Carey Stites is a registered and licensed dietitian working for Wellstone Health Partners in HarkerHeights, Texas. Carey has been a practicing dietitian since 2001 with experience in both outpatient and inpatient medical nutrition therapy and sports nutrition. Carey is also an AFAA-certified group fitness instruc-tor and personal trainer. She has pro-moted health and wellness through presentations, classes, and cooking demonstrations all over Texas.

Purpose• Increaseawarenessoftheprevalenceofliverdiseaseamong womenandcurrentgender-specificresearch.

Objectives• Developanunderstandingofthediagnostics,treatment,and prognosisofthevarioustypesofliverdiseases.

• Recognizetheimportanceofnutritionandlifestyleinrelation tothemostcommonformsofliverdisease.

• Becomefamiliarwithcurrentmedicalnutritiontherapy recommendations.

Introduction and SummaryTheprevalenceofliverdiseaseisincreasing,particularlyinwomen.Whileliverdiseaseaffectsbothmenandwomen,themedicalandlife-longhealthimpactonwomenappearstobeunique.Researchontheimpactofliverdiseaseonwomenisfocusedonprotocolsandmanagementtopromoteearlydiagnosisandinitiateeffectivetreatmenttoimprovepatientoutcomes.

Prevalence of Liver Disease in WomenComparedtomen,womenaremorelikelytohaveacuteliverfailure,autoimmunehepatitis,benign liver lesions, primarybiliary cirrhosis, and drug-induced liver disease; howev-er, women have a decreasedriskofmalignantlivertumors,viral hepatitis, and liver trans-plant. Additionally, womenhave a slower rate of diseasemanifestation of cirrhosis and

hepatitisCthanmen.Survivalrateofalcoholicliverdiseaseandlivercancerarethesameforbothsexes.1

Alcohol and Drug Induced Liver Disease (ALD and DLD)Among those over the age of 26, alcohol dependence is twiceas common in men than women; however, women appear tobe more affected by the toxic effects of alcohol on the liver,with damage developing more rapidly in women than men.1,2Theseverityofalcoholicliverdiseaseinwomenismultifactorial;a study involving more than 107,000 women from the UnitedKingdom suggests that high BMI and high consumption ofalcohol increase the risk of disease.3 Additionally, endotoxinlevels, estrogen receptor concentrations, and gene expressioninwomenappeartocontributetotheseverityofalcoholic liverdisease.Womenseemtobetwiceassensitivetoalcohol-inducedliver toxicity with a lower amount of alcohol consumption incomparison to men. Preliminary research suggests that rapidtoxicity inwomenmaybeattributabletovariations inestrogenlevels, BMI, body fat percentage, and the menstrual cycle.4,5Socially, alcohol consumption among women has increased formany reasons, including thedecrease incostofalcohol in rela-tiontofinancialearnings,easieraccesstoalcoholicbeveragesingrocerystoresandgasstations,andthesocietalacceptabilityofroutinelydrinkingalcoholinpublic.4

Drug-inducedliverdisease(DLD)isduetorare,adversereactionscausedbyan individual’s immuneresponsetoadrug likeacet-aminophen.InastudybytheAcuteLiverFailureStudyGroup,outof133patientsdiagnosedwithdrug-inducedhepatotoxicity,71%werewomen;notably,bioavailability,metabolism,andexcretionofdrugsinwomenplayaroleindiseaseprogression.1,6

Nonalcoholic Fatty Liver Disease (NAFLD)Nonalcoholic fatty liver disease, commonly known as NAFLD, isthemostprevalentformofchronicliverdiseasewithanestimat-ed34%ofadultsintheUnitedStatesdiagnosed.8NAFLDoccurswhen fat accumulates abundantly in the liver cells of patientswhodonotusealcoholinexcess.Thisbuildupoffatisknownassteatosis.Whilethelivernaturallycontainsfat,clinicalsteatosisisdiagnosedifthelivercontainsmorethan5-10%fat.9-11

NAFLD is referredtoasa“diseaseof lifestyle,”as therisk factorsinclude obesity, lack of physical activity, hyperlipidemia, andtype 2 diabetes. Furthermore 60-80% of NAFLD patients havediabetes and/or are obese.12 Interestingly, livers affected byNAFLDandalcoholicliverdiseaseappearextremelysimilarunderamicroscope.Forbothtypesanestimated10%willprogresstocirrhosis.1,7,13

Continued on page 3

Women’sHealthREPORT Issue 1, 2017-2018

AQUARTeRLyPUBLICATIoNoFWoMeN’SHeALTHDIeTeTICPRACTICeGRoUP

inthisissue From the Chair 2

Alcohol and Women 5

Commission on Dietetic Registration 6

HOD Fact Sheet 7

2017 WH DPG Awards 11

WH DPG 2017 Leaders 12

Women and Liver disease: role of nutritional interventions By Carey Stites, MS, RD, LD, CPT This article is approved for 1 CPEU by the Commission on Dietetic Registration. Please complete the quiz at: http://bit.ly/2B7ngrc

As we embark on a new exciting year, we introduce our first issue of themembership year packed to the brim, offering practical and applicableresources to better accommodate our female population, covering topicssuchas liverdiseaseandalcoholconsumption,alongwithadditionalCDRupdates to our professional portfolio. We hope our quarterly publicationhelpslaunchyournutritionalexpertiseintothenextcentury.

