The National Cholesterol Education Program: implications for dietetic practitioners from the Adult Treatment Panel...

The National Cholesterol Education Program (NCEP) was initiated to contribute to the prevention of illness and death from coronary heart disease by reducing the prevalence of high blood cholesterol. The report of an expert panel of this program provides guidelines for the treatment of high blood cholesterol in adults 20 years of age and over. Dietary therapy is the primary treatment. The goal of the recommended dietary therapy is to lower the LDL-cholesterol concentration, although measurement of total blood cholesterol can be used to monitor the response to diet. Dietary modification involves a progressive decrease in intake of saturated fatty acids and cholesterol. The Step-One Diet calls for an intake of total fat less than 30% of calories, saturated fatty acids less than 10% of calories, and cholesterol less than 300 mg/day. If the desired decrease in LDL-cholesterol is not achieved with that dietary change, then the Step-Two Diet is begun. It requires a reduction in saturated fatty acids to less than 7% of calories and cholesterol to less than 200 mg/day. This article provides background information on the organization and objectives of the NCEP and focuses on the recommendations of the Adult Treatment Panel (ATP), e.g., classification of risk for developing coronary heart disease based on total and low-density-lipoprotein cholesterol levels and recommendations for treatment of patients with high blood cholesterol. The emphasis of the discussion is on dietary treatment. The implications of the recommendations for the dietetic practitioner are discussed. These include an expanded leadership role to meet the education needs of health professionals and patients.