ADVANCED MEDICAL NUTRITION THERAPY

Nutrition 316 Spring 2017

Time and location of the course: Wednesdays 1:30 pm – 4:30 pm; Location: Room 118 Instructors : Kathy Prelack, PhD, RD kprelack@tufts.edu| Phone 617.371.4756 Office Hours: by appointment Kelly Kane, MS, RD, LDN, CNSC kkane@tuftsmedicalcenter.org| Phone 617.636.8309 Office Hours: by appointment Tufts Graduate Credit: 1 credit Prerequisites for taking this course: Graduate standing or instructor consent

Course Description: The goal of the course is to expand students’ knowledge on a variety of common pathophysiological conditions and integrate this knowledge with the intervention of clinical nutrition therapies.

Course Objectives: At the completion of the course, students should be able to:

1. Discuss the key elements of nutritional assessment and diet therapy, describe their alterations during various disease states and relate this information to support nutrition intervention strategies in individuals during altered pathological states.

2. Interpret information from medical, social and nutritional histories, combined with biochemical and anthropometrical indices during different pathophysiological states to assess nutritional status, develop nutrition care plans, and problem solve.

3. Accurately define, both in writing and orally, how pathophysiology of a selected disease state impacts nutritional status and what nutrition interventions are indicated.

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Description of assignments, tests, and other required activities: Assignments for this course include readings, online and in person lectures, one online discussion, in class assignments, one take home exam, two case studies, a clinical controversy discussion and an essay review paper and paper presentation. For the most up to date information regarding assigned readings, instructions, and due dates please login to your Trunk course site and click on the tab labeled "Weekly Overviews."

Readings and Lectures

Students will be expected to read the assigned background materials prior to coming to class and/or listen to the pre-recorded lectures as applicable each week. Familiarity with the recorded lectures will be necessary in order to understand the in-class assignments and activities. Supplemental readings, although not required, may also be posted and are highly recommended.

Online Discussion

For the online discussion, all students must participate in the graded discussion forum. Each student will be expected to post thoughtful comments relevant to the assigned topic and the specific questions posed by the instructor. Students will be graded on the quality and timeliness of their postings, as well as their understanding of the assigned materials. Students are expected to participate actively and in a timely fashion. Students may submit their postings only during the week in which the discussion forum is active.

Take Home Exam

The first half of the course will focus on the core subject areas of nutrition assessment and nutritional therapy during pathophysiology. The take home exam will assess this material.

Clinical Controversy Discussion

There will be one Clinical Controversy discussion which serves to highlight a current controversy in practice. You and your group members will be asked to take a specific position on a clinical topic that is currently controversial. You will need to identify 1 peer reviewed journal article that supports your position, while your “opponents” will research the alternate view. You will be asked to represent your position and defend it as a practice standard.

Case Studies

There will be two case studies during the semester. Topics in specific pathological states and methods of nutritional therapy during these disease states that are

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presented in the lectures both by the instructors and guest lecturers will be addressed and students will answer questions based on the case studies.

Essay Review Paper (approximately 10-15 pages, double-spaced)

Paper topic will chosen by the student and approved by the instructors. Paper topics are due on 3/15/17 and will be discussed in class. Topic should not be one that is presented as part of the scheduled lectures, although special instances of a general topic discussed in during lecture is acceptable. The paper should reflect the current state of knowledge in the particular area as supported by research and expert opinion in the field. The content’s focus should be on the nutritional implications and dietary management of the specific disease state or condition. An overview of physiological mechanisms of the disease and aspects of treatment should be included. Paper should include an introduction, review of literature, discussion of important findings, and conclusion. The conclusion should include directions of the future research and controversies if applicable. Essay Review Paper Presentation A presentation of your paper will take place during the last class. Each student will present their topic orally to the class and will be graded by their peers. The presentation should be no longer than 10-15 minutes in length.

Summary of Assignments and Grading

Assignment(s) Grading Weight

In Class and Online Discussion 10%

Midterm Take Home Exam 20%

Clinical Controversy 10%

Case Studies (2) 30%

Paper 20%

Paper Presentation 10%

TOTAL 100%

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Grade Scale

Grade Score Grade Score Grade Score

A+ 100 C+ 77-79.99 F 0-59.99

A 94-99.99 C 74-76.99

A- 90-93.99 C- 70-73.99

B+ 87-89.99 D+ 67-69.99

B 84-86.99 D 64-66.99

B- 80-83.99 D- 60-63.99

Class Policies, Expectations, and Evaluation

Students will have only one opportunity to complete each assignment, and all assignments are due on the date/time specified. Students must submit their online discussion postings only during the week in which a discussion is active or lose ½ point for each day it is late. Students will have only one opportunity to compete the exam. Each exam must be completed and successfully submitted within the specified time period. Students who are unable to complete an assignment on time for any reason should notify the instructors by email (preferred) or phone call prior to the deadline, with a brief explanation for why the extension is needed.

