RD Exam: Principles of Dietetics (21% of exam)

Summarize some important interpersonal communication skills.

Communication is more than just one person talking. Communication is an exchange of ideas and information among people. The manner in which we communicate can affect the outcome of situations, work projects, or interventions. Perhaps one of the most important aspects of communication is actually listening. You need to hear and process what others are saying to be an effective communicator. Ask questions during the exchange and repeat responses in the form of paraphrasing showing there is acknowledgement of understanding. The nonverbal cues that you send also impact the communication process. Appearing with arms crossed and a scowl on the face sends a negative message; alternatively eye contact and nodding are encouraging and show understanding. Also, consider your tone of voice. You may say something kind or encouraging, but if the tone is rough or sarcastic, the message will not be received as perhaps you intended. It is also important to provide feedback in a nonjudgemental manner.

Each descriptive and inferential statistics.

Descriptive statistics are summaries of data and may be presented in graphical or table form. Some terminology associated with descriptive statistics include the mean, medians, and mode. The mean is the average of a set of numbers; the median is the number in the middle of a numerical, ordered set; the mode is the number that appears most often in the data set. The standard deviation indicates how spread out the numbers are from the average and is also the square root of the variance. Inferential statistics infers information from a data sample. For instance, if you want information on dietary intake for a particular state or metropolitan area, it would be unrealistic to questions every individual. Rather, a sample of the population would be interviewed or studied, and conclusion could be drawn from that sample.

Explain an orientation and training program.

Orientation programs may be conducted at the onset of a program or employment. Orientation programs take many forms, but they serve to orient the participant or employee to the program or workplace. Training programs can be effective in the workplace when teaching new skills. Ongoing training can be essential in the workplace to reinforce information and to enhance job skills.

Summarize the functions of phosphorus, selenium, and iodine.

Phosphorus contributes to the structural integrity of teeth and bones and is a component of phospholipids. Phosphorus deficiency is rarely observed. Selenium functions are not well understood, but selenium's most notable role include that of an enzyme cofactor and its role in iodine metabolism. Selenium deficiency is not widespread but can occur with total parenteral nutrition.

Discuss nutritional needs during pregnancy and lactation.

Pregnancy is unlike any other time in life. Although there is not a necessity for an expectant mother to "eat for two," her intake must increase to support the many changes and growing fetus. Weight gain during pregnancy on average is 25-35 pounds. If underweight prior to pregnancy, a greater weight gain of 28-40 pounds is suggested. If overweight prior to conception, 15-25 pounds are optimal. As expected, additional energy is required during pregnancy. During the first trimester, energy needs are not expected to increase. During the second trimester, an additional 340kcals per day is warranted, and during the third trimester, the daily reference intakes (DRI) for energy is an additional 452kcals per day. Protein needs increase during the second trimester of pregnancy, and the recommended daily allowance (RDA) for this time is 1.1g/kg/day. During pregnancy (and ideally prior to conception) folic acid supplementation of 400 micrograms is recommended to help prevent neural tube defects ad other congenital malformations. Energy needs during lactation are demanding. Lactation during the first 6 months postpartum requires an additional 330kcals per day, and during the second 6 months postpartum, an additional 400kcals per day is recommended.

Explain how and why sensory evaluation of foods is used.

Sensory evaluation is a scientific approach used by food producers to test and evaluate food products. These tests are carried out by food scientists utilizing a panel of judges to evaluate products using their senses. Such experiments are carried out to produce product formulations that have the potential to be successful in the marketplace. Most people are concerned with how their product tastes; we are unlikely to purchase a product if the taste is unsatisfactory. Food scientists want to know if the food is sweet, salty, bitter, or sour. Does the food leave an aftertaste? Another important factor to consider is visual appeal. If you have ever eaten food that taste good but looks unappealing, you know this measurement is important for food producers to consider. Color and shape are important considerations. A cake that generally expected to be fluffy would be a disappointment if it is flat in appearance. Mouthfeel is also an important consideration - is the texture pleasing and expected or is it hard and lumpy. The smell of the food is also measure; a good smell is a very attractive feature for foods, whereas an off smell can be unappetizing.

Summarize some additional preservation methods that may be used at home or in a commercial setting.

Sugar provides a hospitable medium for food preservation by means of osmosis, which limits the water available for microbes to grow. Jellies and jams are effectively preserved, and microbes are killed with addition of sugar and boiling heat. Freeze-drying is actually a form of food dehydration methods, with freeze-drying, foods are first frozen, and then water is extracted. Freeze-drying produces a more visually appealing product because the original size of the food is better maintained as opposed to a shrunken appearance. Food irradiation uses gamma rays to kill microorganisms and is an effective means of preserving food while maintaining food integrity. According to the Food and Drug Administration (FDA), irradiating foods is a safe process, and nutritional quality is not compromised by this form of food preservation.

Water is a major component of many foods. Describe the states of matter in which water can be found in foods.

Water is composed of 2 hydrogen atoms connected by 1 oxygen atom. Water is liquid at room temperature, but at 32 degrees F/ 0 degrees C, it becomes a solid. At 212 degrees F/ 100 degrees C water boils (at sea level), turning into steam. Atmospheric pressures have an effect on boiling point of water; the higher the elevation, the lower the atmospheric pressure and, therefore, the lower the boiling point. The freezing point of water can be decreased by the addition of salt, sugar, or alcohol. This is why salt is often used to treat icy roadways in the winter.

Explain how and why fats become rancid.

When fats become rancid, the essentially "go bad" due to chemical changes; rancidity results in an altered tasted and appearance. Like most organic compounds, degradation and breakdown begins to affect the chemical structure of fats and result in poor quality. Because of their chemical structure, unsaturated fats degrade more quickly. Because they are not completely saturated with hydrogen atoms and have "free space" available, this configuration attracts oxygen atoms, resulting in oxidation. Regardless of the configuration, all fats are subject to the oxidative process over time. Both light and heat facilitate the oxidative process over time. Storage of the fat or oil is important; containers that are darker in color may shade the oil from light, and storage in a cool and dark environment will also extend the shelf life. Food manufacturers may add antioxidants to oils to help prohibit oxidation; butylated hydroxy anisole (BHA) and butylated hydroxytoluene (BHT) are two common additives.

Describe fat, protein, and carbohydrate makeup of milk and dairy products.

Whole cow's milk is the highest in fat content and contains approximately 3.3-3.7% fat. Two percent milk contains approximately 2% fat. Low-fat milk contains about 1% fat. Skim milk is very low in fat, with less than 0.5% fat. The content of other nutrients does not vary based on fat content. In general, milk is composed of 5% carbohydrates (~12-15g) and 3.5% protein (~8-10g). Lactose is the main carbohydrate present in milk, whereas casein and whey are the primary proteins. The major component of milk is water.

Discuss the characteristics of types of flours.

Whole-wheat flour has undergone less processing, and the grain remains mostly intact; a large portion of the bran and shorts remain. Flour can be refined, which removes much of the bran and shorts; this also results in a white appearance. All-purpose flour is commonly used in baking and is a mixture of hard and soft wheats. All-purpose flour has a relatively high protein content as compared to cake and pastry flours. The protein content of flour dictates the texture of the final product. Pastry and cake flours have less protein content, resulting in softer or flakier products. Bread flour has a higher than all-purpose flour, and this gives bread its heavier and rougher characteristic texture. Using the wrong type of flour can yield an unsatisfactory result.

Define and discuss herbals, botanicals, and dietary supplements.

According to the FDA, "The law defines dietary supplements in part as products taken by mouth that contain a 'dietary ingredient.' Dietary ingredients include vitamins, minerals, amino acids, and herbs or botanicals as well as other substances that can be used to supplement the diet." The use of supplements may fall under the terminology complementary or alternative medicine. Many different types of supplements exist, and their intended purposes vary. Botanicals or herbals may be used interchangeably; they are derived from plants. Examples of herbals and botanicals are garlic, gingko biloba, and St. John's Wart. Other types of supplements include vitamins and minerals. These supplements may be sold as a multivitamin that provides a combination of vitamins and minerals or may be packaged individually. Examples include calcium, vitamin E, and fish oil. It is important for the RD to be familiar with supplements to evaluate their use in patients.

Summarize the nutrient needs for adolescents.

Adolescence and the teenage years bring with it many changes. Growing independence brings more choices for food beyond the family meal. School and peer influences may have significant impacts on the dietary patterns for this age group. Nevertheless, continued promotion of healthy dietary intake is important. Due the varying growth and changes associated with puberty, actual nutrient needs will vary depending on age and stage of development/growth. The following indicates the estimated energy requirements (EER): Girls 9 to 18 years: 135.3 - (30.8 x age in years) + activity factor(10 x weight in kg) + (934 x height in meters) + 25 Boys 9 to 18 years: 88.5 - (61.9 x age in years) + activity factor(26.7 x weight in kg) + (903 x height in meters) + 25 The recommended daily allowance (RDA) for protein for 9 to 13 years of age is 0.95g/kg/d, and for 14 to 18 years of age, the requirement decreases to 0/85g/kg/d.

Discuss some alcoholic beverages and their characterisitics.

Alcoholic beverages are generally subdivided into liquor, beer, and wine; each is distinctive in characteristics. Liquor is fermented and distilled; the process of distilling produces a higher alcohol content. Liquors contain the most alcohol by volume; 1.5oz is typically 80 proof or 40% alcohol. Beer is produced from a variety of grains; barley is typically used, but wheat, rye, and even corn are sometimes use. Beer alcohol content can vary, but 5% is typical of a 12oz beer. Wine is a product of fermented grape juice; the process for making red wine and white wines varies slightly. Ultimately, the type of wine produced will depend on the type or types of grape used in the process. The flavor of wine is dependent on grape type, the amount of aging, and the type of container in which the wine is aged such as an oak barrel.

Discuss the nutrient needs of children.

Although the growth rate has slowed since infancy, children are still experiencing rapid growth and development. As children grow, they become more independent, and this include dietary independence. Many factors influence dietary intake but possibly none more than the family. It is important to set a healthy tone for dietary intake and offer a variety of healthy choices. The prevalence of obesity has risen in recent decades, and to curb this trend early education and intervention is necessary. Children may attend daycare or school; this too influences the eating patterns of this age group with peers. Estimated Energy Requirements (EER): Males and females ages 13 to 35 months: (89 x child weight in kg - 100) + 20 Girls 3 to 8 years: 135.3 - (30.8 x age in years) + activity factor(10 x weight in kg) + (903 x height in meters) + 20 Boys 3 to 8 years: 88.5 - (61.9 x age in years) + activity factor(26.7 x weight in kg) + (903 x height in meters) + 20 With age, protein needs decrease. At 1 to 3 years of age, protein needs are 1.05g/g/d, whereas at 4 to 8 years of age, protein needs to drop to 0.95g/kg/d.

