eNCPT 2020 Lengkap

Nutrition Assessment and Monitoring and Evaluation Terminology
This is a combined list of Nutrition Assessment and Monitoring and Evaluation terms. All terms can be used for Nutrition Assessment. Client History terms are used for
Nutrition Assessment, but not for Nutrition Monitoring and Evaluation. Each term is designated with an alpha numeric NCPT hierarchical code, followed by a five-digit
(eg, 99999) Academy SNOMED CT/LOINC unique identifier (ANDUID). Neither should be used in nutrition documentation. The ANDUID is for data-tracking
purposes in electronic health records.
NCPT Code ANDUID NCPT Code ANDUID
FOOD/NUTRITION-RELATED HISTORY ❑ Liquid dairy product estimated oral FH-1.2.1.1.1.6 14017

(FH) intake in 24 hours
Food and nutrient intake, food and nutrient ❑ Caffeinated beverage estimated oral FH-1.2.1.1.1.7 14018
administration, medication and intake in 24 hours
complementary/alternative medicine use, ❑ Nutritionally complete liquid FH-1.2.1.1.1.8 14019
knowledge/beliefs/attitudes, behavior, food and supply supplement estimated oral intake in 24
availability, physical activity and function, nutrition- hours
related client-centered measures. ❑ Liquid meal replacement estimated FH-1.2.1.1.1.9 14020
Food and Nutrient Intake (1) oral intake in 24 hours
Composition and adequacy of food and nutrient intake, ❑ Fluid estimated intake per kg in 24 hours FH-1.2.1.1.2 14021
meal and snack patterns, current and previous diets ❑ Fluid estimated intake from food FH-1.2.1.1.3 10009
and/or food modifications, and eating environment. ❑ Free water estimated intake in 24 hours FH-1.2.1.1.4 14022
Energy Intake (1.1) ❑ Free water estimated intake from FH-1.2.1.1.4.1 14023
Total energy intake from all sources including, food, breastmilk in 24 hours
beverages, breastmilk/formula, supplements, and via ❑ Free water estimated intake from FH-1.2.1.1.4.2 14024
enteral and parenteral routes. infant formula in 24 hours
Energy intake (1.1.1) ❑ Free water estimated intake from FH-1.2.1.1.4.3 14025
❑ Estimated energy intake FH-1.1.1.1 14219 enteral nutrition in 24 hours
❑ Total energy estimated intake in 24 hours FH-1.1.1.1.1 11383 ❑ Free water estimated intake from FH-1.2.1.1.4.4 14026
❑ Energy estimated intake per kg in 24 FH-1.1.1.1.2 14001 parenteral nutrition in 24 hours
hours ❑ Free water estimated intake from FH-1.2.1.1.4.5 14027
❑ Energy estimated intake from oral FH-1.1.1.1.3 14002 intravenous fluids in 24 hours
nutrition in 24 hours ❑ Measured fluid intake FH-1.2.1.2 14028
❑ Energy estimated intake from enteral FH-1.1.1.1.4 14003 ❑ Total fluid measured intake in 24 hours FH-1.2.1.2.1 14029
nutrition in 24 hours ❑ Fluid measured intake from oral FH-1.2.1.2.1.1 10008
❑ Energy estimated intake from parenteral FH-1.1.1.1.5 14004 nutrition in 24 hours
nutrition in 24 hours ❑ Water measured oral intake in 24 hours FH-1.2.1.2.1.2 14030
❑ Energy estimated intake from intravenous FH-1.1.1.1.6 14005 ❑ Sugar sweetened beverage measured FH-1.2.1.2.1.3 14031
fluids in 24 hours oral intake in 24 hours
❑ Measured energy intake FH-1.1.1.2 14220 ❑ Beverage with high intensity sweetener FH-1.2.1.2.1.4 14032
❑ Total energy measured intake in 24 hours FH-1.1.1.2.1 10005 measured oral intake in 24 hours
❑ Energy measured intake per kg in 24 FH-1.1.1.2.2 14006 ❑ 100 percent fruit juice measured oral FH-1.2.1.2.1.5 14033
hours intake in 24 hours
❑ Energy measured intake from oral FH-1.1.1.2.3 14007 ❑ Liquid dairy product measured oral FH-1.2.1.2.1.6 14034
nutrition in 24 hours intake in 24 hours
❑ Energy measured intake from enteral FH-1.1.1.2.4 14008 ❑ Caffeinated beverage measured oral FH-1.2.1.2.1.7 14035
nutrition in 24 hours intake in 24 hours
❑ Energy measured intake from parenteral FH-1.1.1.2.5 14009 ❑ Nutritionally complete liquid FH-1.2.1.2.1.8 14036
nutrition in 24 hours supplement measured oral intake in 24
❑ Energy measured intake from intravenous FH-1.1.1.2.6 14010 hours
fluids in 24 hours ❑ Liquid meal replacement measured FH-1.2.1.2.1.9 14037
Food and Beverage Intake (1.2) oral intake in 24 hours
Type, amount, and pattern of intake of foods and food ❑ Fluid measured intake from food FH-1.2.1.2.2 14038
groups, indices of diet quality, intake of fluids, ❑ Fluid measured intake per kg in 24 hours FH-1.2.1.2.3 14039
breastmilk and infant formula ❑ Free water measured intake in 24 hours FH-1.2.1.2.4 14040
Fluid intake (1.2.1) ❑ Free water measured intake from FH-1.2.1.2.4.1 14041
❑ Estimated fluid intake FH-1.2.1.1 14011 breastmilk in 24 hours
❑ Total fluid estimated intake in 24 hours FH-1.2.1.1.1 14012 ❑ Free water measured intake from FH-1.2.1.2.4.2 14042
infant formula in 24 hours
❑ Fluid estimated intake from oral FH-1.2.1.1.1.1 11386
nutrition in 24 hours ❑ Free water measured intake from FH-1.2.1.2.4.3 14043
enteral nutrition in 24 hours
❑ Water estimated oral intake in 24 hours FH-1.2.1.1.1.2 14013
❑ Free water measured intake from FH-1.2.1.2.4.4 14044
❑ Sugar sweetened beverage estimated FH-1.2.1.1.1.3 14014
parenteral nutrition in 24 hours
oral intake in 24 hours
❑ Free water measured intake from FH-1.2.1.2.4.5 14045
❑ Beverage with high intensity sweetener FH-1.2.1.1.1.4 14015
intravenous fluids in 24 hours
estimated oral intake in 24 hours
❑ 100 percent fruit juice estimated oral FH-1.2.1.1.1.5 14016
intake in 24 hours Food intake (1.2.2)
❑ Amount of food FH-1.2.2.1 10012
1
Nutrition Care Process Terminology (eNCPT), 2020 Edition. Copyright 2020 Academy of Nutrition and Dietetics. Updated October 2021.
❑ Estimated amount of food FH-1.2.2.1.1 13125 ❑ Breastmilk intake measured volume in 24 FH-1.2.3.1.6.1 11408
❑ Grain servings estimated in 24 hours FH-1.2.2.1.1.1 11387 hours
❑ Fruit servings estimated in 24 hours FH-1.2.2.1.1.2 11389 ❑ Breastmilk intake measured volume per FH-1.2.3.1.6.2 14061
kg in 24 hours
❑ Vegetable servings estimated in 24 hours FH-1.2.2.1.1.3 11391
❑ Milk product servings estimated in 24 FH-1.2.2.1.1.4 11393
❑ Infant formula intake FH-1.2.3.2 10019
hours ❑ Infant formula feedings in 24 hours FH-1.2.3.2.1 11412
❑ Protein food servings estimated in 24 FH-1.2.2.1.1.5 11395 ❑ Adequacy of infant formula intake FH-1.2.3.2.2 11413
hours ❑ Infant formula intake composition FH-1.2.3.2.3 14211
❑ Fat servings estimated in 24 hours FH-1.2.2.1.1.6 11397 ❑ Infant formula intake concentration FH-1.2.3.2.4 14062
❑ Empty energy servings estimated in 24 FH-1.2.2.1.1.7 11399 ❑ Estimated infant formula intake FH-1.2.3.2.5 14063
hours ❑ Infant formula intake estimated volume in FH-1.2.3.2.5.1 11410
❑ Estimated percent of meals eaten in 24 FH-1.2.2.1.1.8 14046 24 hours
hours ❑ Infant formula intake estimated volume FH-1.2.3.2.5.2 14064
❑ Measured amount of food FH-1.2.2.1.2 13126 per kg in 24 hours
❑ Grain servings measured in 24 hours FH-1.2.2.1.2.1 11388 ❑ Measured infant formula intake FH-1.2.3.2.6 14065
❑ Fruit servings measured in 24 hours FH-1.2.2.1.2.2 11390 ❑ Infant formula intake measured volume in FH-1.2.3.2.6.1 11411
❑ Vegetable servings measured in 24 hours FH-1.2.2.1.2.3 11392 24 hours
❑ Milk product servings measured in 24 FH-1.2.2.1.2.4 11394 ❑ Infant formula intake measured volume FH-1.2.3.2.6.2 14066
hours per kg in 24 hours
❑ Protein food servings measured in 24 FH-1.2.2.1.2.5 11396 Enteral and Parenteral Nutrition Intake (1.3)
hours Specialized nutrition support intake from all sources,
❑ Fat servings measured in 24 hours FH-1.2.2.1.2.6 11398 eg, enteral and parenteral routes.
❑ Empty energy servings measured in 24 FH-1.2.2.1.2.7 11400 Enteral nutrition intake (1.3.1)
hours ❑ Enteral nutrition formula/solution FH-1.3.1.1 10022
❑ Measured percent of meals eaten in 24 FH-1.2.2.1.2.8 14047 ❑ Enteral nutrition formula composition FH-1.3.1.1.1 11414
hours
❑ Enteral nutrition formula concentration FH-1.3.1.1.2 11415
❑ Types of food FH-1.2.2.2 10013
❑ Enteral nutrition formula estimated volume in FH-1.3.1.1.3 11416
❑ Fortified food intake FH-1.2.2.2.1 14048 24 hours
❑ Enriched food intake FH-1.2.2.2.2 14049 ❑ Enteral nutrition formula measured volume in FH-1.3.1.1.4 13227
❑ Special dietary food intake FH-1.2.2.2.3 14050 24 hours
❑ Medical food intake FH-1.2.2.2.4 14051 ❑ Enteral tube feeding flush estimated volume in FH-1.3.1.2 10023
❑ Processed food intake FH-1.2.2.2.5 14052 24 hours
❑ Quick service food intake FH-1.2.2.2.6 14053 ❑ Enteral tube feeding flush measured volume in FH-1.3.1.3 13228
❑ Self prepared food intake FH-1.2.2.2.7 14054 24 hours
❑ Prepared food intake FH-1.2.2.2.8 14210 Parenteral nutrition intake (1.3.2)
❑ Meal/snack pattern FH-1.2.2.3 10014 ❑ Parenteral nutrition formula/solution FH-1.3.2.1 10025
❑ Estimated meal and snack pattern FH-1.2.2.3.1 13127 ❑ IV fluids FH-1.3.2.2 10026
❑ Number of meals estimated in 24 hours FH-1.2.2.3.1.1 11404 Bioactive Substance Intake (1.4)
❑ Number of snacks estimated in 24 hours FH-1.2.2.3.1.2 11402 Alcohol, plant stanol and sterol esters, soy protein,
psyllium and beta glucan, and caffeine intake from all
❑ Measured meal and snack pattern FH-1.2.2.3.2 13128
sources, eg, food, beverages, supplements, and via
❑ Number of meals measured in 24 hours FH-1.2.2.3.2.1 11405
enteral and parenteral routes.
❑ Number of snacks measured in 24 hours FH-1.2.2.3.2.2 11403
Alcohol intake (1.4.1)
❑ Diet quality index FH-1.2.2.4 10015
❑ Alcohol intake in one week FH-1.4.1.1 14172
❑ Healthy eating index (HEI) 2015 score FH-1.2.2.4.1 14055
❑ Alcohol intake in 24 hours FH-1.4.1.2 14173
❑ Food variety FH-1.2.2.5 10016
❑ Beer intake in 24 hours FH-1.4.1.2.1 14174
Breastmilk/infant formula intake (1.2.3) ❑ Distilled alcohol intake in 24 hours FH-1.4.1.2.2 14175
❑ Breastmilk intake FH-1.2.3.1 10018 ❑ Wine intake in 24 hours FH-1.4.1.2.3 14176
❑ Breastmilk feeding attempts in 24 hours FH-1.2.3.1.1 11406 ❑ Hard cider intake in 24 hours FH-1.4.1.2.4 14177
❑ Adequacy of breastmilk intake FH-1.2.3.1.2 11409 ❑ Days per week alcoholic drinks consumed FH-1.4.1.3 14188
❑ Donor breastmilk intake FH-1.2.3.1.3 14056
❑ Alcohol intake pattern on drinking days FH-1.4.1.4 10031
❑ Mother’s expressed breastmilk intake FH-1.2.3.1.4 14057
Bioactive substance intake (1.4.2)
❑ Estimated breastmilk intake FH-1.2.3.1.5 14058
❑ Estimated bioactive substance intake FH-1.4.2.1 13129
❑ Breastmilk intake estimated volume in 24 FH-1.2.3.1.5.1 11407
❑ Plant stanol ester estimated intake in 24 hours FH-1.4.2.1.1 11422
hours
❑ Breastmilk intake estimated volume per FH-1.2.3.1.5.2 14059
❑ Plant sterol ester estimated intake in 24 hours FH-1.4.2.1.2 11424
kg in 24 hours ❑ Soy protein estimated intake in 24 hours FH-1.4.2.1.3 11426
❑ Measured breastmilk intake FH-1.2.3.1.6 14060 ❑ Psyllium estimated intake in 24 hours FH-1.4.2.1.4 11428
❑ Beta glucan estimated intake in 24 hours FH-1.4.2.1.5 11430
2
Nutrition Care Process Terminology (eNCPT), 2020 Edition. Copyright 2020 Academy of Nutrition and Dietetics. Updated October 2021
❑ Measured bioactive substance intake FH-1.4.2.2 13130 ❑ Monounsaturated fat measured intake in 24 FH-1.5.1.2.5 11442
❑ Plant stanol ester measured intake in 24 hours FH-1.4.2.2.1 11423 hours
❑ Plant sterol ester measured intake in 24 hours FH-1.4.2.2.2 11425 ❑ Omega 3 fatty acid measured intake in 24 FH-1.5.1.2.6 11444
hours
❑ Soy protein measured intake in 24 hours FH-1.4.2.2.3 11427
❑ Alpha linolenic acid measured intake in FH-1.5.1.2.6.1 11446
❑ Psyllium measured intake in 24 hours FH-1.4.2.2.4 11429
24 hours
❑ Beta glucan measured intake in 24 hours FH-1.4.2.2.5 11431
❑ Eicosapentaenoic acid measured intake in FH-1.5.1.2.6.2 11448
❑ Food additive intake (specify) FH-1.4.2.3 10038 24 hours
❑ High intensity sweetener additive intake FH-1.4.2.3.1 14067 ❑ Docosahexaenoic acid measured intake in FH-1.5.1.2.6.3 11450
❑ Excessive high intensity sweetener FH-1.4.2.3.1.1 14068 24 hours
additive intake ❑ Essential fatty acid measured intake in 24 FH-1.5.1.2.7 11452
Caffeine intake (1.4.3) hours
❑ Total caffeine estimated intake in 24 hours FH-1.4.3.1 11432 ❑ Medium chain triglyceride measured intake in FH-1.5.1.2.8 11454
24 hours
❑ Total caffeine measured intake in 24 hours FH-1.4.3.2 10041
❑ Fat measured intake in one meal FH-1.5.1.2.9 14072
Macronutrient Intake (1.5)
❑ Percent saturated fat measured intake in 24 hours FH-1.5.1.2.10 14073
Fat and cholesterol, protein, carbohydrate, and fiber
intake from all sources including food, beverages, ❑ Fat measured intake from oral nutrition in 24 FH-1.5.1.2.11 14074
supplements, and via enteral and parenteral routes. hours
Fat intake (1.5.1) ❑ Fat measured intake from enteral nutrition in 24 FH-1.5.1.2.12 14075
hours
❑ Estimated fat intake FH-1.5.1.1 13131
❑ Fat measured intake from parenteral nutrition in FH-1.5.1.2.13 14076
❑ Total fat estimated intake in 24 hours FH-1.5.1.1.1 11433
24 hours
❑ Saturated fat estimated intake in 24 hours FH-1.5.1.1.2 11435
❑ Fat measured intake from intravenous fluids in 24 FH-1.5.1.2.14 14077
❑ Trans fatty acid estimated intake in 24 hours FH-1.5.1.1.3 11437 hours
❑ Polyunsaturated fat estimated intake in 24 FH-1.5.1.1.4 11439 ❑ Fat additive measured intake in 24 hours FH-1.5.1.2.15 14078
hours ❑ Percent fat measured intake in 24 hours FH-1.5.1.2.16 14217
❑ Linoleic acid estimated intake in 24 hours FH-1.5.1.1.4.1 11602 Cholesterol intake (1.5.2)
❑ Monounsaturated fat estimated intake in 24 FH-1.5.1.1.5 11441 ❑ Cholesterol estimated intake in 24 hours FH-1.5.2.1 11455
hours
❑ Cholesterol measured intake in 24 hours FH-1.5.2.2 11456
❑ Omega 3 fatty acid estimated intake in 24 FH-1.5.1.1.6 11443
Protein intake (1.5.3)
hours
❑ Estimated protein intake FH-1.5.3.1 13133
❑ Alpha linolenic acid estimated intake in FH-1.5.1.1.6.1 11445
24 hours ❑ Total protein estimated intake in 24 hours FH-1.5.3.1.1 11457
❑ Eicosapentaenoic acid estimated intake in FH-1.5.1.1.6.2 11447 ❑ High biological value protein estimated intake FH-1.5.3.1.2 11459
24 hours in 24 hours
❑ Docosahexaenoic acid estimated intake in FH-1.5.1.1.6.3 11449 ❑ Casein estimated intake in 24 hours FH-1.5.3.1.3 11461
24 hours ❑ Whey estimated intake in 24 hours FH-1.5.3.1.4 11463
❑ Essential fatty acid estimated intake in 24 FH-1.5.1.1.7 11451 ❑ Gluten estimated intake in 24 hours FH-1.5.3.1.5 11465
hours ❑ Protein estimated intake per kg in 24 hours FH-1.5.3.1.6 11467
❑ Medium chain triglyceride estimated intake in FH-1.5.1.1.8 11453 ❑ Natural protein estimated intake in 24 hours FH-1.5.3.1.7 11610
24 hours
❑ Protein estimated intake in one meal FH-1.5.3.1.8 14079
❑ Fat estimated intake in one meal FH-1.5.1.1.9 14069
❑ Percent protein estimated intake in 24 hours FH-1.5.3.1.9 14080
❑ Percent saturated fat estimated intake in 24 FH-1.5.1.1.10 14070
❑ Protein estimated intake from oral nutrition in FH-1.5.3.1.10 13003
hours
24 hours
❑ Fat estimated intake from oral nutrition in 24 FH-1.5.1.1.11 13000
❑ Protein estimated intake from enteral nutrition FH-1.5.3.1.11 13004
hours
in 24 hours
❑ Fat estimated intake from enteral nutrition in FH-1.5.1.1.12 12014
❑ Protein additive estimated intake in 24 hours FH-1.5.3.1.12 14081
24 hours
❑ Measured protein intake FH-1.5.3.2 13134
❑ Fat estimated intake from parenteral nutrition FH-1.5.1.1.13 13001
in 24 hours ❑ Total protein measured intake in 24 hours FH-1.5.3.2.1 11458
❑ Fat estimated intake from intravenous fluids in FH-1.5.1.1.14 13002 ❑ High biological value protein measured intake FH-1.5.3.2.2 11460
24 hours in 24 hours
❑ Fat additive estimated intake in 24 hours FH-1.5.1.1.15 14071 ❑ Casein measured intake in 24 hours FH-1.5.3.2.3 11462
❑ Percent fat estimated intake in 24 hours FH-1.5.1.1.16 14216 ❑ Whey measured intake in 24 hours FH-1.5.3.2.4 11464
❑ Measured fat intake FH-1.5.1.2 13132 ❑ Gluten measured intake in 24 hours FH-1.5.3.2.5 11466
❑ Total fat measured intake in 24 hours FH-1.5.1.2.1 11434 ❑ Protein measured intake per kg in 24 hours FH-1.5.3.2.6 11468
❑ Saturated fat measured intake in 24 hours FH-1.5.1.2.2 11436 ❑ Natural protein measured intake in 24 hours FH-1.5.3.2.7 14082
❑ Trans fatty acid measured intake in 24 hours FH-1.5.1.2.3 11438 ❑ Protein measured intake in one meal FH-1.5.3.2.8 14083
❑ Polyunsaturated fat measured intake in 24 FH-1.5.1.2.4 11440 ❑ Percent protein measured intake in 24 hours FH-1.5.3.2.9 14212
hours ❑ Protein measured intake from oral nutrition in FH-1.5.3.2.10 14084
❑ Linoleic acid measured intake in 24 hours FH-1.5.1.2.4.1 13225 24 hours
3
❑ Protein measured intake from enteral nutrition FH-1.5.3.2.11 14085 ❑ Simple carbohydrate estimated intake in 24 FH-1.5.5.1.3 11628
in 24 hours hours
❑ Protein additive measured intake in 24 hours FH-1.5.3.2.12 14087 ❑ Galactose estimated intake in 24 hours FH-1.5.5.1.4 11629
Amino acid intake (1.5.4) ❑ Lactose estimated intake in 24 hours FH-1.5.5.1.5 11630
❑ Estimated amino acid intake FH-1.5.4.1 13135 ❑ Fructose estimated intake in 24 hours FH-1.5.5.1.6 11631
❑ Total amino acid estimated intake in 24 hours FH-1.5.4.1.1 10057 ❑ Carbohydrate estimated intake per kg in 24 FH-1.5.5.1.7 14088
❑ Essential amino acid estimated intake in 24 FH-1.5.4.1.2 10058 hours
hours ❑ Carbohydrate estimated intake in one meal FH-1.5.5.1.8 14089
❑ Histidine estimated intake in 24 hours FH-1.5.4.1.2.1 11612 ❑ Percent carbohydrate estimated intake in 24 FH-1.5.5.1.9 14090
❑ Methionine estimated intake in 24 hours FH-1.5.4.1.2.2 11613 hours
❑ Isoleucine estimated intake in 24 hours FH-1.5.4.1.2.3 11614 ❑ Carbohydrate estimated intake from oral FH-1.5.5.1.10 12143
nutrition in 24 hours
❑ Leucine estimated intake in 24 hours FH-1.5.4.1.2.4 11615
❑ Carbohydrate estimated intake from enteral FH-1.5.5.1.11 12011
❑ Lysine estimated intake in 24 hours FH-1.5.4.1.2.5 11616
❑ Threonine estimated intake in 24 hours FH-1.5.4.1.2.6 11617
❑ Carbohydrate estimated intake from parenteral FH-1.5.5.1.12 11180
❑ Tryptophan estimated intake in 24 hours FH-1.5.4.1.2.7 11618 nutrition in 24 hours
❑ Phenylalanine estimated intake in 24 FH-1.5.4.1.2.8 11619 ❑ Carbohydrate estimated intake from FH-1.5.5.1.13 11240
hours intravenous fluids in 24 hours
❑ Valine estimated intake in 24 hours FH-1.5.4.1.2.9 11620 ❑ Carbohydrate additive estimated intake in 24 FH-1.5.5.1.14 14091
❑ Nonessential amino acid estimated intake in FH-1.5.4.1.3 11621 hours
24 hours ❑ Estimated daily glycemic index value FH-1.5.5.2 12013
❑ Arginine estimated intake in 24 hours FH-1.5.4.1.3.1 11622
❑ Estimated daily glycemic load FH-1.5.5.3 12142
❑ Glutamine estimated intake in 24 hours FH-1.5.4.1.3.2 11623
❑ Insulin to carbohydrate ratio FH-1.5.5.4 10066
❑ Homocysteine estimated intake in 24 FH- 11624
❑ Measured carbohydrate intake FH-1.5.5.5 13154
hours 1.5.4.1.3.3
❑ Total carbohydrate measured intake in 24 FH-1.5.5.5.1 13155
❑ Tyramine estimated intake in 24 hours FH-1.5.4.1.3.4 11625 hours
❑ Tyrosine estimated intake in 24 hours FH-1.5.4.1.3.5 11626 ❑ Complex carbohydrate measured intake in 24 FH-1.5.5.5.2 13156
❑ Measured amino acid intake FH-1.5.4.2 13226 hours
❑ Total amino acid measured intake in 24 hours FH-1.5.4.2.1 13137 ❑ Simple carbohydrate measured intake in 24 FH-1.5.5.5.3 13157
❑ Essential amino acid measured intake in 24 FH-1.5.4.2.2 13138 hours
hours ❑ Galactose measured intake in 24 hours FH-1.5.5.5.4 13158
❑ Histidine measured intake in 24 hours FH-1.5.4.2.2.1 13139 ❑ Lactose measured intake in 24 hours FH-1.5.5.5.5 13159
❑ Methionine measured intake in 24 hours FH-1.5.4.2.2.2 13140 ❑ Fructose measured intake in 24 hours FH-1.5.5.5.6 13160
❑ Isoleucine measured intake in 24 hours FH-1.5.4.2.2.3 13141 ❑ Carbohydrate measured intake per kg in 24 FH-1.5.5.5.7 14092
❑ Leucine measured intake in 24 hours FH-1.5.4.2.2.4 13142 hours
❑ Lysine measured intake in 24 hours FH-1.5.4.2.2.5 13143 ❑ Carbohydrate measured intake in one meal FH-1.5.5.5.8 14093
❑ Threonine measured intake in 24 hours FH-1.5.4.2.2.6 13144 ❑ Percent carbohydrate measured intake in 24 FH-1.5.5.5.9 14094
hours
❑ Tryptophan measured intake in 24 hours FH-1.5.4.2.2.7 13145
❑ Phenylalanine measured intake in 24 FH-1.5.4.2.2.8 13146 ❑ Carbohydrate measured intake from oral FH-1.5.5.5.10 14095
hours nutrition in 24 hours
❑ Valine measured intake in 24 hours FH-1.5.4.2.2.9 13147 ❑ Carbohydrate measured intake from enteral FH-1.5.5.5.11 14096
❑ Nonessential amino acid measured intake in FH-1.5.4.2.3 13148
24 hours ❑ Carbohydrate measured intake from parenteral FH-1.5.5.5.12 14097
❑ Arginine measured intake in 24 hours FH-1.5.4.2.3.1 13136
❑ Carbohydrate measured intake from FH-1.5.5.5.13 14098
❑ Glutamine measured intake in 24 hours FH-1.5.4.2.3.2 13149
intravenous fluids in 24 hours
❑ Homocysteine measured intake in 24 FH-1.5.4.2.3.3 13150
❑ Carbohydrate additive measured intake in 24 FH-1.5.5.5.14 14099
hours
hours
❑ Tyramine measured intake in 24 hours FH-1.5.4.2.3.4 13151
Fiber intake (1.5.6)
❑ Tyrosine measured intake in 24 hours FH-1.5.4.2.3.5 13152
❑ Estimated fiber intake FH-1.5.6.1 13161
❑ Amino acids from enteral nutrition FH-1.5.4.2.4 13005
❑ Total fiber estimated intake in 24 hours FH-1.5.6.1.1 10068
❑ Amino acids from parenteral nutrition FH-1.5.4.2.5 13006
❑ Soluble fiber estimated intake in 24 hours FH-1.5.6.1.2 10069
❑ Amino acids from intravenous fluids FH-1.5.4.2.6 13007
❑ Insoluble fiber estimated intake in 24 hours FH-1.5.6.1.3 10070
Carbohydrate intake (1.5.5)
❑ Fiber estimated intake from oral nutrition in 24 FH-1.5.6.1.4 14213
❑ Estimated carbohydrate intake FH-1.5.5.1 13153 hours
❑ Total carbohydrate estimated intake in 24 FH-1.5.5.1.1 10060 ❑ Fiber estimated intake from enteral nutrition in FH-1.5.6.1.5 14100
hours 24 hours
❑ Complex carbohydrate estimated intake in 24 FH-1.5.5.1.2 11627 ❑ Fiber additive estimated intake in 24 hours FH-1.5.6.1.6 14214
hours
❑ Measured fiber intake FH-1.5.6.2 11519
4
❑ Total fiber measured intake in 24 hours FH-1.5.6.2.1 13162 ❑ Sodium estimated intake in 24 hours (7) 10095
❑ Soluble fiber measured intake in 24 hours FH-1.5.6.2.2 13163 ❑ Zinc estimated intake in 24 hours (8) 10096
❑ Insoluble fiber measured intake in 24 hours FH-1.5.6.2.3 13164 ❑ Sulfate estimated intake in 24 hours (9) 10097
❑ Fiber measured intake from oral nutrition in 24 FH-1.5.6.2.4 14101
❑ Fluoride estimated intake in 24 hours (10) 10098
hours
❑ Copper estimated intake in 24 hours (11) 10099
❑ Fiber measured intake from enteral nutrition in FH-1.5.6.2.5 14102
24 hours ❑ Iodine estimated intake in 24 hours (12) 10100
❑ Fiber additive measured intake in 24 hours FH-1.5.6.1.6 14103 ❑ Selenium estimated intake in 24 hours (13) 10101
Micronutrient Intake (1.6) ❑ Manganese estimated intake in 24 hours (14) 10102
Vitamin and mineral intake from all sources, including ❑ Chromium estimated intake in 24 hours (15) 10103
food, beverages, supplements, and via enteral and
parenteral routes. ❑ Molybdenum estimated intake in 24 hours (16) 10104
Vitamin intake (1.6.1) ❑ Boron estimated intake in 24 hours (17) 10105

