Nutrition Diagnosis Examples: A Comprehensive Guide for Dietitians

A nutrition diagnosis pinpoints a specific nutrition-related problem that a Registered Dietitian Nutritionist (RDN) is qualified and responsible to address. It’s a critical step within the Nutrition Care Process (NCP), a systematic framework for delivering nutrition care. These diagnoses are articulated as PES (Problem, Etiology, Signs/Symptoms) statements, utilizing standardized nutrition diagnostic terminology.

Understanding Nutrition Diagnoses in the Nutrition Care Process

The Nutrition Care Process is structured around four essential stages:

Nutrition assessment
Diagnosis
Intervention
Monitoring and evaluation

Following a thorough nutrition assessment or reassessment, the RDN identifies and labels one or more nutrition problems that fall within their scope of practice to treat. This identification is the nutrition diagnosis. These nutrition-related issues are then targeted for resolution or improvement through the third phase of the NCP – the nutrition intervention.

Key Differences: Nutrition Diagnosis vs. Medical Diagnosis

It is crucial to understand that dietitians do not diagnose medical conditions. Medical diagnoses are outside the dietitian’s professional purview. Nutrition diagnoses and medical diagnoses serve distinct purposes.

A nutrition diagnosis is formulated by a dietitian to specifically describe a nutrition-related problem. These problems are typically amenable to improvement or resolution through targeted nutrition interventions provided by a nutrition professional.

Conversely, a medical diagnosis is typically established by a physician to name a disease or pathology.

Consider diabetes as a clear example. Diabetes is the medical diagnosis given by a physician. However, an RDN might identify several nutrition diagnoses in a patient with diabetes, such as excessive carbohydrate intake, inadequate protein intake, or knowledge deficit regarding healthy meal planning.

Standardized Language: Nutrition Diagnostic Terminology

ICD-10 codes represent the standardized language for medical diagnoses. In medical documentation, a physician might note “hypertension,” but will also typically include a corresponding ICD-10 code, like I10, for essential (primary) hypertension. This coding system ensures universal communication, streamlining billing and data collection processes.

Similarly, dietitians employ a standardized language system for nutrition diagnoses, known as nutrition diagnostic terminology. While specific alpha-numeric codes aren’t typically used in patient charts, the terminology itself provides a precise and consistent way to communicate nutrition problems. This structured approach ensures clarity and consistency within the nutrition care field.

The Four Domains of Nutrition Diagnostic Terminology

The spectrum of nutrition diagnoses is broad, categorized into four primary domains:

Intake
Clinical
Behavioral-environmental
Nutrition situation

Intake Domain: Nutrition Diagnosis Examples

Diagnoses within the intake domain are concerned with issues related to the amount of energy, nutrients, fluids, or bioactive substances consumed through diet, enteral, or parenteral nutrition, compared to actual or desired levels.

This domain is further divided into classes like:

Calorie Balance: Example: Inadequate energy intake, Excessive energy intake.
Oral or Nutrition Support Intake: Example: Inadequate oral intake, Excessive parenteral nutrition intake.
Fluid Intake: Example: Inadequate fluid intake, Excessive fluid intake.
Bioactive Substances Intake: Example: Inadequate bioactive substance intake.
Nutrient Intake: This is further broken down by macronutrient and micronutrient intake.
- Macronutrient Intake: Example: Inadequate protein intake, Excessive carbohydrate intake, Inappropriate fat intake.
- Micronutrient Intake: Example: Inadequate vitamin intake (specify vitamin), Excessive mineral intake (specify mineral).

For instance, “Inadequate oral intake” could be used for a patient who is not consuming enough food to meet their estimated energy needs through oral diet alone.

Clinical Domain: Nutrition Diagnosis Examples

Clinical nutrition diagnoses relate to identified medical or physical conditions that have nutritional implications. Subclasses within this domain include:

Functional: Problems with physical functioning or mechanical problems that impact nutrition. Example: Swallowing difficulty (dysphagia), Chewing difficulty.
Biochemical: Nutritional problems identified through lab data, medical tests, or procedures. Example: Altered nutrition-related lab values (specify lab value), Hypoglycemia, Hyperglycemia.
Weight: Issues related to body weight. Example: Underweight, Overweight/Obesity, Unintended weight loss, Unintended weight gain, Failure to thrive.
Malnutrition: Diagnoses specifically related to malnutrition, categorized by etiology and severity. Example: Severe malnutrition related to chronic illness, Mild malnutrition related to inadequate energy intake.

For example, “Swallowing difficulty” would be appropriate for a patient who has difficulty safely swallowing foods and liquids, impacting their ability to consume adequate nutrition orally.

Behavioral-Environmental Domain: Nutrition Diagnosis Examples

This domain encompasses nutrition problems related to knowledge, attitudes, beliefs, physical environment, access to food, and food safety. Subclasses include:

Knowledge and Beliefs: Issues related to nutrition knowledge, attitudes, and beliefs. Example: Food and nutrition-related knowledge deficit, Not ready for diet/lifestyle change, Undesirable food choices.
Physical Activity and Function: Problems related to physical activity, mobility, and functional limitations. Example: Physical inactivity, Impaired ability to prepare foods/meals.
Food Safety and Access: Issues related to food safety and access to nutritious food. Example: Food insecurity, Limited access to food, Unsafe food handling.

