Medical Nutrition Therapy 2002

EVIDENCE SUPPORTS MEDICAL NUTRITION THERAPY FOR PREVENTION AND TREATMENT

Diet More Effective than Drugs in Cardiovascular Disease

A 50-70% reduction in recurrent cardiovascular disease events (cardiac death, non-fatal heart attacks, angina, stroke) may be achieved in people on diet treatment alone.  The Mediterranean style diet was low in saturated fat and cholesterol and high in omega-3 fatty acids and emphasized fruits, vegetables, bread and cereals and fish.  Based on current evidence, the results of the Lyon Diet Heart Study have shown that a Mediterranean-style diet intervention can reduce cardiovascular disease risk twice as much as combined drug and diet therapy. (Circulation 1999;99:779-785; ATP III Report, NIH/NHLBI 2002)

Diet Therapy Lowers Blood Pressure Similar to Drug Therapy

The Dietary Approaches to Stop Hypertension (DASH) study concluded that the diet focused on decreased sodium, increased fruits, vegetables, and fat-free diary products is likely to show up to 12 percent reduction in risk of CHD.  Study was hailed as offering the most significant evidence to date of the role of diet in health promotion, disease prevention, and disease treatment.  Studies also showed that combining various components of diet therapy would enhance results, such as plant sterols with low fat diets, or oat products combined with low fat diets.  Additional benefits were seen with sodium restriction.  To effectively integrate these multiple changes requires the unique skills of a registered dietitian. (American Journal of Clinical Nutrition, 2001, Athlerosclerosis, 2001, European Journal of Nutrition, 2001,Obesity Research, 2001)
 
A Cochrane review confirms that Registered Dietitian (RD) counseling is more effective than physician counseling in the short to medium term for lowering cholesterol.  Delahanty, et al reported that clients who received MNT from dietitians showed better outcomes than usual care from a physician and reported a cost-effectiveness ratio of $36 per 1% decrease in cholesterol.  Although current Medicare guides indicate that nutrition counseling should be provided prior to initiating medication, Congress omitted coverage of cardiovascular conditions from the coverage of Medical Nutrition Therapy. (Cochrane Database Syst Rev, 2001, Journal of the American Dietetic Association, 2001)

MNT Improves Quality of Life

Registered Dietitians who provide MNT for patients with high cholesterol levels can achieve a positive impact on satisfaction and quality of life (QOL) outcomes when compared to patients receiving usual care from their physicians.  According to Delahanty et al, the MNT group reported significant and lasting improvements in perceived QOL related to self-care.  They were more satisfied with their ability to manage their cholesterol, eating habits and life in general.  (Annals of Behavioral Medicine, 2002)

MNT is Critical to Prevent and Treat Chronic Disease

Findings from the Diabetes Prevention Program showed that diet and exercise can effectively delay diabetes in a diverse American population of overweight persons with impaired glucose intolerance by 58%.  Over 3,200 participants ranging in age from 25 to 85 participated study.  In the lifestyle intervention provided by RDs, participants received training in diet, exercise and behavior modification skills.  On average, this group maintained their physical activity at 30 minutes per day, usually with walking or other moderate intensity exercise, and lost 5-7 percent of their body weight.  Participants randomized to treatment with the drug metformin reduced their risk of getting type 2 diabetes by only 31 percent.  Evidence-based research strongly supports that MNT provided by RDs is clinically effective in the management of diabetes with documented reductions in HbA1c of 1-2%. (http://www.preventdiabetes.com. Aug 8, 2001, Diabetes Care, 2002)