Medical nutrition therapy lowers serum cholesterol and saves medication costs in men with hypercholesterolemia

This study was designed to evaluate whether medical nutrition therapy administered by registered dietitians could lead to a beneficial clinical and cost outcome in men with hypercholesterolemia. Ninety-five subjects participating in a cholesterol-lowering drug study took part in an 8-week nutrition intervention program before initiating treatment with a cholesterol-lowering medication. Patient records were reviewed via a retrospective chart review to determine plasma lipid levels at the beginning and end of the program and the number and length of sessions with a dietitian. Complete information was available for 74 subjects aged 60.8+/-9.8 years (mean +/-SD). Medical nutrition therapy lowered total serum cholesterol levels 13% (P<.0001), low-density lipoprotein cholesterol (LDL-C) 15% (P<.0001), triglyceride 11% (P<.05), and high-density lipoprotein- cholesterol (HDL-C) 4% (P<.05). Total dietitian intervention time was 144+/-21 minutes (range=120 to 180 minutes) in 2.8+/-0.7 sessions (range=2 to 4) during 6.8+/-0.7 weeks of medical nutrition therapy (range=6 to 8 weeks). Analysis of covariance was conducted to examine whether mean change in LDL-C differed by number of dietitian visits. Results showed a marginal difference between the number of dietitian visits and change in LDL-C f=2.6, P<.084). However, the magnitude of LDL-C reduction was significantly higher with 4 dietitian visits (180 minutes) than with 2 visits (120 minutes) (21.9% vs 12.1%; P=.027). Lipid drug eligibility was obviated in 34 of 67 (51%) subjects per the National Cholesterol Treatment Program guidelines algorithm. The estimated annualized cost savings from the avoidance of lipid medications was $60,561.68. Therefore, we conclude that 3 or 4 individualized dietitian visits of 50 minutes each over 7 weeks are associated with a significant serum cholesterol reduction and a savings of health care dollars.