ForthoseofyouwhowereinChicagocelebratingtheAcademy’scentennial,ahugethankyoufor stopping by the WH DPG showcase and attending our featured spotlight session-PCoS:BeyondHormonesandHotFlashes.Agratefulshout-outtoourmagnificentpresenters,AngelaGrassiandLynnMonahan,whoofferedanimpressivesession.Thissessionwassowellattendedthatanoverflowroomwascreatedtoaccommodateattendees!ThankyouAngelaandLynnforsharingcutting-edgeresearchthatcanbereadilyappliedwhenworkingwiththispopulation!

Ifyouhaven’talready,pleasecheckouttheWHDPGsocialmediaoutlets! overthenextfewmonths,anyWHDPGmemberwhosharesWHDPGinfo/articlesviaFacebook,whoretweetsortags@WomensHealthDPG,#WHDPG,orwhoencouragesafellowRDNtojointheWHDPG,willbeenteredintoaquarterlyraffletowinanAmazongiftcard!PicturestakenduringFNCe®atanyWHDPGrelatedeventalsocount,sotagaway.

Thankyoutoallthecontributorstothisnewsletterandtoallofyouforcontributingeverydaytothewonderfulworldofwomen’shealth;wehavesomeprettyamazingmembersthatcon-tinuetoinspire!

FrOm the ChAIr Katie Leahy, MS, RDN, LD

ChairKatieLeahy,MS,RDN,LD

Publications EditorKathleenPellechia,MS,RDN

Assistant Publications EditorLeeCrosby,RD,LD

Resource/Book Reviewer

JessicaRedmond,MS,RD,CSCS

Research CoordinatorChristineGarner,PhD,MS,RD,CLC

Member SpotlightVacant

Design and LayoutSteveBonnel

Editorial Board MiriRotkovitz,MA,RD

DeniseAndersen,MS,RDN,LD,CLC

KathleenPellechia,RDN

CatherineSullivan,MPH,RDN,LDN,IBCLC,RLC

Reviewers HeatherGoesch,MPH,RDN,LDN

HelenW.Lane,PhD,RDKendraTolbertMS,RDN,CDN,CLC

Pleasesendanyquestionsorcommentstopublications@womenshealthdpg.org

The Women’s Health report (ISSN-3233)isanonlinequarterlypublicationoftheWomen’sHealthDieteticPracticeGroup(WHDPG)oftheAcademyofNutritionandDietetics.TheWHReportfeaturesarticles,aswellasinformationonprograms,materi-als,positions,andproductsforuseofitsreaders.Newsofmembers,bookreviews,announcementsoffuturemeetings,requestsforinformation,orotheritemsofinteresttowomenandreproductivenutri-tiondieteticspractitionersshouldbesenttothePublicationseditoratpublications@womenshealthdpg.org.

The statements in this publication do not imply endorsement of the WH DPG or the Academy of Nutrition and Dietetics. © 2018.

We’re on the web!www.womenshealthdpg.org

Women’sHealthREPORT

2

HelloWHDPGMembers,

IamexcitedtokickoffanotheryearoftheWomen’sHealthReport!Thisissuefeatures a cover article on“Women and Liver Disease: Role of NutritionalInterventions” by Carey Stites, MS, RD, LD, CPT. It is becoming more evi-dentthatdifferencesexist innotonlytheratesatwhichmenandwomendevelopcertaindiseases,butinoptimalstrategiesfordiseasemanagement

andtreatment.Asdietitians,itisessentialthatweunderstand,asbestwecan,theroleofgenderindiseaseprevention,diagnosis,andmanagement.Thisarticleisapprovedforonecontinuingeducationcredit.

Thisissuealsoincludesadiscussionofthelatestrecommendationsforalcoholconsumptionforwomen,andaQ&AonthenewProfessionalDevelopmentPortfolio(PDP)system.

ForthoseofyouwhoattendedFNCe,Ihopeyouwereabletomakeconnectionsandexpandyour learning opportunities.We will be sharing highlights from the conference in upcomingissues.

Asalways,wewelcomeyoursuggestionsforfutureissuesandespeciallylovehavingourmem-bers contribute content. Contact me at publications@womenshealthdpg.org with commentsorideas.

Warmregards,Kathleen

FrOm the eDItOr Kathleen Pellechia, MS, RDN

Women and Liver diSeaSe Continued from page 1

3

DataonNAFLDinwomenappearsconflicting.Someresearchsug-gests women are 1.5 times more likely than men to be diagnosedwithNAFLD,whileotherresearchindicatesnogenderconnection.2

To date, the possible genetic link to NAFLD development remainsundefined;however,researchpointstoanincreaseddiseasepreva-lenceinthoseofHispanic,NativeAmerican,andAsiandescent.10

Nonalcoholic Steatohepatitis (NASh)Nonalcoholic steatohepatitis (NASH) is a more damaging form ofNAFLDinwhichthetrifectaofliverinjury,inflammation,andsteato-sisoccursinnon-alcoholicpatients.AstudyconductedbytheThirdNationalHealthandNutritionexaminationSurvey from1988-1994foundthatof1,266patientswithNASH,64%werefemale(agenotdisclosed), resulting inmorewomendevelopingsevere thickeningandscarringoftheliverversusmen.1,2

Preliminary population-based studies reveal estrogen may servea protective role in preventing NASH in women. More post-meno-pausal women over the age of 50 have a form of NAFLD versuswomen under 50 producing ample estrogen. Ultimately, furtherresearchisneededtoidentifyapossiblelinkbetweenestrogenanddecreasedriskofNASHinwomen.2

