Cholesterol-Lowering Power Of Dietitian Visits

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Cholesterol-Lowering Power Of Dietitian Visits

http://www.medicalnewstoday.com/articles/99546.php

Worried about your cholesterol? You may want to schedule a few

appointments with a registered dietitian, to get some sound advice

about how to shape up your eating habits, according to a new national

study led by University of Michigan Health System researchers.

Not only are you likely to lower your cholesterol levels, you may be

able to avoid having to take cholesterol medication, or having to

increase your dose if you're already taking one. And you'll probably

lose weight in the process, which also helps your heart.

The new results, published in the February issue of the Journal of

the American Dietetic Association, are based on data from 377

patients with high cholesterol who were counseled by 52 registered

dietitians at 24 sites in 11 states.

In the group of 175 patients who started the study with triglycerides

less than 400 milligrams per deciliter of blood (mg/dL), and who had

their cholesterol measured before they changed or added medication,

44.6 percent either reduced their levels of " bad " cholesterol by at

least 15 percent, or reached their cholesterol goal.

The results reflect progress in approximately eight months, after

three or more appointments with a dietitian. But the results add

further evidence that medical nutrition therapy, as it is called, can

make a big difference in a patient's life.

All of the R.D.s in the study based their advice to their patients on

the latest research-based evidence about eating habits and

cholesterol levels available at the time of the study: the American

Dietetic Association's 1998 Medical Nutrition Therapy Hyperlipidemia

Protocol.

Since that time, the ADA has updated the clinical guideline based on

new research, which means that patients who see an R.D. today may

have even more success.

The study was funded by the ADA and its Clinical Nutrition Management

Dietetic Practice Group, and based on a framework developed for a

pilot project carried out in Michigan by the Michigan Dietetic

Association and led by U-M cardiovascular dietitians.

" Everyone knows that nutrition is important for cholesterol

management, and that a registered dietitian is the professional most

thoroughly trained to help patients choose foods wisely, " says lead

author Kathy , Ph.D., R.D., manager of Nutrition Services with

the U-M Cardiovascular Medicine program at Domino's Farms and the U-M

Cardiovascular Center. " But this is the first national study to show

what happens when high-risk patients work with R.D.s to follow

nutrition guidelines grounded in the best evidence. "

Key nutrition issues in the 1998 guidelines used in the study include

reducing saturated and trans fat and increasing " healthy " fats such

as olive oil; increasing soluble and insoluble fiber; eating fish

twice a week; increasing fruits and vegetables; regular exercise and

healthy weight management. Information about food-label reading and

dining out was also included.

Called the Lipid Management Nutrition Outcomes Project or LMNOP, the

national study was launched by and her U-M colleagues Melvyn

fire, M.D., and Martha Weintraub, MPH, R.D., after the

successful completion of the Michigan-wide pilot project. fire,

Weintraub and Biesemeier, M.S., R.D., FADA, of Vanderbilt

University are co-authors of the new study.

The study gives us an important " real world " picture of what happens

when R.D.s try to implement evidence-based nutrition guidelines in

daily practice, notes.

Some commercial health insurance plans are beginning to cover

appointments with registered dietitians, but many still do not. Only

dietitian visits for diabetes or kidney disease are covered by

Medicare. It is important for people to check their specific health

insurance plan to see whether nutrition is covered, says. But

even if individuals need to pay for the appointments out of their own

pocket, they may find that an R.D.'s advice will pay off in the long

run, she says.

To get uniform data, the researchers brought lead R.D.s from each

state to U-M for training on the cholesterol and nutrition

guidelines, and on the data collection practices used in the study.

R.D.s at Veterans Affairs hospitals got their training by phone

conferencing. R.D.s then returned to their own practices, trained

their colleagues and implemented the ADA guidelines.

The study included only patients between the ages of 25 and 70 years

who had high cholesterol levels, or triglyceride levels over 200

mg/dL, and who met other inclusion criteria including no recent

changes in their cholesterol medication status. Neither the R.D.s nor

their patients were paid to participate in the study.

The " real world " aspect of this study included the disappointing

finding that many patients dropped out of nutrition counseling after

one or two visits, when three or four sessions with an R.D. is

recommended to make and sustain truly effective changes in eating

habits. Lack of insurance coverage was a major factor in this dropout

rate.

Patients whose doctors changed their cholesterol medication status,

either by starting them on a drug for the first time, or increasing

their dose before assessing the effect of diet change, were not

included in the analysis. But for the 219 patients who didn't have

any change in their medication status, the impact of the R.D.

counseling became apparent in the first year after the initial visit.

" Although some patients may already be eating a relatively healthy

diet, medical nutrition therapy can increase patient's knowledge

of 'cardioprotective foods' and assist them in individualizing the

guidelines to fit their preferences and lifestyle, " says Weintraub. A

significant number of patients reduced the fat in their diets to less

than 30 percent of calories, as recommended for a heart health. Many

participants also lost weight and/or increased the number of days

each week on which they exercised for 30 minutes or more.

" Often, we see heart patients who are on multiple cholesterol

medications but have never seen a dietitian. And even when a patient

with high cholesterol does get to see an R.D., their care team may

not allow enough time to see how effective diet is before they add

additional treatment, " says . " We hope that this demonstration

of how well cholesterol can be lowered without medication or

increases in medication will be very useful for patients and

physicians, and perhaps insurers too. "

To learn more about how eating habits can influence cholesterol

levels, or to find an R.D., visit the ADA's web site at

http://www.eatright.org/. For more on U-M Cardiovascular Medicine and

its nutrition services, visit

http://www.med.umich.edu/cvc/prevention. Reference: JADA, Vol. 108,

No. 2, Feb. 2008.