Prepared by:

CURRICULUM COMMITTEE of the

NUTRITION ACADEMIC AWARD PROGRAM

National Institutes of Health Staff

Elaine Stone, PhD, MPH, Advisor, Program Officer (1998-2001)

Marcel Salive, MD, Advisor, Program Officer (2001-2003)

National Heart, Lung & Blood Institute (NHLBI)

National Institute of Diabetes, Digestive & Kidney Diseases (NIDDK)

Curriculum Committee1

Charles B. Eaton, MD, MS, Chair Brian W. Tobin, PhD, Editor

Lisa A. Hark, PhD, RD, Chair Mike U. Smith, PhD, Editor

Nutrition Curriculum Guide for Training Physician

Practice Behavior Skills and Attitudes Across the Curriculum

For more information, contact:

Charlotte Pratt, PhD, MS, RD

NAA Program Officer

National Heart, Lung, and Blood Institute

Division of Epidemiology and Clinical Applications

6701 Rockledge Drive

MSC 7936, Room 8134

Bethesda, MD 20892 (Overnight 20817)

Tel.: (301) 435-0382

Fax: (301) 480-1669

Email: prattc@nhlbi.nih.gov
Curriculum Committee Members 

Lars Berglund, MD 

Frances Burke, MS, RD 

Darwin Deen, MD, MS 

Marie Dent, PhD 

Marilyn Edwards, PhD, RD 

Marion Fitzgibbon, PhD 

Frank A. Frankin, MD, PhD 

Kim Gans, PhD, MPH, LDN 

Joel Gordon, MD 

Steven Havas, MD, MPH 

Doug Heimburger, MD 

Ronald Kahn, MD 

Robert Knopp MD 

Nancy Krebs, MD 

Robert Kushner, MD 

Tanis Mihalynuk, PhD, RD 

Scott Mcintosh, PhD 

Patrick, McBride, MD, MPH 

Elizabeth Moreno, MA, MS 

Gail Morrison, MD 

Thomas Pearson, MD, PhD, MPH 

Elizabeth Ross, MD 

Craig Scott, PhD 

Nancy Sheard, DSc 

Mike Smith, PhD 

Colleen Smith, PhD 

Linda Snetselaar, PhD, RD 

Sachiko T. St. Jeor, PhD, RD 

Alvin Telser, PhD 

Andrew Tershakovec, MD 

Brian Tobin, PhD 

Linda Van Horn, PhD, RD 

Tracy Veach, EdD 

Alan Walker, MD 

Francine Welty, MD, PhD 

Christine Williams, MD 

Margo Woods, DSc 

Judy Wylie-Rosett, EdD, RD 

Charles B. Eaton, MD, MS 

1 See Appendix 2 for further information on committee members, staff and contributors. 

www.nhlbi.nih.gov/funding/training/naa/guide.htm 
Nutrition Curriculum Guide for Training Physicians 8/30/2002 

Practice Behavior Skills and Attitudes Across the Curriculum 

Nutrition Curriculum Guide For Training Physicians 

Table of Contents

Preface/User’s Guide 

Dedication 

A. Practice Behavior Skills Across the Curriculum 

 A.1 Practice Behavior Skills Across the Curriculum 

 A.2 Attitudes Across the Curriculum 

B. Overview and Nutrition Basics 

 B.1 Nutrition Principles 

 B.2 Community and Population Health 

 B.3 Behavioral Science Principles 

 B.4 Nutrition Assessment 

 B.5 Physical Activity 

C. Lifespan 

 C.1 Pediatrics 

 C.2 Young Adulthood/Middle Age 

 C.3 Geriatrics 

 C.4 Women’s Health 

D. Cardiovascular System (See also Physical Activity, Obesity, and Diabetes Mellitus) 

 D.1 Hyperlipidemia and Atherosclerosis 

 D.2 Hypertension 

 D.3 Heart Failure and Cardiomyopathy 

E. Metabolic/Endocrine Systems 

 E.1 Obesity 

 E.2 Diabetes Mellitus 

F. Other Organ Systems 

 F.1 Gastrointestinal 

 F.2 Hematology/Oncology 

 F.3 Immunology 

 F.4 Rheumatology 

 F.5 Pulmonary 

 F.6 Renal 

 F.7 Bone 

G. Other Areas 

G.1 Nutrition Support 

 G.2 Contemporary Trends 

H. Appendices 

H.1 Nutrition Academic Award Program Principal Investigators 

 H.2 Nutrition Curriculum Guide for Training Physicians Contributors 

 H.3 Description of How the Guide Was Developed
Nutrition Curriculum Guide for Training Physicians 8/30/2002 

Practice Behavior Skills and Attitudes Across the Curriculum 

Nutrition Curriculum Guide for Training Physicians 

Preface/User’s Guide

The purpose of this preface is to serve as both a brief introduction to this document and 

a User’s Guide to assist readers in finding the information most useful to them. 

 

Background and Introduction: In recognition of the need to develop and enhance 

undergraduate and graduate medical nutrition education, the National Heart Lung and 

Blood Institute (NHLBI) and the National Institute of Diabetes and Digestive and Kidney 

Diseases (NIDDK) established the Nutrition Academic Award (NAA) Program in 1997 

(www.nhlbi.nih.gov/funding/training/naa). The NAA Program provided 21 U.S. medical 

schools with five-year grants to support nutrition education programs for medical 

students, medical residents, and clinical faculty (Appendix). This Nutrition Curriculum 

Guide for Training Physicians represents the efforts of medical nutrition educators at 

these schools. The section topics were selected after reviewing the existing literature 

and curricula. Members of the NAA Curriculum Committee were then assigned the task 

of creating or reviewing first drafts of a given section. 

 Each section was written with four components: a brief list of content areas, 

consistent with previous curriculum recommendations for nutrition, and learning 

objectives written for knowledge, practice behavior skills, and attitudes. After each 

section was reviewed, the entire document was revised by Drs. Brian Tobin and Michael 

Smith at Mercer School of Medicine to ensure that the learning objectives used 

language consistent with Bloom’s taxonomy and included objectives that represented 

each area of development of expertise (cognitive and problem-solving). At this point the 

objectives were submitted to a consensus-generating “Delphi” process with the 

assistance of Dr. Craig Scott, at the University of Washington School of Medicine. 

 Nutrition education spans the continuum for medical students, residents, and 

specialists and we have attempted to address this issue by listing objectives as 

appropriate for each of these levels. Learners at each level would be expected to have 

some degree of competency in those objectives listed for learners below their level. The 

Delphi process allowed us to prioritize objectives and we have done this by placing in 

BOLD type the items ranked in the top 1/3 of all objectives at each learner level. 

Objectives that follow are not in order of priority. Clearly, an individual programs’ ability 

to accomplish these objectives depends upon many factors (educational priorities, 

resources, etc.). 

 This curriculum is designed to be used by medical educators and evaluators, 

curriculum committees, Deans offices, etc. to assist in creating, evaluating, modifying, 

and updating nutrition curricula at individual programs (medical schools, residency and 

fellowship training programs). We have organized the Chapters in a way that allows 

individual course leaders to rapidly identify those areas relevant to their course. 

Curriculum committees will be most interested in the global behavior and attitude 
Nutrition Curriculum Guide for Training Physicians 8/30/2002 

Practice Behavior Skills and Attitudes Across the Curriculum 

objectives listed first in this manual. These objectives were common themes across 

many of the individual sections. 

 The goal of any curriculum is to elucidate for teachers and learners the 

knowledge, practice behavior skills, and attitudes that are expected for competence and 

mastery. It also allows for specific evaluation strategies to be created. These objectives 

are already in use at many of the NAA schools to help define and refine teaching efforts. 

They have begun to appear in syllabi, chapter headings, lecture introductions, course 

summary guides, etc. Evaluation strategies have been (and will continue to be) 

developed to assist educators in assessing student’s progress in meeting these 

objectives. 

 The National Board of Medical Examiners (NBME) who administers the USMLE 

Step 1, 2 and 3 exams has developed a nutrition sub-score for the Step 1 exam. The 

NBME has approved members of the NAA Program to review the Step 1, 2 and 3 

exams in 2002 in order to assess the quantity and quality of the nutrition-related items. 

This process will also determine if it is appropriate to recommend a nutrition-subscore 

for the Step 2 and Step 3 exams. As schools modify their nutrition curriculum, they will 

be able to assess student progress through this mechanism. 

Conclusion and Use of the Guide: On behalf of the entire NAA Curriculum 

Committee and Principal Investigators, we hope that the objectives in the Nutrition

Curriculum Guide for Training Physicians will be as valuable a resource for our readers 

as we have found them to be in our teaching efforts. These objectives can be used by 

medical educators and evaluators involved in planning, implementing and evaluating 

nutrition curriculum across the continuum of medical education. 

This effort represents a continuation of prior work in this field and is not intended to be 

the final work on this subject. This document will be revised as users provide feedback 

on it and as new medical information accumulates. A process for revising it has been 

created by the authors. 

For a complete description of how the Nutrition Curriculum Guide for Training 

Physicians was developed, see Appendix 3. 

Please visit the NAA Web site for additional nutrition education resources 

(www.nhlbi.nih.gov/funding/training/naa). 

Lisa A. Hark, PhD, RD and Charles B. Eaton, MD 

and Members of the Curriculum Committee 
Nutrition Curriculum Guide for Training Physicians 8/30/2002 

Practice Behavior Skills and Attitudes Across the Curriculum 

Dedication 

Elaine Stone, PhD, MPH served as the Project Officer for the Nutrition Academic Award 

during its first three years. Her support of awardees, enthusiasm for good nutrition, and 

commitment to professional education were essential to the creation of the Curriculum 

Guide. In recognition of her central role and contributions to the Nutrition Academic 

Award, we gratefully dedicate this Nutrition Curriculum Guide for Training Physicians to 

Elaine Stone, PhD, MPH. 
Nutrition Curriculum Guide for Training Physicians 8/30/2002 

Practice Behavior Skills and Attitudes Across the Curriculum 

A. Practice Behavior Skills and Attitudes Across the Curriculum 

A.1 Practice Behavior Skills Across the Curriculum 

A.2 Attitudes Across the Curriculum

 
Nutrition Curriculum Guide for Training Physicians 8/30/2002 

A.1: Practice Behavior Skills Across the Curriculum 

A.1: Practice Behavior Skills Across the Curriculum 

After training, the learner will be able to: 

History 

Take an appropriate patient medical history, including family, social, nutritional/dietary, physical 

activity, and weight histories; use of prescription medicines, over-the-counter medicines, dietary 

and herbal supplements; and consumption of alcohol and other recreational drugs. 

Physical 

Conduct an appropriate physical examination, including anthropometrics, evaluation of growth 

and development and signs of nutritional deficiency or excess. 

Test Selection

Select and interpret the results of screening measures, laboratory tests, and diagnostic 

procedures appropriate to assess and manage a patient’s nutrition. 

Evaluation

Evaluate a patient’s diet and current nutritional status based on the USDA Food Guide 

Pyramid. 

Identify individuals who require medical nutritional therapy and lifestyle modification,. 

Integrate nutritional assessment information into an individualized nutritional management and 

physical activity plan for optimal health, risk factor reduction and common medical problems. 

 

. 

Counseling 

Effectively counsel patients to make informed nutritional decisions consistent with adopting and 

maintaining a healthy lifestyle and with establishing appropriate dietary, exercise and behavioral 

goals. 

Effectively communicate with patients in a culturally competent manner to provide 

accurate nutritional information and dispel misinformation. 

Employ effective counseling techniques matched to the patient’s level of motivation and 

readiness for change, encouraging the use of goal setting, identification of barriers, problem 

solving, self-monitoring, self-reinforcement, and stimulus control. 

Consultation and Referral 

Consult with or refer to a registered dietitians or other credentialed healthcare professionals and 

refer to community nutrition resources as appropriate. 
8/30/2002

* Bold items were ranked in the top 1/3 of all objectives. 

7/27/02 

Nutrition Curriculum Guide for Training Physicians 

A.2: Attitudes Across the Curriculum 

A.2: Attitudes Across the Curriculum

After training, the learner will be able to: 

Attitude Objectives 

Recognize that nutrition, physical activity, and health lifestyle behaviors can have direct, 

substantial, and long-term effects on growth and development, health maintenance, and 

disease prevention and treatment. 

Demonstrate a commitment to interact with patients in a culturally competent manner that 

appropriately acknowledges the unique characteristics and nutritional needs of each 

individual. 

