NASM CNC Chapter 1 - 4

noncummunicable disease

"chronic disease" A noncommunicable disease (NCD) is a medical condition or disease that is not caused by infectious agents; it can refer to chronic diseases which last for long periods of time and progress slowly.

Hierarchy of evidence

(most credible to least) 1. systematic reviews and meta analysis of RCTs 2. RCTs 3. Observational Research 4. Peer Reviewed Editorials + Expert Opinions 5. Non-Peer-Reviewed Media, including anecdote and tradition

What A Nutrition Coach CAN do?

- evaluate current eating plan + provide general guidance - recommend the client discuss supplement use with their personal RDN, physician, or pharmacist. - promote caloric guidelines outlined by USDA's myplate, the UK eatwell guide, or other acceptable entities - Recommend gradual dietary modifications - discuss importance of balance intake of macronutrients. - refer back to clients personal healthcare provider when necessary - provide guidance for healthy populations - offer advice on eating behaviors and/or macronutrients that are known to reduce the risk of disease / slow progression - offer exercise and physical activity guidelines

What a Nutrition Coach CANNOT do?

- specific meal plans/ menus - specific supplements / vitamins / minerals/doses -suggest drastic caloric restric - promote fasting / detoxes / other extreme nutritional practices - prescribe diets that omit or severely restrict certain food groups - go against recommendations fo licensed healthcare professionals. - prescribe dietary plans for athletes in extreme training programs, OR those with chronic health conditions - provide nutrition therapy to treat / prevent disease - provide exercise prescriptions / programming *unless cpt

SCOFF questionnaire

1. Do you make yourself Sick because you feel uncomfortably full? 2. Do you worry that you have lost Control over how much you eat? 3. Have you recently lost more than One stone (14 lbs) in a 3-month period? 4. Do you believe yourself to be Fat when others say you are too thin? 5. Would you say that Food dominates your life? The Nutrition Coach could informally work these questions into conversation, but not necessarily as part of a formal eating disorder assessment.

5 steps of scientific method

1. Identify a problem 2. Form a hypothesis 3. Design a study or test method 4. Collect data, synthesize it, and interpret it. 5. Discard unsupported hypotheses or continue testing supported hypotheses.

The spectrum of health

1. Pathalogy ( heart attack, diabetes, cancer) 2. transition zone (heart disease, malaise, fatigue, mood disorder, bloating, chronic unwellness, myalgia) 3. Optimal Wellbeing (no negative signs/symptoms)

What are the 3 components of evidence based practice?

1. The weight of the evidence from scientific research 2. Field Observations 3. Individual client needs and preferences

economics is ___1__ tied to ___2___ choices.... Why?

1. directly 2. food Individuals living in poverty generally develop poor eating habits simply out of a need to survive. High-calorie, highly processed foods are cheap and widely available, and often the availability of grocery stores in economically depressed areas is limited (known as "food deserts")

food changes ____1_____ and are impacted by ______2_____

1. evolve over time 2. biological, genetic, social, economic, and personal experiences/choices.

types of exploratory/epidemiological research

1.cross sectional studies 2.case control studies 3. cohort studies

According to the SCOFF eating disorder assessment, what is the minimum number of positive answers which might indicate an eating disorder?

2

satiety

A feeling of fullness and satisfaction. Satiety is a multi-factor theory Ex: consuming high proteins of protein and complex carbs tends to inspire a high satiety response. Whereas fat has the lowest satiety signal response Food satiety signaling is complex and influenced by cognitive, sensory, and physiological responses. These include: - GAstric distension - Gut hormone CCK - The energy density of food consumed Foods high in protein and fiber tend to have stronger satiety sensations, making them highly beneficial for balanced weight management.

Nutritionist

A generic term for someone who provides nutrition counseling

obese

A high degree of excess body fat - a BMI greater than 30. CDC reports that 40% of American Adults were obese in 2016 Obesity-related conditions ( including heart disease, stroke, type 2 diabetes, and certain types of cancer ) are the leading cause of preventable, premature death.

theory

A hypothesis or set of hypotheses for which a large body of high-quality evidence has been accumulated.