Explain an experimental and observational statistical study.

An experimental study isolated a variable to be studied and then further identifies other variables that may impact the variable of study. From a nutrition perspective, let's suppose we wanted to study how to intake of certain foods affect cholesterol levels. Cholesterol would be out primary study variable, and other variables included in the study might be fiber and beef. The objective of the study is to determine how the other variables affect cholesterol levels. An observational study does not control the variable in the same manner. A survey is an example of an observational study.

Discuss types of research.

Analytical: Analytical research attempts to establish a cause-and effect relationship. Regression analysis is one such example of an analytical research method. Descriptive: Descriptive research is intended to describe a problem or event rather than making cause-and-effect predictions. The case study method is an example of descriptive research. Qualitative: Qualitative research generally involves thoughts and opinions rather than facts; it is often conducted as initial research that then leads to further research. Quantitative: Quantitative research involves facts and figures (numbers).

Discuss some classes of food additives and their role in foods.

Antimicrobial agents work to prevent the growth of microbes such as bacteria or mold. Example of antimicrobial additives include sodium nitrite and sodium benzoate. Antioxidants may be added to food to provide a more stable product by increasing shelf life through limiting the oxidative process. Examples of antioxidants include ascorbic acid and vitamin E. Emulsifiers are necessary to allow for proper mixing of liquids so that it is appealing and more edible. Mayonnaise is a emulsion; without an emulsifier mayonnaise would be separated into a solid and liquid form. Lecithin and monoglycerides are examples of emulsifiers. Humectants are used in foods that need to retain moisture. Because moisture can promote microbial growth over time, humectants may be added, which is turn bind to the water; this process extends shelf life. Humectant examples include salt and glycerin. Stabilizers impact the texture of foods by adding a smoothing quality while preventing separation. Without the use of stabilizers many foods would be lumpy or have an inconsistent texture. Stabilizers used include pectin, gelatin, and hydrolyzed vegetable protein.

Discuss evidence-based research and how it applies to dietetics.

As RDs it is imperative to put evidence-based research into practice because our message should be based on sound, peer-reviewed research, and scientific principles. The Academy of Nutrition and Dietetics describe evidence-based practice as follows: "Evidence-based dietetics practice is the use of systematically reviewed scientific evidence in making good and nutrition practice decisions by integrating best available evidence with professional expertise and client values to improve outcomes." The incorporation of evidence-based practice guidelines into our everyday practice can help improve patient care, lends credibility, and can lead to better outcomes. Part of the NCP is to support and utilize evidence-based research and guidelines in the practice of dietetics. The Academy of Nutrition and Dietetics provides resources to incorporate sound principles into practice; an example is the Evidence Analysis Library (EAL). The EAL provides reliable, peer-reviewed information for RDs to access and apply to practice.

Explain why it is important for RDs to participate in public policy discussion and be familiar with the legislative process.

As healthcare professionals, RDs may wish to advocate for their patients and their profession. Citizens can offer a voice by contacting your elected representatives in matter involving funding and legislation that can impact RD practice or healthcare in general. The steps in the legislative process are as follows: 1. A bill is proposed or introduced. 2. The bill goes to committee; it may die in committee or may move forward. 3. A hearing or vote may be scheduled. 4. If the bill passes, it can be moved to the other chamber (Senate or House depending on its origin). 5. A similar process is followed in this chamber (the bill goes to committee). 6. If there are changes to the original bill, the changes must be resolved and agreed upon by both chambers. 7. The final bill will be voted on by the House and Senate. 8. The president has the option to sign the bill into law or veto.

Discuss some content considerations in educational planning.

Before conducting an education session, the RD must first plan the content of the class or counseling session. What will happen in the class? How will it be conducted? What type of education materials will you provide to the participants? These are all questions that must be answered during the preparation stage. First, consider who will teach the class? Will you teach the class, or will you invite a guest speaker from the community? For instance, suppose you are conducting a class on cardiovascular health. Perhaps you could invite an exercise physiologist to discuss incorporating exercise into a healthy lifestyle. What type of visual aids will be used? Although hearing a speaker provides information, incorporating visual senses is often helpful in a classroom environment. Options include using slide shows, a whiteboard, and food models to reinforce the message. If you are using a program such as a slid show presentation, the content should be easy to read (font at least 24) and not too cluttered (leave white space). Will you provide handouts for take-home reference? Handouts can be a useful tool, but they should be easy to read and concise. Adequate planning and use of resources are necessary in facilitating an education session.

Explain why conducting a needs assessment is necessary.

Before the RD begins education, he/she must understand the needs of the individual or needs of the group. An understanding of needs will help the RD develop a framework for the education plan. Without first conducting a needs assessment, the RD will not have a baseline from which to work. It is important to assess the current knowledge base of the client or clients to direct the education appropriately. A newly diagnosed individual with DM may have a limited understanding of DM, whereas a previously diagnosed individual with DM may have more knowledge. At the same time, the previously diagnosed individual may have a limited understanding of how diet affects his/her DM, so it is important to avoid making assumptions. A thorough needs assessment will evaluate knowledge and the ability to comply, along with other pertinent details that may affect the education plan and outcomes.

Explain the difference between a formative and a summative evaluation.

Both summative and formative measures are used to evaluate learning. Formative evaluations provide continuous feedback about how a class or counseling is proceeding. Having real-time data to assess can help the practitioner make changes in the plan or approach. Alternatively, summative evaluations measure learning at the end of an educational period. For example, if you were conducting a series of classes and you evaluated outcomes at the end of that series, this is a type of summative evaluation. If you measured at the end of each individual class, you would be using formative evaluation.

Provide examples of some moist heat methods of food preparation.

Braising: First the meat is typically browned in a skillet to lock in the juices; then the meat is transitioned to a moist heat cooking method and cooked in a juice such as broth. Typically, the meat is cooked slowly for a long period of time. Examples of meats that are commonly braised include roasts and short ribs. Boiling: Food is cooked in boiling water; examples, include rice and pasta Simmering: Liquids are kept very hot but not quite at the boiling point. Many recipes will call for simmering of ingredients. Spaghetti sauce or marinara sauce may be simmered to allow liquids to dissipate and spices to infiltrate the sauce. Steaming: Food is cooked from the steam given off by boiling water. Veggies are commonly steamed. Stewing: This involves slowly cooking at high temperatures in juices; beef stew is a good example of this cooking method.

Provide examples of some dry heat cooking methods used in food preparation.

Broiling: Food is cooked in an oven utilizing radiant, high heat emitted from the top of the oven; meats are good candidates for broiling. Frying: Foods are cooked in oil; foods may be deep fried, which involves completely covering the foods with oil (french fries), or smaller but significant amounts may used for pan frying (fried green tomatoes). Grilling: Foods are cooked via a direct flame from heat below the food. Many items can be successfully grilled, including hamburgers, steaks, and f/v. Roasting: Roasting is essentially baking, but we often refer to roasting when talking about meats and f/v; foods can be baked for shorter periods of times, or items may be slow roasted. Many items can be baked, including potatoes, tenderloin, chicken, and f/v. Sautéing: Foods are cooked in a small amount of fat or oil; the food is not covered in oil. Veggies are commonly sautéed.

Explain Cognitive Behavioral Therapy (CBT).

CBT can be used in many different types of counseling situations. RDs can successfully employ this approach as well in addressing nutrition-related issues such as obesity and some eating disorders. CBT can used to help patients "unlearn" certain unhealthy behaviors. For instance, if you are addressing someone who eats when he/she feels stressed or unhappy, it is important that this person learn to disassociate feelings and food. The way we feel, in reality, does not necessitate the need to eat. More likely, eating when we are stressed or upset has become a habit. With CBT, you train yourself not to associate food with feelings. Rather food should be associated with true hunger and sustaining life; the emotions should be dealt with in more constructive ways.

Summarize the functions of calcium and magnesium.

Calcium has a variety of functions but is well-known for its contribution to strong teeth and bones. In additions, calcium is involved in the transmission of nerve impulses and cell function and plays a role in muscle contraction. A lack of recommended calcium may result in the disease rickets in children, and a lack of adequate calcium may contribute to osteopenia and osteoporosis in older adults. Magnesium, like calcium, is essential for strong bones. Magnesium and calcium work together in bone metabolism; magnesium is necessary for parathyroid hormone secretion. Magnesium also plays a role in energy production, the synthesis of deoxyribonucleic acid (DNA) and ribonucleic acid (RNA), heart rhythm, and muscular contractions. A deficiency of magnesium is rare. Susceptible individuals includes alcoholics, the elderly, and those with diseases resulting in malabsorption.

Discuss the process of canning foods as a preservation method.

Canning of foods may take place on a large commercial scale or may take place in the home. The goal is essentially the same - to achieve a safe, highly shelf-stable product. Canned products can be held for approximately 2 years and still maintain their safety; nutrient loss will occur during this time. Heat is the key to canning; the presence of heat combine with adequate time and correct temperatures are all factors in safe canning. A major pathogen concern among canned products is Clostridium botulinum; this pathogen produces spores that are very heat resistant. Foods that are low in acid, such as most veggies, should be canned under pressurization to reduce risk of botulinum contamination. Fruits may be canned using a water bath method. Fruits are placed in glass jars and immersed in boiling water. Because fruits are generally higher in acid content (lower pH), pressurization is not necessary. Beyond the initial destruction of pathogenic organisms, it is critical that cans and jars are sealed properly. An inadequate seal allows oxygen to enter and opens the door for spoilage.

Summarize caramelization and the Maillard reaction.

Caramelization occurs when sugars are heated to high temperatures, resulting in a crispy browning of the product. This often results in desirable product taste and appearance. A good example of the caramelization reaction is exhibited in the heating/torching of creme brulee. Desserts are not the only products that can be caramelized because sugar is present or can be added to many food types. Onions can be caramelized because they naturally contain sugar. The Maillard reaction is a browning that occurs when sugar and amino acids are combined primarily through heating, but browning can also occur when this mixture is stored for long periods of time. This reaction results in an attractive product appearance and different taste. The Maillard reaction does not involve enzymes. Oven-roasted meats will brown as they are cooked; this is an example of a Maillard reaction.

Summarize the function of carbohydrates.

Carbohydrates supply the body with energy and are the main source of fuel for humans. The chemicals' structure for carbohydrates consists of carbon, hydrogen, and oxygen. Carbohydrates can be divided into three major subcategories: (1) monosaccharides; (2) oligosaccharides; and (3) polysaccharides. Fructose, galactose, and glucose are examples of monosaccharides, which are considered simple sugars. The class oligosaccharides consist of the maltose, lactose, and sucrose, which are also termed disaccharides. Polysaccharides include glycogen, fiber, and starch; they are often referred to complex carbohydrates. Glycogen is the stored form of glucose; the capability to convert glucose to glycogen is essential for the body to function efficiently.

