BENEFITS AND COSTS OF MEDICAL NUTRITION THERAPY BY REGISTERED DIETITIANS FOR PATIENTS WITH HYPERCHOLESTEROLEMIA

The Massachusetts Dietetic Association implemented a statewide retrosp ective quality assurance audit to determine the effectiveness and cost of medical nutrition therapy in patients with hypercholesterolemia (> 5.20 mmol/L). Hypercholesterolemia is a major risk factor for coronary artery disease (CAD). Data were collected at 23 sites from 285 outpat ients seen by a registered dietitian for a minimum of two visits. Pati ents taking lipid-lowering medications were excluded. Of the 285 patie nts, 108 (38%) were men and 177 (62%) were women. The mean age was 51. 4 years (range=22 to 79 years). Results showed that the mean reduction in serum cholesterol level was 8.6%, which translates to a decrease o f approximately 17.2% in risk of CAD. Forty-five percent of the total population showed an 11% or greater reduction in serum cholesterol lev els. Reduction;in serum cholesterol levels correlated with increased t ime spent with a dietitian (r=.188, P<.001). The mean cost for nutriti on intervention with a dietitian was $163 (a mean of four visits). In contrast, the estimated annual cost of treatment for patients with hyp ercholesterolemia using drug therapy is $1,450. A 1993 report calculat ed the annual cost of treating heart disease in the United States to b e $80 billion. Medical nutrition therapy should be considered the init ial, effective, and low-cost approach in the management of patients wi th mild to moderate hypercholesterolemia.