1.1 Nutrition Fundamentals

Why Fundamentals Anchor the Whole Exam

Nutrition makes up roughly 20% of the CDM, CFPP Credentialing Exam (a 160-item, three-hour computer test scored on 140 items, with about 70% needed to pass, administered by the Certifying Board for Dietary Managers under ANFP). Almost every other domain — menu planning, therapeutic diets, even cost control — rests on the fundamentals here. A Certified Dietary Manager (CDM) must calculate calories, balance a tray, and explain choices to residents in plain language.

The Six Classes of Essential Nutrients

An essential nutrient is one the body cannot make in sufficient amounts and must obtain from food.

• Carbohydrates — the body's main and preferred energy source; broken down to glucose
• Proteins — build and repair tissue; supply the nine essential amino acids
• Fats (lipids) — concentrated energy; carry fat-soluble vitamins A, D, E, and K
• Vitamins — regulate body processes (no calories); water-soluble (B, C) vs. fat-soluble (A, D, E, K)
• Minerals — structure and regulation, e.g. calcium, sodium, iron, potassium (no calories)
• Water — the most essential nutrient; the body holds no reserve and dies fastest without it

Only carbohydrate, protein, and fat supply energy. Vitamins, minerals, and water are vital but provide zero calories.

Calories Per Gram (Memorize This)

This single table answers a large share of calculation questions on the exam.

Carbohydrate and protein tie at 4, fat is more than double at 9, and alcohol — though not a nutrient — still contributes 7 calories per gram. To find calories, multiply each gram amount by its value and add. Example: a snack with 20 g carb, 5 g protein, and 10 g fat = (20x4) + (5x4) + (10x9) = 80 + 20 + 90 = 190 calories. A common trap is reading a "% Daily Value" as grams, or using fat's value (9) for carbohydrate; keep the four numbers separate.

Fiber and Fluid

Fiber is an indigestible carbohydrate. Because the body cannot break it down for energy, it is not counted toward usable calories, yet it promotes regular bowel function and helps control blood glucose and cholesterol. The Dietary Guidelines suggest roughly 25-38 grams of fiber per day for adults.

Water deserves special attention in long-term care. A practical estimate is about 30 mL per kilogram of body weight, or roughly 1,500-2,000 mL (6-8 cups) daily for most older adults. A blunted thirst response puts elders at constant risk of dehydration, so fluid is offered proactively, not on request.

Federal Frameworks: MyPlate and the Dietary Guidelines

The Dietary Guidelines for Americans (2020-2025) are the federal evidence-based recommendations issued jointly by the USDA and HHS and updated every five years. MyPlate is the consumer-facing icon that translates them into five food groups: fruits, vegetables, grains, protein, and dairy. CDMs use both to plan balanced, regulation-compliant menus and to teach residents.

Key planning principles drawn from these frameworks:

• Make half the plate fruits and vegetables; vary the protein sources
• Make at least half of grains whole grains
• Limit added sugars to under 10% of calories and saturated fat to under 10%
• Keep sodium under 2,300 mg/day for the general adult
• Choose nutrient-dense foods so each calorie carries vitamins and minerals — critical for elders who eat small volumes

Energy Needs and Digestion in Brief

Basal metabolic rate (BMR) is the energy a body uses at rest; total needs add activity and the thermic effect of food. Most ambulatory older adults need roughly 25-30 kcal/kg/day, adjusted up for wounds, infection, or fever and down for low activity. Digestion begins in the mouth (salivary amylase on starch), continues with stomach acid and pepsin on protein, and finishes in the small intestine where most absorption occurs. Understanding this flow lets the CDM explain why texture changes, fiber, and fluid affect a resident's comfort and intake.

Key Vitamins and Minerals to Know

The exam expects familiarity with high-impact micronutrients and their roles, since deficiencies are common in elders:

Protein deserves emphasis in long-term care: residents with pressure injuries, infection, or unintended weight loss often need 1.2-1.5 g of protein per kg of body weight daily — well above the general adult Recommended Dietary Allowance of about 0.8 g/kg. The CDM supports this with fortified foods (adding milk powder, eggs, cheese) and oral nutrition supplements rather than larger portions a frail resident cannot finish.