Clinical Dietitian cheat sheet

Atwater factors: carbohydrate 4 kcal/g, protein 4 kcal/g, fat 9 kcal/g, alcohol 7 kcal/g, and dietary fiber ~2 kcal/g (2 kcal/g per FDA for insoluble fiber).

Total energy expenditure = resting energy expenditure (60-70%) + thermic effect of food (~10%) + physical activity (~20-30%); REE by Mifflin-St Jeor: men 10W + 6.25H - 5A + 5; women 10W + 6.25H - 5A - 161 (W kg, H cm, A years).

Amino acid classification: 9 indispensable (histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, valine); conditionally indispensable include glutamine, arginine, cysteine, tyrosine, proline, glycine.

Protein digestibility-corrected amino acid score (PDCAAS) caps at 1.0; digestible indispensable amino acid score (DIAAS) is not capped and uses ileal digestibility.

Fatty acids: saturated (no double bonds), monounsaturated (one), polyunsaturated (two or more); omega-3 alpha-linolenic acid is essential, omega-6 linoleic acid is essential; trans fats raise LDL and lower HDL.

Glycemic index compares 50 g available carbohydrate of a food to a reference (glucose or white bread); glycemic load = GI x grams available carbohydrate / 100.

Bioavailability modifiers: vitamin C and meat enhance nonheme iron absorption; phytates, oxalates, polyphenols, and calcium inhibit it; fat-soluble vitamins A, D, E, K require dietary fat for absorption.

Thermic effect of food by macronutrient: protein ~20-30%, carbohydrate ~5-10%, fat ~0-3%; protein has the highest postprandial thermogenesis.

NCP four steps in fixed order: Nutrition Assessment, Nutrition Diagnosis, Nutrition Intervention, Nutrition Monitoring and Evaluation; documentation uses ADIME (Assessment, Diagnosis, Intervention, Monitoring/Evaluation).

PES statement structure: Problem (diagnostic label from IDNT) + Etiology ("related to") + Signs/Symptoms ("as evidenced by"); etiology must be a modifiable root cause, not a sign/symptom.

ABCD anthropometrics: weight, height, BMI (kg/m^2), waist circumference (risk: men >102 cm, women >88 cm), mid-upper arm circumference, and percent weight change = (usual - current)/usual x 100.

Significant unintentional weight loss thresholds: >5% in 1 month, >7.5% in 3 months, >10% in 6 months.

Biochemical reference: albumin half-life ~20 days, prealbumin (transthyretin) ~2 days; both are negative acute-phase reactants, so they reflect inflammation, not nutritional status alone.

Nutrition-focused physical exam signs: temporal wasting and thenar wasting (muscle), poor skin turgor and sunken eyes (hydration), koilonychia (iron), Bitot spots (vitamin A), glossitis (B vitamins).

Estimated energy needs: 25-30 kcal/kg and 1.0-1.2 g protein/kg for stable adults; 30-35 kcal/kg and 1.2-2.0 g/kg for stressed/catabolic states; 1.2-2.0 g/kg in chronic kidney disease not on dialysis.

Ideal body weight: men 50 kg + 2.3 kg per inch over 5 ft; women 45.5 kg + 2.3 kg per inch over 5 ft; adjusted body weight = IBW + 0.25(actual - IBW) for obesity.

Intervention categories: food/nutrient delivery, nutrition education, nutrition counseling, and coordination of nutrition care; each has an IDNT intervention code.

Enteral access decision rule: gastric feeding is preferred when the gut works and aspiration risk is low; post-pyloric (duodenal/jejunal) when gastroparesis, severe reflux, or high aspiration risk is present.

Enteral formula osmolality: isotonic ~300 mOsm/kg; hyperosmolar formulas (>500 mOsm/kg) can cause osmotic diarrhea, especially with bolus delivery; standard 1.0 kcal/mL is ~300 mOsm/kg.

Refeeding syndrome risk factors: BMI <16, >15% weight loss in 3-6 months, little or no intake >10 days, low potassium/magnesium/phosphate; start at 10-20 kcal/kg and replete thiamine, phosphate, potassium, magnesium.

Parenteral nutrition indications: nonfunctional GI tract (short bowel, obstruction, severe malabsorption, high-output fistula); use central line for >900-1000 mOsm/L dextrose-amino acid solutions.

Carbohydrate counting: 1 carbohydrate exchange = 15 g carbohydrate; basal-bolus insulin-to-carb ratio and correction factor are individualized; consistent carbohydrate diets typically distribute 45-60 g per meal.

Renal diet: limit sodium ~2000 mg, potassium 2000-3000 mg (individualized), phosphorus 800-1000 mg; restrict protein only in non-dialyzed CKD (0.6-0.8 g/kg).

DASH pattern: 4-5 servings vegetables, 4-5 fruits, 6-8 grains, 2-3 low-fat dairy, <=6 oz lean meat, 4-5 nuts/seeds/legumes per week; targets sodium <=2300 mg (ideal 1500 mg).

