Sikand G, Kashyap M L, Yang I
Division of Cardiology, University of California-Irvine, Orange 92868-3298, USA.
J Am Diet Assoc. 1998 Aug;98(8):889-94; quiz 895-6. doi: 10.1016/S0002-8223(98)00204-1.
This study was designed to evaluate whether medical nutrition therapy administered by registered dietitians could lead to a beneficial clinical and cost outcome in men with hypercholesterolemia. Ninety-five subjects participating in a cholesterol-lowering drug study took part in an 8-week nutrition intervention program before initiating treatment with a cholesterol-lowering medication, Patient records were reviewed via a retrospective chart review to determine plasma lipid levels at the beginning and end of the program and the number and length of sessions with a dietitian. Complete information was available for 74 subjects aged 60.8 n+/- 9.8 years (mean +/- SD). Medical nutrition therapy lowered total serum cholesterol levels 13% (P < .001), low-density lipoprotein cholesterol (LDL-C) 15% (P < .0001), triglyceride 11% (P < .05), and high-density lipoprotein-cholesterol (HDL-C) 4% (P < .05). Total dietitian intervention time was 144 +/- 21 minutes (range = 120 to 180 minutes) in 2.8 +/- 0.7 sessions (range = 2 to 4) during 6.81 +/- 0.7 weeks of medical nutrition therapy (range = 6 to 8 weeks). Analysis of covariance was conducted to examine whether mean change in LDL-C differed by number of dietitian visits. Results showed a marginal difference between the number of dietitian visits and change in LDL-C (f = 2.6, P < .084). However, the magnitude of LDL-C reduction was significantly higher with 4 dietitian visits (180 minutes) than with 2 visits (120 minutes) (21.9% vs 12.1%; P = .027). Lipid drug eligibility was obviated in 34 of 67 (51%) subjects per the National Cholesterol Treatment Program guidelines algorithm. The estimated annualized cost savings from the avoidance of lipid medications was $60,561.68. Therefore, we conclude that 3 or 4 individualized dietitian visits of 50 minutes each over 7 weeks are associated with a significant serum cholesterol reduction and a savings of health care dollars.
本研究旨在评估注册营养师实施的医学营养治疗是否能给高胆固醇血症男性带来有益的临床和成本效益。95名参与降胆固醇药物研究的受试者在开始使用降胆固醇药物治疗前，参加了一个为期8周的营养干预项目。通过回顾性病历审查来查看患者记录，以确定项目开始和结束时的血脂水平以及与营养师会面的次数和时长。74名年龄为60.8±9.8岁（均值±标准差）的受试者拥有完整信息。医学营养治疗使血清总胆固醇水平降低了13%（P<.001），低密度脂蛋白胆固醇（LDL-C）降低了15%（P<.0001），甘油三酯降低了11%（P<.05），高密度脂蛋白胆固醇（HDL-C）升高了4%（P<.05）。在为期6.81±0.7周（范围为6至8周）的医学营养治疗期间，营养师的总干预时间为144±21分钟（范围为120至180分钟），共进行2.8±0.7次会面（范围为2至4次）。进行协方差分析以检验LDL-C的平均变化是否因营养师访视而有所不同。结果显示，营养师访视次数与LDL-C变化之间存在微小差异（F=2.6，P<.084）。然而，4次营养师访视（180分钟）时LDL-C的降低幅度显著高于2次访视（120分钟）时（21.9%对12.1%；P=.027）。根据国家胆固醇治疗项目指南算法，67名受试者中有34名（51%）不再符合使用降脂药物的标准。避免使用降脂药物估计每年可节省成本60,561.68美元。因此，我们得出结论，在7周内进行3或4次每次50分钟的个体化营养师访视，可显著降低血清胆固醇水平并节省医疗费用。
