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1Department of NutritionGillings School of Global Public HealthUniversity of North Carolina at Chapel HillNUTRITION 640: Medical Nutrition Therapy I: Chronic DiseasesSPRING 2013Tuesday and Thursdays, 9:30am-10:45am, Room 235 Rosenau HallI.Course DescriptionA lecture and skills course where students practice skills (such as calculating caloric intake andmodifying intake, calculating diabetic diets, calculating sodium content of intakes, etc.) under thesupervision of a Registered Dietitian. Nutrition 611 and 630 or equivalents are required as aprerequisite or as a co-requisites.II.InstructorAmanda S. Holliday MS, RD, LDNOffice: 261 RosenauOffice Hours: By AppointmentTelephone: 966-7214Email: amanda [email protected]: @amandashollidayIII.TextbooksRequired:th Mahan, K. and Escott-Stump, S. Krause’s Food, Nutrition and Diet Therapy, 13 Editionrd Nelms, M, Long, S and Lacey, K. Medical Nutrition Therapy: A Case Based Approach, 3Edition, 2008.th Pronsky, Zaneta M. Food-Medication Interactions. 17 Edition, 2012. IDNT Manual, 4th Edition: https://www.eatright.org/shop/product.aspx?id 6442471409Other resources: Academy of Nutrition and Dietetics web site: www.eatright.org for Position Papers link (alongleft side of home page) and other menu items of interest (explore and learn more about theprofession) Sakai website. Please sure to download the zip file titled Coursepak Download. ADA Nutrition Care Manual (www.nutritioncaremanual.org), ADA Evidence Analysis Library(www.adaevidencelibrary.com) 2nd floor study/mail room (McGavern-Greenberg)- A physiology text and a medical dictionaryIV.Foundation Knowledge covered in this course:1. the pathophysiology related to nutrition care;2. the macronutrient, fluid and electrolyte needs of individuals with a variety of disease states;3. laboratory parameters relating to various disease states;4. translate nutrition needs for common conditions into menus for individuals;5. document nutrition needs and suggested therapies in appropriate medical format;7. complementary and alternative nutrition and herbal therapies;6. some of the ethical issues related to nutrition care7. evolving methods of assessing health status8. assessment and treatment of nutritional health risks9. medical nutrition therapy10. strategies to assess need for adaptive feeding techniques and equipmentBy the end of this course students will have demonstrated the ability to:1. screen individuals for nutritional risk2. collect pertinent information for comprehensive nutrition assessments3. interpret medical terminology

24.5.6.7.8.9.interpret laboratory parameters relating to nutritioncalculate and interpret nutrient composition of foodscalculate and/or define diets for health conditionscalculate enteral and parenteral nutrition formulationstranslate nutrition needs into food choices and menuscounsel individuals on nutritionV.Learning Experiences1. Students will independently complete assignments covering varying aspects of the disordersunder discussion.2. Study Guides/Modules are provided that will help the student organize information aroundvarious disease states. Completion of the study guides is optional for Nutrition 640 but will berequired for the MPH/RD students during Nutrition 644 and 710.3. In the assigned groups, students will work on the case study and lead a discussion of about20 minutes on the case.4. Each student who plans to become a registered dietitian in the near future would benefit fromdeveloping a Pocket Brain/Cheat Book to be used during supervised practice experiences.This is a collection of material you feel will help you get through your day. Throughout thesemester suggestions will be made about what to put in your pocket brain but it is really up tothe individual. Pocket brains can be used during the completion of the open bookportions of exams in this class.VI.GradingEvaluation of student performance in this course will be based on the following:Learning experiences30%Exams (3)70%Exams in this class are both closed book and open book. The open book exams will bepractical work similar to homework assignments. Any reference that you have can beused.Grading 8277-7973-7670-72Below 70Below 60A AAB BBC CCDFGraduates:832-895( 93%)671-831 (75-92%)626-670 (70-74%) 625 (Below 70%)HPLFHonor System: The Honor Code is in effect in this class and all others at the University. I amcommitted to treating Honor Code violations seriously and urge all students to become familiarwith its terms set out at http://instrument.unc.edu. If you have questions, it is your responsibility toask me about the Code’s application.All exams and assignments must be submitted with the following signed statement:On my honor, no unauthorized assistance has been received or given in the completion of thiswork.Signature:NOTE: THOSE STUDENTS PLANNING TO TAKE NUTRITION 720: PUBLIC HEALTH NUTRITIONMANAGEMENT AND/OR NUTRITION710: CLINICAL NUTRITION PRACTICE DURING SUMMER,MUST RECEIVE A GRADE OF P OR BETTER IN NUTR 640 IN ORDER TO ENROLL IN EITHERCLASS.

