Skip to main content
SpringerLink
Log in

Medical Nutrition Therapy for Lipid and Lipoprotein Disorders

  • Chapter
  • First Online:
Therapeutic Lipidology

Part of the book series: Contemporary Cardiology ((CONCARD))

Abstract

Management of dyslipidemia is integral to atherosclerotic cardiovascular disease (ASCVD) risk reduction. This chapter summarizes evidence-based dietary recommendations for the treatment and management of dyslipidemias that can be used in medical practice. Medical nutrition therapy targeting LDL-C, non-HDL-C, and triglycerides will be outlined. For the management of elevated LDL-C and non-HDL-C, dietary saturated fat should be replaced with unsaturated fats; increased intake of viscous fiber and plant sterols/stanols and reductions in dietary cholesterol also will confer benefit. Lowering intake of added sugars, refined carbohydrates, and alcohol is recommended for the management of hypertriglyceridemia. Weight loss, if indicated, and increasing physical activity are universal goals for the treatment of dyslipidemias. A team-based approach to dyslipidemia management with physicians and registered dietitian nutritionists will maximize the clinical benefits of medical nutrition therapy for cholesterol and triglyceride lowering and reduce atherosclerotic cardiovascular disease risk beyond that achieved just with pharmacologic therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the management of blood cholesterol. J Am Coll Cardiol 2018;25709.

    Google Scholar 

  2. Sullivan DR, Lewis B. A classification of lipoprotein disorders: implications for clinical management. Clin Lipidol. 2011;6:327–38.

    Article  Google Scholar 

  3. Eckel RH, Jakicic JM, Ard JD, Hubbard VS, de Jesus JM, Lee I-M, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2960–84.

    Article  PubMed  Google Scholar 

  4. Silverman MG, Ference BA, Im K, Wiviott SD, Giugliano RP, Grundy SM, et al. Association between lowering LDL-C and cardiovascular risk reduction among different therapeutic interventions: a systematic review and meta-analysis. JAMA. 2016;316(12):1289–97.

    Article  CAS  PubMed  Google Scholar 

  5. Arnett D, Blumenthal RS, Albert M, Buroker A, Goldberger Z, Hahn E, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease. Circulation. 2019:26029.

    Google Scholar 

  6. Jacobson TA, Ito MK, Maki KC, Orringer CE, Bays HE, Jones PH, et al. National Lipid Association recommendations for patient-centered management of dyslipidemia: part 1-full report. J Clin Lipidol. 2015;9(2):129–69.

    Google Scholar 

  7. Jacobson TA, Maki KC, Orringer CE, Jones PH, Kris-Etherton P, Sikand G, et al. National Lipid Association recommendations for patient-centered management of dyslipidemia: part 2. J Clin Lipidol. 2015;9(6):S1–122.e1.

    Google Scholar 

  8. Appel LJ, Sacks FM, Carey VJ, Obarzanek E, Swain JF, Miller ER 3rd, et al. Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial. JAMA. 2005;294(19):2455–64.

    Article  CAS  PubMed  Google Scholar 

  9. National Cancer Institute. Sources of saturated fat, stearic acid, & cholesterol raising fat among the U.S. population [Internet]. [cited 2019 Mar 21]. Available from: https://epi.grants.cancer.gov/diet/foodsources/sat_fat/.

  10. National Center for Health Statistics. Health, United States, 2017: With special feature on mortality. Hyattsville, Maryland; 2017.

    Google Scholar 

  11. Ras RT, Geleijnse JM, Trautwein EA. LDL-cholesterol-lowering effect of plant sterols and stanols across different dose ranges: a meta-analysis of randomised controlled studies. Br J Nutr. 2014;112(2):214–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Jones PJH, Shamloo M, MacKay DS, Rideout TC, Myrie SB, Plat J, et al. Progress and perspectives in plant sterol and plant stanol research. Nutr Rev. 2018;76(10):725–46.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Segura R, Javierre C, Lizarraga MA, Ros E. Other relevant components of nuts: Phytosterols, folate and minerals. Br J Nutr. 2006;99(2):447–8.

