Lifestyle Modification & Nutrition Counseling Flashcards

Which type of dietary fiber has the greatest evidence for LDL cholesterol reduction?

Answer: Soluble viscous fiber found in oats and psyllium

Soluble viscous fibers (beta-glucan from oats, psyllium) bind bile acids in the gut, increasing fecal excretion and reducing hepatic LDL-C, with a well-established evidence base.

A patient following a very-low-carbohydrate ketogenic diet shows elevated LDL-C on labs. What is the most likely explanation?

Answer: High saturated fat intake common in ketogenic diets upregulates LDL receptor degradation

High saturated fat consumption typical of ketogenic diets increases hepatic PCSK9 activity and reduces LDL receptor expression, leading to elevated plasma LDL-C.

Which strategy best helps a patient adhere to long-term dietary changes for lipid management?

Answer: Use motivational interviewing to align dietary changes with the patient's own values and goals

Motivational interviewing is an evidence-based counseling approach that improves long-term dietary adherence by exploring patient ambivalence and building intrinsic motivation.

Plant sterols and stanols lower LDL cholesterol primarily through which mechanism?

Answer: Competing with dietary and biliary cholesterol for intestinal absorption

Plant sterols and stanols are structural analogs of cholesterol that displace cholesterol from intestinal micelles, reducing its absorption by 30-50%.

A 45-year-old sedentary patient with mixed dyslipidemia asks which type of exercise most effectively lowers triglycerides. What is most accurate?

Answer: Aerobic exercise of sufficient duration and intensity is most effective for lowering triglycerides

Sustained aerobic exercise increases lipoprotein lipase activity and reduces hepatic VLDL secretion, making it the most effective exercise modality for triglyceride reduction.

Which omega-3 fatty acid has the strongest evidence for reducing cardiovascular events at prescription doses?

Answer: Eicosapentaenoic acid (EPA) as icosapentaenoic acid ethyl ester

High-dose icosapentaenoic acid (EPA ethyl ester, 4g/day) demonstrated significant CV event reduction in the REDUCE-IT trial, distinct from ALA or DHA alone.

A patient with familial hypercholesterolemia asks if lifestyle changes alone can normalize their LDL-C. What is the most appropriate response?

Answer: Lifestyle changes are important adjuncts but rarely normalize LDL-C in FH; pharmacotherapy is almost always required

In FH, the defective LDL receptor limits the efficacy of lifestyle interventions; while helpful, lifestyle alone typically cannot achieve adequate LDL-C reduction without pharmacotherapy.