Supervised Practice Experience competencies

Updated June 2024. These are the competencies a CNS^® candidate develops during the 1,000 hours of Supervised Practice Experience. Candidates and supervisors review them together, and the supervisor confirms them in the Supervisor’s Report.

Category A: Personalized nutrition assessment

Health history

Know how to elicit a patient-appropriate health history, including data such as:

• Current health concerns, past and present health history, and family health history
• Body weight history and recent weight changes
• Psychosocial history, including access to food, occupation, living situation, smoking, drug and alcohol use
• Medication and supplement use
• Review of body systems
• Mastication and swallowing difficulty, appetite and bowel function
• Pregnancy history and/or desired pregnancy
• Sleep patterns
• Stress levels

Nutrition and lifestyle history

• Obtain a focused nutrition history via multi-day food record, a food frequency record and a 24-hour recall
• Identify limitations of food records, food frequency questionnaires, and recalls and understand the appropriate use of these tools
• Determine suboptimal dietary intake or status of nutrients
• Evaluate eating patterns, stress eating tendencies and disordered eating behaviors
• Identify dietary avoidance behaviors
• Identify allergies and sensitivities to foods and dietary supplement ingredients based on history and symptom reports
• Physical activity, identifying frequency, intensity, type and limitations to exercise

Biochemical and lab assessment

• Evaluate signs of vitamin and mineral deficiencies or toxicities
• Interpret laboratory data as it applies to nutrition-related conditions and systemic imbalances
• Monitor growth, weight and BMI
• Identify hormonal and neurotransmitter imbalances based on laboratory assessment
• Identify personalized and biochemical laboratory value ranges as compared to normal reference value ranges

Genetic and genomic factors

• Demonstrate understanding of the basics of gene expression, transcription and translation
• Demonstrate understanding of genetic disorders in nutrient metabolism
• Evaluate family health history as it relates to current health status and risk factors

Anthropometrics

• Be familiar with the following anthropometric measurements: mid-arm circumference, triceps skin-fold and mid-arm muscle circumference
• Be familiar with bioelectric impedance
• Be familiar with waist to hip ratio measurements
• Be familiar with emerging tools of anthropometrics (ultrasound, DEXA, MRI, CT scanning, and air displacement)
• Be familiar with computerized analysis of food intake
• Determine individual micro- and macro-nutrient requirements using guidelines and recommendations, customizing them according to the individual’s age, sex, body type, reproductive status, activity level and metabolism

Identification of clinical status

• Identify symptoms that require medical referral
• Correlate constellations of symptoms for the most effective and efficient treatment protocols

Category B: Personalized nutrition intervention, education, counseling and management

The following six systems include an array of conditions; 1 through 5 are required.

1. Underweight, overweight, malnutrition, and obesity. Examples: obesity, eating disorders / disordered eating, bariatric surgery, or disorders of mastication, swallowing, or absorption of nutrients due to medical interventional procedures or treatments.
2. Cardiometabolic. Examples: cardiovascular disease, dyslipidemia, hypertension, insulin resistance and non-insulin dependent diabetes.
3. Endocrine. Examples: endocrine disorders, bone disorders such as osteopenia and osteoporosis.
4. Immune and autoimmune. Examples: autoimmune disorders, food allergies and intolerances; apply specific dietary and nutraceutical modifications as adjuvant therapy in immuno-compromised individuals (those with HIV-AIDS, cancer, tuberculosis).
5. Gastrointestinal disorders. Examples: gastroesophageal reflux disease, peptic ulcer disease, dumping syndrome, irritable bowel syndrome, inflammatory bowel disease, short bowel syndrome, diverticulosis, and colorectal cancer.
6. Other system disorders. Not required, but experience here enhances the candidate’s experience. Examples: hematologic disorders, hepatic disorders, pulmonary disorders, renal disorders, cognitive/neurological disorders, mental health and mood disorders, compromised individuals (those undergoing chemotherapy, radiation, surgical procedures, dialysis).

In developing an MNT plan, the following must be included

Drug-nutrient and drug-herb interactions

• Identify common drug-nutrient and drug-herb interactions affecting glucoregulation, coagulation, and metabolism
• Identify drug/herb action, duration of action, indication and dose of a patient’s current therapeutic regimen
• Identify dietary factors that affect the actions of common drugs and the underlying mechanisms of action
• Identify nutrient depletions which can occur related to commonly used drugs
• Identify interactions between drugs and foods (including herbs) and their constituents
• Assess the interaction of nutrients with alcohol

Interactions between nutrients

• Assess the synergistic effects and antagonistic interactions of nutrients in foods and supplements and how they may impact the health status of an individual

Dietary therapeutics and behavior optimization

• Assess the advantages and limitations of popular diets
• Identify the therapeutic usefulness of specific foods
• Apply scientific evidence and methods when developing specific dietary recommendations
• Assess the link between behaviors learned in childhood and their impact on obesity and other chronic health issues in adulthood
• Apply psychological and motivational skills to enhance clinical outcomes
• Gauge and optimize compliance with recommendations

Nutraceutical and supplement therapeutics

• Apply evidence-based dose and duration of use of nutraceuticals for common conditions
• Develop working knowledge of good manufacturing practices and other markers of quality end-products

Eating behaviors and eating disorders

• Assess the effects of disordered eating patterns on nutritional status, body composition and function

Data comprehension and translation

• Assess individual patient data and compare with other data (national guidelines, policies, consensus statements, expert opinions and previous outcome experience) to develop nutritional therapeutic interventions

Botanical and related therapeutics

• Develop working knowledge of the effects of common botanical supplements and their indication for health promotion
• Assess the safe use and potential toxicity of botanical supplements

Professional issues (covered in categories A, B and C)

Food quality and safety

• Develop working knowledge of the causes and preventive measures for the most common food borne illnesses
• Monitor current developments and outbreaks of food borne illnesses and translate media information into science-based evidence and patient recommendations
• Assess populations at risk for food safety issues
• Assess factors that may negatively affect food quality (pesticides, xenobiotics, GMOs, hormones, food additives, PCBs, heavy metals)

Cultural issues, ethical standards and boundaries

• Apply all HIPAA compliance requirements
• Refer clients to appropriate healthcare providers when their care requires services outside the scope of practice of a CNS
• Assess the impact of personal and cultural beliefs on dietary and lifestyle patterns and be able to address these beliefs when developing nutrition intervention plans

Epidemiology and biostatistics (covered in categories A, B and C)

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