CHAPTER 7. NUTRITION 171 a"Determine Your Nutrition Health "checklist. The National Screening Initiative is targeted for identification of elderly individuals who are at nutritional risk. USing the Mnemonic D-E-T-E-R-M-I-N-E, it provides a list of warning signs for malnutrition that should be addressed(see Tables 7.1 and 7.2) Subjective Global Assessment The Subjective Global Assessment of Nutritional Status(see Table 7.3)does not employ objective biochemical and anthropometric measurements. It is a screening tool that requires clinical judgMent to interpret information collected by interviews and observations. The instrument correlates well with other more objective measures and is cost effective (2) THE IMPORTANCE OF NUTRITION COUNSELING A clinician's advice on nutrition is of great im portance in helping patients to modify dietary practices. This chapter provides detailed guidance, but the science of healthy living needs to be made practical for patients. Short and useful recommendations can be as simple as: (a)do not crash diet, (b)eat real foods, (c)watch your portion size, and(d)eat breakfast. Eating breakfast is a caloric plus in that it increases the metabolic rate and can provide nutrients needed for the day Adopting a healthy diet can be simple but is not always easy. Patients can easily become discouraged when they attempt to change too many eating habits at once. Clinicians can advocate small steps, perhaps through a nutrition prescription"of adding one fruit or vegetable today or changing to 1% milk. Remind patients that healthy living is not defined by just one meal or I day but the accumulation of small changes; these changes become habits over time. Behavior modification can begin with modest steps, such as not bringing foods home that are too tempting or replacing them with better choices. Choose/do not choose "lists are often excellent tools to change behavior. The short but essential admonition to watch portions and be active can sum up basic first steps to meeting healthy nutrition goals(see Table 7. 4) THE DIETARY GUIDELINES FOR AMERICANS In 2005, the Food and Nutrition Board of the Institute of Medicine(IOM), along with Health Canada, released the sixth in a series of reports on dietary reference values for the intake of macronutrients and energy (U.S. Dietary Guidelines). This report established Dietary Reference Intakes(DRIs) for carbohydrates, fiber, fatty acids, cholesterol protein, amino acids, energy, and physical activity, replacing older