QCHP Dietitian cheat sheet

Atwater factors: carbohydrate 4 kcal/g, protein 4 kcal/g, fat 9 kcal/g, alcohol 7 kcal/g.

Essential amino acids: histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, valine.

Glycolysis yields net 2 ATP and 2 NADH per glucose; Krebs cycle yields 3 NADH, 1 FADH2, 1 GTP per acetyl-CoA.

Fatty acid beta-oxidation: each cycle removes 2 carbons, yielding 1 FADH2, 1 NADH, and 1 acetyl-CoA.

Ketone bodies (acetoacetate, beta-hydroxybutyrate, acetone) are produced in the liver from excess acetyl-CoA during fasting.

Transcription: DNA to mRNA in nucleus; translation: mRNA to protein at ribosome; each amino acid coded by a triplet codon.

Enzyme cofactors: thiamin (TPP) for decarboxylation, riboflavin (FAD/FMN) for redox, niacin (NAD/NADP) for redox, pyridoxine (PLP) for transamination.

Hormonal regulation: insulin promotes anabolism (glycogenesis, lipogenesis); glucagon promotes catabolism (glycogenolysis, gluconeogenesis).

HACCP seven principles: hazard analysis, critical control points, critical limits, monitoring, corrective actions, verification, recordkeeping.

Danger zone for bacterial growth: 4°C to 60°C (40°F–140°F); limit time in zone to 2 hours.

Maillard reaction: non-enzymatic browning between amino acids and reducing sugars, enhanced by heat and low moisture.

Emulsion types: oil-in-water (milk, mayonnaise) and water-in-oil (butter, margarine); stabilized by emulsifiers like lecithin.

Food service systems: conventional (cook-serve), commissary (cook-chill), ready-prepared (cook-freeze), assembly-serve.

Gelatinization: starch granules absorb water and swell when heated; retrogradation is reassociation on cooling.

Cross-contamination prevention: separate raw and ready-to-eat foods, color-coded cutting boards, sanitize surfaces.

Modified atmosphere packaging reduces oxygen to slow oxidation and microbial growth; vacuum packaging removes air.

Diabetes: carbohydrate consistency, glycemic index consideration; HbA1c goal <7% for most adults.

Chronic kidney disease: limit sodium, potassium, phosphorus; protein intake 0.6–0.8 g/kg for non-dialysis, higher for dialysis.

Hypertension: DASH diet emphasizes fruits, vegetables, low-fat dairy, whole grains; sodium <2300 mg/day (ideal 1500 mg).

Heart failure: sodium restriction (2–3 g/day), fluid restriction if hyponatremia; monitor weight daily.

Celiac disease: lifelong gluten-free diet; avoid wheat, barley, rye; oats only if certified gluten-free.

Phenylketonuria: restrict phenylalanine, supplement tyrosine; avoid aspartame (contains phenylalanine).

Liver disease: adequate protein (1.2–1.5 g/kg) and frequent meals to prevent catabolism; restrict sodium for ascites.

Post-bariatric surgery: progressive diet from clear liquids to soft to regular; prioritize protein (60–80 g/day) and hydration.

ABCDs of assessment: Anthropometric, Biochemical, Clinical, Dietary.

BMI = weight (kg) / height (m)^2; underweight <18.5, normal 18.5–24.9, overweight 25–29.9, obese ≥30.

Albumin half-life ~20 days; prealbumin (transthyretin) half-life ~2 days; both are negative acute-phase reactants.

24-hour recall relies on memory; food frequency questionnaire assesses usual intake; food records require literacy and motivation.

PES statement: Problem (nutrition diagnosis), Etiology (cause), Signs/Symptoms (evidence).

Nitrogen balance = nitrogen intake – (urinary urea nitrogen + 4 g); positive in growth, negative in catabolism.

Waist circumference: increased risk if >102 cm (40 in) men, >88 cm (35 in) women.

Indirect calorimetry measures resting energy expenditure via oxygen consumption and carbon dioxide production.

Healthy People 2030 objectives: reduce food insecurity, increase fruit/vegetable intake, reduce added sugars.

Food insecurity defined by USDA as limited or uncertain access to adequate food due to lack of money.

SNAP provides food purchasing benefits; WIC targets pregnant women, infants, and children under 5.

Social determinants of health: economic stability, education, social context, health care access, neighborhood environment.

Nutrition education theories: Health Belief Model, Transtheoretical Model (stages of change), Social Cognitive Theory.

Community needs assessment methods: surveys, focus groups, key informant interviews, secondary data analysis.

Food deserts: areas with limited access to affordable, nutritious food, often low-income neighborhoods.

Breastfeeding promotion: WHO recommends exclusive breastfeeding for first 6 months, continue with complementary foods to 2 years.

Transtheoretical Model stages: precontemplation, contemplation, preparation, action, maintenance.

Motivational interviewing: open-ended questions, affirmations, reflective listening, summarizing (OARS).

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

Adult learning principles (Knowles): adults need relevance, problem-centered learning, and respect for experience.

Health literacy: use plain language, teach-back method, limit to 3–5 key points per session.

Behavior change strategies: self-monitoring, goal setting, stimulus control, problem solving, relapse prevention.

Cultural competence: assess cultural food practices, avoid stereotyping, adapt education materials to language and literacy.

Counseling setting: private, comfortable, minimize distractions; build rapport and empathy.

Scope of practice: dietitian vs dietetic technician vs nutritionist varies by state licensure/certification.

Code of Ethics principles: competence, integrity, confidentiality, accountability, collaboration, advocacy.

HIPAA protects patient health information; minimum necessary standard applies to disclosures.

Informed consent: patient must be competent, informed of risks/benefits, and volunteer voluntarily.

Conflict of interest: disclose financial or personal interests that could influence professional judgment.

Documentation: use SOAP (Subjective, Objective, Assessment, Plan) or ADIME (Assessment, Diagnosis, Intervention, Monitoring/Evaluation).

Mandatory reporting: suspected abuse, neglect, or certain communicable diseases must be reported per law.

Reimbursement: Medicare covers medical nutrition therapy for diabetes and renal disease with referral.

Levels of evidence: systematic reviews/meta-analyses > randomized controlled trials > cohort > case-control > case series > expert opinion.

PICO format: Population, Intervention, Comparison, Outcome for clinical questions.

Sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives).

Relative risk (RR) = incidence in exposed / incidence in unexposed; odds ratio (OR) used in case-control studies.

Statistical significance: p < 0.05; confidence interval indicates precision; power is probability of detecting true difference.

Quality improvement models: PDSA (Plan-Do-Study-Act), Six Sigma, Lean; focus on systems and processes.

Evidence-based practice steps: formulate question, search literature, critically appraise, apply, evaluate.

Bias types: selection, information, recall, publication bias; randomization reduces selection bias.