Medical Nutrition Therapy Intervention Research Articles

Position of the Academy of Nutrition and Dietetics: Medical Nutrition Therapy Behavioral Interventions Provided by Dietitians for Adults With Overweight or Obesity, 2024

Providing interventions that facilitate improvement of dietary intake and other health behaviors can improve nutrition-related outcomes in adults with overweight or obesity. Medical nutrition therapy (MNT) behavioral interventions require expertise from registered dietitian nutritionists or international equivalents (dietitians), which no other health care provider can provide for adults with obesity. Current evidence supports the role of MNT behavioral interventions for adults with overweight or obesity as an effective treatment option, when appropriate for and desired by the client. This Academy of Nutrition and Dietetics Position Paper describes potential benefits and concerns regarding dietitian-provided MNT behavioral interventions for adults with overweight and obesity and informs dietitians about implications for practice. This Position Paper is supported by a systematic review examining effectiveness of MNT interventions provided by dietitians and by an evidence-based practice guideline. It is the position of the Academy of Nutrition and Dietetics that MNT behavioral interventions for adults (aged 18 years and older) with overweight or obesity should be a treatment option, when appropriate and desired by the client, to improve cardiometabolic, quality of life, and anthropometric outcomes. Dietitians providing MNT recognize the complex contributors to overweight and obesity, and thus individualize interventions, based on a shared decision-making process, and deliver interventions in an inclusive, compassionate, and client-centered manner. Interventions should include collaboration with an interprofessional team when needed. Dietitians strive to increase health equity and reduce health disparities by advocating and providing opportunities for increased access to effective nutrition care services. This position remains in effect until December 31, 2031.

The effectiveness of medical nutrition therapy provided by a dietitian in adults with prediabetes: a systematic review and meta-analysis

BackgroundA total of 374 million adults worldwide are living with prediabetes, 70% of whom will develop type 2 diabetes mellitus (T2DM) in their lifetime. Medical nutrition therapy (MNT) provided by a dietitian, such as that found in lifestyle interventions, has the potential to improve glycemic control and prevent progression to T2DM. ObjectivesThe objective of this systematic review was to examine the effectiveness of MNT provided by a dietitian, compared with standard care, on glycemic, cardiometabolic, and anthropometric outcomes in adults with prediabetes. MethodsSearches were conducted for randomized controlled trials (RCTs) published between 1995 and 2022 using electronic databases MEDLINE, CINHAL, and Cochrane Central. The risk of bias was assessed using version 2 of the Cochrane risk-of-bias tool for RCTs. Meta-analyses were conducted using a random-effects model. The certainty of evidence was assessed for each outcome using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method, and a summary of findings table was created using the GRADEpro Guideline Development Tool. ResultsThirteen RCTs were included in the analysis, showcasing a variety of MNT interventions delivered by dietitians. Intervention durations ranged from 3 to 24 mo. Compared with standard care, MNT improved hemoglobin A1c (HbA1c) (mean difference [95% confidence interval]: −0.30% [−0.49, −0.12]) and fasting blood glucose (FBG) (−4.97 mg/dL [−6.24, −3.71]). Statistically significant improvements were found in anthropometrics (weight, body mass index, and waist circumference), cholesterol (total, high-, and low-density lipoproteins), and blood pressure (systolic and diastolic). No significant effect was found on T2DM or triglycerides. The certainty of evidence was moderate for FBG and low for HbA1c and incidence of T2DM. ConclusionsIn adults with prediabetes, MNT was effective in improving glycemic outcomes, anthropometrics, blood pressure, and most lipid levels. However, most studies had a risk of bias because of the randomization process or deviations from intended interventions. MNT plays a key role in improving cardiometabolic risk factors in adults with prediabetes. Trial registration numberThis study was registered with the registration ID #351421, available from https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=351421.