Recognize how personal, environmental, and social factors interact and impact on eating 

behaviors and overall nutrition. 

Demonstrate sensitivity to biomedical and nutritional changes as well as psychological, social, and 

ethical issued that affect patient care. 

Recognize the importance of using a multi-disciplinary team approach in nutritional health 

care.

 Recognize the importance of patient autonomy and shared decision making in the nutritional 

management of patients. 

. 

Encourage physicians to serve as positive role model for patients regarding nutrition and healthly 

lifestyles. 

Recognize the importance of attention to nutritional management to enhance a patient’s quality of 

life 

 Encourage physicians to be involved in public health initiatives that promote community health 

regarding nutrition and physical activity 
Nutrition Curriculum Guide for Training Physicians 8/30/2002 

B. Overview and Nutrition Basics 

B. Overview and Nutrition Basics 

B.1 Nutrition Principles 

B.2 Community and Population Health 

B.3 Behavioral Science Principles 

B.4 Nutrition Assessment 

B.5 Physical Activity 

* Bold items were ranked in the top 1/3 of all objectives. 
Nutrition Curriculum Guide for Training Physicians 8/30/2002 

B.1: Nutrition Principles

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. 

* Bold items were ranked in the top 1/3 of all objectives. 
Nutrition Curriculum Guide for Training Physicians 8/30/2002 

B.1: Nutrition Principles

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. 

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.

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. 

* Bold items were ranked in the top 1/3 of all objectives. 
Nutrition Curriculum Guide for Training Physicians 8/30/2002 

B.1: Nutrition Principles

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. 

Practice Behavior Skills: Medical Students 

Translate basic science information into clinically relevant principles that guide medical 

decision-making. 

Practice Behavior Skills: Residents

Translate medical literature into lay terminology that could be used for counseling patients. 

Attitudes: All Learners 

Acknowledge that effective patient management requires an understanding of basic nutrition 

science principles/ 

* Bold items were ranked in the top 1/3 of all objectives. 
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

B.2: Community and Population Health 

 

B.2: Community and Population Health

Content Areas 

Population-based disease prevention and health promotion 

Epidemiological measures and tools 

Community health assessment 

Interaction of nutrition with lifestyle, environment, biology, and health care system 

Food insecurity 

After training, the learner will be able to: 

Knowledge Objectives: Medical Students 

Summarize the Dietary Guidelines for Americans and explain how they are important in patient 

care. 

Describe the role of nutrition in health promotion and disease prevention, particularly as related 

to chronic diseases. 

Identify the prevalence of individuals who are overweight, obese, or malnourished in the U.S. 

List the food categories in the Food Guide Pyramid and the recommended number of servings 

in each. 

Knowledge Objectives: Residents

Explain the interactions among lifestyle, environment, biology, and the health care system in 

the development of nutrition-related chronic diseases. 

Compare and contrast the Dietary Guidelines for Americans with the nutrition guidelines 

promulgated by the American Heart Association and the American Cancer Society. 

List at least four community agencies that commonly provide nutrition-related resources and 

describe the types of information and services that they provide. 

Describe at least four food-borne illnesses, and outline the process of reporting and 

investigating outbreaks of these illnesses. 

Knowledge Objectives: Specialists 

Outline contemporary public health strategies aimed at reducing the burden of disease 

in the United States through nutrition education. 

Define the basic measures and tools of epidemiology that are utilized in the identification, 

interpretation, and monitoring of diets and nutrition 

Identify and summarize at least one nutrition-related example of the different types of 

epidemiological studies (e.g. case control, cohort, randomized intervention trial). 

Outline the framework and processes required to conduct a comprehensive assessment of a 

community’s health and nutrition needs. 

Describe the Healthy People 2010 Initiative, and summarize the nutrition-related objectives. 

Describe the levels at which diet can be influenced (individual, family/household, organization, 

community setting, environmental, and public policy). 

Distinguish among primary, secondary, and tertiary levels of prevention by giving the definition 

of each and nutrition-related examples of each. 

Practice Behavioral Skills: Medical Students

Given a 24-hour dietary recall, assess the status of a patient’s diet using the Food Guide 

Pyramid and Dietary Guidelines for Americans. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

B.2: Community and Population Health 

 

Provide nutritional counseling and dietary recommendations that appropriately take into 

account the patient’s health status, the Food Guide Pyramid, and Dietary Guidelines for 

Americans. 

Practice Behavioral Skills: Residents

Provide effective preventive nutrition counseling appropriate for any well or diseased 

individual.

Refer patients to community nutrition agencies, resources, and services as appropriate. 

Practice Behavioral Skills: Specialists

Conduct a comprehensive community needs assessment that includes the following 

components: 

• Identification of ethnic, social, and cultural issues relating to the nutritional health and 

preventive medicine needs of the population; 

• Translation of epidemiological findings into specific interventions for the community; 

• Assessment of the nutritional status of the community and specific groups in that 

community;

• Analysis of the morbidity and mortality trends of the community; 

• Design and evaluation of nutrition/preventive-oriented interventions targeted at reducing 

and eliminating community-based risk factors; and 

• Identification of the types and extent of community resources related to nutrition, disease 

prevention and health promotion that may complement individualized clinical care. 

Access and evaluate a variety of print and electronic data sources used to assess the diets of 

community populations, and provide appropriate nutrition-related counseling based on this 

information. 

Interact sensitively, effectively, and professionally with persons from diverse cultural,

socioeconomic, educational, and professional backgrounds.

Attitude Objectives: All Learners 

Recognize the importance of nutrition and community nutrition services in health promotion, 

disease prevention, and disease management. 

Demonstrate a personal commitment to the importance of prevention in health care.

Exhibit a non-judgmental demeanor and sensitivity toward patients, families, and community 

members. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

B.3: Behavioral Principles

 

B.3: Behavioral Principles 

Content Areas 

Social and cultural determinants of eating behavior 

Barriers to dietary change 

Behavioral theory in nutritional counseling 

Behavioral counseling 

Lifestyle modification 

Efficacy of behavioral treatments 

After training, the learner will be able to: 

Knowledge Objectives: Medical Students 

List at least three common barriers to dietary change, and identify effective strategies for 

overcoming these barriers. 

Describe common social, ethnic, cultural, and societal factors that contribute to the 

prevalence of nutritional problems and should be considered in their management. 

Explain how to apply the Brief Counseling Model in the context of patient nutrition management. 

Knowledge Objectives: Specialists 

Compare and contrast the efficacy of the three most commonly employed behavioral 

approaches to nutrition counseling. 

Practice Behavior Skills: Medical Students 

Effectively counsel patients, employing behavior theory principles and specific effective 

counseling techniques including: goal setting, barrier identification, problem solving, 

and relapse prevention techniques, including self-monitoring, self-reinforcement, and 

stimulus control. 

Practice Behavior Skills: Residents 

Assess a patient's readiness for change and match the counseling intervention to the 

patient’s current stage in the continuum of change. 

Effectively counsel patients to set realistic nutritional goals and timelines for behavioral 

change. 

Attitude Objectives: All Learners 

Demonstrate a belief in his/her ability effectively to promote patient behavior change. 

Recognize the preeminence of the patient’s taking responsibility for his/her own nutritional 

health. 

Recognize the importance of enabling patients to believe in their ability to change current 

behavior patterns. 

Demonstrate a commitment to promote behavior change through establishing the best possible 

physician-patient relationship. 

 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

B.4: Nutrition Assessment 

 

B.4: Nutrition Assessment

Content Areas

Overweight and obesity 

Malnutrition 

Diet history 

Family, medical, and social histories 

Review of systems 

Physical examination 

Functional status 

Subjective global assessment 

Laboratory data 

Energy expenditure 

After training, the learner will be able to: 

Knowledge Objectives: Medical Students

Describe the metabolic and medical consequences of varying degrees of over- and undernutrition. 

Compare and contrast the “ABCD’s” (anthropometric, biochemical, clinical, and dietary intake 

measures) of nutrition assessment. 

Describe the impact of the altered nutritional status associated with five common acute and five 

common chronic diseases. 

List the laboratory measurements commonly used to assess the nutritional status of patients. 

Describe the food pyramid, explain how it could be used as a nutrition assessment tool, and give 

functional definitions of portion size in each category of the pyramid. 

Outline a laboratory profile indicative of malnutrition, protein-energy malnutrition, iron deficiency 

anemia, or megaloblastic anemia. 

Identify the likely physical examination findings associated with over- and under-nutrition and 

vitamin/mineral deficiencies or toxicities. 

Knowledge Objectives: Residents

Compare and contrast use of Body Mass Index (BMI), waist circumference, skin fold thickness, 

mid-arm muscle circumference, and waist-hip ratio, and explain the usefulness of these measures 

in the clinical setting. 

Knowledge Objectives: Specialists 

Compare and contrast the utility, validity, and reliability of at least three commonly used 

dietary screening/assessment methods. 

Summarize the American Dietetic Associations (ADA) recognized functions of a registered 

dietitian. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

B.4: Nutrition Assessment 

 

Practice Behavior Skills: Medical Students 

Take an appropriate patient medical history of a standardized patient, including dietary and 

social histories. 

Given height and weight, calculate the BMI, and interpret the BMI according to published 

NIH guidelines. 

Practice Behavior Skills: Residents 

Conduct an appropriate nutritional assessment on all ambulatory and hospitalized patients, 

including those with acute or chronic disease as well as healthy individuals of all ages. 

Conduct an appropriate physical examination in a patient of any age, including

anthropometrics; select appropriate laboratory tests and procedures to diagnose and treat 

nutritional conditions such as over- and under-nutrition in hospitalized and ambulatory

patients. Identify appropriate nutritional therapies. 

Effectively counsel patients about their nutrition, providing recommendations matched to 

the patient’s age, sex, family history, chronic conditions, activity level, family, culture, and 

ethnicity. 

Seek consultation with and refer patients to a registered dietitian or other credentialed nutrition 

professionals as appropriate. 

Attitude Objectives: All Learners 

Recognize the value of nutritional assessment in the comprehensive care of ambulatory and 

hospitalized patients. 

Recognize the importance of nutrition in health maintenance, disease prevention, and 

management. 

Demonstrate a commitment to utilizing a multidisciplinary approach to screening, assessing, and 

counseling individuals at nutritional risk. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

B.5: Physical Activity 

 

B.5: Physical Activity 

Content Areas 

Energy expenditure, energy transfer 

Body composition 

Physiologic adaptation to physical activity 

Risks and benefits of physical activity

Physical activity guidelines and recommendations throughout the lifecycle

Pre-participation screening and risk stratification

Social, behavioral, and attitudinal factors 

After training, the learner will be able to: 

Knowledge Objectives: Medical Students

Describe the beneficial effects of physical activity and the detrimental effects of inactivity

on the cardiovascular, musculoskeletal, pulmonary, neurological systems. 

Identify the relative contribution of basal and resting metabolism, dietary thermogenic 

influences, and physical activity to the total daily energy expenditure (TDEE). Differentiate 

between moderate and vigorous activity; classify various physical activities by their energy

expenditure rates. 

List the four compartments of the body used to determine body composition. Identify different 

regional patterns of adipose tissue deposition and the influence of caloric intake on body fat. 

Describe the cardiovascular and metabolic responses to short-term and long-term physical activity. 

Explain how varying levels of physical activity influence an individual’s nutritional requirements. 

Knowledge Objectives: Residents

For patients at any age, identify the appropriate type, intensity, quantity, frequency, and duration of

physical activity as influenced by the energy balance requirements. 

Classify individuals according to standardized levels of physical activity and physical fitness. List 

four measures commonly used to assess a patient’s level of physical activity and physical fitness. 

Knowledge Objectives: Specialists 

Describe how differences in total skeletal muscle mass, total adiposity, and regional 

adiposity patterns can influence selected components of the total energy expenditure (TEE) 

and caloric balance. Explain how physical activity affects body composition and how body

composition in turn affects health (e.g., insulin resistance, hyperlipidemia, atherosclerosis). 

Summarize the 2000 American College of Sports Medicine (ACSM) Exercise Testing and 

Prescription Guidelines for pre-participation health screening and risk stratification for preventive 

and rehabilitative exercise programs. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

B.5: Physical Activity 

 

Practice Behavior Skills: Medical Students 

Conduct an appropriate exercise history.

Practice Behavior Skills: Residents

Given a detailed medical history that includes a physical activity assessment, prescribe an 

appropriate regimen of diet and exercise for patients at varying levels of risk for 

cardiovascular disease (CVD). 