There are NO opportunities for extra credit work.

Students are expected to complete all assignments on their own, i.e. without assistance from other students, faculty, etc. unless otherwise noted. All outside documents used in the preparation of students’ work must be properly referenced. (References to the textbook are not required).

Instructors and other university personnel may request that students submit written assignments to plagiarism prevention resources, websites, or other authoritative databanks, such as (but not limited to) “turnitin.com” or a similar site. These services compare students-produced documents with web content, newspapers, journals, magazines, books, student essays, and other data to determine the originality of student work.

The following guidelines are used in evaluating course performance: 1. Assignments will be evaluated on the basis of completeness, originality, scientific soundness and relevance to the assigned topic.

2. Written work will be evaluated on the quality of thought, completeness, and adherence to guidelines, scientific integrity, and ability to incorporate and communicate ideas and information effectively.

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Online Discussion Assignment Grading Criteria

Quality of Posting/Reply Points Details

No Posting, Postings are not relevant to questions posed

0 Not Acceptable

Postings reflect reading and are relevant to questions posed

1 Met minimum standards

Postings reflect reading are relevant to questions posed and some outside source material used (must be cited)

2 Exceeded minimum standards

Course texts and Materials: There is no textbook for this course. Weekly readings from review or original research articles will be assigned. One-two articles per topic relating to the guest lecture may be required at discretion of speaker and should be completed prior to that lecture. The following reference books may be used as a complement to the required readings. Krause’s Food and the Nutrition Care Process, 14th edition: Mahan, Escott-Stump, and Raymond. WB Saunders, 2017

Academic Conduct Each student is responsible for upholding the highest standards of academic integrity, as specified in the Friedman School’s Policies and Procedures manual (http://nutrition.tufts.edu/student/documents) and Tufts University policies (http://uss.tufts.edu/studentaffairs/judicialaffairs/Academic Integrity.pdf). It is the responsibility of each student to understand and comply with these standards, as violations will be sanctioned by penalties ranging from failure on an assignment and the course to dismissal from the school.

3. Adherence to instructions and guidelines of the assignments.

4. Participation in all class activities and discussion. Missed work will affect your grade unless prior arrangements were requested and approved in writing by the instructors for make-up work.

5. On-line discussions will be evaluated according to the discussion matrix (see below).

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Course & Assignment Schedule:

DATE & LOCATION

WEEK and TIME

TOPIC OR CLASS TITLE ASSIGNMENTS & ACTIVITIES

LECTURER(S)

1/25/17 1 1:30-3:00 3:00-4:30

Introduction Nutritional Assessment (live) Nutrition Focused Physical Assessment (live) Biochemical Assessment (recorded)

Nutritional Assessment and Nutrition Focused Physical Examination Lecture in class

Elizabeth Marino-Costello MS, RD Kelly Kane MS, RD Kathy Prelack, PhD, RD

2/1/17 2 1:30-3:00 3:00-4:30

Pediatric Nutrition Assessment, Failure to Thrive, and Pediatric Obesity (recorded) Pediatric Assessment activity (live) Neonatal Nutrition (live) Online Discussion assigned

Pediatric Assessment activity in class Neonatal Nutrition lecture in class

Kathy Prelack, PhD, RD Annie Paquette, MS, RD Yvonne Penner, RD Kelly Kane MS, RD

2/8/17 3 1:30-3:00

Energy Expenditure, Body Composition and Metabolic Support in Critical Illness (recorded) Energy Expenditure (live)

Online Discussion due by 2/8 at 12:00 noon

Energy Expenditure lecture in class

Kathy Prelack, PhD, RD Linda Bandini, PhD, RD Kelly Kane MS, RD

2/15/17 4 1:30-3:00

Enteral Nutrition Support (recorded) Parenteral Nutrition Support (recorded) Nutritional Care During Metabolic Stress: Putting it all Together Exam Assigned