HealthyRHearts - reducing cholesterol in rural adults via telehealth-based medical nutrition therapy: protocol for a cluster randomised controlled trial

BackgroundFew randomised controlled trials specifically focus on prevention in rural populations. Cardiovascular disease (CVD) contributes to approximately one quarter of deaths in Australia. Nutrition is a key component affecting many risk factors associated with CVD, including hypercholesterolaemia. However, access to medical nutrition therapy (MNT) is limited for people living in rural areas, potentially exacerbating inequities related to health outcomes. Telehealth services present an opportunity to improve MNT access and address healthcare disparities for rural populations. The present study aims to evaluate feasibility, acceptability, and cost-effectiveness of a telehealth MNT CVD intervention program in lowering CVD risk over 12-months in regional and rural primary health care settings.Methods/designA cluster randomised controlled trial set in rural and regional general practices in NSW, Australia, and their consenting patients (n = 300 participants). Practices will be randomised to either control (usual care from their General Practitioner (GP) + low level individualised dietetic feedback) or intervention groups (usual care from their GP + low level individualised dietetic feedback + telehealth MNT intervention). Telehealth consultations will be delivered by an Accredited Practising Dietitian (APD), with each intervention participant scheduled to receive five consultations over a 6-month period. System-generated generic personalised nutrition feedback reports are provided based on completion of the Australian Eating Survey – Heart version (AES-Heart), a food frequency questionnaire. Eligible participants must be assessed by their GP as at moderate (≥ 10%) to high (> 15%) risk of a CVD event within the next five years using the CVD Check calculator and reside in a regional or rural area within the Hunter New England Central Coast Primary Health Network (HNECC PHN) to be eligible for inclusion. Outcome measures are assessed at baseline, 3, 6 and 12 months. The primary outcome is reduction in total serum cholesterol. Evaluation of the intervention feasibility, acceptability and cost-effective will incorporate quantitative, economic and qualitative methodologies.DiscussionResearch outcomes will provide knowledge on effectiveness of MNT provision in reducing serum cholesterol, and feasibility, acceptability, and cost-effectiveness of delivering MNT via telehealth to address CVD risk in rural regions. Results will inform translation to health policy and practice for improving access to clinical care in rural Australia.Trial registrationThis trial is registered at anzctr.org.au under the acronym HealthyRHearts (Healthy Rural Hearts), registration number ACTRN12621001495819.

SISTER (Sisters Inspiring Sisters to Engage in Relevant Diabetes Self-Care) Diabetes Study: Protocol for diabetes medical nutrition therapy randomized clinical trial among African American women

BackgroundAfrican American (AA) women with type 2 diabetes (T2D) carry disproportionate diabetes-related morbidity and mortality burdens. Diabetes medical nutrition therapy (MNT) improves glycemic, blood pressure, and cholesterol control, all critical in preventing and reducing diabetes complications. Yet, MNT does not address low motivation for dietary intake management, which is frequently reported among AA women with T2D living in the Southeastern US. MethodsA randomized controlled trial will be used to test the central hypothesis that diabetes MNT plus culturally-tailored motivational interviewing (MI) (diabetes MNT plus MI) is more effective than diabetes MNT alone (diabetes MNT). Two hundred ninety-one Southeastern AA women who are at risk for development and/or progression of T2D complications will be randomized to diabetes MNT plus MI or diabetes MNT. Both groups will include: 1) a 3-month active intervention period, consisting of group-based, nutritionist-facilitated MNT sessions; 2) a 3-month maintenance intervention period, including one group-based, nutritionist-facilitated maintenance support session; and 3) a 6-month inactive period. Culturally-adapted MI exercises will be integrated into the diabetes MNT plus MI group only. Primary (HbA1c) and secondary (systolic blood pressure, LDL cholesterol) outcomes will be assessed at baseline and 3, 6, and 12 months following the active intervention period. DiscussionThe results from this study, called the SISTER (Sisters Inspiring Sisters to Engage in Relevant Diabetes Self-Care) Diabetes Study, are vital to the adoption and uptake of rigorously-tested MNT interventions that address motivation among AA women with T2D as a way to reduce their risk and/or progression of diabetes-related complications.

