CMSN(C)® cheat sheet

Atwater factors: carbohydrate 4 kcal/g, protein 4 kcal/g, fat 9 kcal/g, alcohol 7 kcal/g, and fiber 2 kcal/g (or 1.5–2.5 kcal/g depending on source).

Nitrogen balance = nitrogen intake − (urinary nitrogen + fecal nitrogen + miscellaneous losses); a positive balance indicates anabolism, negative indicates catabolism.

Protein quality is assessed by PDCAAS (protein digestibility-corrected amino acid score) or DIAAS (digestible indispensable amino acid score); scores ≥1.0 indicate a complete protein.

Essential fatty acids: linoleic acid (omega-6) and alpha-linolenic acid (omega-3); deficiencies manifest as dermatitis, poor wound healing, and growth retardation.

Glycemic index (GI) ranks carbohydrate foods by postprandial glucose response; glycemic load (GL) = GI × grams of carbohydrate ÷ 100.

Basal energy expenditure (BEE) is estimated using the Mifflin-St Jeor equation: men BEE = 10W + 6.25H − 5A + 5; women BEE = 10W + 6.25H − 5A − 161 (W in kg, H in cm, A in years).

Thermic effect of food (TEF) accounts for ~10% of total energy expenditure; physical activity and BEE make up the remainder.

Water-soluble vitamins (B-complex, C) are not stored appreciably and excess is excreted; fat-soluble vitamins (A, D, E, K) are stored in liver and adipose tissue and can reach toxic levels.

Dietary Reference Intakes (DRIs) include EAR (Estimated Average Requirement), RDA (Recommended Dietary Allowance), AI (Adequate Intake), UL (Tolerable Upper Intake Level), and AMDR (Acceptable Macronutrient Distribution Range).

The Nutrition Care Process (NCP) has four steps: Nutrition Assessment, Nutrition Diagnosis, Nutrition Intervention, and Nutrition Monitoring and Evaluation.

Nutrition assessment domains (ABCD): Anthropometric, Biochemical, Clinical, Dietary, and Environmental/Behavioral data.

Nutrition diagnosis is written as a PES statement: Problem (diagnostic label), Etiology (cause), and Signs/Symptoms (evidence).

The five diagnostic categories are Intake, Clinical, Behavioral-Environmental, and others; the standardized language is maintained by the Academy of Nutrition and Dietetics (eNCPT).

Anthropometric measurements include weight, height, BMI (kg/m²), waist circumference, mid-upper arm circumference (MUAC), and skinfold thickness.

Biochemical markers: albumin (half-life ~20 days) and prealbumin (half-life ~2 days) reflect inflammation rather than nutritional status alone; CRP is an acute-phase reactant.

Dietary assessment methods include 24-hour recall, food frequency questionnaire (FFQ), food records (3–7 days), and direct observation; each has strengths and limitations in validity and burden.

Nutrition screening tools (e.g., MUST, NRS-2002, MNA) identify individuals at risk and trigger a full assessment; they are not diagnostic.

BMI classification: underweight <18.5, normal 18.5–24.9, overweight 25–29.9, obesity ≥30 kg/m².

Nutrition intervention includes food and/or nutrient delivery, nutrition education, nutrition counseling, and coordination of care.

The intervention must address the etiology of the PES statement to resolve the nutrition diagnosis.

Monitoring and evaluation indicators are selected based on the nutrition diagnosis and intervention; they must be measurable and time-specific.

SMART goals: Specific, Measurable, Achievable, Relevant, and Time-bound.

Energy and protein requirements should be reassessed periodically; indirect calorimetry is the gold standard for measuring resting energy expenditure (REE).

Documentation follows the ADIME format: Assessment, Diagnosis, Intervention, Monitoring and Evaluation.

Outcome indicators include weight change, laboratory values, dietary intake, functional status, and quality of life.

Intervention strategies for malnutrition include food fortification, oral nutritional supplements (ONS), and, when indicated, enteral or parenteral nutrition.

Enteral nutrition (EN) is preferred over parenteral nutrition (PN) when the gastrointestinal tract is functional; it maintains gut mucosal integrity and is associated with fewer infectious complications.

Contraindications to EN include mechanical bowel obstruction, severe ileus, high-output fistula, and hemodynamic instability.

Gastric residual volume (GRV) monitoring: a GRV >250–500 mL may prompt holding feeds; thresholds vary by institution.

