By: Coralis Alsina, RD, LND, CWCM, DEPR
Medical Nutrition Center President and Nutritionist / MCS Collaborator

The nutritionist-dietitian plays a critical role in the care of patients with chronic conditions such as prediabetes, diabetes, chronic kidney disease, hyperlipidemias, morbid and bariatric obesity, metabolic syndrome, chronic pain and morbidity. The ancient civilizations of Greece, India and China had already discerned the intimate relationship between what we eat and how we feel – a wisdom that Hippocrates encapsulated in his famous statement, urging us to consider food as medicine. As the centuries passed, the Middle Ages continued with the belief that a balanced diet was key to maintaining body equilibrium and health.

The nineteenth century marked a turning point when vitamins and minerals emerged in the fight against ancient diseases. Today, the dietitian-nutritionist has become an essential pillar of the holistic approach, working hand-in-hand with other healthcare professionals to prevent diseases, slow their progress, and treat them.

Multidisciplinary Collaboration

The information and history collected in the nutritional assessment immediately aids in the identification of a patient’s nutritional status. This includes the analysis of current intakes, the identification of nutritional deficiencies or excesses, and the patient’s current nutrition as related to his or her health status. This information is vital for prescribing a nutritional care plan, which is also reported to the multidisciplinary team.

To manage hyperlipidemias, the nutritionist may recommend eating patterns such as the Mediterranean, DASH or MIND diet, or promote specific foods and emphasize the elimination of those high in saturated fat and sodium. The nutritionist-dietitian also creates a therapeutic relationship for patients who need to manage their weight, while aligning expectations and accompanying them on their way to mastering the principles of a process that requires active participation. When the only treatment option is a strict diet that requires eliminating foods in patients with inflammatory digestive tract conditions (IBD), their role expands to comprehend the identification and/or prevention of nutritional deficiencies, among others. A nutritionist specializing in renal nutrition will help patients manage related labs, such as calcium, phosphorus, and potassium. In addition, patients and their caregivers are educated on how to modify recipes and read nutrition labels.

Results of Medical Nutritional Therapy

Information on the effectiveness of medical nutritional therapy provided by nutritionist-dietitians is offered by the Academy of Nutrition and Dietetics. Their latest report highlighted health indicators that showed significant improvements after the nutritionist’s intervention, based on observational and clinical studies spanning three-month periods, six months, and even more than a year.

Hiperlipidemias

• Average total cholesterol reductions up to 52 mg/dL
• LDL cholesterol reductions up to 32 mg/dl
• Increased HDL cholesterol up to 5 mg/dl
• Triglyceride reductions up to 100 mg/dL

Obesity

• • Decrease in weight as much as 38 lbs.
• • BMI reductions of 9.5 kg/m2
• • Waist circumference reductions as much as 14 inches
• • Body fat reductions from 3.2% to 5.7%

Hipertension

• • Systolic blood pressure reduction up to 8.76 mm Hg

Celiac Disease

• • Increased adherence to a gluten-free diet
• • Reductions in gastrointestinal distress
• • Improvements in intestinal villous atrophy

Chronic Kidney Disease

• • Slower decrease in glomerular filtration rates (GFRs)
• • 3.15 times less likely to require dialysis
• • Albumin levels more within the normal range

Integrating medical nutritional therapy empowers providers and helps them address their patients’ needs while improving health outcomes. By prioritizing nutrition as a key component for treating chronic conditions, we’re fostering quality and effective health care.

References

1. “The Role of Dietitians in Chronic Kidney Disease and How to Find One  – Kidney Community Kitchen.” Kidney Community Kitchen – Information and Tools to Help You Manage Your Renal Diet. Accessed 4 Mar. 2024.
2. Academy of Nutrition and Dietetics Evidence Analysis Library. "In adults with type 1 and type 2 diabetes, how effective is MNT provided by an RD/RDN on glycemia (A1C or glucose)?" Accessed 2 May 2016.
3. de Waal, D., Heaslip, E., & Callas, P. (2016). Medical Nutrition Therapy for Chronic Kidney Disease Improves Biomarkers and Slows Time to Dialysis. Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation, 26(1), 1–9.
4. Gładyś, K., Dardzińska, J., Guzek, M., Adrych, K., Kochan, Z., & Małgorzewicz, S. (2021). Expanded Role of a Dietitian in Monitoring a Gluten-Free Diet in Patients with Celiac Disease: Implications for Clinical Practice. Nutrients, 13(6), 1859.
5. Sadílková, A., Čmerdová, K., & Hásková, A. (2020). Role of dietitian in obese patients care. Úloha nutričního terapeuta v péči o obézní. Casopis lekaru ceskych, 159(3-4), 131–135.
6. Sikand, G., Handu, D., Rozga, M., de Waal, D., & Wong, N. D. (2023). Medical Nutrition Therapy Provided by Dietitians is Effective and Saves Healthcare Costs in the Management of Adults with Dyslipidemia. Current atherosclerosis reports, 25(6), 331–342.
7. Hwalla, N., & Koleilat, M. (2004). Dietetic practice: the past, present and future. Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit, 10(6), 716–730.