The impact of medically tailored meals and nutrition therapy on biometric and dietary outcomes among food-insecure patients with congestive heart failure: a matched cohort study

BackgroundTo evaluate the impact of home-delivered, medically tailored meals and medical nutrition therapy among food-insecure patients following hospitalization for congestive heart failure by comparing clinical outcomes to a retrospectively matched cohort.MethodsPatients at high risk for readmission and food insecurity received up to three months of medically tailored meals and medical nutrition therapy after discharge. Pre-intervention and post-intervention weight, body mass index, blood pressure, and dietary intake were assessed. A combination of difference-in-difference and logistic regression models were used to compare changes between cohorts and evaluate impact attributable to the program.ResultsThirty-nine program participants were compared to a matched cohort of 117 unexposed patients. Participants experienced a marginal reduction in body mass index and an increase in systolic and diastolic blood pressure; however, these results were not statistically significant. To determine relevance to clinical cut-offs, logistic regressions were used, demonstrating that exposure to the intervention resulted in higher odds of a categorical reduction in blood pressure (OR: 1.85), though this did not reach statistical significance (95% CI: 0.67–5.32). Pre vs. post trends indicated that more-healthful foods and drinks increased numerically or remained similar to baseline, while less-healthful foods decreased numerically or remained similar to baseline.Conclusions and implicationsThese findings highlight the need for more longitudinal research on medically tailored meals and medical nutrition therapy interventions using clinical outcomes while setting realistic suggestions for program implementation. This study additionally illustrates the promise of integrating electronic medical record data and matched cohorts into medical nutrition program evaluation within the health sector.

Effectiveness of medical nutrition therapy in the management of adult dyslipidemia: A systematic review and meta-analysis

Cardiovascular disease (CVD) is a leading cause of mortality in the United States. Many primary risk factors, such as dyslipidemia and blood pressure, are modifiable with diet and lifestyle interventions. Therefore, the objective of this systematic review and meta-analysis was to evaluate the effectiveness of medical nutrition therapy (MNT) interventions provided by registered dietitian nutritionists (RDN) or international equivalents, compared to usual care or no MNT, on lipid profile and blood pressure (secondary outcome) in adults with dyslipidemia. The databases MEDLINE, CINAHL, Cochrane CENTRAL, and Cochrane Database of Systematic Reviews were searched for randomized controlled trials (RCTs) published between January 2005 and July 2021. Meta-analyses were performed using a random-effects model for lipid outcomes (seven RCTs, n=838), systolic blood pressure (SBP) (three RCTs, n=308), and diastolic blood pressure (DBP) (two RCTs, n=109). Compared to usual care or no intervention, MNT provided by RDNs improved total cholesterol (total-C) [mean difference (95% CI): -20.84 mg/dL (-40.60, -1.07), P=0.04]; low-density lipoprotein cholesterol (LDL-C) [-11.56 mg/dL (-21.10, -2.03), P=0.02]; triglycerides (TG) [-32.55 mg/dL (-57.78, -7.32), P=0.01];; and SBP [ -8.76 mm Hg (-14.06 lower to -3.45) P<0.01].High-density lipoprotein cholesterol (HDL-C) [1.75 mg/dl (-1.43, 4.92), P=0.28] and DBP [-2.9 mm Hg (-7.89 to 2.09), P=0.25] were unchanged. Certainty of evidence was moderate for total-C, LDL-C, and TG, and low for HDL-C, SBP, and DBP. In conclusion, in adults with dyslipidemia, MNT interventions provided by RDNs are effective for improving serum lipids/lipoproteins and SBP levels.

