CNS® Examination Content Outline

Domains and Content Items 2024-2028

 

Domain I:  Principles of Nutrition (13% of exam) 

  • Practical application of evidenced based research 

  • Physiology of the digestive tract (motility, absorption, secretion, intestinal barrier function) 

  • Digestion, absorption, and transport of macronutrients and micronutrients 

  • Inflammatory pathways including insulin, oxidative stress, and fatty acid oxidation 

  • Effect of microbiome on metabolism of macronutrients and micronutrients, including use of probiotics and prebiotics 

  • Nutritional considerations related to physiologic changes associated with life cycle stage 

  • Effect of microbiome on body composition and metabolism  

  • Tailoring of assessment and therapy specific to life cycle stage 

  • Nutritional considerations related to psychological and social factors associated with life cycle stage 

  • Effects of age, gender, and physical activity on body composition and energy expenditure 

  • Disease risk and prevalence related to socioeconomic status, geographic residency, ethnicity, and life cycle stage 

  • Regulation of fluid, electrolyte, and acid-base balance 

  • Basic understanding of nutritional genomics research in practice 

  • Calculation of individual caloric requirements 

  • Estimation of caloric values of specific meals 

 

Domain II: Nutritional Biochemistry (12% of exam) 

  • Nutritional considerations related to psychological and social factors associated with life cycle stage 

  • Metabolism (biochemical pathways and reactions) of carbohydrates, lipids, proteins, and micronutrients physiologic changes associated with life cycle stage 

  • Role of oxidative stress and detoxification pathways on health status 

  • Nutritional biochemical pathways including energy production and detoxification 

  • Genomics research in practice 

  • Chemistry of enzymes, co-factors and organic acids 

  • Lipid metabolism, including cytokine and eicosanoid pathways 

  • Epigenetics: methyl donor biochemistry and hypo and hyper methylation specific to life cycle stage 

 

Domain III: Nutrients & Human Health (13% of exam) 

  • Macronutrient and micronutrient food sources and impact on health 

  • Nutrient deficiency and insufficiency: causes, symptoms, and treatment 

  • Appropriate use of nutrient supplementation  

  • Supplemental sources of nutrients 

  • Functional and medical foods and their impact on health  

  • Role of oxidative stress and detoxification pathways on health status 

  • Structure and function of soluble and insoluble fiber and impacts on health 

  • Role of key phytochemicals and zoochemicals in health 

  • Chemistry of enzymes, co-factors and organic acids 

  • Impact of agricultural methods and food processing, preparation, and storage on nutrient value 

  • Tolerable upper intake levels of nutrients 

  • Nutrient toxicity: causes, symptoms, and treatment 

  • Dietary Guidelines and Dietary Reference Intakes for preventive and therapeutic interventions 

  • Nutrients used in fortification and applicable food sources 

 

Domain IV: Nutrition Assessment (13% of exam) 

  • Lifestyle factors which impact nutrient needs and compliance such as exercise, stress, and sleep 

  • Comprehensive medical nutrition health history 

  • Use of behavior change strategies such as Motivational Interviewing and Stages of Change Theory 

  • Evaluation of laboratory data including identification of optimal value ranges 

  • Identify signs and symptoms of nutrient status 

  • Identification of symptoms that require medical referral 

  • Evaluation of functional testing (organic acid, stool, and saliva tests for adrenals and hormones) 

  • Evaluation of hormonal and neurotransmitter imbalances based on laboratory assessment 

  • Computerized analysis of food intake 

  • Body composition analysis (skin fold, bioelectrical impedance, waist-to-hip, BMI, other) 

  • Assessment of single nucleotide polymorphisms (SNPs)  

  • Nutritional inborn errors of metabolism 

 

Domain V: Clinical Intervention & Monitoring (16% of exam) 

  • Gauging and optimizing client compliance 

  • Consideration of client's personal and cultural beliefs when developing nutrition intervention plans 

  • Malabsorption and effects on macronutrients and micronutrient status 

  • Effectiveness and contraindications of various diets 

  • Drug/herb action, duration of action, purpose and dose of a client's current therapeutic regimen 

  • Interactions between drugs and foods, alcohol, vitamins, minerals, herbs, phytochemicals, and zoochemicals 

  • Nutrient depletions related to commonly used drugs 

  • Evidence-based dose and duration of nutraceutical use for common conditions  

  • Evidence-based use of common botanical supplements for health promotion and common conditions 

  • Synergistic effects and antagonistic interactions of nutrients in foods and supplements 

  • Effects of disordered eating patterns on nutrition status, body composition, and body functions 

  • Safety, toxicity, and interactions of botanical supplements  

  • Good manufacturing practices and other quality markers for nutritional supplements 

  • Application of national guidelines, policies, consensus recommendations, and evidence-based research in the development of personalized therapeutic interventions  

  • Linking childhood behaviors to obesity and other chronic health issues in adults 

  • Impact of nutritional genomics on health 

 

Domain VI: Medical Nutrition Therapy (MNT) (15% of exam) 

  • MNT for gastrointestinal disorders 

  • MNT for food allergies and intolerances 

  • MNT for autoimmune disorders 

  • MNT for mental health/mood disorders 

  • MNT for insulin resistance and type 2 diabetes 

  • MNT for cardiovascular disease, dyslipidemias, and hypertension 

  • MNT for endocrine disorders 

  • MNT for obesity 

  • MNT for cognitive and neurodegenerative disorders 

  • MNT for hepatic disorders 

  • MNT for neurodivergence 

  • MNT for dermatological disorders 

  • MNT for bone disorders 

  • MNT for type 1 diabetes 

  • MNT for cancer 

  • MNT for renal disorders 

  • MNT for hematologic disorders 

  • MNT for mastication, swallowing, and nutrient absorption disorders 

  • MNT for pulmonary disorders 

  • MNT for surgical procedures 

  • MNT for communicable diseases and sequalae 

  • MNT for bariatric surgery 

 

Domain VII: Public Health (12% of exam) 

  • Impact of environmental toxicity on health 

  • Translation of nutritional epidemiology into practice 

  • Factors that negatively affect food quality and safety 

  • Causes and preventative measures for common foodborne illnesses 

  • Identification of populations at risk for food safety issues 

  • Tracking current outbreaks of food borne illness and communication with clients 

 

Domain VIII: Practice Management (6% of exam)  

  • Compliance with ethical standards 

  • Working within scope of practice and in collaboration with other healthcare professionals as needed 

  • Evaluate sources of nutrition information for trustworthiness and bias 

  • HIPAA compliance requirements 

  • Licensure and certification 

  • Cultural competency and mitigating implicit bias 

  • Insurance coverage and reimbursement 

 

This CNS Exam Content Outline will take effect in 2024 beginning with the June 2024 exam

Updated: 12/14/2023