CNS® Examination Content Outline

Domains and Content Items

A. Fundamental Principles of Nutrition (25% of exam and 250 SPE hours)

  • Basic understanding of nutritional genomics research in practice
  • Nutritional considerations related to physiologic changes associated with life cycle stage
  • Tailoring of assessment and therapy specific to life cycle stage
  • Nutritional considerations related to psychological and social factors associated with life cycle stage
  • Estimation of caloric values of specific meals
  • Calculation of individual caloric requirements
  • Effects of age, gender, and physical activity on body composition and energy expenditure
  • Effect of microbiome on body composition and metabolism
  • Metabolism (biochemical pathways and reactions) of carbohydrates, lipids, proteins, and micronutrients
  • Effect of microbiome on metabolism of macronutrients & micronutrients, including use of probiotics & prebiotics
  • Nutritional biochemical pathways including energy production and detoxification
  • Regulation of fluid, electrolyte, and acid-base balance
  • Inflammatory pathways including insulin, oxidative stress, and fatty acid oxidation
  • Chemistry of enzymes, co-factors, and organic acids
  • Chemistry of enzymes, co-factors, and organic acids in genomic theory
  • Epigenetics: methyl donor biochemistry, and hypo- and hyper-methylation
  • Pathway genomics: one carbon, methylation, tetrahydrobiopterin, and transsulfuration
  • Physiology of the digestive tract (motility, absorption, secretion, intestinal barrier function)
  • Malabsorption and effects on macronutrients and micronutrient status
  • Role of oxidative stress and detoxification pathways on health status
  • Digestion, absorption, and transport of macronutrients and micronutrients
  • Impact of nutrition on disease states of the GI tract
  • Effects of macronutrients, vitamins, and minerals on health and disease states
     

B. Nutrients and Human Health (14% of exam)

  • Lipid metabolism, including cytokine and eicosanoid pathways
  • Structure and function of soluble and insoluble fiber and impacts on health
  • Tolerable upper intake levels of nutrients
  • Symptoms and treatment of nutrient toxicity
  • Macronutrient and micronutrient food sources and impact on health
  • Functional and medical foods and their impact on health
  • Supplemental sources of nutrients
  • Impact of agricultural methods and food processing, preparation, and storage on nutrient value
  • Nutrients used in fortification and applicable food sources
  • Dietary Guidelines and Dietary Reference Intakes for preventive and therapeutic interventions
  • Appropriate use of nutrient supplementation
  • Role of key phytochemicals and zoochemicals in health
  • Nutrient deficiency and insufficiency: causes, symptoms, and treatment
     

C. Nutrition Assessment (14% of exam)

  • Comprehensive medical nutrition health history
  • Evaluation of laboratory data including identification of optimal value ranges
  • Evaluation of functional testing (organic acid, stool, and saliva tests for adrenals and hormones)
  • Evaluation of hormonal and neurotransmitter imbalances based on laboratory assessment
  • Assessment of single nucleotide polymorphisms (SNPs)
  • Nutritional inborn errors of metabolism
  • Body composition analysis (skin fold, bioelectrical impedance, other)
  • Waist-to-hip ratio measurements
  • Computerized analysis of food intake
  • Identification of symptoms that require medical referral
  • Correlation of symptoms and lab findings for research and development of personalized Medical Nutrient Therapy (MNT) protocol
  • Use of behavior change strategies such as Motivational Interviewing and Stage of Change theory
  • Lifestyle factors which impact nutrient needs and compliance such as exercise, stress, and sleep

 

D. Clinical Intervention and Monitoring (35% of exam)

  • Impact of nutritional genomics on health
  • Drug/herb action, duration of action, purpose and dose of a client's current therapeutic regimen
  • Nutrient depletions related to commonly used drugs
  • Interactions between drugs and foods, alcohol, vitamins, minerals, herbs, phytochemicals, and zoochemicals
  • Synergistic effects and antagonistic interactions of nutrients in foods and supplements
  • Effectiveness and contraindications of popular diets
  • Linking childhood behaviors to obesity and other chronic health issues in adults
  • Gauging and optimizing client compliance
  • Evidence-based dose and duration of nutraceutical use for common conditions
  • Good manufacturing practices and other quality markers for nutritional supplements
  • Effects of disordered eating patterns on nutrition status, body composition, and body functions
  • Application of national guidelines, policies, consensus recommendations, and evidence-based research in the development of personalized therapeutic interventions
  • Evidence-based use of common botanical supplements for health promotion and common conditions
  • Safety, toxicity, and interactions of botanical supplements
  • Consideration of client's personal and cultural beliefs when developing nutrition intervention plans
  • MNT for obesity
  • MNT for cardiovascular disease, dyslipidemias, and hypertension
  • MNT for type 1 diabetes
  • MNT for insulin resistance and type 2 diabetes
  • MNT for endocrine disorders
  • MNT for autoimmune disorders
  • MNT for gastrointestinal disorders
  • MNT for hematologic disorders
  • MNT for bone disorders
  • MNT for hepatic disorders
  • MNT for pulmonary disorders
  • MNT for renal disorders
  • MNT for cognitive and neuro-cognitive disorders
  • MNT for food allergies and intolerances
  • MNT for cancer
  • MNT for bariatric surgery
  • MNT for surgical procedures
  • MNT for mastication, swallowing, and nutrient absorption disorders
  • MNT for HIV-AIDS
  • MNT for dermatological disorders
  • MNT for mental health/mood disorders
     

E. Public Health (6% of exam)

  • Nutritional epidemiology and translation of research studies into practice
  • Disease risk and prevalence related to socioeconomic status, geographic residency, ethnicity, and life cycle stage
  • Causes and preventative measures for common food borne illnesses
  • Tracking current outbreaks of food borne illness and communication with clients
  • Identification of populations at risk for food safety issues
  • Factors that negatively affect food quality and safety
  • Impact of environmental toxicity on health
     

F. Practice Management (6% of exam)

  • HIPAA compliance requirements
  • Working within scope of practice and in collaboration with other healthcare professionals as needed
  • Compliance with ethical standards
  • Licensure and certification
  • Insurance coverage and reimbursement