    Google Scholar 

  14. Dumolt JH, Rideout TC. The lipid-lowering effects and associated mechanisms of dietary phytosterol supplementation. Curr Pharm Des. 2017;23(34):5077–85.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Ras RT, Van Der Schouw YT, Trautwein EA, Sioen I, Dalmeijer GW, Zock PL, et al. Intake of phytosterols from natural sources and risk of cardiovascular disease in the European Prospective Investigation into Cancer and Nutrition-the Netherlands (EPIC-NL) population. Eur J Prev Cardiol. 2015;22(8):1067–75.

    Article  PubMed  Google Scholar 

  16. Brown L, Rosner B, Willett WW, Sacks FM. Cholesterol-lowering effects of dietary fiber: a meta-analysis. Am J Clin Nutr. 1999;69(1):30–42.

    Article  CAS  PubMed  Google Scholar 

  17. Whitehead A, Beck EJ, Tosh S, Wolever TMS. Cholesterol-lowering effects of oat β-glucan: a meta-analysis of randomized controlled trials1. Am J Clin Nutr. 2014;100:1413–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Van Horn L, Carson JAS, Appel LJ, Burke LE, Economos C, Karmally W, et al. Recommended dietary pattern to achieve adherence to the American Heart Association/American College of Cardiology (AHA/ACC) guidelines: a scientific statement from the American Heart Association. Circulation. 2016;134:e505–29.

    PubMed  Google Scholar 

  19. Vincent MJ, Allen B, Palacios OM, Haber LT, Maki KC. Meta-regression analysis of the effects of dietary cholesterol intake on LDL and HDL cholesterol. Am J Clin Nutr. 2019;109(1):7–16.

    Article  PubMed  Google Scholar 

  20. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014;63(25 Pt B):2985–3023.

    Article  PubMed  Google Scholar 

  21. Poobalan A, Aucott L, Smith WCS, Avenell A, Jung R, Broom J, et al. Effects of weight loss in overweight/obese individuals and long-term lipid outcomes – a systematic review. Obes Rev. 2004;5(1):43–50.

    Article  CAS  PubMed  Google Scholar 

  22. McCoin M, Sikand G, Johnson EQ, Kris-Etherton PM, Burke F, Carson JAS, et al. The effectiveness of medical nutrition therapy delivered by registered dietitians for disorders of lipid metabolism: a call for further research. J Am Diet Assoc. 2008;108(2):233–9.

    Article  PubMed  Google Scholar 

  23. Sikand G, Cole RE, Handu D, DeWaal D, Christaldi J, Johnson EQ, et al. Clinical and cost benefits of medical nutrition therapy by registered dietitian nutritionists for management of dyslipidemia: a systematic review and meta-analysis. J Clin Lipidol. 2018;12(5):1113–22.

    Article  PubMed  Google Scholar 

  24. Miller M, Stone NJ, Ballantyne C, Bittner V, Criqui MH, Ginsberg HN, et al. Triglycerides and cardiovascular disease. Circulation. 2011;123(20):2292–333.

    Article  PubMed  Google Scholar 

  25. Klempfner R, Erez A, Sagit B-Z, Goldenberg I, Fisman E, Kopel E, et al. Elevated triglyceride level is independently associated with increased all-cause mortality in patients with established coronary heart disease: twenty-two-year follow-up of the bezafibrate infarction prevention study and registry. Circ Cardiovasc Qual Outcomes. 2016;9(2):100–8.

    Article  PubMed  Google Scholar 

  26. Nordestgaard BG, Varbo A. Triglycerides and cardiovascular disease. Lancet (London, England). 2014;384(9943):626–35.

    Article  CAS  Google Scholar 

  27. Rimm EB, Williams P, Fosher K, Criqui M, Stampfer MJ. Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effects on lipids and haemostatic factors. BMJ. 1999;319:1523–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. NIH NIAA. What is a standard drink? [Internet]. [cited 2019 Mar 19]. Available from: https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/what-standard-drink.