Viral hepatitis: hepatitis CHepatitis,whetherviralorgenetic,isinflammationoftheliver.Awell-known form of viral hepatitis is hepatitis C, which typically affectsbabyboomersbornbetween1946and1964.13ResearchnotesthatwomenclearthehepatitisCvirus(HCV)fasterthanmen.RiskfactorsforhepatitisCincludeintravenousdruguse,bloodtransfusionspriorto1991,hemodialysis,workinginhealthcare,andsexualtransmis-sionthroughunprotectedsexormultiplepartners.1,7estrogenmayprotectwomenagainstfibrosisoftheliverinviralhepatitisandslowthe progression. In a study of 251 women, 121 were post-meno-pausal,and65ofthosepost-menopausalwomenreceivedhormonereplacementtherapy(HRT).The65womenonHRTtherapyshowedalowerrateoffibrosiscomparedtopost-menopausalwomennotonthistreatmentprotocol.1

Gestational Diabetes and Liver DiseaseDuringtheyearsof1985and1986acrossfourU.Scities,1,115blackandwhitewomenwhogavebirthtoonechildwerestudied.Thesewomendidnothavediabetesoranytypeofliverdisease.ofthesewomen, 124 were diagnosed with gestational diabetes mellitus(GDM)duringthecourseofthepregnancy.Twenty-fiveyearslater,75ofthe124GDMwomenacquiredNAFLD.Theresearchersconcludedthe women with GDM during pregnancy were more than twice aslikelytodevelopNAFLDlaterinlife.Notably,thesewomenwerealsomore likely to be overweight, suggesting importance of medicalnutritiontherapyinthemanagementofGDMandNAFLD.14

Nutrition and Lifestyle in relation to the most Common Forms of Liver DiseaseCertain liver diseases specifically parallel diet and lifestyle habits.NAFLD is the most prevalent known liver disease directly relatedto obesity. As one of the most common causes of liver problemsinindustrializedareas,NAFLDisrelatedtoexcessbodyweightandpoor lifestyle habits. Both excess body weight and poor lifestylehabitscontributetothedevelopmentofNASH.12

A study of 129 patients with NAFLD followed for almost 14 yearsfoundthatdeathfromcardiovasculardiseasewasmore likelythan

death from liver complications. Additionally, the death rate forpatientswhodevelopedNASHduringthestudywastwiceashighasthedeathrateinthosewithonlyNAFLD.12

Withnutritiontherapyasthefirstlineoftreatmentforpatients,clini-ciansmustbeawareofthenutritionalriskfactorsandmedicalnutri-tiontherapyprotocolsforimprovingpatientoutcomes.

excess Caloric IntakeobesityandexcesscaloricintakearedirectlyassociatedwithNAFLDinadults.Researchstates80%ofadultscategorizedwithclass1orclass 2 obesity and 90% with class 3 obesity have NAFLD; acrossall cases, 36% of those cases progress to NASH. Class 1 obesity isdefinedasaBMIof30to<35,class2asaBMIof35to<40,andclass3asaBMIof40orhigher.excesscaloricintakeandinactivityforcesthe livertostorefat,which isnotaprimaryfunctionofthisorgan.This can lead to the development of NAFLD. Additionally, studiescitingenergyintakeamongpatientswithNASHshowanincreasedconsumptionofcalories,fat,andsimplesugars.8

CommonpracticefornutritioninterventionintreatmentofNAFLDincludes weight loss and a reduction of sugar intake. Accordingto recent data, a 5–10% weight loss in patients with NAFLD candecrease fat accumulation in the liver. Additionally, patients areencouragedtoreducesugarconsumptionbycontrollingtheintakeofbakedgoods,desserts,sodas,snackfoodsandcookies.Thecon-sensus is that daily sugar intake should be less than 10% of totaldailycalories.15

excess Fat Intakeexcess fat intake, especially saturated fat, is an important risk fac-tor forNAFLDandNASHduetotheassociated increase incaloriesand body fat. A survey showed NAFLD patients typically consumemoresaturatedfatthanhealthypatients.ThesamesurveyrevealedNAFLD and NASH patients had a higher consumption of total fatthan healthy patients. Additionally, the intake of polyunsaturatedfatty acids was lower in patients with NAFLD; researchers suggestthedeficiencymaybeacontributingfactortothedevelopmentofNAFLD.12

Most patients require a meal plan specifically designed by a regis-tereddietitiannutritionistbasedontheclinicalcourseandmedicaldiagnosis. For patients with NAFLD, a recommendation of total fatintakeof25to30%oftotaldailycaloriesisoftenisastartingpointandisgenerallyanimprovementfromthepatient’spreviousintake.Saturated fat intake of more than 7% of caloric intake should beavoided for patients with NAFLD.15 A food recall is an extremelyvaluable tool for clinicians in order to evaluate current eating pat-terns and recommend appropriate nutrient parameters for clinicalimprovement.9,12

eliminating whole milk, full-fat cheese, butter, fried foods, high-fatmeats,andpackaged foods,andreplacing foodshigh insaturatedfatwithfoodsrich inomega-3fat (e.g.,salmon,tuna,andflax),areoftensuggested forpatientswith liverdiseasesuchasNAFLDandNASH.9,16

Sodium and Fluid restrictionsMedical nutrition therapy for patients with liver disease typicallyinvolvesarestrictionofsodiumintakeandfluid.Sodiumaffectsfluidretentioninpatientsandwithexcessfluidintakecanleadtoedema

