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National Cholesterol Education Program

Adult Treatment Panel III (ATP III) Guidelines Slide Set

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SLIDE 1: ATP III Guidelines
Therapeutic Lifestyle Changes (TLC)

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SLIDE 2: Therapeutic Lifestyle Changes in LDL-Lowering Therapy
Major Features

• TLC Diet
  • Reduced intake of cholesterol-raising nutrients (same as previous Step II Diet)
    • Saturated fats <7% of total calories
    • Dietary cholesterol <200 mg per day
  • LDL-lowering therapeutic options
    • Plant stanols/sterols (2 g per day)
    • Viscous (soluble) fiber (10-25 g per day)
• Weight reduction
• Increased physical activity

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SLIDE 3: Therapeutic Lifestyle Changes Nutrient Composition of TLC Diet

Nutrient	Recommended Intake
Saturated fat	Less than 7% of total calories
Polyunsaturated fat	Up to 10% of total calories
Monounsaturated fat	Up to 20% of total calories
Total fat	25-35% of total calories
Carbohydrate	50-60% of total calories
Fiber	20-30 grams per day
Protein	Approximately 15% of total calories
Cholesterol	Less than 200 mg/day
Total calories (energy)	Balance energy intake and expenditure to maintain desirable body weight/ prevent weight gain

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SLIDE 4: A Model of Steps in Therapeutic Lifestyle Changes (TLC)
Visit 1: Begin Lifestyle Therapies

• Emphasize reduction in saturated fat & cholesterol
• Encourage moderate physical activity
• Consider referral to a dietitian

Visit 2: Evaluate LDL response If LDL goal not achieved, intensify LDL-Lowering Tx

• Reinforce reduction in saturated fat and cholesterol
• Consider adding plant stanols/sterols
• Increase fiber intake Consider referral to a dietitian

Visit 3: Evaluate LDL response If LDL goal not achieved, consider adding drug Tx

• Initiate Tx for Metabolic Syndrome
• Intensify weight management & physical activity
• Consider referral to a dietitian

Visit N: Monitor Adherence to TLC

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SLIDE 5: Steps in Therapeutic Lifestyle Changes (TLC)
First Visit

• Begin Therapeutic Lifestyle Changes
• Emphasize reduction in saturated fats and cholesterol
• Initiate moderate physical activity
• Consider referral to a dietitian (medical nutrition therapy)
• Return visit in about 6 weeks

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SLIDE 6: Steps in Therapeutic Lifestyle Changes (TLC) (continued)
Second Visit

• Evaluate LDL response
• Intensify LDL-lowering therapy (if goal not achieved)
  • Reinforce reduction in saturated fat and cholesterol
  • Consider plant stanols/sterols
  • Increase viscous (soluble) fiber
  • Consider referral for medical nutrition therapy
• Return visit in about 6 weeks

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SLIDE 7: Steps in Therapeutic Lifestyle Changes (TLC) (continued)
Third Visit

• Evaluate LDL response
• Continue lifestyle therapy (if LDL goal is achieved)
• Consider LDL-lowering drug (if LDL goal not achieved)
• Initiate management of metabolic syndrome (if necessary)
  • Intensify weight management and physical activity
• Consider referral to a dietitian

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