Summarize the composition of f/v.

Cellulose (an insoluble fiber) is an important building component of f/v, adding to structural integrity. Hemicelluloses also play a role in structure as do pectic substances. Heating cellulose softens the characteristically rough texture; this may be desirable when eating some veggies. F/v generally have very high water content. Veggies have more cellulose than fruit, and water within the cells gives veggies their crisp texture (turgidity) as exhibited in celery.

Describe some pigments present in the f/v.

Chlorophyll is the pigment that gives f/v their green coloring. Prior to ripening, fruits will often have a green coloring; this is from chlorophyll. As the fruit ripens, the green color will be replaced by other colors because the amount of chlorophyll is decreasing. A strawberry is a good example of a fruit that changes from a greenish color to a bright red when it is fully ripe. Chlorophyll is also affected by heating; when a veggie is cooked, it may turn a brownish green color. Green beans area a good example of this process taking place; fresh green beans are a brighter green, and upon cooking the color change is evident. Blanching and freezing generally maintain the bright green coloring, making the veggie more appealing. Carotenoids are responsible for giving f/v their yellow and orange coloring, such as in carrots. Red, purple, and blue hues come from the anthocyanins, as seen in blueberries and raspberries. High pH levels will alter the color of anthocyanins, turning them a blue shade, and more acidic mediums turn anthocyanins red.

Explain the properties of coffee, and discuss the techniques brewing coffee.

Coffee comes from a plan; the Coffea Arabica and Coffee Robusta are the plants responsible for providing coffee beans. After the beans are harvested and dried, they are roasted to provide optimal flavor. Tannins are naturally present in coffee and contribute to the characteristic bitter taste. Coffee naturally contains caffeine, but it also contains other antioxidants that may contribute to health. There are a variety of ways to brew coffee; the most commonly used method in the US is the drip method. Most households have a coffeemaker that employs this method. Coffee grounds are put into the machine, and hot water runs over the coffee grounds; typically, the grounds are filtered with a removable paper filter. Coffee percolators are not as commonly used but were once very popular. Percolation involves very hot water continuously passing over the coffee grounds; this method can produce a more bitter-tasting coffee. Single-serve coffee brew machines have become quite popular in recent years. A single pod is placed into the machine, and hot water runs through the coffee grounds in the pod. The single-serve method is very quick, but the taste may be sacrificed.

Explain glycogenesis.

Conversion of glucose to glycogen takes place in the liver; glycogen is also stored in the liver and muscles. When the body detects excess glucose in the bloodstream, the process of glycogenesis initiates. Glucose-6-phosphate begins the process of glycogenesis, and insulin facilitates the process. This process is impaired in individuals with T1DM because of the lack of insulin (insulin stimulates glucose uptake). Through a series of chemical reactions, the excess glucose is converted to glycogen for use as energy at a later time. Because we are not constantly eating and providing a continuous stream of carbohydrates, low circulating levels of glucose in the bloodstream signal the body to access "energy reserves." The process of glycogenesis provides metabolic balance and allows the human body to operate seamlessly.

Detail the functions of copper, iron, and chromium.

Copper functions as an enzyme and is involved in energy production, iron metabolism, and collagen synthesis. Copper deficiency is not widespread, but those susceptible include individuals with malabsorption problems, cystic fibrosis patients, and individuals consuming excess zinc. Iron composes a major portion of hemoglobin, which is involved in the vital activity of oxygen transport. A deficiency of iron is called iron deficiency anemia, and this is common. The problem is encountered most often in infants, younger children, adolescents, females of childbearing age, and pregnant women. Also, anyone with prolonged loss of blood or absorptive problems, such as those with Celiac disease, mat become iron deficient. Chromium's most important role may be in the action of insulin, but the exact mechanism is not completely understood. Chromium deficiency is quite rare.

Describe some approaches to teaching nutrition classes, and relay when those approaches might be used.

Culinary demonstrations could be used when the audience has limited knowledge of cooking or when the audience has a specific interest in cooking. The demonstration would be tailored to the skill level of the audience. If you have a group needing to prepare quick, yet healthy family meals, your demo would illustrate that approach. Rather if you have an audience that is less restrained by time and more focused on other culinary aspects you might focus on meals that require more time and skill. Perhaps a group member has a favorite recipe that he or she would like to "make healthy." This would be a good cooking illustration. Grocery store tours can be incorporated into a class and are an effective means to discuss specific foods and read food labels. Often, one can get overwhelmed by the endless choices in the grocery store aisles. The grocery store tour enables the RD to promote specific, healthier choices while also communicating items that should be limited or avoided. Class members can begin the tour with a "grocery list" and use this as the basis for teaching.

Provide examples of how research data can be presented and describe the components of a typical research publication.

Data should be presented in a way that is easy to read and understand. In research, you may be reporting a tremendous amount of data. Text may be used to convey some information, especially qualitative information. Quantitative information is often best displayed in a table or chart. Research published in a peer-reviewed journal will generally follow a typical format that includes the following components: 1. Abstract: overviews the research. 2. Introduction: tells you why the research is being done. 3. Literature review: reviews existing literature on the subject. 4. Methods: describes how the research was conducted. 5. Results: includes findings of the research. 6. Discussion: includes interpretation and implications of research. 7. Conclusions: describes final comments about results and need for further research. 8: References

Describe how proteins function within the body.

Dietary protein provides energy at 4kcals per gram but more importantly protein is composed of amino acids, which are essential for life. Complete dietary proteins generally come from animal sources and contain all the amino acids required. In contrast, incomplete dietary proteins do not provide all the necessary amino acids. Incomplete protein are contained in plant food sources. Proteins contribute to the composition of the human body; most protein is concentrated in muscle, followed by the organs. The role of proteins in the body are vast. Amino acids are involved in the production of several hormones such as tyrosine and insulin. Enzymes are also composed of proteins; enzymes facilitate chemical reactions within the body. Collagen and muscles are also comprised of proteins. Proteins serve as carriers for other substances in the body; albumin is an example.

Explain the composition and structure of fats.

Different types of fats will have varying chemical structures. Fats are composed of carbon, hydrogen, and oxygen. The chemical structure of the fat influences the melting point. Longer chain fats have higher melting points vs short-chain fatty acids. Saturation refers to the amount of "free" space available for hydrogen. Saturated fats are saturated with hydrogen, meaning they cannot hold any more. Unsaturated fats essentially have "free spaces" and do not contain all the hydrogens the chemical structure will allow. Saturated fats tend to be solid at room temperature and have higher melting points. Fats are configured in either cis or trans formation. Cis formations have the hydrogen atoms on the same side of the double-bonded carbons. Trans formations have the hydrogen atoms diagonally on opposite sides of the double bond. Trans formations have higher melting points than cis formations.

Discuss the role of enzymes and hormones in the absorption of nutrients.

Digestion is not just a physical process that begins in the mouth, it is also a chemical process facilitated by enzymatic action and hormones. The enzyme salivary lipase is secreted in the mouth, thus initiating the breakdown of starch and fats. In the stomach, pepsin begins the work of breaking down proteins. Gastric lipase contributes to the breakdown of some fats. In the small intestine, bile salts are instrumental in absorption of fat-soluble vitamins and lipids. Pancreatic lipase and colipase are pancreatic enzymes that further aid in the digestion of fats, whereas pancreatic amylase facilitates the digestion of starch. Trypsin and chymotrypsin from the pancreas further break down protein. The small intestine is structurally designed to absorb nutrients. The small intestines consist of many folds and villi; as such the surface area for absorption is massive.

Discuss nutrient needs for adults and for the aging population.

During adult years, the goal is to maintain a healthy diet and a healthy weight. Growth should be complete, so nutrient needs should generally stabilize. As an individual advances in age, a healthy diet continues to be important, but additional needs may arise as part of the aging process. Recommended Daily Allowance (RDA) for Protein (Adults): 0.80g/kg/day The progression in aging may result in a variety of physical changes. These changes can affect dietary intake and nutrient needs. With aging may come poor eyesight and hearing; poor eyesight can affect the ability to shop for or prepare foods. Taste and smell may also be adversely affected, resulting in poor intake. Mobility issues may result, which can produce a host of problems related to intake. Mental changes may occur that affect the desire to eat. In addition, other health problems including CVD and gastrointestinal disease may have adverse effects. These are all issues that must be managed because malnutrition is a concern with the aging population. Nutrient needs vary greatly in this population because there are so many variable to consider. Energy needs can be estimated using the Mifflin-St. Jeor equation, and protein needs may increase to 1.0-1.2g/kg/d.

Discuss egg quality and grading.

Eggs are graded based on quality and candling is used to observe specific characteristics. Grade AA is the highest quality, consisting of a normal-appearing outer shell and a firm-looking yolk. Grade A quality eggs show a normal-looking shell, a firm yolk, and some thinning white. Grade A eggs are what you typically buy from the grocery store. Grade B quality eggs may show minor shell defects and a flatter yolk with runny whites. Because of these characteristics, grade B eggs are frequently used by food manufacturers to produce egg products. Although eggs have a rather long shelf life when refrigerated, changes do occur with time, affecting the quality of the egg. As moisture and carbon dioxide are lost, the albumin experiences an increase in pH' this change in pH can affect both the taste and appearance of the egg.

Summarize the physical and chemical properties of eggs.

Eggs have a porous outer shell that is made up of calcium. Inside the shell, the vitelline membrane surrounds the yolk. The egg white, known as albumin, provides additional protection for the delicate yolk. Both the yolk and white are high in protein, but the white contains very little fat compared to the yolk. Cholesterol is found within the yolk but not in the egg whites. One large egg contains approximately 70kcal and includes 5g of fat, 1.5g of saturated fat, and 6g of protein. A concern with eggs is the potential source of salmonella. There is a chance for eggs to contain salmonella, so care must be taken to properly cook eggs to destroy any harmful bacteria.

Summarize the purposes for in service-education.

Facilities and organizations should strive to provide an environment of ongoing education for employees, volunteers, and student interns. In-services and frequent education are part of a more comprehensive training programming. Training does not end after the 2-day orientation period; effective training is continuous. In-services are beneficial for employees and other workers to reinforce priorities, review goals, and set new objectives. These meetings also provide an avenue to share new information, education, and serve to remind employees of proper workplace behavior. Whereas some in-services may focus on quality assurance and risk reduction, others may provide diversity training.

Summarize the function and types of fats in the body.