Metabolic Stress Case study activity in Class

Kathy Prelack, PhD, RD Kelly Kane, MS, RD

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2/22/17 5 1:30-3:00 3:00-4:30

Cancer(live) Obesity (live) Exam Due

Cancer and Obesity lectures in class

Alicia Romano, MS, RD Melissa Page, MS, RD Kelly Kane, MS, RD Kathy Prelack, PhD, RD

3/1/17 6 1:30-3:00

Liver Disease (recorded) Nutrition in Solid Organ Transplantation (live) Liver Disease Case Study assigned

Nutrition in Solid Organ Transplant lecture in class

Kelly Kane, MS, RD Lauren Parsly, RD Kathy Prelack, PhD, RD

3/8/17 7 1:30-3:00

Nutrition and Oral Health (recorded) Eating Disorders (live) Liver Disease Case Study Due Clinical Controversy Introduced

Eating Disorder lecture in class

Carole Palmer, EdD, RD Kelly Kane MS, RD Kathy Prelack, PhD, RD

3/15/17 8 1:00-4:30

Clinical Controversy Paper Topics Due

Panel Discussion

Kathy Prelack, PhD, RD Kelly Kane MS, RD

3/22/17 BREAK No Class

3/29/17 9 1:30-3:00 3:00-4:30

Hyperlipidemia (live) Diabetes Mellitus (live)

Hyperlipidemia lecture in class Diabetes Mellitus lecture in class

Gitanjali Singh, MPH, PhD Richard Siegel, MD Kelly Kane, MS, RD Kathy Prelack, PhD, RD

4/5/17 10 3:00-4:30

Malabsorption, Pancreatitis, IBD, and Short Bowel Syndrome (recorded) Allergy (live)

Allergy lecture in class

Kathy Prelack, PhD, RD John Leung, MD Kelly Kane, MS, RD

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4/12/17 11 1:30 –3:00 3:00-4:30

Maldigestion and Malabsorption (live) Probiotics (live) Gastroenterology Case Study Assigned

Maldigestion and Malabsorption and Probiotics lecture in class

Joel Mason, MD Kathy Prelack, PhD, RD Kelly Kane, MS, RD

4/19/17 12 1:30-3:00

Clinical Roundtable Gastroenterology Case Study Due

Clinical Rountable in class

Kathy Prelack, PhD, RD

4/26/17 13 1:30-3:00 3:00-4:30

Renal Disease (live) Nutrition in Renal Disease (live)

Renal Disease lecture in class Nutrition in Renal Disease lecture in class

Dan Weiner, MD Poon Har Poon, MS, RD Kelly Kane MS, RD Kathy Prelack, PhD, RD

5/3/17 READING PERIOD 1:30-4:30

Review of Case Studies and (live) Class Presentations

Case Study review and in class Student Presentations in class

Kelly Kane MS, RD Kathy Prelack, PhD, RD

5/10/17 FINALS PERIOD 1:30-4:30

Class Presentations Paper Due

Student Presentations in class

Kathy Prelack, PhD, RD Kelly Kane MS, RD

This schedule is subject to modifications at the discretion of the instructors.

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Course Schedule

Class 1: Nutritional and Biochemical Assessment Instructors: Kane, Prelack, Marino-Costello 1/25/17

Learning Objectives for class 1: Upon completion of this class, students will be able to: Nutritional Assessment and Nutrition Focused Physical Exam (live):

Identify the types of malnutrition and the role of malnutrition in hospitalization.

Identify the purpose of nutrition screening.

Name the components of a nutrition assessment and describe the features of each.

Identify the physical features that can be influenced by an individual’s nutritional status.

Biochemical Assessment (recorded):

Identify the serum electrolytes and symptoms and potential causes of deficiencies and excesses.

Name at least 2 markers of visceral protein status and the advantages and disadvantages associated with the use of each.

Identify the components of a complete blood count and iron study and the role of each in the diagnosis of macrocytic and microcytic anemias.

Required Readings for class 1: Kyle J. The effects of iron in health and disease. Support Line. 2008;30(5):16-23. Pogatshnik C and Hamilton C. Nutrition focused physical examination: skin, nails, hair, eyes, and oral cavity. Support Line. 2011;33(2):7-13.