3VII.ThCourse Schedule1/10Introduction to the courseA review of the medical record and an introduction to medical terminologyText: Krause, Chapter 11 and Appendix 1-4: General AbbreviationsCourse Download: NCP and MNT (side by side) Summary: Health IT and Patient Safety (p S1-S11), IOM 2012 Ayres, EJ. 2011 Nutrition Informatics Member Survey. JAND 112(3): 360-364. SOP/SOPP Update 2008, JADA, Sept. 2008 Code of Ethics, JADA, August 2009 Mr. Hill’s Admission Note Mp3 Download for ipod: Basic Word Structure (follow with Chabner Ch.1)Tools JCAHO Do Not Use List (March 2009)Assignment #1: Medical Terminology (due 1/15)T1/15Routine Hospital Diets and Nutritional SupplementsCourse Download: Gelber, S. The Healing Potential of Hospital Food. Medscape General Medicine 7(3):1-3, July 2005.Tools Nutrition Care Manual Formulary (Oral)o Familarize yourself with the various product types UNC Formulary Card (Oral)Assignment #1 Due: Medical Terminology-30ptsMD Note to Decipher for Extra Credit (3pts) DueTh1/17Estimating Intakes and Needs (Bring Exchange book)Text: Krause, Chapter 2 and Appendices 19-31Course Download: Boullata, et. al, Accurate Determination of Energy Needs in Hospitalized Patients,JADA 107 (3): 393-401, 2007 Support Line article by Fish: Using equations to estimate caloric requirements inobese people 26 (6): 20-22, 2004Tools Zeman Chapter 6 (print for pocket guide) Exchange Lists for Weight Management (from Nutrition 630) Review assessment materials from Nutrition 630 or Krause, Chapters 4 and 6;Appendix 29 and 30.NOTE TO DPD GRADUATES: Please review NCP/IDNT notes and LaboratoryAssessment Lecture from NUTR 630. I’m also happy to meet with you as a group toreview how to write a IDNT note.T1/22The Upper GI TrackText: Krause, Chapter 28Course Download: Beyer, P. L. Gastrointestinal disorders: Role of nutrition and the dietetics practitioner.JADA 98(3): 272-277, 1998. Nilsson et al. Lifestyle related risk factors in the aetilogy of gastroesophageal refluxGut 2004; 53: 1730-1735 Flook. GERD: A fresh look at a common problem in primary care. The Journal ofFamily Practice, 2007, 56(10A), pgs31a-34a.

4Th1/24The Upper GI (con’t) and Malabsorption ProblemsTexts: Krause, pp. 790-794 (CF information)Course Download: Grant, J. P., et. al. Malabsorption Associated with Surgical Procedures and ItsTreatment. Nutrition in Clinical Practice 11(2): 43-52, 1996. Wooldridge, N. H. Nutrition Management of Cystic Fibrosis. Nutrition Focus 17(5): 1-9,September/October 2002. Gordon, et al. Nutrient Status of Adults with Cystic Fibrosis, JADA 107(12): 21142119, 2007. Niewinski, M. Advances in Celiac Disease and the Gluten-Free Diet, JADA 108: 661672, 2008. See and Murray. Gluten-Free Diet: The Medical and Nutrition Management of CeliacDisease. Nutrition in Clinical Practice 21:1-15, 2006. Thompson, T. Gluten in Cosmetics: Is There a Reason for Concern? JAND. 112(9):1316-1321.Tools Gluten Free Pocket Guide (keep for your pocket) Gluten Free Website: www.zeer.com (Have fun!!)T1/29Malabsorption and The Lower GI Track: Part ITexts: Krause, Chapter 29; Appendix 41Course Download: Matarese, et al. Short Bowel Syndrome: Clinical Guidelines for Nutrition Management.Nutrition in Clinical Practice 20: 493-502, 2005. McKenzie, et al. British Dietetic Assocition evidence-based guidelines for the dietarymanagement of irritable bowel syndrome in adults. J Hum Nutr Diet. 25, 260–274 Wong, K. The Role of Fiber in Diarrhea Management. Support Line 20(6): 16-20,December 1998.Th1/31The Lower GI Track: Part IIGroup #2: Celiac Disease, Case #12 (Mrs. Gaines) Smith, M. Descriptive Clinical Evaluation of Stool Output. Support Line 31 (5): 20-26,2009. Position Paper: Health Implications of Dietary Fiber. 108(10): 1716-31, 2008 Soothing the Symptoms of IBS With Diet Therapy. Today’s Dietitian, June 2009T2/5Finish GI (all parts)Assignment #2 Due: GI Nutrition- 50pts.Th2/7Cardiovascular Disease: HTNText: Krause, Chapter 34Course Download: Ayala, C., Croft, J.B. Wattigney, W.A. ad Mensah, G. A. Trends in HypertensionRelated Death in the US: 1980-1998. J Clin Hypertension 6(12): 675-681, 2004. Appel, L.J. Lifestyle Modification: Is It Achievable and Durable? The Argument For(Part 1) J Clin Hypertension 6(10):578-581, 2004. Kokkinos, P., Panagootakos, D.B. and Polychronopoulous, E. Dietary influences onblood pressure: The effects of the Mediterranean diet on theprevalence ofhypertension. J Clin Hypertension 7(3):165-170, 2005. Web site: r Guide To Lowering Your Blood Pressure With DASH; NIH Publication #06- 4082