Continued on page 4

and ascites from portal hypertension. Portal hypertension is theincrease in blood pressure in the portal venous system due to theinabilityofbloodtoflowthroughthedamagedliver.Thisresults inascites,whichistheaccumulationoffluidintheabdominalcavity.Inmostcases,patientsareinstructedtoconsumenomorethan2gramsofsodiumand6-8cupsoffluid(48-64ounces)perday.17,18

Liver Disease and the Prevalence of malnutritionResearch suggests 20% of patients with early-stage liver diseaseand 60% of those with late-stage liver disease are malnourished.19MalnutritioncanbedefinedasdeficiencyofvitaminsA,D,ande,aswellasthiamine,orasclinicallydiagnosedprotein-caloriemalnutri-tion.5,12,19 Malnutrition is common in patients with certain liverdiseases,suchasALDorDLD,duetothepresenceoffluidgainseenin most of these patients. While often overlooked, the process ofscreeningpatientswithknownliverdiseaseforthepresenceofmal-nutritionisvitaltoimprovingpatientoutcomes.Formanyyears,cliniciansassumedthedegreeofmalnutritionversuspatient alcohol consumption directly affected the degree of liverdisease. New research, however, suggests the alcohol itself causestheliverdiseaseeveninpatientswithabalanceddietwhoconsumeexcess alcohol. Studies show hospitalized patients consuming anutritiousdailydietdevelopedfattyliverwhencarbohydrateswerereplacedwithalcoholwhileproteinandfatremainedthesame.20

Malnutrition in patients with liver disease results from a variety offactorsaffectingnutritionalstatus,whichcanincludelossofappetitewith reduced oral intake, inadequate digestion, impaired nutrientstorage, or malabsorption of nutrients. Additionally, the presenceof ascites, or the abnormal accumulation of fluid in the abdomenresultingfromliverdisease,provokesearlysatietyforpatientswhenattempting to eat. Patients with ALD may forego food altogether,choosinginsteadtoconsumealcoholandlimitinteractionwiththeoutside world. Under medical supervision, the nutrition care planmayincludealow-sodiumdiet,fluidrestriction,specificproteinrec-ommendations,andintakeofsmall,frequentmeals.19

SummaryDatasuggestsdifferencesbetweenwomenandmeninriskfactors,clinical manifestations, treatment protocol, and prognosis for liverdiseases such as ALD, DLD, PBC, NAFLD, NASH, and HCV. Proposedexplanationsforthesedifferences,basedonlimitedevidence,includevariancesinhormonesandgeneticfactors,suggestinggender-spe-cifictreatmentscouldbevaluableintheclinicalmanagementofliverdisease. Generally speaking, however, the most common forms ofliver disease can be effectively managed with appropriate medicalnutritiontherapyincludingareductionincalorie,fat,andsugarcon-sumptionasdirectedbyaregistereddietitiannutritionist.

References1. Guy J, Peters M. Liver disease in women: the influence of gender on epidemiology, natural history, and patient outcomes. Gastroenterology and Hepatology. 2013;9(10):633-639.2. Durazzo M, Belci P, Collo A, Prandi V, Martorana M, Gambino R, Bo Simona. Gender specific medicine in liver disease: a point of view. World Journal of Gastroenterology. 2014;20(9):2127-2135. 3. Trembling PM, Apostolidou S, Parkes J, et al. Influence of BMI and alcohol on liver-related morbidity and mortality in a cohort of 108,000 women from the general population from UKCTOCS. Gut. 2013;62:A3.4. Sherlock S. Liver disease in women—alcohol, autoimmunity, and gallstones. Women and Medicine. 1988;149:683-686.

5. O’Shea R, Dasarathy, S, McCullough, A. Alcoholic liver disease. American Journal of Gastroenterology. 2010;105:14-32.6. Uetrecht J, Naisbitt D. Idiosyncratic adverse drug reaction: current concepts. Pharmacological Reviews. 2013;65:779-808.7. Kim W, Brown R, Terrault N, El-Serag H. Burden of liver disease in the United States: summary of a workshop. Hepatology. 2002;36(11):227-242.8. McCarthy E. Nonalcoholic fatty liver disease. Today’s Dietitian. 2015;16(1):48.9. Stites C. What is non-alcoholic fatty liver disease? Harker Heights Herald. 2017. Available at http://kdhnews.com/harker_heights_herald/opinion/wellness_works/good-nutrition-can- help-reverse-liver-damage/article_a335b7ec-2b9b-11e7-a0ad-477575278440.html. Accessed June 8, 2017. 10. Non-alcoholic Fatty Liver Disease. NIH:U.S. National Library of Medicine. Available at https:// ghr.nlm.nih.gov/condition/non-alcoholic-fatty-liver-disease. Accessed June 16, 2017. 11. NAFLD. American Liver Foundation Website. Available at http://liverfoundation.org/aboutthe liver/info/nafld/. Accessed June 16, 2017.12. Yasutake K, Kohijima M, Nakashima M, Nakamuta M, Enjoji M. Dietary habits and behaviors associated with nonalcoholic fatty liver disease. World Journal of Gastroenterology. 2014;20(7):1756-1767.13. Sears D. The many forms of liver disease. Tex Appeal. 2016:16-18.14. Kennedy, M. New analysis shows that women who develop diabetes while pregnant are likely to develop fatty liver disease. The Hospitalist. 2016;4:15-16.15. Ahmed M. Non-alcoholic fatty liver disease in 2015. World Journal of Hepatology. 2015;7(11):1450-1459.15. a. Kani A, Alavian S, Haghighatdoost F, Azabakht, L. Diet Macronutrients Consumption in Nonalcoholic Fatty Liver Disease: A Review on the Related Documents. Hepatitis Monthly. 2014; 14(2): 1-9.16. Diet—liver disease. Medline Plus Website. Available at http://medlineplus.giv/ency/arti cle/002441.htm. Accessed June 8, 2017.17. Nutrition & liver disease. American Liver Foundation Website. Available at http://www.liver foundation.org/downloads/alf_download_200.pdf. Accessed October 9, 2017.18. Eghtead S, Poustchi H, Malekzadeh R. malnutrition in liver cirrhosis: the influence of protein and sodium. Middle East Journal of Digestive Diseases. 19. Saunders J, Brian A, Wright M, Stroud M. Malnutrition and nutrition support in patients with liver disease. Frontline Gastroenterology. 2010;1(2):105-111.20. Lieber C. Relationships Between nutrition, alcohol use, and liver disease. National Institute on Alcohol Abuse and Alcoholism. 2004.

