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B.
Overview and Nutrition Basics
B.1
Nutrition Principles
Content
Areas:
- Fuels:
Carbohydrates, proteins, and fats
- Energy
balance, body composition, body weight
- Cholesterol
and lipoprotein metabolism
- Vitamins,
minerals, and trace elements
- Fiber:
soluble and insoluble
- Fluid
and electrolyte balance
- Food
and nutrient deficiencies and excesses
- Free
radical injury
- Food
and nutrient requirements, recommendations and guidelines
- Inborn
errors of metabolism
| After
training, the learner will be able to: |
| Knowledge
Objectives: Medical Students |
- Define
a fuel; name the 3 classes of fuels in the human diet (carbohydrate,
fat and protein). Distinguish among the classes according
to their structural features and caloric content.
- Outline
the metabolic pathways involved in the generation of energy
from fuel oxidation and explain how each pathway is regulated
in response to cellular energy demand.
- Describe
crucial variation in the patterns of exogenous and endogenous
fuel utilization among tissues.
- Outline
the metabolic pathways involved in fuel interconversion,
fuel storage and fuel mobilization. Specify the tissues
involved in synthesis and storage of fuels, and trace the
pathway of transport among tissues.
- Explain
the concept of fuel homeostasis and use this concept to
explain the changes of blood glucose, fatty acids and amino
acid levels that occur in response to variations in timing,
quantity, and type of dietary fuel intake and to variations
in the intensity or duration of physical exercise.
- Describe
the role of individual hormones in regulating fuel homeostasis
in response to variations of dietary and physiologic state;
describe the specific mechanisms by which hormones regulate
the individual metabolic pathways involved, including nutrient
regulation of gene expression.
- Define
calorie, basal metabolic rate, respiratory quotient, and
daily energy expenditure, and describe how these values
are measured or calculated. Explain how each of these values
is related to physical exercise, caloric balance, weight
gain or loss, and the rate of fuel metabolism.
- Describe
the physiological mechanisms that relate hunger, satiety,
and appetite to diet and physical exercise.
- Define
nitrogen balance and explain how it is affected by dietary
intake and growth.
- Describe
the structural feature of each of the following lipids:
cholesterol, fatty acids (including saturated, mono-, polyunsaturated,
omega-6 and omega-3; short-, medium, long-chain; odd and
uneven chain, essential fatty acids), and eicosanoids.
Describe the mechanism of absorption and tissue distribution.
- Outline
the pathways for synthesis and degradation of cholesterol,
and explain the mechanisms that regulate these pathways
in response to cholesterol intake, saturated fat, and other
dietary components.
- Distinguish
among the classes of lipoproteins involved in cholesterol
and lipid transport in the blood, and explain how different
genetic and dietary factors influence lipoprotein concentrations
and composition.
- Name
the vitamins and relate the essential structural features
of each vitamin to its stability, lipid solubility, transport,
coenzyme form, and role in metabolism.
- Name
the minerals required in the human diet, and explain how
each is absorbed, transported, and stored and how its turnover
is regulated. Distinguish among macrominerals, microminerals,
and trace elements.
- Describe
the role of each required vitamin and mineral in molecular
and systemic physiology.
- Explain
how a daily vitamin or mineral intake that is greater than
or less than the DRI causes common clinical symptoms or
pathology.
- Distinguish
between the two types of dietary fiber, and explain the
potential contributions of fiber to health maintenance.
- Describe
the pathways of alcohol metabolism in the liver in well
individuals compared to chronic alcoholics.
- Define
fluid and electrolyte balance and explain how they are maintained.
Identify dietary components and common physiological or
pathological conditions that create imbalances, and explain
the consequences of these imbalances.
- Identify
the major oxygen free radicals and reactive oxygen species
(ROS) generated in human cells and explain how they are
generated; describe the primary ways they injure cells.
- Describe
the natural defense mechanisms present in cells to protect
against ROS generation and injury.
- Define
Recommended Dietary Allowance (RDA), Dietary Reference Intake
(DRI), Adequate Intake (AI), Estimated Average Requirement
(EAR); and Upper Limit (UL); explain how these values are
established for different age groups; and identify the population
groups to which they apply.
- Using
the US Dietary Guidelines and the Food Pyramid, describe
the general characteristics of a healthy diet, including
the recommended contribution of various food groups, good
common sources of individual nutrients, foods to be consumed
in limited amounts, and the carbohydrate: fat: protein distribution.
- Identify
types of individuals, populations or communities at risk
for specific or general dietary vitamin and mineral deficiencies
or imbalances as a result of genetic, environmental, or
socio-cultural influences.
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| Knowledge
Objectives: Residents |
- Access
the most accurate current general and disease-specific nutritional
information and recommendations.
- Describe
the changes in nutritional requirements that occur with
aging and development.
- Predict
the consequences of a real or hypothetical inherited or
acquired metabolic abnormality or hormonal imbalance on
fuel utilization, fuel homeostasis, BMR and/or caloric balance.
- Evaluate
the quality of nutritional information provided in lay and
medical literature.
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| Knowledge
Objectives: Specialists |
- Name
the dietary essential amino acids. Outline the pathways
for the synthesis of nonessential amino acids and identify
the tissues involved. Summarize the major physiologic roles
and metabolic fates of each amino acid.
- Explain
the role of the free amino acid pool in the blood as a dynamic
reservoir; describe the relationship of this pool of amino
acids to protein turnover and to changes of dietary state,
physiological state, infective stress and disease, development
and pregnancy.
- Given
a particular dietary pattern or deficiency, predict its
effect on the immune response.
- Identify
dietary components that affect the generation of ROS or
the extent of free radical injury and explain the mechanism
involved.
- Identify
the genetic, behavioral, socio-cultural, nutritional, and
environmental factors that might influence hunger, satiety,
eating behavior, and food choices of an individual.
- Given
a specific inborn error of metabolism, explain how the diet
should be adjusted to accommodate the resultant changes
of metabolite concentrations.
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| Practice
Behavior Skills: Medical Students |
- Translate
basic science information into clinically relevant principles
that guide medical decision-making.
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| Practice
Behavior Skills: Residents |
- Translate
medical literature into lay terminology that could be used
for counseling patients.
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| Attitudes:
All Learners |
- Acknowledge
that effective patient management requires an understanding
of basic nutrition science principles.
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