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Nutrition and Medicine

Fall 2006

"Let food be your medicine and medicine be your food." (Hippocrates). Pierre-Auguste Renoir's Luncheon of the Boating Party, 1881.

Highlights of this Course

Only 25% of US medical schools have a required nutrition course.  Tufts provides such a course with 25 hours of instruction as lectures and small group activities.  The course spans the theoretical to the clinical aspects of nutrition. The student learns to obtain information and knowledge, develop the ability to interpret and evaluate current nutrition research, and develop critical thinking skills on the use of nutrition in medical care.  Small group assignments include: making a personal dietary assessment, trying a dietary change based on the DASH diet (Dietary Approach to Stop Hypertension), and interviewing a subject to obtain information on current eating patterns (with evaluation of this intake and dieatary recommendations developed as a report). The "4 Messages" from the DASH diet are used as the overall unifying nutrition messages for the general US population and those at risk or with problems of hypertension, obesity, cardiovascular disease, or type 2 diabetes. Also addressed is the the role of exercise and the identification of behavioral skills from the perspective of the physician and the patient in order to successfully achieve a change in lifestyle for better health.

Course Description

This course teaches basic nutrition principles that are relevant to other medical courses such as pathology, growth and development, and pharmacology.  The student can then integrate the role of nutrition into issues of overall health and disease development.

In the Nutrition and Medicine course, the student will:

    * Become familiar with the 3 standards of evaluation for dietary adequacy. What do they each do and how are they different?
    * Become familiar with the 5 questions to ask patients during the medical interview that constitute the "basic" nutrition assessment.
    * Know the 4 messages (WHAT) and WHY and HOW they can be used as nutrition interventions for basic health, weight maintenance, CVD, Hypertension and Type 2 Diabetes.
    * List the 4-5 nutrition components that influence the development and progression for the 4 chronic diseases (Obesity, CVD, Hypertension, and Type 2 Diabetes). Know the mechanism of the nutrient action, if known.
    * Be able to identify the top 4-5 nutrition issues for life stages: Pregnancy, Infants/Children, and the Elderly, as critical times for nutritional adequacy.
    * Understand the role of exercise in the development of chronic diseases.
    * Understand the role of behavioral skills in lifestyle change.
    * Identify the nutrition skills needed to make a successful lifestyle change in eating.
    * Gain the SKILL of being able to evaluate a "usual" intake of a patient's day to identify his/her main nutritional issues in relation to the 4 messages and justify your nutrition recommendaitons.  This is in relation to the 4 chronic diseases and the 3 life stages listed above.
    * Know the 3 critical issues for nutirition support in the hospitalized patient.
    * Know the 5 top nutritional areas related to risk of cancer and the mechanism by which they are proposed to act.
    * Be able to identify 3-4 of the issues identified in the Controversy Panel and why they are important using CRITICAL THINKING.

Popular Content

    * Mind Mapping for Nutrition (Physician Handout)
    * Omega-3 Fatty Acids
    * Overview/ Nutrition Assessment I and II: Objectives and Answers
    * Fiber
    * Macronutrients and Carbohydrates


  • Develop a foundation of nutrition knowledge.
  • Develop skills to assess the nutritional status of your patients.
  • Develop skills to counsel your patients on making lifestyle changes in eating habits to decrease risk of disease and to aid in treatment of disease.

1. Syllabus/Assignments

The lectures in the syllabus are set up chronologically according to the course lecture schedule. The small group materials follow the lecture materials, and are listed chronologically.

Assignments consist of:

  • For each lecture you are responsible for reading the Learning Objectives and Answers to the Learning Objectives, as well as any readings on the Reading List. Additional suggested readings are identified on the last page of the lecture materials.

  • Small Group Assignments.

    Grading Policy

2. Grading Policy

This is an Honors/Pass/Fail course.

3. Reading List

3.1. Lectures I & II: Nutrition Assessment

Nutrition Assessment article.

3.2. Lecture III: Macronutrients/Carbohydrates

Ludwig DS. The Glycemic Index: Physiological Mechanisms Related to Obesity, Diabetes and Cardiovascular Disease. JAMA . 2002;287:2414-23.

3.3. Lecture VII/VIII: Lipids/Cardiovascular Disease

Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Executive Summary of the Third Report of the National Cholesterol Education Program (NCEF). JAMA . May 16, 2001; 285(19):2486-97. Only the section on diet is required reading. The remainder of the article is supplemental reading.

3.4. Lecture IX: Water Soluble Vitamins

" Clinical Applications of Vitamin B12 and Folate Metabolism " by Joel Mason.

3.5. Lecture X: Diabetes

Pittas AG. Nutritional interventions for prevention of type 2 diabetes and the metabolic syndrome. Nutr Clin Care . 2003;May-Sep;6(2):79088.