Rhoda KM and Porter MJ. Fluid and electrolyte management: putting a plan in motion. J Parenter Enteral Nutr. 2011;35:675-685. Russell MK. Functional assessment of nutrition status. Nutr Clin Pract. 2015;30:211-218. Supplementary Readings: Krause: Chapters 4, 6, 7, 10, 32 Fabiasen C. Phelan KPQ, Cichon B, et al. Short children with a low mid upper arm circumference respond to food supplementation: an observational study form Burkina

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Faso. Am J Clini Nutr. 2016; 103 (2):415-421. White JV, Guenter P, Jensen G, et al. Consensus Statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: Characteristics Recommended for the Identification and Documentation of Adult Malnutrition (Undernutrition) J Acad Nutr Diet. 2012;112:730-738.

Class 2: Pediatric Nutrition Assessment, Failure to Thrive, and Pediatric Obesity Instructors: Prelack, Kane, Paquette, Penner 2/1/17

Learning Objectives for class 2: Upon completion of this class, students will be able to:

Describe assessment of nutritional status in children using appropriate tools and markers.

Identify specific nutritional concerns during the nutritional support and management of hospitalized pediatric patients including low birth weight infants.

Define energy and protein requirements in well and diseased children.

Define failure to thrive and pediatric obesity and the criteria for its diagnosis.

Describe the role of medical nutrition therapy and the role of the registered dietitian in the management of failure to thrive and pediatric obesity.

Required Readings for class 2: Corkings KG. Nutrition-focused physical examination in pediatric patients. Nutr Clin Pract. 2015;30:203-209. Jesuit C, Dillon C, Compher C, ASPEN Board of Directors, Lender C. A.S.P.E.N. Clinical Guidelines: Nutritional Support of Hospitalized Pediatric Patients with Obesity. J Parenter Enteral Nutr. 2010; 34(1):13-20. Nofal AA and Schwenk WF. Growth failure in children: a symptom or a disease? Nutr Clin Pract. 2013;28:651-658.

Skillman HE and Wischmeyer PE. Nutritional therapy in critically ill infants and children. J Parenter Enteral Nutr.2008 32(5):520-534.

Supplementary Readings: Krause: Chapters 16, 17, 18, 42 Barlow SE. Expert Committee Recommendations Regarding the Prevention, Assessment and Treatment of Child and Adolescent Overweight and Obesity: Summary

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Report. Pediatrics. 2007;120;S164. Freedman DS, Srinvasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: The Bogalusa Heart Study. J Pediatr. 2007;150:12-17.

Joeckel RJ and Phillips SK. Overview of infant and pediatric formulas. Nutr Clin Pract. 2009;24:356:363. Standards for Specialized Nutritional Support: Hospitalized Pediatric Patients. American Society for Enteral and Parenteral Nutrition Board of Directors and Task Force on Specialized Nutrition Support for Hospitalized Pediatric Patients. Nutr Clin Pract. 2005;20:103. Online Discussion: Pediatric Obesity

Class 3: Metabolic Support in Critical Illness and Energy Expenditure Instructors: Prelack, Kane, Bandini 2/8/17

Learning Objectives for class 3: Upon completion of this class, students will be able to:

Body Composition and Metabolic Support in Critical Illness (recorded):

Understand the inflammatory response following critical illness and the metabolic sequellae that accompanies it particularly as it relates to energy and protein metabolism.

Identify the effects of physiologic stress and altered nutrition on body composition.

Determine appropriate goals for nutrition support using information related to energy expenditure, and protein turnover, and substrate utilization during critical illness.

Using the burn injury model, apply the concepts of assessment and metabolic support in critically ill.

Energy Expenditure (live):

Identify the components of energy expenditure.

Name the methodologies available for determining energy needs and the advantages and disadvantages of each.

Describe the methods used in calculating daily energy needs, resting metabolic rate, and daily energy expenditure.

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Required Readings for class 3: Body Composition and Metabolic Support in Critical Illness: Reid CL and Campbell IT. Nutritional and metabolic support in trauma, sepsis and critical illness. Current Anesthesia and Critical Care. 2004;16:336-349. Energy Expenditure: Frankenfield D, Ashcraft CM. Estimating energy needs in nutrition support patients. J Parenter Enteral Nutr. 2011;35:563-570. Hemysfield SB, Harp JB, Rowell AM, Nguyeg AM and Pietrobelli A. How much may I eat? Calorie estimates based upon energy expenditure prediction equations. Obesity Reviews. 2006;7:361-370.

