After taking the Nutrition Assessment, the dietitian formulates some preliminary Nutrition Diagnoses, and considers which Nutrition Interventions to propose for the patient/client’s consideration. The initial Nutrition Diagnoses can be modified as the patient supplies more information and the true underlying causes or etiologies of their condition become clear. The dietitian’s final understanding of the nutrition problems will be outlined in the Nutritional Diagnosis Statement, consisting of the Problem/Etiology/Signs and Symptoms (PES) documented in the nutrition progress note or chart entry. The dietitian may have identified several possible Nutrition Diagnoses during the course of the consultation. However, if the patient is unwilling to address a particular Nutrition Diagnosis during counseling, the practitioner may discuss another.
Not all Nutrition Diagnoses are of equal importance. Examples of criteria dietitians might use to select the most important Diagnosis are included in the Introduction chapter. If the dietitian identifies other nutrition problems with lower priority (suboptimal intake of nutrients of concern such as calcium, iron, iodine, or excess intake of nutrients of concern such as sodium, saturated fat) these should be included in the progress notes as items to be addressed in subsequent consultations.
Hint — use the eNCPT Diagnosis Reference Sheets at ncpro.org to identify the Signs and Symptoms (Potential Indicators) necessary to document that a Nutrition Diagnosis applies to your patient.
Explanatory additions to the NCP Mind Map are in blue italics. NCP terms and codes are in black font.
Nutrition Diagnosis Status Values
Dietitians are encouraged to use the labels below to communicate the status of each nutrition diagnosis identified. Definitions are provided to explain the meaning of the label on the Nutrition diagnosis status (EV-2) reference sheet.
Additional details can be found at Nutrition Monitoring and Evaluation Actions: Monitor, Measure, and Evaluate page. These concepts are on the Nutrition Assessment/Monitoring and Evaluation terminology list at eNCPT.
| NUTRITION DIAGNOSIS STATUS VALUES | |
| New nutrition diagnosis | Problem identified in nutrition diagnosis was not identified in any nutrition diagnoses made in the previous assessment. |
| Active nutrition diagnosis | The signs and symptoms in the nutrition diagnosis require nutrition intervention and monitoring and evaluation to meet the goal. |
| Resolved nutrition diagnosis | The signs and symptoms identified in the Nutrition Diagnosis have met or exceeded the goal. |
| Discontinued nutrition diagnosis | The nutrition diagnosis no longer exists because the client’s condition or situation has changed. The client’s current assessment data no longer support this nutrition diagnosis. |
| INTAKE NUTRITION DIAGNOSIS (NI) |
|
ENERGY BALANCE NUTRITION DIAGNOSES (NI-1)
|
| CLINICAL NUTRITION DIAGNOSES (NC) |
| BIOCHEMICAL NUTRITION DIAGNOSES (NC-2) Food-medication interaction (specify) (NC-2.3) · Some medications increase/decrease appetite including certain beta blockers, medications for diabetes, antidepressants, antipsychotics, anti-epileptic agents, antihistamines and corticosteroids. · Refer to the Practice Consideration: Medications that Cause Weight Gain Predicted food medication interaction (specify) (NC-2.4) WEIGHT NUTRITION DIAGNOSES (NC-3) Overweight/obesity (NC-3.3) · Overweight, adult or pediatric (NC-3.3.1) · Obesity, adult or pediatric (NC-3.3.1) - Obesity, pediatric (NC-3.3.2.1) - Obesity, Class I (NC-3.3.2.2) - Obesity, Class II (NC-3.3.2.3) - Obesity, Class III (NC-3.3.2.4) Unintended weight gain (NC-3.4), involuntary |
| BEHAVIORAL-ENVIRONMENTAL NUTRITION DIAGNOSES (NB) |