Fats are also known as lipids. Dietary lipids provide more energy than carbohydrates and protein at 9kcal per gram. Lipids have many important functions within the human body, including insulation, cell membrane integrity and composition, and hormone structure. Lipids are divided into several different classes according to their structure. Fatty acids have a simple chemical makeup. Fatty acids may be saturated or unsaturated and can be essential or nonessential. Essential fatty acids are a necessary component of the human diet; examples include linoleic and alpha-linoleic acid. If these fatty acids are excluded from the diet, growth failure and cognitive implications ensue. Another classification of fats is sterols and steroids. Cholesterol is a member of this class and has important roles in the development of hormones and vitamin D. Phosholipids deviate from the structure of other lipids in that they contain phosphate. Phospholipids are components of cell membranes and are structurally significant in the myelin sheath of nerve tissues. Another class, glycolipids, function primarily as structural contributors within the body; this includes the composition of brain tissue.

Summarize why it is important to develop a budget for educational programs.

First, you must consider whether you have the funds for your program offering and whether you wish to use those funds on the program under consideration. Most likely, your department or project will have a specific amount of funds allocated. You must decide how to use those funds to meet your objectives, and this information should be detailed in the form of a budget for your educational program. Why budget? A budget is really a plan for how money will be spent. Without a proper plan, you could use all of your funds in one area and not have enough money for another area. Planning and allocating funds appropriately while involving stake holders in the budgetary process will help avoid a negative financial outcome.

Explain the processes involved in food biotechnology and genetic engineering.

Food biotechnology is also referred to as genetic engineering and involves genetically modifying a food to produce a desired outcome. This type of modification is unlike forms of food processing. According to the Food and Administration (FDA), the majority of genetically modified foods are corn, cotton, canola, and soybean. Genetically modified foods may be engineered to resist insects and disease. This should result in fewer pesticides being used and a greater crop yield, which is beneficial from health and economic standpoints. In addition, foods can be modified to withstand environmental barriers to successful crop growing. For instance, drought conditions and cold climates can adversely affect many types of plants; these disadvantages can be overcome through food biotechnology. Foods can even be modified to exhibit certain nutrition enhancements, such as increasing beta-carotene or iron. Like other foods, genetically modified foods are regulated by the FDA, and steps are taken to ensure safety.

Summarize food dehydration for food preservation.

Food dehydration significantly reduces the moisture content from foods, thus making them more shelf stable and less subject to deterioration or contamination. Because most microbes require moisture, drying foods destroys bacteria, yeast, and mold, and airtight packaging helps maintain the preservation and retard growth. Commercial means of dehydration include spray drying, freeze drying, and vacuum belt drying. Many types of foods can be dehydrated including meats (beef jerky), fruits (grapes and bananas), and even veggies (green beans). Physical and nutrient changes occur during the dehydration process. The removal of water content will have an obvious effect on the product's appearance. The product may appear shrunken or shriveled due to the loss of water (water adds to plumpness and shape). Color changes may also be evident as browning tends to occur because of the Maillard reaction. Dehydration also causes protein denaturation and vitamin C loss.

Summarize the types of food packaging commonly used.

Food is commonly packaged to maintain safety and quality and to provide a means for storage and easy transport. Glass jars are frequently used to package products such as spaghetti sauces, pickles, and other sauces. Glass may be clear, offering the consumer an opportunity to view the product, or it may be colored to prevent light penetration, thus helping to prevent degradation. Glass does not impart a taste to the product, which may occur with metal containers. Metal containers are widely used, and you may see drinks, veggies, soups, cream, and other products packaged in metal cans consisting of aluminum or steel. Metal containers are lightweight and relatively durable compared to glass. Plastics are another type of package commonly used in the food industry in part because they are cost-effective. Plastics or polymers are used to house an almost endless variety of products including milk, oils, cheeses, frozen microwave meals, and margarines. Bisphenol-A (BPA) is a component of some plastics. Although the Food and Drug Administration (FDA) has deemed it safe for current use, BPA is no longer used in the production of infant baby bottles, sippy cups, or infant formula. Other food manufacturers have voluntarily chosen to eliminate BPA from their packaging. Paper and paperboard may also be used to package products such as milk, snack foods, cereals, and pastas.

Discuss the process and methods of freezing to preserve foods.

Food is subject to spoilage, and a continuous supply of fresh foods is not always available; thus, food preservation is an important component of an adequate supply of food. Freezing can kill or slow growth of microorganisms that are harmful. Enzymes will not be destroyed by freezing, which means degradations can continue. To stop the enzymatic process, blanching of veggies is done, and this action also maintains the green coloring in veggies (due to chlorophyll). Fruits are not suitable for blanching because they are delicate; ascorbic acid or sugar can help prevent the natural enzymatic process. Air blast freezing is a very quick method of freezing that employs a blast of cold (-30 degrees C to -45 degree C or -31 degrees F to -49 degrees F), circulating air. Indirect contact freezing is conducted by cold temperature transfer in which food is placed on a flat holding plate, and the shelves holding the food contain frigid liquids. Immersion freezing involves immersing or submerging the food into a very cold liquid such as sodium chloride; the liquid can also be a cryogenic liquid such as nitrogen and carbon dioxide.

Discuss the process of ingestion and digestion.

Food is taken in by mouth (ingested) then is mixed with saliva and chewed. The food is swallowed and travels through the esophagus into the stomach. Digestion truly begins in the stomach due to the breakdown of food from gastric acids and enzymes. When this phase is complete, the contents are referred to as chyme, and the contents pass into the small intestine through the pyloric valve. The small intestine, divided into the duodenum, jejunum, and ileum, is where the majority of digestion takes place. Specifically, the duodenum, the first section of the small intestine, is the site of the most digestion. With the help of enzymes and hormones, food is further broken down, and the majority of nutrients are absorbed. The remaining contents pass through the ileocecal valve into the large intestines. Very few nutrients or fluids are absorbed in the colon. The final portion of the digestive tract is the rectum, and the remaining contents exit the digestive tract through the anus.

Summarize gluten's role in food products.

Gluten is a protein found in types of grains including wheat, barely, and rye. Gluten contributes to the characteristics of breads and doughs and is comprised of gliadin and glutenin. Gluten is formed when these two molecules become intertwined. These two components of gluten contribute to bread's ability to rise and to the elasticity of dough. When considering elasticity, pizza dough is a good example of this characteristic. Gluten formation can be slowed with the addition of sugars and fats, whereas a rise in temperature aids gluten development.

Define glycolysis.

Glycolysis involves the breakdown of glucose into either pyruvate or lactate. Glucose breakdown via this pathway is necessary to produce the large amounts of energy that result from the Krebs cycle. This presence or absence of oxygen during the process determines the end product. In aerobic glycolysis, pyruvate is produced. In anaerobic glycolysis, lactate becomes the end product from the conversion of pyruvate. Pyruvate production is significant because it is involved in the Krebs cycles in which it is completely oxidized. Typically, pyruvate becomes the end product, and this it the preferred route that will ultimately result in sufficient energy release. Under condition where the body is lacking oxygen, such as the case with vigorous exercise, lactate is produced. Less energy is release during the lactic acid cycle as the body is not designed to sustain prolonged periods of oxygen debt.

Discuss why goal setting is important for the RD client relationship.

Goal setting is part of the NCP. Goal setting is not only for the RD to measure whether objectives are met, but setting goals is also important for the client. Ideally, the RD will set goals with the client (or caregiver if the client is unable to participate in the process). Why is this important? When goals are set, the client has something measurable toward which to work. Along with setting goals, the RD and client should discuss how to reach those goals. With this frame work, the stakeholders in this process know where they are going and how they will get there. Goals should be measurable, and a time period for achieving should be specified. Goals are not objectives set in stone; they can be changed or altered to better meet the needs of the client and to coincide with clinical objectives. Goals may also apply to other situations; the RD may set goals in his or her workplace with the employer, or the RD may be the employer and set goals with his/her organization. When setting goals, it is important to involve stakeholders - those who have a stake in the organization. It is important to consider factors and objectives that are important to partners and others who are involved. Otherwise, setting objective may prove fruitless.

Discuss some benefits and limitations of group education.

Group education occurs when more than one person is present for education or counseling. This may occur in the form of a class or a smaller gathering. Group educating provides an opportunity for many people facing the same challenges to be together and learn from one another. For example, diabetes education classes provide a setting where newly diagnosed individuals can interact with others who are in the same situation. This setting not only provides the necessary education but also lends support. Of course, there are downsides to group education classes. Some members of the group may not feel comfortable sharing information in front of the group. This should be respected. Some individuals may also benefit from individuals education in addition to the group setting. Also the group setting limits individual education, so specific needs are best handled in a one-on-one setting.

Describe some characteristics of effective groups.

Groups of people work together to achieve a specific objective. How that group operates together should have clear goals. Members should be committed to the task at hand and willing to participate. Effective teams should communicate often, openly, and honestly. Team members should promote unity, and a sense of trust is important. Members should know and understand their roles and feel comfortable carrying out their responsibilities. People working in groups often produces interesting, unpredictable outcomes. The Risky Shift Phenomenon says group decision making tends to result in decisions that are riskier or more extreme than they might make if acting alone. The opposite of greater risk-taking behavior also results in that groups are afraid their actions will adversely impact the group, so they take fewer risks. This phenomenon could have both positive and negative outcomes depending on the situation.

Summarize what groupthink is, and detail how can it be avoided.

Groupthink is a common phenomenon that occurs when people go along with the group. Perhaps no one wants "to rock the boat" or dissent. Groupthink can have negative consequences in that poor decisions may result. Most groups have a combination of outgoing and dominating personalities combined with more reserved individuals. It is important that everyone has a chance to be heard, and there are steps that should be taken to ensure the team is performing at an optimal level. Groupthink can be limited with the following actions: -Assign a devil's advocate to challenge decisions. -Encourage open dialogue, questions, and concerns. -Seek outside opinions. -As a leader, do not be overbearing. -Explore and establish alternatives plans - do not decide on one method or plan at the onset.

Explain the use of health claims on food products.

Health claims that are allowed by the FDA for food labeling and dietary supplement fall into three categories: (1) health claims; (2) nutrient content claims; and (3) structure and function claims. Health claims indicate a relationship between the food and a health or medical condition. According to the FDA, an example of a health claim is that "adequate calcium throughout life may reduce the risk of osteoporosis" Prior to including a health claim on a food label, permission from the FDA must be obtained. Nutrient content claims indicate how much of a nutrient is contained in the food product. Terminology included in these claims relate a nutrient to a bodily function. According to the FDA, a structure or function statement could be: "fiber maintains bowel regularity." Food manufacturers are not required to notify or obtain permission from the FDA to use structure or function claims (dietary supplements are subject to different restrictions).

Discuss fat hydrogenation.