Systematic Review

A review where scientists systematically gather all research on a topic and evaluate it based on predefined criteria and rules. - Tries to minimize bias by using established guidelines

selection bias

A sample of people under study is not representative of the larger population that scientists are looking to make inferences about.

Meta analysis

A statistical analysis of a group of studies to assess the overall weight of the evidence. "A study of studies"

evidence based practice

A three-pronged approach to working with clients, which consists of making decisions based on the weight of the scientific evidence, field observations, and individual client needs and preferences

ARNP

Advanced Registered Nurse Practitioner requiring 2 more years of college beyond an RN - many then choose a specialty or primary focus of care.

sensory stimuli and food

Appetite can be triggered by: emotions, mood, sight, smell, and proximity of food The pleasure of past experiences when eating, combined with visual and auditory cues, can be a powerful driving force for hunger and food choices Low energy stores, a low blood sugar level, and an empty, growling stomach are also powerful forces that stimulate hunger *For this reason - going to the grocery store or out to eat should be planned around having an adequate energy balance to make healthy food choices

Age and food

As we age, our dietary habits may change. As metabolisms slow and less energy is expended over the course of the day, we tend to need fewer calories to survive A poor diet is common among older people, mostly due to changing economic and social

3 important steps to coaching

Assess Educate Implement

Refer clients who have orthopedic issues or injuries who need advice on fitness and rehab; gain athlete referrals who need assistance with weight loss or nutrition accountability.

Athletic Trainer

Which observational study design allows scientists to hypothesize a potential causal association?

Cohort Study

CDR

Commission on Dietetic Registration acts as the credentialing arm of the Academy of Nutrition and Dietetics for the purpose of establishing and enforcing certification standards for registered dieticians and other licensed nutritional professionals and issues credentials to those who successfully meet said standards. The CDR also provides a professional code of ethics and recertification standards.

pace of eating

Comparing the effect of slow and rapid eating patterns on hunger, fullness, glucose, insulin, and appetite related gut hormones in Overweight and obese participants with type 2 diabetes mellitus. Slower paced eating increased fullness and decreased hunger in all three groups

The Mayo Clinic (2018) offers the following heart-healthy dietary recommendations:

Control portion size. Eat more fruits and vegetables. Eat more whole grains. Limit unhealthy fats (no more than 5 to 6% of total calories from saturated fat and NO trans fat); monounsaturated fats (olive oil) are preferred. Choose low-fat protein sources such as fish, legumes, lean meat, and low-fat dairy products. Reduce sodium intake (no more than 1,500 mg of sodium per day). Plan and create menus ahead of time. Treat yourself on occasion.

Which of the following represents a weakness of observational studies?

Correlation does not equal causation

retrospective

Describes a study that looks backward in time.

Pharm D

Doctor of Pharmacy A pharmacist with an advanced degree who works in conjunction with a medical doctor to prepare and/or dispense prescription drugs or compounds.

Warning signs of disordered eating?

Drastic change in weight Behaviors such as vomiting after a meal, or using laxatives to enhance weight loss.

The following dietary habits have been associated with a lower incidence of cancer rates

Eating foods high in antioxidants (foods that are bright in colors, such as dark green, orange, purple, and red fruits and vegetable such as spinach, carrots, and tomatoes) Eating low glycemic index (GI) foods - Consuming foods with a high GI is associated with a significantly greater risk of certain types of cancer. Increasing dietary calcium intake - There is strong evidence to suggest that higher calcium intake can help reduce the risk of cancer. Maintaining a low BMI - A higher body mass index increases the risk of developing some of the most common cancers.

6 dimensions of wellness

Emotional, Social, Intellectual, Spiritual, Physical, Occupational

Which term describes how a body of knowledge is based on observation and experience?

Empirical

Scientists find that a protein supplement increases lean mass in the elderly. However, they caution that the results may not apply to other populations, like younger people. What term best describes what the scientists are referring to?

