Statement 3

From the Clinical Practice Guidelines for the Management of Dyslipidemia by the Philippine Heart Association
This guideline starts below.

Statement 3

In poorly nourished and elderly patients, correction of nutritional deficiencies can be achieved even with low-fat, low-cholesterol diet.

Summary of Evidence

In recent meta-analysis that included 27 studies, comprising a total of 40 intervention arms and 30,901 person-years of data, was the basis of assessing the benefit of dietary fat restriction or modification--which may reduce serum lipid levels--in reducing clinical outcomes such as CV events and mortality.

Dietary interventions in the studies included in this meta-analysis were generally characterized by a recommended total fat intake ranging from 30% to 40% of total caloric intake or a reduction in fat intake to about 35 g/day to 40 g/day. Dietary cholesterol intake recommendations ranged from more than 300 mg/day, to approximately 450 mg/day, to 100 mg for every 1000 kilocalories consumed daily.

Validation and appraisal showed that this meta-analysis had high methodological quality. However, Filipinos and females were not represented in the primary studies, which raised the issue of applicability. Long-term follow-up data was also sparse. These issues decreased overall evidence quality, from high to low (with regard to mortality outcomes) and moderate (CV events).

Nonetheless, the study clearly showed that dietary interventions have a protective effect against CV events, with NNT of as low as 8 among those who maintain dietary intervention for more than two years. No cost-effectiveness study on low- or modified-fat dietary interventions has been made locally, but dietary interventions in the form of advice is generally very cost-effective and should be recommended. As patients vary with regard to nutritional status and lipid levels, there remains the need for clinicians to provide patient-specific and appropriate dietary advice.