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Medical nutrition therapy
(MNT) can improve patients' health and quality of life, effectively
treat and manage disease, reduce complications and decrease the need
for prescription drugs. It can help patients manage conditions such
as cardiovascular disease, hypertension, diabetes, kidney disease,
obesity and related complications, cancer, and HIV/AIDS.
Patients who undergo medical nutrition therapy receive an assessment
by a registered dietitian followed by appropriate therapy, such as:
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Medical and diet history |
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Blood chemistry values |
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Anthropometric measurements to determine
nutritional status and treatment methods of high risk patients for
malnutrition |
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Diet modification (diet therapy) |
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Counseling and education |
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Food and drug interactions |
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Disease self-management skills training |
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Administration of special therapies
such as medical foods, supplementations, enteral feedings, and intravenous
nutrition |
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Findings from the Diabetes
Prevention Program showed that diet and exercise can effectively delay
diabetes in a diverse American population of overweight persons with
impaired glucose intolerance by 58%. Over 3,200 participants ranging
in age from 25 to 85 participated study. In the lifestyle intervention
provided by RDs, participants received training in diet, exercise,
and behavior modification skills. On average, this group maintained
their physical activity at 30 minutes per day, usually with walking
or other moderate intensity exercise, and lost 5-7 percent of their
body weight. Participants randomized to treatment with the drug metformin
reduced their risk of getting type 2 diabetes by only 31 percent.
Evidence-based research strongly supports that MNT provided by RDs
is clinically effective in the management of diabetes with documented
reductions in HbA1c of 1-2%. (http://www.preventdiabetes.com. Aug
8, 2001, Diabetes Care, 2002).
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A 50-70% reduction in
recurrent cardiovascular disease events (cardiac death, non-fatal
heart attacks, angina, stroke) may be achieved in people on diet treatment
alone. The Mediterranean style diet is low in saturated fat and cholesterol
and high in omega-3 fatty acids and emphasized fruits, vegetables,
bread and cereals, and fish. Based on current evidence, the results
of the Lyon Diet Heart Study have shown that a Mediterranean-style
diet intervention can reduce cardiovascular disease risk twice as
much as combined drug and diet therapy. (Circulation 1999;99:779-785;
ATP III Report, NIH/NHLBI 2002).
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The Dietary Approaches
to Stop Hypertension (DASH) study concluded that the diet focused
on decreased sodium, increased fruits, vegetables, and fat-free dairy
products is likely to show up to 12 percent reduction in risk of CHD.
Study was hailed as offering the most significant evidence to date
of the role of diet in health promotion, disease prevention, and disease
treatment. Studies also showed that combining various components of
diet therapy would enhance results, such as plant sterols with low
fat diets, or oat products combined with low fat diets. Additional
benefits were seen with sodium restriction. To effectively integrate
these multiple changes requires the unique skills of a registered
dietitian. (American Journal of Clinical Nutrition, 2001, Athlerosclerosis,
2001, European Journal of Nutrition, 2001,Obesity Research, 2001)
A Cochrane review confirms that Registered Dietitian (RD) counseling
is more effective than physician counseling in the short to medium
term for lowering cholesterol. Delahanty, et al reported that clients
who received MNT from dietitians showed better outcomes than usual
care from a physician and reported a cost-effectiveness ratio of $36
per 1% decrease in cholesterol. Although current Medicare guides indicate
that nutrition counseling should be provide prior to initiating medication,
Congress omitted coverage of cardiovascular conditions from the coverage
of Medical Nutrition Therapy. (Cochrane Database Syst Rev, 2001, Journal
of the American Dietetic Association, 2001).
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Registered Dietitians
who provide MNT for patients with high cholesterol levels can achieve
a positive impact on satisfaction and quality of life (QOL) outcomes
when compared to patients receiving usual care from their physicians.
According to Delahanty et al, the MNT group reported significant and
lasting improvements in perceived QOL related to self-care. They were
more satisfied with their ability to manage their cholesterol, eating
habits, and life in general. (Annals of Behavioral Medicine, 2002).
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Per Case Savings For Diseases/Conditions
in which Medical Nutrition Therapy
is Appropriate
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Disease |
Savings
Per Case
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Reason for Savings
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AIDS |
$10,719 |
Maintenance of weight reduces susceptibility
to infection and hospitalization
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Cancer |
$13,830 |
Specialized nutrition therapy enhances
effectiveness of chemotherapy and radiation therapy
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Heart Disease |
$10,993 |
Reduces need for drugs and other artery
clearing procedures and/or surgery
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Type I Diabetes |
$8,375 |
Reduces diabetic complication that result
in hospitalization
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Type II Diabetes |
$2,178 |
Reduces or eliminates the need for insulin
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Pediatric Failure
to Thrive |
$13,758 |
Reduces hospitalization and prevents permanent
damage such as mental and physical retardation
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Kidney Disease |
$19,039 |
Postpones need for dialysis
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Tube/IV Feeding |
$6,556 |
Moves patient to lower cost feeding alternatives
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High Cholesterol |
$2,496 |
Reduces need for drugs
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Hypertension |
$4,608 |
Reduces drug use and can prevent complications
such
as stroke
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SOURCE:
The American Dietetic Association, July 1994. Data is derived
from 1,601 cases, classified by primary diagnosis. For more
detailed information and methodology, please contact the ADA,
Division of Government Affairs at (202) 371-0500 |
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