MNT: Disorders of Lipid Metabolism (2015)
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.PubMed ID: 18237570
- Sample size less than 10 in each treatment group
- Drop-out rate was more than 20%
- Nutrition counseling was provided by someone other than an RD
- The study did not assess the impact of dietary change on lipids
- The intervention was not individualized.
- A panel of experts was convened by the American Dietetic Association to conduct research review for evidence-based practice guidelines within the Evidence Analysis Library
- Literature search included PubMed, the Database of Abstracts of Reviews of Effects and the Agency for Healthcare Research and Quality database.
DesignSelected research was assessed for quality and validity with summarized comparisons of notable features.
InterventionAs noted in individual studies reviewed.
Statistical AnalysisAs noted in individual studies reviewed.
Timing of Measurements
- All studies were published between 1991 and 2006
- Intervention duration varied from six weeks to six months.
- Duration of Medical Nutrition Therapy
- Mode of Medical Nutrition Therapy
- Findings of each study.
Control VariablesNot specified.
- Initial N: 23 articles
- Attrition (final N): Eight studies accepted for inclusion
- Age: Not specified in all studies
- Ethnicity: Not specified
- Other relevant demographics: Not specified
- Anthropometrics: See individual study summaries
- Location: USA.
- RD-delivered Medical Nutrition Therapy (with two to six planned visits) for patients with hypercholesterolemia yielded reported dietary reductions of 15% to 23% in total fat and 22% to 36% in saturated fat (Grade I)
- This treatment resulted in lipid changes of 6% to 13% reduced total cholesterol, 7% to 14% reduced LDL-cholesterol and inconsistent changes in triglycerides and HDL-cholesterol (Grade I).
|Study Citation||Sample Size/Design||Quality||Intervention||Findings|
|Dalgard et al, 2001||
||+||10 minutes vs. 50-60 minutes individual counseling with 40- to 50-minute follow-up 12 weeks later (1 year study)||At 1 year:
|Sikand et al, 2000||
||+||2-4 MNT visits ranging 30-70 minutes (step 1 diet) each within 8 weeks||
At 6-7 weeks:
|Hebert et al, 1999||
||+||No RD visit vs. 2 MNT individual visits plus two 2-hour group visits in a 6-week period||
At 1 year:
|Dallongeville et al, 1994||
||+||No counseling vs. 45-60 minute MNT plus 1 follow-up (step 1 diet) within 2 months||
At 2 months (hyperchol vs. hypertriglyceridemia subjects):
|Delahanty et al, 2001||
||Ø||Usual care with MD vs. 2-3 MNT visits in 2-3 months if lipids were not at goal (step 2 diet). Study: 6 months.||
At 6 months:
|Henkin et al, 2000||
||Ø||Usual care with MD vs. 2-4 MNT counseling sessions (step 1 or 2) in 3 months||
At 3 months:
|Sikand et al, 1998||
||Ø||2-4 MNT visits ranging from 30-60 minutes (step 1 diet) within 6-8 weeks||
At 6-8 week:
|McGehee et al, 1995||
||Ø||≥2 MNT visits at various hospitals or health organizations; intervention duration varied||
Length of intervention unknown: 6.8% decrease in total cholesterol and reduction corresponded with increase time spent with RD (R=0.118, P<0.001)
- Data suggest greater decreases in total cholesterol and LDL-cholesterol occur as the number of MNT visits and time spent with dietitian increases (Grade III)
- Optimal duration and frequency of follow-up visists by a RD are not known (Grade V).
- The eligible studies reviewed show that MNT is an effective approach to changing dietary intake and reducing total and LDL-cholesterol and body weight
- Conclusive findings are limited by the lack of available research. Additional research is needed to identify optimal MNT intervention, duration and frequency of RD MNT visits.
|Other:||American Dietetic Association|
Quality Criteria Checklist: Review Articles
|1.||Will the answer if true, have a direct bearing on the health of patients?||Yes|
|2.||Is the outcome or topic something that patients/clients/population groups would care about?||Yes|
|3.||Is the problem addressed in the review one that is relevant to dietetics practice?||Yes|
|4.||Will the information, if true, require a change in practice?||Yes|
|1.||Was the question for the review clearly focused and appropriate?||Yes|
|2.||Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described?||Yes|
|3.||Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased?||Yes|
|4.||Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible?||Yes|
|5.||Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined?||Yes|
|6.||Was the outcome of interest clearly indicated? Were other potential harms and benefits considered?||Yes|
|7.||Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described?||Yes|
|8.||Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included?||Yes|
|9.||Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed?||Yes|
|10.||Was bias due to the review's funding or sponsorship unlikely?||Yes|