Psota T and Chen KY. Measuring energy expenditure in clinical populations:rewards and challenges. Eur J Clin Nutr. 2013;67(5):436-442.

Supplementary Readings: Krause: Chapters 38, 2 Boullata J, Williams J, Cottrell F, et al. Accurate determination of energy needs in hospitalized patients. J Am Diet Assoc. 2007;107:393-401.

Frankenfield D, Hise M, Malone A et al. Prediction of resting metabolic rate in critically ill adult patients: results of a systematic review of the evidence. J Am Diet Assoc. 2007;107:1552-1561. Frankenfield D, Roth-Yousey L, Compher C. et al. Comparison of predictive equations for resting metabolic rate in healthy non obese and obese adults: a systemic review. J Am Diet Assoc. 2005;105:775-789 Spears KE, Hyunsook K, Behall KM, Conway JM. Hand-held indirect calorimetry offers advantages compared with prediction equations, in a group of overweight women, to determine resting energy expenditures and estimated total energy expenditures during research screening. J Am Diet Assoc. 2009;109:836-845.

Magnuson B, Peppard A, Flomenhoft DA. Hypocaloric considerations in patients with potentially hypometabolic disease states. Nutr Clin Pract. 2011;26:253-260.

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Melanson EL, Coelho LB, Tran ZV et al. Validation of the BodyGem hand held calorimeter. Int J Obes. 2004;28:1479-1484.

Rodriquez, NA. Jesche MG, Williams, FN, Kamolz, LP, Herndon, D. Nutrition in burns: Galveston contributions. J Parenter Enteral Nutr. 2011:35:704-714.

Schoeller D. Making indirect calorimetry a gold standard for predicting energy requirements for institutionalized patients. J Am Diet Assoc. 2007;107:390-392.

Class 4: Enteral and Parenteral Nutrition Support Instructors: Prelack, Kane 2/15/17

Learning Objectives for class 4: Upon completion of this class, students will be able to: Enteral Nutrition Support (recorded):

Describe different types of enteral feedings, their distinguishing characteristics, and how they are given.

Determine appropriate route, timing and composition of enteral feeding in various patient settings.

Identify tube feedings complications and strategies for their management.

Describe composition of specialty enteral feedings and indications for their use. Parenteral Nutrition Support (recorded):

Name the components of parenteral nutrition.

Identify the indications and contraindications for central and peripheral parenteral nutrition.

Describe the potential mechanical and metabolic complications associated with parenteral nutrition and methods of management of each.

Required Readings for class 4: Enteral: Kozeniecki M and Fritzshall R. Enteral nutrition for adults in the hospital setting. Nutr Clin Pract. 2015;30:634-651. Miller KR, Kiraly LN, Lowen CC, et al. “Can We Feed?” A mneumonic to merge intensive care assessment of the critically ill patient. J Parenter Enteral Nutr. 2011:35:643-660. Miller KR, McClave SA, Kiraly NA, et al. A Tutorial on enteral access in adult

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patients in the hospitalized setting. J Parenter Enteral Nutr. 2014;38:282-295. Parenteral: Burke PA, Young LS, Bistrian B. Metabolic vs. nutritional support: a hypothesis. J Parenter Enteral Nutr. 2010;334(5):546-548. Casaer MP, Mesotten D, Hermans G, et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med 2011;365:506-517. Supplementary Readings: Krause: Chapter 13 Enteral: Brown B, Roehl K, and Betz M. Enteral nutrition formula selection: current evidence and implications for practice. Nutr Clin Pract. 2015;30:72-85. Mizock BA. Immunonutrition and critical illness: an update. Nutrition. 2010;26:701–707. Parenteral: Jeejeebhoy K. Total parenteral nutrition: potion or poison? Am J Clin Nutr. 2001;74:160–163. Woodcock NP, Zeigler D, Palmer MD, Buckley P, et al. Enteral versus parenteral nutrition: a pragmatic study. Nutrition. 2001;17:1–12. In Class Discussion: Parenteral and Enteral Calculations and Discussion EXAM ASSIGNED

Class 5: Cancer and Obesity Instructors: Prelack, Kane, Page, Romano 2/22/17

Learning Objectives for class 5: Upon completion of this class, students will be able to: Cancer (live)

Define cancer, identify types of cancer, potential causes, and treatment

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options.

Identify the nutritional implications associated with cancer and its treatment.

Describe conventional nutritional therapies and complementary and alternative medicine in cancer treatment

Obesity (live)

Define adult obesity.