Effectively counsel an individual to adopt and maintain a level of physical activity consistent with 

the 1999 Patient-Centered Assessment and Counseling for Exercise and Nutrition (PACE) 

guidelines. 

Evaluate an individual’s physical activity and physical fitness levels using the ASCM’s Guidelines 

for Exercise Testing and Prescriptions (2000). 

Practice Behavior Skills: Specialist

Given a detailed medical history for an individual that includes an eating disorder, heavy exercise, 

amenorrhea, and/or fad diet/nutritional supplement use, prescribe an appropriate regimen of diet 

and physical activity. 

Attitude Objectives: All Learners 

Recognize that physicians can have a substantial positive impact on an individual’s level of 

physical activity. 

Demonstrate a personal commitment to evaluate the physical activity needs of all patients and 

promote adequate levels of exercise to prevent disease and promote physical and mental health.

Demonstrate a commitment to discourage sedentary lifestyles in patients as well as to encourage 

simple physical activity (e.g., walking, gardening) for patients who are not compliant or for whom 

vigorous activity is inappropriate. 

Demonstrate a personal commitment to serve as a positive role model for patients by maintaining 

a healthy personal lifestyle. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

C. Lifespan 

 

C. Lifespan 

C.1 Pediatrics 

C.2 Young Adulthood/Middle Age 

C.3 Geriatrics 

C.4 Women’s Health 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

C.1: Pediatrics 

 

C.1: Pediatrics 

Content Areas 

Premature infants, infants, toddlers, children and adolescents 

Growth and development 

Breast feeding versus formula feeding 

Introduction to solid foods 

Food preferences and feeding problems 

Vitamin and mineral requirements/deficiencies and recommendations 

Failure to thrive, malnutrition 

Iron deficiency anemia 

Dental caries

Overweight and obesity 

Eating disorders (anorexia and bulimia) 

Special nutrition programs for children 

Prevention and lifestyle modification

Physical activity 

After training, the learner will be able to 

Knowledge Objectives: Medical Students 

Identify the nutritional, metabolic, immunologic, social, economic, and long-term health 

benefits of breast-feeding. 

Describe at least one nutritional intervention effective for preventing each of the following 

pediatric diseases: dental caries, obesity, type 2 diabetes, and cardiovascular disease. 

Summarize the short-term and long-term impacts of malnutrition on the physical and cognitive 

development of infants, children, and adolescents. 

Summarize the recommendations for healthy nutrition of infants, children, and adolescents by 

age, gender, and activity level as proposed by relevant medical societies and governmental 

agencies. 

Compare and contrast the complete nutritional needs of adolescents of varying levels of physical 

activity, particularly teens engaged in vigorous sports. 

Knowledge Objectives: Residents 

Compare and contrast the complete nutritional needs of well infants, children, and 

adolescents with those who have celiac disease, food allergies, type 1 diabetes, 

inflammatory bowel disease, or cystic fibrosis. 

Compare and contrast the energy, protein, and mineral needs of premature, low-birth weight, and 

normal-birth weight infants. 

Differentiate between anorexia and bulimia as to etiology, signs, symptoms, and nutritional 

treatment. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

C.1: Pediatrics 

 

Practice Behavior Skills: Medical Students 

Take an appropriate pediatric medical history, including growth parameters, dietary intake, 

level of physical activity, and family/social history.

Conduct a pediatric physical examination, including anthropometrics and evaluate the child 

for normal development and signs of nutritional deficiency or excess. 

Evaluate the length/height, weight, head circumference, and Body Mass Index (BMI) of an 

infant, child, or adolescent over time against the appropriate growth charts published by

the US Centers for Disease Control and Prevention (CDC). 

Practice Behavior Skills: Residents 

Given a detailed pediatric diet and medical history, evaluate the appropriateness of the 

child’s diet and propose a diet consistent with maintaining health. 

Select laboratory tests and diagnostic procedures appropriate to assess, support, and 

manage the nutrition of infants, children, and adolescents. 

Effectively counsel families with children to develop and maintain healthy eating habits. 

Refer families to the Women, Infants, and Children (WIC) Program or other pediatric nutrition 

counseling interventions to support the nutritional needs of their infants and children as 

appropriate.

Attitude Objectives: All Learners 

Actively support the mother who chooses breast-feeding and refer the mother to support 

programs and lactation consultants as appropriate. 

Recognize the need to attend to the unique behavioral, psychosocial, and developmental 

characteristics of children and adolescents in the design of nutritional interventions for these 

patients. 

Demonstrate a commitment to utilizing a multi-disciplinary team approach to managing the 

nutrition of infants, children, and adolescents as appropriate. 

Recognize that childhood nutrition can have both short-term and long-term, and sometimes 

irreversible, effects. 

Demonstrate a commitment to encourage adolescents to adopt a pattern of appropriate lifelong

physical activity. 

Show sensitivity to the unique power of social influences on children and adolescents and to their 

special nutritional needs. 

Recognize the need to take the family context into account when managing the nutrition of children 

and adolescents. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

C.2: Young Adulthood/Middle Age 

 

C.2: Young Adulthood/Middle Age 

Content Areas

Food preparation 

Vitamin and mineral requirements/deficiencies and recommendations 

Preconception nutrition counseling 

Nutrition counseling for the active adult 

Nutritional effects of smoking and alcohol use 

Prevention and lifestyle modification

Physical activity 

After training, the learner will be able to

Knowledge Objectives: Medical Students

Identify at least four chronic diseases common to young and middle-aged adults, and 

identify at least one effective nutritional modification used to prevent and/or treat each. 

Explain the metabolic and morphologic changes involved in growth and development during the 

transition from adolescence to adulthood. 

Summarize the current US Dietary Guidelines and the USDA Food Guide Pyramid. 

Cite the prevalence of alcohol and tobacco use among young adults, and describe the most 

common nutritional effects of tobacco and excessive alcohol use. 

Compare and contrast the components of the Dietary Reference Intake (DRI), including

Recommended Dietary Allowance (RDA), Adequate Intake (AI), and Upper Limit (UL); describe the 

appropriate use for each.

Knowledge Objectives: Residents 

Identify the prevalence of eating disorders by age and gender. Identify at least four special 

populations (e.g., wrestlers and models) at high risk for eating disorders. 

Knowledge Objectives: Specialists

Summarize the published nutritional recommendations for adults who engage in differing levels of

physical activity according to the various governmental/professional medical/nutrition

organizations. 

Practice Behavior Skills: Medical Students 

Take an appropriate medical and dietary history of a healthy young adult; evaluate the 

patient’s nutritional status and identify any nutritional concerns. 

Take a 24-hour diet recall history, assessing the appropriateness of food intake using the 

USDA Food Guide Pyramid and the US Dietary Guidelines. 

Effectively demonstrate how to interpret a food label to a young or middle-aged patient. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

C.2: Young Adulthood/Middle Age 

 

Practice Behavior Skills: Residents 

Effectively counsel young adult and middle-aged patients to make informed nutritional 

decisions consistent with maintaining a healthy lifestyle and preventing disease, 

establishing appropriate dietary, physical activity, and behavioral goals and adopting 

strategies to achieve and maintain these goals. 

Given a medical history including a 24-hour dietary recall, evaluate the nutritional status of 

a woman of childbearing age, determine the potential risk to a fetus should conception 

occur, and provide appropriate nutritional recommendations. 

Based on an accurate assessment of the physician’s own knowledge and limitations, seek 

consultation with and refer young adult and middle-aged patients to a registered dietician 

other credentialed nutrition professionals as appropriate. 

Provide effective individualized nutrition counseling to young adult and middle-aged patients, 

taking into account level of physical activity, dietary intake patterns, and general health status. 

Interact sensitively, effectively, and professionally with persons from diverse cultural,

socioeconomic, educational, and professional backgrounds.

Attitude Objectives: All Learners 

Recognize that the influences of society during young adulthood (busy schedules, eating 

restaurant foods, etc.) have nutritional implications and may make optimum nutritional choices 

difficult.

Demonstrate a commitment to answer patients’ nutrition-related questions and counsel young and 

middle-aged adults about the impact that daily nutritional choices can have on their long-term 

health and/or the health of their unborn children. 

Recognize the importance of sound nutritional choices for both healthy and ill individuals. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

C.3: Geriatrics 

 

C.3: Geriatrics 

Content Areas 

Physiologic changes in nutrient metabolism and absorption associated with aging 

Alterations in nutrient requirements with aging 

Functional status 

Vitamin and mineral requirements deficiencies and recommendations 

DETERMINE Your Nutrition Health Checklist 

Subjective Global Assessment 

Chronic diseases 

Malnutrition 

Obesity and overweight 

Osteoporosis 

Prevention and lifestyle modification

Physical activity 

Medical nutrition therapy 

After training, the learner will be able to

Knowledge Objectives: Medical Students

Describe the physiologic changes associated with aging and the effects of these changes 

on nutrient requirements, absorption, and metabolism. 

Identify five common risk factors for poor nutritional status in older individuals.

List five pathophysiological conditions common among older individuals that affect nutritional 

status. 

Describe the effects of malnutrition on physiologic function in geriatric patients. 

Describe how the process of aging alters the nutritional needs and the functioning of the 

gastrointestinal tract of older individuals, especially the absorption of essential vitamins. 

Knowledge Objectives: Residents 

Compare and contrast pharmacological and non-pharmacological approaches to managing 

high blood pressure and diabetes in older patients. 

Given any one of the four most common aging-related nutritional conditions, describe the 

appropriate nutrition management options. 

Cite the prevalence of hunger and food insecurity among older individuals, and identify three 

locally available food programs that service this population. 

Outline a typical medical, social, economic, psychological profile of an older patient with one of the 

four most common aging-related nutritional conditions. 

Practice Behavior Skills: Medical Students 

Take a thorough medical history and an assessment of functional status of an older patient, 

including alcohol use, abuse, and dependence. 

Conduct a physical examination of an apparently healthy geriatric patient, employing instruments 

such as the “Mini Nutritional Assessment” (MNA), the “Subjective Global Assessment” (SGA), and 

the DETERMINE Your Nutritional Health Checklist. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

C.3: Geriatrics 

 

Practice Behavior Skills: Residents 

Given an elderly patient’s medical and dietary history and functional status, physical 

examination, laboratory assays and other diagnostic tests, recognize extant malnutrition, 

and plan an appropriate nutrition and exercise intervention. 

Given an older patient with a nutrition-related health problem, seek consultation with and refer 

patients to healthcare professionals as appropriate. 

Propose, monitor, and revise as necessary an appropriate plan of treatment for a geriatric patient

with a nutritional deficiency. 

Compare and contrast the utility of a food-first approach to maintaining geriatric health and treating 

disease vs. the use of nutritional supplements and vitamin/mineral formulas. 

Attitude Objectives: All Learners 

Provide nutritional counseling that is sensitive to the physiologic, emotional, social, and monetary 

changes that occur with aging. 

Demonstrate a commitment to identify malnutrition in older patients and to prescribe appropriate

nutrition support. 

Demonstrate a commitment to inquire about the nutritional health of older patients. 

 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

C.4: Women’s Health 

 

C.4: Women’s Health 

Content Areas 

Lifespan: pediatrics, adulthood, and geriatrics 

Pregnancy, lactation, menopause

Immunology and breastfeeding 

Vitamin and mineral requirements and recommendations 

Bone health 

Gender differences in common nutrition related diseases 

Effects of diabetes 

Gastrointestinal effects of female hormones 

Complementary and alternative therapies 

Prevention and lifestyle modification

Physical activity 

After training, the learner will be able to:

Knowledge Objectives: Medical Students

Identify at least three common high-risk eating patterns (e.g., low calcium intake) that may

negatively impact the growth and development of pediatric and adolescent females. 

Describe the potential metabolic, immunologic, social, economic, and health benefits of 

breast-feeding. 

Cite the current nutritional recommendations for adolescents and adult women during 

preconception, pregnancy, and lactation. Identify at least four types of foods or 

supplements that should be included or avoided in the diet during this period. 

Describe how to assess the nutritional status of adolescent and adult women during 

preconception, pregnancy (including multiple gestation), post-partum, and lactation. 

Summarize the physiological and biochemical changes that occur during and after menopause, 

and describe the nutrition effects of these changes. 

Compare and contrast the patterns of body fat distribution and weight gain in males and females. 

Differentiate between anorexia and bulimia as to etiology, signs, symptoms, effects on menstrual 

function and nutritional treatment. 