Educational Resources for DietitiansWorld Journal of GastroenterologyGastroenterology & Hepatology JournalAmerican Liver FoundationAmerican College of Gastroenterology

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Women and Liver diSeaSe Continued from page 3

our vision “Optimizing the future of

women’s health at all ages.”

Aglassofwinewithdinner,abeeratthebaseballgame,oracelebra-torydrinkwithfriendsatthebarallseemlikenormal,harmlesshab-its.Butwhatabouttwoglassesofwine?Threebeers?Fourdrinks?

It’s clear that women who drink more than moderate amounts ofalcohol, defined by the Dietary Guidelines for Americans as up toonedrinkperdayforwomen,haveincreasedhealthrisks.However,studies have also identified benefits to alcohol within the recom-mendedlimits.

Basedonseveralstudies,alcoholinmoderationmaylowertheriskofcoronaryheartdisease inwomen,especiallythoseovertheageof 55.1This makes sense, because the active ingredient in alcohol–ethanol–promotestheproductionofHDL.2

Depending on the patient, then, suggesting a glass of wine withdinner may be healthful. However, the benefits must be weighedagainsttherisks.

Women process alcohol differently than men. Women on averagehavelesswaterperpoundofbodyweightthanmen,astheytypi-callyhavelessleanmass.Therefore,whenalcoholisconsumedanditdispersesinthebody’swater,theratioofalcoholtowaterishigher,increasing the toxic effects on women’s organs.1 even one drinkeffectswomenmorerapidlyandmoreseverely.

Moreover,evenonedrinkperdaycanincreasebreastcancerriskinwomenwhoarepost-menopausalorhaveafamilyhistoryofthedis-ease.1GiventhatheartdiseaseisthenumberonekillerintheUnitedStates,3 though, risks of moderate drinking should be weighedagainstpotentialheart-healthbenefits.

Consuming alcohol above identified moderate levels can result inhigherbloodpressureanddirectdamagetotheessentialorgans.2Inaddition,alcoholconsumptionofgreaterthanfourdrinksperday,oreightdrinks inaweek,can leadtoalcoholdependence,andanincreasedriskofliverdisease,breastcancer,andseveralotherformsofcancer.1Alcoholdependenceoftenrunsinfamilies,thusobtain-ingafamilyhistoryofalcoholismisanimportantstepinthecoun-selingprocess. Ifapatienthasafamilyhistoryofalcoholism,avoidrecommendingwineasaprotectivemeasurefortheirheart.

Thedrawbacksofover-consumptionaren’tonlylimitedtothelong-termandcanimpactmorethanthewomanherself:

• Fiftypercentofallfatalcaraccidentsarealcoholrelated.other injuriesarealsomorecommonwithalcoholconsumption,as decision-makingandmotorskillsareimpaired.Alcoholcanalso interactwithmedications,increasingthesideeffectofdrowsi- ness.1Makesuretoreviewapatient’smedicationsbeforerecom- mendinganyalcoholconsumption.

• IntheUS,nearlyhalfofallpregnanciesareunplanned.4There isnorecommendedsafeamountalcoholforwomenwhoare pregnantorwhoaretryingtobecomepregnant.Awoman couldgetpregnantandnotknowitfor4-6weeks,duringwhich timekeyfetaldevelopmentisalreadyoccurring.Fetalalcohol spectrumdisorders,whichincludearangeofphysicaland mentalproblemsfortheinfant,arepreventableifwomendo notconsumealcoholduringpregnancy.

Asof2015,60%ofwomenintheUSdrankat leastonedrinkeachyear. of those, 5.3 million drank alcohol in a way that threatenedtheirhealth.5Thatisalotofwomenputtingthemselvesinthewayofpreventable illnessand injury.Addressingalcoholconsumption,bingedrinking,andalcoholismwithallpatientswhoreportitaspartoftheirdailyintakeisessentialforthedieteticspractitioner.

So, can there be benefits to wine, beer or even spirits? Definitely.one drink every few days (or even every day) could be a boon tohearthealth.However,ifcontrollingconsumptionbecomestoodif-ficult,orotherriskfactorsexist,thebestwaytoprotecttheheartandall-aroundhealthistoabstainfromalcoholentirely.