External Validity

Implement

Extreme diets and extreme workouts cannot be maintained indefinitely, so it is important to have an open and honest conversation with the client who may have unrealistic expectations If a Nutrition Coach finds that a client is very preoccupied with body image and is considering extreme measures to enhance their physique, it would be prudent to refer the client to an RDN who specializes in disordered eating. Body dysmorphic disorder is a true medical condition that affects both men and women.

A nutrition coach can provide meal plans and recommend supplements to their client (T or F)

False

Every region requires that a Nutrition Coach work under the supervision of a Registered Dietitian.

False

scientific data is fixed and immutable (t or f)

False

Socio-cultural factors & Food choices

Food choices and dietary behaviors can have high social context to little social context, depending on culture and individual Both positive and negative social influences can be linked to emotional eating and may lead to eating disorders and obesity

Which of the following is the leading cause of death?

Heart disease

Cancer + diet

Highly processed foods, red meat, and salt-preserved foods have been shown to increase the risk of developing cancer. A health-supporting diet including fresh fruits, vegetables, and foods high in fiber has been shown to reduce the risk of cancer. Genetics & environment = 30%

biological influences and food choices

Hunger, appetite, taste regulate food choices → which are regulated by complex biological, neuro-chemical, and physiological mechanisms. We need energy to survive and thus our hunger and satiety responses are powerful signals for us to consume and store food.

communicable disease

Infectious diseases caused by microorganisms such as bacteria, viruses, parasites, and fungi that can be spread (directly or indirectly) from one person to another. Most communicable diseases are preventable through proper hygiene, vaccinations, and taking necessary precautions.

Refer clients who have sudden onset of digestive issues; gain client referrals who need detailed education on sound nutritional practices.

Internal medicine doctor

Which statement best describes science?

It is the use of evidence to construct explanations and predictions of natural phenomena.

Which of the following represents a strength of observational studies?

Large subject numbers

Licensed vs Certified Nutritionist.

Licensing is typically provided on a state or federal level. Common prerequisites of licensing include formal education/training, a predetermined number of supervised contact hours, and successful completion of a standardized test. Most healthcare providers require licensure. Certification is granted to a person who has participated in an educational course (either live or online) and successfully completed a standardized test: written, practical, or both.

Historical Research

Looks at events in past and uses it to make inferences about other times, including the future limitations: - info from past may be incomplete or inaccessible -may be subject to biases of researchers involved.

Scientists perform a diet study in which they assign half the people to a continuous dieting group and the other half to an intermittent fasting group. Which term best describes this study design?

Parallel

Patient vs Client

Patient is used for licensed professionals Client is more appropriate for certified professionals

Which of the following represents a critical evaluation of a study by other scientists?

Peer Review

Which of the following is the best source of information?

Peer reviewed scientific journals

when providing information/educating to clients, what kind of information is this? If a client just lost a partner to a heart attack, the client may be likely be very interested in heart-healthy foods.

Perceived to be important

PA

Physician Assistant A licensed healthcare professional who works under the supervision of a doctor or other medical professional, typically requires a 4-year degree plus a post-graduate program.

Questionable or poor, non-peer reviewed sources of information

Popular media. This includes television and radio shows (whose main objective is ratings and advertising revenues, not scientific accuracy) and most popular diet and health books. Anecdotes and testimonials. Anecdotes are at the bottom of the hierarchy of evidence and can be unreliable. Advertisements of products or special methods and protocols Most blogs (and their comment sections)

A scientist proposes that sugar is inherently fattening, independent of its calorie content. If that proposal is true, then that would mean that high-sugar diets should increase fat gain independent of their calorie content. What term describes this potential consequence?