Cite the prevalence of overweight and obese individuals and those with eating disorders in the 

U.S. by age, gender, and ethnicity. 

Identify six nutrient and immunologic components of human breast milk, and describe the immune

benefits to the breast-fed child. 

Compare and contrast effective nutritional regimens for the prevention of chronic diseases in men

vs. women.

Knowledge Objectives: Residents 

Identify at least five medical conditions common to women that may increase medical 

and/or nutritional risk during pregnancy, and describe at least one intervention to 

effectively address the nutritional effects of each condition. 

Summarize the health effects of oral and implant contraceptives, including their effects on 

lipid levels, body weight, and the risk of heart disease. 

Summarize the American Diabetes Association (ADA) criteria used to diagnose type 1, type 2, and 

gestational diabetes, and outline the ADA principles for treating diabetes during pregnancy. 

Summarize the dietary and endocrine effects of common strategies for the prevention and 

treatment of breast, cervical, endometrial, and uterine cancer. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

C.4: Women’s Health 

 

Explain how energy balance and obesity are related to breast cancer development and 

reoccurrence. 

Compare and contrast the physiological and biochemical changes that occur during pregnancy 

including multiple gestation, post-partum, and lactation for adolescents vs. adult women. 

Compare and contrast the prevalence of the most common macronutrient and exercise-related 

anemias for men vs. women. 

Knowledge Objectives: Specialists 

Identify the effects of endocrine changes during pregnancy, lactation, and menopause on 

gastrointestinal function; describe the effects of hormone replacement on nutrient 

digestion and absorption. 

Compare and contrast the incidence, etiology, and morbidity in men vs. women with rheumatic 

disease, and describe effective dietary interventions for these patients. 

Practice Behavior Skills: Medical Students 

Take an appropriate medical history and assess the nutritional status of an adolescent 

female or a pregnant and/or lactating woman, including family, social, nutritional/dietary, 

physical activity, and weight histories; use of prescription medicines, over-the-counter 

medicines and dietary supplements; and consumption of alcohol and other recreational 

drugs. 

Given the pre-pregnancy height and weight, calculate a patient’s Body Mass Index (BMI) 

and identify appropriate weight gain goals for normal-weight, underweight, and overweight 

pregnant women. 

Given a detailed medical, obstetric, dietary, and social history of a female of any age and weight, 

evaluate the patient’s risk of developing chronic disease. 

Perform an appropriate history and physical examination of an overweight or obese female child,

adolescent, or adult, and accurately assess her nutritional status. 

Practice Behavior Skills: Residents

Effectively counsel female patients of any age and weight to make informed nutritional decisions 

consistent with maintaining a healthy lifestyle, establishing appropriate dietary and behavioral 

goals, and adopting strategies to achieve and maintain these goals. 

Attitude Objectives: All Learners 

Maintain due vigilance to recognize any early signs and symptoms of eating disorders in females. 

Actively support women who choose to breast-feed. 

Demonstrate a commitment to consider a diagnosis of cardiovascular disease in both men and 

women equally. 

Demonstrate a commitment to counsel women of all ages about the impact of daily nutritional 

choices on their long-term health and/or the health of their unborn children. 

Recognize the right of a pregnant woman to decide whether or not to breast-feed her infant. 

Demonstrate a sensitivity to the unique physiological and behavioral characteristics of each female 

in your medical practice.

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

D.1: Hyperlipidemia/Atherosclerosis

 

D.1: Hyperlipidemia/Atherosclerosis 

Content Areas 

Cholesterol 

Lipoproteins 

Hyperlipidemia 

Metabolic Syndrome 

Dietary fatty acids 

Antioxidants 

Vitamin and methionine influences on homocyst(e)ine levels 

Fiber: soluble and insoluble 

Complex carbohydrate 

Alcohol 

Plant sterols and stanol ester 

Sodium 

National Cholesterol Education Program and American Heart Association dietary guidelines 

Prevention and lifestyle modification 

Physicial activity 

Medical nutrition therapy 

After training, the learner will be able to:

Knowledge Objectives: Medical Students 

Describe how fatty acids and cholesterol are absorbed in the intestine and how the body 

controls cholesterol absorption, including the role of the ABC protein. 

Outline the pathways of cholesterol and triglyceride transport between tissues and identify sites 

of regulation that influence VLDL, LDL, and HDL levels. 

Describe the role of the three major lipoprotein classes in atherogenesis.

Identify the effects of saturated, monounsaturated and polyunsaturated fatty acids on plasma 

LDL and cholesterol levels. 

Identify at least three common foods that are high in cholesterol, saturated, monounsaturated 

and polyunsaturated fatty acids. 

Compare and contrast the structure of saturated fatty acids and trans fatty acids and 

their differential effects on atherogenesis. 

Identify at least three common foods high in n-3 fatty acids. 

Evaluate the utility of lowering homocyst(e)ine levels to prevent atherosclerosis. 

Outline homocyst(e)ine metabolism and the roles of folate, B6 and B12. 

List at least two common foods high in folate, B6, B12, or methionine. 

Distinguish between soluble and insoluble fiber.

Identify at least three common foods that are high in soluble and insoluble fiber. 

Describe the effects of soluble and insoluble fiber on LDL and triglyceride levels. 

Identify the effects of soluble and insoluble fiber on the absorption of bile acids and simple 

sugars. 

Compare and contrast the effects of complex carbohydrates and simple sugars on plasma 

glucose and triglyceride levels. 

Identify at least five common foods that are high in complex carbohydrates. 

Items in this section are placed in sequential order according to topic rather than rank.

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

D.1: Hyperlipidemia/Atherosclerosis

 

Describe the effect of the level of alcohol consumption on VLDL and HDL in normal and 

hypertriglyceridemic persons and any subsequent effect on atherosclerosis. 

Describe how plant sterols and stanols influence cholesterol absorption and LDL levels. 

Identify at least three common foods that are high in dietary sodium, calcium, and potassium. 

Identify NCEP ATP-III criteria defining the metabolic syndrome. 

Explain how weight loss affects LDL and HDL levels, insulin resistance, abdominal 

obesity, glucose intolerance, hypertriglyceridemia, and the risk of diabetes. 

Summarize the Therapeutic Lifestyle Change (TLC) diet recommendation of the National 

Cholesterol Education Program (NCEP). Compare the TLC Diet with diets advocating 

extremely low or high fat intakes and the expected effects on levels of the major classes 

of lipoproteins. 

Knowledge Objectives: Residents

Evaluate the utility of lowering homocyst(e)ine levels to prevent atherosclerosis. 

Provide at least two examples of individual genetic variations affecting the efficacy of the 

nutritional management of cardiovascular disease. 

Describe the gender-related differences in energy balance, diet-associated lipoprotein 

levels, and the incidence of CVD. 

Describe the controversy surrounding the use of antioxidant vitamin supplements/foods to 

prevent CVD. 

Knowledge Objectives: Specialists 

Explain the effects of the metabolic pathways from N-6 and N-3 fatty acids to prostaglandins on 

vascular reactivity and platelet aggregation. 

Explain the effects of N-3 fatty acids on plasma triglyceride levels and cardiac electrical 

conduction. 

Describe the effects of altering dietary folate, B6, B12, or methionine on homocyst(e)ine 

levels and CVD risk. 

Describe at least five dietary intervention clinical trials and five observational studies 

that demonstrated a reduction in the incidence of CVD, and identify the specific dietary

constituents associated with cardiovascular health in each study.

Estimate and justify with scientific evidence the total quantitative benefit achievable from 

combining at least five diet and exercise modifications in the prevention of 

cardiovascular disease. 

Describe the controversy regarding the vascular benefit of adding antioxidant vitamins and 

foods to the diet.

Take a comprehensive patient medical history, and identify any risk factors and 

symptoms of cardiovascular disease present. 

Take an appropriate nutrition history to determine the intake of saturated fat, cholesterol, 

sodium, soluble fiber, fruits, vegetables, complex carbohydrates, alcohol and vitamin, 

mineral and herbal supplements. 

Conduct a focused physical examination that includes assessment of abdominal obesity

estimated by waist circumference and accumulation of cholesterol in the skin, tendons, 

and eyes. 

Given a patient’s medical history, select appropriate lipid laboratory tests to estimate CHD risk 

using the NCEP ATP III Guidelines.

Distinguish between normal and abnormal serum concentrations of total cholesterol, LDL 

cholesterol, HDL cholesterol, and triglycerides using NCEP ATP-III criteria. 

Items in this section are placed in sequential order according to topic rather than rank.

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

D.1: Hyperlipidemia/Atherosclerosis

 

Assess a patient’s risk using the Framingham Risk Assessment Tool for Estimating 10-year Risk 

of Developing CHD. 

Given a patient’s medical history and the results of appropriate lipid laboratory tests, 

propose an optimal set of goals for nutritional risk factor reduction using the NCEP and 

AHA guidelines for nutrition and exercise. 

Recognize the cumulative significance of appropriate dietary fats and maintaining a diet in the 

prevention of CVD. 

Demonstrate a commitment to promoting dietary and lifestyle modifications that can diminish the 

risk of cardiovascular disease. 

Recognize the value of a cardiovascular disease prevention diet for nutritional health in general, 

including maintaining normal body weight. 

Demonstrate a personal commitment to serve as a positive role model for patients by 

maintaining a healthy diet and active lifestyle consistent with reducing CVD risk. 

Encourage fellow physicians to refer patients with CVD or CVD risk to registered dietitians 

or other credentialed healthcare professionals as appropriate to assist with medical 

nutrition therapy goals.

Food examples for some of knowledge objectives 

Foods high in 

Cholesterol: egg yolks, shrimp, liver, kidney 

 Saturated fat: Palm oil, coconut oil, whole milk and cheese, fatty red meat

 Monounsaturated fat: olive oil, avocado, canola oil, nuts 

 Polyunsaturated fat: safflower oil, corn oil, soybean oil, sunflower oil 

N-3 fatty acids: salmon, herring, halibut, flax seed, nuts 

Folate: brewers yeast, orange juice, liver, legumes, leafy vegetables, fortified grain products 

 Vitamin B6: Meat, poultry, fish, green leafy vegetables, whole grains, legumes 

Vitamin B12: Meat, poultry, fish, eggs, dairy products 

Methionine: whole grains, sesame seeds, sunflower seeds, brewer’s yeast 

Sodium: canned, frozen and dehydrated foods, chips, restaurant food 

Potassium: Fruits and vegetables, milk, potatoes 

Calcium: dairy products, calcium-fortified foods (e.g. orange juice, cereals)

Examples of genetic variations/control of cholesterol levels: 

2 examples 

Apo E4: raises LDL 

Apo A-IV polymorphisms: may reduce response to dietary cholesterol 

Items in this section are placed in sequential order according to topic rather than rank.

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

D.2: Hypertension 

 

D.2: Hypertension 

Content Areas 

Insulin resistance syndrome 

Sodium 

Potassium 

Calcium 

Magnesium 

Alcohol 

Prevention and lifestyle modification

Physical activity

Dietary Approaches to Stop Hypertension (DASH) Diet 

Medical nutrition therapy 

After training, the learner will be able to:

Knowledge Objectives: Medical Students

Explain the effects of abdominal obesity, insulin resistance, lack of physical activity, high 

sodium intake, and high alcohol consumption on blood pressure control in both 

hypertensive and non-hypertensive individuals; explain possible mechanisms for each 

effect. 

Summarize the recommendations of the DASH-sodium diet. 

Describe the metabolic and pathophysiologic consequences of hypertension including

cardiovascular, cerebrovascular, and peripheral vascular disease. Identify those forms of 

hypertension that are responsive to nutritional management. 

Explain how high intake of sodium and low intake of calcium, potassium, and magnesium affect 

the control of blood pressure in normal and hypertensive individuals. 

List at least five common foods that contain large amounts of each of the following: sodium, 

calcium, potassium, and magnesium. 

Knowledge Objectives: Residents 

Summarize the scientific evidence evaluating the effectiveness of the DASH-sodium diet, 

and describe when it should be prescribed. 

Compare and contrast the DASH-sodium diet with the National Cholesterol Education Program 

(NCEP) Therapeutic Lifestyle Changes (TLC) Diet. 

Practice Behavior Skills: Medical Students 

Take an appropriate medical history that includes family history of hypertension; duration 

of hypertension; recent weight change; sequelae of co-morbid conditions including 

cardiovascular, cerebrovascular, and renal diseases; and use of prescribed and over-thecounter medications and nutritional supplements. 