References

1. National Institute on Alcohol Abuse and Alcoholism, U.S. Department of Health and Human Services. Women and drinking. 2015. https://pubs.niaaa.nih.gov/publications/brochurewomen/women.htm. Accessed October 16, 2017.2. Harvard T.H. Chan School of Public Health. The Nutrition Source: Alcohol, balancing risks and benefits. 2016. https://www.hsph.harvard.edu/nutritionsource/alcohol-full-story/. Accessed October 15, 2017. 3. Centers for Disease Control and Prevention. National Center for Health Statistics. Leading causes of death. March 2017. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm. Accessed October 16, 2017.4. Centers for Disease Control and Prevention. Facts about FASDs. June 2017. Accessed October 16, 2017.5. Centers for Disease Control and Prevention. Fact Sheets - Excessive alcohol use and risks to women's health. March 2016. https://www.cdc.gov/alcohol/fact-sheets/womens-health.htm. Accessed October 15, 2017.

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aLCohoL and Women: Protector and Poison all in one? By Julia Werth, Dietetic Intern, University of Maryland College Park

attention aLL Women’S heaLth dPG memBerS our survey regarding health and Wellness has been completed! Listed below is the wording that was sent out with our survey.

The Academy House of Delegates has embarked on a new process for cap-turing member insight on key issues impacting the profession. Women’s Health is seeking your thoughts on the future ideal state of Wellness and Prevention and the RDN's and NDTR's role in this segment of our profession. Please answer this short 6 question survey. Thank you in advance for your participation in this survey and your ongoing commitment to the Women’s Health DPG.

We are happy to report that we do have Wh dPG members who are employed in health and Wellness, and would like to ask if any of you would be willing to write an article for a new section on health and Wellness in our newsletter. You can write about your careers and how you got started working in health and Wellness. this is an exciting time for all academy members as we head into our Second Century.

interested Wh dPG members should contact: Denise Andersen MS RDN LD CLC, WH DPG Delegate for the Academy’s House of Delegates. My email address is: dandersster@gmail.com.

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CommiSSion on dietetiC reGiStration (Cdr) inCorPorateS eSSentiaL PraCtiCe ComPetenCieS: revised Professional development Portfolio (PdP) recertification Process By Karen Lacey, MS, RDN, CD

Karen Lacey is a Senior Lecturer Emerita and Former Director of the Dietetic Programs at the University of Wisconsin-Green Bay. She is a past-president of the Wisconsin Academy of Nutrition and Dietetics and most recently served as a Commissioner on the Commission for Dietetic Registration (CDR). She currently chairs the Competency Assurance Panel (CAP), a subcommittee of CDR that oversees the Professional Continuing Education for registered dietitians and dietetic technicians. CAP developed

the newly revised Professional Development Portfolio process utilizing practice competencies.

Her awards and recognitions include: Academy’s Outstanding Dietetic Educator Awards for Didactic Program and Dietetic Internship, the Wisconsin Academy of Nutrition and Dietetics’ Outstanding Dietitian and the Academy’s Medallion Award.

Since1969,whenregistrationwasfirstestablishedwithamandatorycontinuingprofessionaleducationunit(CPeU)requirement,CDRhasbeencommittedtoongoingenhancementoftherecertificationpro-cesstosupportpractitioners’competence.Themostrecentrevisionresulted in the PDP process moving away from goals and learningneedcodestousingpracticecompetenciesandperformanceindica-torstocreateeachnew5-yearlearningplan.This revisionwas first implemented in June2015bynewlycreden-tialedpractitionersbeginningtheir first5-yearcycle. InJune2016,practitioners who were recertifying began using the process, andeachyearanewgroupwilldeveloptheirnext5-year learningplanwiththerevisedprocess.ByJune2020,recertificationwithessentialpracticecompetencieswillbefullyimplemented.

Giventhenewrecertificationprocess,practitionershaveraisedmanyquestions.Forexample:Whatdoesthismeanforhowlearningplansarecreated?WillIhavetotaketheRDorDTRexamoveragain?CanthenewplanmeetmyneedsifIamnotcurrentlyworkingorwhatifIwanttochangejobs?Restassuredthattherevisedprocessaddressestheseconcerns,andinfactmanyprefertheupdatedprocess.Belowareaseriesofcom-monquestionsandanswersaboutkeychangestotheprocessandwhatyoucanexpectfromusingessentialpracticecompetencies.

1. Why did CDr make these changes? The transformation of thePDPprocessawayfromgoalsandlearningneedcodestocompeten-cies and performance indicators helps address regulatory changesand expectations of regulatory bodies such as the Department ofHealth and Human Services (which administers HIPAA) and theJoint Commission. These groups and others have raised standardsfordemonstratingprofessionalcompetenceinpracticefornutritionanddieteticspractitioners.Theuseofpracticecompetenciesbetterreflects not only the knowledge, but also the skills, judgment, andattitudesnecessarytoperformdutiesinacompetentmanner.Alongwith the Code of ethics, Standards of Practice, and other Academyresources, the new competencies will further enhance the overallqualityofdieteticspractice.

2. What are competencies? Acompetencyisasetofdefinedbehav-iors that provide a structured guide enabling the identification,

evaluation, and development of behaviors in an individual. Theessential Practice Competencies for CDR-credentialed nutritionand dietetics practitioners define the knowledge, skills, judgment,and attitude requirements throughout a credentialed practitioner’scareer, across practice settings, and within focus areas. They arebroad and encompass a wide variety of learning needs.They havealso been validated by practitioners so that they accurately reflectwhatisvitaltopracticeandinthebestinterestofthepublic.

