Dietary treatment of hypercholesterolemia: Do dietitians do it better? A randomized, controlled trial

PURPOSE: Current guidelines of the National Cholesterol Education Program ( NCEP) recommend initial dietary counseling by physicians for most patients with hypercholesterolemia; referral to a registered dietitian and lipid-low ering drugs are recommended only for patients who remain hypercholesterolem ic. We evaluated the incremental value of detailed nutritional counseling b y dietitians when added to general nutritional advice provided by physician s. SUBJECTS AND METHODS: Hypercholesterolemic patients detected during a chole sterol screening project were randomly assigned to receive dietary counseli ng by a physician only (70 patients) or by a physician and a registered die titian (66 patients). Patients were observed for 1 year to determine compli ance with NCEP guidelines. RESULTS: At 3 months, the mean (+/- SD) decrease in the se rum low-density lipoprotein (LDL) cholesterol level was 7% +/- 11% in the physician group a nd 12% +/- 10% in the dietitian group (P <0.004). A decrease of 10% or more in the LDL cholesterol level was seen in 25 patients (36%) in the physicia n group and 43 patients (65%) in the dietitian group (P <0.001). Only 40 (2 9%) of the patients in both groups achieved their NCEP target goals at 3 mo nths. The majority of these were low-risk patients with an LDL cholesterol target goal of 160 mg/dL. At 12 months, both groups lost about half of the beneficial effects on LDL cholesterol levels, and the difference between th e two groups diminished. CONCLUSIONS: The short-term reduction in LDL cholesterol level, achieved af ter counseling by dietitians is superior to that achieved by physicians. Ho wever, long-term compliance remains inadequate. For patients at high risk, consideration should be given to a more aggressive dietary approach and pos sibly earlier introduction of lipid-lowering medications. Am J Med. 2000;10 9:549-555. (C) 2000 by Excerpta Medica, Inc.