Are your patients with risk of CVD getting the viscous soluble fiber they need?

High-intensity interventions yield the largest effect. These involve multiple sessions lasting 30 minutes or longer⁷ and use office-level supports and algorithms to estimate the baseline risk of CVD, individual calorie and nutrients intake, and energy expenditure.⁴⁵

The Adult Treatment Panel III outlines a model for initiating and monitoring dietary therapy for adults with risk of CVD (FIGURE 2). You may start by assessing the risk of CVD with Framingham scores and current dietary patterns, then counsel patients directly or engage dietitians to help patients institute therapeutic lifestyle changes. After 6 weeks of the therapeutic diet, repeat the lipoprotein examination to determine recommendations to continue or intensify the lifestyle changes. After another 6 weeks, you may consider adding drug therapy and further reinforcing dietary recommendations.

Regardless of the approach you use to assess a patient’s diet, a comprehensive individualized nutritional prescription will effectively increase daily intake of dietary fiber, with success similar to that achieved in a major randomized clinical trial.⁴⁶

FIGURE 2
ATP III guidance on initiating dietary changes: Determine your patient’s 10-year risk for CVD

Acknowledgments

The authors thank Heather Haley, MS for editing the manuscript, and Elizabeth Greene, for her help in its preparation. Dr. Shamliyan thanks Professor E. B. Arushanian, MD, PhD, Department of Pharmacology, Stavropol Medical Academy, Russia for motivating her enthusiasm for scientific research.

CORRESPONDENCE
Joseph M. Keenan, MD, Department of Family Medicine and Community Health, University of Minnesota Medical School, MMC 381, 420 Delaware Street SE, Minneapolis, MN 55455. E-mail: keena001@umn.edu