The resident should develop attitudes that recognize the following:

1. Nutrition is an integral part of:
   1. Health promotion and disease prevention
   2. Medical treatment of disease
2. Dietary intake is influenced by a variety of patient factors, including:
   1. Culture
   2. Socioeconomic (ability to purchase food, living situation)
   3. Psychosocial and mental health (depression, anorexia, dementia, bulimia)
   4. Knowledge
   5. General health and lifestyle (co-morbid conditions, diseases, habits)

The resident should develop knowledge of:

1. General principles of nutrition:
   1. The roles of dietary components: carbohydrates, fats, proteins, vitamins, minerals, water and fiber
   2. Dietary reference intakes
   3. Nutritional content of foods
   4. Dietary recommendations, e.g., dietary guidelines for Americans, food pyramid, DASH diet, Step I and II diets
2. Nutritional assessment
   1. Medical/social history and physical examination
   2. Anthropometrics (height/weight, body mass index [BMI], head circumference, body-fat distribution)
   3. Ordering and evaluating laboratory tests (inpatient and outpatient)
3. Nutritional issues of different stages of the life cycle
   1. Infancy-e.g., breastfeeding, bottle-feeding, adding solids, allergy prevention
   2. Children-e.g., picky eating, pica, snacks
   3. Adolescents-e.g., healthy choices, eating disorders
   4. Adults-e.g., portion size, habits, convenience foods
   5. Pregnancy-e.g., weight gain, folic acid, iron, calcium
   6. Lactation-e.g., nutritional needs, support, counseling
   7. Elderly-e.g., psychosocial issues, co-morbid conditions, swallowing disorders
4. The role of nutrition in the prevention and treatment of specific diseases
   1. Cancer
   2. Cardiovascular disease
   3. Dental disease
   4. Diabetes
   5. Gastrointestinal disorders
   6. Hematologic disorders
   7. Hypertension
   8. Liver disease
   9. Obesity
   10. Osteoporosis
   11. Renal disease
5. Secondary malnutrition caused by systemic diseases
   1. Alcoholism
   2. Cancer
   3. HIV/AIDS
   4. Malabsorption
   5. Pulmonary disease
6. Weight loss strategies and counseling
   1. Behavior modification and goal setting
   2. Diet drugs (prescription, herbal and over-the-counter)
   3. Popular diets and supplements
   4. Surgical approaches
7. Disordered eating
   1. Anorexia nervosa
   2. Binge eating
   3. Bulimia
8. Use of dietary supplements, including:
   1. Vitamin and mineral deficiency, toxicity, and recommended intakes
   2. Guidelines for herbal, alternative and other supplements, including drug interactions, safety and efficacy
   3. Evidence-based nutrition resources and signs of quackery
9. Preventing and recognizing and treating foodborne illness
10. Allergies and food intolerance
11. Physical activity and sports
    1. Recommendations for health and weight loss
    2. Nutritional needs for various levels of activity (i.e., elite athletes) and for different ages
    3. Hydration
12. Enteral and parenteral nutrition
13. Community nutrition resources, e.g., food bank, Meals on Wheels, Women, Infants and Children (WIC) supplemental food program

1. Integrating nutrition assessment and intervention into the medical history, review of systems, physical examination, laboratory evaluation and plan of care.
2. Assessing the nutritional status and writing diet prescriptions for inpatients, e.g., hospitals, nursing homes and other supervised living situations.
3. Ordering and interpreting laboratory and metabolic studies related to nutritional assessment.
4. Ordering and managing oral supplements and tube feeding, and understanding when and how to order and monitor total parental nutrition.
5. Counseling patients and family members about specific nutritional needs related to stages of the life cycle, lifestyle and habits, disease prevention and/or disease.
6. Counseling patients on safe lifestyle approaches to weight management and balancing caloric intake and physical activity.
7. Advising patients about appropriate use of and, when needed, prescribing vitamin, mineral and other dietary and botanic supplements.
8. Collaborating with registered dieticians and certified diabetes educators, and referring patients to community nutrition resources, including Internet sites.
   

1. Physician's curriculum in clinical nutrition- A competency based approach for primary care, Kansas City, MO: Group on Nutrition Education, Society of Teachers of Family Medicine, 1995.
2. Manual of Clinical Dietetics, 5th edition. Chicago, IL: The American Dietetic Association, 1996.
3. Mahan LK and Escott-Stump S. Krause's Food, nutrition and diet therapy, 10th ed. Harcourt, Brace and Co. 1999.
4. Modern Nutrition in Health and Disease, 9th Edition, Williams and Wickins, 1999.
5. Medical Nutrition and Disease, Blackwell Science Inc., 1996.

1. American Dietetic Association: http://www.eatright.org
2. Tufts University Nutrition Navigator, a Rating Guide to Nutrition Websites: http://www.navigator.tufts.edu
3. Arbor Nutrition Guide: http://www.arborcom.com
4. National Center for Complementary and Alternative Medicine: http://nccam.nih.gov
5. Office of Disease Prevention and Health Promotion: http://www.odphp.osophs.dhhs.gov
6. USDA Center for Nutrition Policy and Promotion: http://www.usda.gov/cnpp
7. CNN health-related site: http://www.cnn.com/HEALTH