Hydrogenation is a chemical process used by the food industry to modify the original structure of fats to achieve a desired product. Hydrogenated oils were frequently found in margarines and commercial baked goods. Hydrogenation increases the melting point, makes the fat more saturated, and increases the shelf life of fats. In addition, the configuration of the molecule changes to include more trans formations rather than cis formations. Hydrogenation has been shown to have negative impacts on cardiovascular health and is linked to increased levels of low-density lipoprotein (LDL) cholesterol. In 2015, the Food and Drug Administration (FDA) announced that partially hydrogenated oils are not generally recognized as safe and instructed food manufacturers to begin removing such oils from products.

Explain respiratory acidosis and alkalosis.

If breathing is impaired, gas exchange can be affected. Decreased ventilation or slowed breathing can cause a buildup of carbon dioxide. Too much carbon dioxide may result in the blood becoming too acidic, and this is called respiratory acidosis. When this occurs, the kidneys work to rid the body of excess acid. Respiratory alkalosis can also occur as blood pH rises due to excessive carbonic acid loss. Alkalosis may occur from hyperventilation; the kidneys work to remove base from the body to bring pH into balance.

Discuss how and why program promotion should be considered.

If you are putting time, money, and effort into creating an educational program, you want people to attend, so they must know the program is taking place and be informed of details such as date and time, location, and the purpose of the session. Who are you trying to reach (target audience), and how will you reach these individuals? If you are offering a diabetes education class, you can consider contacting local physician groups and providing them with the details. In turn, they may refer their patients. You can also have flyers distributed or displayed in doctor's offices, hospitals, and senior centers advertising the program. Perhaps you already have a list of potential attendees from your patient list. You can reach out via mail or email to these individuals with program details. Another avenue to advertise is through participation in health fairs. This provides an opportunity to share with the public any programs or other offering your organization may sponsor.

Describe the role of the musculoskeletal system.

In part, we can attribute our ability to move, walk, and run to our musculoskeletal system. Although the brain signals the body, bones, muscles, and ligaments provide the physical means to carry about the movement. The adult body contains 206 bones, whereas infants and children actually have more bones. As growth occurs, the bones fuse together. If some of our bones were already fused, growth would be limited. Bones do more than just provide structure and protection, although these are primary functions of the skeletal system. Bones also store calcium, which is necessary for many other bodily functions, and they house bone marrow, where red blood cell production take place. Bones are connected to each other at hinges called joint. Ligaments help anchor the bones together, and tendons connect muscle to bone. Cartilage is also present to serve as a lubricator between bone surfaces. Skeletal muscles, which are attached to the tendons, are ultimately responsible for initiating movement.

Discuss some effective interviewing techniques you might use as a RD.

Interviewing is how you gather information, and your approach will impact the type and usefulness of the feedback. To provide targets intervention, you want to gather quality information that helps you assess the patient. Open-ended questions or statements are more likely to provide you with the most information as compared to closed-ended questions or statements. The following is an example of an open-ended statement that asks for information: "Tell me about some challenges you have faced in trying to lose weight." This type of approach will provide you with more detailed information than a closed-ended question, such as, "Have you had challenges losing weight?" This type of questions is not particularly helpful because most likely the patient is seeking the RD's expertise due to challenges. As the RD, you need to know what challenges are being faced so you can provide the best education and intervention strategies. Use caution when using leading questions. As the name suggests, such questions can lead the client to a specific answer that may not be the most accurate.

Describe some considerations for written communication.

Just as one should use care with spoken word, the same is true for written communications. When writing, there is a record of what you have communicated, and your words and approach should be thoughtful and professional. Although emails have become casual over time, remember you are a professional. Emails can offer an avenue for quick exchanges but take care to maintain a professional tone and image when writing. One should seek to avoid spelling and grammatical errors. As always, patient privacy should be maintained with any form of communication. As a RD, you may be asked to prepare reports for work or write grant proposals to obtain funding. Writing skills are important in these endeavors, and your writing is reflective of you as a RD. As with all forms of written communication, a thorough, professional approach is expected.

Discuss the role of leavening agents in baking.

Leavening agents cause breads to rise. Steam is one such leavening agent; steam is created when water reaches the boiling point. Steam cause batter and dough to expand. Carbon dioxide also causes expansion of doughs and batters. Yeast is often used in breads because yeast yields carbon dioxide, thus creating a leavening effect. The addition of acids when combined with alkaline ingredients can also produce a leavening effect through carbon dioxide production. Acidic products include buttermilk and sour cream, whereas baking soda is an alkaline ingredient. Eggs also produce leavening when beaten by trapping air in the batter; this trapped air allows for expansion when the product is baked.

Explain what macronutrients are and indicate their food sources.

Macronutrients are carbohydrates, proteins, and fats. The body requires large amounts of these nutrients to function properly. Carbohydrates are the body's primary source of fuel or energy. Carbohydrates provide 4kcal per gram. Of the macronutrients, carbohydrates should compose most of our dietary intake (50-60% of daily kcal for most individuals). Carbohydrates come from plant sources such as grains, fruits, and starchy veggies, but dairy products also contain carbohydrates. Protein is involved in muscle composition and serves many other important roles. Protein also provides 4kcal per gram. Dietary protein sources are mainly from meats, fish, and poultry, but beans, nuts, and dairy also contain protein. Fats are components of cell members and aid in digestion; they can be used as energy when other sources are depleted. Dietary sources of fat typically come from meats, fish, dairy, and oils.

Discuss. the safety of food additives.

Many of the additives used in foods are the same ingredients we use at home in own kitchens. According to the Food and Drug Administration (FDA), food additives are used in food to maintain or nutrition, and improve texture, taste, and appearance. The FDE maintains a database of additives used in foods, and food additives are regulated. Still, concerns about additive safety are abundant, but the FDA does take the measures that promote safety, and their actions are based upon prevailing, available scientific evidence. The FDA is tasked with evaluating food additives and considers four main factors: (1) composition and properties; (2) the amount one would typically consume; (3) health effects; and (4) other safety factors. If an additive is ultimately approved, the FDA may set limits on how the additive can be used. Beyond initial approval, the FDA monitors new additives and reserves the right to re-review and revoke approval. Other food additives known as generally recognized as safe (GRAS) are not subject to approval. Based on long-standing use and scientific evidence, these ingredients are accepted to be safe. Examples of such ingredients include sugar, salt, and spices. Although there cannot be a 100% guarantee of safety with food additives, the processes in place aim to provide a safe food supply for all Americans.

Discuss some benefits and concerns associated with electronic health records.

Merriam-Webster define informatics as, "the collection, classification, storage, retrieval, and dissemination of recorded knowledge." The electronic health record is an example of informatics in use. There are advantages to the electronic medical record (EMR) compared to a paper record. Whereas only one paper record may exist, the EMR allows for access by multiple locations. This may help improve access to information and continuity of care. Of course, with this ease of access also comes privacy concerns. Confidentiality of health information remains paramount; organizations and providers are required to take steps that protect health information.

Explain what micronutrients are and in what food they can be found.

Micronutrients are vitamins and minerals, and compared to macronutrients the body only requires small amounts of micronutrients. Examples of micronutrients include the fat-soluble vitamins A, D, E, and K, and the water-soluble C and B vitamins. Also included, but not limited to the micronutrient class, are the minerals calcium, iron, sodium, potassium, and magnesium. Milk and dairy products are prominent sources of both calcium and vitamin D. Vitamin E is commonly found in nuts and oils; vitamin A is concentrated in carrots, sweet potatoes, and other carotenoids; and vitamin K is found in leafy green veggies. The B vitamins will generally be found in grains and fortified cereal, whereas vitamin C can be found in f/v. The best source of iron is meats, but some whole grains and leafy green veggies also contain iron. Sodium can be found in abundance in a large variety of dietary sources, whereas potatoes and bananas are good sources of potassium. Fish, nuts, and whole grains provide excellent sources of magnesium.

Discuss the differences between moist heat cooking and dry heat cooking.

Moist heat cooking utilizes moisture to help prevent the toughening of the meat while providing an ample time frame for collagen to be broken down and softened. Moist heat is especially advantageous when cooking tough cuts of meat with a lot of connective tissue. Stews are an example of moist heat cooking. When cooking beef stew, chuck roast, which comes from the shoulder, is typically used. Chuck has a lot of connective tissue, which is slowly broken down during the heating process. Other types of moist heating methods include steaming and braising. Dry heat cooking does not utilize moisture and is best suited for tender cuts of meat. Sirloin can be successfully cooked using dry heat as can poultry and fish. Tender cuts of meat have less collagen and generally do no benefit from prolonged cooking periods. Oven roasting, grilling, and broiling are example of dry heat cooking.

Explain telehealth and remote health monitoring and how they may be used.

More and more, alternatives to traditional healthcare settings are being introduced and are known as telehealth. Telehealth options offer patients and providers the ability to interact remotely without being in the same physical location. Telehealth provides convenience and can also promote access to providers in underserved or rural areas. Telehealth sessions are often conducted by video but could also be conducted by phone. Remote health monitoring programs collect health information (while the patient is at home or work), and the data is transmitted electronically to another location (the provider). Like telehealth, remote health monitoring systems provide greater access for those who are unable to visit a provider. Telehealth may help eliminate the need for individuals to take time off work or travel great distances. Barriers such as limited provider access or lack of transportation can be somewhat alleviated with remote health monitoring. Telehealth services and remote health monitoring offer the opportunity for improving health in some populations that might otherwise be underserved.

Explain what motivational counseling is.

Motivational counseling may also be referred to as motivational interviewing. Motivational counseling is an approach one takes to counseling. A key part of behavior change is the motivation to do so, and as a nutrition counselor, part of your job is to help motivate. Rather than talking at someone, which may result in one-way communication, motivational interviewing involves a healthy, productive exchange of information. As part of motivational interviewing you not only provide feedback in the form of education, but you listen to what is being communicated by the client. In turn, you show empathy and understanding for challenges and triumphs the client is facing. In many ways, motivational interviewing can be thought of as a pointed conversation that facilitates behavior change.

Describe some notable structural components of meats.

Muscle is a component of living creatures; in addition to water, muscle is composed of proteins called myofibrillar proteins and a smaller amount of fat. Collagen is a tough connective tissue present in abundance in many animals. Heat does act upon collagen to soften the tissue, whereas elastin, another connective tissue present in the meat, the less tender the cut of meat. Fat is another major component of meats; the amount and types of fat vary depending on the animal. Poultry tends to be leaner with less saturated fat than beef products. Many fish such as salmon contain ample amounts of omega-3 fats, which are generally regarded as healthy. Beef products that show fat marbling are often considered to be most tender and tasty cuts of beef.

Define and explain nutrient databases and nutrient analysis.

