Supervised Practice Experience Competencies

Supervised Practice Experience Competencies – Updated June 2024 

Category A: Personalized Nutrition Assessment 

• Health History: Know how to elicit a patient-appropriate health history, including data such as: 
• Current health concerns, past and present health history, and family health history 
• Body weight history and recent weight changes 
• Psychosocial history, including access to food, occupation, living situation, smoking, drug and alcohol use 
• Medication and supplement use 
• Review of body systems 
• Mastication and swallowing difficulty, appetite and bowel function 
• Pregnancy history and/or desired pregnancy 
• Sleep patterns 
• Stress levels 
• Obtain a focused nutrition history via multi-day food record, a food frequency record and a 24-hour recall 
• Identify limitations of food records, food frequency questionnaires, and recalls and understand the appropriate use of these tools 
• Determine suboptimal dietary intake or status of nutrients 
• Evaluate eating patterns, stress eating tendencies and disordered eating behaviors 
• Identify dietary avoidance behaviors 
• Identify allergies and sensitivities to foods and dietary supplement ingredients based on history and symptoms reports 
• Physical activity, identifying frequency, intensity, type and limitations to exercise 
• Physical activity, identifying frequency, intensity, type and limitations to exercise 
• Biochemical & Lab Assessment 
• Evaluate signs of vitamin and mineral deficiencies or toxicities 
• Interpret laboratory data as it applies to nutrition-related conditions and systemic imbalances 
• Monitor growth, weight and BMI 
• Identify hormonal and neurotransmitter imbalances based on laboratory assessment 
• Identify personalized and biochemical laboratory value ranges as compared to normal reference value ranges 
• Genetic/Genomic Factors 
• Demonstrate understanding of the basics of gene expression, transcription and translation 
• Demonstrate understanding of genetic disorders in nutrient metabolism 
• Evaluate family health history as it relates to current health status and risk factors 
• Anthropometrics 
• Be familiar with the following anthropometric measurements: mid-arm circumference, triceps skin-fold and mid-arm muscle circumference 
• Be familiar with bioelectric impedance 
• Be familiar with waist to hip ratio measurements 
• Be familiar with emerging tools of anthropometrics (ultrasound, DEXA, MRI, CT scanning, and air displacement 
• Be familiar with computerized analysis of food intake 
• Determine individual micro- and macro-nutrient requirements using guidelines and recommendations customizing them according to the individual’s age, sex, body type, reproductive status, activity level and metabolism 
• Identification of Clinical Status 
• Identify symptoms that require medical referral 
• Correlate constellations of symptoms for the most effective and efficient treatment protocols
  

Category B: Personalized Nutrition Intervention, Education, Counseling, & Management 

• The following six systems include an array of conditions; 1-5 are required.  
• Underweight, overweight, malnutrition, and obesity 
  • Examples: obesity, eating disorders / disordered eating, bariatric surgery, or disorders of mastication, swallowing, or absorption nutrients due to medical interventional procedures or treatments)
• Cardiometabolic 
  • Examples: cardiovascular disease, dyslipidemia, hypertension, insulin resistance and non-insulin dependent diabetes
• Endocrine 
  • Examples: endocrine disorders, bone disorders such as osteopenia and osteoporosis
• Immune and autoimmune
  • Examples: autoimmune disorders, food allergies and intolerances, apply specific dietary and nutraceutical modifications as adjuvant therapy in immuno-compromised individuals (those with HIV-AIDS, cancer, tuberculosis)
• Gastrointestinal disorders
  • Examples: gastrointestinal disorders (gastroesophageal reflux disease, peptic ulcer disease, dumping syndrome, irritable bowel syndrome, inflammatory bowel disease, short bowel syndrome, diverticulosis, and colorectal cancer)
• Other system disorders  
• NOTE: while not required, experience in the following conditions enhances the candidate’s experience 
  • Examples: hematologic disorders, hepatic disorders, pulmonary disorders, renal disorders, cognitive/neurological disorders, mental health and mood disorders, compromised individuals (those undergoing chemotherapy, radiation, surgical procedures, dialysis) 
• In developing an MNT plan, the following must be included: 
  • Drug-nutrient/ drug-herb interactions
  • Examples:   
    • Identify common drug-nutrient and drug-herb-interactions affecting glucoregulation, coagulation, and metabolism  
    • Identify drug/herb action, duration of action, indication and dose of a patient’s current therapeutic regimen  
    • Identify dietary factors that affect the actions of common drugs and the underlying mechanisms of action  
    • Identify nutrient depletions which can occur related to commonly used drugs Identify interactions between drugs and foods (including herbs) and their constituents  
    • Assess the interaction of nutrients with alcohol  
  • Interactions between nutrients
  • Example:
    • Assess the synergistic effects and antagonistic interactions of nutrients in foods and supplements and how they may impact the health status of an individual
      
  • Dietary therapeutics and behavior optimization 
  • Examples:   
    • Assess the advantages and limitations of popular diets  
    • Identify the therapeutic usefulness of specific foods  
    • Apply scientific evidence and methods when developing specific dietary recommendations  
    • Assess the link between behaviors learned in childhood and their impact on obesity and other chronic health issues in adulthood  
    • Apply psychological and motivational skills to enhance clinical outcomes  
    • Gauge and optimize compliance with recommendations 

• • Nutraceutical and supplement therapeutics 
  • Examples:   
    • Apply evidence-based dose and duration of use of nutraceuticals for common conditions  
    • Develop working knowledge of good manufacturing practices and other markers of quality end-products  
  • Eating behaviors and eating disorders 
  • Example: Assess the effects of disordered eating patterns on nutritional status, body composition and function  
  • Data comprehension and translation 
  • Example: Assess individual patient data and compare with other data (national guidelines, policies, consensus statements, expert opinions and previous outcome experience) to develop nutritional therapeutic interventions  
  • Botanical and related therapeutics 
  • Examples:  
    • Develop working knowledge of the effects of common botanical supplements and their indication for health promotion  
    • Assess the safe use and potential toxicity of botanical supplements 

Professional Issues – Covered in Categories A, B, & C 

• Food quality and safety 
• Develop working knowledge of the causes and preventive measures for the most common food borne illnesses 
• Monitor current developments and outbreaks of food borne illnesses and translate media information into science-based evidence and patient recommendations 
• Assess populations at risk for food safety issues 
• Assess factors that may negatively affect food quality (pesticides, xenobiotics, GMO’s, hormones, food additives, PCB, heavy metals) 
• Cultural issues, ethical standards and boundaries 
• Apply all HIPAA compliance requirements 
• Refer clients to appropriate healthcare providers when their care requires services outside the scope of practice of a CNS 
• Assess the impact of personal and cultural beliefs on dietary and lifestyle patterns and be able to address these beliefs when developing nutrition intervention plans 

Epidemiology & Biostatistics – Covered in Categories A, B, & C 

• Apply the knowledge of basic epidemiology of nutrition into practice 
• Utilize knowledge from research studies to compare outcomes and translate them into science-based therapies for clients.