Genetically-Guided Medical Nutrition Therapy in Type 2 Diabetes Mellitus and Pre-diabetes: A Series of n-of-1 Superiority Trials

Type 2 diabetes mellitus (T2DM) is a heterogeneous metabolic disorder of multifactorial etiology that includes genetic and dietary influences. By addressing the latter, medical nutrition therapy (MNT) contributes to the management of T2DM or pre-diabetes toward achieving glycaemic control and improved insulin sensitivity. However, the clinical outcomes of MNT vary and may further benefit from personalized nutritional plans that take into consideration genetic variations associated with individual responses to macronutrients. The aim of the present series of n-of-1 trials was to assess the effects of genetically-guided vs. conventional MNT on patients with pre-diabetes or T2DM. A quasi-experimental, cross-over design was adopted in three Caucasian adult men with either diagnosis. Complete diet, bioclinical and anthropometric assessment was performed and a conventional MNT, based on the clinical practice guidelines was applied for 8 weeks. After a week of “wash-out,” a precision MNT was prescribed for an additional 8-week period, based on the genetic characteristics of each patient. Outcomes of interest included changes in body weight (BW), fasting plasma glucose (FPG), and blood pressure (BP). Collectively, the trials indicated improvements in BW, FPG, BP, and glycosylated hemoglobin (HbA1c) following the genetically-guided precision MNT intervention. Moreover, both patients with pre-diabetes experienced remission of the condition. We conclude that improved BW loss and glycemic control can be achieved in patients with pre-diabetes/T2DM, by coupling MNT to their genetic makeup, guiding optimal diet, macronutrient composition, exercise and oral nutrient supplementation in a personalized manner.

Snacks for the Patient With Chronic Kidney Disease

Nutrition for the patient with chronic kidney disease (CKD) can be complex. Research has shown that nutritional intake can play a significant role in disease progression and includes consideration of dietary sodium, protein, potassium, phosphorus, and calcium. Depending on the phase of CKD, individuals will have different nutrient needs and therefore medical nutrition therapy intervention should be individualized.1 In the 2020 Kidney Disease Quality Initiative Outcomes Clinical Nutrition Guidelines for CKD, the role of the registered dietitian nutritionist with diet individualization was specifically highlighted.

Acetyl CoA Carboxylase is an Unexpected Mediator Between Macrophage Metabolism and Inflammation

Cardiovascular disease (CVD) is a leading cause of mortality in the United States. Many primary risk factors, such as dyslipidemia and blood pressure, are modifiable with diet and lifestyle interventions. Therefore, the objective of this systematic review and meta-analysis was to evaluate the effectiveness of medical nutrition therapy (MNT) interventions provided by registered dietitian nutritionists (RDN) or international equivalents, compared to usual care or no MNT, on lipid profile and blood pressure (secondary outcome) in adults with dyslipidemia. The databases MEDLINE, CINAHL, Cochrane CENTRAL, and Cochrane Database of Systematic Reviews were searched for randomized controlled trials (RCTs) published between January 2005 and July 2021. Meta-analyses were performed using a random-effects model for lipid outcomes (seven RCTs, n=838), systolic blood pressure (SBP) (three RCTs, n=308), and diastolic blood pressure (DBP) (two RCTs, n=109). Compared to usual care or no intervention, MNT provided by RDNs improved total cholesterol (total-C) [mean difference (95% CI): -20.84 mg/dL (-40.60, -1.07), P=0.04]; low-density lipoprotein cholesterol (LDL-C) [-11.56 mg/dL (-21.10, -2.03), P=0.02]; triglycerides (TG) [–32.55 mg/dL (-57.78, -7.32), P=0.01];; and SBP [ -8.76 mm Hg (-14.06 lower to -3.45) P<0.01].High-density lipoprotein cholesterol (HDL-C) [1.75 mg/dl (-1.43, 4.92), P=0.28] and DBP [-2.9 mm Hg (-7.89 to 2.09), P=0.25] were unchanged. Certainty of evidence was moderate for total-C, LDL-C, and TG, and low for HDL-C, SBP, and DBP. In conclusion, in adults with dyslipidemia, MNT interventions provided by RDNs are effective for improving serum lipids/lipoproteins and SBP levels.