PN is indicated when the gut cannot be used or EN is insufficient (e.g., short bowel syndrome, severe malabsorption, prolonged ileus).

Refeeding syndrome risk is highest in patients with low BMI, significant weight loss, or low baseline electrolytes; monitor and replete phosphate, potassium, and magnesium.

Catheter-related bloodstream infection (CRBSI) is a major PN complication; strict aseptic technique and catheter care reduce risk.

EN formulas are categorized as polymeric, oligomeric (elemental), or modular; disease-specific formulas exist for renal, hepatic, and pulmonary conditions.

Transition from PN to EN should be gradual and guided by tolerance and intake; monitor for hypoglycemia during weaning.

Diabetes: medical nutrition therapy (MNT) emphasizes individualized carbohydrate intake, consistency in meal timing, and weight management; the American Diabetes Association does not endorse a single ideal macronutrient distribution.

Chronic kidney disease (CKD): protein restriction (0.6–0.8 g/kg/day) for non-dialyzed patients; dialysis patients require higher protein (1.0–1.2 g/kg/day). Monitor potassium, phosphorus, and sodium.

Cardiovascular disease: the TLC (Therapeutic Lifestyle Changes) diet limits saturated fat <7% of calories and cholesterol <200 mg/day; the Mediterranean and DASH patterns are also recommended.

Hypertension: the DASH diet emphasizes fruits, vegetables, low-fat dairy, and reduced sodium (<2300 mg/day, ideally <1500 mg/day).

Liver disease: in cirrhosis, protein should not be restricted; 1.2–1.5 g/kg/day is recommended to prevent sarcopenia; small frequent meals and a late-evening snack may help.

Chronic obstructive pulmonary disease (COPD): a high-calorie, high-protein diet with a lower carbohydrate proportion may reduce CO2 production in ventilator-dependent patients.

Obesity: a 500–1000 kcal/day deficit is commonly used for weight loss; comprehensive lifestyle intervention includes diet, physical activity, and behavior therapy.

Cancer: energy and protein requirements are elevated; cachexia management includes ONS, appetite stimulants, and treatment of underlying inflammation.

The Transtheoretical Model (Stages of Change) includes precontemplation, contemplation, preparation, action, maintenance, and termination.

Motivational interviewing (MI) is a client-centered, directive method for enhancing intrinsic motivation by exploring and resolving ambivalence.

MI core skills: open-ended questions, affirmations, reflective listening, and summaries (OARS).

The Health Belief Model posits that behavior change depends on perceived susceptibility, severity, benefits, barriers, and cues to action.

Social Cognitive Theory emphasizes self-efficacy, observational learning, and reciprocal determinism.

SMART goal setting and self-monitoring are effective behavioral strategies.

Counseling should be culturally sensitive and tailored to health literacy level.

The nutrition educator should use teach-back to confirm client understanding.

Foodservice systems include conventional (cook-serve), commissary (cook-chill/freeze), ready-prepared, and assembly-serve.

HACCP (Hazard Analysis Critical Control Point) has seven principles: hazard analysis, determine CCPs, establish critical limits, monitor CCPs, establish corrective actions, verify, and record-keeping.

The flow of food includes purchasing, receiving, storage, preparation, cooking, holding, service, and cooling.

Temperature danger zone is 41°F–135°F (5°C–57°C); food should not remain in this zone for more than 2 hours (4 hours cumulative).

Management functions: planning, organizing, staffing, directing, and controlling (POSDC).

Budgeting types include operating budget, capital budget, and cash budget; variance analysis compares actual to budgeted performance.

Productivity measures include meals per labor hour (MPLH) and labor minutes per meal.

Inventory management methods: FIFO (first-in, first-out), par stock, and perpetual inventory.

The Academy of Nutrition and Dietetics (AND) Code of Ethics includes principles such as competence, integrity, confidentiality, and social responsibility.

Scope of practice defines the boundaries of professional practice based on education, training, and licensure.

Licensure, certification, and registration are distinct: licensure is a legal credential; certification is a voluntary credential; registration is a professional credential (e.g., RD).

HIPAA (Health Insurance Portability and Accountability Act) protects patient health information; nutrition professionals must maintain confidentiality.

Informed consent requires disclosure, comprehension, voluntariness, and competence.

Cultural competence and humility are essential for ethical practice with diverse populations.

Evidence-based practice integrates best available research, clinical expertise, and patient values.

Continuing education and professional development are required to maintain competence and credentials.