Domains and Content Items 2024-2028
Domain I: Principles of Nutrition (13% of exam)
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Practical application of evidenced based research
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Physiology of the digestive tract (motility, absorption, secretion, intestinal barrier function)
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Digestion, absorption, and transport of macronutrients and micronutrients
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Inflammatory pathways including insulin, oxidative stress, and fatty acid oxidation
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Effect of microbiome on metabolism of macronutrients and micronutrients, including use of probiotics and prebiotics
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Nutritional considerations related to physiologic changes associated with life cycle stage
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Effect of microbiome on body composition and metabolism
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Tailoring of assessment and therapy specific to life cycle stage
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Nutritional considerations related to psychological and social factors associated with life cycle stage
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Effects of age, gender, and physical activity on body composition and energy expenditure
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Disease risk and prevalence related to socioeconomic status, geographic residency, ethnicity, and life cycle stage
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Regulation of fluid, electrolyte, and acid-base balance
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Basic understanding of nutritional genomics research in practice
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Calculation of individual caloric requirements
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Estimation of caloric values of specific meals
Domain II: Nutritional Biochemistry (12% of exam)
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Nutritional considerations related to psychological and social factors associated with life cycle stage
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Metabolism (biochemical pathways and reactions) of carbohydrates, lipids, proteins, and micronutrients physiologic changes associated with life cycle stage
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Role of oxidative stress and detoxification pathways on health status
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Nutritional biochemical pathways including energy production and detoxification
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Genomics research in practice
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Chemistry of enzymes, co-factors and organic acids
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Lipid metabolism, including cytokine and eicosanoid pathways
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Epigenetics: methyl donor biochemistry and hypo and hyper methylation specific to life cycle stage
Domain III: Nutrients & Human Health (13% of exam)
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Macronutrient and micronutrient food sources and impact on health
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Nutrient deficiency and insufficiency: causes, symptoms, and treatment
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Appropriate use of nutrient supplementation
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Supplemental sources of nutrients
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Functional and medical foods and their impact on health
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Role of oxidative stress and detoxification pathways on health status
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Structure and function of soluble and insoluble fiber and impacts on health
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Role of key phytochemicals and zoochemicals in health
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Chemistry of enzymes, co-factors and organic acids
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Impact of agricultural methods and food processing, preparation, and storage on nutrient value
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Tolerable upper intake levels of nutrients
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Nutrient toxicity: causes, symptoms, and treatment
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Dietary Guidelines and Dietary Reference Intakes for preventive and therapeutic interventions
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Nutrients used in fortification and applicable food sources
Domain IV: Nutrition Assessment (13% of exam)
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Lifestyle factors which impact nutrient needs and compliance such as exercise, stress, and sleep
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Comprehensive medical nutrition health history
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Use of behavior change strategies such as Motivational Interviewing and Stages of Change Theory
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Evaluation of laboratory data including identification of optimal value ranges
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Identify signs and symptoms of nutrient status
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Identification of symptoms that require medical referral
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Evaluation of functional testing (organic acid, stool, and saliva tests for adrenals and hormones)
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Evaluation of hormonal and neurotransmitter imbalances based on laboratory assessment
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Computerized analysis of food intake
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Body composition analysis (skin fold, bioelectrical impedance, waist-to-hip, BMI, other)
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Assessment of single nucleotide polymorphisms (SNPs)
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Nutritional inborn errors of metabolism
Domain V: Clinical Intervention & Monitoring (16% of exam)
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Gauging and optimizing client compliance
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Consideration of client's personal and cultural beliefs when developing nutrition intervention plans
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Malabsorption and effects on macronutrients and micronutrient status
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Effectiveness and contraindications of various diets
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Drug/herb action, duration of action, purpose and dose of a client's current therapeutic regimen
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Interactions between drugs and foods, alcohol, vitamins, minerals, herbs, phytochemicals, and zoochemicals
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Nutrient depletions related to commonly used drugs
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Evidence-based dose and duration of nutraceutical use for common conditions
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Evidence-based use of common botanical supplements for health promotion and common conditions
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Synergistic effects and antagonistic interactions of nutrients in foods and supplements
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Effects of disordered eating patterns on nutrition status, body composition, and body functions
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Safety, toxicity, and interactions of botanical supplements
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Good manufacturing practices and other quality markers for nutritional supplements
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Application of national guidelines, policies, consensus recommendations, and evidence-based research in the development of personalized therapeutic interventions
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Linking childhood behaviors to obesity and other chronic health issues in adults
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Impact of nutritional genomics on health
Domain VI: Medical Nutrition Therapy (MNT) (15% of exam)
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MNT for gastrointestinal disorders
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MNT for food allergies and intolerances
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MNT for autoimmune disorders
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MNT for mental health/mood disorders
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MNT for insulin resistance and type 2 diabetes
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MNT for cardiovascular disease, dyslipidemias, and hypertension
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MNT for endocrine disorders
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MNT for obesity
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MNT for cognitive and neurodegenerative disorders
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MNT for hepatic disorders
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MNT for neurodivergence
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MNT for dermatological disorders
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MNT for bone disorders
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MNT for type 1 diabetes
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MNT for cancer
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MNT for renal disorders
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MNT for hematologic disorders
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MNT for mastication, swallowing, and nutrient absorption disorders
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MNT for pulmonary disorders
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MNT for surgical procedures
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MNT for communicable diseases and sequalae
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MNT for bariatric surgery
Domain VII: Public Health (12% of exam)
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Impact of environmental toxicity on health
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Translation of nutritional epidemiology into practice
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Factors that negatively affect food quality and safety
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Causes and preventative measures for common foodborne illnesses
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Identification of populations at risk for food safety issues
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Tracking current outbreaks of food borne illness and communication with clients
Domain VIII: Practice Management (6% of exam)
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Compliance with ethical standards
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Working within scope of practice and in collaboration with other healthcare professionals as needed
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Evaluate sources of nutrition information for trustworthiness and bias
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HIPAA compliance requirements
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Licensure and certification
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Cultural competency and mitigating implicit bias
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Insurance coverage and reimbursement
This CNS Exam Content Outline will take effect in 2024 beginning with the June 2024 exam
Updated: 12/14/2023