Based on the current Joint National Committee on Prevention, Detection, Evaluation, and 

Treatment of High Blood Pressure (JNC 6), differentiate between patients who, in addition to 

lifestyle modification, require medication and/or dietary modification for the control of blood 

pressure. 

Take an appropriate social and dietary history, including an assessment of the patient’s diet, 

exercise patterns, and weekly alcohol consumption, and identify areas of concern. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

D.2: Hypertension 

 

Practice Behavior Skills: Residents 

Provide effective individualized dietary counseling for hypertensive patients, focusing on 

body weight, energy balance, and dietary intake of fruits, vegetables, sodium, potassium, 

calcium, magnesium, and total and saturated fat. 

Consult with a registered dietitian as appropriate to prioritize dietary guidelines and lifestyle 

changes for hypertensive patients with or without other common chronic diseases. 

Clearly explain to a patient what the DASH-sodium diet is and how it works; effectively support the 

patient who adopts the DASH-sodium diet. 

Attitudes Objectives: All Learners 

Recognize the value of a healthy diet and lifestyle in the prevention and treatment of patients with 

hypertension. 

Demonstrate a commitment to utilize a multi-disciplinary team approach in medical care, seeking 

consultation with and referring patients to registered dietitians and other credentialed healthcare 

professionals as appropriate. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

D.3: Heart Failure and Cardiomyopathy 

 

D.3: Heart Failure and Cardiomyopathy 

Content Areas

Nutritional causes of cardiac failure 

Pathophysiology of cardiac cachexia 

Exercise regimens and restrictions

Herbal supplement-nutrient/drug interactions 

Medical nutrition therapy 

After training, the learner will be able to:

Knowledge Objectives: Medical Students

List at least eight physical signs and symptoms of congestive heart failure. 

Summarize the dietary and hygienic modifications that should be recommended to patients with 

congestive heart failure.

Knowledge Objectives: Residents 

Identify at least three nutritional deficiencies and two toxins that may precipitate heart 

failure; explain the mechanism of each effect. 

Identify the two most common pharmacologic regimens used to treat heart failure, and identify the 

two most common drug-nutrient interactions. 

Describe how heart failure may lead to cardiac cachexia. 

Practice Behavior Skills: Residents 

Take an appropriate nutrition history to determine whether a patient’s heart failure is due at 

least in part to a nutritional cause, and evaluate the level of each of the following in the diet: 

alcohol, salt, potassium, calcium, magnesium, selenium, total and saturated fat, and herbal 

supplements. 

Based on an accurate assessment of the physician’s own knowledge and limitations, seek 

consultation with and refer patients to registered dieticians or other credentialed healthcare 

professionals as appropriate. 

Attitude Objectives: All Learners 

Recognize the importance of nutritional deficiencies as potential causes of heart failure. 

Demonstrate a commitment to promoting a healthy diet and lifestyle modification in patients with

congestive heart failure.

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

E. Metabolic/Endocrine Systems 

 

E. Metabolic/Endocrine Systems 

E.1 Obesity 

E.2 Diabetes Mellitus 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

E.1: Obesity 

 

E.1: Obesity 

Content Areas 

Diagnosis: BMI and waist circumference 

NHLBI Obesity Guidelines 

Metabolic and pathophysiology consequences 

Epidemiology 

Etiology 

Treatment : behavioral, pharmacological, surgical, dietary 

Fad diets 

Prevention and lifestyle modification

Physical activity 

Medical nutrition therapy 

After training, the learner will be able to:

Knowledge Objectives: Medical Students 

State the National Heart Lung and Blood Institute (NHLBI) guidelines used to classify a 

person as overweight and/or obese. 

Describe the metabolic and pathologic consequences of being overweight or obese as 

associated with the following chronic disorders: hypertension, insulin resistance, and 

dyslipidemia. Explain the mechanism by which each disorder results in these effects. 

Identify at least four effective changes to daily activity regimens that can be used to prevent 

excessive weight gain and at least two behavioral strategies for sustaining appropriate weight 

following weight reduction. 

Describe the risks and benefits of the following non-traditional weight loss interventions: 

pharmaceutical treatments, very low calorie diets, the protein sparing modified fast, and surgical 

treatment. 

Give at least four examples of specific changes in diet, exercise, and other behaviors (e.g., 

consuming smaller food portions) that promote optimal health, and explain how each change 

results in its specific effect. 

Identify those stages of life when becoming overweight or obese is most likely to occur, and 

identify effective strategies that medical professionals can use to help patients prevent excess 

body weight. 

Compare and contrast the clinical usefulness of each of the following measures in predicting 

morbidity and mortality: body weight and height, waist circumference, percent body fat, Body 

Mass Index (BMI), and body fat distribution. 

Cite the prevalence of persons who are overweight or obese in the U.S. by age, gender, and 

ethnicity. 

Identify at least three characteristics or behaviors of people who are most successful at 

maintaining appropriate weight after a weight loss regimen. 

Knowledge Objectives: Residents

Outline and evaluate the evidence evaluating the short-term and long-term efficacy of 

various commonly adopted diets, such as the Zone, Atkins, Weight Watchers, LA Weight 

Loss, Sugar Busters, and Jenny Craig diets. 

Given the weight, height, age, and sex of a child or adolescent, assess the patient’s risk of 

becoming overweight or obese as an adult in the U.S. using the US Centers for Disease Control 

and Prevention (CDC) pediatric BMI growth charts. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

E.1: Obesity 

 

Identify common metabolic and pathophysiologic consequences of specific nutritional regimens 

used to treat common obesity-related morbidity in ambulatory and inpatient (ICU and non-ICU) 

care, and explain the mechanism of each effect.

Knowledge Objectives: Specialists

Explain how an individual’s genetic makeup, metabolism, diet, physical activity, and 

weight history affect body weight and responsiveness to dietary interventions. 

Compare and contrast the CDC recommendations for the treatment of childhood obesity vs. the 

NHLBI recommendations for the treatment adults who are overweight or obese. 

Practice Behavior Skills: Medical Students 

Take an appropriate dietary and social history including family history of being overweight 

or obese, develop an appropriate differential diagnosis, and design an effective nutritional 

management plan. 

Perform an appropriate physical examination for an overweight and/or obese child, 

adolescent, or adult; measure the patient’s body weight and waist circumference, 

determine the percent body fat, calculate the BMI, estimate the patient’s body fat 

distribution, and evaluate the patient for other signs and symptoms of weight related 

morbidity.

Effectively educate patients about the goals they can realistically expect to achieve, as well as 

the potential complications of common therapies for overweight or obese individuals.

Practice Behavior Skills: Residents

Appropriately refer overweight or obese patients for individualized nutrition therapy based on the 

NHLBI guidelines. 

Identify the five dietary supplements most commonly used in weight reduction plans, and 

compare and contrast their efficacy.

Attitude Objectives: All Learners 

Recognize that being overweight or obese has become a national epidemic of increasing 

prevalence in the United States, and appreciate the value of as little as a 10% decrease in weight 

on co-morbidities or even maintaining body weight for those likely to become more obese. 

Demonstrate a commitment to utilizing a multi-disciplinary team approach to the medical care of

overweight and/or obese patients. 

Demonstrate sensitivity to the social, emotional, and psychological factors that may affect an 

individual’s behavior and body image. 

Demonstrate a commitment to interact with overweight and/or obese patients in a non-judgmental 

manner. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

E.2: Diabetes Mellitus 

 

E.2: Diabetes Mellitus 

Content Areas 

Glucose metabolism 

Insulin secretion and sensitivity 

Diagnostic criteria and classification 

Epidemiology 

Hyperlipidemia 

Prevention and lifestyle modification

Physical activity 

Medical nutrition therapy 

After training, the learner will be able to:

Knowledge Objectives: Medical Students

Identify the minimum components of a healthy diet and lifestyle for the prevention of Type 

2 diabetes. 

Describe the most common macrovascular, renal, retinal, and neural complications 

associated with diabetes mellitus and describe the role of glycemic control and diet in 

reducing the secondary complications of diabetes. 

Explain how endocrine system control of nutrient metabolism maintains energy 

balance in normal and diabetic individuals. 

Differentiate between the short-term and the long-term effects of macronutrients 

on insulin secretion and insulin sensitivity in diabetes mellitus.

Knowledge Objectives: Residents

Summarize the current Nutrition Recommendations and Principles for People with

Diabetes Mellitus developed by the American Diabetes Association and American 

Dietetics Association, and compare and contrast the dietary goals for persons with Type 1

vs. Type 2 diabetes. 

Describe and classify the hyperlipidemia seen in patients with diabetes mellitus, and 

explain how glycemic control, diet, and weight loss can be used to correct plasma lipid 

levels. 

Explain how to choose an appropriate drug therapy on the basis of pharmacokinetics and 

endogenous insulin secretion and resistance.

Practice Behavior Skills: Medical Students 

Take a thorough nutritional and physical activity history of a person with diabetes, 

including an assessment of the (a) family history of diabetes mellitus, (b) onset and 

duration of diabetes symptoms, and (c) evidence of complications, as well as the patient’s 

(a) weight history, (b) usual dietary intake, (c) frequency, intensity, and duration of 

physical activity, and (d) use of medications, and (e) alcohol consumption, and identify

any problem areas. 

Conduct an appropriate physical examination for a patient with diabetes including assessments 

of height, weight, Body Mass Index (BMI), body fat, fundus, feet, vascular sufficiency and 

peripheral neuropathy. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

E.2: Diabetes Mellitus 

 

Practice Behavior Skills: Residents 

Given a detailed scenario describing a patient with diabetes, provide individualized dietary 

counseling that takes into account insulin regimen, type of diabetes, total calorie requirements for 

weight maintenance or weight loss, carbohydrate counting, glucose and lipid goals, and timing of 

eating. 

Seek consultation with a registered dietitian, a certified diabetes educator, or other credentialed 

nutrition professionals as appropriate. 

Attitude Objectives: All Learners

Demonstrate a personal commitment to the importance of diet and exercise in preventive 

medicine by serving as a positive role model for patients with diabetes. 

Recognize the central importance of nutrition in the maintenance of health, and demonstrate a 

commitment to support patient adherence to the Nutrition Recommendations and Principles for 

People with Diabetes Mellitus accepted by the American Diabetes Association. 

Recognize the importance of patient self-motivation and demonstrate a commitment to shared 

decision making with diabetic patients. 

Recognize the value of utilizing a team approach in the treatment of diabetes mellitus that 

includes registered dietitians, certified diabetes educators, exercise physiologists, clinical 

psychologists/behavioral medicine specialists, nurse practitioners, and clinical pharmacists. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

F.1: Gastrointestinal Disease 

 

F.1: Gastrointestinal Disease 

Content Areas 

Overview of function: digestion and absorption 

Peptic ulcer disease 

Gastroesophageal reflux disease 

Liver disease 

Short bowel syndrome 

Malabsorption 

Dumping syndrome 

Inflammatory bowel disease (Crohn’s disease, ulcerative colitis, IBD) 

Diverticulitis/diverticulosis 

Pancreatitis 

Constipation

Nutritional consequences of GI surgery 

Fiber: soluble and insoluble 

Prevention of colorectal cancer 

Medical nutrition therapy 

After training, the learner will be able to:

Knowledge Objectives: Medical Students

Explain how common GI diseases (Crohn’s disease, ulcerative colitis, chronic pancreatitis, 

cystic fibrosis, and hepatic cirrhosis) affect a patient’s nutrition health, including effects on 

appetite, digestion/absorption, weight loss, and vitamin and mineral levels. 

Describe the processes of digestion and absorption of specific macro- and micronutrients, 

including the roles of different organs, regions, and cells in the GI tract, pancreatic and 

intestinal cell secretions, and the hepatobiliary circulation. 

Identify dietary components that interfere with or enhance the digestion/absorption of specific 

nutrients (including those that influence GI transit time, affect gastric acid secretion, or cause 

irritation of the mucosa), and explain how each component affects nutritional status. 

Describe the nutritional and metabolic consequences of small and large intestinal resection. 

Describe the relationship between dietary habits and the risk of colorectal cancer, and identify 

those dietary and physical activity changes that appear to be the most efficacious in preventing 

this type of cancer. 

Knowledge Objectives: Residents

Identify the four most common causes of diarrhea and constipation, outline the direct 

nutritional effects of each condition on patient nutritional status, and describe the 

nutritional treatment regimen most commonly used to treat each condition. 

Explain how to determine when a patient’s diet should be advanced from NPO to solid foods after

major GI surgery. 