Describe the relationship between obesity and health.

Identify useful methods of nutrition assessment in obesity.

Describe both medical and surgical treatment approaches to obesity and their success rates.

Required Readings for class 5: Cancer: Palesty JA and Dudrick SJ. Cachexia, malnutrition, the refeeding syndrome, and lessons from Goldilocks. Surg Clin North Am. 2011; 91(3):653-73. Widlicka A and Reynolds V. Indications for nutrition support in hematopoetic stem cell transplant patients. Support Line. 2012; 34(3):2-12. Obesity: Hurt RT, Varayil JE, and Ebbert JO. New Pharmacological Treatments for the Management of Obesity. Curr Gastroenterol Rep ;2014(16)387-394. Kushner RJ and Blatner DJ. Risk Assessment of the Overweight and Obese Patient. J Am Diet Assoc.2005;105:S53-S62. Sacks FM, Bray GA, Carey VJ, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009;360:859-873. Sarwer DB, Butryn ML, Forman E, and Bradley LE. Lifestyle Modification for the Treatment of Obesity. The ASMBS Textbook of Bariatric Surgery: Volume 2. Springer Science and Business Media; New York. 2014: 147-153. Supplementary Readings: Obesity: Aills L. Blankenship J. Buffington C. Furtado M. et al. Allied Health Sciences Section Ad Hoc Nutrition Committee. Bariatric nutrition: suggestions for the surgical weight loss

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patient. Surg Obes Relat Dis. 2008;4(5 Suppl):S73-108. Position of the American Dietetic Association: Weight Management. J Am Diet Assoc. 2009;109:330-346. Krause: Chapters 36, 21

Class 6: Liver Disease and Solid Organ Transplantation Instructors: Prelack, Kane, Parsly 3/1/17

Learning Objectives for class 6: Upon completion of this class, students will be able to: Liver Disease (recorded):

Describe the association of between liver disease and malnutrition.

Name the possible causes and treatment of various types of liver disease.

Identify the signs and symptoms of liver disease and the nutritional implications of each

Define the consequences of liver disease (i.e. portal hypertension, ascites, gastrointestinal bleeding) and describe the nutritional management of each.

Solid Organ Transplantation (live):

Describe medical nutrition therapy post solid organ transplant, including liver, cardiac, and renal transplants.

Describe the nutritional implications of common medications in solid organ transplants.

Liver Disease Case Study Assigned

Required Readings for class 6: Liver: Cabral CM and Burns DL. Low-protein diets for hepatic encephalopathy debunked: let them eat steak. Nutr Clin Pract. 2011;26:155-159. Kramlich M. Nonalcoholic fatty liver disease: prevalence, progression, prognosis. Support Line. 2012:34(5):16-26. Mouzaki M, Ng V, Kamath BM, et al. Enteral energy and macronutrients in end-stage liver disease. J Parenter Enteral Nutr. 2014;38:673-68.

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Solid Organ Transplantation: Glassman K. An overview of Nutrition for Cardiac Transplant Recipients. Support Line. 2012:34(5):8-13. Karosanidze T. Kidney and Pancreas Transplantation. Nutrition Challenges and Management. Support Line. 2012:34(5):3-7. Supplementary Readings: Krause: Chapters 29 DiCecco SR, Francisco-Ziller N. Obesity and organ transplantation: successes, failures, and opportunities. Nutr Clin Pract. 2014;29:171-191. Johnson TM, Ivergard EB, Cohen AE, et al. Nutrition Assessment and Management in Advanced Liver Disease. Nutr Clin Pract. 2013;28:15-19. Kawaguchi T, Taniguchi E, and Sata M. Effects of oral branched-chain amino acids on hepatic encephalopathy and outcome in patients with liver cirrhosis. Nutr Clin Pract. 2013;28:580-588. CLINICAL CONTROVERSY TOPICS ASSIGNED

Class 7: Nutrition and Oral Health and Eating Disorders Instructors: Kane, Prelack, Palmer 3/8/17

Learning Objectives for class 7: Upon completion of this class, students will be able to: Nutrition and Oral Health (recorded):

Describe the interrelationship between nutrition and oral health.

Outline common oral problems through the life cycle.

Identify how poor oral health affects nutritional status and how to eat for optimal oral health

Eating Disorders (live):

Recognize the differences between disordered eating and eating disorders, and classify eating disorders.