❑ Estimated vitamin intake FH-1.6.1.1 13165 ❑ Cobalt estimated intake in 24 hours (18) 10106
❑ Vitamin A estimated intake in 24 hours (1) 10073 ❑ Multimineral estimated intake in 24 hours (19) 10107
❑ Vitamin C estimated intake in 24 hours (2) 10074 ❑ Multitrace element estimated intake in 24 10108
❑ Vitamin D estimated intake in 24 hours (3) 10075 hours (20)
❑ Measured mineral intake FH-1.6.2.2 13183
❑ Vitamin E estimated intake in 24 hours (4) 10076
❑ Calcium measured intake in 24 hours (1) 13184
❑ Vitamin K estimated intake in 24 hours (5) 10077
❑ Chloride measured intake in 24 hours (2) 13185
❑ Thiamin estimated intake in 24 hours (6) 10078
❑ Iron measured intake in 24 hours (3) 13186
❑ Riboflavin estimated intake in 24 hours (7) 10079
❑ Magnesium measured intake in 24 hours (4) 13187
❑ Niacin estimated intake in 24 hours (8) 10080
❑ Potassium measured intake in 24 hours (5) 13188
❑ Folate estimated intake in 24 hours (9) 10081
❑ Phosphorus measured intake in 24 hours (6) 13189
❑ Vitamin B6 estimated intake in 24 hours (10) 10082
❑ Sodium measured intake in 24 hours (7) 13190
❑ Vitamin B12 estimated intake in 24 hours (11) 10083
❑ Zinc measured intake in 24 hours (8) 13191
❑ Pantothenic acid estimated intake in 24 hours 10084
(12) ❑ Sulfate measured intake in 24 hours (9) 13192
❑ Biotin estimated intake in 24 hours (13) 10085 ❑ Fluoride measured intake in 24 hours (10) 13193
❑ Multivitamin estimated intake in 24 hours (14) 10086 ❑ Copper measured intake in 24 hours (11) 13194
❑ Measured vitamin intake FH-1.6.1.2 13167 ❑ Iodine measured intake in 24 hours (12) 13195
❑ Vitamin A measured intake in 24 hours (1) 13168 ❑ Selenium measured intake in 24 hours (13) 13196
❑ Vitamin C measured intake in 24 hours (2) 13169 ❑ Manganese measured intake in 24 hours (14) 13197
❑ Vitamin D measured intake in 24 hours (3) 13170 ❑ Chromium measured intake in 24 hours (15) 13198
❑ Vitamin E measured intake in 24 hours (4) 13171 ❑ Molybdenum measured intake in 24 hours (16) 13199
❑ Vitamin K measured intake in 24 hours (5) 13172 ❑ Boron measured intake in 24 hours (17) 13200
❑ Thiamin measured intake in 24 hours (6) 13173 ❑ Cobalt measured intake in 24 hours (18) 13201
❑ Riboflavin measured intake in 24 hours (7) 13174 ❑ Multimineral measured intake in 24 hours (19) 13202
❑ Niacin measured intake in 24 hours (8) 13175 ❑ Multitrace element measured intake in 24 13203
❑ Folate measured intake in 24 hours (9) 13176 hours (20)
Food and Nutrition Component Intake (1.7)
❑ Vitamin B6 measured intake in 24 hours (10) 13177
Intake of substances for modifying the composition of
❑ Vitamin B12 measured intake in 24 hours (11) 13178
oral or enteral nutrition intake.
❑ Pantothenic acid measured intake in 24 hours 13179 Consistency modifier intake (1.7.1)
(12)
❑ Estimated consistency modifier intake FH-1.7.1.1 14104
❑ Biotin measured intake in 24 hours (13) 13180
❑ Thickener additive estimated intake in 24 FH-1.7.1.1.1 14105
❑ Multivitamin measured intake in 24 hours (14) 13181 hours
Mineral/element intake (1.6.2) ❑ Measured consistency modifier intake FH-1.7.1.2 14106
❑ Estimated mineral intake FH-1.6.2.1 13182 ❑ Thickener additive measured intake in 24 FH-1.7.1.2.1 14107
❑ Calcium estimated intake in 24 hours (1) 10089 hours
❑ Chloride estimated intake in 24 hours (2) 10090 Food and Nutrient Administration (2)
❑ Iron estimated intake in 24 hours (3) 10091 Current and previous diets and/or food modifications,
eating environment, and enteral and parenteral
❑ Magnesium estimated intake in 24 hours (4) 10092 nutrition administration.
❑ Potassium estimated intake in 24 hours (5) 10093 Diet History (2.1)
❑ Phosphorus estimated intake in 24 hours (6) 10094
5
Description of food and drink regularly provided or ❑ Nutrition skill of the community FH-4.2.1 13207
consumed, past diets followed or prescribed and ❑ Nutrition skill of supportive individuals FH-4.2.2 13208
counseling received, and the eating environment.
❑ Nutrition skill of individual client FH-4.2.3 13209
Diet order (2.1.1)
Beliefs and attitudes (4.3)
❑ General, healthful diet order FH-2.1.1.1 10113
❑ Nutrition priority of individual client FH-4.3.1 14508
❑ Modified diet order FH-2.1.1.2 10114
❑ Nutrition priority of client’s supportive FH-4.3.2 14509
❑ Enteral nutrition order FH-2.1.1.3 10115 individuals
❑ Parenteral nutrition order FH-2.1.1.4 10116 ❑ Nutrition priority of client’s supportive structures FH-4.3.3 14510
Diet experience (2.1.2) ❑ Nutrition priority of client’s stakeholders FH-4.3.4 14511
❑ Previously prescribed diets FH-2.1.2.1 10118 ❑ Conflict with individual client’s value system FH-4.3.5 14512
❑ Previous diet/nutrition education/counseling FH-2.1.2.2 10119 ❑ Conflict with client’s supportive individuals’ FH-4.3.6 14513
value system
❑ Self selected diet/s followed FH-2.1.2.3 10120
❑ Conflict with client’s supportive structures’ value FH-4.3.7 14514
❑ Dieting attempts FH-2.1.2.4 10121
system
❑ Food allergies FH-2.1.2.5 10805
❑ Conflict with client’s stakeholders’ value system FH-4.3.8 14515
❑ Food intolerance FH-2.1.2.6 10806 ❑ Behavioral beliefs FH-4.3.9 14516
Eating environment (2.1.3) ❑ Perceived susceptibility to nutrition related FH-4.3.9.1 14517
❑ Location FH-2.1.3.1 10123 health problems score
❑ Atmosphere FH-2.1.3.2 10124 ❑ Perceived severity of risk to health score FH-4.3.9.2 14518
❑ Caregiver/companion FH-2.1.3.3 10125 ❑ Perceived benefit of nutrition related change FH-4.3.9.3 14519
score
❑ Appropriate breastfeeding FH-2.1.3.4 10126
accommodations/facility ❑ Likelihood of performing nutrition related FH-4.3.9.4 14520
behavior score
❑ Eats alone FH-2.1.3.5 10127
❑ Perceived control over nutrition related FH-4.3.9.5 14521
Enteral and parenteral nutrition administration behavior score
(2.1.4)
❑ Nutrition self efficacy score FH-4.3.9.6 14522
❑ Enteral access FH-2.1.4.1 10129
❑ Perceived barrier to nutrition related behavior FH-4.3.9.7 14523
❑ Parenteral access FH-2.1.4.2 10130 score
❑ Body position, EN FH-2.1.4.3 10804 ❑ Readiness to change nutrition related behavior FH-4.3.9.8 10151
Fasting (2.1.5) stage
❑ Fasting pattern in one calendar day, reported FH-2.1.5.1 11633 ❑ Precontemplation stage for readiness to FH-4.3.9.8.1 14524
change
❑ Fasting pattern in one calendar week, reported FH-2.1.5.2 11634
❑ Contemplation stage for readiness to FH-4.3.9.8.2 14525
❑ Fasting pattern in one calendar month, reported FH-2.1.5.3 11635
change
❑ Fasting pattern in one calendar year, reported FH-2.1.5.4 11636
❑ Preparation stage for readiness to change FH-4.3.9.8.3 14526
❑ Fasting tolerance, reported FH-2.1.5.5 11637
❑ Action stage for readiness to change FH-4.3.9.8.4 14527
Medication and Complementary/Alternative ❑ Maintenance stage for readiness to change FH-4.3.9.8.5 14528
Medicine Use (3) ❑ Relapse stage for readiness to change FH-4.3.9.8.6 14529
Prescription and over the counter medications, ❑ Readiness to change nutrition related behavior FH-4.3.9.9 14590
including herbal preparations and score
complementary/alternative medicine products used.
❑ Negative emotions about food and nutrition FH-4.3.10 14530
Medications (3.1)
❑ Positive emotions about food and nutrition FH-4.3.11 14531
❑ Prescription medication use FH-3.1.1 10820
❑ Unrealistic nutrition related goals FH-4.3.12 10154
❑ Insulin sensitivity factor FH-3.1.1.1 11241
❑ Unscientific nutrition beliefs FH-4.3.13 14532
❑ Over the counter (OTC) medication use FH-3.1.2 10134
❑ Body image disturbance FH-4.3.14 10146
❑ Misuse of medication FH-3.1.3 10135
❑ Preoccupation with food FH-4.3.15 10149
Complementary/Alternative Medicine (3.2)
❑ Preoccupation with weight FH-4.3.16 10150
❑ Nutrition related complementary/alternative FH-3.2.1 10137
❑ Preoccupation with body shape FH-4.3.17 14533
medicine use
❑ Negative nutrition self talk FH-4.3.18 14534
Knowledge/Beliefs/Attitudes (4)
❑ Positive nutrition self talk FH-4.3.19 14535
Understanding of nutrition-related concepts and
conviction of the truth and feelings/emotions toward ❑ Preferences for food FH-4.3.20 10156
some nutrition-related statement or phenomenon, along ❑ Preferences for beverages FH-4.3.21 14537
with readiness to change nutrition-related behaviors. Behavior (5)
Food and nutrition knowledge(4.1) Client activities and actions, which influence
❑ Nutrition knowledge of community FH-4.1.1 13204 achievement of nutrition related goals.
❑ Nutrition knowledge of supportive individuals FH-4.1.2 13205 Adherence (5.1)
❑ Nutrition knowledge of individual client FH-4.1.3 13206 ❑ Self reported nutrition adherence score FH-5.1.1 10160
Food and nutrition skill (4.2) ❑ Nutrition encounter ratio FH-5.1.2 14215
6
❑ Ability to recall nutrition goals FH-5.1.3 10162 ❑ Access to assistive food preparation devices FH-6.4.3 10203
❑ Nutrition self monitoring at agreed upon rate FH-5.1.4 10163 Food and nutrition sanitation (6.5)
❑ Nutrition self management as agreed upon FH-5.1.5 10164 ❑ Availability of suitable sanitation facilities FH-6.5.1 14551
Avoidance behavior (5.2) ❑ Ability to wash hands with soap and water FH-6.5.2 14552
❑ Avoidance FH-5.2.1 10166 Physical Activity and Function (7)
❑ Restrictive eating FH-5.2.2 10167 Physical activity, cognitive and physical ability to
engage in specific tasks, eg, breastfeeding and self-
❑ Cause of avoidance behavior FH-5.2.3 10168
feeding.
Bingeing and purging behavior (5.3)
Breastfeeding Assessment (7.1)
❑ Binge eating behavior FH-5.3.1 10170
❑ Initiation of breastfeeding FH-7.1.1 10206
❑ Purging behavior FH-5.3.2 10171
❑ Start breastfeeding FH-7.1.1.1 14108
Mealtime behavior (5.4)
❑ Stop breastfeeding FH-7.1.1.2 14109
❑ Meal duration FH-5.4.1 10173
❑ Breastfeeding approach FH-7.1.2 14110
❑ Percent of meal time spent eating FH-5.4.2 10174
❑ Exclusive breastfeeding FH-7.1.2.1 10208
❑ Preference to drink rather than eat FH-5.4.3 10175 ❑ Predominant breastfeeding FH-7.1.2.2 14111
❑ Refusal to eat/chew FH-5.4.4 10176 ❑ Partial breastfeeding FH-7.1.2.3 14112
❑ Spitting food out FH-5.4.5 10177 ❑ Breastfeeding difficulties FH-7.1.3 10209
❑ Rumination FH-5.4.6 10178 ❑ Infant able to latch on to breast for FH-7.1.3.1 14113
❑ Patient/client/caregiver fatigue during feeding FH-5.4.7 10179 feeding
process resulting in inadequate intake ❑ Infant unable to latch on to breast for FH-7.1.3.2 14114
❑ Willingness to try new foods FH-5.4.8 10180 feeding
❑ Limited number of accepted foods FH-5.4.9 10181 ❑ Difficulty latching onto breast for feeding FH-7.1.3.3 14115
❑ Abscess of breast associated with FH-7.1.3.4 14116
❑ Rigid sensory preferences FH-5.4.10 10182
lactation
Social network (5.5)
❑ Cracked nipple associated with lactation FH-7.1.3.5 14117
❑ Ability to build and utilize social network FH-5.5.1 10184
❑ Infection of nipple associated with FH-7.1.3.6 14118
Factors Affecting Access to Food and lactation
Food/Nutrition Related Supplies (6) ❑ Non purulent mastitis associated with FH-7.1.3.7 14119
Factors that affect intake and availability of a sufficient lactation
quantity of safe, healthful food as well as food/nutrition- ❑ Retracted nipple associated with lactation FH-7.1.3.8 14120
related supplies.
❑ Inversion of nipple associated with FH-7.1.3.9 14121
Food and nutrition program participation (6.1) lactation
❑ Eligibility for government nutrition programs FH-6.1.1 10187 ❑ Breast engorgement associated with FH-7.1.3.10 14122
❑ Enrollment in government nutrition programs FH-6.1.2 14538 lactation
❑ Eligibility for community nutrition programs FH-6.1.3 10189 ❑ Previous breast surgery associated with FH-7.1.3.11 14123
lactation
❑ Enrollment in community nutrition programs FH-6.1.4 14539
❑ Breast abnormality associated with FH-7.1.3.12 14124
❑ Awareness of programs offering food support and FH-6.1.5 14540 lactation
nutrition intervention
❑ Inadequate flow of breastmilk FH-7.1.3.13 14125
Safe food availability (6.2)
❑ Finding related to infant’s ability to suck FH-7.1.4 14126
❑ Availability of shopping facilities FH-6.2.1 10192
❑ Infant able to suck FH-7.1.4.1 14127
❑ Ability to procure safe food FH-6.2.2 10800
❑ Infant unable to suck FH-7.1.4.2 14128
❑ Access to food preparation equipment FH-6.2.3 14541 ❑ Difficulty sucking FH-7.1.4.3 14129
❑ Availability of food refrigeration FH-6.2.4 14542 Nutrition related ADLs and IADLs (7.2)
❑ Ability to store food safely FH-6.2.5 14543 ❑ Physical ability to complete tasks for meal FH-7.2.1 10211
❑ Ability to identify safe food FH-6.2.6 10801 preparation
❑ Individual client food security level FH-6.2.7 14544 ❑ Physical ability to self feed FH-7.2.2 10212
❑ Household food security level FH-6.2.8 14545 ❑ Ability to position self in relation to plate FH-7.2.3 10213
❑ Situational food insecurity FH-6.2.9 14546 ❑ Receives assistance with intake FH-7.2.4 10214
❑ Chronic food insecurity FH-6.2.10 14547 ❑ Ability to use adaptive eating devices FH-7.2.5 10215
Safe water availability (6.3) ❑ Cognitive ability to complete tasks for meal FH-7.2.6 10216
❑ Availability of potable water FH-6.3.1 10198 preparation
❑ Ability to decontaminate water FH-6.3.2 14548 ❑ Remembers to eat FH-7.2.7 10139
❑ Awareness of public health water alert FH-6.3.3 14549 ❑ Recalls eating FH-7.2.8 10218
Food and nutrition related supplies availability ❑ Mini mental state examination score FH-7.2.9 10219
(6.4) ❑ Nutrition related activities of daily living (ADL) FH-7.2.10 10220
❑ Access to food and nutrition related supplies FH-6.4.1 10201 score
❑ Access to assistive eating devices FH-6.4.2 10202
7
❑ Nutrition related instrumental activities of daily FH-7.2.11 10221 ❑ Stated prepregnancy weight AD-1.1.2.8 12036
living (IADL) score ❑ Dosing weight AD-1.1.2.9 12037
Physical activity (7.3) ❑ Estimated dry weight AD-1.1.2.10 12038
❑ Physical activity history FH-7.3.1 10223 ❑ Preamputation measured weight AD-1.1.2.11 12039
❑ Consistency FH-7.3.2 10224 ❑ Preamputation estimated weight AD-1.1.2.12 12040
❑ Frequency FH-7.3.3 10225 ❑ Postamputation measured weight AD-1.1.2.13 12041
❑ Duration FH-7.3.4 10226 ❑ Postamputation estimated weight AD-1.1.2.14 12042
❑ Intensity FH-7.3.5 10227 ❑ Predialysis weight AD-1.1.2.15 12043
❑ Type of physical activity FH-7.3.6 10228 ❑ Postdialysis weight AD-1.1.2.16 12044
❑ Strength FH-7.3.7 10229 ❑ Frame AD-1.1.3 10241
❑ Handgrip strength FH-7.3.7.1 11680 ❑ Frame size AD-1.1.3.1 12045
❑ TV/screen time FH-7.3.8 10230 ❑ Wrist circumference AD-1.1.3.2 12046
❑ Other sedentary activity time FH-7.3.9 10231 ❑ Weight change AD-1.1.4 10242
❑ Involuntary physical movement FH-7.3.10 10232 ❑ Weight gain AD-1.1.4.1 12047
❑ Non exercise activity thermogenesis FH-7.3.11 10233 ❑ Weight loss AD-1.1.4.2 12048
Factors affecting access to physical activity (7.4) ❑ Weight change percentage AD-1.1.4.3 12049
❑ Neighborhood safety FH-7.4.1 10822 ❑ Measured interdialytic weight gain AD-1.1.4.4 12050
❑ Walkability of neighborhood FH-7.4.2 10823 ❑ Measured interdialytic weight loss AD-1.1.4.5 12051
❑ Proximity to parks/green space FH-7.4.3 10824 ❑ Measured gestational weight gain AD-1.1.4.6 12052
❑ Access to physical activity facilities/programs FH-7.4.4 10825 ❑ Measured gestational weight loss AD-1.1.4.7 12053
Nutrition Related Patient/Client Centered ❑ Weight change intent AD-1.1.4.8 12054
Measures (8) ❑ Body mass AD-1.1.5 10243
Patient/client’s perception of his or her nutrition ❑ Body mass index (BMI) AD-1.1.5.1 12055
intervention and its impact on life. ❑ Body mass index prime ratio (BMI prime) AD-1.1.5.2 12056
Nutrition quality of life (8.1) ❑ Growth pattern indices AD-1.1.6 10244
❑ Nutrition quality of life responses FH-8.1.1 10236 ❑ BMI for age percentile AD-1.1.6.1 12057
❑ BMI for age z score AD-1.1.6.2 12058
ANTHROPOMETRIC MEASUREMENTS ❑ Head circumference AD-1.1.6.3 12059
(AD) ❑ Birth head circumference AD-1.1.6.4 12060
Height, weight, body mass index (BMI), growth pattern ❑ Head circumference for age percentile AD-1.1.6.5 12061
indices/percentile ranks, and weight history. ❑ Head circumference for age z score AD-1.1.6.6 12062
Body composition/growth/weight history (1.1) ❑ Length for age percentile AD-1.1.6.7 12063
❑ Height AD-1.1.1 10239 ❑ Length for age z score AD-1.1.6.8 12064
❑ Measured height AD-1.1.1.1 11377 ❑ Stature for age percentile AD-1.1.6.9 12065
❑ Measured length AD-1.1.1.2 12015 ❑ Stature for age z score AD-1.1.6.10 12066
❑ Birth length AD-1.1.1.3 12016 ❑ Weight for length percentile AD-1.1.6.11 12067
❑ Preamputation measured height AD-1.1.1.4 12017 ❑ Weight for length z score AD-1.1.6.12 12068
❑ Preamputation estimated height AD-1.1.1.5 12018 ❑ Weight for age percentile AD-1.1.6.13 12069
❑ Estimated height AD-1.1.1.6 12019 ❑ Weight for age z score AD-1.1.6.14 12070
❑ Stated height AD-1.1.1.7 12020 ❑ Weight for stature percentile AD-1.1.6.15 12071
❑ Measured peak adult height AD-1.1.1.8 12021 ❑ Weight for stature z score AD-1.1.6.16 12072
❑ Stated peak adult height AD-1.1.1.9 12022 ❑ Mid parental height comparator AD-1.1.6.17 12073
❑ Knee height AD-1.1.1.10 12023 ❑ Body compartment estimates AD-1.1.7 10245
❑ Tibia length AD-1.1.1.11 12024 ❑ Body fat percentage AD-1.1.7.1 12074
❑ Arm span AD-1.1.1.12 12025 ❑ Body fat percentage technique AD-1.1.7.2 12075
❑ Arm demispan AD-1.1.1.13 12026 ❑ Body surface area AD-1.1.7.3 12076
❑ Arm halfspan AD-1.1.1.14 12027 ❑ Calculated body surface area AD-1.1.7.4 12077
❑ Height measurement device AD-1.1.1.15 12028 ❑ Bone age AD-1.1.7.5 12078
❑ Weight AD-1.1.2 10240 ❑ Bone mineral density t score AD-1.1.7.6 12079
❑ Measured weight AD-1.1.2.1 12029 ❑ Bone mineral density z score AD-1.1.7.7 12080
❑ Stated weight AD-1.1.2.2 12030 ❑ Bone mineral density technique AD-1.1.7.8 12081
❑ Stated peak weight AD-1.1.2.3 12031 ❑ Mid arm muscle circumference AD-1.1.7.9 12082
❑ Measured peak weight AD-1.1.2.4 12032 ❑ Mid arm muscle circumference percentile AD-1.1.7.10 12083
❑ Usual stated body weight (UBW) AD-1.1.2.5 12033 ❑ Triceps skinfold thickness AD-1.1.7.11 12084
❑ UBW percentage AD-1.1.2.6 12034 ❑ Triceps skinfold percentile AD-1.1.7.12 12085
❑ Birth weight AD-1.1.2.7 12035 ❑ Triceps skinfold z score AD-1.1.7.13 12086
8
❑ Waist circumference AD-1.1.7.14 12087 ❑ Fecal calprotectin BD-1.4.17 11245