List the indications for fecal fat, d-xylose, and hydrogen breath tests, and explain how to interpret 

the results of each test. 

Identify the potential nutritional consequences of medications used to treat GI diseases. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

F.1: Gastrointestinal Disease 

 

Knowledge Objective: Specialists 

Identify at least four diseases of the GI system that can be treated by specialized nutritional 

support, identify three specific nutrients utilized, and describe the scientific evidence that 

supports this approach. 

Practice Behavior Skills: Medical Students 

Given a patient complaining of constipation, identify the likely causes and make 

appropriate recommendations to correct the condition and prevent future episodes. 

Practice Behavior Skills: Residents 

Evaluate the nutritional status of a patient with a gastrointestinal complaint by taking 

his/her medical, diet and social histories, conducting a physical examination, and selecting 

appropriate laboratory tests and diagnostic procedures. 

Effectively counsel patients to establish appropriate dietary and behavioral goals and to adopt 

strategies to achieve these goals. Develop a plan to monitor the patient’s progress and elicit 

his/her commitment.

Based on an accurate assessment of the physician’s own knowledge and limitations, seek 

consultation with and refer patients to a registered dietician or other credentialed healthcare 

professionals as appropriate. 

Practice Behavior Skills: Specialists

Given the history of a patient with GI disease, develop an appropriate nutritional management plan 

that incorporates individualized nutritional recommendations based on a patient’s nutritional status, 

food preferences, disease state, and socio- cultural-, and economic background. 

Attitude Objectives: All Learners 

Recognize the central importance of nutrition in the treatment and management of patients 

with GI disease and demonstrate a commitment to providing appropriate nutritional 

intervention (including dietary modification and enteral or parenteral nutrition therapy). 

Recognize the importance of dietary and lifestyle factors in the prevention of GI diseases. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

F.2: Hematology/Oncology

 

F.2: Hematology/Oncology 

Content Areas 

Nutritional epidemiology 

Malignancy-associated malnutrition 

Nutrition-related anemias 

Nutritional consequences of cancer chemotherapy and radiation 

Nutrition support in cancer patients 

Complementary and alternative therapies 

Prevention of cancer and anemia 

Medical nutrition therapy 

After training, the learner will be able to:

Knowledge Objectives: Medical Students

Distinguish among the various nutritional anemias, including those caused by

deficiencies of iron, folate, Vitamin B12 , and pyridoxine.

List the appropriate laboratory tests used to assess the nutritional status of 

malnourished patients, and identify tests that distinguish between nutritional anemias 

and hematopoetic disorders. 

Summarize the proposed mechanisms by which antioxidants protect against cancers. Identify 

the four antioxidants for which the evidence of efficacy is strongest. 

Summarize the proposed mechanisms by which folate, fiber, and excess dietary fat increase or 

decrease the risk of specific cancers. 

Summarize the American Cancer Society’s Dietary recommendations. 

Identify the vitamins and minerals that cause or ameliorate nutrition-related anemias, and 

explain how these effects arise. 

List at least eight common foods that are high in bioavailable iron that are appropriate for 

inclusion in the diet of a patient with iron-deficiency anemia. 

Knowledge Objectives: Residents 

List the most prevalent drug and nutrient interactions associated with cancer 

chemotherapy, and explain how each intervention can reduce the efficacy of the other. 

Explain how cancer causes malnutrition and cachexia. 

Explain how common cancer treatments alter nutritional status. 

List at least four common foods that are high in bioavailable folate and four that are high in 

Vitamin B12 that are appropriate for inclusion in the diet of a patient with a megaloblastic 

anemia. 

List at least two foods and two common medications that can increase or decrease absorption 

of each of the following: iron, folate, Vitamin B12. 

Knowledge Objectives: Specialists 

Identify the nutritional components known to enhance or prevent the initiation, 

promotion, and progression of carcinogenesis, and explain how these effects arise. 

Summarize and evaluate the epidemiological, clinical, and basic science evidence linking 

nutrients, dietary intake, obesity, smoking and lifestyle with increased cancer risk. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

F.2: Hematology/Oncology

 

Compare and contrast the strengths and limitations of randomized clinical trials, withincountry case-control trials, and cohort studies as experimental designs for the study of 

the role of nutrition in cancer. 

Define and explain how to use the Bradford-Hill criteria to evaluate the evidentiary support for 

the role of a specific nutrient in a specific type of cancer. 

Compare and contrast the different methods used to assess dietary intake and nutritional status. 

Practice Behavior Skills: Medical Students 

Take a thorough medical history that includes social and dietary history, family history of cancer, 

history of recent weight change, and use of nutritional supplements and herbal therapies. 

Given the height and weight of a patient with a common hematologic or oncologic disease, 

calculate the BMI, explain to the patient how their disease alters nutritional status, and make 

appropriate nutritional recommendations. 

Practice Behavior Skills: Residents 

Given the history of a patient with hematologic/oncologic disease, recommend therapies 

that may help to alleviate adverse chemotherapy and radiation effects including nausea, 

mouth sores, odynaphagia, dysaphagia, and diarrhea. 

Effectively counsel patients patient with a strong family history of cancer or a 

precancerous lesion to make informed nutritional decisions consistent with maintaining 

a healthy lifestyle and decreasing cancer risk, establishing appropriate dietary and 

behavioral goals and adopting strategies to achieve and maintain these goals. 

Identify oncology patients who would benefit from nutritional guidance and supplementation to 

increase energy and protein intake.

Practice Behavior Skills: Specialists

Provide individualized dietary counseling to a patient with a common hematologic or oncologic 

disease based on an assessment of dietary intake that focuses on total calories and protein, as 

well as fruits, vegetables, whole grains, and alcohol. 

Conduct a Medline search focusing on the role of specific nutrients in the development of 

cancer, classify each study by type of design, and use the Bradford-Hill criteria to evaluate the 

strength of the evidence for the role of each nutrient in oncogenesis. 

Attitude Objectives: All Learners 

Recognize the value of early nutrition intervention during cancer treatment to reduce or delay 

the development of malnutrition. 

Demonstrate a commitment to include nutritional assessment and therapy in routine patient care

to prevent cancer and anemia. 

Recognize the importance of nutrition and healthy lifestyle behaviors in the decreasing risk of 

cancer. 

Recognize the value of utilizing a team approach in the treatment of cancer that includes 

registered dietitians and other credentialed nutrition professionals, as well as exercise 

physiologists, clinical psychologists/behavioral medicine specialists, nurse practitioners, and 

clinical pharmacists. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

F.3: Immunology 

 

F.3: Immunology 

Content Areas 

Effect of nutrition and nutritional status on host defense mechanisms 

Protein-energy malnutrition 

Food allergy and intolerance 

Protein, amino acids, and nucleic acids and immune function

Lipid peroxidation 

Diet and HIV 

Breast milk 

Vitamins and minerals in immune function 

Medical nutrition therapy 

After training, the learner will be able to:

Knowledge Objectives: Medical Students 

Explain how both protein and protein-energy malnutrition alter the rate of tissue repair 

and causes immunodeficiency.

Identify the nutrient and immunologic components of human breast milk, and describe 

the effects of these components on immune response in the breast-fed child. 

Compare and contrast food allergies vs food intolerance, and describe two

pathophysiological manifestations of each. 

Explain how caloric intake influences immune competence. 

Explain how antioxidants influence lipid peroxidation and thus immune function. 

Knowledge Objectives: Residents

Identify changes in diet shown to decrease morbidity and mortality of HIV-positive patients. 

Knowledge Objectives: Specialists 

Describe the role of three vitamins and three micronutrients in the development and 

maintenance of a healthy immune system; name three common food sources of these 

nutrients. 

Practice Behavior Skills: Residents 

Evaluate a patient’s diet and his/her current nutritional status, and identify patients 

whose immune function may improve with nutritional therapy, lifestyle modification, 

and/or medication. 

Given the nutritional history of a patient, and the results of antigen skin testing, total lymphocyte 

count, and complete and differential blood counts, evaluate the nutritional status of the patient 

and prescribe an appropriate nutritional plan. 

Effectively counsel patients to make informed nutritional decisions consistent with maintaining a 

healthy immune system, establishing appropriate dietary and behavioral goals and adopting 

strategies to achieve and maintain these goals.

Given a detailed medical history and the current pharmacologic regimen of a HIV-positive 

patient with or without full-blown AIDS, provide appropriate nutritional counseling. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

F.3: Immunology 

 

Attitude Objectives: All Learners 

Recognize the importance of nutrition and healthy lifestyle behaviors in maintaining a 

healthy immune system. 

Demonstrate a commitment to life-long learning about the effectiveness of nutritional 

supplements, natural products, and herbal supplements on immune function. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

F.4: Rheumatology 

 

F.4: Rheumatology

Content Areas 

Osteo and rheumatoid arthritis 

Physical activity limitations and/or interventions 

Herbal supplement-nutrient/drug interactions 

Complementary and alternative therapies 

Physical activity 

Medical nutrition therapy 

After training, the learner will be able to:

Knowledge Objectives: Residents 

Compare and contrast the pathophysiology of osteoarthritis and rheumatoid arthritis and 

explain the relative influence of nutritional status on the progression of each disease. 

List the common pharmacologic agents used to treat rheumatoid arthritis, and identify

the most common drug-nutrient interactions. 

Given a patient history that includes rheumatoid disease the use of nutrient and herbal 

supplements, evaluate the appropriateness of this dietary regimen, and provide 

evidence-based nutritional advice about their chosen supplements. 

Effectively communicate with patients with rheumatoid disease to provide accurate 

nutritional information and dispel misinformation, including information about dietary

supplements and fad diets. 

Monitor weight changes in a patient with rhematologic disease and recommend a diet and 

physical activity plan to maintain a healthy weight. 

Identify the most commonly used dietary supplements and diets used by patients with

rheumatoid diseases, and evaluate the scientific evidence for the efficacy of each. 

Cite at least three examples of dietary supplements for which there is sufficient scientific 

evidence to warrant their use in the treatment of rheumatic disease. 

Describe the changes in body composition and eating behavior typically associated with active 

rheumatic disease. 

Evaluate the evidence that supports the use of complementary and alternative medicine to treat 

patients with rheumatoid disease. 

Summarize the benefits of incorporating physical activity in the treatment of patients with 

rheumatoid disease. 

Knowledge Objectives: Specialists 

Describe how to tailor a nutritional management plan to the physical limitations and 

rehabilitation program of patients with ankylosing spondylitis, polymyositis and 

osteoarthritis. 

Explain how schleroderma and ALS alter nutritional status. 

Practice Behavior Skills: 

Given a patient with rheumatic disease, employ specific effective counseling techniques 

matched to the patient’s status, including assessing stage of change, goal setting, problem 

solving, self monitoring, positive reinforcement, and stimulus control. 

Attitude Objectives: All Learners 

Demonstrate appropriate sensitivity to rheumatic disease patients with physical limitations. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

F.4: Rheumatology 

 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

F.5: Pulmonary Disease 

 

F.5: Pulmonary Disease 

Content Areas 

Respiratory quotient 

Chronic obstructive pulmonary disease 

Mechanical ventilation 

Obstructive sleep apnea syndrome 

Cystic fibrosis 

Medical nutrition therapy 

After training, the learner will be able to:

Knowledge Objectives: Medical Students 

Explain the association between obesity and sleep apnea, and outline the nutritional 

regimen recommended for these patients. 

Explain how acute lung injury and chronic lung diseases alter a patient’s nutritional 

requirements. 

Knowledge Objectives: Residents 

Outline the clinical evidence supporting the efficacy of nutrition therapy for malnutrition 

associated with lung disease. 

Identify recommended nutritional interventions for patients with respiratory insufficiency

that includes C02 retention and enhanced ventilatory drive; explain how these 

interventions alter the respiratory quotient (RQ). 

Identify two common nutritional side effects of the three medications most commonly used in the 

treatment of pulmonary disease. 

List the three most common respiratory complications of malnutrition among patients with 

chronic lung disease; propose an appropriate treatment plan for these patients. 

Knowledge Objectives: Specialists 

Define the nutrient composition of enteral nutrition formulas designed for critically ill 

patients on mechanical ventilation. Explain the mechanism of action of each of the 

primary constituents of these formulae. 

Outline the recommended nutritional regimen for patients with cystic fibrosis. 

Identify the immune factors that mediate inflammatory response in malnourished patients with 

chronic lung disease, and explain how response to these factors alters nutritional requirements. 