Prediction

High Quality Non peer reviewed sources of information

Recently published academic textbooks University public health websites (e.g., Harvard School of Public Health) Academy of Nutrition and Dietetics website (https://www.eatright.org/) U.S. government health websites (e.g., Centers for Disease Control and Prevention) International health websites (e.g., Eat Well Guide or World Health Organization) Conference presentations by primary researchers without a brand or ideology to defend or product or supplement to promote Podcast interviews with primary researchers

Holiday tips to not overdo it:

Reduce portion sized Eat smaller meals during the days Keep water bottle handy Drink water between cocktails Minimize alcohol Keep moving Return to your fitness routine asap

A client has several relatives who have recently been diagnosed with cancer. She has been reading many books about natural health and is interested in taking herbal supplements that will help prevent cancer. What is the best course of action?

Refer her to a pharmacist or her physician.

Refer to ? Has been recently diagnosed with type 2 diabetes

Registered Dietician

RDN

Registered Dietitian Nutritionist This term is used interchangeably with a Registered Dietitian (RD) and it is also a legally protected designation.

when providing information/educating to clients, what kind of information is this? Discussions on meal prep for a family wouldn't be relevant if the client is single and lives alone.

Relevant

Science vs research

Science = philosophy & process to investigate the natural world Research = the way people try to carry out principles of science

cultures + religions and food example

Seventh Day adventists - vegan Catholics - avoid meat on fridays Muslims who typically eat Halal (religiously lawful) foods, consisting of fruit, vegetables, eggs, and meat farmed, slaughtered, and prepared under strict criteria. Hindus who are primarily lacto-vegetarian (avoiding most meat and eggs). Sikhs who are also primarily vegetarian Jews who often follow Kosher dietary practices that are similar to Halal traditions.

Which of the following best represents a weakness of interventional designs?

Small number of subjects

Strength + Limatation of Observational Designs:

Strengths - allow for the examination of large populations over long periods of time. - help examine potential associations that occur over long periods of time - allow for the generation of hypotheses that can be further studied in RCTs Limitations - Cannot establish cause and effect - lack of control of variables increases the chance of false associations

strength and Limitations of interventional designs

Strengths: - allow for demonstration of cause and effect. - Scientists can control many variables that would be impossible to control in an observational study - Scientists can explore mechanistic explanations for observed effects Limitations: - The high degree of control, while a strength, is also a limitation. Notably, the study may not reflect real-world conditions. (limits external validity) - these designs are only capable of examining a limited number of variables at a time

Which of the following is an example of descriptive research?

Survey

test- retest reliability

The ability to get similar results when something is measured under the same conditions.

Validity

The assessment of whether a tool is measuring what it is supposed to measure.

reliability

The consistency of a measure.

palatability

The degree of pleasure or taste provided by a food - a highly palatable food is one that is tasty and pleasant to consume. can be influenced by the taste, smell, texture, and appearance of foods, and acts as a powerful determinant of food choices, hunger, and satiety

heart disease + diet

The higher a diet is in saturated fat and cholesterol, the higher the risk of developing heart disease, independent of all other risk factors there is a strong correlation between reduced risk of developing heart disease and choosing a diet low in saturated fat, high in fiber, low in salt and sugar, and high in plant foods

What best describes the healthcare Continuum?

The many disciplines that make up the healthcare system

define wellness

The overall quality of health one is experiencing, especially as an actively sought lifestyle that leads to optimal health and well-being

A scientist hypothesizes that a supplement will increase resistance training performance. A study is carried out, and the results do not support the hypothesis. Multiple studies by independent labs also fail to support the hypothesis. What is the appropriate response regarding the hypothesis?

The predictions have been falsified and the hypothesis is discarded.

scientific method

The process of formulating explanations about the natural world and testing those explanations with experiments and data.

Numerous studies, including genetic studies, randomized controlled trials on lipid lowering medications, and observational studies point to LDL having a causal role in heart disease. Which term best describes the concept that LDL plays a causal role in heart disease?

Theory

Which term refers to a hypothesis or set of hypotheses for which a large body of high quality evidence has been accumulated?

Theory

Which of the following is true in regards to obesity-related conditions?

They are one of the leading preventable causes of death.

A Nutrition Coach can provide clients non-medical nutrition information and behavior guidance.