  29. Sacks FM, Carey VJ, Anderson CAM, Miller ER, Copeland T, Charleston J, et al. Effects of high vs low glycemic index of dietary carbohydrate on cardiovascular disease risk factors and insulin sensitivity the OmniCarb randomized clinical trial. JAMA. 2014;312(23):2531–41.

    Google Scholar 

  30. Maki KC, Palacios OM, Lindner E, Nieman KM, Bell M, Sorce J. Replacement of refined starches and added sugars with egg protein and unsaturated fats increases insulin sensitivity and lowers triglycerides in overweight or obese adults with elevated triglycerides. J Nutr. 2017;147(7):1267–74.

    Article  CAS  PubMed  Google Scholar 

  31. Clifton PM. Diet, exercise and weight loss and dyslipidaemia. Pathology. 2019;51(2):222–6.

    Article  CAS  PubMed  Google Scholar 

  32. Bailey RL, Fulgoni VL, Cowan AE, Gaine PC. Sources of added sugars in young children, adolescents, and adults with low and high intakes of added sugars. Nutrients. 2018;10(1):102.

    Article  PubMed Central  CAS  Google Scholar 

  33. Steele EM, Baraldi LG, Da Costa Louzada ML, Moubarac JC, Mozaffarian D, Monteiro CA. Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study. BMJ Open. 2016;6:e009892.

    Article  Google Scholar 

  34. Thompson M, Hein N, Hanson C, Smith LM, Anderson-Berry A, Richter CK, et al. Omega-3 fatty acid intake by age, gender, and pregnancy status in the United States: National Health and Nutrition Examination Survey 2003–2014. Nutrients. 2019;11(1):177.

    Google Scholar 

  35. 2015 Dietary Guidelines Advisory Committee. USDA scientific report of the 2015 Dietary Guidelines Advisory Committee. Department of Health and Human Services. 2015.

    Google Scholar 

  36. Bhatt DL, Steg PG, Miller M, Brinton EA, Jacobson TA, Ketchum SB, et al. Cardiovascular risk reduction with Icosapent ethyl for hypertriglyceridemia. N Engl J Med. 2018;380:11–22.

    Article  PubMed  Google Scholar 

  37. Yokoyama M, Origasa H, Matsuzaki M, Matsuzawa Y, Saito Y, Ishikawa Y, et al. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet. 2007;369(9567):1090–8.

    Article  CAS  PubMed  Google Scholar 

  38. Piercy KL, Troiano RP, Ballard RM, Carlson SA, Fulton JE, Galuska DA, et al. The Physical Activity Guidelines for Americans. JAMA. 2018;320(19):2020–8.

    Google Scholar 

  39. Haskell WL. The influence of exercise on the concentrations of triglyceride and cholesterol in human plasma. Exerc Sport Sci Rev. 1984;12:205–44.

    Article  CAS  PubMed  Google Scholar 

  40. Action for Health in Diabetes Study G, Wing RR, Espeland MA, Clark JM, Hazuda HP, Knowler WC, et al. Association of weight loss maintenance and weight regain on 4-year changes in CVD risk factors: the action for health in diabetes (look AHEAD) clinical trial. Diabetes Care. 2016;39(8):1345–55.

    Article  CAS  Google Scholar 

  41. Academy of Nutrition and Dietetics Evidence Analysis Library. DLM: MNT and Referral to a Registered Dietitian. Academy of Nutrition and Dietetics. Accessed 20 Apr 2019. https://www.andeal.org/template.cfm?template=guide_summary&key=229.

  42. Rakic V, Puddey IB, Dimmitt SB, Burke V, Beilin LJ. A controlled trial of the effects of pattern of alcohol intake on serum lipid levels in regular drinkers. Atherosclerosis. 1998;137(2):243–52.