3. Do I need to retake the rD or Dtr exam?The transition to thiscompetency-basedsystemdoes noTrequirere-examination.

4. how are the competencies organized? Theoverallcompetencyframeworkisdividedintothreeinterconnectedparts.First,thereare14spheresthatdefinetheareasinwhichpractitionersact,work,orhave influence. examples include such areas as communications,educationandcounseling,clinicalcare,andcommunityandpopula-tion health. Second, within each sphere are the competencies thatdescribe expected performance or behaviors. These competenciesreplace the goal statements.Third are performance indicators thatdefine the level of expected performance. These replace learningneedcodes.Lastinthisframeworkarepracticeexamplesintendedtohelppractitionersapplycompetenciesinday-to-dayperformance.

The entire list of all of the spheres, competencies, performanceindicators, and practice examples can be found and downloadedfrom the CDR website in the document entitled “Essential Practice Competencies for the Commission on Dietetic Registration’s Credentialed Nutrition and Dietetics Practitioners.”

5. how do I use these competencies and performance indicators to create a new learning plan? ThecurrentPDPsystemasksyoutoreflect on your past, current, and possible future employment andprofessionalexperiences,andthentowritegoalsandselectlearningneedcodestoaddressyourlearningplan.Therevisedsystemutilizesan online Goal Wizard, accessed via your usual log-on to the CDRwebsite,www.cdrnet.org,andthentheMyCDRpage.TheenhancedGoalWizardwillwalkyouthroughanumberofcomputerizedstepsin which you reflect, assess, and ultimately create a new learningplan.Steps includedefiningyourpractice; reflectingonday-to-dayactivities; assessing the skills, knowledge, and judgment that youdemonstrate; identifying interestsand futurework;andmandatorylearningandrequiredethics.youwillbeabletodevelopacompletepersonalized competency profile listing all the competencies thatrelatetoyourprofessionalstatusandperformance.Fromthislist,youwill then be able to select which competencies best describe yourdesiredlearningplanfortheupcoming5-yearrecertificationcycle.

There are a number of resources on the CDR website that canhelp prepare you for using this new Goal Wizard. you can accessthese resources via the home page link to PDP and Competencies Information; then Practitioners.onceonthepractitioner’s informa-tionsite,therearewebinars,videos,andfrequentlyaskedquestions(FAQs).one of themosthelpful resources isademoversionof theGoalWizardentitled the dream Wizard thatwill takeyou throughsimulatedstepsoftheGoalWizard.

Continued on page 11

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FNCE® On-Demand (synchronized audio and PowerPoint screen captures) from the 2017 Food & Nutrition Conference & Expo™ are now available. Don‘t

miss out on important research and key learning objectives from the

meeting attended by thousands of your colleagues.

Available for three years from the live date, utilize FNCE On-Demand® to

increase your knowledge while earning CPE credits on your own time!

FNCE® On-Demand features:• Over 130 sessions from 17 educational tracks

• 24/7 education via online streaming

• Up to 30 hours of CPEUs for self-study and up to 50 hours of CPEUs for

group learning

The complete recording set from FNCE® 2017 is available to Academy members for $489 ($549 for nonmembers).

Individual sessions are also on sale for $32 for Academy members ($37 nonmember price).

*Please note, all full-week registrants of FNCE® 2017 receive FNCE® On-Demand for free.

Visit www.starlibraries.com/fnce to purchase.

Empower Yourself with Nutrition Informatics:Informatics in Nutrition Certi�cate of Training Program

Start improving your nutrition care today! Learn more at www.eatrightPRO.org/onlinelearning

Through an innovative blend of technology and information, nutrition Informatics is increasingly vital to nutrition care across all areas of practice. This online program enables nutrition professionals to apply the best informatics concepts to improve the care of those utilizing a patient centered, team approach to coordinated care.

The Level 2 program consists of �ve separate modules that build on each other:• Module 1: Overview of Informatics at the Academy, Academy Resources and Tools

• Module 2: “Data Follows the Patient”: Interoperability, Patient Generated Data, ProtectedHealth Information, Security and Ethics

• Module 3: Communications: Current Capabilities and Future Endeavors: Social Media,Telehealth, the Direct Project, and Blue Button

• Module 4:

• Module 5: Analytical Skills: Data Big and Small

Academy members enjoy a reduced rate of $24 for each module or may complete all �ve modules and earn 10.0 hours of CPEUs for $120.

eachyearatFNCe®theWHDPGgivesoutawardstoitsmembers.For2017,twoawardswerepresented:

excellence in Practice in Women’s healthThepurposeoftheexcellenceinPracticeinWomen’sHealthAwardis to recognize a member of the Women’s Health Dietetic PracticeGroup(WHDPG)whohasexhibitedoutstandingservice,dedicationand/orinnovationtothefieldofwomen’shealthnutrition.

recipient: Helen Lane, Phd, rd

HelenobtainedherBSfromUniversityofCalif-ornia,Berkeley;MSfromUniversityofWisconsin,Madison; and PhD from University of Florida,Gainesville. She worked at the VA hospitals inMadisonWisconsinandGainesvilleFlorida.Shewas assistant and associate professor of nutri-tion and dietetics at University ofTexas Health

ScienceCenter,Houston,andprofessoroffoodscienceandnutritionatAuburnUniversity.Herresearchwasonantioxidantseleniumandprevention of breast cancer and had students completing researchwith WIC and school lunch. She worked for NASA/Johnson Spacecenter as the chief nutritionist and senior scientist in health andhumanperformance.SheservedonInstituteofMedicine(includingdietaryrecommendationsforwomeninthemilitary)andNIHcom-mittees. For the dietetics profession, she was a district president,directoroftheTexasAcademyFoundation,chairofTexasnominatingcommittee, chair of the Academy Position Committee, a memberof the House of Delegates, chair of the Committee for ProfessionalDevelopment, chair of Dietetics Practice-Based Research Networkoversight Committee, and member of Council on Research alongwith treasure of Research and Vegetarian DPG. She has over 100

peer-reviewedpublications,haseditedfourbooks,andhastwopat-ents.ShereceivedtheTexasDistinguishedScientistawardandistheseniorscientistemeritusatNASA.

emerging Professional in Women’s healthThepurposeofthisawardistorecognizeamemberoftheDPGwhohasexhibitedinterestandinitiativeintheareaofwomen’shealth.

recipient: Kendra Tolbert, ms, rdn, Cdn, CLC, CHC

Kendra isaprivatepracticedietitianandwriter.Shehelpswomenandcouplesprepareforpreg-nancyandimprovetheirfertility.