Identify nutrition related consequences of disordered eating and eating disorders.

Describe the role of the registered dietitian and of medical nutrition therapy in the treatment of eating disorders.

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Required Readings for class 7: Eating Disorders: Position of the American Dietetic Association: Nutrition intervention in the treatment of eating disorders. J Am Diet Assoc. 2011;111:1236-1241. Supplementary Readings: Krause: Chapters 22 and 25 Radler D and Lister T. Nutrient deficiencies associated with nutrition-focused physical findings of the oral cavity. Nutr Clin Pract. 2013;28:710-721.

Class 8: Clinical Controversy Panel Discussion Instructors: Prelack, Kane 3/15/17

Learning Objectives for class 8: Upon completion of this class, students will be able to:

Interpret scientific research as presented in peer reviewed journals

Abstract relevant information

Communicate findings effectively and persuasively to others

Required Readings for class 8: Morrow L, Gogineni V, Maleskar MA. Synbiotics and probiotics in the critically ill after the PROPATRIA trial. Curr Opin Clin Nutr Metab Care 2012, 15:147–150. Whelan K, Meyers C. Safety of probiotics in patients receiving nutritional support: a systematic review of case reports, randomized controlled trials, and nonrandomized trials. Am J Clin Nutr 2010; 91:687–703. NIH State-of-the-Science Conference Statement on Multivitamin/Mineral Supplements and Chronic Disease Prevention NIH Consens State Sci Statements. 2006 May 15-17;23(2):1-30. Ward E. Addressing nutritional gaps with multivitamin and mineral supplements. Nutrition Journal 2014, 13:72. Schultz MJ, Harmsen RE, Spronk PE. Clinical review: strict or loose glycemic control in critically ill patients - implementing best available evidence from randomized controlled trials. Critical Care. 2010;14:223-231.

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Class 9: Hyperlipidemia and Diabetes Mellitus Instructors: Prelack, Kane, Singh, Siegel 3/29/17

Learning Objectives for class 9: Upon completion of this class, students will be able to:

Hyperlipidemia (live):

Describe the role of dietary modifications in the prevention and treatment of cardiovascular disease.

Diabetes Mellitus (live):

Identify the 4 classifications of DM and describe the features and risk factors of each.

Name the classes of human insulins and analogues and describe the method of action of each.

Describe the components of medical nutrition therapy for type 1 and type 2 DM

Required Readings for class 9: Hyperlipidemia: Estroch R, Ros E, et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. N Engl J Med 2013;368:1279-90. Mozzafarian D, Afshin A, Benowitz NL, et al. Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association. Circulation. 2012;126:00-00. Diabetes: American Diabetes Association Standards of Medical Care in Diabetes 2016. Diabetes Care. 2016;39(Suppl. 1):S23–S35. Bell KJ, Smart CE, Steil GM, et al. Impact of fat, protein, and glycemic index on postprandial glucose control in type 1 diabetes: implications for intensive diabetes management in the continuous glucose monitoring era. Diabetes Care. 2015; 38:1008-1015. Morris SF and Wylie-Rosett J. Medical nutrition therapy: a key to diabetes management and prevention. Clinical Diabetes. 2010;28(1):12-18.

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Supplementary Readings: Krause: Chapters 30, 33 Hyperlipidemia: Astrup A, Dyerberg J, Elwoon P, et al. The role of reducing intakes of saturated fat in the prevention of cardiovascular disease: where does the evidence stand in 2010. Am J Clin Nutr. 2011;93:684-688. Gupta R, Deedwania P. Interventions for cardiovascular disease prevention. Cardiol Clin. 2011;29:15-34. Siri-Tarino PW, Sun Q, Hu FB, et al. Saturated fat, carbohydrate, and cardiovascular disease. Am J Clin Nutr. 2010;91-502-509. Diabetes Mellitus: Ajala O, English P, Pinkney J. Systematic review and meta-analysis of different dietary approach to the management of type 2 diabetes. Am J Clin Nutr. 2013;97:505–16. Elia M, Cerriello A, Laube H, et al. Enteral nutritional support and use of diabetes-specific formulas for patients with diabetes. Diabetes Care. 2005;28(9): 2267-2279. Garner C, Wylie-Rosett J, Gidding SS. Nonnutritive sweeteners: current use and health perspectives. Diabetes Care. 2012;35: 1798-1807. Hamdy O and Horton ES. Protein content in diabetes nutrition plan. Curr Diab Rep. 2011;11:111-119. Inzucci SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient centered approach. Diabetes Care. 2015; 38:140-149. Joslin Diabetes Center and Joslin Clinic. Clinical nutrition guideline for overweight and obese adults with type 2 diabetes, prediabetes or those at high risk for developing type 2 diabetes. 2007. Prevention or delay of type 2 diabetes. Diabetes Care. 2016;39(Suppl. 1):S36–S38. Sheard NF, Clark NG, Brand-Miller JC, et al. Dietary carbohydrate (amount and type) in the prevention and management of diabetes. Diabetes Care. 2004;27(9): 2266-2271. Wheeler ML. Dunbar SA, Jaacks SM, et al. Macronutrients, food groups, and eating