❑ Waist circumference narrowest point AD-1.1.7.15 12088 ❑ Fecal lactoferrin BD-1.4.18 11246
❑ Waist circumference iliac crest AD-1.1.7.16 12089 ❑ Pancreatic elastase BD-1.4.19 11150
❑ Hip circumference AD-1.1.7.17 12090 ❑ 5'nucleotidase BD-1.4.20 11247
❑ Waist to hip ratio AD-1.1.7.18 12091 ❑ D xylose BD-1.4.21 10286
❑ Mid upper arm circumference AD-1.1.7.19 12092 ❑ Lactulose hydrogen breath test BD-1.4.22 11248
❑ Mid upper arm circumference left arm AD-1.1.7.20 12093 ❑ Lactose hydrogen breath test BD-1.4.23 11249
❑ Mid upper arm circumference z score AD-1.1.7.21 12094 ❑ Fructose hydrogen breath test BD-1.4.24 11250
❑ Glucose hydrogen breath test BD-1.4.25 11251
BIOCHEMICAL DATA, MEDICAL TESTS, ❑ Urea hydrogen breath test BD-1.4.26 11252
AND PROCEDURES (BD) ❑ Intestinal biopsy BD-1.4.27 10288
Laboratory data, (eg, electrolytes, glucose, and lipid ❑ Stool culture BD-1.4.28 10289
panel) and tests (eg, gastric emptying time, resting ❑ Gastric emptying time BD-1.4.29 10290
metabolic rate). ❑ Small bowel transit time BD-1.4.30 10291
Acid base balance (1.1) ❑ Abdominal X-ray BD-1.4.31 11253
❑ Arterial pH BD-1.1.1 10248 ❑ Abdominal CT (computed tomography) BD-1.4.32 11254
❑ Arterial bicarbonate BD-1.1.2 10249 ❑ Abdominal ultrasound BD-1.4.33 11255
❑ Partial pressure of carbon dioxide in arterial blood BD-1.1.3 10250 ❑ Endoscopic ultrasound BD-1.4.34 11256
(PaCO2)
❑ Pelvic CT (computed tomography) BD-1.4.35 11257
❑ Partial pressure of oxygen in arterial blood BD-1.1.4 10251
❑ Modified barium swallow BD-1.4.36 11258
(PaO2)
❑ Barium swallow BD-1.4.37 11259
❑ Venous pH BD-1.1.5 10252
❑ Esophagogastroduodenoscopy BD-1.4.38 11260
❑ Venous bicarbonate BD-1.1.6 10253
❑ Endoscopic retrograde cholangiopancreatography BD-1.4.39 11261
Electrolyte and renal profile (1.2)
(ERCP)
❑ BUN BD-1.2.1 10255 ❑ Capsule endoscopy BD-1.4.40 11262
❑ Creatinine BD-1.2.2 10256 ❑ Esophageal manometry BD-1.4.41 11263
❑ BUN:creatinine ratio BD-1.2.3 10257 ❑ Esophageal pH test BD-1.4.42 11264
❑ Glomerular filtration rate BD-1.2.4 10258
❑ Gastroesophageal reflux monitoring BD-1.4.43 11265
❑ Sodium BD-1.2.5 10259
❑ Gastrointestinal sphincter monitoring BD-1.4.44 11266
❑ Chloride BD-1.2.6 10260
❑ Urate BD-1.4.45 11638
❑ Potassium BD-1.2.7 10261
Glucose/endocrine profile (1.5)
❑ Magnesium BD-1.2.8 10262
❑ Glucose, fasting BD-1.5.1 10295
❑ Calcium, serum BD-1.2.9 10263
❑ Glucose, casual BD-1.5.2 10296
❑ Calcium, ionized BD-1.2.10 10264
❑ Hemoglobin A1c (HgbA1c) BD-1.5.3 10297
❑ Phosphorus BD-1.2.11 10265
❑ Preprandial capillary plasma glucose BD-1.5.4 10298
❑ Serum osmolality BD-1.2.12 10266
❑ Peak postprandial capillary plasma glucose BD-1.5.5 10299
❑ Parathyroid hormone BD-1.2.13 10267
❑ Glucose tolerance test BD-1.5.6 10300
Essential fatty acid profile (1.3)
❑ Cortisol level BD-1.5.7 10301
❑ Triene:tetraene ratio BD-1.3.1 10269 ❑ IGF binding protein BD-1.5.8 10302
Gastrointestinal profile (1.4) ❑ Thyroid stimulating hormone BD-1.5.9 11639
❑ Alkaline phosphatase BD-1.4.1 10271 ❑ Thyroxine test BD-1.5.10 11640
❑ Alanine aminotransferase (ALT) BD-1.4.2 10272 ❑ Triiodothyronine BD-1.5.11 11641
❑ Aspartate aminotransferase (AST) BD-1.4.3 10273 ❑ Adrenocorticotropic hormone BD-1.5.12 11642
❑ Gamma glutamyl transferase (GGT) BD-1.4.4 10274 ❑ Follicle stimulating hormone BD-1.5.13 11643
❑ Gastric residual volume BD-1.4.5 10275 ❑ Growth hormone BD-1.5.14 11644
❑ Bilirubin, total BD-1.4.6 10276 ❑ Luteinizing hormone BD-1.5.15 11645
❑ Ammonia, serum BD-1.4.7 10277 Inflammatory profile (1.6)
❑ Toxicology report, including alcohol BD-1.4.8 10278 ❑ C reactive protein BD-1.6.1 10305
❑ Prothrombin time (PT) BD-1.4.9 10279 Lipid profile (1.7)
❑ Partial thromboplastin time (PTT) BD-1.4.10 10280
❑ Cholesterol, serum BD-1.7.1 10307
❑ INR ratio BD-1.4.11 10281
❑ Cholesterol, HDL BD-1.7.2 10308
❑ Amylase BD-1.4.12 10283
❑ Cholesterol, LDL BD-1.7.3 10309
❑ Lipase BD-1.4.13 10284
❑ Cholesterol, non HDL BD-1.7.4 10310
❑ Fecal fat, 24 hour BD-1.4.14 11242
❑ Total cholesterol:HDL cholesterol ratio BD-1.7.5 10311
❑ Fecal fat, 72 hour BD-1.4.15 11243
❑ LDL:HDL ratio BD-1.7.6 10312
❑ Fecal fat, qualitative BD-1.4.16 11244
❑ Triglycerides, serum BD-1.7.7 10313
9
Metabolic rate profile (1.8) ❑ Lysine:arginine ratio BD-1.11.29 11173

