Download Flowchart for Disorders of Lipid Metabolism

©2006 American Dietetic Association
Disorders of lipid Metabolism Toolkit
Flowchart for Disorders of Lipid Metabolism
Referral/Consult Information (< 30 days prior to encounter 1)
RD to obtain pertinent clinical data from referral source or client medical record/information system:
 Laboratory values (eg, fasting lipid profile,
 Presenting signs and symptoms
glucose, homocysteine, TSH, others as needed)
 Other clinical data (eg blood pressure level)
 Physician treatment goals or medical plans
 Medications (dose, frequency), dietary
supplements
 Past medical history (history of heart disease or
 Physical activity clearance or limitations
stroke, comorbidities, risk factors)

Encounter 1: 45-90 minutes
RD to obtain clinical data from client medical record/information system and client interview:
Assessment
Evaluate height, weight, weight change, BMI, waist circumference, biochemical data, and physical findings (eg,
blood pressure). Document client’s food and nutrition history by obtaining comprehensive diet history
including current dietary intake (calories, total fat, and sources of fat, cholesterol, fiber, folate, B-vitamins, and
alcohol), physical activity pattern, nutrition and health awareness, food availability, and psychosocial/economic
issues impacting nutrition therapy. Assess prescribed medications and use of over the counter supplements that
affect nutrition therapy or with potential for food/drug interaction. Assess client’s knowledge base, motivation
level, and readiness to change. Consider cardiovascular risk factors and co-morbid conditions when
determining need for additional modifications in nutrition care plan. .
Nutrition Diagnosis
List and prioritize the nutrition diagnosis(es) that includes the problem (P), etiology (E), and signs and
symptoms (S). For example, patient has an excessive fat intake related to food and nutrition knowledge deficit
as evidenced by high-fat food intake, elevated BMI, and hypercholesterolemia.
Nutrition Intervention
Individualize nutrition prescription (e.g., % fat intake, % type of fat, cholesterol, intake of fiber, and folate) and
behavioral goals that are focused on the etiology of the problem. Include a statement of specific expected
outcomes, amount of change (if applicable) and timeline for each. For example, in 6 weeks, client decreases
blood lipid levels (LDL-C goals determined by number of risk factors–ATP III) and increases physical activity
to 30 minutes 3 days per week. List materials provided and referrals or resources used. Provide
recommendations to other health care team members such as reinforce nutrition and physical activity goals,
recheck lab data, re-evaluate dosage and necessity of lipid lowering medications.
Nutrition Monitoring and Evaluation
Specify next appointment and goal. Establish timeline for follow-up visit to monitor and evaluate response to
nutrition intervention. Include future plans for care such as incorporation of plant stanols/sterols if LDL-C goal
not achieved after 4 to 6 weeks. Provide documentation to physician and other relevant health care team
members according to organization’s policy.

4 to 6 weeks between encounters
©2006 American Dietetic Association
Disorders of lipid Metabolism Toolkit
Encounter 2-6: 30-60 minutes
RD to obtain clinical data from client medical record/information system and client interview:
Assessment
Reassess weight, BMI, waist circumference, biochemical data, and other clinical data (e.g., blood pressure), and
medication changes. Obtain brief diet history and client’s adherence/comprehension to meal plan (e.g., intake
of calories, amount and food sources of fat, cholesterol, fiber), physical activity pattern (refer to food/activity
records). Compare to expected outcomes and goals. Determine adherence/barriers to learning or implementing
behavioral changes and progress/barriers towards biochemical, anthropometric, physical exam findings and
food and nutrition goals. Identify any positive or negative outcomes.
Nutrition Diagnosis
Based on outcome data from initial encounter list and prioritize new or existing nutrition diagnosis(es) that
includes the problem (P), etiology (E), and signs and symptoms (S).
Nutrition Intervention
Reinforce or modify nutrition prescription and behavioral goals that are focused on the etiology of the
problem(s). Include a statement of specific expected outcomes, amount of change (if applicable) and timeline
for each. For example, in 6 weeks client further decreases LDL-C to reach target goal by adding 2-3 grams of
plant stanol/sterol esters daily. List materials provided and referrals or resources used (e.g., Tips: Label
Reading, Shopping Tips, Cooking Tips). Request follow-up laboratory tests if needed.
Nutrition Monitoring and Evaluation
Specify next appointment and new or existing goals. Establish timeline for follow-up visit to monitor and
evaluate response to nutrition intervention. Include future plans for care. Provide documentation to physician
and other relevant health care team members according to organization’s policy.
*See Summary Page for Disorders of Lipid Metabolism with Metabolic Syndrome