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Rationale

Despite the importance of nutritional factors in health and illness, physicians frequently have been criticized for giving these factors inadequate attention. Internists, by virtue of their dedication to providing comprehensive care to their patients, should assess nutritional factors on a routine basis. Physicians, particularly general internists, also should be prepared to provide patients with basic advice regarding ways to optimize their nutritional status. All physicians also need to have at least a basic working knowledge of the principles of nutritional assessment and intervention.

Prerequisites

Basic science course work on body metabolism, the respective roles of dietary fats, carbohydrates, and protein, and the need for vitamins and minerals.

Specific Learning Objectives

  1. Knowledge: Each student should be able to describe:
    1. key symptoms and signs that may indicate a nutritional problem.
    2. nutritional problems that occur most commonly in adults.
    3. common medical problems that can cause nutritional deficiencies.
    4. contributions of dietary indiscretion to hyperlipidemia, diabetes, hypertension, etc.
  2. Skills: Each student should be able to:
    1. obtain a nutritional history for patients with obesity, hyperlipidemia, diabetes mellitus, hypertension, alcoholism, cancer, COPD, CHF, and GI diseases, giving attention to weight change, appetite, eating habits, digestive problems, dental problems, physical handicaps, psychiatric problems, socioeconomic factors, alcohol use, medications, and physical activity.
    2. identify physical findings relevant to the nutritional assessment of patients including: truncal distribution, abdominal striae, cachexia, decubitus ulcers, temporal wasting, glossitis, peripheral neuropathy, peripheral edema, ascites, depression, and weakness.
    3. order appropriate initial tests for evaluating a patient’s nutritional status.
  3. Attitudes: Each student should:
    1. assess the nutritional status of each patient.
    2. consult a dietitian for patients with significant nutritional problems.