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patterns in the management of diabetes. Diabetes Care. 2012;35: 434-445.

Class 10: Gastroenterology (Part 1) and Allergy Instructors: Prelack, Kane, Leung 4/5/17

Learning Objectives for class 10: Upon completion of this class, students will be able to: Gastroenterology (Part 1-recorded):

Describe the clinical manifestations and nutritional management of several gastroenterological disease states, such as pancreatitis and inflammatory bowel disease.

Allergy (live):

Describe the relationship between food allergens and the immunological response.

Distinguish between food allergies, food intolerances, and food sensitivities.

Identify symptoms related to food allergies and food intolerances.

Required Readings for class 10: GI (Part 1): Duggan S, O’Sullivan M, Feehan S, et al. Nutrition treatment of deficiency and malnutrition in chronic pancreatitis: a review. Nutr Clin Pract. 2010:25:362-370. Forbes A, Goldesgeyme E, Paulon E. Nutrition in inflammatory bowel disease. J Parenter Enteral Nutr. 2011;35:571-580. Garcia-Manzanares A and Lucendo AJ. Nutritional and dietary aspects of celiac disease. Nutr Clin Pract. 2011;26:163-173. Allergy: Du Toit G et al. Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy. N Engl J Med. 2015; 372:803-813. Hays T. Special considerations for managing food allergies. J Parenter Enteral Nutr. 2012;36:56S-59S. Supplementary Readings: Krause: Chapter 1, 26, 27, 28

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GI Mullin GE; Shepherd SJ, Roland BC, et al. Irritable bowel syndrome: contemporary nutrition management strategies. J Parenter Enteral Nutr. 2014;38:781-799. Allergy Sova CS, Feuling MB, Baumler M, et al. Systematic review of nutrient intake and growth in children with multiple IgE-mediated food allergies. Nutr Clin Pract. 2013;28:669-675.

Class 11: Gastroenterology (Part 2) Instructors: Prelack, Mason 4/12/17

Learning Objectives for class 11: Upon completion of this class, students will be able to:

Define and differentiate maldigestion and malabsoption.

Identify factors with cause maldigestion and malabsorption.

Describe the efficacy and safety of using probiotics and prebiotics under specific clinical conditions.

Required Readings for class 11: GI (Part 2): Ciorba MA. A gastroenterologist’s guide to probiotics. Clinical Gastroenterology and Hepatology. 2012;10:960–968.

GASTROENTEROLOGY CASE STUDY ASSIGNED

Class 12: Clinical Roundtable Instructor: Prelack 4/19/17

No Required or Supplementary Readings for class 12: GASTROENTEROLOGY CASE STUDY DUE

Class 13: Renal Disease Instructors: Prelack, Kane, Weiner, Poon 4/26/17

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Learning Objectives for class 13: Upon completion of this class, students will be able to:

Describe the causes and management of acute and chronic renal failure.

Name the nutritional concerns and outline the nutritional requirements and dietary modifications associated in chronic renal disease.

Describe the methods of renal replacement therapy and the nutritional requirements and dietary modifications associated with each in end stage renal disease.

Required Readings for class 13: Steiber A. Chronic kidney disease: considerations for nutrition interventions. J Parenter Enteral Nutr.2014;38:418-426. Supplementary Readings: Krause: Chapter 35 Kalista-Richards M. The kidney: medical nutrition therapy - yesterday and today. Nutr Clin Pract. 2011;26:143-150. Weisen P, Van Overmeire L, Delanye P, et al. Nutritional disorders during acute renal failure and renal replacement therapy. J Parenter Enteral Nutr. 2011;35:217-222.

This schedule is subject to modifications at the discretion of the instructor.