Nutritional Management of Dyslipidemia in Pakistan: A Systematic Review of International Guidelines and Practices.

Objectives: Dyslipidemia and atherosclerotic cardiovascular events are highly prevalent in Pakistan, which could be attributed to a lack of education, poverty, unhealthy dietary habits, and the absence of local guidelines. Our main goal was to develop a comprehensive comparison of the existing international dyslipidemia guidelines, highlighting the different nutritional recommendations proposed by each. A secondary objective was to establish local food sources beneficial for dyslipidemia coexistent with other morbidities.

Methods: We conducted a systematic review of three databases Pubmed, Scopus, and International Guidelines Library to acquire guidelines for the management of dyslipidemia. The guidelines fulfilling the criteria of the Clinical Practice Guidelines developed by the Institute of Medicine in 2011 were selected for data extraction and their quality was assessed by the Mini-Checklist (MiChe) tool. Using the Harvard Healthy Eating Plate, a modified MyPlate describing portion of each macronutrient was established. Dietary recommendations for dyslipidemia and other comorbidity conditions were developed based on the review of guidelines and data from randomized control trials.

Results: A total of 23 guidelines were selected based on our inclusion criteria. Final guidelines presented dietary patterns beneficial for the management of dyslipidemia, which differed due to the availability and cost-effectiveness of nutritional sources in Pakistan. After developing a modified MyPlate better suited to the dietary intakes of the population of Pakistan, nutritional recommendations for dyslipidemia with other comorbids were developed using local sources suggested by practicing dietitians.

Conclusions: Dietary modification is the cornerstone of managing dyslipidemia. Due to Pakistan's unique dietary patterns and the economic condition, a multidisciplinary approach with physicians and dietitians is required to develop easily applicable dietary regimes for dyslipidemia.