Module 14 – Domain II: Nutrition Diagnosis
After reviewing Module 14 lecture, you should be able to:
- Describe the Nutrition Diagnosis step in the Nutrition Care Process.
- Plan nutrition care for individual including identification of desired outcomes/actions.
- Determine energy/nutrient needs throughout the lifespan.
- Discuss menu planning for health promotion.
Nutrition Diagnosis
Nutrition Diagnosis - second step of the Nutrition Care Process; involves naming and classification of existing or risk for a certain nutrition problem in which dietary professionals treat solely.
Relationship between nutrition diagnoses and medical diagnoses
· The nutrition problem or diagnosis is different from a medical diagnosis. The medical diagnosis remains as long as the condition exists while the nutrition problem can change as the patient reacts, ie: a patient with a medical diagnosis of heart disease may have a nutrition problem or diagnosis of excessive fat intake.
Problem definition (Diagnostic labels)
· labels for a variety of nutrition problems/diagnoses have been assigned; they have been broken down into 3 categories or domains
- Intake - nutritional problems related to intake of energy, nutrients, fluids, etc. through the diet via oral consumption or nutrition support
§ inadequate energy intake, excessive intake from enteral/parenteral nutrition, inadequate fiber intake, etc.
- Clinical - nutritional problems associated with medical condition
§ altered GI function, impaired nutrient utilization, etc.
- Behavioral-Environmental - nutritional problems associated with beliefs, knowledge, physical surroundings, availability of food, etc
§ disordered eating, impaired ability to prepare foods/meals, etc.
Etiologies (cause/contributing risk factors)
· factors that support the identified physiological, situational, etc. problems
o physiological causes that result in increased energy requirements, decreased functional length of GI tract such as short-bowel syndrome, physical disability, etc.
· linked to the Nutrition Diagnosis label with the words "related to" or "RT"
Signs and symptoms (Defining characteristics)
· subjective (symptoms) and/or objective (signs) information used to establish if the patient has nutrition problem defined
o weight loss, abnormal digestive enzyme study, inability to purchase and transport foods to home, etc.
· connected to etiology with the words "as evidenced by" or "AEB"
Documentation - Developing nutrition diagnostic statements (PES statements)
· summarizes the nutrition diagnosis; Problem, Etiology, Sign and Symptom statement
· ie: Involuntary weight loss (problem) related to lack of self feeding ability (etiology) as evidenced by weight loss of 5% in the past 30 days.
· ie: Inadequate calcium intake RT lack of knowledge concerning food sources of calcium AEB diminished bone mineral density.
Nutrition Intervention
Identification of desired outcomes/actions
Evaluation of Nutrition Information
When evaluating diet plans, consider whether:
· All food groups are present; not deficient in any nutrients including calories
· Specialty foods required including foods which are costly or generally limited availability
· Achievable over a long period of time
· Offers quick weight loss or requires supplements
Health Fraud
Guidance on dietary supplements is offered via Food and Nutrition Science Alliance.
Complimentary Care
Herbal Supplements
· Echinacea - claimed uses include:
o improves immune system
o prevents cold or flu symptoms
o contraindicated for those with auto immune disorders
· Garlic – claimed uses include:
o aids in lowering blood pressure and/or cholesterol
o antibacterial agent
o contraindicated with anticoagulant medications
· Ginkgo biloba – claimed uses include:
o improved peripheral circulation
o inhibits platelet aggregation
o improved mental function
o contraindicated with anticoagulant medications
· Ginseng – claimed uses include:
o energy and mental improvement
o contraindicated with hypertension, diabetes, those taking steroid therapy or MAO inhibitors
· Ma Huang (Ephedra) – claimed uses include:
o energy improvement
o nasal decongestant
o asthma therapy
o contraindicated with hypertension, cardiac diseases, neurological diseases, and thyroid diseases
o in 2004 the FDA prohibited the sale of dietary supplements containing ephedrine alkaloids (ephedra) after finding the supplements present an unreasonable risk of illness or injury
· St. John's Wort – claimed uses include:
o anti-depressant
o contraindicated with anti-depressant medications
· Valerian – claimed uses include:
o sedative effects
o contraindicated with sedative, anti-anxiety, or anti-depressant medications
Determination of energy/nutrient needs specific to life span stage
· Greatest calorie needs per kg are during infancy
· Additional calories are required for physical activity, illness, healing, pregnancy, etc.
· Protein requirements for adults is 0.8 g/kg of IBW; requirements increase with illness, healing, etc.
· Fluid requirements for adults is 1 ml/kcal or ~1800-2500 ml/day; needs are increased with illness, fevers, etc.
Menu planning for health promotion
Food Labeling
Nutrition Labeling and Education Act - 1990 (NLEA) - all food products under FDA carry label including the following:
· Standard serving size including household measurement and metric measurement
· Number of servings in the package
· Calories per serving and calories from fat
· Daily Values - percentage of daily values of nutrients based on a 2000 calorie diet
o includes fat, saturated fat, CHO, protein, fiber, cholesterol, sodium, potassium, vitamin A, C, Iron, Calcium
· Total fat in grams (30% of calories from fat) and saturated fat (10% of calories from saturated fat)
· Cholesterol in milligrams (300 mg or less)
· CHO, sugar, fiber in grams (CHO ~60%, 23 grams of fiber/2000 calories)
· Protein in grams (10% of calories)
· Ingredients are listed by order of predominant weight
Descriptions of nutrient claims
· Free - no amount of or a trivial amount of calories, fat, saturated fat, cholesterol or sodium; calorie-free is defined as less than 5 calories per serving
· Good source - is defined as 10-19% of daily value of a certain nutrient per serving
· High - is defined as more than 20% of daily value of a certain nutrient per serving
· Less - is defined as containing 25% less of a certain nutrient than a standard food
· Light - is defined as containing 1/3 less calories or 1/2 fat of a standard food
· Low - is defined in certain nutrient terms
o low fat - 3 grams or less per serving
o low saturated fat - 1 gram or less per serving
o low sodium - 140 mg or less per serving
o low calorie - 40 calories or less per serving
· more - is defined as containing 10% of nutrient daily value when compared to a standard food
Food Label Health Claims - those foods making health claims must follow the following criteria:
- must be a naturally good source of at least one of the following nutrients - vitamin A, vitamin C, iron, calcium, protein, or fiber
- foods containing more than 20% daily value of total fat, saturated fat, cholesterol, or sodium cannot carry health claims
· Calcium and osteoporosis
· Folic acid and neural tube defects
· Saturated fat and cholesterol and heart disease
· Whole grains and heart disease & cancer
· Sugar alcohols and tooth decay
· Potassium and hypertension & stroke
Cancer: fat, fiber (F & V, whole grains), F/V
Heart Disease: fiber, Sat fat, cholesterol, whole grains, soluble fiber, soy protein,
plant sterols
HTN: sodium, potassium
Now that you have read the lecture, consider the following:
- Describe the problem definition, etiologies, and signs & symptoms of Nutrition Diagnosis
- Discuss how to write a PES statement.
- Compare and contrast nutrient needs of an infant versus an adult.
- On a food package, what does "less" versus "low fat" indicate?
- Describe the Nutrition Labeling & Education Act. What does the act require on the label?
- How would you best evaluate a popular fad diet a patient is following?