❑ Resting metabolic rate, measured BD-1.8.1 10315 ❑ Tryptophan BD-1.11.30 11174
❑ Respiratory quotient, measured BD-1.8.2 10316 ❑ Plasma organic acid panel BD-1.11.31 11175
Mineral profile (1.9) ❑ Organic acids/creatinine BD-1.11.32 11176
❑ Copper, serum or plasma BD-1.9.1 10318 ❑ 3 hydroxybutyrate BD-1.11.33 11181
❑ Iodine, urinary excretion BD-1.9.2 10319 ❑ 3 hydroxyisovalerate BD-1.11.34 11182
❑ Zinc, serum or plasma BD-1.9.3 10320 ❑ Acetoacetate BD-1.11.35 11183
❑ Boron, serum or plasma BD-1.9.4 10841 ❑ Ethylmalonate BD-1.11.36 11184
❑ Chromium, serum or urinary BD-1.9.5 10842 ❑ Succinate BD-1.11.37 11185
❑ Fluoride, plasma BD-1.9.6 10843 ❑ Fumarate BD-1.11.38 11186
❑ Manganese, urinary, blood, plasma BD-1.9.7 10844 ❑ Glutarate BD-1.11.39 11187
❑ Molybdenum, serum BD-1.9.8 10845 ❑ 3 methylglutarate BD-1.11.40 11188
❑ Selenium, serum or urinary BD-1.9.9 10846 ❑ Adipate BD-1.11.41 11189
Nutritional anemia profile (1.10) ❑ 2 hydroxyglutarate BD-1.11.42 11190
❑ Hemoglobin BD-1.10.1 10323 ❑ 3 hydroxyphenylacetate BD-1.11.43 11191
❑ Hematocrit BD-1.10.2 10324 ❑ 2 ketoglutarate BD-1.11.44 11192
❑ Mean corpuscular volume BD-1.10.3 10325 ❑ Citrate BD-1.11.45 11193
❑ Red blood cell folate BD-1.10.4 10326 ❑ Propionate BD-1.11.46 11194
❑ Red cell distribution width BD-1.10.5 10327 ❑ Methylcitrate BD-1.11.47 11195
❑ B12, serum BD-1.10.6 10328 ❑ 3 hydroxy propionate BD-1.11.48 11196
❑ Methylmalonic acid, serum BD-1.10.7 10329 ❑ Beta hydroxy butyrate BD-1.11.49 11197
❑ Folate, serum BD-1.10.8 10330 ❑ Creatine kinase BD-1.11.50 11198
❑ Homocysteine, serum BD-1.10.9 10331 ❑ Troponin I. cardiac BD-1.11.51 11199
❑ Ferritin, serum BD-1.10.10 10332 ❑ Troponin T. cardiac BD-1.11.52 11200
❑ Iron, serum BD-1.10.11 10333 ❑ B type natriuretic peptide BD-1.11.53 11201
❑ Total iron binding capacity BD-1.10.12 10334 ❑ Succinylacetone BD-1.11.54 11202
❑ Transferrin saturation BD-1.10.13 10335 ❑ Total serum immunoglobulin A BD-1.11.55 11267
Protein profile (1.11) ❑ Tissue transglutaminase antibodies (IgA) BD-1.11.56 11268
❑ Albumin BD-1.11.1 10337 ❑ Tissue transglutaminase antibodies (IgG) BD-1.11.57 11269
❑ Prealbumin BD-1.11.2 10338 ❑ Deamidated gliadin peptide antibodies (IgG) BD-1.11.58 11270
❑ Transferrin BD-1.11.3 10339 ❑ Endomysial antibodies BD-1.11.59 11271
❑ Phenylalanine, plasma BD-1.11.4 10340 ❑ Carbohydrate deficient transferrin BD-1.11.60 10847
❑ Tyrosine, plasma BD-1.11.5 10341 Urine profile (1.12)

❑ Amino acid panel BD-1.11.6 10342 ❑ Urine color BD-1.12.1 10345
❑ Phenylalanine, dried blood spot BD-1.11.7 11151 ❑ Urine osmolality BD-1.12.2 10346
❑ Tyrosine, dried blood spot BD-1.11.8 11152 ❑ Urine specific gravity BD-1.12.3 10347
❑ Phenylalanine:tyrosine ratio BD-1.11.9 11153 ❑ Urine volume BD-1.12.4 10349
❑ Hydroxyproline BD-1.11.10 11154 ❑ Urine calcium, 24 hour BD-1.12.5 11272
❑ Threonine BD-1.11.11 11155 ❑ Urine d xylose BD-1.12.6 11273
❑ Serine BD-1.11.12 11156 ❑ Urine glucose BD-1.12.7 11203
❑ Asparagine BD-1.11.13 11157 ❑ Urine ketones BD-1.12.8 11204
❑ Glutamate BD-1.11.14 11158 ❑ Urine sodium BD-1.12.9 11205
❑ Glutamine BD-1.11.15 11159 ❑ Urine microalbumin BD-1.12.10 11206
❑ Proline BD-1.11.16 11160 ❑ Urine protein, random BD-1.12.11 11207
❑ Glycine BD-1.11.17 11161 ❑ Urine protein, 24 hour BD-1.12.12 11208
❑ Alanine BD-1.11.18 11162 ❑ Urine uric acid, random BD-1.12.13 11209
❑ Citrulline BD-1.11.19 11163 ❑ Urine uric acid, 24 hour BD-1.12.14 11210
❑ Valine BD-1.11.20 11164 ❑ Urine organic acid panel BD-1.12.15 11211
❑ Cysteine BD-1.11.21 11165 ❑ Urine glutarate BD-1.12.16 11212
❑ Methionine BD-1.11.22 11166 ❑ Urine methylmalonate BD-1.12.17 11213
❑ Isoleucine BD-1.11.23 11167 ❑ Urine acylglycines/creatinine BD-1.12.18 11214
❑ Leucine BD-1.11.24 11168 ❑ Urine argininosuccinate BD-1.12.19 11215
❑ Ornithine BD-1.11.25 11169 ❑ Urine succinylacetone/creatinine BD-1.12.20 11216
❑ Lysine BD-1.11.26 11170 ❑ Urine orotate BD-1.12.21 11217
❑ Histidine BD-1.11.27 11171 ❑ Urine orotate/creatinine BD-1.12.22 11218
❑ Arginine BD-1.11.28 11172 ❑ Urine 2 hydroxyisovalerate BD-1.12.23 11219
10
❑ Urine 2 oxoisovalerate BD-1.12.24 11220 ❑ Fatty acid panel mitochondrial C8 to C18 BD-1.15.6 11235
❑ Urine galactitol BD-1.12.25 11221 ❑ Fatty acid panel essential C12 to C22 BD-1.15.7 11236
❑ Urine reducing substances BD-1.12.26 11222 ❑ Fatty acid panel peroxisomal C22 to C26 BD-1.15.8 11237
❑ Urine porphyrins BD-1.12.27 11274 ❑ MCAD enzyme assay in fibroblasts or other BD-1.15.9 11238
❑ Urine creatinine, 24 hour BD-1.12.28 14189 tissues
❑ Urine citrate, 24 hours BD-1.12.29 14190 ❑ Fatty acid beta oxidation in fibroblasts BD-1.15.10 11239
❑ Urine phosphorus, 24 hour BD-1.12.30 14191
❑ Urine pH, random BD-1.12.31 14192 NUTRITION-FOCUSED PHYSICAL
❑ Urine pH, 24 hour BD-1.12.32 14193 FINDINGS (PD)
❑ Urine sodium, 24 hour BD-1.12.33 14194 Findings from a nutrition-focused physical exam,
❑ Urine urea nitrogen, 24 hour BD-1.12.34 14195 interview, or the medical record including muscle and
subcutaneous fat, oral health, suck/swallow/breathe
❑ Urine oxalate, 24 hour BD-1.12.35 14196
ability, appetite, and affect.
❑ Urine chloride, 24 hour BD-1.12.36 14197
Nutrition-focused physical findings (1.1)
❑ Urine ammonium, 24 hour BD-1.12.37 14198
❑ Overall findings (1)
❑ Urine magnesium, 24 hour BD-1.12.38 14199
❑ Asthenia PD-1.1.1.1 11646
❑ Urine potassium, 24 hour BD-1.12.39 14200
❑ Buffalo hump PD-1.1.1.2 11647
❑ Urine sulfate, 24 hour BD-1.12.40 14201
❑ Cachexia PD-1.1.1.3 11648
❑ Urine cystine, 24 hour BD-1.12.41 14202
❑ Cushingoid appearance PD-1.1.1.4 11649
❑ Calcium oxalate supersaturation in 24 hour urine BD-1.12.42 14203
❑ Ectomorph PD-1.1.1.5 11650
❑ Calcium phosphate supersaturation in 24 hour BD-1.12.43 14204
❑ Endomorph PD-1.1.1.6 11651
urine
❑ Lethargic PD-1.1.1.7 11652
❑ Brushite supersaturation in 24 hour urine BD-1.12.44 14205
❑ Mesomorph PD-1.1.1.8 11653
❑ Uric acid supersaturation in 24 hour urine BD-1.12.45 14218
❑ Neglect of personal hygiene PD-1.1.1.9 11654
Vitamin profile (1.13)
❑ Obese PD-1.1.1.10 11655
❑ Vitamin A, serum or plasma retinol BD-1.13.1 10351
❑ Short stature for age PD-1.1.1.11 11656
❑ Vitamin C, plasma or serum BD-1.13.2 10352
❑ Tall stature PD-1.1.1.12 11657
❑ Vitamin D, 25 hydroxy BD-1.13.3 10353
❑ Body language that may suggest discomfort PD-1.1.1.13 14553
❑ Vitamin E, plasma alpha-tocopherol BD-1.13.4 10354
with interaction
❑ Thiamin, activity coefficient for erythrocyte BD-1.13.5 10355
❑ Adipose (2)
transketolase activity
❑ Atrophy of orbital fat PD-1.1.2.1 11659
❑ Riboflavin, activity coefficient for erythrocyte BD-1.13.6 10356
glutathione reductase activity ❑ Excess subcutaneous fat PD-1.1.2.2 11660
❑ Niacin, urinary N’methyl-nicotinamide BD-1.13.7 10357 ❑ Loss of subcutaneous fat PD-1.1.2.3 11661
concentration ❑ Central adiposity PD-1.1.2.4 11662
❑ Vitamin B6, plasma or serum pyridoxal BD-1.13.8 10358 ❑ Loss of subcutaneous triceps fat PD-1.1.2.5 12095
5’phosphate concentration ❑ Loss of subcutaneous biceps fat PD-1.1.2.6 12096
❑ Pantothenic acid, urinary pantothenate excretion, BD-1.13.9 10850 ❑ Loss of subcutaneous fat overlying the ribs PD-1.1.2.7 12097
plasma
❑ Lipodystrophy PD-1.1.2.8 14554
❑ Biotin, urinary 3 hydroxyisovaleric acid excretion BD-1.13.10 11275
❑ Bones (3)
❑ Biotin, lymphocyte propionyl CoA carboxylase in BD-1.13.11 11276
❑ Bow legs PD-1.1.3.1 11664
pregnancy, serum
❑ Frontal bossing PD-1.1.3.2 11665
❑ Biotinidase BD-1.13.12 11223
❑ Harrison’s sulcus PD-1.1.3.3 11666
❑ Protein induced by vitamin K absence or BD-1.13.13 11224
antagonist II ❑ Rachitic rosary PD-1.1.3.4 11667
Carbohydrate metabolism profile (1.14) ❑ Rickets PD-1.1.3.5 11668

❑ Scoliosis PD-1.1.3.6 11669
❑ Galactose 1 phosphate in red blood cell BD-1.14.1 11226
❑ Acromion abnormal prominence PD-1.1.3.7 12098
❑ Galactose 1 phosphate uridyl transferase BD-1.14.2 11227
❑ Bone widening at ends PD-1.1.3.8 12099
❑ Fructose BD-1.14.3 11228
❑ Clavicle abnormal prominence PD-1.1.3.9 12100
❑ Lactate BD-1.14.4 11177
❑ Rib abnormal prominence PD-1.1.3.10 12101
❑ Pyruvate BD-1.14.5 11178
❑ Scapula abnormal prominence PD-1.1.3.11 12102
❑ Lactate:pyruvate ratio BD-1.14.6 11179
❑ Spine abnormal prominence PD-1.1.3.12 12103
Fatty acid profile (1.15)
❑ Iliac crest abnormal prominence PD-1.1.3.13 12104
❑ Acylcarnitine panel BD-1.15.1 11230
❑ Patella abnormal prominence PD-1.1.3.14 12105
❑ Acylcarnitine, plasma BD-1.15.2 11231
❑ Lordosis PD-1.1.3.15 14556
❑ Free carnitine BD-1.15.3 11232
❑ Cardiovascular-pulmonary system (4)
❑ Total carnitine BD-1.15.4 11233
❑ Absent breath sounds PD-1.1.4.1 11670
❑ Free carnitine:total carnitine BD-1.15.5 11234
❑ Bradycardia PD-1.1.4.2 11671
11
❑ Bradypnea PD-1.1.4.3 11672 ❑ Edema of thigh PD-1.1.6.12 11723