True

If the Nutrition Coach intends to work as an employee in a private health club, it is important to consult with an attorney and accountant to ensure proper business practices.(T or F)

True

The Nutrition Coach can offer advice on eating behaviors and/or macronutrients that are known to reduce the risk of disease or slow disease progression

True

The uncertainty of science is a strength, as nothing is ever 100% certain (t or f)

True

When it comes to client confidentiality, all personal information should be kept in a locked or secure area. (T or F)

True

RCT's (True Experimental Design) & 3 types

True experimental design consists of randomized controlled trials (RCTs) which are the gold standard of research due to degree of rigor and control 1. parallel design 2. Factorial Design 3. crossover design

Which term describes a variable in an experiment for which a scientist takes no steps to account for?

Uncontrolled variable

Science

a method of attempting to arrive at objective truths

hypothesis

a proposed explanation for an observation

how does WHO define health?

a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.

anecdote

an account of a persons experience or event

Emprical

based on observation or experience

when providing information/educating to clients, what kind of information is this? The client who has had countless attempts at weight loss can relate to weight loss strategies, especially if he or she is open to options and has bought into trying new things.

based on prior experience

geographical and seasonal availability of food - affecting food choices

because of the global economy, most foods are available year-round, though maybe just not locally sourced. We also tend to prefer certain foods over others based on the season. Weather and seasonal influences affect food choice soups, vegetables, and dark leafy greens are preferred in winter months, citrus fruits and colorful vegetables are preferred in warmer months

Which of the following is the technical term for body measurements and calculations as they refer to metrics related to human characteristics?

biometrics

3 types of descriptive research

case studies surveys historical research

CDE

certified diabetes educator 1000 contact hours in diabetes education is required for certification.

Non-communicable diseases are also known as which of the following?

chronic disease

Which of the following best describes an empirical scientific approach?

controlled observation

How dos BMR change with age?

decreases

Scientists identify what is most likely to be true by?

demonstrating what is not true

2 types of observational research and describe them.

descriptive research: describes individuals or populations exploratory or epidemiological research: looks for relationships between variables in large populations

case-control studies

determine if exposure to something is associated with an outcome scientists identify people with the outcome and similar ppl who dont have the outcome uses data that has already been collected or occurred in past

Which of the following terms is best defined as a disorder of structure or function in a human, animal, or plant, especially one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury?

disease

What kind of condition is health?

dynamic

Satiety is achieved by the relatively simple process of the stomach recognizing that it is full of food. (t or f)

false

cohort studies

group (cohort) followed over time to determine association between an exposure and an outcome or disease 1. cohort free of outcome or disease 2. researchers identify exposure or event of interest 3. cohort followed overtime until disease or outcome occurs 4. association between exposure and risk of outcome assessed. Limitations: - susceptibility to selection bias - subjects are followed for extended periods of time may withdraw or be lost follow- up - if retrospective: less control over variables, and that subjects may be susceptible to recall bias.

Which of the following components of the Illness-Wellness Continuum relate to a high level of wellness?

growth, awareness, education

Which of the following is best defined as the tendency toward a relatively stable equilibrium between interdependent elements, especially as maintained by physiological processes?

homeostasis

hypoglecemia and type 2 diabetes

hypoglycemia: significant hunger, dizziness, loss of energy, sweating, thirst *Those with pre-existing conditions will need detailed guidance on topics like food intake, timing of meals, and food interactions as they relate to their medications

What should you do when a client has a change in health status?

if any client has a change in health status, shows an unexplained drop or increase in weight, or shows signs or symptoms of a psychological disorder, the coach must not only recommend that his or her client consult with a professional, but also refuse further sessions until cleared by a licensed healthcare provider.