Nutrient databases house data on specific nutrients in foods. Although there are commercial databases available to purchase and use, the USDA provides a massive, online database available for anyone to use. The database may be searched by food or by entering a nutrient or combination of nutrients. The output includes information on macronutrients in addition to specific vitamins, minerals, and fiber. Nutrient databases can be used by RDs to conduct nutrient analysis of foods. An analysis will help determine approximately the amount of kcal, fat, and protein provided by each food item. Additional analysis can be done that includes fiber content, a specific breakdown of fats, or other vitamins and minerals of interest.

Explain milk pasteurization and homogenization, and discuss why each process takes place.

Pasteurization of milk products is used to eliminate pathogens and make milk safe to drink. High-temperature, short-time pasteurization is commonly used. Milk products are heated to 161 degrees F for 15 seconds to kill dangerous microbes. Unpasteurized milk can be contaminated with E. coli, listeria, and salmonella. Pasteurization does not significantly affect the nutrition content of milk products. Consuming unpasteurized or "raw" milk products does not have any appreciable health benefits and is not advised due to potential for food-borne illness. Homogenization results in the physical separation of fat from the liquid in milk. Through a pressure apparatus, fats are made smaller, and they no longer clump. Although this process is not absolutely necessary, it does make the milk more pleasant to drink. Without homogenization, fat will cluster rather than being uniformly dispersed throughout the milk. The clustering of fat particles will lead to lumpy product, which is less appealing to consumers.

Define phytochemicals, and summarize their roles in nutrition.

Phytochemicals are components of food that are believed to offer protective health benefits. These chemicals occur naturally in plant-based foods, making f/v and whole grains even more attractive. Specific, recommended levels of intake have not been developed for phytochemicals because additional research is still needed to study these chemicals. As RDs, we can recommend consuming a plant-based diet because doing so is related to better health, and phytochemicals are thought to play a role in the protective effect. There are thousands of phytochemicals found in foods. Some of the better known phytochemicals include flavonoids, anthocyanins, carotenoids, and lignans. Additional studies are needed, but research suggests phytochemicals may play a role in cancer and CVD prevention. Studies linking phytochemicals to decreased risk for T2DM and neurodegenerative diseases like Parkinson's and Alzheimer's are also promising.

Explain what a processed food is and give examples of processing.

Process foods encompass a broad range of foods. Strictly speaking, processed foods are foods that have been changed in some way prior to delivery to the customer. This certainly includes many foods, and a processed food is not always synonymous with unhealthy. Gone are the days where most people go to their gardens to pick fresh foods and have farm animals to utilize for protein sources. Although this way of life certainly still exists, we live in a society in which food is transported from one region of the country to another. Although fresh fruits are transported and distributed across state lines or country borders, we also rely on the convenience of processed foods to safely fill out dinner tables and lunch boxes. Processed foods are more shelf stable so they can keep for longer periods of time either with or without refrigeration or freezing. Food processing may involve canning, drying, and other forms of food preservation such as smoking and salting. Milling of grains is another type of food processing that turns grains into more usable forms. Pasteurization of milk, egg products, and juice take place to ensure a safer product. Food preservation provides us the opportunity to safely enjoy f/v in December even when they are not in season. Without food processing, many conveniences and healthy options would not be available.

Summarize the functions of pyridoxamine, pantothenic acid, biotin, and cobalamin.

Pyridoxamine is also referred to as vitamin B6. Vitamin B6 functions as an enzyme and coenzyme. Pyridoxamine is involved in hemoglobin synthesis and is involved in metabolism. Those at risk for vitamin B6 deficiency include alcoholics, the elderly, and renal patients on dialysis. Pantothenic acid is involved in the formation of coenzyme A, which is essential for nutrient metabolism. Deficiency of pantothenic acid usually does not occur alone - typically there would be other nutrient deficiencies as well. Biotin also serves as a coenzyme and is involved in metabolism. Deficiency is uncommon but can occur due to malabsorption or alcoholism. Cobalamin is also referred to as vitamin B12. Cobalamin is involved in the metabolism of folate. A deficiency of vitamin B12 may result in megaloblastic anemia.

Summarize the characteristics and mixing methods of quick breads.

Quick breads do not utilize yeast for leavening; yeast often takes time to rise, whereas other types of leavening agents produce this effects more quickly. In essence, quick breads may be prepared more quickly than yeast breads. Muffins, pancakes, and biscuits are all example of quick breads. Depending on the product being made, the process and ingredients for producing quick breads differ. In general, a liquid, flout, and sometimes salt are components. The approach to mixing the ingredients varies by product. The biscuit method cuts fat into the dry ingredients, followed by the addition of liquid. The muffin method mixes dry ingredients and liquid ingredients separately at first then combines the two. The conventional method of mixing initially combines the fat and sugar followed by adding egg. Then, dry ingredients are incorporated, followed by the addition of liquids.

Discuss how a RD might use media in his/her practice.

RDs have more outlets for communication than ever before. To communicate our nutrition message, we can use a variety of media including websites, magazines, flyers, billboards, and social media. Print media is still used today even with the influence of the Internet. Not all individuals relay on the Internet for the exchange of all information, so print media still has a place. To advertise a nutrition class, you may want to use flyers and hang them in strategic locations. You may use pamphlets and business cards to provide information about your business. To reach a greater audience, you may establish a web age that can be continuously updated where people can go to find detailed information about your practice or class offerings. Social media is yet another tool that allows RDs to reach an audience. Many use social media to quickly provide updates, education, and announcements.

Software may be used by RDs and food service organizations. Discuss how software may be used in practice.

RDs may use nutrient analysis software and databases to help analyze diets for adequacy. The USDA provides a free nutrient database, and several commercial databases are available for purchase. Foodservice operations often employ software to facilitate business activities. Software may be used to track inventory and for costing and ordering, menu development, and scheduling. Healthcare facilities may also use the preceding types of software but in addition often require software that helps manage therapeutic diets.

Discuss regression analysis.

Regression analysis looks at the relationship between two variables (simple regression). The dependent variable is generally denoted by the letter Y, and Y is the variable we will predict (the outcome of Y depends on X). X is the independent variable and will be used to predict Y. Regression analysis will yield an output that can be interpreted. The R value will tell us if there is a linear relationship. R^2 tells us whether our regression line mimics reality. The high the value, the better. The p-value gives us an indication as to whether the results occurred by chance. A lower p-value supports a valid result. For example, a p-value of 0.019 indicates there is only a 1.9% that the result is a fluke. A cut-off p-value of less than 0.05 is often used in research to indicate significance. The standard error is another output and measures whether our sample is representative of the overall population. If our sample does not reflect reality, this makes it difficult to draw accurate conclusions.

Explain the steps involved in the research method.

Research will generally be conducted by following the scientific method. The following are some basic steps involved in research: 1. Define the problem or area to be studied. 2. Gather information (one method is through literature review). 3. Establish hypothesis (the hypothesis is what you are trying to prove or disprove). 4. Design and conduct an experiment (test the hypothesis and collect experimental data; the study should be repeated for accuracy). 5. Analyze and interpret data (may use statistical analysis). 6. Discuss results (how do the results compare with other studies; was the hypothesis proved or disproved). The Institutional Research Board (IRB) is a governing body that exists to protect the welfare of human research subjects by instituting ethical standards; furthermore, the IRB ensures applicable laws are followed.

Explain the types of tests used to conduct sensory evaluations of food.

Single sample: As the name implies, a single sample is tested to determine whether it is adequate. This type of test may serve as an initial step to determine if product development should continue. Duo-Trio: This test uses a control and two samples. The objective is to decide which sample differ from the control. Triangle Test: Three samples are used; two of the sample are the same, whereas a third is unlike the others. The judge must identify the sample that is different. Descriptive Testing: A scorecard composed of very descriptive sensory words that may be used by the judges to provide additional feedback about the food product. Hedonic Scale: This is a scale measuring the degree of acceptability; wording will vary, but as an example, the scale may indicate a rating of 1 is "extremely tasty" and a rating of 10 might be "terrible".

Discuss the functions of sodium, chloride, and potassium.

Sodium is important in fluid and electrolyte balance in addition to muscle contraction. Sodium deficiency is rare, and sodium concentrations are well regulated, but sodium losses could result from intense sweating. Chloride works as an electrolyte alongside sodium to maintain fluid balance and also composes gastric acids. In the diet, chloride is generally consumed with sodium. Chloride deficiency is not common, but fluids loss from prolonged diarrhea or vomiting could upset the balance. Potassium, like sodium and chloride, is involved in fluid homeostasis and is involved in muscle contraction. Potassium is concentrated inside the cells; it is known as an intracellular cation.

Explain the ripening process in fruits.

Some fruits may be harvested when ripe, whereas other fruits continue to ripen after they are picked. Bananas are an example of a fruit that continues to ripen after harvest, whereas strawberries do no continue to ripen. Enzymes such as ethylene gas affect ripening, and eventually quality and taste of the fruit will also be affected due to enzymatic action. Ripening affects the sweetness of fruits as starch is converted to sugar. The structural integrity will also change; as enzymes alter the cells, fruits become softer. Generally, refrigeration can slow the degradation process.

Summarize the properties of tea.

Tea has been around for a very long time, and it is derived from the plant Camellia Sinensis, typically grown in Asia. Like coffee, tea naturally contains caffeine. In general, tea is high in antioxidants; the antioxidant catechin may contribute to he health benefits often associated with tea. Tea types include black tea, green tea, and oolong tea. Tea is derived from the same plant; the process is what determines the type of tea or the final product. All tea is allowed to oxidize, which affects flavor and appearance. Oolong tea is partially oxidized; green tea undergoes very little oxidation; and black tea is allowed to completely oxidize.

Explain % daily value.

The % daily value listed on the food label is based on a 2000kcal diet. If the food label indicates 14% for dietary fiber, the consumer knows 1 serving of the product he/she is eating provides 14% of his/her daily fiber needs. Of course, not everyone should follow a 2000kcal diet. Because individuals needs will vary, the 200kcal reference serve as a guide. The daily values are listed based on the Recommended Dietary Allowances (RDA).

Discuss the 2016 Nutrition Facts food label.

The FDA governs food labeling practices. The Nutrition Labeling and Education Act (NLEA) says most foods must have a label, and if health claims are made, additional requirements must be met. In 2016, labeling changes were finalized that included requiring manufacturers to list the actual amounts of vitamin D, calcium, iron, and potassium (in addition to the % daily value). Based on scientific feedback, daily values are also being updated for several nutrients. Specifying "added sugars" in grams is also new. There is no longer a requirement to list vitamin A and vitamin C. The "calories from fat" category is no longer required. According to the FDA, the law indicates serving sizes are to be based on amounts consumers are typically eating rather than what people should be eating. Serving sizes on food labels have generally not reflected reality in that they are too small and will be updated.

Explain the Krebs cycle.