Kendra lives by the quote, "People don't carehowmuchyouknowuntiltheyknowhowmuchyoucare,"andbelievescompassionandalisten-ingeararetwoofthemostpowerfulmedicines.

Priortostartingherownpractice,Kendraworkedasaconsultantfornon-profitsandasanutrition-

ist in acute care, food assistance programs, and outpatient clinics.A lifelonglearner,she'sconstantlydiggingintobooksandresearchaboutaromatherapy,herbalism,women'shealth,spirituality,move-ment,andnutrition.

Kendra is also a certified lactation counselor and certified aroma-therapist.SheholdsamasterofscienceinnutritionandpublichealthfromTeachersCollege,ColumbiaUniversity.

Congratulations to Helen and Kendra and thank you for your contribu-tions to our DPG and to the profession!

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2017 Wh dPG aWardS

Congratulations again to

rita K Batheja,MS,RDN,CDN,

AFMCP,FAND,WHDPGReimbursement

Coordinator,forreceivinga2017

MedallionawardfromtheAcad-

emyofNutritionandDietetics.

TheAcademyofNutritionandDietetics'Medallion

Awards,giveneachyearsince1976,honorAcademy

memberswhohaveshowndedicationtothehigh

standardsofthenutritionanddieteticsprofession

throughactiveparticipation,leadership,anddevotion

toservingothersinnutritionanddietetics,aswellas

alliedhealthfields.

CommiSSSSion on dietetiC reGiStration Continued from page 6

6. how do I log activities if not using learning need codes? In theActivityLog, insteadof linkingyouractivitiesto learningneedcodesas you have done in the past, you will now align the activities toyourperformanceindicators.Thelaststepoftheprocess,addressingProfessional Development e evaluation requirements, also remainsunchanged.However,youwillneedtoreflectonhowthelearninghasorwillimpactyourpracticeinsteadofmerelystatingwhatyoulearned.Thisisconsistentwiththeemphasisonprofessionalcontinuingeduca-tionthatdemonstratescompetencyinpractice.

7. Where can I find the complete list of possible CPe activities? Are there any changes in requirements? The number of hours requiredremain the same as always: 75 for RD/RDN and 50 for DTR/NDTR.It is extremely important, however, to periodically review the PdP Guide,availableontheCDRwebsite.Thisguide isupdatedannuallyandprovidesdetailedinformationonthevarioustypesofcontinuingeducationaswellasimportantdatesanddeadlines.Ifyouhavefurtherquestionsorconcerns,youcancontactCDRstaff.

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executive Committee

Chair Katie Leahy, MS, RDN, LD

Chair-ElectDawn Ballosingh, MPA, RD, LMNT

Past Chair

Catherine Sullivan, MPH, RDN, LDN, IBCLC, RLC

Treasurer Alena M. Clark, PhD, MPH, RD, CLC

Chairs/Coordinators

Social Media CoordinatorMiri Rotkovitz, MA, RD

Membership ChairRecruiting

Manager, DPG RelationsSusan DuPraw, MPH, RD

Nominating Committee ChairCarrie Dennett, MPH, RDN, CD

Nominating Chair-ElectJulie Harker Buck, EDD, RD

Committee Coordinators

Website/Electronic Mailing List (EML) CoordinatorLeila Shinn, MS, RDN, LDN

Publications EditorKathleen Pellechia, MS, RDN

Assistant Publications EditorLee Crosby, RD, LD

Policy and Advocacy LeaderLisa Eaton Wright, MS, RDN, LDN

Academy House of Delegates RepresentativeDenise Andersen, MS, RDN, LD, CLC

Membership Retention CoordinatorMaria Bournas, MS, RD

Reimbursement RepresentativeRita Kashi Batheja, MS, RDN, CDN, FAND

Webinar CoordinatorMaya Feller, MS, RD, CDN, CLC

Awards CoordinatorGinger Carney, MPH, RD, LDN, IBCLC, RLC, FILCA

Research CoordinatorChristine Garner, PhD, MS, RD, CLC

Mentoring Coordinator Judy Simon, MS, RD, CD, CHES

Please send any questions or comments to info@womenshealthdpg.org.

2017-2018 WOmeN'S heALth DIetetIC PrACtICe GrOUP LeADerS

Learn more and apply today.Visit www.eatrightPRO.org/TransformingVision

The Academy Presents the Transforming Vision into Action Award

Honoring Outstanding Contributions to the Dietetics ProfessionThe Council on Future Practice is pleased to introduce the Transforming Vision into Action Award. This award recognizes RDNs, NDTRs and their teams whose innovative programs transform a vision into nutrition and dietetics practice and/or education with future-focused outcomes.

If you have launched an innovative program or product impacting dietetics, we invite you to learn more about this award.