❑ Decreased breath sounds PD-1.1.4.4 11673 ❑ Edema of vulva PD-1.1.6.13 11724
❑ Dyspnea PD-1.1.4.5 11674 ❑ Mucosal edema PD-1.1.6.14 11725
❑ Increased breath sounds PD-1.1.4.6 11675 ❑ Sacral edema PD-1.1.6.15 11726
❑ Normal breath sounds PD-1.1.4.7 11676 ❑ Extremities (7)
❑ Tachypnea PD-1.1.4.8 11677 ❑ Amputated foot PD-1.1.7.1 11728
❑ Tachycardia PD-1.1.4.9 11678 ❑ Amputated hand PD-1.1.7.2 11729
❑ Respiratory crackles PD-1.1.4.10 11679 ❑ Amputated leg PD-1.1.7.3 11730
❑ Digestive system (5) ❑ Athetoid movement PD-1.1.7.4 11731
❑ Abdominal bloating PD-1.1.5.1 11684 ❑ Decreased range of ankle movement PD-1.1.7.5 11732
❑ Abdominal cramping PD-1.1.5.2 11685 ❑ Decreased range of cervical spine movement PD-1.1.7.6 11733
❑ Abdominal distension PD-1.1.5.3 11686 ❑ Decreased range of elbow movement PD-1.1.7.7 11734
❑ Abdominal pain PD-1.1.5.4 11687 ❑ Decreased range of finger movement PD-1.1.7.8 11735
❑ Absence of bowel sounds PD-1.1.5.5 11688 ❑ Decreased range of foot movement PD-1.1.7.9 11736
❑ Anorexia PD-1.1.5.6 11689 ❑ Decreased range of hip movement PD-1.1.7.10 11737
❑ Ascites PD-1.1.5.7 11690 ❑ Decreased range of knee movement PD-1.1.7.11 11738
❑ Bulky stool PD-1.1.5.8 11691 ❑ Decreased range of lumbar spine movement PD-1.1.7.12 11739
❑ Constipation PD-1.1.5.9 11692 ❑ Decreased range of shoulder movement PD-1.1.7.13 11740
❑ Decrease in appetite PD-1.1.5.10 11693 ❑ Decreased range of subtalar movement PD-1.1.7.14 11741
❑ Diarrhea PD-1.1.5.11 11694 ❑ Decreased range of thumb movement PD-1.1.7.15 11742
❑ Early satiety PD-1.1.5.12 11695 ❑ Decreased range of toe movement PD-1.1.7.16 11743
❑ Epigastric pain PD-1.1.5.13 11696 ❑ Decreased range of thoracic spine movement PD-1.1.7.17 11744
❑ Excessive appetite PD-1.1.5.14 11697 ❑ Decreased range of wrist movement PD-1.1.7.18 11745
❑ Excessive belching PD-1.1.5.15 11698 ❑ Hypertonia PD-1.1.7.19 11746
❑ Excessive flatus PD-1.1.5.16 11699 ❑ Hypotonia PD-1.1.7.20 11747
❑ Fatty stool PD-1.1.5.17 11700 ❑ Joint arthralgia PD-1.1.7.21 11748
❑ Heartburn PD-1.1.5.18 11701 ❑ Lower limb spasticity PD-1.1.7.22 11749
❑ Hyperactive bowel sounds PD-1.1.5.19 11702 ❑ Peripheral cyanosis PD-1.1.7.23 11750
❑ Hypoactive bowel sounds PD-1.1.5.20 11703 ❑ Spasticity PD-1.1.7.24 11751
❑ Increased appetite PD-1.1.5.21 11704 ❑ Tetany PD-1.1.7.25 11752
❑ Liquid stool PD-1.1.5.22 11705 ❑ Upper limb spasticity PD-1.1.7.26 11753
❑ Loose stool PD-1.1.5.23 11706 ❑ Pes planus PD-1.1.7.27 14558
❑ Nausea PD-1.1.5.24 11707 ❑ Eyes (8)
❑ Normal bowel sounds PD-1.1.5.25 11708 ❑ Abnormal vision PD-1.1.8.1 11755
❑ Retching PD-1.1.5.26 11709 ❑ Angular blepharitis PD-1.1.8.2 11756
❑ Vomiting PD-1.1.5.27 11710 ❑ Bitot’s spots PD-1.1.8.3 11757
❑ Gastrointestinal drainage volume PD-1.1.5.28 12106 ❑ Circles under eyes PD-1.1.8.4 11758
❑ Gastric drainage volume PD-1.1.5.29 12107 ❑ Corneal arcus PD-1.1.8.5 11759
❑ Bile duct drainage volume PD-1.1.5.30 12108 ❑ Conjunctival discoloration PD-1.1.8.6 11760
❑ Pancreatic drainage volume PD-1.1.5.31 12109 ❑ Conjunctival hemorrhage PD-1.1.8.7 11761
❑ Chylous drainage volume PD-1.1.5.32 12110 ❑ Conjunctival keratinization PD-1.1.8.8 11762
❑ Wound drainage volume PD-1.1.5.33 12111 ❑ Excessive tear production PD-1.1.8.9 11763
❑ Intestinal fistula output volume PD-1.1.5.34 12112 ❑ Keratomalacia PD-1.1.8.10 11764
❑ Normal stool PD-1.1.5.35 14557 ❑ Jaundiced sclera PD-1.1.8.11 11765
❑ Edema (6) ❑ Night blindness PD-1.1.8.12 11766
❑ +1 pitting edema PD-1.1.6.1 11712 ❑ Ophthalmoplegia PD-1.1.8.13 11767
❑ +2 pitting edema PD-1.1.6.2 11713 ❑ Sunken eyes PD-1.1.8.14 11768
❑ +3 pitting edema PD-1.1.6.3 11714 ❑ Xerophthalmia PD-1.1.8.15 11769
❑ +4 pitting edema PD-1.1.6.4 11715 ❑ Xanthelasma PD-1.1.8.16 11770
❑ Anasarca PD-1.1.6.5 11716 ❑ Pale conjunctiva PD-1.1.8.17 12113
❑ Ankle edema PD-1.1.6.6 11717 ❑ Genitourinary system (9)
❑ Edema of calf PD-1.1.6.7 11718 ❑ Amenorrhea PD-1.1.9.1 11772
❑ Edema of eyelid PD-1.1.6.8 11719 ❑ Anuria PD-1.1.9.2 11773
❑ Edema of foot PD-1.1.6.9 11720 ❑ Delay in sexual development and/or puberty PD-1.1.9.3 11774
❑ Edema of hand PD-1.1.6.10 11721 ❑ Menorrhagia PD-1.1.9.4 11775
❑ Edema of scrotum PD-1.1.6.11 11722 ❑ Oliguria PD-1.1.9.5 11776
12
❑ Polyuria PD-1.1.9.6 11777 ❑ Cheilitis PD-1.1.13.9 11828

❑ Hair (10) ❑ Cleft palate PD-1.1.13.10 11829
❑ Abnormal keratinization of hair follicle PD-1.1.10.1 11779 ❑ Cracked lips PD-1.1.13.11 11830
❑ Alopecia PD-1.1.10.2 11780 ❑ Drooling PD-1.1.13.12 11831
❑ Brittle hair PD-1.1.10.3 11781 ❑ Dry mucous membranes PD-1.1.13.13 11832
❑ Corkscrew hairs PD-1.1.10.4 11782 ❑ Dysgeusia PD-1.1.13.14 11833
❑ Dry hair PD-1.1.10.5 11783 ❑ Excessive salivation PD-1.1.13.15 11834
❑ Fine hair PD-1.1.10.6 11784 ❑ Excessive thirst PD-1.1.13.16 11835
❑ Follicular hyperkeratosis PD-1.1.10.7 11785 ❑ Gingival hypertrophy PD-1.1.13.17 11836
❑ Hair changes due to malnutrition PD-1.1.10.8 11786 ❑ Gingivitis PD-1.1.13.18 11837
❑ Hair lacks luster PD-1.1.10.9 11787 ❑ Halitosis PD-1.1.13.19 11838
❑ Hypertrichosis PD-1.1.10.10 11788 ❑ Hemorrhagic gingivitis PD-1.1.13.20 11839
❑ Increased loss of hair PD-1.1.10.11 11789 ❑ Hypogeusia PD-1.1.13.21 11840
❑ Nutritional hair color change PD-1.1.10.12 11790 ❑ Ketotic breath PD-1.1.13.22 11841
❑ White hair PD-1.1.10.13 11791 ❑ Micrognathia PD-1.1.13.23 11842
❑ Easily pluckable hair PD-1.1.10.14 12114 ❑ Swollen gums PD-1.1.13.24 11843
❑ Lanugo hair formation PD-1.1.10.15 12115 ❑ Oral candidiasis PD-1.1.13.25 11844
❑ Head (11) ❑ Oral lesion PD-1.1.13.26 11845
❑ Altered olfactory sense PD-1.1.11.1 11793 ❑ Parotid swelling PD-1.1.13.27 11846
❑ Anosmia PD-1.1.11.2 11794 ❑ Poor oral hygiene PD-1.1.13.28 11847
❑ Bulging fontanelle PD-1.1.11.3 11795 ❑ Retains food in mouth PD-1.1.13.29 11848
❑ Epistaxis PD-1.1.11.4 11796 ❑ Stomatitis PD-1.1.13.30 11849
❑ Headache PD-1.1.11.5 11797 ❑ Uremic breath PD-1.1.13.31 11850
❑ Hyposmia PD-1.1.11.6 11798 ❑ Pale gums PD-1.1.13.32 12119
❑ Macrocephaly PD-1.1.11.7 11799 ❑ Cleft lip PD-1.1.13.33 14559
❑ Microcephaly PD-1.1.11.8 11800 ❑ Muscles (14)
❑ Nasal mucosa dry PD-1.1.11.9 11801 ❑ Muscle atrophy PD-1.1.14.1 11852
❑ Sunken fontanelle PD-1.1.11.10 11802 ❑ Muscle contracture PD-1.1.14.2 11853
❑ Hand and nails (12) ❑ Muscle cramp PD-1.1.14.3 11854
❑ Beau’s lines PD-1.1.12.1 11804 ❑ Muscle pain PD-1.1.14.4 11855
❑ Clubbing of nail PD-1.1.12.2 11805 ❑ Muscle weakness PD-1.1.14.5 11856
❑ Flaking of nails PD-1.1.12.3 11806 ❑ Quadriceps muscle atrophy PD-1.1.14.6 11857
❑ Koilonychia PD-1.1.12.4 11807 ❑ Deltoid muscle atrophy PD-1.1.14.7 12120
❑ Leukonychia PD-1.1.12.5 11808 ❑ Gastrocnemius muscle atrophy PD-1.1.14.8 12121
❑ Longitudinal grooving of nails PD-1.1.12.6 11809 ❑ Gluteal muscle atrophy PD-1.1.14.9 12122
❑ Muehrcke’s lines PD-1.1.12.7 11810 ❑ Interosseous hand muscle atrophy PD-1.1.14.10 12123
❑ Nail changes PD-1.1.12.8 11811 ❑ Pectoral muscle atrophy PD-1.1.14.11 12124
❑ Palmar erythema PD-1.1.12.9 11812 ❑ Temporalis muscle atrophy PD-1.1.14.12 12125
❑ Ridged nails PD-1.1.12.10 11813 ❑ Trapezius muscle atrophy PD-1.1.14.13 12126
❑ Splits in nails PD-1.1.12.11 11814 ❑ Latissimus dorsi muscle atrophy PD-1.1.14.14 12150
❑ Thin nails PD-1.1.12.12 11815 ❑ Neck (15)
❑ Trachyonychia PD-1.1.12.13 11816 ❑ Goiter PD-1.1.15.1 11859
❑ Splinter hemorrhage under nail PD-1.1.12.14 11817 ❑ Nerves, cognition, and feelings (16)
❑ White flecks in nails PD-1.1.12.15 11818 ❑ Abnormal gait PD-1.1.16.1 11860
❑ Blue nail bed PD-1.1.12.16 12116 ❑ Absent reflex PD-1.1.16.2 11861
❑ Pale nail bed PD-1.1.12.17 12117 ❑ Asterixis PD-1.1.16.3 11862
❑ Russell’s sign PD-1.1.12.18 12118 ❑ Ataxia PD-1.1.16.4 11863
❑ Mouth (13) ❑ Clouded consciousness PD-1.1.16.5 11864
❑ Ageusia PD-1.1.13.1 11820 ❑ Cranial nerve finding PD-1.1.16.6 11865
❑ Angular stomatitis PD-1.1.13.2 11821 ❑ Decreased vibratory sense PD-1.1.16.7 11866
❑ Aphthous ulcer of mouth PD-1.1.13.3 11822 ❑ Delirious PD-1.1.16.8 11867
❑ Aptyalism PD-1.1.13.4 11823 ❑ Dementia PD-1.1.16.9 11868
❑ Blue lips PD-1.1.13.5 11824 ❑ Depressed mood PD-1.1.16.10 11869
❑ Blue line on gingiva PD-1.1.13.6 11825 ❑ Disoriented PD-1.1.16.11 11870
❑ Candidiasis of the mouth PD-1.1.13.7 11826 ❑ Dizziness PD-1.1.16.12 11871
❑ Cheilosis PD-1.1.13.8 11827 ❑ Feels cold PD-1.1.16.13 11872
13
❑ Flat affect PD-1.1.16.14 11873 ❑ Perifollicular hemorrhages PD-1.1.17.45 12127

❑ Hyperreflexia PD-1.1.16.15 11874 ❑ Pressure injury of the coccyx PD-1.1.17.46 12128
❑ Hyporeflexia PD-1.1.16.16 11875 ❑ Pressure injury of the sacrum PD-1.1.17.47 12129
❑ Inappropriate affect PD-1.1.16.17 11876 ❑ Vesiculobullous rash PD-1.1.17.48 12130
❑ Many seizures a day PD-1.1.16.18 11877 ❑ Acne PD-1.1.17.49 14560
❑ Numbness of foot PD-1.1.16.19 11878 ❑ Intertrigo PD-1.1.17.50 14561
❑ Numbness of hand PD-1.1.16.20 11879 ❑ Pannus PD-1.1.17.51 14562
❑ Peripheral nerve disease PD-1.1.16.21 11880 ❑ Striae PD-1.1.17.52 14563
❑ Tremor of outstretched hand PD-1.1.16.22 11881 ❑ Teeth (18)
❑ Tingling of foot PD-1.1.16.23 11882 ❑ Baby bottle tooth decay PD-1.1.18.1 11929
❑ Tingling of hand PD-1.1.16.24 11883 ❑ Broken denture PD-1.1.18.2 11930
❑ Skin (17) ❑ Broken teeth PD-1.1.18.3 11931
❑ Acanthosis nigricans PD-1.1.17.1 11884 ❑ Dental caries PD-1.1.18.4 11932
❑ Calcinosis PD-1.1.17.2 11885 ❑ Dental fluorosis PD-1.1.18.5 11933
❑ Carotenemia PD-1.1.17.3 11886 ❑ Dental plaque PD-1.1.18.6 11934
❑ Cutaneous xanthoma PD-1.1.17.4 11887 ❑ Denture loose PD-1.1.18.7 11935
❑ Decreased skin turgor PD-1.1.17.5 11888 ❑ Denture lost PD-1.1.18.8 11936
❑ Dermatitis PD-1.1.17.6 11889 ❑ Denture present PD-1.1.18.9 11937
❑ Diaper rash PD-1.1.17.7 11890 ❑ Edentulous PD-1.1.18.10 11938
❑ Dry skin PD-1.1.17.8 11891 ❑ Erosion of teeth PD-1.1.18.11 11939
❑ Ecchymosis PD-1.1.17.9 11892 ❑ Impaired dentition PD-1.1.18.12 11940
❑ Erythema PD-1.1.17.10 11893 ❑ Ill fitting denture PD-1.1.18.13 11941
❑ Eczema PD-1.1.17.11 11894 ❑ Mottling of enamel PD-1.1.18.14 11942
❑ Flushing PD-1.1.17.12 11895 ❑ Partially edentulous mandible PD-1.1.18.15 11943
❑ Hirsutism PD-1.1.17.13 11896 ❑ Partially edentulous maxilla PD-1.1.18.16 11944
❑ Hyperpigmentation of skin PD-1.1.17.14 11897 ❑ Rampant dental caries PD-1.1.18.17 11945
❑ Impaired skin integrity PD-1.1.17.15 11898 ❑ Throat and swallowing (19)
❑ Jaundice PD-1.1.17.16 11899 ❑ Choking during swallowing PD-1.1.19.1 11947
❑ Keratinization of skin PD-1.1.17.17 11900 ❑ Cough PD-1.1.19.2 11948
❑ Pale complexion PD-1.1.17.18 11901 ❑ Dysphagia PD-1.1.19.3 11949
❑ Peeling skin PD-1.1.17.19 11902 ❑ Esophageal lesion PD-1.1.19.4 11950
❑ Petechiae PD-1.1.17.20 11903 ❑ Food sticks on swallowing PD-1.1.19.5 11951
❑ Impaired wound healing PD-1.1.17.21 11904 ❑ Gagging PD-1.1.19.6 11952
❑ Pressure injury of ankles PD-1.1.17.22 11905 ❑ Hoarse voice PD-1.1.19.7 11953
❑ Pressure injury of back PD-1.1.17.23 11906 ❑ Hypoactive gag reflex PD-1.1.19.8 11954
❑ Pressure injury of breast PD-1.1.17.24 11907 ❑ Odynophagia PD-1.1.19.9 11955
❑ Pressure injury of buttock PD-1.1.17.25 11908 ❑ Swallow impairment PD-1.1.19.10 11956
❑ Pressure injury of dorsum of foot PD-1.1.17.26 11909 ❑ Suck, swallow, breath incoordination PD-1.1.19.11 11957
❑ Pressure injury of elbow PD-1.1.17.27 11910 ❑ Tongue (20)
❑ Pressure injury of head PD-1.1.17.28 11911 ❑ Atrophy of tongue papillae PD-1.1.20.1 11959
❑ Pressure injury of heel PD-1.1.17.29 11912 ❑ Beefy red tongue PD-1.1.20.2 11960
❑ Pressure injury of hip PD-1.1.17.30 11913 ❑ Difficulty moving tongue PD-1.1.20.3 11961
❑ Pressure injury of knee PD-1.1.17.31 11914 ❑ Dry tongue PD-1.1.20.4 11962
❑ Pressure injury of natal cleft PD-1.1.17.32 11915 ❑ Glossitis PD-1.1.20.5 11963
❑ Pressure injury of shoulder PD-1.1.17.33 11916 ❑ Glossodynia PD-1.1.20.6 11964
❑ Pressure injury stage 1 PD-1.1.17.34 11917 ❑ Hypertrophy of tongue papillae PD-1.1.20.7 11965
❑ Pressure injury stage 2 PD-1.1.17.35 11918 ❑ Lesion of the tongue PD-1.1.20.8 11966
❑ Pressure injury stage 3 PD-1.1.17.36 11919 ❑ Strawberry tongue PD-1.1.20.9 11967
❑ Pressure injury stage 4 PD-1.1.17.37 11920 ❑ Macroglossia PD-1.1.20.10 11968
❑ Pruritus of the skin PD-1.1.17.38 11921 ❑ Short frenulum of tongue PD-1.1.20.11 11969
❑ Psoriasis PD-1.1.17.39 11922 ❑ Split frenulum of tongue PD-1.1.20.12 11970
❑ Scaling skin PD-1.1.17.40 11923 ❑ Blue tongue PD-1.1.20.13 12131
❑ Seborrheic dermatitis PD-1.1.17.41 11924 ❑ Cracked tongue PD-1.1.20.14 12132
❑ Skin rash PD-1.1.17.42 11925 ❑ Magenta tongue PD-1.1.20.15 12133
❑ Stasis ulcer PD-1.1.17.43 11926 ❑ Pale tongue PD-1.1.20.16 12134
❑ Yellow skin PD-1.1.17.44 11927 ❑ Vital signs PD-1.1.21 10370
14
❑ Blood pressure, systolic PD-1.1.21.1 14206 (specify) __________________________ P or F