| KNOWLEDGE AND BELIEFS NUTRITION DIAGNOSES (NB-1) Food and nutrition related knowledge deficit (NB-1.1), limited food and nutrition related knowledge · Lack of knowledge of high-sodium foods, estimated energy needs, impact of physical activity, benefits of healthy weight Belief finding that hinders food and/or nutrition behavior change (NB-1.2) · Misinformation about sodium content of foods Not ready for nutrition related behavior change (NB-1.3) · Resistance to making changes and concern about the impact of lifestyle choices on other family members Self monitoring deficit (NB-1.4) · Confirm use of diet/physical activity logs Limited adherence to nutrition related recommendations (NB-1.6) · Especially in follow-up consultations if the patient is unable to follow the recommendations or plan from a previous consultation Limited food acceptance (NB-1.7) PHYSICAL ACTIVITY AND FUNCTION NUTRITION DIAGNOSES (NB-2) Physical inactivity (NB-2.1) · Sedentary lifestyle and low physical activity levels (PAL) Limited ability to prepare food for eating (NB-2.4) Poor food and/or nutrition quality of life (NB-2.5) · Nutrition Quality-of-Life (NQOL) score reflecting impact of nutrition concerns on quality of life(3,4) FOOD SAFETY AND ACCESS NUTRITION DIAGNOSES (NB-3) Limited access to nutrition related supplies (NB-3.2) · Limited access to healthy, low-sodium foods and beverages, fruits and vegetables contributing potassium, sources of calcium |
EXAMPLE PES STATEMENTS FOR HYPERTENSION(1,2)
| DOMAIN | TERMS | PES |
| INTAKE NUTRITION DIAGNOSES (NI) | NUTRIENT INTAKE NUTRITION DIAGNOSES (NI-5) Mineral (NI-5.10) · Excessive mineral intake (specify) (NI-5.10.2) - Sodium (NI-5.10.2.7) |
Excessive sodium intake (NI-5.10.2.7) (P) related to frequent consumption of high-sodium foods (E) as evidenced by an average daily intake of more than 6 g of salt (2 300 mg) per day, which exceeds the recommended intake of 4 g (1 500 mg) of salt per day (S) |
| CLINICAL NUTRITION DIAGNOSES (NC) | WEIGHT NUTRITION DIAGNOSES (NC-3) Overweight/obesity (NC-3.3) |
Overweight/obesity (NC-3.3) (P) related to Excessive energy intake (NI-1.3) and patient reporting limited physical activity (E) as evidence by BMI of 31 kg/m2, waist circumference of 40 inches (102 cm) and a diet history showing an intake of 1 000 kcal per day in excess of requirements with a sedentary lifestyle (S) |
| BEHAVIORAL-ENVIRONMENTAL NUTRITION DIAGNOSES (NB) | KNOWLEDGE AND BELIEFS NUTRITION DIAGNOSES (NB-1) Not ready for nutrition related behavior change (NB-1.3) |
Not ready for nutrition related behavior change (NB-1.3) (P) related to Food and nutrition-related knowledge deficit (NB-1.1) and a strong preference for salty foods (E) as evidenced by a reluctance to discuss alternatives to high-sodium foods and no previous consultation for lifestyle changes for management of hypertension and the patient reporting limited background knowledge of the condition (S) |
| PHYSICAL ACTIVITY AND FUNCTION (NB-2) Physical inactivity (NB-2.1) |
Physical inactivity (NB-2.1) (P) related to a busy schedule and lack of importance placed on physical activity (E) as evidenced by sedentary lifestyle with less than 30 minutes of exercise five days a week (S) |
References
1. Academy of Nutrition and Dietetics. Nutrition Terminology Reference Manual (eNCPT): Dietetics Language for Nutrition Care. 2023. Accessed 22 March 2024. Available from: https://www.ncpro.org/.
2. Academy of Nutrition and Dietetics. Nutrition Terminology Reference Manual (eNCPT): Dietetics Language for Nutrition Care. NCP Step 1: Nutrition Assessment. 2023. Accessed 22 March 2024. Available from: https://www.ncpro.org/pubs/2023-encpt-en/page-015
3. Barr JT, Schumacher G, Myers EF. Case Problem: Quality of Life Outcomes Assessment. J Am Diet Assoc. 2001; 101(9): 1064-1066.
4. Barr JT, Schumacher G. The need for a nutrition-related quality-of-life measure. J Am Diet Assoc. 2003; 103: 177-180.