An example here could be “Food and nutrition-related knowledge deficit” for a patient who lacks understanding of basic nutrition principles relevant to their health condition, such as understanding carbohydrate counting for diabetes management.

Nutrition Situation Domain: Nutrition Diagnosis Example

The nutrition situation domain contains a single diagnosis: “No nutrition diagnosis at this time.” This is used when no nutrition problem is currently identified.

The Academy of Nutrition and Dietetics (AND) clarifies that this diagnosis should not be used simply because the nutrition assessment is incomplete or pending further information. It truly signifies that based on current assessment data, no nutrition problem requiring dietitian intervention is present.

Examples Across Domains: Nutrition Diagnosis List

To illustrate the breadth of nutrition diagnoses, here are more examples across the four domains:

Intake Domain Examples:

Excessive energy intake
Inadequate enteral nutrition infusion rate
Excessive fluid intake (related to heart failure management)
Inadequate fiber intake (related to constipation)
Inadequate protein intake (inadequate dietary intake)
Excessive sodium intake (related to processed food consumption)
Inadequate calcium intake (dietary intake below recommendations)
Inadequate vitamin D intake (limited sun exposure and dietary intake)

Clinical Domain Examples:

Swallowing difficulty (dysphagia post-stroke)
Underweight (BMI <18.5 kg/m²)
Overweight/Obesity (BMI >30 kg/m²)
Unintended weight loss (significant weight loss over a period of time)
Elevated blood glucose (hyperglycemia related to diabetes)
Malnutrition, severe (in the context of chronic kidney disease)
Growth rate below expected percentile (in pediatric populations)

Behavioral-Environmental Domain Examples:

Food and nutrition-related knowledge deficit (regarding heart-healthy diet)
Self-monitoring deficit (inconsistent blood glucose monitoring)
Limited ability to prepare meals (due to physical limitations)
Food insecurity (lack of consistent access to adequate food)
Poor food safety practices (improper food storage)
Not ready for diet/lifestyle change (precontemplation stage of change)

Nutrition Situation Diagnosis:

No nutrition diagnosis at this time (patient is meeting nutritional needs and has no identified nutrition-related problems).

Accessing the Nutrition Diagnostic Terminology

The complete list of nutrition diagnostic terminology is available through subscription. Initially, this list was published in print as the International Dietetics & Nutrition Terminology (IDNT) Reference Manual. After several editions, it transitioned to an exclusively online format.

Currently, access is obtained through a subscription to the Electronic Nutrition Care Process Terminology (eNCPT) website. Annual subscription fees vary, with discounted rates for Academy of Nutrition and Dietetics members, and different pricing tiers for students, organizations, educators, and developers.

Communicating Nutrition Diagnoses: PES Statements

Identifying a nutrition diagnosis is just the first step. The diagnosis, along with its underlying cause and supporting evidence, must be clearly communicated. This is achieved through a PES statement, also known as a nutrition diagnosis statement.

Constructing a PES Statement: Formula and Examples

PES statements follow a structured format:

[Problem/nutrition diagnosis] related to [Etiology], as evidenced by [Signs/symptoms].

Let’s break down each component:

Problem (P) – The Nutrition Diagnosis

The ‘P’ in PES represents the chosen nutrition diagnosis from the standardized terminology list. Example: Inadequate protein intake.

Etiology (E) – The Root Cause

The etiology is the “why” behind the nutrition problem – the root cause or contributing risk factors. Etiologies can be diverse, ranging from cultural factors, beliefs, medical conditions, physical or cognitive impairments, medical treatments, socioeconomic factors, or social history.

For “Inadequate protein intake,” a potential etiology could be limited access to protein-rich foods due to financial constraints.

Signs/Symptoms (S) – The Evidence

Signs and symptoms are the defining characteristics gathered during the nutrition assessment that support the identified nutrition diagnosis. These data points can come from medical records, patient interviews, nutrition-focused physical exams, and other assessment methods.

You can include multiple signs and symptoms. They should be specific and measurable, enabling effective monitoring and evaluation in the subsequent NCP step.

Here’s a complete PES statement example:

Inadequate protein intake related to limited access to protein-rich foods due to financial constraints, as evidenced by reported dietary intake of 0.6g protein/kg body weight, serum albumin level of 3.0 g/dL, and reported food insecurity.

*Explore more PES statement examples* for a deeper understanding.

Tips for Effective PES Statement Writing

Base your nutrition problem identification on comprehensive assessment data.
Employ critical thinking and clinical judgment to infer appropriate diagnoses.
Ensure the nutrition diagnosis is actionable – something that can be addressed or improved through nutrition intervention.
Prioritize diagnoses from the intake domain when appropriate, as these are often directly impacted by nutrition interventions.
Write clear, concise, and specific PES statements.
Typically, limit PES statements to three or fewer per patient for focused intervention planning.
Omit unnecessary words like “and” or “the” for brevity, focusing on the core components.

Conclusion: The Power of Nutrition Diagnosis

A nutrition diagnosis provides a standardized and formal method for RDNs to articulate identified nutrition problems. The PES statement serves as the communication tool for this diagnosis. Addressing the nutrition diagnosis through targeted interventions, and subsequent monitoring and evaluation, forms the cornerstone of effective nutrition care.

Please note that this information reflects the 2023 edition of the Nutrition Care Process Terminology (eNCPT), the most current version at the time of this publication.