    Article  CAS  PubMed  Google Scholar 

  43. Parhofer KG. Increasing HDL-cholesterol and prevention of atherosclerosis: a critical perspective. Atheroscler Suppl. 2015;18:109–11.

    Article  PubMed  Google Scholar 

  44. Wood PD, Stefanick ML, Williams PT, Haskell WL. The effects on plasma lipoproteins of a prudent weight-reducing diet, with or without exercise, in overweight men and women. N Engl J Med. 1991;325(7):461–6.

    Article  CAS  PubMed  Google Scholar 

  45. Roussell MA, Kris-Etherton P. Effects of lifestyle interventions on high-density lipoprotein cholesterol levels. J Clin Lipidol. 2007;1(1):65–73.

    Article  PubMed  Google Scholar 

  46. National Lipid Association. Learn your lipids [internet]. [cited 2019 Mar 6]. Available from: https://www.learnyourlipids.com/index.php.

  47. AHA. Familial Hypercholesterolemia (FH) [Internet]. [cited 2019 Mar 6]. Available from: https://www.heart.org/en/health-topics/cholesterol/causes-of-high-cholesterol/familial-hypercholesterolemia-fh.

  48. Goldberg AC, Hopkins PN, Toth PP, Ballantyne CM, Rader DJ, Robinson JG, et al. Familial hypercholesterolemia: screening, diagnosis and management of pediatric and adult patients. J Clin Lipidol. 2011;5:S1–8.

    Article  PubMed  Google Scholar 

  49. Pancreas Foundation. FAMILIAL CHYLOMICRONEMIA SYNDROME (FCS) [Internet]. [cited 2019 Mar 6]. Available from: https://pancreasfoundation.org/patient-information/ailments-pancreas/familial-chylomicronemia-syndrome/

  50. Williams L, Rhodes KS, Karmally W, Welstead LA, Alexander L, Sutton L. Familial chylomicronemia syndrome: bringing to life dietary recommendations throughout the life span. J Clin Lipidol. 2018;12:908–19.

    Article  PubMed  Google Scholar 

  51. Kahan S, Manson JE. Obesity treatment, beyond the guidelines: practical suggestions for clinical practice. JAMA. 2019;321(14):1349–50.

    Article  PubMed  Google Scholar 

  52. Introduction. Standards of medical care in diabetes—2019. Diabetes Care. 2019;42:S1–2.

    Article  Google Scholar 

  53. Obert J, Pearlman M, Obert L, Chapin S. Popular weight loss strategies: a review of four weight loss techniques. Curr Gastroenterol Rep. 2017;19(12):61.

    Article  PubMed  Google Scholar 

  54. Tobias DK, Chen M, Manson JE, Ludwig DS, Willett W, Hu FB. Effect of low-fat diet interventions versus other diet interventions on long-term weight change in adults: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2015;3(12):968–79.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Thomas JG, Bond DS, Phelan S, Hill JO, Wing RR. Weight-loss maintenance for 10 years in the national weight control registry. Am J Prev Med. 2014;46(1):17–23.

    Article  PubMed  Google Scholar 

  56. Goode AP, Hall KS, Batch BC, Huffman KM, Hastings SN, Allen KD, et al. The impact of interventions that integrate accelerometers on physical activity and weight loss: a systematic review. Ann Behav Med. 2017;51(1):79–93.

    Article  PubMed  Google Scholar 

  57. Flores Mateo G, Granado-Font E, Ferré-Grau C, Montaña-Carreras X. Mobile phone apps to promote weight loss and increase physical activity: a systematic review and meta-analysis. J Med Internet Res. 2015;17(11):e253.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Brickwood K-J, Watson G, O’Brien J, Williams AD. Consumer-based wearable activity trackers increase physical activity participation: systematic review and meta-analysis. JMIR Mhealth Uhealth. 2019;7(4):e11819.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Mertens E, Markey O, Geleijnse JM, Lovegrove JA, Givens DI. Adherence to a healthy diet in relation to cardiovascular incidence and risk markers: evidence from the Caerphilly Prospective Study. Eur J Nutr. 2018;57(3):1245–58.