Practice Behavior Skills: Medical Students 

Given a patient with pulmonary disease, take an appropriate medical, social, diet, and

weight history that includes an evaluation of current nutritional status, and conduct a

thorough physical examination. 

Practice Behavior Skills: Residents

Given a patient with pulmonary disease, design an appropriate set of individualized dietary 

intake and weight goal recommendations. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

F.5: Pulmonary Disease 

 

Attitude Objectives: All Learners 

Recognize the importance of healthy lifestyle behaviors in the prevention and management of 

pulmonary disease. 

Demonstrate a commitment to utilizing a multi-disciplinary team approach to the treatment of 

pulmonary disease, consulting with registered dietitians, nurses, and clinical pharmacists as

appropriate.

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

F.6: Renal Disease 

 

F.6: Renal Disease 

Content Areas 

Sodium 

Potassium 

Calcium 

Phosphorous 

Fluid and electrolytes 

Acute renal failure 

Chronic renal failure (pre-dialysis) 

Dialysis 

Renal Transplantation 

Nephrotic Syndrome 

Nephrolithiasis 

Herbal supplement-nutrient/drug interactions 

Dyslipidemia or (hyperlipidemia) 

Medical nutrition therapy 

After training, the learner will be able to:

Knowledge Objectives: Medical Students

Describe the nutritional, metabolic, and clinical consequences of 

chronic renal failure.

Explain the interrelationships of renal disease and dietary factors such as protein, sodium, 

potassium, calcium, magnesium, phosphorus, and water; identify which patients need to 

restrict these nutrients. 

List the three most useful laboratory tests used to recognize nutritional causes and 

consequences of renal impairment. 

Explain how protein restriction or other changes in the nutrient composition of the diet can alter the

progression of renal disease in patients with chronic renal failure. 

List three common foods that are relatively high in each of the following: sodium, calcium, 

potassium, and phosphate; identify which patients with renal disease need to restrict these foods. 

Knowledge Objectives: Residents 

Identify the nutritional deficiencies typically found in patients with chronic renal failure 

(CRF); compare and contrast the nutritional needs of those receiving maintenance 

hemodialysis with those receiving continuous ambulatory peritoneal dialysis. 

Identify the proper modification of dietary sodium, calcium, phosphorus, protein and fluids for 

patients with recurrent nephrolithiasis, and explain how each modification decreases morbidity. 

Compare and contrast the nutritional goals of therapy for patients with end-stage renal disease 

receiving dialysis and those not receiving dialysis. 

Knowledge Objectives: Specialists

Identify the specific lipid abnormalities typically associated with CRF, renal transplantation, and the 

nephrotic syndrome and outline the recommended nutritional regimens for these patients. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

F.6: Renal Disease 

 

Practice Behavior Skills: Medical Students 

Take an appropriate medical history, including weight change, history of renal disease, co-morbid 

conditions that can impact renal disease, and use of 

prescribed and over-the-counter medications and nutritional supplements. 

Take an appropriate social and dietary history, including an assessment of the patient’s exercise 

patterns. 

Conduct an appropriate physical examination for a patient with renal disease, including height and

weight; calculate the BMI and determine the fluid status. 

Practice Behavior Skills: Residents

Consult with a registered dietitian as appropriate to provide individualized dietary

counseling based on an assessment of a patient’s dietary intake, including total calories, 

protein, total and saturated fat, sodium, potassium, calcium, phosphorus, magnesium, and 

fluid intake. 

Prioritize dietary guidelines and lifestyle changes for patients with chronic renal disease or 

recurrent nephrolithiasis, with or without other chronic diseases. 

Evaluate the diet of a patient on dialysis and refer to a registered dietitian as appropriate. 

Practice Behavior Skills: Specialists

Evaluate the diet of a renal transplant patient before and after surgery, and develop a nutritional 

plan for the patient with particular focus on the likely effects of immunosuppressive therapy. 

Attitude Objectives: All Learners 

Demonstrate a commitment to utilizing a multi-disciplinary team approach to the treatment of renal 

disease, consulting with registered dietitians, clinical psychologists/behavioral medicine 

specialists, nurse practitioners, physician assistants, and clinical pharmacists as appropriate. 

Demonstrate a commitment to promote appropriate nutrition and lifestyle modifications for patients 

with acute or chronic renal disease, nephrotic syndrome, or nephrolithiasis. 

Recognize the importance of healthy lifestyle behaviors in the treatment and management of renal 

disease. 

Demonstrate an awareness of the impact of co-morbid conditions of patients with renal diseases 

that may influence compliance with recommended changes in diet and lifestyle. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

F.7: Bone Health 

 

F.7: Bone Health 

Content Areas 

Bone mass 

Calcium 

Vitamin D 

Phosphate 

Magnesium 

Dietary supplements 

Osteoporosis and osteomalacia 

Rickets 

Prevention and lifestyle modification

Physical activity 

Medical nutrition therapy 

After training, the learner will be able to:

Knowledge Objectives: Medical Students 

List at least three widely available dietary and supplemental sources of calcium and 

vitamin D. Compare and contrast the sources in terms of its bioavailability, convenience, 

and cost. 

Describe at least three lifestyle changes that can reduce the risk of osteoporosis. 

Identify the RDI for calcium and Vitamin D, the AI for calcium, the RDA for Vitamin D, and 

describe how an individual can meet these recommendations according to the USDA 

food guide pyramid, and the Dietary Guidelines for Americans. 

Identify at least four classes of individuals at risk for developing osteoporosis, and 

compare and contrast the rationales used to explain the relationship of each to 

osteoporosis.

Explain the nutritional basis of the homeostatic mechanisms that maintain adequate bone mass, 

and describe three common pathophysiological conditions that reduce bone mass. 

List at least three medical conditions and at least three medications that typically result in 

secondary osteoporosis.

Identify at least three good sources of dietary Vitamin D, and evaluate the limitations of sun 

exposure for meeting the Vitamin D requirement. 

Explain how physiological aging typically affects the intake and metabolism of nutrients related 

to bone health. 

Identify at least three sources of calcium and Vitamin D appropriate for a patient with lactose 

intolerance. 

Knowledge Objectives: Residents

Identify at least four classes of individuals at risk for developing osteoporosis, and 

compare and contrast the rationales used to explain the relationship of each to 

osteoporosis. 

List at least two physical diagnostic tests used to identify osteoporosis. 

Knowledge Objectives: Specialists

Identify at least four examples of dietary constituents that, when in excess, may increase the

need for calcium. 

Practice Behavior Skill: Medical Students 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

F.7: Bone Health 

 

Effectively counsel pre-and post-menopausal women to maintain a level of calcium in the 

diet adequate to reduce their risk of osteoporosis. 

Practice Behavior Skill: Residents 

Effectively counsel patients of all ages to make informed nutritional decisions that 

maintain current bone health, establishing appropriate dietary and behavioral goals and 

adopting strategies to prevent future osteoporosis. 

During a physical examination, recognize common physical manifestations of late stage 

osteoporosis. 

Using the American College of Sports Medicine and NIH guidelines, effectively counsel a 

healthy adolescent or adult patient to adopt an appropriate exercise regimen to reduce the risk 

of osteoporosis, especially in females.

Conduct an appropriate physical examination of a patient at risk of osteoporosis, including an 

assessment of bone mass. 

Seek out and accurately interpret information from a wide variety of nutrition-related medical 

and lay literature, and apply that knowledge appropriately to maintain the bone health of all 

patients. 

Practice Behavior Skill: Specialists 

Identify and evaluate the dietary sources of calcium in a patient’s diet and evaluate the 

sufficiency of dietary calcium. 

Given a set of detailed medical and dietary histories, identify those patients that would benefit 

from calcium supplementation, and design an appropriate medical nutrition therapy plan for 

each. 

Attitude Objectives: All Learners 

Identify at least one psychosocial factor that commonly affects the intake of nutrients related to 

bone health at each stage of the life cycle. 

Demonstrate a commitment to encourage patients of all ages, especially adolescents, to 

maintain a proper diet adequate to sustain normal bone growth and development and prevent 

bone loss. 

Identify the toxic dose of vitamin D and describe the biological consequences 

of a vitamin D overdose. 

Demonstrate a commitment to promote sound nutritional decision-making and appropriate 

levels of physical activity for all patients regardless of health status. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

G. Other Areas 

G. Other Areas 

G.1 Nutrition Support 

G.2 Contemporary Trends 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

G.1: Nutrition Support 

G.1: Nutrition Support 

Content Areas 

Energy and substrate metabolism in health and disease 

Starvation and malnutrition 

Assessment of nutritional status 

Enteral nutrition 

Total parenteral nutrition

Enteral feeding formulas and selection of products 

Routes of administration 

Indications and contraindications 

Monitoring and complications 

Drug-nutrient interactions

Refeeding syndrome 

Hypermetabolic injury response 

After training, the learner will be able to:

Knowledge Objectives: Medical Students

Compare and contrast energy and substrate metabolism in postprandial, well-fed, short-term 

and long-term starvation states. 

Define malnutrition; describe its environmental and biological causes and clinical 

consequences. 

Knowledge Objectives: Residents 

Differentiate between the indications for enteral and parenteral nutrition support as well 

as the indications for potential delivery sites for each type of support. 

Give six examples of drug-nutrient interactions or incompatibilities that commonly occur among 

patients receiving either enteral or parenteral nutrition support.

Identify at least three measures used to monitor patients for complications of enteral and 

parenteral nutrition support; describe when each is appropriate. 

Explain the refeeding syndrome, identify the type of patient at risk for this syndrome, and outline 

the most appropriate feeding strategy to minimize metabolic complications. 

Summarize the potential metabolic consequences that result from overfeeding calories, fat, 

carbohydrate, or protein to enterally and parenterally fed patients. 

Identify the medical and social services necessary to provide effective home nutrition support, 

and outline at least four factors that should be considered before discharging a patient on 

nutrition support. 

Knowledge Objectives: Specialists 

Explain how neuro-endocrine and immunologic factors mediate the hypermetabolic 

injury response, and explain how catabolic stress affects organ and whole body nutrient 

utilization. 

Practice Behavior Skills: Residents 

Given a patient diagnosis, nutritional regimen, and on-going laboratory data, evaluate the 

effectiveness of the current nutritional treatment and appropriately manage the delivery

of enteral or parenteral nutrition support. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

G.1: Nutrition Support 

Given the results of a detailed history and physical examination of a hospitalized patient, assess 

the patient’s nutritional status and ability to take nutrition by mouth to determine the need for 

enteral or parenteral support. 

Accurately interpret information from a wide variety of medical and lay literature related to 

commonly available commercial products for nutrition support, and apply that knowledge 

appropriately to the care of patients.

Attitude Objectives: All Learners 

Recognize the adverse impacts of malnutrition on disease and the associated benefits of 

providing appropriate nutritional support. 

Recognize the importance of correcting any malnutrition in patients before surgery. 

Carefully attend to the ethical issues involved in the provision of nutritional support in palliative 

care and in settings where patients cannot provide consent. 

Demonstrate a commitment to utilizing a multi-disciplinary team approach to the management of 

patients receiving enteral or parenteral nutrition. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

G.2: Contemporary Trends

G.2: Contemporary Trends 

Content Areas 

Dietary guidelines 

Vitamins, minerals, and herbal supplements 

Food fads, fad diets, and weight loss 

Vegetarianism 

Dietary supplements 

Food safety 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

G.2: Contemporary Trends

 

Knowledge Objectives: Medical Students

Summarize the current American Heart Association (AHA), American Diabetes 

Association (ADA), National Cancer Institute (NCI), USDA, and USDHHS dietary 

guidelines for healthy Americans. 

Knowledge Objectives: Residents 

List the likely nutritional benefits and consequences of a vegetarian diet, and describe 

the typical clinical presentation of a vegetarian patient with a nutritional deficiency.

Knowledge Objectives: Specialists 

Evaluate the evidentiary basis of efficacy for the five most commonly used commercial 

weight reduction diets. 

List at least five of the most commonly used dietary supplements, and identify their 

bioactive components. 

Define the terms phytochemical, phytonutrient, and nutraceutical, give at least three 

examples of each, and evaluate the scientific evidence for the use of these supplements 

to prevent disease. 

Given a patient’s nutrition history and disease status, predict two potential Deleterious and two 

beneficial effects associated with each of five common dietary supplements. 

Define the term functional foods; evaluate the scientific evidence for or against incorporating 

functional foods into the diet for the prevention and treatment of chronic diseases. 