Types of scientific research: Interventional designs

in an interventional design, scientists directly intervene with subjects and look at the impacts of the intervention 2 types: 1. True Experimental Design (RCT's) 2. Quasi Experimental Designs

Educate - 4 components of information

information should be: 1. Highly relevant. - For example, discussions on meal prep for a family would not be relevant if the client is single and lives alone. 2. Based on prior experience. - The client who has had countless attempts at weight loss can relate to weight loss strategies, especially if he or she is open to options and has bought into trying new things. 3. Practical. - The single parent with a full-time job and three children, who have a plethora of after-school activities, may not have time to prep food for an hour every day. 4. Perceived to be important. If a client just lost a partner to a heart attack, the client may likely be very interested in heart-healthy foods. **Important** work with clients to allow for setbacks and develop strategies to overcome obstacles... i.e. late night cravings, boss bringing donuts to work, weekends, etc

Wellness paradigm

left to right (premature death) 1. disabilty 2. symptoms 3. signs ** above is the treartment paradigm (neutral point) 4. awarenss 5. education 6. growth (high level wellness)

which of the following hormones is responsible for feelings of satiety?

leptin

Scientists take 5000 people and have them fill out questionnaires on their dairy intake. They then compare cancer rates between people with high intakes and low intakes. What type of study is this?

observational

Refer clients with new-onset pregnancy; gain referrals for clients who are postpartum and would like to lose weight.

obstetrician

when providing information/educating to clients, what kind of information is this? The single parent with a full-time job, and three children who have a plethora of after-school activities may not have time to prep food for an hour every day.

practical

What are the 2 main components of nutrition coaching?

provide general nutrition guidance providing behavioral change and motivation

Refer clients who have issues with chronic depression or anxiety; gain client referrals who would benefit from regular nutrition guidance and accountability.

psychologist

surveys

questionnaires that are administered to a sample of respondents selected from a target population limitations- - collect self reported data, and that can be subject to bias - potential issues w/ reliability, validity, or how wording of questions can influence ppl's answers

parallel design

research track 2+ independent groups in parallel with each other

factorial design

researchers test the impact of 2+ more variables simultaneously rather than isolating a single variable

Healthcare Continuum

see image in notes (pg 2)

Time series

set of data points that have been collected in time order one example is the study of climate change, where average annual air or ocean temps are collected in a sequence over several years.

quasi experimental designs

similar to RCTs but subjects are not randomly assigned to groups 2 types: 1. non-randomized control group 2. time series

What is the leading contributor to preventable death?

smoking

Older adults + food choices

studies have shown that older adults tend to have lower dietary intake of certain vitamins and minerals, like calcium, iron, zinc, B vitamins, and vitamin E, which could accelerate diet-related illnesses or health problems Older adults should be encouraged to consume less energy-dense sweets and fast foods and choose a diet high in whole grains, lean protein, healthy fats, vegetables, and fruits

Non randomized control group

subjects have not been randomly assigned to that group. carries more potential bias than RCT bc control group might not be equivalent to the treatment group.

Recall bias

the inability to accurately remember past behaviors

crossover design

the same group of subjects are assigned to both the treatment and control groups each subject acts as his/her own control a strength is that they reduce the impact of the variability between subjects

Diabetes + diet

the strongest risk factor for Type 2 diabetes is obesity, which is also strongly correlated with dietary habits. In particular, rapid and significant weight gain and the consumption of high amounts of added sugar in food and drinks are major factors in developing Type 2 diabetes. A diet low in added sugar and total calories is highly recommended for preventing Type-2 diabetes

Independant variable

the variable scientists manipulate in an experiment

confounding variable

there is cause (independant variable) and effect (dependant variable) but there is also other factors that may influence this which is the confounding variable

case studies

track a single person / people over time discuss characteristics of or events that occur within that group/person limitation - may not be generalizable to larger populations

Cross sectional studies

variables in a group at a specific point in time (cross section of ppl) most useful for: - population bases surveys - to assess the prevalence of diseases in a population primary limitation: - impossible to assess causal relationships because its a one time snapshot measurements?

Assess

written questionnaires (i.e. NASM's Health History Questionnaire) Verbal interview Body composition assessment *** assessments will help you rule out if the client is beyond your scope of practice. Food Journals & Nutrient Trackers (Have clients do a 3-5 day food journal so you can see their current habits, food intake, and associated behavior Ex: My Fitness Pal or a written journal)