791-P: Patient Preferences for Medical Nutrition Therapy

Introduction: Medical nutrition therapy (MNT) can have a profound impact on diabetes prevention and treatment. However, most patients with diabetes do not receive MNT interventions. The aim of this survey was to identify current and desired usage of MNT interventions. Methods: Surveys were distributed to adults at San Antonio Military Medical Center and Wilford Hall Medical Center in the fall of 2018. Data included self-reported comorbidities, a validated dietary assessment, current and desired usage of MNT interventions, and current and desired nutrition recommendations from primary care providers. Results: 446 surveys were collected. Self-reported prevalence of diabetes and prediabetes were 23% and 5% respectively. Most respondents (79%) stated they need to eat healthier. Only 41% of respondents ate home-cooked meals at least once daily. Current and desired MNT utilization ranged from 3-15% and 10-26% respectively. The largest gaps between current and desired MNT utilization were nutritional cooking classes (19.3%) and grocery store tours (9.9%). Most respondents (69%) desired an online nutritional cooking class. Most respondents (58%) stated they would cook at home more often if they knew how to cook quick, healthy, inexpensive meals. Frequency of nutrition recommendations by primary care providers ranged from 0.4-6.1%. Results were similar among those with the least and most healthy diets, and when only including patients with diabetes and prediabetes. Conclusion: Most surveyed patients recognize the need to eat healthier. Desired MNT utilization is relatively low, but higher than current MNT utilization. Primary care provider nutrition recommendations are rare. Online nutritional cooking classes may provide a novel and highly desired form of nutrition therapy. Our institution is currently developing an online nutritional cooking class. Disclaimer: The views expressed are those of the authors and do not reflect the official views or policy of the Department of Defense or its Components. Disclosure P.G. Clerc: None. J.L. Wardian: None.

Medical Nutrition Therapy for Patients With Advanced Systemic Sclerosis (MNT PASS): A Pilot Intervention Study.

The objective of this study was to demonstrate the feasibility and associations with short-term outcomes of a medical nutrition therapy (MNT) intervention in patients with systemic scleroderma (SSc). Eighteen patients with SSc, gastrointestinal (GI) involvement, and unintentional weight loss were consented and recruited for a 6-week MNT intervention, in addition to their usual medical management. MNT emphasized increased calorie and protein intake, modified textures, and lifestyle modifications. Symptoms, anthropometrics, diet (24-hour recall), and body composition (dual-energy x-ray absorptiometry) were assessed pre- and postintervention. Sarcopenia was defined as appendicular lean height (ALH) for women <5.45 kg/m2 and for men <7.26 kg/m2. Descriptive, parametric, and nonparametric statistics were conducted. Participants (n = 18) were predominantly white (78%), female (89%), malnourished (83%), and 51.3 ± 11.0 years of age with a body mass index of 22.6 ± 6.7 kg/m2. Significant decreases in nutrition symptom scores (12.8 vs 7.6, P < .05) and improvements in ALH (5.6 ± 0.8 vs 5.8 ± 0.8 kg/m2, respectively; P = .05) occurred pre- vs postintervention, respectively (n = 14). Sarcopenia was observed in 54% of participants at baseline and 39% at follow-up ( P = .02). Caloric intake (1400 vs 1577 kcal/d, P = .12) and macronutrient distribution (ie, % fat, protein, carbohydrate) did not change significantly pre- vs postintervention, respectively. Individually tailored MNT can improve symptom burden and potentially ALH in patients with SSc involving the GI tract. This study underscores the clinical potential of multidisciplinary patient management and the need for larger nutrition intervention trials of longer duration in these patients.