Practice Behavior Skills: Medical Students 

Take an appropriate and culturally sensitive diet history that includes an assessment of

use of fad foods and herbal and dietary supplements. 

Practice Behavior Skills: Residents 

Effectively communicate with patients the benefits and effects of various popular dietary

supplements, complementary and alternative medicines, and commonly used weight 

reduction programs. 

Effectively communicate with patients to provide accurate nutritional information and dispel 

misinformation, including information about dietary supplements, nutraceuticals, functional 

foods, and fad diets for weight loss or disease prevention and treatment. 

Effectively counsel patients to make informed decisions about the use of food supplements and 

adoption of commonly used weight reduction diets and programs. 

Accurately interpret contemporary nutrition information from a wide variety of scientific and lay 

literature and apply that knowledge appropriately to the care of patients.

Attitude Objectives: All Learners 

Demonstrate an accurate awareness of the limitations of his/her knowledge of nutrition. 

Demonstrate a willingness to seek out the best available medical knowledge relevant to the 

nutrition of patients. 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

G.2: Contemporary Trends

Nutrition Curriculum Guide For Training Physicians 

Appendices 

 

Appendix 1: Nutrition Academic Award Program Principal Investigators 

Appendix 2: Nutrition Curriculum Guide for Training Physicians Contributors 

Appendix 3: Description of How the Guide Was Developed

* Bold items were ranked in the top 1/3 of all objectives.
Appendix 1. NHLBI/NIDDK Nutrition Academic Award (NAA) Program 

 Principal Investigators 

Medical School Principal Investigator(s) 

Albert Einstein College of Medicine Judith Wylie-Rosett, EdD, RD and Darwin Deen, MD,MS 

Brown University School of Medicine Charles B. Eaton, MD, MS and Kim Gans, PhD, MPH, 

LDN

Columbia University College of Christine Williams, MD 

 Physicians and Surgeons 

Harvard Medical School Alan Walker, MD and Francine Welty, MD, PhD 

Mercer University School of Medicine Brian Tobin, PhD 

Northwestern University Medical School Linda Van Horn, PhD, RD 

Stanford University School of Medicine John Kerner, MD and Phyllis Gardner, MD 

Tufts University School of Medicine Margo Woods, DSc 

University of Alabama School of Medicine Frank Franklin, MD, PhD 

University of Arkansas for Medical Sciences Ronald Kahn, MD 

University of Colorado Health Science Center Nancy Krebs, MD 

University of Iowa College of Medicine Linda Snetselaar, PhD, RD 

University of Maryland School of Medicine Stephen Havas, MD, MPH 

University of Nevada School of Medicine Sachiko St. Jeor, PhD, RD 

University of Pennsylvania School of Medicine Lisa Hark, PhD, RD and Gail Morrison, MD 

University of Rochester School of Medicine Thomas Pearson, MD, PhD, MPH 

 and Dentistry 

University of Texas Southwestern Scott Grundy, MD, PhD and Jo Ann Carson, PhD, RD 

 Medial Center at Dallas 

University of Texas Medical School at Houston Marilyn Edwards, PhD, RD 

University of Vermont College of Medicine Diane Magrane, MD 

University of Washington School of Medicine Robert Knopp, MD 

University of Wisconsin Medical School Patrick McBride, MD, MPH 
Appendix 2: Nutrition Curriculum Guide for Training Physicians Contributors 

Curriculum Committee Chairs Editors 

Charles B. Eaton, MD, MS Brian W. Tobin, PhD 

Lisa Hark, PhD, RD Mike U. Smith, PhD

 Medical School Contributors 

Albert Einstein College of Medicine Darwin Deen, MD, MS, Judy Wylie-Rosett, PhD, RD 

Brown University School of Medicine Charles B. Eaton, MD, MS, 

 Kim Gans, PhD, MPH, LDN 

Columbia University College of Physicians and Surgeons Christine Williams, MD, Lars Berglund, MD

Harvard Medical School Alan Walker, MD, Frances Welty, MD, PhD

Mercer University School of Medicine Brian Tobin, PhD, Colleen Smith, PhD, 

 Mike Smith, PhD, Marie Dent, PhD, Eds

Northwestern University Medical School Linda Van Horn, PhD, RD, Alvin Telser, PhD

 Robert Kushner, MD, Marion Fitzgibbon, PhD 

Stanford University School of Medicine Elizabeth Moreno, MA, MS 

Tufts University School of Medicine Margo Woods, Dsc, Elizabeth Ross, MD 

University of Alabama School of Medicine Frank Frankin, MD, PhD, 

 Doug Heimburger, MD 

University of Arkansas for Medical Sciences Ronald Kahn, MD 

University of Colorado Health Science Center Nancy Krebs, MD 

University of Iowa College of Medicine Linda Snetselaar, PhD, RD, Joel Gordon, MD 

University of Maryland School of Medicine Steven Havas, MD, MPH 

University of Nevada School of Medicine Sachiko T. St. Jeor, PhD, RD 

University of Pennsylvania School of Medicine Gail Morrison, MD, Lisa Hark, PhD, RD 

 Andrew Tershakovec, MD, Frances Burke, MS, RD 

University of Rochester School of Medicine Thomas Pearson, MD, PhD, MPH, Scott Mcintosh, PhD 

University of Texas Medical School at Houston Marilyn Edwards, PhD, RD 

University of Vermont College of Medicine Nancy Sheard, DSc, Tracy Veach, EdD 

University of Washington School of Medicine Robert Knopp MD, Craig Scott, PhD 

 Tanis Mihalynuk, PhD, RD 

University of Wisconsin Medical School Patrick McBride, MD, MPH 
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

G.2: Contemporary Trends

Nutrition Curriculum Guide for Training Physicians 

Appendix 3: How The Guide Was Developed

Year One: During the first year of the Nutrition Academic Award (NAA) Program, it was 

determined that a Curriculum Committee should be established, with the goal to 

develop curriculum objectives for dissemination to other medical schools. Dr. Charles 

B. Eaton (Brown University) and Dr. Lisa Hark (University of Pennsylvania) were named 

as co-chairs and education experts from each NAA institution were appointed by the 

Principal Investigators. The document was entitled Nutrition Curriculum Guide for 

Training Physicians and consists of nutrition-related knowledge, practice behavior skills 

and attitudinal objectives covering the field of nutrition. The entire process was 

completed over a five year period from 1998 to 2003. 

Initial discussions identified the topics that would be included in the Guide. 

Several key research studies and consensus reports of medical educators served as 

the foundation for these decisions. These included the 1995 American Medical Student 

Association (AMSA) national consensus report which identified 92 content areas as 

“Essential for Nutrition Education in Medical Schools” (1) as well as the American 

Society for Clinical Nutrition (ASCN) Committee on Medical/Dental School and 

Residency Nutrition Education which prioritized 40 nutrition content areas within 

medical school curriculum (2). Finally, the landmark 1985 “Nutrition Education of US 

Medical Schools: “Curriculum Guidelines for Incorporating Nutrition in Medical 

Education” published by the Food and Nutrition Board, Council on Life Sciences, 

National Research Council was also an important resource (3). 

The 40 and 92 content areas in the AMSA and ASCN documents were crossreferenced and organized into 23 topics or chapters, as listed in the table of contents. 

Additional content areas felt to be important in each of the major topics were added as 

needed. A team of multidisciplinary content specialists from each of the 21 NAA schools 

contributed nutrition-related knowledge, practice behavior skills and attitudinal 

objectives for each content area within a specific topic area. The majority of the initial 

contributors and reviewers were members of the NAA Curriculum Committee 

(Appendix). Ongoing drafts underwent multiple rounds of review and revision by other 

NAA members as well. 

Year Two: During year two, Dr. Brian Tobin and Dr. Michael Smith at Mercer University 

School of Medicine were appointed the task of editing all of the objectives in order to 

produce a single, consistent format with behavioral objectives that were educationally 

sound and measurable in keeping with Mager (4). The goal has been to produce a set 

of learning objectives that aimed to promote higher levels of thinking by writing 

objectives that included an appropriate mix at both lower levels of Bloom’s Taxonomy 

(knowledge and comprehension) and objectives at higher levels (e.g., synthesis and 

evaluation) (5). Less than one quarter of the current set of objectives are at the 

knowledge level, and approximately one third are at Bloom’s synthesis or evaluation 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

G.2: Contemporary Trends

level. In addition to cognitive, knowledge-centered objectives, the Guide also includes 

learning objectives for student attitudes and practice behavior skills. Thus, each section 

includes four components: a brief list of content areas consistent with previous national 

curriculum recommendations for nutrition, knowledge objectives, practice behavior skill 

objectives, and attitudinal objectives. 

Year Three: During year three, the revised objectives were resubmitted to the NAA 

contributors for a final review and it was determined that the objectives spanned 

medical students, residents, as well as advanced level practitioners or specialists. 

Therefore, the NAA Curriculum Committee determined that it was critical for each 

objective to be ranked according to the level of the learner (medical student, resident or 

specialist), in order to prioritize the extensive list of objectives. To accomplish this task, 

a modified Delphi technique was successfully implemented under the direction of Dr. 

Craig Scott, at the University of Washington School of Medicine, who established a 

Web-based process to accomplish this arborous task. A team from each NAA school 

was responsible for categorized each objective as either a) core or essential for medical 

students , b) recommended for medical students who want more training in nutrition, c) 

appropriate for residents, or d) appropriate for specialists in post-GME programs. In 

addition, within each of these categories, reviewers were asked to rate each objective 

according to its importance in clinical medicine. Objectives that more than 50 percent of 

the reviewers rated as clinically important are bolded in order to be distinguished among 

the list. 

Year Four: During year four, the NAA Curriculum Committee agreed on the best 

possible way to list the objectives as well as dissemination strategies. It was decided 

that all objectives would be included in the first distribution of the document, since the 

nutrition content at medical schools may be at different levels and the nutrition faculty 

may be also responsible for graduate medical education as well. The medical student, 

resident and specialists objectives were also grouped together within each topic in order 

to help educators incorporate these objectives into their curriculum. 

Year Five: A Web-based version was the top priority for the Nutrition Curriculum Guide 

for Training Physicians, as we agreed that this method would be the most accessible 

and utilization could also be easily tracked. The entire document can be downloaded or 

a single topic area of interest using the links established from the table of contents 

versions in either PDF and HTML format to meet individual user’s needs. The Webbased version of the Guide can be used not only by US medical and health professional 

schools, but also by all medical schools worldwide. In addition, The Guide will be 

disseminated by a variety of professional publications and presentations (6,7) such as 

the Annual Meetings of the Association of American Medical Schools, American Society 

of Clinical Nutrition, Society of Teachers of Family Medicine and the American Dietetic 

Association. 

Lisa A. Hark, PhD, RD, Charles B. Eaton, MD and the Curriculum Committee 

* Bold items were ranked in the top 1/3 of all objectives.
Nutrition Curriculum Guide For Training Physicians 8/30/2002 

G.2: Contemporary Trends

References

1) Essentials of Nutrition Education in Medical Schools; A National consensus. 

Report of the American Medical Students Association’s Nutrition Curriculum 

Project. Academic Medicine. 1996;71:969-971. 

2) Weinsier R, Kushner RF, Visek W, et al. American Society for Clinical Nutrition 

Committee on Medical Dental School and Residency Nutrition Education. 

Priorities for nutrition content in a medical school curriculum: a national 

consensus of medical educators. Academic Medicine. 1990;65:538-40. 

3) Curriculum guidelines for incorporating nutrition in medical education. In: 

Committee on Nutrition in Medical Education, Food and Nutrition Board, Council 

on Life Sciences, National Research Council. Nutrition Education of US Medical 

Schools. National Academy Press, Washington, DC, 1985 

4) Mager R. F. Preparing instructional objectives. Palo Alto, CA: Fearon Publishers. 

1962. 

5) Bloom, Benjamin, ed. Taxonomy of educational objectives, the classification of 

education goals. Handbook I: cognitive domain. New York, NY: David McKay 

Company, Inc. 1956. 

6) Pearson TA, Stone EJ, Grundy SM, McBride PE, Van Horn L, Tobin BW. 

Translation of nutritional sciences into medical education: the Nutritional 

Academic Award Program. Am J Clin Nutr 2001;74:164-70. 

7) Tobin, B., Smith, M., Kushner, R., Hark, L., & Eaton, C. (2001). Nutrition 

curriculum guide for training physicians. FASEB Journal 2001;15(4):A1095. 

* Bold items were ranked in the top 1/3 of all objectives.