Monitoring indicators must be measurable and tied to the nutrition diagnosis (e.g., weight, intake %, labs, functional status); evaluation compares outcomes to goals and determines whether to continue, revise, or discontinue the plan.

HACCP seven principles in order: hazard analysis, determine CCPs, establish critical limits, monitor CCPs, corrective actions, verification, record keeping.

Temperature danger zone 41-135 F (5-57 C); two-hour rule for holding, four-hour cumulative limit for foods out of temperature control; cooling from 135 to 70 F within 2 hours and to 41 F within 6 total hours.

Foodservice systems: conventional (cook-serve on site), commissary (central production, transported), ready-prepared (cook-chill or cook-freeze), assembly-serve (rethermalize preprepared).

Forecasting and production control: standard recipe yields, edible portion vs as-purchased quantity, and AP = EP / yield percentage; overproduction raises food cost and waste.

Menu planning principles: meet nutrition standards, consider budget, equipment, labor, seasonality, and customer acceptance; cycle menus repeat over a set period (e.g., 3-4 weeks).

Food cost percentage = food cost / food sales x 100; labor cost percentage = labor cost / total sales x 100; prime cost = food cost + labor cost.

Transtheoretical model stages: precontemplation, contemplation, preparation, action, maintenance (and termination); interventions should match the person's stage, not jump ahead.

Motivational interviewing spirit: partnership, acceptance, compassion, evocation; core skills OARS = open questions, affirmations, reflections, summaries; avoid the righting reflex.

Health literacy best practice: plain language, teach-back, 5th-6th grade reading level, limit to 3-5 key messages per session.

Behavior change techniques with evidence: self-monitoring, goal setting (SMART), stimulus control, problem solving, relapse prevention, social support.

Cultural competence: assess language preference, use qualified interpreters (not family members for clinical content), and adapt food recommendations to cultural staples.

Group education advantages: peer support, cost efficiency; disadvantages: less individualized attention; individual counseling suits complex medical or psychosocial needs.

Study designs ranked by strength for therapy questions: systematic review/meta-analysis > randomized controlled trial > cohort > case-control > cross-sectional > case report/expert opinion.

Sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives); positive predictive value depends on prevalence.

Relative risk used in cohort studies; odds ratio used in case-control studies; number needed to treat = 1 / absolute risk reduction.

Statistical significance: p < 0.05 conventional; type I error = false positive (alpha), type II error = false negative (beta); power = 1 - beta, conventionally 0.80.

Evidence-based practice steps: formulate the question (PICO: population, intervention, comparison, outcome), search, critically appraise, integrate with expertise and patient values, evaluate.

Quality improvement models: PDSA (Plan-Do-Study-Act) cycles, Six Sigma (reduce variation, DMAIC), Lean (remove waste), and root cause analysis for adverse events.

Levels of evidence grading frameworks include GRADE and the Academy of Nutrition and Dietetics Evidence Analysis Library; recommendations weigh strength and consistency.

Management functions: planning, organizing, staffing, directing, controlling; leadership styles include autocratic, democratic, laissez-faire, and transformational.

Budget types: operating (recurring expenses/revenue), capital (major long-term assets), and cash flow; variance = actual minus budgeted, favorable or unfavorable.

FTE = total paid hours / 40 (or standard hours per week); productivity measured as meals per labor hour (MPLH) or labor minutes per meal.

Scope of practice: RD credential via CDR; state licensure, certification, or title protection varies; maintain continuing professional education (75 CPEU per 5-year cycle).

Ethics: Academy/AND Code of Ethics emphasizes beneficence, nonmaleficence, autonomy, justice, veracity; conflicts of interest and confidentiality must be managed.

Staffing and scheduling: consider skill mix, workload, patient acuity, and labor laws; delegation must match competency and legal scope.

Performance improvement: conduct job analysis, write measurable standards, appraise against them, and document corrective action progressively.

US federal programs: SNAP (food purchasing), WIC (women, infants, children; specific supplemental foods and nutrition education), National School Lunch Program, School Breakfast Program, CACFP, and Older Americans Act nutrition services.

Dietary reference intakes: EAR (used to set RDA), RDA (covers 97-98% of healthy people), AI (used when RDA cannot be set), UL (highest safe intake), and AMDR (macronutrient distribution ranges).

AMDR: carbohydrate 45-65% of energy, fat 20-35%, protein 10-35%; added sugars <10% of energy; saturated fat <10% of energy; sodium <2300 mg/day.

Healthy People framework sets national objectives with measurable targets over a decade; social determinants of health shape diet-related disparities.

Food insecurity screening uses the USDA 18-item Household Food Security Survey Module or the 2-item Hunger Vital Sign; food insecurity is linked to chronic disease and poor diet quality.

Community needs assessment steps: define community, gather data (primary and secondary), analyze, prioritize, plan, implement, evaluate.

Nutrition education theories at community level: social cognitive theory (self-efficacy, observational learning), health belief model (perceived susceptibility, severity, benefits, barriers), and ecological model (individual to policy levels).