©2006 American Dietetic Association Disorders of Lipid Metabolism Toolkit
Summary Page for Disorders of Lipid Metabolism
Setting: Ambulatory Care or adapted for other health care settings (Adult 19+ years old)
Medical Nutrition Therapy (MNT) by an RD improves dietary patterns to reduce CVD risk (Grade I)
Encounter
Length of contact
Time between encounters
1
45-90 minutes
4-6 weeks
2 to 6
30-60 minutes
4-6 weeks (# of encounters depends on risk category, amount of TLC modification, level of
motivation)
Expected Outcomes of MNT
Outcome Assessment Factors*
Ideal/goal value of MNT
Biochemical Data and Anthropometric Measurements
Lipid Profile (Fasting Blood
 Total Cholesterol
Total Chol<200, Fasting Trig<150 mg/dL,
Cholesterol, Triglycerides*, LDL- Trig  or no change
Non-HDL=LDL-C goal +30*
C, HDL-C*), Fasting Glucose*,
Non-HDL (if Trig >200mg/dL)* LDL-C<160 (0-1 Risk Factor)
BP*
LDL-C
LDL-C<130 mg/dL (Multiple (2+) Risk Factors)
HDL-C or no change
LDL-C<100 mg/dL (CHD and CHD Risk Equivalent), HDL-C
Fasting Glucose WNL or 
>40 mg/dL (males), >50 mg/dL (females) (ATPIII)
BP WNL or 
BP<130/<85mmHg, Fasting Glucose<100mg/dL
Height, Weight, BMI, Waist
Circumference* Waist to hip ratio#
Maintain healthy weight and
appropriate waist circumference*
Food and Nutrition and Client Data**
Food variety and caloric intake
Selects nutrient-rich food sources &
plans calorie intake toward goal.
Fat and cholesterol intake
Limits foods  in cholesterol,
saturated fat, and trans fat and uses
food sources of unsaturated fat, as
preferred fat
Soluble fiber intake
Increases intake of foods  in
soluble fiber
Plant stanol/sterol products
Considers plant stanol/sterols if
cholesterol and LDL goal not met.
Omega-3 fatty acids
Incorporates both marine and plant
based sources in weekly meal plan
if consistent with preference and not
contraindicated by risks or harms.
Nuts, soy protein
Vitamin/supplement intake
Food preparation
Recipe modification
Dining out
Risks/benefits of alcoholic
beverages
Physical activity
Smoking cessation
Potential food/drug interaction
Within reasonable body weight* , BMI 18.5-24.9 kg/m2
Waist Circumference <40” (102 cm) males, <35” (88 cm)
females (Grade: II)
Calories to maintain/reduce weight
Percentage of total kcal from fat: 25-35% total fat, less than 7 %
sat fat and trans fat. Isocalorically replace saturated fat with
mono and polyunsaturated fat (Grade I). Dietary cholesterol
intake of <200 mg/day (Grade: I)
Daily dietary fiber of >25g, 7-13g of which should be viscous
(soluble) fiber (Grade: I)
Daily intake of 2-3 g/day stanol/sterols (Grade: I)
Fatty fish (avg. of 7oz/wk) (Grade: II). In patients with heart
disease, incorporate approximately 1g/day of EPA and DHA
from fish or a supplement (Grade II),
Plant based foods containing 1.5 g alpha-linolenic acid (1 Tbsp
canola, walnut oil, 0.5 g ground flax seed) (Grade III)
Incorporates nuts and soy in meal
Nuts (1 ounce ~5 times/week (Grade: II)
plan if consistent with preference & Soy products (~26-50g/day) (Grade: II).