The Krebs cycles is also referred to as the citric acid cycle. This metabolic pathway cause the release of energy; this pathway is the most critical because it accounts for the majority of energy utilized from foods. Although the process is complex and microscopic, in broad terms, the Krebs cycles could be thought of as extracting energy from the food we eat. This cycle takes place in the mitochondria of the cells. The process initiates with the acetyl CoA formed from the breakdown of nutrients such as fatty acids or glucose. Pyruvate enters the cycles as a result of glycolysis. Steps in Krebs Cycle: 1. Citrate is formed. 2. Citrate is isomerized (molecules are changed into different molecules). 3. Isocitrate dehydrogenase reaction produces energy by reoxidizing NADH; CO2 is given off. 4. Alpha-ketoglutarate is decarboxylized and dehydrogenated; CO2 is given off. 5. Phosphorylation occurs and guanosine triphosphate (GTP) is produced. 6. Oxidation occurs in which FAD is the hydrogen receptor. 7. Malate is formed. 8. Malate is converted to oxaloacetate, concluding the cycle. Note: 30-32 adenosine tri-phosphates (ATPs) are produced from the oxidation of one molecule of glucose.

Explain the term epidemiology. Describe how the term is related to nutrition and health promotion.

The World Health Organization defines epidemiology as "the study of the distribution and determinants of health-related states or events (including disease) and the application of this study to the control of diseases and other health problems." Thus, epidemiology really looks at what conditions affect our health and impact disease. Organizations and individuals that study epidemiology, seek to determine factors that may contribute to our health. To impact and reduce disease (and thus improve our health), it is essential to know what leads to health problems. Although, epidemiology is important in may aspects of healthcare, it is also important for nutrition-related problems. We know may factors such as income and cultural norms can affect our nutrition status, whereas factors such as gender and race influence our risk factors for certain diseases. Being aware of these determinants can help RDs make better choices in providing nutrition intervention for our patients and the community.

Describe some types of food additives and their purposes.

The addition of food additives is an example of food processing. According to the Food and Drug Administration (FDA), a food additive can be "any substance added to the food." The FDA cites the legal definition of a food additive as "any substance the intended use of which results or may reasonably be expected to result, directly, or indirectly, in its becoming a component or otherwise affecting the characteristics of any food." Food additives that are generally recognized as safe (GRAS) do not need prior approval before inclusion in a food product. There are many types of additives, and they are used for multiple purposes. For example, salt may be added to foods for the purpose of preservation and/or taste enhancement. Folic acid and vitamin D may be added to food products to provide nutritive value. Dyes may be used to improve color, and citric acid may be used to control pH. Cornstarch and dextrin provide texture for foods, whereas yeasts and baking powder are used for leavening.

Define and describe the body's nervous system.

The brain and spinal cord are the primary components of the body's central nervous system. The brain has three main parts: (1) the cerebrum; (2) the cerebellum; and (3) the brainstem. It is further subdivided into lobes. The brainstem connects the brain to the spinal cord. The spinal cord acts as the highway between the body and the brain - it transports signals to and fro the brain. The brain lobes include the frontal lobe, which controls areas such as speech and behavior. The occipital love controls sight. The parietal lobe is involved in speech, and the temporal lobe is involved in memory and hearing. Located within the brain are also the hypothalamus and the pituitary gland. The hypothalamus controls hunger and thirst, and it also controls the pituitary gland. The pituitary gland is the regulator of our endocrine system and secretes many important hormones. Specifically, thyroid-stimulating hormone and human growth hormone come from the pituitary gland.

List and describe the functions of fat-soluble vitamins.

The fat-soluble vitamins are A, D, E and K. Vitamin A: Vitamin A has a variety of functions within the body - one of the most notable is its significant role in eyesight. For its role in vision, vitamin A is actually metabolized in the retina. Rhodopsin, which is involved in night vision, is made from vitamin A. Vitamin A is also involved in epithelial cell function, growth and bone metabolism and functions as an antioxidant. Vitamin D: Vitamin D plays an important role in bone mineralization through the uptake and release of calcium and phosphorus, but it is critical in many lesser known functions. Vitamin D is found primarily in fortified foods, but the body is able to synthesize vitamin D when sunlight exposure is sufficient. Calcitriol is the active form of vitamin D and acts as a hormone. Vitamin D is involved in immune function and nutrient absorption - specifically calcium and phosphorus. Vitamin E: Vitamin E is actually an antioxidant; this role makes vitamin E interesting in the role of disease prevention, but this role as an antioxidant is also important to preserve normal cell function. Vitamin E works to prevent oxidation of cell membranes, thus it is essential in preventing cell damage and deterioration that naturally occurs. Vitamin K: Vitamin K plays a role in bone mineralization and blood clotting. Although dietary sources exist, the body is able to produce vitamin K in the intestines from the presence of bacteria.

Explain the role of the cardiovascular system.

The heart plays the central role in the functioning of the cardiovascular system, but the cardiovascular system is composed of a vast network of blood vessels that run like a series of roads and highways throughout the body. Arteries transport blood away from the heart, and the veins return blood to the heart (i.e., the pulmonary vein brings oxygenated blood to the heart from the lungs). Oxygenated blood and nutrients can be pumped to other parts of the body, while the blood containing carbon dioxide travels to the lungs for removal. The heart is actually a muscle, and contraction results from electrical impulses. The heart's anatomy consists of four different chambers: (1) right ventricle; (2) left ventricle; (3) left atrium; and (4) right atrium. The right atrium and right ventricle are separated by the tricuspid valve. The left atrium and left ventricle are separated by the mitral valve. The pulmonary valve is the gatekeeper for blood that will flow to the lungs, and the aortic valve is the gatekeeper for the aorta.

Summarize the role of the renal system.

The kidneys are the primary component of the renal system. The kidneys are a pair of bean-shaped organs responsible for maintaining fluid and electrolyte balance within the body and also contribute to the production of red blood cells. The kidneys filter using nephrons and rid the body of waste products or urea. The kidneys are also involved in blood pressure regulation through the release of renin. Renin is involved in the renin angiotensin aldosterone system, which controls blood volume. Other components of the urinary system include the bladder, ureters, and urethra. The ureters transport the urine to the bladder. The bladder is a pouch that holds the urine. The urethra is the structure that carries urine out of the body for excretion.

Explain the logic model, and discuss why it is used.

The logic model is one method to evaluate the effectiveness of your educational plan. Logic models can demonstrate and illustrate a framework for how your educational plan will operate. Logic models use pictures to shows a sequence of events in a plan. Logic models may have different steps illustrated, but the following provides some useful components. First, you should explain the purpose of the program or why you are conducting the class. For instance, why are you offering a diabetes education class? What are you hoping to accomplish with this educational program? Next, you may illustrate the resources and challenges anticipated. A resource might be subject-matter experts, whereas a challenge might be regular class attendance for participants. Then, you should illustrate what you will do in class or educational series. Finally, you should illustrate outcomes and detail whether you were successful in meeting your program goals. If your goals are not met, what areas of the logic model would you change or adjust to improve the effectiveness of your program? Regardless of which model of approach you use, evaluation your educational plan provides valuable feedback for improvement.

Summarize what documentation is, and discuss HIPAA.

The medical record is a legal document, and it should be treated as such. Information contained in the medical record is confidential. HIPAA is the Health Insurance Portability and Accountability Act and was enacted in 1996. As electronic systems were becoming the norm, HIPAA was enacted to protect the public by putting security and privacy rules into place. HIPAA also gives patient the right to view their medical records. Beyond the legalities, the medical record houses pertinent health information about the patient. Healthcare professionals document or record their interactions and interventions with the patient; documentation provides a record of care that helps ensure continuity. The medical record also serves as tool to communicate with other professionals. With proper documentation, the plan of care for an individual should be evident and clear to others reading the documentation. As a RD, you will also document your plan of care. RDs should adopt to the NCP and use standardized language when documenting.

Summarize how cooking techniques affect nutrient retention and food appearance.

The method of cooking can have an impact on the final nutrient content of foods. Some methods of cooking preserve nutrients rather well, whereas others tend to destroy or promote nutrient loss. Many factors such as time and temperature also affect nutrient retention. Vitamin C is not very heat stable, so it is expected that losses of vitamin C will occur in food. Minerals tend to be more stable and less affected by cooking compared to many vitamins. Boiling of foods tends to promote the greatest loss of nutrients; water-soluble vitamins may be leeched into the water. Frying will promote some loss of nutrients and deep frying may promote greater losses with higher temperatures and immersion in oil. Sautéing is typically one of the best methods for preserving nutrients. Because foods are cooked quickly in a small amount of oil, losses are minimized. Changes in food appearance also occur with cooking. Caramelization causes browning and produces a crispy texture. Meats will brown when cooking, thus improving their appearance. Foods can also lose water during cooking and therefore lose plumpness of volume. Color losses (chlorophyll) may also occur when foods are heated; broccoli loses its bright green coloring and takes on a more green-brown appearance.

Summarize the grief model.

The model was originally designed to explore the stages of grief prior to death, but it is also has implication for behavior change. For instance, a newly diagnosed CVD patient who has recently had a a heart attack might go through the stages described in the grief model. The stages are as follows: -Denial: the patient tell him/herself that heart disease is no big deal. It is hard to accept the reality of having had a heart attack and the implications that come with having heart disease. -Anger: the patient gets mad about the situation. He/she focuses on the unfairness of the situation. He/she might consider a person they know who eats whatever they want and never exercises but did not have a heart attack! -Bargaining: this is when the patient might say, "I will exercise a couple of times per week and try to eat a little better." There really is not commitment to change at this point. -Depression: the patient realizes he/she will have to do more than make small changes. This disease is life changing; depression may result from this change-of-life event. -Acceptance: at this stage, the patient either resolves to make real changes or accepts the reality of what may result from not making health changes.

Explain some important aspects for the RD to consider during the patient/client counseling session.

The objective of the counseling session is to impart information and education to the patient. In doing so, the patient or caregivers must also provide you with necessary information. The RD should seek to establish a working relationship with the client. Building trust is important, and judgement should be avoided, but professional honesty is necessary. The client should feel comfortable sharing information about his/her life that affects nutrition status. If in a hospital setting, family and friends may be present, and the patient may feel uncomfortable about counseling during this time. The RD should ask the patient who may be present during the interview and seek to establish a comfortable atmosphere for the patient to speak. Asking open-minded questions and careful listening while showing empathy will help the RD gain a better understanding of the challenges affecting the client. During the communication process, the RD should be mindful and respectful of cultural differences. The nutrition education message should be delivered in a respectful manner that seeks to involve the client in the decision-making process.

Explain the pulmonary system and its function.

