Dietitian's support can help people cut cholesterol

NEW YORK (Reuters Health) - Working with a dietitian is an effective way for some people to bring down their cholesterol levels without drugs, a new study shows.

Katherine S. Rhodes of the University of Michigan Health System in Ann Arbor and colleagues followed 51 registered dietitians as they implemented the 1998 Medical Nutrition Therapy Hyperlipidemia Protocol with their patients.

The protocol includes recommendations to eat more fruits and vegetables, eat fish twice weekly, increase intake of good fats such as olive oil while reducing consumption of saturated and trans fat, and exercise more. Patients were supposed to meet with a dietitian for an initial hour-long visit, followed by two or three additional half-hour appointments. A patient's primary care doctor could recommend additional visits. Dietitians were to check patients' bloodwork at the study's outset and again three months later.

A total of 377 patients met criteria for inclusion in the study. Follow-up data was available for 74.3 percent, while 42.9 percent participated in three to four visits with the dietitian as recommended.

On average, patients reported cutting their fat consumption to less than 30 percent of total calories after working with dietitians; they also lost weight and started exercising more.

Among the 175 patients whose initial triglyceride levels were below 400 mg/dL, 44.6 percent experienced a 15 percent drop in their LDL or "bad" cholesterol or reached their goal for reducing LDL cholesterol.

While the protocol recommended three to four weeks between appointments, actual intervals were longer, ranging from an average of eight weeks between the first and second appointments to nearly 13 weeks between the third and fourth. Many patients didn't make follow-up appointments, or keep scheduled appointments; reasons cited included lack of insurance reimbursement or inability to pay.

And the researchers had a hard time recruiting registered dietitians for the study. Many said they couldn't participate because they couldn't obtain necessary lab tests or lacked time and administrative support.

This study "highlights frustrations" in trying to gather information on program effectiveness in real life, while underscoring the value of this data, the researchers say.

SOURCE: Journal of the American Dietetic Association, February 2008.