not contraindicated by risks/harms
Maintains dietary reference intake
Increased intake of: Folate (DRI 400 mcg/day ages >19), B6
of foods folate, B6; B12
(DRI 1.3mg/day ages 19-50), B12 (DRI 2.4 mcg/day ages 19-50)
(Grade: II)
Uses cooking techniques to modify Consistently uses cooking techniques to modify fat intake
fat intake
Modifies recipes to saturated fat, Recipes consistently modified to  saturated and trans fats
trans fats
Selects appropriately from
Consistently selects appropriately from restaurant menu
restaurant menu
States the risk/benefits of alcoholic May have up to 1-2 drinks per day of an alcohol containing
beverages
beverage (Grade: II)
Participates in aerobic activity
Moderate intensity exercise at 40%-60% of exercise capacity for
~30 min/day most days of the week (Grade: II)
Verbalizes importance of smoking
Smoking cessation successful
cessation
Verbalizes potential food/drug
No food/drug interaction
interaction
*Assess for Metabolic Syndrome. See Summary Page for Disorders of Lipid Metabolism with Metabolic Syndrome, **Encounter in which behavioral topics are covered may
vary according to client’s readiness, skills, resources, and need for lifestyle changes. Consider combination of other protocols, e.g., Hypertension, based on co-morbid
conditions, # National standard unavailable
©2006 American Dietetic Association Disorders of Lipid Metabolism Toolkit
Summary Page for Disorders of Lipid Metabolism with Metabolic Syndrome
Setting: Ambulatory Care or adapted for other health care settings (Adult 19+ years old)
Medical Nutrition Therapy (MNT) by an RD improved dietary patterns to reduce CVD risk (Grade I)
Length of
Encounter
contact
Time between encounters
1
45-90 minutes 4-6 weeks
2 to 6
30-60 minutes 4-6 weeks (# of encounters depends on risk category, amount of TLC modification, level of motivation)
Outcome Assessment Factors
Expected Outcome of MNT
Ideal/goal value of MNT
Biochemical Data and Anthropometric Measurements
Lipid Profile (Fasting Blood
 Total Cholesterol
Total Chol<200, Fasting Trig<150 mg/dL
Cholesterol, Triglycerides*, LDL- Trig  or no change
Non-HDL=LDL-C goal +30*
C, HDL-C*),
Non-HDL(if Trig >200 mg/dL)* LDL-C<160 (0-1 Risk Factor)
LDL-C
LDL-C<130 mg/dL (Multiple (2+) Risk Factors)
Fasting Glucose*, BP*
HDL-C or no change
LDL-C<100 mg/dL (CHD and CHD Risk Equivalent), HDL-C
Fasting Glucose WNL or 
>40 mg/dL (males), >50 mg/dL (females) (ATPIII)
BP WNL or 
BP<130/<85mmHg, Fasting Glucose<100mg/dL
Height, Weight, BMI and Waist
Maintain healthy weight and
Within reasonable body weight, BMI 18.5-24.9 kg/m2
Circumference*
appropriate waist circumference*
Waist Circumference <40” (102 cm) males, <35” (88 cm)
Waist to hip ratio#
females (Grade: II)
Food and Nutrition and Client Data**
Food variety and caloric intake
Selects nutrient-rich food sources & Calorie intake to reduce weight
consistently plans calories to reduce Reduce/maintain BP WNL (Grade: I)
weight and reduce/maintain BP
Fat and cholesterol intake
Limits foods  in cholesterol,
Percentage of total kcal from fat: 25-35% total fat (if trig >500
saturated fat, and trans fat and uses mg/dL then very low fat diet <15% of calories from fat
food sources of unsaturated fat, as
(ATPIII)), less than 7% saturated fat and trans fat. Isocalorically
preferred fat
replace saturated fat with mono and polyunsaturated fat (Grade
I).Dietary cholesterol intake of <200 mg/day (Grade: I)
Soluble fiber intake
Increases intake of foods  in
Daily dietary fiber of >25g, 7-13g of which should be viscous
soluble fiber
(soluble) fiber (Grade: I)
Plant stanol/sterol products
Considers plant stanol/sterols if
Daily intake of 2-3 g/day stanol/sterols (Grade: I)
cholesterol and LDL goal not met.
Omega-3 fatty acids
Incorporates both marine and plant Fatty fish (avg. of 7oz/wk) (Grade: II), In patients with heart
based sources in weekly meal plan disease, incorporates approximately 1g/day of EPA and DHA
if consistent with patient preference from fish or a supplement (Grade II),
and not contraindicated by risks or Plant based foods containing 1.5 g alpha-linolenic acid (1 Tbsp
harms.
canola, walnut oil, 0.5 g ground flax seed) (Grade III)
Nuts, soy protein
Incorporates nuts and soy in meal
Nuts (1 ounce ~5 times/week (Grade: II)
plan if consistent with preference & Soy products (~26-50g/day) (Grade: II)
not contraindicated by risks/harms
Vitamin intake
Maintains dietary reference intake
Increased intake of: Folate (DRI 400 mcg/day ages >19), B6
of foods folate, B6; B12
(DRI 1.3mg/day ages 19-50), B12 (DRI 2.4 mcg/day ages 19-50)
(Grade: II)
Food preparation
Uses cooking techniques to modify Consistently uses cooking techniques to modify fat intake
fat intake
Recipe modification
Modifies recipes to saturated fat, Recipes consistently modified to  saturated fat and trans fats
trans fats
Dining out
Selects appropriately from
Consistently selects appropriately from restaurant menu
restaurant menu
Risks/benefits of alcoholic
States the risk/benefits of alcoholic May have up to 1-2 drinks per day of an alcohol containing
beverages
beverages
beverage (Grade: II)
Physical activity
Increase participation in aerobic
Exercise intensity at 40% to 60% of exercise capacity for ~30
activity
min/day most days of the week (Grade: II)
Smoking cessation
Verbalizes importance of smoking
Smoking cessation successful
cessation
Potential food/drug interaction
Verbalizes potential food/drug
No food/drug interaction
interaction
©2006 American Dietetic Association Disorders of Lipid Metabolism Toolkit
**Encounter in which behavioral topics are covered may vary according to client’s readiness, skills, resources, and need for lifestyle changes. Consider combination of other
protocols, e.g., Hypertension, based on co-morbid conditions, # National standard unavailable.