Disorders of Lipid Metabolism

DLM: Scope of Guideline (2005)

Guideline Scope Characteristics

Below you will find a list of characteristics that describe the Scope of this Guideline.

Disease/Condition(s)

The purpose of this guideline is to provide an evidence-based summary of effective practice in the nutrition management of  lipid metabolism disorders.

Recommendations have been formulated for the treatment of lipid metabolism disorders within the context of the nutrition care process. The major focus of this guideline is on counseling, evaluation, risk assessment, and treatment of lipid metabolism disorders in adults 20 years of age and older.

This guideline is intended for use by dietetics practitioners involved in the clinical management of lipid metabolism disorders and cardiovascular risk factors. It may also be a valuable resource to registered dietitians involved in the care of people with other chronic conditions or disease states such as metabolic syndorme, diabetes, hypertension, and obesity. It is hoped that the information in this guideline will be used to provide individualized nutrition care with practical nutrition recommendations that are based on current state of the science for nutrition and nutrition-related treatment of lipid metabolism disorders.

Guideline Category

Counseling, Management, Prevention, Treatment

Clinical Specialty

Cardiology, Endocrinology, Geriatrics, Internal Medicine, Nutrition, Pharmacology, Physical Medicine and Rehabilitation, Preventive Medicine

Intended Users

Registered Dietitians

Guideline Objective(s)

Overall Objective:

To provide Medical Nutrition Therapy guideline recommendations for disorders of lipid metabolism that support improvement in lipid levels and risk factor management of cardiovascular disease.

Specific Objectives:

  • To define evidence based recommendations within the scope of practice for registered dietitians (RDs) that are carried out in collaboration with other healthcare providers
  • To guide practice decisions that integrate medical, nutritional, and behavioral elements
  • To reduce variations in practice among RDs
  • To promote self-management strategies that empower the patient to take responsibility for day-to-day management and provide the RD with data to make recommendations to adjust Medical Nutrition Therapy, or recommend other therapies to achieve clinical outcomes
  • To enhance the quality of life for the patient, utilizing customized meal planning strategies based on the individual’s eating preferences, lifestyle, and goals to improve metabolic control
  • To develop content for intervention that can be tested for impact on clinical outcomes
  • To define highest quality of care within cost constraints of the current healthcare environment.

Target Population

Adult (19 to 44 years), Middle Age (45 to 64 years), Aged (65 to 79 years), Male, Female

Target Population Description

Considerations and Assumptions Based on the NCEP ATP III in the Treatment of Disorders of Lipid Metabolism  

The recent publication on the implications of recent clinical trials for the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III Guidelines provides updated information on several issues related to the treatment of cholesterol-lowering therapy (Grundy et al., 2004). Since the NCEP Expert Panel released evidence-based recommendations on the management of high blood cholesterol and related disorders in 2001, five major clinical trials with clinical end points have been published.

The recommendations provided in this guideline take into account several basic assumptions previously addressed in the ATP III report, as well as information available from the new trials that have implications for individuals with lipid disorders. The new data is especially relevant for those who are considered to be at high risk for coronary heart disease. Emphasis is still given to therapeutic lifestyle changes (TLC) as an essential modality in the management of serum cholesterol levels.

Recommendations from the Recent Clinical Trials and NCEP ATP III report that form the basis for the Medical Nutrition Therapy (MNT) approach for treatment of lipid metabolism disorders are as follows:

Recommendations From Recent ATP III Report

  • Therapeutic lifestyle changes (TLC) remain an essential modality in clinical management. TLC has the potential to reduce cardiovascular risk through several mechanisms beyond LDL lowering.
  • In high-risk persons, the recommended LDL-C goal is <100 mg/dL.
    • An LDL-C goal of <70 mg/dL is a therapeutic option on the basis of available clinical trial evidence, especially for patients at very high risk
    • If LDL-C is > 100 mg/dL, an LDL-lowering drug is indicated simultaneously with lifestyle changes
    • If baseline LDL-C is <100 mg/dL, institution of an LDL-lowering drug to achieve an LDL-C level <70 mg/dL is a therapeutic option on the basis of available clinical trial evidence
    • If a high-risk person has high triglycerides or low HDL-C, consideration can be given to combining a fibrate or nicotinic acid with an LDL-lowering drug. When triglycerides are 200 mg/dL, non-HDL-C is a secondary target of therapy, with a goal 30 mg/dL higher than the identified LDL-C goal
    • For moderately high-risk persons (2+ risk factors and 10-year risk 10-20%), the recommended LDL-C goal is <130 mg/dL; an LDL-C goal <100 mg/dL is a therapeutic option on the basis of available clinical trial evidence. When LDL-C level is 100-129 mg/dL, at baseline or on lifestyle therapy, initiation of an LDL-lowering drug to achieve an LDL-C level <100 mg/dL is a therapeutic option on the basis of available clinical trial evidence.
    • Any person at high risk or moderately high risk, who has lifestyle-related risk factors (eg, obesity, physical inactivity, elevated triglyceride, low HDL-C, or metabolic syndrome) is a candidate for TLC to modify these risk factors regardless of LDL-C level
    • When LDL-lowering drug therapy is employed in high-risk or moderately high-risk persons, it is advised that intensity of therapy be sufficient to achieve at least a 30-40% reduction in LDL-C levels
    • For people in lower risk categories, recent clinical trials do not modify the goals and cutpoints of therapy.

    Grundy et l., J Am Coll Cardiol 2004;44:720-32

Interventions and Practices Considered

I. Referral to a Registered Dietitian

II. Medical Nutrition Therapy

A. Nutrition Assessment

Below you will find the nutrition assessment terms related to libid metabolism disorder care from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process, Second Edition. To view a complete list of all nutrition assessment terms, click here.

  1. Medical history and laboratory values including fasting lipid profile (blood cholesterol, low-density and high-density lipoprotein cholesterol, triglycerides), glucose, blood pressure, and others as needed
  2. Nutrition-focused assessment including:
    • BMI, waist circumference, waist-hip ratio
    • Assessment of client’s readiness to learn
    • Comprehensive diet history, including current dietary intake (calories, total fat, and sources of fat, cholesterol, sugar, sodium, vitamin E, folate, B-vitamins and alcohol)
    • Physical activity pattern
    • Psychosocial/economic issues impacting nutrition therapy
    • Consideration of comorbid conditions and need for additional modifications in nutrition care plan.

B. Nutrition Intervention (Planning and Implementation )

Below you will find the nutrition diagnoses related to lipid metabolism disorder care from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process, Second Edition. To view a complete list of all nutrition diagnoses, click here.

Individualized nutrition prescription

  1. Calories
  2. Macronutrients: Major dietary fat components (includes carbohydrate and protein consideration): Fat Composition- Trans-fatty Acids, Omega-3 fatty Acids, and Fiber
  3. Micronutrients: Homocysteine, folate, B12 antioxidants, vitamins E and C, ß-carotene, selenium
  4. Food recommendations: Nuts, fish, soy products, plant stanol/sterol products
  5. Healthful habits limiting alcohol, increasing physical activity.

 


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