The 2006 American Diabetes Association Nutrition Recommendations and Interventions for the Prevention and Treatment of Diabetes

The 2006 American Diabetes Association (ADA) nutrition recommendations reaffirm the importance of medical nutrition therapy (MNT) in the prevention of diabetes, treatment of existing diabetes, and prevention and treatment of the complications of diabetes in which MNT plays a role. The differences between the 2002 technical review1 and the 2006 position statement2 reflect research published after 2000. The recommendations continue to be graded according to the ADA evidence grading system. MNT, as illustrated in Table 1, plays a vital role across the continuum of diabetes, and interventions change as the disease progresses. Primary prevention first seeks to reduce the prevalence of obesity and thus reduce the risk of developing pre-diabetes and diabetes. For individuals with pre-diabetes, MNT focuses on the prevention or delay of diabetes by moderate weight loss and increased physical activity. However, when overt diabetes develops, MNT interventions focus on normalization of metabolic parameters to prevent or control the complications of diabetes. View this table: Table 1. Nutrition and MNT MNT for people at risk for and with diabetes should be individualized, and clinical trials and outcome studies suggest that such therapy is best provided by a registered dietitian familiar with diabetes. Monitoring of metabolic parameters, including glucose, hemoglobin A1c (A1C), lipids, blood pressure, body weight, and renal function, is essential to assess the need for changes in therapy to ensure successful outcomes. Taking into account an individual's personal needs, willingness, and ability to change remains crucial. Clinical trials and outcome studies of MNT have reported decreases in A1C of ∼ 1% in type 1 diabetes and 1–2% in type 2 diabetes, depending on the duration of diabetes.3 After initiation of MNT, improvements were apparent in 6 weeks to 3 months. Meta-analysis of studies in nondiabetic, free-living subjects and expert committees report that MNT reduces LDL cholesterol by …

Using focus groups to determine what constitutes quality of life in clients receiving medical nutrition therapy: first steps in the development of a nutrition quality-of-life survey.

As the first part of a multiphase process to develop a Nutrition Quality of Life (NQOL) survey, our objective was to identify items that later will be psychometrically evaluated for inclusion into the NQOL survey, a survey that can be used in routine practice to monitor the impact of medical nutrition therapy (MNT). We used a prospective, six-step iterative process involving focus groups, surveys, and consensus processes to build a conceptual framework to describe health-related quality of life in individuals receiving MNT, to identify items for inclusion in an NQOL survey, and to refine these items and the survey format. Subjects/Setting and Methods Items were generated from 65 patients in five geographically diverse locations participating in 10 focus groups and 46 dietitians in the same geographic locations participating in seven focus groups. Patients represented a variety of ages, ethnicities, and clinical and economic conditions. Dietitians were primarily from outpatient locations with both general and speciality practices. Sixty-one percent of the participants provided feedback via mailed surveys. Additional input was received from audience attendees at sessions at two national nutrition meetings. Based on comments generated in client and dietitian focus groups, we identified 50 items in six clusters: 9 items in food impact; 6, self-image; 10, psychological factors; 7, social/interpersonal; 9, physical; and 9, self-efficacy. Whenever possible, we developed items using the clients' own words. Clients, responding to the mailed survey, indicated that they took approximately 10 minutes to complete the NQOL survey. Applications/Conclusions At this time, dietitians may use the 50 questions to probe the impact of MNT on their clients' NQOL. However, psychometric and clinical testing will be necessary to further refine these items before the NQOL survey can be scored and used to measure the NQOL of patients at baseline, to monitor the impact of MNT over time, and to manage future MNT interventions by using an NQOL survey in a quality improvement program.