❑ Blood pressure, diastolic PD-1.1.21.2 14207 ❑ Musculoskeletal CH-2.1.10 10395
❑ Blood pressure, systolic, reported PD-1.1.21.3 14208 (specify) __________________________ P or F
❑ Blood pressure, diastolic, reported PD-1.1.21.4 14209 ❑ Neurological CH-2.1.11 10396
❑ Heart rate PD-1.1.21.5 12139 (specify) __________________________ P or F
❑ Jugular venous pressure PD-1.1.21.6 12140 ❑ Psychological CH-2.1.12 10397
❑ Mean arterial pressure PD-1.1.21.7 12138 (specify) __________________________ P or F
❑ Pulse rate PD-1.1.21.8 12141 ❑ Respiratory CH-2.1.13 10398
❑ Respiratory rate PD-1.1.21.9 12137 (specify) __________________________ P or F
❑ Temperature PD-1.1.21.10 12136 ❑ Other CH-2.1.14 10399
(specify) __________________________ P or F
CLIENT HISTORY (CH) Treatments/therapy (2.2)
Current and past information related to personal, Documented medical or surgical treatments that may
medical, family, and social history. Client History terms impact nutritional status of the client
are used for Nutrition Assessment, but not for Nutrition ❑ Medical treatment/therapy CH-2.2.1 10401
Monitoring and Evaluation. (specify) _______________________________
Personal History (1) ❑ Surgical treatment CH-2.2.2 10402
General /client information such as age, gender, sex, (specify) _______________________________
race, ethnicity, language, education, and role in family. ❑ Palliative/end of life care CH-2.2.3 10404
Personal data (1.1) (specify) _______________________________
❑ Age CH-1.1.1 10374
Social History (3)
❑ Gender CH-1.1.2 10375
Client socioeconomic status, housing situation, medical
❑ Sex CH-1.1.3 11138 support, and involvement in social groups.
❑ Race CH-1.1.4 11139 Social history (3.1)
❑ Ethnicity CH-1.1.5 11140 ❑ Socioeconomic factors CH-3.1.1 10407
❑ Language CH-1.1.6 10377 (specify) _______________________________
❑ Literacy factors CH-1.1.7 10378 ❑ Living/housing situation CH-3.1.2 10408
❑ Education CH-1.1.8 10379 (specify) _______________________________
❑ Role in family CH-1.1.9 10380 ❑ Domestic issues CH-3.1.3 10409
❑ Tobacco use CH-1.1.10 10381 (specify) _______________________________
❑ Physical disability CH-1.1.11 10382 ❑ Social and medical support CH-3.1.4 10410
❑ Mobility CH-1.1.12 10383 (specify) _______________________________
Patient/Client/Family Medical/Health History ❑ Geographic location of home CH-3.1.5 10411
(2) (specify) _______________________________
Patient/client or family disease states, conditions, and ❑ Occupation CH-3.1.6 10412
illnesses that may have nutritional impact.
(specify) _______________________________
Patient/client OR family nutrition-oriented
❑ Religion CH-3.1.7 10413
medical/health history (2.1)
(specify) _______________________________
Specify issue(s) and whether it is patient/client history
❑ History of recent crisis CH-3.1.8 10414
(P) or family history (F)
(specify) _______________________________
❑ Patient/client chief nutrition complaint CH-2.1.1 10386
❑ Daily stress level CH-3.1.9 10415
(specify) __________________________ P or F
(specify) _______________________________
❑ Cardiovascular CH-2.1.2 10387
ASSESSMENT, MONITORING AND
(specify) __________________________ P or F
EVALUATION TOOLS (AT)
❑ Endocrine/metabolism CH-2.1.3 10388
Tools used for health or disease status or risk
(specify) __________________________ P or F assessment, reassessment, and monitoring and
❑ Excretory CH-2.1.4 10389 evaluation.
(specify) __________________________ P or F Nutrition assessment, monitoring and evaluation
❑ Gastrointestinal CH-2.1.5 10390 tool ratings (1)
(specify) __________________________ P or F ❑ Subjective global assessment (SGA) rating AT-1.1 14132
❑ Gynecological CH-2.1.6 10391 ❑ Patient generated subjective global assessment AT-1.2 14133
(specify) __________________________ P or F (PG-SGA) rating
❑ Hematology/oncology CH-2.1.7 10392 ❑ Patient generated subjective global assessment AT-1.3 14134
(PG-SGA) score
(specify) __________________________ P or F
❑ Mini nutritional assessment long form (MNA-LF) AT-1.4 14135
❑ Immune (eg, food allergies) CH-2.1.8 10393
rating
(specify) __________________________ P or F
❑ Subjective global nutritional assessment (SGNA) AT-1.5 14564
❑ Integumentary CH-2.1.9 10394 for children rating
15
Household food security assessment tool scores Estimated fluid needs (3.1)
(2) ❑ Total fluid estimated needs CS-3.1.1 10440
❑ US household food security module: six item AT-2.1 14137 ❑ Method for estimating needs CS-3.1.2 10441
short form raw score
Micronutrient Needs (4)
❑ US household food security module: six item AT-2.2 14138
Estimated vitamin needs (4.1)
short form scale score
❑ Food insecurity experience scale (FIES) raw AT-2.3 14139 ❑ A (1) 10444
score ❑ C (2) 10445
Food variety assessment tool scores (3) ❑ D (3) 10446
❑ Minimum dietary diversity for women (MDD-W) AT-3.1 14141 ❑ E (4) 10447
indicator score
❑ K (5) 10448
ETIOLOGY CATEGORY (EY) ❑ Thiamin (6) 10449
Categories to communicate the type of nutrition ❑ Riboflavin (7) 10450

diagnosis etiology. ❑ Niacin (8) 10451
Nutrition Diagnosis Etiology Category ❑ Folate (9) 10452
Identification (1)
❑ B6 (10) 10453
Beliefs attitudes etiology EY-1.1 14567
❑ B12 (11) 10454
Cultural etiology EY-1.2 14568
EY-1.3 14569 ❑ Pantothenic acid (12) 10455
Knowledge etiology
Physical function etiology EY-1.4 14570 ❑ Biotin (13) 10456
Physiologic metabolic etiology EY-1.5 14571 ❑ Method for estimating needs (14) 10458
Psychological etiology EY-1.6 14572 Estimated mineral needs (4.2)

Social personal etiology EY-1.7 14573 ❑ Calcium (1) 10460
Treatment etiology EY-1.8 14574 ❑ Chloride (2) 10461
Access etiology EY-1.9 14575
❑ Iron (3) 10462
Behavior etiology EY-1.10 14576
❑ Magnesium (4) 10463
COMPARATIVE STANDARDS (CS)
❑ Potassium (5) 10464
Energy Needs (1)
❑ Phosphorus (6) 10465
Estimated energy needs (1.1)
❑ Sodium (7) 10466
❑ Total energy estimated needs in 24 hours CS-1.1.1 12205
❑ Zinc (8) 10467
❑ Method for estimating total energy needs CS-1.1.2 10420
❑ Sulfate (9) 10469
❑ Energy estimated needs per kg of body weight CS-1.1.3 13008
Macronutrient Needs (2) ❑ Fluoride (10) 10470
Estimated fat needs (2.1) ❑ Copper (11) 10471
❑ Total fat estimated needs in 24 hours CS-2.1.1 12206 ❑ Iodine (12) 10473
❑ Fat estimated needs per kg of body weight CS-2.1.2 13010 ❑ Selenium (13) 10474
❑ Method for estimating total fat needs CS-2.1.3 10425 ❑ Manganese (14) 10475
❑ Proportion of energy needs from fat in 24 hours CS-2.1.4 13009 ❑ Chromium (15) 10476
Estimated protein needs (2.2) ❑ Molybdenum (16) 10477
❑ Total protein estimated needs in 24 hours CS-2.2.1 12207 ❑ Boron (17) 10478
❑ Protein estimated needs per kg of body weight CS-2.2.2 13011 ❑ Cobalt (18) 10479
❑ Method for estimating total protein needs CS-2.2.3 10429 ❑ Method for estimating needs (19) 10480
❑ Proportion of energy needs from protein in 24 CS-2.2.4 13012
Weight and Growth Recommendation (5)
hours
Recommended body weight/body mass
Estimated carbohydrate needs (2.3)
index/growth (5.1)
❑ Total carbohydrate estimated needs in 24 hours CS-2.3.1 12208
❑ Ideal/reference body weight (IBW) CS-5.1.1 10483
❑ Carbohydrate estimated needs per kg of body CS-2.3.2 13013
❑ Recommended body mass index (BMI) CS-5.1.2 10484
weight
❑ Goal weight CS-5.1.3 12144
❑ Method for estimating total carbohydrate needs CS-2.3.3 10433
❑ Goal weight gain/day CS-5.1.4 12145
❑ Proportion of energy needs from carbohydrate in CS-2.3.4 13014
24 hours ❑ Goal weight for length z score CS-5.1.5 12146
Estimated fiber needs (2.4) ❑ Goal mid upper arm circumference z score CS-5.1.6 12147
❑ Total fiber estimated needs in 24 hours CS-2.4.1 12209 ❑ Goal BMI for age z score CS-5.1.7 12148
❑ Percent median BMI CS-5.1.8 12149
❑ Method for estimating total fiber needs CS-2.4.2 10437
Fluid Needs (3) PROGRESS EVALUATION (EV)
16
Evaluation of progress toward a nutrition related ❑ Some progress toward goal EV-1.5 14583
goal(s) and resolution of a nutrition diagnosis(es). ❑ Some digression away from goal EV-1.6 14584
Intervention goal status (1) Nutrition diagnosis status (2)
❑ New goal identified EV-1.1 14579 ❑ New nutrition diagnosis EV-2.1 14586
❑ Goal achieved EV-1.2 14580 ❑ Active nutrition diagnosis EV-2.2 14587
❑ Goal discontinued EV-1.3 14581 ❑ Resolved nutrition diagnosis EV-2.3 14588
❑ Goal not achieved EV-1.4 14582 ❑ Discontinued nutrition diagnosis EV-2.4 14589
17
12/15/21, 9:10 AM Energy Intake
ENERGY INTAKE
Food/Nutrition-Related History Domain – Food and Nutrient Intake
Energy Intake (FH-1.1.1)

Definition
Amount of energy intake from all sources including food, beverages, breastmilk/formula, supplements, and via
enteral and parenteral routes
Note: Whenever possible, nutrient intake data should be considered in combination with clinical,
biochemical, anthropometric information, medical diagnosis, clinical status, and/or other factors to
provide a valid assessment of nutritional status based on a totality of the evidence. (Institute of Medicine.
Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: National Academies
Press; 2000.)
Nutrition Assessment and Monitoring and Evaluation

Indicators
Estimated energy intake
Total energy estimated intake in 24 hours (calories, kcal or kJ/day) - defined as the approximate intake in
one day of all energy
Energy estimated intake per kg in 24 hours (calories, kcal, or kJ/kg/day)—defined as the approximate
intake per kg of body weight in one day of all energy
Energy estimated intake from oral nutrition in 24 hours (calories, kcal, or kJ/day)—defined as the
estimated intake of energy in one day derived from oral intake
Energy estimated intake from enteral nutrition in 24 hours (calories, kcal, or kJ/day)—defined as the
estimated intake of energy in one day derived from enteral nutrition infusion
Energy estimated intake from parenteral nutrition in 24 hours (calories, kcal, or kJ/day)—defined as the
estimated intake of energy in one day derived from parenteral nutrition infusion
Energy estimated intake from intravenous fluids in 24 hours (calories, kcal, or kJ/day)—defined as the
estimated intake of energy in one day derived from intravenous fluid (IV) infusion
Measured energy intake
Total energy measured intake in 24 hours (calories, kcal, or kJ/day)—defined as the known quantity of
intake in one day of all energy
Energy measured intake per kg in 24 hours (calories, kcal, or kJ/kg/day)—defined as the known quantity
of intake per kg of body weight in one day of all energy
Energy measured intake from oral nutrition in 24 hours (calories, kcal, or kJ/day)—defined as the known
quantity of energy in one day derived from oral intake
Energy measured intake from enteral nutrition in 24 hours (calories, kcal, or kJ/day)—defined as the
known quantity of energy in one day derived from enteral nutrition infusion
Energy measured intake from parenteral nutrition in 24 hours (calories, kcal, or kJ/day)—defined as the
known quantity of energy in one day derived from parenteral nutrition infusion
Energy measured intake from intravenous fluids in 24 hours (calories, kcal, or kJ/day)—defined as the
known quantity of energy in one day derived from intravenous fluid (IV) infusion
Note: Weight and weight change can be found on the Body Composition/Growth/Weight History reference
sheet.
Examples of the measurement methods or data sources for these outcome indicators: Food intake records,
24-hour recalls, 3 to 5 day food diary, food frequency questionnaire, caretaker intake records, menu analysis,
intake and output records
https://www.ncpro.org/pubs/2020-encpt-en/codeFH-1-1-1 1/3
Typically used with the following domains of nutrition interventions: Food and/or nutrient delivery, nutrition
education, nutrition counseling, coordination of nutrition care by nutrition professional
Typically used to determine and to monitor and evaluate change in the following nutrition
diagnoses: Inadequate energy intake, excessive energy intake, malnutrition (undernutrition), inadequate protein
energy intake, underweight, unintended weight loss, overweight/obesity, unintended weight gain, swallowing
difficulty, breastfeeding difficulty, altered GI function, limited adherence to nutrition related recommendations
Judgment must be used to select indicators and determine the appropriate measurement techniques and
reference standards for a given client population and setting. Once identified, these indicators, measurement
techniques, and reference standards should be identified in policies and procedures or other documents for use
in client records, quality or performance improvement, or in formal research projects.
Client Example(s)
Example of one of the Nutrition Care Indicators (includes sample initial and reassessment of documentation for
one of the indicators)
Indicator(s) Selected
Total energy estimated intake in 24 hours (kcal/day)
Criteria for Evaluation

Comparison to Reference Standard, Recommendation, or Goal:
1. Reference Standard: Food diary indicates that client consumes approximately 2600 calories/kcal (11,000
kJ) per day. 145% of estimated energy needs per day.
2. Recommendation: Client’s recommended calorie intake level is 1,800-2,000 calories/kcal (7,500-
8,400 kJ) per day.
3. Goal: Client's goal calorie intake level is 1,800 calories/kcal (7,500 kJ) per day.
Sample Nutrition Assessment and Monitoring and Evaluation Documentation
Based on client food diary, client's total energy estimated intake in 24 hours
averages approximately 2,600 calories/kcal (11,000 kJ) per day, 145% of
Initial encounter recommended level of 1,800 calories/ kcal (7,500 kJ) per day. Client's goal is 1,800
calories/kcal (7,500 kJ) per day. Will evaluate calorie intake at next encounter in
two weeks.
Significant progress toward meeting goal. Based on client's food diary, patient/client
Reassessment after consuming approximately 2,100 calories/kcal (9,000 kJ) per day, 117% of goal level
nutrition intervention of 1,800 calories/ kcal (7,500 kJ) per day. Will evaluate energy intake at next
encounter in two weeks.
References
The following are some suggested references for indicators, measurement techniques, and reference standards
for the outcome; other references may be appropriate.
1. Academy of Nutrition and Dietetics. Evidence Analysis Library: Measuring resting metabolic rate (RMR)
in the healthy and non-critically ill guideline. https://www.andeal.org/topic.cfm?menu=5299&cat=5217.
Accessed February 4, 2019.
2. Academy of Nutrition and Dietetics. Nutrition Care Manual.
https://www.nutritioncaremanual.org/index.cfm. Accessed February 4, 2019.
3. Government of Canada. Dietary Reference Intakes. https://www.canada.ca/en/health-
canada/services/food-nutrition/healthy-eating/dietary-reference-intakes.html. Accessed February 4, 2019.
4. Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids,
Cholesterol, Protein, and Amino Acids. Washington, DC: National Academies Press; 2002.
5. Israel Dietary Reference Intakes.
https://www.health.gov.il/Subjects/FoodAndNutrition/Nutrition/Documents/70420914_2.pdf. Accessed
February 20, 2019.

