Medical Nutrition Therapy for Acute and Chronic Disease
What this domain tests
This domain tests disease-specific nutrition prescriptions, monitoring parameters, and the ability to avoid harmful over-restriction in acute and chronic illness.
Core rules
- Diabetes: medical nutrition therapy is individualized; carbohydrate consistency and portion control matter more than a single glycemic index number. Treat hypoglycemia with 15 g fast carbohydrate and recheck in 15 minutes.
- CKD not on dialysis: protein 0.6–0.8 g/kg/day; dialysis: 1.0–1.2 g/kg/day. Energy 30–35 kcal/kg. Sodium under 2 g/day; potassium and phosphate are individualized, not blanket-restricted.
- CVD: DASH or Mediterranean patterns; saturated fat below 7–10% of energy; soluble fiber 5–10 g/day; sodium reduction.
- COPD: energy 30–35 kcal/kg and protein 1.2–1.5 g/kg; small frequent meals; monitor for carbon dioxide retention only in selected patients.
- Cirrhosis: protein 1.2–1.5 g/kg; late-evening snack reduces catabolism; sodium restriction for ascites.
- Acute pancreatitis: early enteral nutrition within 24–48 hours when tolerated; prolonged NPO is not required.
Worked example
A 60 kg adult with stage 4 CKD, eGFR 25, and type 2 diabetes. Prescribe protein 0.7 × 60 = 42 g/day, energy 30 × 60 = 1800 kcal, sodium under 2 g, and individualized potassium. Carbohydrate can remain about 45–50% of energy with consistent distribution. Do not use dialysis protein targets because the patient is not dialyzed. Recheck potassium, phosphate, albumin, and glycemic control.
Traps
Applying dialysis protein targets to predialysis CKD; restricting potassium for every renal patient; continuing NPO in mild pancreatitis; using tight glycemic targets in frailty or terminal illness; prescribing a renal diet for acute kidney injury without assessing catabolism and urine output.