Writing Nutrition Practice Guidelines for Spinal Cord Injury

A task force has been developed under the direction of Dietetics Practice Group-Dietetics in Physical Medicine and Rehabilitation to develop and publish through the ADA, nutrition practice guidelines for spinal cord injury (SCI). Spinal cord injury affects over 10,000 persons in the United States each year. High costs associated with problems that result when medical nutrition therapy (MNT) is not provided, such as pressure ulcer management, variations in the role of the registered dietitian in spinal cord injury treatment, variations in how the registered dietitian is providing nutrition care for spinal cord injury, and inconsistencies about nutrition risk criteria and realistic outcome criteria necessitates the development of nutrition practice guidelines for spinal cord injury.Following spinal cord injury, immobilization impacts body systems and metabolism. This impact involves nutritional status and MNT intervention. Key components of these guidelines will include evaluation of the assessment indices; feeding mastication and swallowing abilities; physiological, psychological and environmental factors that impact nutrition; and potential pulmonary, gastrointestinal and integumental complications. Practice guidelines for spinal cord injury are needed to identify nutrition risk criteria, provide uniform MNT, and define and support the role of the registered dietitian in provision of MNT.Our goal is to develop the guidelines by the year 2001. Future efforts are warranted on outcome/effectiveness studies.

Using Disease-State Management as the Key to Promoting Employer Sponsorship of Medical Nutrition Therapy

The purpose of this project was to design, implement, and improve a nationwide medical nutrition therapy (MNT) intervention program for nutritionally at-risk employees and their dependents and retirees (hereinafter referred to as clients) with a Fortune 100 company (Texas Instruments, Dallas, Tex) with a dispersed population of 80,000. Preferred Nutrition Therapists (PNT), a network of registered dietitians, with the assistance of the Texas Instruments Health Promotion and Benefits Department, identified International Classification of Diseases, 9th ed (ICD-9), codes for which MNT intervention was appropriate. PNT then negotiated a contract with the Texas Instruments Health Promotion and Benefits Department and implemented clients’ self-referral process. The main challenge was to promote utilization of a new service from an outside vendor (PNT) and to measure outcomes in meaningful ways. The goal was to use MNT as a tool to prevent the progression of clients’ diseases to states that require more costly treatments. PNT used a continuous quality improvement process to refine the system and improve information gathering and reporting, by providing quarterly reports to the Health Promotion and Benefits Department. These reports summarized the outcomes for all clients seen at least 3 times during the quarter. The cost was less than $0.35 per member per month (less than the employer spent on advertising the program), and 0.5% of the population requested MNT during the first year of implementation (about what was expected for a new carveout benefit). J Am Diet Assoc. 1999;99:583–588.

Cost Effectiveness of Medical Nutrition Therapy Provided by Dietitians for Persons With Diabetes Mellitus

LEARNING OUTCOME: The economic impact of Medical Nutrition Therapy resulting from improving the nutritional status of patients with diabetes mellitus. Medical Nutrition Therapy (MNT) proves to be more cost effective by providing alternatives to more costly therapies. With increased emphasis on cost containment it is important for the Registered Dietitian to show MNT intervention is cost effective. Ten patients with diabetes mellitus, aged 17-75 years, who had been physician referred for MNT were randomly selected. Their medical records were reviewed to determine height, weight, blood glucose, current medications and general health. Nutrition intervention designed to improve glycemic control included portion control, constant carbohydrate counting and general principles of nutrition management. Follow-up phone calls were made to patients and/or physicians 4-6 months after MNT intervention to obtain current clinical outcomes. Patients who had been admitted to long term care were excluded from this study because of their inability to effect behavioral changes in a controlled environment. Costs were established through an average of actual current hospital/physicians and pharmacy charges that patients would have incurred. Positive health outcomes included increased nutritional status resulting in weight loss, decreased blood sugars, improved diet, and increased exercise levels. The average annual cost savings per Type II diabetic patient was $4,145, for Type I patient $9,990 and projected annual cost saving for patients with renal insufficiency $60,958. The average cost per patient for MNT was $41. Savings per case were annual net saving (cost of alternative therapy minus cost of dietitian services). Findings suggest substantial monetary savings, and improved quality of life can be achieved by MNT. Dietetic professionals are key members of the health care team and can play an aggressive roll in controlling health care expenses.