6. Mountjoy M, Sundgot-Borgen J, Burke L, et al. International Olympic Committee (IOC) Consensus
Statement on Relative Energy Deficiency in Sport (RED-S): 2018 Update. Int J Sport Nutr Exerc Metab.
2018;28(4):316-331.
7. The National Health and Medical Research Council. Nutrient Reference Values for Australia and New
Zealand. https://www.health.govt.nz/publication/nutrient-reference-values-australia-and-new-zealand.
8. Nordic Council of Ministers. Nordic Nutrition Recommendations 2012: Integrating nutrition and physical
activity. 2012; https://www.norden.org/en/publication/nordic-nutrition-recommendations-2012-0.
9. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015-2020 Dietary
Guidelines for Americans. https://health.gov/dietaryguidelines/2015/. Accessed February 4, 2019.
2020 EDITION
COPYRIGHT 2021. POWERED BY WEBAUTHOR ®. PRIVACY POLICY. ALL RIGHTS RESERVED. LX-133-218 (EXECUTION TIME: 0.18 SECONDS)
12/15/21, 9:13 AM Fluid Intake
FLUID INTAKE
Food/Nutrition-Related History Domain – Food and Beverage Intake
Fluid Intake (FH-1.2.1)

Definition
Amount of fluid consumed orally from all sources including food, beverages, breastmilk, infant formula,
supplements, and via enteral and parenteral routes
Press; 2000.)

Indicators
Estimated fluid intake
Total fluid estimated intake in 24 hours (mL/day)—defined as the approximate intake in one day of fluid
from all sources
Fluid estimated intake from oral nutrition in 24 hours (mL/day)—defined as the approximate
intake in one day of fluid from oral intake
Water estimated oral intake in 24 hours (mL/day)—defined as the approximate intake in

one day of water
Sugar sweetened beverage estimated oral intake in 24 hours (mL/day)—defined as the

approximate intake in one day of sugar sweetened beverages
Beverage with high intensity sweetener estimated oral intake in 24 hours (mL/day)—
defined as the approximate intake in one day of high intensity, nonnutritive and nutritive,
sweetened beverages that contain nutritive and nonnutritive sugar substitutes
100 percent fruit juice estimated oral intake in 24 hours (mL/day)—defined as the
approximate intake in one day of 100% fruit juice
Liquid dairy product estimated oral intake in 24 hours (mL/day)—defined as the

approximate intake in one day of dairy beverages
Caffeinated beverage estimated oral intake in 24 hours (mL/day)—defined as the

approximate intake in one day of caffeinated beverages
Nutritionally complete liquid supplement estimated oral intake in 24 hours (mL/day)—

defined as the approximate intake in one day of liquid oral enteral nutrition supplements
Liquid meal replacement estimated oral intake in 24 hours (mL/day)—defined as the

approximate intake in one day of liquid meal replacement
Fluid estimated intake per kg in 24 hours (mL/kg/day)--defined as the approximate intake per kg of body
weight in one day of fluid from all sources
Fluid estimated intake from food in 24 hours (mL/day)—defined as the approximate intake in one day of
fluid from food intake
Free water estimated intake in 24 hours (mL/day)—defined as the approximate intake in one day
of free water from all sources
Free water estimated intake from breastmilk in 24 hours (mL/day)—defined as the approximate
intake in one day of free water derived from breastmilk
Free water estimated intake from infant formula in 24 hours (mL/day)—defined as the
approximate intake in one day of free water derived from infant formula
Free water estimated intake from enteral nutrition in 24 hours (mL/day)—defined as the
approximate intake of free water per day derived from enteral nutrition infusion
Free water estimated intake from parenteral nutrition in 24 hours (mL/day)—defined as the
approximate intake of free water per day derived from parenteral nutrition infusion
Free water estimated intake from intravenous fluids in 24 hours (mL/day)—defined as the
approximate intake of free water per day derived from intravenous fluid (IV) infusion
Measured fluid intake
Total fluid measured intake in 24 hours (mL/day)—defined as the known quantity of intake in one day of
fluid from all sources
Fluid measured intake from oral nutrition in 24 hours (mL/day)—defined as the known quantity of
intake in one day of fluid from oral intake
Water measured oral intake in 24 hours (mL/day)—defined as the known quantity of intake in one
day of water
Sugar sweetened beverage measured oral intake in 24 hours (mL/day)—defined as the known
quantity of intake in one day of sugar sweetened beverages
Beverage with high intensity sweetener measured oral intake in 24 hours (mL/day)—defined as
the known quantity of intake in one day of high intensity sweetened beverages that contain
nutritive and nonnutritive sugar substitutes
100 percent fruit juice measured oral intake in 24 hours (mL/day)—defined as the known quantity
of intake in one day of 100% fruit juice
Liquid dairy product measured oral intake in 24 hours (mL/day)—defined as the known quantity
of intake in one day of dairy beverages
Caffeinated beverage measured oral intake in 24 hours (mL/day)—defined as the known quantity
of intake in one day of caffeinated beverages
Nutritionally complete liquid supplement measured oral intake in 24 hours (mL/day)—defined as

the known quantity of intake in one day of nutrition supplements
Liquid meal replacement measured oral intake in 24 hours (mL/day)—defined as the known
quantity of intake in one day of a liquid that can replace a meal
Fluid measured intake from food in 24 hours (mL/day)—defined as the known quantity of intake in one
day of fluid from food intake
Fluid measured intake per kg in 24 hours (mL/kg/day)--defined as the known quantity of intake per kg of
body weight in one day of fluid from all sources
Free water measured intake in 24 hours—defined as the known quantity of intake from all sources
Free water measured intake from breastmilk in 24 hours (mL/day)—defined as the known quantity
of intake in one day of free water derived from breastmilk
Free water measured intake from infant formula in 24 hours (mL/day)—defined as the known
quantity of intake in one day of free water derived from infant formula
Free water measured intake from enteral nutrition in 24 hours (mL/day)—defined as the known
quantity of intake of free water per day derived from enteral nutrition infusion
Free water measured intake from parenteral nutrition in 24 hours (mL/day)—defined as the known
quantity of intake of free water per day derived from parenteral nutrition infusion
Free water measured intake from intravenous fluids in 24 hours (mL/day)—defined as the known
quantity of intake of free water per day derived from intravenous fluid (IV) infusion
Note: Alcohol intake is recorded on the Alcohol intake reference sheet. Total volumes of breastmilk and
infant formula can be found on the Breastmilk/Infant formula intake reference sheet. Total volume of
enteral nutrition can be found on the Enteral nutrition intake reference sheet. Total volume of parenteral
nutrition can be found on the Parenteral nutrition intake reference sheet. Biochemical measures of
hydration status can be found on the Electrolyte and Renal Profile and Urine Profile reference sheets
Examples of the measurement methods or data sources for these outcome indicators: Food and fluid intake
records, 24-hour recalls, food frequency questionnaire, intake and output data, observation, weight measurement
records
education, nutrition counseling, coordination of nutrition care by nutrition professional, population based
nutrition action
Typically used to determine and monitor and evaluate change in the following nutrition diagnoses:
Excessive or inadequate oral intake, food medication interaction, underweight, overweight/obesity, unintended
weight loss, unintended weight gain, disordered eating pattern, undesirable food choices, limited adherence to
nutrition related recommendations, inability to manage self care, swallowing difficulty, breastfeeding difficulty,
altered GI function
Client Example
Example of one (or more) of the Nutrition Care Indicators (includes sample initial and reassessment
documentation for one of the indicators)
Fluid estimated intake from oral nutrition in 24 hours (mL/day)
1. Reference Standard: Reference intake standards
2. Recommendation: Client's fluid estimated intake from oral nutrition in 24 hours is 1,000 mL (33 oz).
Recommendated intake is 2,600 mL per 24 hours.
3. Goal: Client currently drinks 1,000 mL (33 oz) of oral fluids per day and has a personal goal of
consuming 1,920 mL(64 oz) of fluid per day.
Based on client's food diary, Fluid estimated intake from oral nutrition in 24 hours is
Initial nutrition assessment approximately 1,000 mL(33 oz). Goal is to consume approximately 1,920 mL (64
oz) of fluid per day. Will monitor fluid intake at next encounter.
Reassessment after Significant progress toward goal fluid intake. Based on fluid intake records,
nutrition intervention patient/client increased consumption of fluids from 1,000 mL (33 oz) to 1,920 mL
per day, exceeding goal and meeting recommended intake.

References
1. Canadian Nutrient File. https://food-nutrition.canada.ca/cnf-fce/index-eng.jsp. Accessed February 22,
2019.
3. Institute of Medicine. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate.
Washington, DC: National Academies Press; 2004.
February 20, 2019.
6. New Zealand Food Composition Data. https://www.foodcomposition.co.nz/foodfiles/concise-tables/.
8. US Department of Agriculture. Food and Nutrition Research Center. What’s in the Foods You Eat Search
Tool. https://www.ars.usda.gov/northeast-area/beltsville-md-bhnrc/beltsville-human-nutrition-research-
center/food-surveys-research-group/docs/whats-in-the-foods-you-eat-emsearch-toolem. Accessed
February 4, 2019.
2020 EDITION
12/15/21, 9:12 AM Food Intake
FOOD INTAKE
Food Intake (FH-1.2.2)

Definition
Amount, type, and pattern of food consumed and quality of diet
Press; 2000.)

Indicators
Amount of food
Estimated amount of food
Grains servings estimated in 24 hours (number/day)

Fruits servings estimated in 24 hours (number/day)
Vegetable servings estimated in 24 hours (number/day)
Milk products servings estimated in 24 hours (number/day)
Protein food servings estimated in 24 hours (number/day) (eg, meat, poultry, fish, eggs, beans, nut
products)
Fat servings estimated in 24 hours (number/day)
Empty energy servings estimated in 24 hours (number/day)
Estimated percent of meals eaten in 24 hours (percent/day)—defined as the approximate
proportion of all meals in one day that is consumed
Measured amount of food

Grains servings measured in 24 hours (number/day)
Fruits servings measured in 24 hours (number/day)
Vegetable servings measured in 24 hours (number/day)
Milk products servings measured in 24 hours (number/day)
Protein food servings measured in 24 hours (number/day) (eg. meat, poultry, fish, eggs, beans, nut
products)
Fat servings measured in 24 hours (number/day)
Empty energy servings measured in 24 hours (number/day)
Measured percent of meals eaten in 24 hours (percent/day)—defined as the known proportion of
all meals in one day that is consumed
Types of food
Fortified food intake (present/absent)—defined as oral intake of foods with extra nutrients added
(eg, calcium-fortified orange juice)
Enriched food intake (present/absent)—defined as oral intake of foods that contain the nutrients
that were added back after being lost during processing
Special dietary food intake (present/absent)—defined as oral intake of foods that have been
modified for a nutrition purpose, eg, lactose free, gluten free, sugar free, low fat, nut free
Medical food intake (present/absent)—defined as oral intake of foods for a special medical
purpose to manage a nutrition related disease
Processed food intake (present/absent)—defined as oral intake of commercial convenience foods

Quick service food intake (present/absent)—defined as oral intake of fast foods
Self prepared food intake (present/absent)—defined as oral intake of foods prepared by the client
or supportive individuals
Prepared food intake (present/absent)—defined as oral intake of food that is ready to eat, at or
from a restaurant, market, food station, but excludes quick service food
Meal/snack* pattern
Estimated meal and snack pattern
Number of meals estimated in 24 hours (number/day)

Number of snacks estimated in 24 hours (number/day)
Measured meal and snack pattern

Number of meals measured in 24 hours (number/day)
Number of snacks measured in 24 hours (number/day)
Diet (food and beverages) Quality Index
Healthy eating index (HEI) 2015 score—defined as an assessment of how well reported food intake
aligns with the 2015-2020 Dietary Guidelines for Americans
Food variety (present/absent)—defined as consumption of a wide assortment of foods from different food groups
on a regular basis
Note: Liquid meal replacements/supplements are found on the Fluid Intake reference sheet.
* Snack is defined as food served between regular meals.
24-hour recalls, food frequency questionnaire, menu analysis, dietary and physical activity assessment tool (eg,
MyPlate), diet quality index (eg, Healthy Eating Index) or other reference intake standard tool
Typically used with the following domains of nutrition interventions:Food and/or nutrient delivery, nutrition
nutrition action
Excessive or inadequate oral intake, food medication interaction, underweight, overweight/obesity, disordered
eating pattern, unintended weight gain, unintended weight loss, undesirable food choices, limited adherence to
nutrition related recommendations, inability to manage self care, limited access to food, intake of unsafe food,
inadequate or excessive energy, macronutrient or micronutrient intake
Client Example
Example(s) of one (or more) of the Nutrition Care Indicators (includes sample initial and reassessment
Vegetable servings estimated in 24 hours and Fruit servings estimated in 24 hours

1. Reference Standard: Not applicable
2. Recommendation: Client's intake reflects an average of 1 to 2 servings vegetable servings in 24 hours and
1 fruit servings estimated in 24 hours, which is below the Dietary Approaches to Stop Hypertension
(DASH) Eating Plan recommendation of 9 servings of fruits and vegetables per day.
3. Goal: Client’s goal is to increase fruit and vegetable intake to 5 servings per day.
Based on client’s recalls, client’s intake reflects an average of 1-2 vegetable servings estimated in
Initial
24 hours and 1 fruit serving estimated in 24 hours, which is below client goal of 5 servings of
encounter
fruits and vegetables per day. Will monitor fruit and vegetable intake at next encounter.
Reassessment
after nutrition Met goal of increasing fruit and vegetable intake to 5 servings per day.
intervention
References
1. Academy of Nutrition and Dietetics. Evidence Analysis Library: Gestational Diabetes Evidence-Based
Nutrition Guideline. https://www.andeal.org/topic.cfm?menu=5288&cat=5537. Accessed February 4,
2019.
3. European Commission. Food for special medical purposes.
https://ec.europa.eu/food/safety/labelling_nutrition/special_groups_food/medical_en. Accessed February
4, 2019.
4. Food Standards Australia and New Zealand. Food for special medical purposes.
http://www.foodstandards.gov.au/consumer/nutrition/foodspecial/Pages/default.aspx. Accessed February
4, 2019.
6. Krebs-Smith SM, Pannucci TE, Subar AF, et al. Update of the Healthy Eating Index: HEI-2015. J Acad
Nutr Diet. 2018;118(9):1591-1602.
8. National Health and Medical Research Council. Australian Dietary Guidelines Summary. 2013;
https://www.eatforhealth.gov.au/sites/default/files/content/The%20Guidelines/n55a_australian_dietary_gu
idelines_summary_131014_1.pdf. Accessed February 4, 2019.
9. Ogata BN, Hayes D. Position of the Academy of Nutrition and Dietetics: nutrition guidance for healthy
children ages 2 to 11 years. J Acad Nutr Diet. 2014;114(8):1257-1276.
10. US Food and Drug Administration. Medical Foods Guidance Documents & Regulatory Information.
https://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/MedicalFood
s/default.htm. Accessed February 4, 2019.
11. USDA Center for Nutrition Policy and Promotion. MyPlate. https://www.choosemyplate.gov/. Accessed
February 4, 2019
2020 EDITION
12/15/21, 9:13 AM Breastmilk*/Infant Formula Intake
BREASTMILK*/INFANT FORMULA INTAKE
Breastmilk*/Infant Formula Intake (FH-1.2.3)

Definition
Amount of breastmilk, and/or the amount of infant formula consumed orally

Indicators
Breastmilk intake
Breastmilk feeding attempts in 24 hours (number/day)

Adequacy of breastmilk intake (inadequate, adequate, excessive)
Donor breastmilk intake (yes/no)—defined as human milk expressed from a woman’s breast to
feed an infant that is not the donor’s infant
Mother’s expressed breastmilk intake (yes/no)—defined as human milk expelled from the
mother’s breast to feed her own infant
Estimated breastmilk intake
Breastmilk intake estimated volume in 24 hours (mL/day)—defined as the approximate
intake in one day of breastmilk
Breastmilk intake estimated volume per kg in 24 hours (mL/kg/day)—defined as the
approximate intake per kg of body weight in one day of breastmilk
Measured breastmilk intake
Breastmilk intake measured volume in 24 hours (mL/day)—defined as the known quantity
of intake in one day of breastmilk
Breastmilk intake measured volume per kg in 24 hours (mL/kg/day)—defined as the known
quantity of intake per kg of body weight in one day of breastmilk
Infant formula intake (oz or mL/day)
Infant formula feedings in 24 hours (number/day)

Adequacy of infant formula intake (inadequate, adequate, excessive)
Infant formula intake composition (eg, cow’s milk, soy-based)—defined as the formula
characteristics and components
Infant formula intake concentration (calories/oz, kcal/mL)—defined at the energy density of the
infant formula
Estimated infant formula intake
Infant formula intake estimated volume in 24 hour (mL/day)—defined as the approximate
intake in one day of infant formula
Infant formula intake estimated volume per kg in 24 hours (mL/kg/day)—defined as the
approximate intake per kg of body weight in one day of infant formula
Measured infant formula intake
Infant formula intake measured volume in 24 hour (mL/day)—defined as the known
quantity of intake in one day of infant formula
Infant formula intake measured volume per kg in 24 hours (mL/kg/day)—defined as the
known quantity of intake per kg of body weight in one day of infant formula
Note: Breastfeeding ability and capacity can be found on the Breastfeeding Assessment reference
sheet.
Weight change can be found on the Body Composition/Growth/Weight History reference sheet.
Number of wet diapers per day can be found on the Urine Profile reference sheet.
Number/consistency of bowel movements can be found on the Nutrition-Focused Physical Exam

reference sheet.
If provided via tube use the Enteral and Parenteral Nutrition Intake reference sheet.
Examples of the measurement methods or data sources for these outcome indicators: Intake records, 24-
hour recalls, usual intake recalls, observation of feeding (bottle or breast), pre and post breastfeeding infant
weights.
Typically used to determine and monitor and evaluate change in the following nutrition
diagnoses: Underweight, overweight, unintended weight gain, unintended weight loss, growth rate less than
expected, limited adherence to nutrition-related recommendations, inadequate or excessive energy intake,
inadequate or excessive oral or fluid intake
*If a synonym for the term “breastmilk” is helpful or needed, an approved alternate is “human milk.”
Client Example
Example of one of the Nutrition Care Indicators (includes sample initial and reassessment documentation for one
of the indicators)
Indicator Selected
Infant formula intake volume estimated in 24 hours (mL/day)

1. Reference Standard:Client's infant formula volume estimated in 24 hours averages 410 mL (100 mL/kg
body). This is below the reference standard of 150 mL/kg/day to support adequate growth.
2. Recommendation: Not applicable
3. Goal: Client currently consumes approximately 100 mL/kg/kg body weight infant formula per day.
Client's goal is to increase intake to 150 mL/kg per day.
Based on mother’s recalls, infant formula intake volume estimated in 24 hours is

Initial nutrition assessment 410 mL (100 mL/kg/day), 33% below the reference standard of 150 mL/kg per day.
Will monitor formula intake at next encounter.
Significant progress toward goal of consuming 150 mL/kg per day. Based on
Reassessment after
mother’s records, infant formula intake volume estimated in 24 hours has increased
to approximately 575 mL (140 mL/kg/day) over the past 7 days.
References
1. Academy of Nutrition and Dietetics. Pediatric Nutrition Care Manual.

https://www.nutritioncaremanual.org/. Accessed February 19, 2019.
2. Lessen R, Kavanagh K. Position of the Academy of Nutrition and Dietetics: Promoting and supporting
breastfeeding. J Acad Nutr Diet. 2015;115(3):444-449.
3. Martins-Celini FP, Gonçalves-Ferri WA, Aragon DC, et al. Association between type of feeding at
discharge from the hospital and nutritional status of very low birth weight preterm infants. Brazilian
journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas.
2018;51(3):1-6.
4. Newkirk M, Shakeel F, Parimi P, et al. Comparison of calorie and protein intake of very low birth weight
infants receiving mother's own milk or donor milk when the nutrient composition of human milk Is
measured with a breast milk analyzer. Nutr Clin Pract. 2018;33(5):679-686.
5. Quigley M, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight
infants. The Cochrane database of systematic reviews. 2014(4):Cd002971.
6. Swerts M, Westhof E, Bogaerts A, Lemiengre J. Supporting breast-feeding women from the perspective
of the midwife: A systematic review of the literature. Midwifery. 2016;37:32-40.
7. Van Ginkel CD, van der Meulen GN, Bak E, et al. Retrospective observational cohort study regarding the
effect of breastfeeding on challenge-proven food allergy. Eur J Clin Nutr. 2018;72(4):557-563.
2020 EDITION
12/15/21, 9:16 AM Enteral Nutrition Intake
ENTERAL NUTRITION INTAKE
Food/Nutrition-Related History Domain – Enteral/Parenteral Nutrition
Enteral Nutrition Intake (FH-1.3.1)

Definition
Amount or type of enteral nutrition provided via a tube.
Press; 2000.)