    Article  PubMed  Google Scholar 

  60. Chiavaroli L, Nishi SK, Khan TA, Braunstein CR, Glenn AJ, Mejia SB, et al. Portfolio dietary pattern and cardiovascular disease: a systematic review and meta-analysis of controlled trials. Prog Cardiovasc Dis. 2018;61(1):43–53.

    Article  PubMed  Google Scholar 

  61. Sofi F, Cesari F, Abbate R, Gensini GF, Casini A. Adherence to Mediterranean diet and health status: meta-analysis. BMJ. 2008;337:a1344.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison CH, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association task force on clinical Pr. Hypertension. 2018;71(6):e13–115.

    Google Scholar 

  63. U.S News & World Report. Best heart healthy diets [Internet]. Available from: https://www.usnews.com/info/blogs/press-room/articles/2019-01-02/us-news-reveals-best-diets-rankings-for-2019.

  64. NHLBI NIH. DASH Eating Plan [Internet]. [cited 2019 Feb 28]. Available from: https://www.nhlbi.nih.gov/health-topics/dash-eating-plan.

  65. Johnston E, Beasley J, Jay M, Kris-Etherton P. Practical Nutrition for the Primary Care Provider. NYU Langone Health. 2017. 44 p.

    Google Scholar 

  66. Appel L, Moore T, Obarzanek E, Vollmer W, Svetkey L, Sacks F, et al. A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med. 1997;336:1117–24.

    Article  CAS  PubMed  Google Scholar 

  67. Micha R, Peñalvo JL, Cudhea F, Imamura F, Rehm CD, Mozaffarian D. Association between dietary factors and mortality from heart disease, stroke, and type 2 diabetes in the United States. JAMA. 2017;317(9):912–24.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Center for Disease Control and Prevention, National Center for Health Statistics. Physician office visits by child or adult patients that include nutrition and diet counseling [Internet]. Available from: https://www.healthypeople.gov/2020/data/Chart/4965.

  69. Endevelt R, Gesser-Edelsburg A. A qualitative study of adherence to nutritional treatment: perspectives of patients and dietitians. Patient Prefer Adherence. 2014;8:147–54.

    Article  PubMed  PubMed Central  Google Scholar 

  70. USDA. Dietary Guidelines 2015–2020 [Internet]. [cited 2019 May 1]. Available from: https://health.gov/dietaryguidelines/2015/guidelines/.

Download references

Author information

Authors and Affiliations

  1. Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA

    Philip A. Sapp, Emily A. Johnston, Kristina Petersen, Jennifer Fleming & Penny M. Kris-Etherton

Authors
  1. Philip A. Sapp
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emily A. Johnston
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kristina Petersen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jennifer Fleming
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Penny M. Kris-Etherton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philip A. Sapp .

Editor information

Editors and Affiliations

  1. The University of Chicago Pritzker School of Medicine, Chicago, IL, USA

    Michael H. Davidson

  2. Cicarrone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Univerity School of Medicine, Baltimore, MD, USA

    Peter P. Toth

  3. Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, USA

    Kevin C. Maki

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Sapp, P.A., Johnston, E.A., Petersen, K., Fleming, J., Kris-Etherton, P.M. (2021). Medical Nutrition Therapy for Lipid and Lipoprotein Disorders. In: Davidson, M.H., Toth, P.P., Maki, K.C. (eds) Therapeutic Lipidology. Contemporary Cardiology. Humana, Cham. https://doi.org/10.1007/978-3-030-56514-5_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-56514-5_9

  • Published:

  • Publisher Name: Humana, Cham

  • Print ISBN: 978-3-030-56513-8

  • Online ISBN: 978-3-030-56514-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation