Dietitian

§ 1.3 · Thinking Patterns — Mental Models

Energy Needs Calculation:

def mifflin_st_jeor_REE(weight_kg, height_cm, age, sex):
    """
    Mifflin-St Jeor equation for Resting Energy Expenditure (REE/BMR).
    Most accurate for most adults (validated vs. indirect calorimetry).
    sex: 'M' or 'F'
    """
    if sex.upper() == 'M':
        REE = 10 * weight_kg + 6.25 * height_cm - 5 * age + 5
    else:
        REE = 10 * weight_kg + 6.25 * height_cm - 5 * age - 161
    return round(REE, 0)

ACTIVITY_FACTORS = {
    'Sedentary (desk job, no exercise)': 1.2,
    'Lightly active (1-3 days/week exercise)': 1.375,
    'Moderately active (3-5 days/week)': 1.55,
    'Very active (6-7 days/week hard exercise)': 1.725,
    'Extremely active (physical job + training)': 1.9,
}

CLINICAL_INJURY_FACTORS = {
    'Minor surgery': 1.0,
    'Major surgery': 1.1,
    'Sepsis': 1.2,
    'Severe burns (> 40% BSA)': 1.5,
    'Head trauma/TBI': 1.4,
    'Cancer (varies)': '1.0-1.5',
}

PROTEIN_TARGETS_g_kg = {
    'Healthy adult (maintenance)': 0.8,
    'Older adult (> 65 years, sarcopenia prevention)': 1.0,
    'Weight loss (preserve muscle)': 1.2,
    'Post-surgery
    'ICU
    'CKD (non-dialysis)': '0.6-0.8',
    'CKD (dialysis)': '1.2',
    'Oncology (active treatment)': '1.2-1.5',
}

# Example: 55yo female, 70kg, 165cm, moderately active
REE = mifflin_st_jeor_REE(70, 165, 55, 'F')
TDEE = REE * 1.55
print(f"REE: {REE} kcal/day; TDEE: {TDEE:.0f} kcal/day")
print(f"Protein: {70 * 1.0:.0f}–{70 * 1.2:.0f} g/day")

§ 10 · Gotchas & Anti-Patterns

1. Using Harris-Benedict when Mifflin-St Jeor is preferred — Mifflin-St Jeor is more accurate for most adults; Harris-Benedict overestimates by ~5% on average [✓] Done when: | [✗] FAIL if:
2. Applying high-protein targets in CKD without checking GFR — 1.2 g/kg protein (standard for weight loss) is harmful in non-dialysis CKD4 (target 0.6-0.8 g/kg) [✓] Done when: | [✗] FAIL if:
3. Ignoring phosphorus additives in processed foods — Inorganic phosphate additives (labeled as E numbers) are nearly 100% absorbed vs. 40-60% from organic food sources; CKD patients must read labels [✓] Done when: | [✗] FAIL if:
4. Recommending low-carb diet without monitoring in insulin-dependent diabetes — Carbohydrate reduction without insulin dose adjustment causes hypoglycemia; must coordinate with prescriber [✓] Done when: | [✗] FAIL if:
5. Using BMI-based weight for protein/energy calculations in edematous patients — Use dry weight (pre-dialysis weight or estimated dry weight); actual weight overestimates needs [✓] Done when: | [✗] FAIL if:

§ 11 · Integration with Other Skills

• General Practitioner / Clinical Physician — Coordinate MNT referrals; lab monitoring (albumin, HbA1c, BUN/Cr for CKD)
• Clinical Pharmacist — Food-drug interaction counseling (vitamin K/warfarin, tyramine/MAOI, grapefruit)

§ 12 · Scope & Limitations

Educational reference. Clinical nutrition therapy requires individualized RDN assessment. Not a substitute for medical care.

§ 14 · Quality Verification

→ See references/standards.md §7.10 for full checklist

§ 16 · Domain Deep Dive

Specialized Knowledge Areas

Knowledge Maturity Model

§ 17 · Risk Management Deep Dive

🔴 Critical Risk Register

🟠 Risk Response Strategies

🟡 Early Warning Indicators

• Stakeholder engagement dropping
• Requirement changes increasing
• Team velocity declining
• Defect rates rising

§ 18 · Excellence Framework

World-Class Execution Standards

Excellence Cycle

ASSESS → PLAN → EXECUTE → REVIEW → IMPROVE
   ↑                              ↓
   └────────── MEASURE ←──────────┘

§ 19 · Best Practices Library

Industry Best Practices

§ 21 · Resources & References

Quality Checklist

• Requirements met
• Standards compliant
• Reviewed by peers

Performance Metrics

Additional Resources

• Industry standards
• Best practice guides
• Training materials

References

Detailed content:

• ## § 2 · What This Skill Does
• ## § 3 · Risk Disclaimer
• ## § 4 · Core Philosophy
• ## § 6 · Professional Toolkit
• ## § 8 · Workflow
• ## § 9 · Scenario Examples
• ## § 20 · Case Studies

Examples

Example 1: Standard Scenario

Input: Handle standard dietitian request with standard procedures Output: Process Overview:

1. Gather requirements
2. Analyze current state
3. Develop solution approach
4. Implement and verify
5. Document and handoff

Standard timeline: 2-5 business days

Example 2: Edge Case

Input: Manage complex dietitian scenario with multiple stakeholders Output: Stakeholder Management:

• Identified 4 key stakeholders
• Requirements workshop completed
• Consensus reached on priorities

Solution: Integrated approach addressing all stakeholder concerns

Error Handling & Recovery

Workflow

Phase 1: Triage

• Assess patient vital signs and chief complaint
• Identify immediate life threats
• Prioritize treatment order

Done: Triage complete, patient prioritized, urgent issues identified Fail: Missed critical symptoms, incorrect prioritization

Phase 2: Diagnosis

• Gather detailed history and perform examination
• Order appropriate diagnostic tests
• Analyze results with differential diagnosis

Done: Diagnosis established, differentials considered Fail: Diagnostic errors, missed conditions, test delays

Phase 3: Treatment

• Develop treatment plan per guidelines
• Obtain patient consent
• Implement interventions

Done: Treatment initiated, patient stable, consent documented Fail: Treatment errors, patient deterioration, consent issues

Phase 4: Follow-up

• Monitor treatment response
• Adjust plan as needed
• Provide patient education and discharge planning

Done: Patient discharged safely, follow-up arranged Fail: Readmission risk, inadequate instructions, missed follow-up

Domain Benchmarks