DLM: Introduction (2005)
Disorders of Lipid Metabolism (2005) Evidence-Based Nutrition Practice Guideline
Guideline Narrative Overview
The focus of this guideline is on the treatment of lipid metabolism disorders- that is, patients with elevated LDL cholesterol, total cholesterol, and triglyceride levels and corollary health issues such as hypertension and metabolic syndrome, which includes some individuals with low HDL-C.
Lipid Metabolism Disorders are recognized risk factors for atherosclerotic diseases, including coronary heart disease (CHD). The relationship of blood lipid levels of total and LDL cholesterol (LDL-C) subsequent to CHD events has been documented in several major observational studies.1 An increasing body of evidence links dyslipidemias to the occurrence of stroke.2 Clinical trials have found that lowering LDL-C lowers coronary events. Evidence is also accumulating that risk for CHD can be reduced beyond LDL-lowering therapy by modification of other risk factors.
One potential secondary target of therapy is the metabolic syndrome which represents a constellation of lipid and non-lipid risk factors of metabolic origin. ATP III recognizes the metabolic syndrome as a secondary target of risk reduction therapy.3 This guideline includes metabolic syndrome management as a consideration.
Medical Nutrition Therapy and Dyslipidemia
Scientific evidence strongly supports the effectiveness of medical nutrition therapy as a means to manage dyslipidemia and reduce risk factors associated with cardiovascular disease.3 Studies indicate that the amount of time dyslipidemic patients spend with the registered dietitian is associated with a reduction in total serum cholesterol, a reduction in LDL-cholesterol levels, and decreased dependence on drug therapy. Evidence supports the need for three to four visits with the registered dietitian to achieve optimal outcomes.1, 4, 5, 7
Populations to Whom This Guideline May Apply
Population groups, medical conditions, or coexisting diagnoses where the lipid metabolism disorders recommendations may be indicated include:
- Coronary heart disease (CHD)
- Cerebral vascular disease (CVD)
- Familial or combined hyperlipidemia, hypertriglyceridemia, hypercholesterolemia
- Metabolic syndrome
- Diabetes mellitus (Type 2)
- History of cardiovascular disease and dyslipidemia in first degree relatives
- Hypertension (HTN)
- Obesity and smoking
- History of Myocardial infarction
Disorders of Lipid Metabolism and Medical Nutrition Therapy
National evidence-based guidelines recommend nutrition therapy as the first line therapy for management of dyslipidemia.3 The nutrition prescription goes beyond the realm of fat intake, integrating the use of food sources providing key nutrients that have been demonstrated to improve lipid management and cardiovascular disease outcomes.
The registered dietitian plays an integral role in the interdisciplinary healthcare team by designing the optimal nutrition prescription that coincides with pharmacotherapy when necessary. Based on the client’s treatment plan and comorbid conditions, other nutrition practice guidelines such as hypertension, and Type 2 diabetes mellitus may be needed in order to provide optimal treatment.
Other factors to consider when exploring dietary treatment options include the presence of secondary causes and conditions associated with hyperlipidemia. Total cholesterol, triglycerides, and HDL cholesterol levels may be affected by an individual’s medical history, including use of prescription drugs, metabolic or endocrine conditions such as diabetes or obesity, kidney disease, and liver disease. In addition, certain dietary practices such as alcohol abuse, a high- or low-fat diet, high cholesterol intake, weight gain, and a very high fiber diet can affect lipid profiles as well.