This study was designed to evaluate whether medical nutrition therapy administered by registered dietitians could lead to a beneficial clinical and cost outcome in men with hypercholesterolemia. Ninety-five subjects participating in a cholesterol-lowering drug study took part in an 8-week nutrition intervention program before initiating treatment with a cholesterol-lowering medication. Patient records were reviewed via a retrospective chart review to determine plasma lipid levels at the beginning and end of the program and the number and length of sessions with a dietitian. Complete information was available for 74 subjects aged 60.8+/-9.8 years (mean+/-SD). Medical nutrition therapy lowered total serum cholesterol levels 13% (P<.0001), low-density lipoprotein cholesterol (LDL-C) 15% (P<.0001), triglyceride 11% (P<.05), and high-density lipoprotein-cholesterol (HDL-C) 4% (P<.05). Total dietitian intervention time was 144+/-21minutes (range=120 to 180minutes) in 2.8+/-0.7 sessions (range=2 to 4) during 6.8+/-0.7 weeks of medical nutrition therapy (range=6 to 8 weeks). Analysis of covariance was conducted to examine whether mean change in LDL-C differed by number of dietitian visits. Results showed a marginal difference between the number of dietitian visits and change in LDL-C (f=2.6, P<.084). However, the magnitude of LDL-C reduction was significantly higher with 4 dietitian visits (180minutes) than with 2 visits (120minutes) (21.9% vs 12.1%; P=.027). Lipid drug eligibility was obviated in 34 of 67 (51%) subjects per the National Cholesterol Treatment Program guidelines algorithm. The estimated annualized cost savings from the avoidance of lipid medications was $60,561.68. Therefore, we conclude that 3 or 4 individualized dietitian visits of 50minutes each over 7 weeks are associated with a significant serum cholesterol reduction and a savings of health care dollars. J Am Diet Assoc. 1998;98:889-894.