3.6. Small Group III: Nutrition and Cardiovascular Disease

Howard BV, et al. Low-fat dietary pattern and risk of cardiovascular disease: the Women's Health Initiative Randomized Controlled dietary Modification Trial. JAMA . 2006 Feb 8;295(6):655-66.

3.7. Small Group V: Nutrition and the Elderly

All four articles will be read and discussed during small group time, but students are responsible for the topics covered during small group for all articles.

  • Print out all of these papers and bring to small group.

  • Read the "clinical case" prior to the group.

Stage 1 - Osteporosis

  • Dawson-Hughes B. Calcium, vitamin D and risk of osteoporosis in adults: essential information for the clinician. Nutrition in Clinical Care. 1998;1:63-70.

  • Three pages (p.930-933) from: Shearer MJ. The roles of vitamin d and K in bone health and osteoporosis prevention. Proceedings of the Nutrition Society. 1997;56:915-97.

Stage 2 - Sarcopenia

  • Fiatrone Singh M, and Rosenberg IH. Nutrition and Aging. In: Hazzard WR, Blass JP, Ettinger, WH, et al., editors. Principles of Geriatric Medicine and Gerontology. Fourth edition. McGraw-Hill Professional. 1998. Chapter 6, p. 81-96.

Stage 3 - Vitamin B12

Baik HW and Russell RM. Vitamin B12 deficiency in the elderly. Ann Rev Nutr . 1999;19:357-77.

4. Supplemental Readings

4.1. Lecture VII/VIII: Lipids/Cardiovascular Disease

Lichtenstein AH. Thematic review series: patient-oriented research. Dietary fat, carbohydrate, and protein: effects on plasma lipoprotein patterns. J Lipid Res . 2006;Aug;47(8):1661-7. Epub 2006 May 31.

4.2. Lecture IX: Water Soluble Vitamins

  • Willet WC et al. What vitamins should I be taking, Doctor? NEJM. December 20,2001;345(25):1819-1824.

  • MRC Vitamin Study Research Group. Prevention of neural tube defects: results of the MRC vitamin study. Lancet 1991;338:131-137. [Full-Text Link Not Available]

  • Selhub J et al. Association between plasma homocysteine and extracranial carotid artery stenosis. New Eng J Med 1995;332:286-291.

  • Mason J et al. Folate: effects on carcinogenesis and the potential for cancer chemoprevention. Oncology 1996;10: 1727-1743.

  • Fletcher RH, Fairfield KM. Vitamins for Chronic Disease Prevention in Adults: Clinical Applications. JAMA. 2002;287(23):3127-3129.

  • Fairfield KM, Fletcher RH. Vitamins for Chronic Disease Prevention in Adults: Scientific Review. JAMA. 2002;287(23):3116-3126.

4.3. Lecture X: Diabetes

Schulze MB et al. Dietary pattern, inflammation, and incidence of type 2 diabetes in women. Am J Clin Nutr 2005;82:675-84.

4.4. Lecture XVI: Nutrition and Exercise

McDermott AY, Mernitz H. Exercise and older patients: prescribing guidelines. Am Fam Physician . 2006 Aug 1;74(3):437-44.

5. Important Website Resources

  • My Pyramid (USDA) -

  • Tufts Evidence-based Approach to Complementary and Alternative Medicine -

  • Guide to Lowering Your Blood Pressure with DASH (National Heart Lung and Blood Institute) -

    Session   Type Title  
    1 Lecture Overview/Nutrition Assessment I  
    2 Lecture Nutrition Assessment II  
    3 Lecture Macronutrients/Carbohydrates  
    4 Lecture Obesity  
    5 Small Group Small Group: Personal Dietary Assessment  
    6 Lecture Minerals and Nutrition  
    7 Lecture Behavioral Skills  
    8 Lecture Lipids/CVD I  
    9 Small Group Small Group: Intervention with DASH Diet  
    10 Lecture Lipids/CVD II  
    11 Lecture Water Soluble Vitamins  
    12 Lecture Diabetes/Metabolic Syndrome  
    13 Small Group Small Group: Nutrition and CVD  
    14 Small Group Pregnancy and Lactation  
    15 Lecture Infant and Child Nutrition  
    16 Lecture Nutrition and Acute Illness  
    17 Small Group Small Group: Preventative/Therapeutic Intervention  
    18 Lecture Nutrition and the Elderly  
    19 Lecture Nutrition and Cancer  
    20 Lecture Nutrition and Exercise  
    21 Small Group Small Group: Nutrition and the Elderly  
    22 Conference Panel: Obesity in Children  
    23 Examination Final Examination   Tell A Friend