-441.
      • Hebert JR, Ebbeling CB, Ockene IS, Ma Y, Rider L, Merriam PA, Ockene JK, Saperia G. 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: 544-552.
      • Henkin Y, Shai I, Zuk R, Brickner D, Zuilli I, Neumann L, Shany S. Dietary treatment of hypercholesterolemia: Do dietitians do it better? Am J Med. 2000: 109: 549-555.
      • Lim HJ, Choi YM, Choue R. Dietary intervention with emphasis on folate intake reduces serum lipids but not plasma homocysteine levels in hyperlipidemic patients. Nutr Res. 2008 Nov; 28(11): 767-774.
      • McGehee MM, Johnson EQ, Rasmussen HM, Salryoun N, Lynch MM, Carey M. Benefits and costs of medical nutrition therapy by registered dietitians for patients with hypercholesterolemia. JADA. 1995; 95: 1,041-1,043.
      • Sikand G, Kashyap ML, Yang I. Medical nutrition therapy lowers serum cholesterol and saves medication costs in men with hypercholesterolemia. JADA. 1998; 98: 889-894.
      • Sikand G, Kashyap ML, Wong ND, Hsu JC. Dietitian intervention improves lipid values and saves medication costs in men with combined hyperlipidemia and a history of niacin noncompliance. JADA. 2000; 100: 218-224.
  • Search Plan and Results: DLM: Medical Nutrition Therapy 2010