Medical Nutrition Therapy for Disorders of Lipid Metabolism
Manual of Clinical Nutrition Management C- 42 Copyright © 2 013 Compass Group, Inc.
Nutritional Adequacy
The Therapeutic Lifestyle Changes Diet is planned to meet the Dietary Reference Intakes as outlined in Section
IA: Statement on Nutritional Adequacy.
The National Institutes of Health maintain that the Therapeutic Lifestyle Changes Diet is consistent with good
nutrition, and the aim of this diet is to achieve healthy eating patterns consistent with the Dietary Guidelines for
Americans and American Heart Association Diet and Lifestyle Recommendations 2006 (1,3). A diet low in
saturated fat, trans fats, cholesterol, and total fat is recommended for all healthy persons 2 years of age and
older (1,3).
How to Order the Diet
Specify all that apply:
Indicate Therapeutic Lifestyle Changes Diet (preferred) or Low-Fat, Low-Cholesterol Diet. The registered
dietitian will determine the specific approaches used to implement the Therapeutic Lifestyle Changes Diet
and medical nutrition goals based on individualized assessment and target treatment objectives to reduce
CHD risk.
Further reduction in total fat intake may be implemented. This additional reduction depends on the
dietitian’s assessment and the patient’s compliance.
If required, sodium control or other dietary modification should be specifically ordered.
If weight reduction is desired, the dietitian should set the weight loss goal with the patient and determine
the appropriate weight loss regimen.
Planning the Cardioprotective Diet
The Therapeutic Lifestyle Changes Diet stresses reductions in intake of saturated and trans fat (less than 7%)
and cholesterol (less than 200 mg/dL) as the primary dietary modifications to lower LDL cholesterol in patients
requiring primary and secondary prevention (1). Based on the response to a low-saturated fat, low-cholesterol
diet, additional therapeutic options, such as plant stanols/sterols (2 g/day) and increased viscous (soluble)
fiber (10 to 25 g/day), can be implemented as part of MNT self-management training (1). Refer to Disorders in
Lipid Metabolism Evidence-Based Nutrition Practice Guideline (5). When metabolic syndrome or its associated
lipid risk factors (elevated triglycerides level or low HDL cholesterol level) are present, therapeutic lifestyle
changes also should include weight reduction and increased physical activity (1,5).
Table C-10: Nutrient Composition of Therapeutic Lifestyle Changes Diet (1,3,5)
Nutrient Recommended Intake
Saturated and trans fata <7% of total energy combined (5) (trans fat <1% of total energy) (3)
Polyunsaturated fat Up to 10% of total energy
Monounsaturated fat Up to 20% of total energy
Total fat 25% to 35% of total energy
Carbohydrateb 50% to 60% of total energy
Fiber 25 to 30 g/day
Protein Approximately 15% of total energy
Plant stanol/sterols 2 g/day (optional)
Cholesterol <200 mg/day
Total energyc Balance energy intake and energy expenditure to maintain desirable body weight
and to prevent weight gain
a Trans fatty acids are an LDL-raising fat; AHA recommends <1% of energy from trans fats (3).(^) b Carbohydrate should be derived predominately from foods rich in complex carbohydrates, including grains (especially whole grains),
fruits, and vegetables.
c Daily energy expenditure should include at least moderate physical activity (contributing approximately 200 kcal/day).
Source: Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection,
Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285:2486-2497.
Updates based on: Disorders in Lipid Metabolism Evidence-Based Nutrition Practice Guideline. Academy of Nutrition and Dietetics Evidence
Analysis Library. Academy of Nutrition and Dietetics; 2005. Available at: http://www.andevidencelibrary.com. Accessed June 1, 2006.
Cardioprotective Dietary Approaches in Managing Disorders in Lipid Metabolism
Total fat and saturated fatty acids: Elevated LDL cholesterol is an independent risk factor for CHD (1).
Saturated fat is the principal dietary determinant of LDL cholesterol levels (6). The reduction of dietary
saturated fat directly decreases clearance of LDL and very-low-density lipoprotein (VLDL) remnants (1). The
recommendations for saturated fat are based on existing cardiovascular disease, risk factors, and LDL
cholesterol value. A diet consisting of 25% to 35% total fat, <7% saturated and trans fat, and <200 mg
cholesterol lowers serum total cholesterol and LDL cholesterol by 9% to 16% and decreases the risk of CHD