5TTh2/122/14Exam 1A: Closed Book (1/10 through and including 2/5)-110ptsExam 1B: Open Book – 40ptsT2/19Cardiovascular Disease: Atherosclerosis and Heart FailurePractical Work related to Cardiovascular Disease (take home)Group #3: Hypertension and Cardiovascular Disease, Case #6 (James Klosterman)Text: Krause, Chapter 34Course Download: Barclay, L. Waist-to-Hip Ratio vs BMI may be more accurate predictor of CV Risk.Medscape Medical News, November 7, 2005.http://www.medscape.org/viewarticle/516170 Third Report of the National Cholesterol Education Panel Expert Program onDetection, Evaluation and Treatment of High Blood Cholesterol in Adults: ExecutiveSummary, May 2001. p3 rpt.htm Your Guide to Lowering Cholesterol With TLC NIH Publication 06-5235Download Practical Work for CVD and bring to class.Th2/21Discuss Take Home Practical Work and Type I DiabetesText: Krause, Chapter 31Course Download: Position Statement American Diabetes Association: Nutrition Recommendations andInterventions for Diabetes. Diabetes Care, 31 (S1), S61-78, 2008. Gregory, P. Nutrition management of a collegiate football player with insulindependent diabetes: Guidelines and a case study. JADA 94(7): 775-777, 1994.(Getting old but illustrates a point) Mayer-Davis, et. al The Many Faces of Diabetes in American Youth: Type 1 and Type2 Diabetes in Five Race and Ethnic Populations: The SEARCH for Diabetes in youthStudy. Diabetes Care 32(S2): S99-S101, 2009. (Read the rest of the supplement ifyou are interested.)T2/26Type II Diabetes and Gestational DiabetesCourse Download: Position Statement American Diabetes Association: Gestational Diabetes Mellitus.Diabetes Care 27: S88-90, 2004. Position Statement American Diabetes Association: Type 2 Diabetes in Children andAdolescents. Diabetes Care 23(3): 381-389, 2000. Jovanovic, L. Current Management of Gestational Diabetes Mellitus. Nutrition & theMD 24(12):1-8, 1998. Jovanovic, L. Nutrition and Pregnancy: The Link Between Dietary Intake andDiabetes. Current Diabetes Reports. 4: 266-272, 2004.Th2/28Group #4: Type 1 Diabetes, Case #22 (Susan Cheng)Practical Work in DiabetesCourse Download: Evidence Based Nutrition Principles and Recommendations for the Treatment andPrevention of Diabetes and Related Complications, Diabetes Care 26:S51-S61, 2003.T3/5Renal Disease - Pre-dialysisText: Krause, Chapter 36Assignment #3 Due: Diabetes-100 pts.Th3/7Renal Disease - Peritoneal DialysisCourse Download: Beto, J. A. Which Diet for Which Renal Failure: Making Sense of the Options. JADA

695(8): 898-903, 1995.Support Line article by Richards, M. Nutrition management of the patient with acuterenal failure. Support Line 26(6): 10-19, 2004.TTh3/123/14Spring BreakSpring BreakT3/19Renal Disease – HemodialysisText: Krause, Chapter 36Course Download: Rubin, H.R., et.al. Patient Ratings of Dialysis Care with Peritoneal Dialysis vsHemodialysis. JAMA 291(6): 697-703, February 11, 2004. Charney, David I. Medical Treatment in Renal Disease: Basic Concepts in Dialysis.Support Line 20(1): 3-7, 1998.Th3/21Group #5: Renal Disease, Case #26 (Enez Joaquin)Practical work related to kidney diseaseT3/26Exam 2A: Closed Book (2/16 through and including 3/15)- 100ptsTh3/28Exam 2B: Open Book – 50ptsT4/2Nutrition and Breast Feeding: Techniques and BarriersGuest Speaker: Ellen Chetwynd RN BSN IBCLCCourse Download: Visit Kellymom, http://www.kellymom.com/bf/start/index.html (Read 2 articles ofinterest) Tully, et al. Donor Milk: What’s in It and What’s Not. Journal of Human Lacation17:152, 2001. Stuebe et al. Lactation and Incidence of Premenopausal Breast Caner. Arch InternMed. 169 (15) 1354-1371. 2009. Owen, et al. Effect of Infant Feeding on the Risk of Obesity Across the Life Course:A Quantative Review of Published Evidence. Pediatrics 2005; 115; 1367-1377. Complementary Foods "Guiding Principles for the Complementary Feeding of theBreastfed Child" http://whqlibdoc.who.int/paho/2003/a85622.pdf (Great referencetool!)Th4/4Adult ObesityGuest Lecturer: Toni Hartley MPH, RD, LDNText: Krause, Chapter 22Course Download: Clinical Guidelines of the Identification, Evaluation, and Treatment of Overweightand Obesity in Adults. NIH Publication No. 98-4083, Septe