Clinical and cost outcomes of medical nutrition therapy for hypercholesterolemia: A controlled trial

Objective To compare the results and cost-effectiveness of a cholesterol lo wering protocol implemented by registered dietitians with cholesterol lower ing advice by physicians. Design Six month randomized controlled trial, cost-effectiveness analysis. Subjects included 90 ambulatory care patients (60 men, 30 women), age range 21 to 65 years, with hypercholesterolemia and not taking hypolipidemic dru gs. Patients were randomly assigned to receive medical nutrition therapy (M NT) from dietitians using a NCEP based lowering protocol or usual care (UC) from physicians. Outcome measures were plasma lipid profiles, dietary inta ke, weight, activity, patient satisfaction, and costs of MNT. Changes from baseline for each variable of interest were compared between treatment grou ps using analysis of covariance controlling for baseline value of the varia ble and gender. Results MNT achieved a 6% decrease in total and LDL cholesterol levels at 3 and 6 months compared with a 1% increase and a 2% decrease in both values at 3 and 6 months with UC (P < .001 and P < .05, respectively). Weight loss (1.9 vs 0 kg, P < .001) and dietary intake of saturated fat (7% of energy vs 10%, P < .001) were better in the MNT than the UC group. The additional costs of MNT were $217 per patient to achieve a 6% reduction in cholesterol and $98 per patient to sustain the reduction. The cost-effectiveness ratio for MNT was $36 per 1% decrease in cholesterol and LDL level. Applications/conclusions MNT from registered dietitians is a reasonable inv estment of resources because it results in significantly better lipid, diet , activity, weight, and patient satisfaction outcomes than UC.