The pulmonary system is responsible for gas exchange; we breathe oxygen and exhale carbon dioxide. We breathe air in through the nose, and air travels via the trachea into the lungs. The lungs are complex and composed of bronchi, bronchioles, and alveoli, and cilia. The main site of gas exchange is in the alveoli sacs, and cilia are "hairlike" extrusions that play a role in the removal of foreign bodies by facilitating the movement of mucus into the gastrointestinal tract. Breathing in air is a result of the contraction of the diaphragm. The pulmonary arteries transport blood rich in carbon dioxide to the lungs, where it is expelled, and the oxygen is absorbed. Oxygenated blood can then be pumped throughout the body. The lungs also play a metabolic role such as helping to maintain pH balance, and the lungs are the site of conversion of angiotensin I to angiotensin II (involved in blood pressure regulation).

Describe how you could evaluate the success of an educational class.

The purpose of the class is to educate, so clearly you want to know if the goals of the session have been met. Having your participants evaluate the speaker, materials, presentation, and overall class effectiveness is one such way to determine success. There is always room for improvement, and unless the educational session is evaluated, you cannot access where assess where to improve or how to improve. You could ask the audience if they felt the presentation was useful, but many people would feel uncomfortable publicly commenting. Providing a questionnaire to the class will offer you valuable feedback. With the feedback provided, you can improve upon elements that were effective for the participants and delete or change aspects that were not helpful. You can also determine the types of programs or topics the audience would like to see in the future. To encourage participation, the form should be relatively short and easy to read.

Summarize the nutritional needs during infancy.

The rapid growth associated with infancy results in a tremendous amount of energy needed to support the growth changes. Energy needs vary by age, and the estimated energy requirements are calculated using the following equations: 0-3 months: (89 x infant weight in kg - 100) + 175 4-6 months: (89 x infant weight in kg - 100) + 56 7-12 months: (89 x infant weight in kg - 100) + 22 The daily reference intakes (DRI) for protein in as follows: 0-6 months: 1.52g/kg/d 6-12 months: 1.2g/kg/d Infants less than 12 months of age should consume at least 30 grams of fat per day. With particular emphasis on alpha-linolenic and linoleic acid which are essential fatty acids. Breast milk naturally contains these fats, and most formulas are fortified. Breast milk or formula is the only requirement for infants during the first 6 months of life, but solid foods are introduced anywhere from 4 to 6 months of age. A slow progression of solid foods initiates with the introduction of cereal, followed by pureed vegetables and fruits and finger foods. The infant gradually progresses with different textures and is able to tolerate strained and chopped foods followed by the introduction of table foods at 9 to 12 months of age.

Discuss how pigments may affect beef coloring.

The red coloring in beef is due to myoglobin, and in presence of oxygen, myoglobin forms oxymyoglobin, and the result is a bright red color. Further oxidation will result in a brownish gray appearance of meat. Cooking meats has a similar effect upon the color. The myoglobin is converted to oxymyoglobin, and the browning process occurs as the meat cooks. A well-done steak will have a gray-brown appearance, and a rare steak will maintain more red coloring.

Discuss excretion.

The removal of waste products from the body is excretion. For solid products, the final destination is the terminal end of the rectum, known as the anus; contents are propelled via muscular reflex. Feces exit the anus and are composed of undigested material including fiber, bile pigments, and other undigested waste produces. Urea is filtered by the kidneys and removed from the body in the form of liquid urine.

Summarize the role of the reproductive system.

The reproductive system is responsible for reproducing, and the contributing structures differ in males and females. In females, the vagina, cervix, uterus, fallopian tubes, and ovaries are primary. In males, the penis, testes, and prostate gland are involved in the reproductive process. The testes make sperm and produce the hormone testosterone. The prostate provides fluid to aid the sperm during their journey. The penis is responsible for delivering the sperm to the female for the fertilization of the egg. The sperm and ejaculate enter the female through the vagina. Eggs and hormones are produced and released by the ovaries; fertilization occurs in the fallopian tubes. Once fertilized, the eggs travels to the uterus, where is implants and remains until birth. Unlike males, who can continuously produce sperm, females are born with a set number of eggs and do not produce any beyond the fetal stage. The number and viability of eggs decreases as the female ages.

Discuss the physical and chemical properties sugars.

There are many different types of sugars, and the sweetness of the sugar depends on the chemical structure as well as temperature. Simple sugars are carbohydrates, and may be monosaccharides or disaccharides, but most sugars encountered are disaccharides. Disaccharides are a combination of monosaccharides. The monosaccharides fructose and glucose can join together to form sucrose, a disaccharide. Sugar not only provides taste to food products, but it also contributes to the appearance and texture of foods. Fructose is the sweetest of sugars, followed by sucrose then glucose. Sugar is water soluble, but the degree of solubility varies depending on the sugar; fructose is most soluble and lactose least soluble in water. The degree of water solubility will have an effect on food product texture.

Discuss some behavioral change models.

There are many models that address behavior change, and two are described here. Lewin's Change Management Model can be applied to changes in organizations, but it can also be applied to individuals. This model takes a 3-step approach to change. The 1st step is to unfreeze. In this initial step, you the RD should open the door to change by explaining why change is necessary and the benefits associated with change. The 2nd step change. At this point, behavioral changes begin to occur over a period of time. The last step is refreezing. At this stage, changes have been implemented and have become commonplace. You want to this behavioral trend to continue and become commonplace. The Theory of Planned Behavior proposed by Ajzen and Fishbein proposes that our beliefs and attitudes, coupled with beliefs of influencing people, will predict behavior. From a health perspective, the patient would consider his/her disease and take into account how close family members might feel about treatment or intervention. Theories abound that try to predict behavior and explain behavioral change. In reality, behavior change is a complicated process that involves emotions, desires, finances, physical and mental limitations, as well as social aspects. There are many influences that impact our behavior, and the RD must carefully consider these areas when approaching change.

Define and explain how functional foods are used.

There is not an official definition for the term functional food, but functional foods can be considered foods that provide a health benefit beyond basic nourishment of the body. The Academy of Nutrition and Dietetics defines functional foods as "whole foods along with fortified, enriched, or enhanced foods that have a potentially beneficial effect on health when consumed as part of a varied diet on a regular basis at effective levels based on significant standards of evidence." A good example of a true functional food is salmon; salmon is recognized as having heart-healthy effects due to the presence of omega-3 fatty acids. Foods that contain plant sterols are another example of functional foods. Plant sterols may be added to products such as margarine and may have a positive effect upon cholesterol levels. Functional foods do exist and incorporating these foods into the diet may offer health benefits, but it is important to understand that marketing of some "functional foods" is also aimed at selling a product. Investigating the product and ingredients is a wise endeavor for the consumer.

Explain metabolic acidosis and alkalosis.

These conditions are related to kidney function. The kidneys function as a filter in part to maintain acid-base balance within the body. Metabolic acidosis results when there is too much acid in the bloodstream, this lowering the pH. In this scenario the kidneys have increased production of hydrogen or failed to remove hydrogen, and the result is an increase in carbonic acid. Increased blood acidity will prompt the lungs to increase respiration rate. Metabolic alkalosis results when the pH is too high because of inadequate hydrogen present or the retention of too much bicarbonate (base). The result is slowed breathing in an effort to retain more carbon dioxide.

Summarize the functions of thiamin, riboflavin, and niacin..

Thiamin is also known as vitamin B1. Thiamin functions primarily as a coenzyme and is involved in carbohydrate metabolism and energy production. A deficiency of thiamin is known as beriberi. Specifically, thiamin deficiency as a result of alcoholism is called Wernicke-Korsakoff syndrome. Riboflavin is known as vitamin B2 and has a variety of metabolic roles. Deficiency of riboflavin is known as ariboflavinosis; alcoholics are more susceptible to riboflavin deficiency due to poor intake. Niacin is also known as vitamin B3. Niacin functions as a coenzyme in many capacities and play a prominent role in glycolysis and the Krebs cycle. Pellagra is the term for deficiency of niacin.

Describe both verbal and nonverbal forms of communications.

Verbal communication is what we speak and how we say things. When speaking, we want to speak clearly and thoughtfully using a nonjudgemental and non-condescending tone of voice. Just as important as our verbal communication is our nonverbal communication. We do not always communicate with our words; sometimes our body language sends messages as well. When we cross our arms, we portray a closed-off mentality rather than someone who encouraged communication. Our facial expressions also send positive or negative messages to our clients and coworkers. It is also important to make eye contact rather than looking around when speaking and listening to someone. Eye contact signals that you are paying attention and hearing what is being communicated. As trusted healthcare professional who spend time interacting with patients, it is important that we communicate appropriately to be the most effective at our jobs.

Explain the functions of vitamin C and folic acid.

Vitamin C is also known as ascorbic acid. Vitamin C has several important roles within the body. Among these functions include synthesis of collagen, carnitine (an amino acid involved in energy production), and tyrosine (involved in melanin production and neurotransmitter production). Vitamin C also functions as an antioxidant. As an oxidant, ascorbic acid is thought to play a role in the prevention of CVD, some cancers, and macular degeneration. A deficiency of vitamin C can result in scurvy. Folic acid or folate is involved in cell division and cell production. Folic acid plays a role in deoxyribonucleic acid (DNA) metabolism and amino acid metabolism. Folate deficiency has been linked to neural tube defects, and deficiency is thought to play a role in the development of some cancers. Normal cell division is adversely affected when the body is deficient in folate; a folate deficiency is known as megaloblastic anemia.

Summarize why a RD must consider educational readiness in his/her practice.

Why is educational readiness important? Being ready to change or open to change certainly improves the odds of behavior change and helps improve the chances your message will be received. If your client or patient is not ready to make some life-altering changes, it likely will not happen. Although you the RD may have a wonderful plan to help the client meet your goals, you must consider the goals of the client and his/her openness to being educated and modifying behavior. Assessing education readiness in your client is an important first step. If he/she is not ready, you may take steps that will promote readiness. The Health Belief Model suggests a person's attitudes towards an illness or disease is coupled with the perceived effectiveness of the treatment will ultimately predict whether change will occur. Does the patient take his/her disease seriously? Do negative outcomes of the disease concern them? Does the patient have confidence that what you are proposing (nutrition intervention) will improve his/her outcomes? This is one model, and certainly behavioral change is rarely this simple. People are often resistant to change; many contributing factors should be considered when behavior change is needed.

Discuss zinc, manganese, and fluoride.

Zinc is involved in a variety of bodily functions including taste and smell, energy metabolism, and protein synthesis. Zinc deficiency is uncommon, but alcoholics and those receiving total parenteral nutrition without zinc are most likely to be affected. Manganese is involved in lipid and glucose metabolism as well as collagen and bone growth. Manganese deficiency generally does not occur under normal circumstances, but toxicity can occur in those experiencing liver failure. Fluoride is known for its role in strengthening tooth enamel. A lack of sufficient fluoride may lead to dental caries.