Indicators
Enteral nutrition formula/solution (specify)
Enteral nutrition formula composition (formula)

Enteral nutrition formula concentration (calories/kcal/kJ in each mL)
Enteral nutrition formula estimated volume in 24 hours (mL/day)
Enteral nutrition formula measured volume in 24 hours (mL/day)
Enteral tube feeding flush estimated volume in 24 hours (mL/day)
Enteral tube feeding flush measured volume in 24 hours (mL/day)
Note: Enteral nutrition tolerance can be found on the Physical Exam reference sheet and/or the pertinent
biochemical/sign or symptom reference sheet.
Examples of the measurement methods or data sources for these outcome indicators: Client report/recalls,
patient/client record, home evaluation, intake and output record
education, coordination of nutrition care by nutrition professional
Inadequate or excessive intake of enteral nutrition, inadequate fluid intake, food medication interaction,
unintended weight loss or gain
Client Example
of the indicators)
Indicator Selected
Enteral nutrition formula volume in 24 hours (mL/day)

Comparison to Goal or Reference Standard:
1. Reference-Standard: Not applicable

12/15/21, 9:16 AM Enteral Nutrition Intake
2. Recommendation: Client’s enteral nutrition formula volume in 24 hours meets the nutrition prescription
of 80 mL/hour in 24 hours.
3. Goal: Not applicable
Enteral nutrition formula volume in 24 hours meets 60% of recommended volume

Initial nutrition assessment for 24 hours. Increase enteral nutrition rate tored 80 mL/hour. Monitor enteral
nutrition rate advancement.
Enteral nutrition formula volume in 24 hours meeting 85% estimated need. Progress
Reassessment after
toward nutrition prescription of 1 calorie or kcal per mL at 80 mL per hour in 24
hours.
References
The following are some suggested references for indicators, measurement techniques, and reference standards;
other references may be appropriate.
1. Charney P, Malone A. ADA Pocket Guide to Nutrition Assessment. 3rd ed. Chicago, IL: American
Dietetic Association; 2015.
2. Academy of Nutrition and Dietetics. Nutrition Care Manual. www.nutritioncaremanual.org. Accessed
December 17, 2017.
3. Centers for Medicare and Medicaid Services. National coverage determination (NCD) for enteral and
parenteral nutrition therapy. http://www.cms.hhs.gov/mcd/viewncd.asp?
ncd_id=180.2&ncd_version=1&basket=ncd%3A180%2E2%3A1%3AEnteral+and+Parenteral+Nutritiona
l+Therapy. Accessed May 3, 2018.
4. Compher C, Frankenfield D, Keim N, Roth-Yousey L. Best practice methods to apply to measurement of
resting metabolic rate in adults: A systematic review. J Am Diet Assoc. 2006;106:881-903.
5. Kovacevich DS, Frederick A, Kelly D, Nishikawa R, Young L. American Society for Parenteral and
Enteral Nutrition Board of Directors, Standards for Specialized Nutrition Support Task Force. Standards
for specialized nutrition support: home care patients. Nutr Clin Pract. 2005;20:579-590.
6. Steiger E, HPEN Working Group. Consensus statements regarding optimal management of home
parenteral nutrition (HPN) access. J Parenter Enteral Nutr. 2006;30(1 Suppl):S94-S95.
2020 EDITION
12/15/21, 9:17 AM Parenteral Nutrition Intake
PARENTERAL NUTRITION INTAKE
Food/Nutrition-Related History Domain – Enteral/Parenteral Nutrition
Parenteral Nutrition Intake (FH-1.3.2)

Definition
Amount or type of parenteral nutrition and/or fluids provided intravenously.
Press; 2000.)

Indicators
Parenteral nutrition formula/solution (specify)
Composition (formula or description)

Concentration (eg, percent, grams of solute per mL)
Rate (eg, mL/hour)
Schedule (eg, hours, timing, taper schedule)
Intravenous fluids, eg, type; amount mL/day, mL/hr, mL with medications
Note: Parenteral nutrition tolerance can be accomplished with the Physical Exam Reference sheet and/or
the pertinent biochemical/sign or symptom reference sheet.
client record, home evaluation, intake and output record
Inadequate or excessive intake of parenteral nutrition, inadequate fluid intake, food–medication interaction,
unintended weight loss or gain
Judgment must be used to select indicators and determine the appropriate measurement techniques and reference
standards for a given client population and setting. Once identified, these indicators, measurement techniques,
and reference standards should be identified in policies and procedures or other documents for use in client
records, quality or performance improvement, or in formal research projects.

1. Goal (tailored to patient/client’s needs)

OR
2. Reference Standard
Client Example
Example(s) of one or two of the Nutrition Care Indicators (includes sample initial and reassessment
Rate/schedule (mL/hour × number of hours)

1. Goal: Patient/client’s parenteral nutrition formula is at a rate of 50 mL per hour × 24 hours of standard
solution compared to the nutrition prescription of 80 mL/hour × 24 hours to meet estimated nutrition
requirements.
OR
2. Reference Standard: There is no reference standard for this outcome as the provision of EN/PN is
individualized.
Sample Nutrition Assessment Documentation
Parenteral nutrition formula rate of 25 mL per hour × 24 hours of standard solution

Initial nutrition assessment
compared to the nutrition prescription of 80 mL/hour to meet estimated nutrition
with client
requirements. Monitor nutrition initiation and rate advancement.
Reassessment after Parenteral nutrition formula at 70 mL per hour × 24 hours. Significant progress
nutrition intervention toward nutrition prescription of 80 mL per hour × 24 hours.
References
1. Charney P, Malone A. ADA Pocket Guide to Nutrition Assessment. 2nd ed. Chicago, IL: American
June 17, 2015.
3. Cavicchi M, Philippe Beau P, Crenn P, Degott C, Messing B. Prevalence of liver disease and contributing
factors in patients receiving home parenteral nutrition for permanent intestinal failure. Intern Med.
2000;132:525-532.
4. Centers for Medicare and Medicaid Services. National coverage determination (NCD) for enteral and
parenteral nutrition therapy. http://www.cms.hhs.gov/mcd/viewncd.asp?
ncd_id=180.2&ncd_version=1&basket=ncd%3A180%2E2%3A1%3AEnteral+and+Parenteral+Nutritiona
l+Therapy. Accessed June 17, 2015.
resting metabolic rate in adults: a systematic review. J Am Diet Assoc. 2006;106:881-903.
6. American Society for Parenteral and Enteral Nutrition Board of Directors and the Clinical Guidelines
Task Force. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients:
administration of specialized nutrition support—issues unique to pediatrics. J Parenter Enteral Nutr.
2002;26(Suppl):S97-S110.
specific guidelines for disease—adults. J Parenter Enteral Nutr. 2002;26(Suppl):S61-S96.
specific guidelines for disease—pediatrics. J Parenter Enteral Nutr. 2002;26(Suppl):S111-S138.
Task Force. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients: Life
cycle and metabolic conditions. J Parenter Enteral Nutr. 2002;26(Suppl):S45-S60.
10. Kovacevich DS, Frederick A, Kelly D, Nishikawa R, Young L. American Society for Parenteral and
Enteral Nutrition Board of Directors, Standards for Specialized Nutrition Support Task Force. Standards

http://peds.nutritioncaremanual.org. Accessed June 17, 2015.
2020 EDITION
12/15/21, 9:21 AM Alcohol Intake
ALCOHOL INTAKE
Food/Nutrition-Related History – Bioactive Substances
Alcohol Intake (FH-1.4.1)

Definition
Amount and pattern of alcohol (ethanol) consumption

Indicators
Alcohol intake in one week (g/week)—defined as the approximate intake over seven days of all sources
of alcohol
Alcohol intake in 24 hours (g/day)—defined as the approximate intake in one day of all sources of
alcohol
Beer intake in 24 hours (mL/day)—defined as the approximate intake in one day of beer
Distilled alcohol intake in 24 hours (mL/day)—defined as the approximate intake in one day of
distilled alcohol
Wine intake in 24 hours (mL/day)—defined as the approximate intake in one day of wine
Hard cider intake in 24 hours (mL/day)—defined as the approximate intake in one day of cider
that contains alcohol
Days per week alcoholic drinks consumed (number)—defined as usual or average number of days per
week when alcohol containing drinks are consumed
Alcohol intake pattern on drinking days (number)—defined as the typical number of standard alcohol
containing drinks on a drinking day
Note: One alcohol containing drink is defined differently in countries around the world, with countries
using grams, ounces, milliliters, and units. Where applicable in this reference sheet, one standard alcohol
containing drink equals 10 g of pure alcohol (ethanol). Professionals need to refer to guidelines in their
respective countries to determine the alcohol content of one standard alcohol containing drink.
self-monitoring log
Typically used with the following domains of nutrition interventions: Nutrition education, nutrition
counseling, coordination of nutrition care by a nutrition professional, population based nutrition action
diagnoses: Excessive intake of alcohol, excessive or inadequate intake of energy, altered nutrition-related
laboratory values, impaired nutrient utilization, overweight/obesity
Client Example
12/15/21, 9:21 AM Alcohol Intake
Alcohol intake pattern on drinking days (number)

1. Reference Standard: Refer to country standards, if present, for alcohol reference standards.
2. Recommendation: Client’s intake of three to four standard alcohol drinks on drinking days is significantly
above the recommendation of one standard alcohol drink per day for adult females.
3. Goal: Client established a goal to reduce standard alcohol drink intake to one standard alcohol drink per
day.
Based on recalls, client’s Alcohol intake pattern on drinking days is three to four standard alcohol
Initial drinks, which is above the recommended amount for adult females. Client established goal to
encounter reduce intake to one standard alcohol drink on drinking days. Will monitor change in alcohol intake
at next encounter
Reassessme
nt after Progress toward goal. Alcohol intake pattern on drinking days, based on multiple 7-day records, is
nutrition approximately two standard alcohol drinks on drinking days.
intervention
References
1. National Institutes of Health. National Institute on Alcoholism and Alcohol Abuse. National Council on
Alcohol Abuse and Alcoholism Recommended Sets of Alcohol Consumption Questions.
https://www.niaaa.nih.gov/research/guidelines-and-resources/recommended-alcohol-questions. Accessed
February 26, 2019.
2. National Institutes of Health. National Institute on Alcoholism and Alcohol Abuse. What is a standard
drink? https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/what-standard-drink.
3. Sobell LC, Sobell MB. Alcohol consumption measures.
https://pubs.niaaa.nih.gov/publications/AssessingAlcohol/sobell.pdf. Accessed February 27, 2019.
5. World Health Organization. Management of substance abuse.
https://www.who.int/substance_abuse/publications/alcohol/en/. Accessed February 27, 2019.
2020 EDITION
12/15/21, 9:21 AM Bioactive Substance Intake
BIOACTIVE SUBSTANCE INTAKE
Bioactive Substance Intake (FH-1.4.2)

Definition
Amount and type of bioactive substances consumed
Note: Bioactive substances are not part of the Dietary Reference Intakes, and therefore there are no
established minimum requirements or Tolerable Upper Intake Levels. However, RDNs can assess whether
estimated intakes are adequate or excessive using the client goal or nutrition prescription for
comparison.
Working definition of bioactive substances—physiologically active components of foods that may have an
effect on health. There is no scientific consensus about a definition for bioactive substances/components.

Indicators
Estimated bioactive substance intake
Plant stanol ester estimated intake in 24 hours (g/day)—defined as the approximate intake in one day of
plant stanol esters
Plant sterol ester estimated intake in 24 hours (g/day)—defined as the approximate intake in one day of
plant sterol esters
Soy protein estimated intake in 24 hours (g/day)—defined as the approximate intake in one day of soy
protein
Psyllium estimated intake in 24 hours (g/day)—defined as the approximate intake in one day of psyllium
Beta glucan estimated intake in 24 hours (g/day)—defined as the approximate intake in one day of beta
glucan
Measured bioactive substance intake
Plant stanol ester measured intake in 24 hours (g/day)—defined as the known quantity of intake in one
day of plant stanol esters
Plant sterol ester measured intake in 24 hours (g/day)—defined as the known quantity of intake in one
day of plant sterol esters
Soy protein measured intake in 24 hours (g/day)—defined as the known quantity of intake in one day of
soy
protein
Psyllium measured intake in 24 hours (g/day)—defined as the known quantity of intake in one day of
psyllium
Beta glucan measured intake in 24 hours (g/day)—defined as the known quantity of intake in one day of
beta glucan
Food additives intake (those thought to have an effect on a client’s health); specify
High intensity sweetener additive intake
Excessive high intensity sweetener additive intake (present/absent)—defined as intake above the
recommended acceptable daily intake (ADI) of high intensity sweeteners the contain nutritive and
nonnutritive sugar substitutes
self monitoring log
counseling, population based nutrition action
diagnoses: Inadequate or excessive intake of bioactive substances, food medication interaction
Client Example
of the indicators)
Indicator Selected
Plant sterol ester estimated intake in 24 hours (g/day)

1. Reference Standard:Not applicable

2. Recommendation: Client does not consume plant sterol esters compared to the recommended intake of 2
to 3 grams per day.
3. Goal: Client established a goal to consume approximately 2 g of plant sterol esters per day 5 of 7 days per
week.
Based on recalls, client consuming 0 gramsof plant sterol ester per day. Goal intake
Initial assessment of 2 g per day 5 out of 7 days per week established. Will monitor change in plant
sterol ester intake at next encounter.
Good progress toward the goal of 2 g per day 5 out of 7 days per week of plant
Reassessment after
sterol ester. Based on diet records, plant sterol ester estimated intake in 24 hours is
approximately 2 g per day 2 to 3 days per week.
References
1. Academy of Nutrition and Dietetics. Evidence Analysis Library: Disorders of Lipid Metabolism.
https://www.andeal.org/topic.cfm?menu=5300. Accessed February 4, 2019.
2. Academy of Nutrition and Dietetics. Evidence Analysis Library-GDM: Non-nutritive sweeteners. 2008;
https://www.andeal.org/topic.cfm?
cat=3037&highlight=nonnutritive%20sweetener&evidence_summary_id=250587&home=1%2E.
3. Academy of Nutrition and Dietetics. Evidence Analysis Library. Gestational Diabetes Mellitus
Conclusion Statements: Carbohydrate (2001). https://www.andeal.org/topic.cfm?
highlight=nonnutritive%20sweetener&home=1&evidence_summary_id=250309&cat=3820. Accessed
February 27, 2019.
4. Academy of Nutrition and Dietetics. Evidence Analysis Library-Nutritive and Non-Nutritive Sweeteners.
2010-2011; https://www.andeal.org/topic.cfm?menu=5307. Accessed February 4, 2019.
5. Briggs Early K, Stanley K. Position of the Academy of Nutrition and Dietetics: The Role of Medical
Nutrition Therapy and Registered Dietitian Nutritionists in the Prevention and Treatment of Prediabetes
and Type 2 Diabetes. J Acad Nutr Diet. 2018;118(2):343-353.
6. Crowe KM, Francis C. Position of the Academy of Nutrition and Dietetics: Functional foods. J Acad Nutr
Diet. 2013;113(8):1096-1103.
7. European Commission. Food improvement agents: Additives.
https://ec.europa.eu/food/safety/food_improvement_agents/additives_en. Accessed February 4, 2019.
8. US Food and Drug Administration. Overview of Food Ingredients, Additives and Colors.
https://www.fda.gov/Food/IngredientsPackagingLabeling/FoodAdditivesIngredients/ucm094211.htm.
2020 EDITION
12/15/21, 9:21 AM Caffeine Intake
CAFFEINE INTAKE
Caffeine Intake (FH-1.4.3)

Definition
Amount of caffeine intake from all sources including food, beverages, supplements, medications, and via enteral
and parenteral routes

Indicators
Total caffeine estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day of
caffeine
Total caffeine measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one day
of caffeine
self monitoring log
counseling
Typically used to determine and monitor and evaluate change in the following nutrition diagnoses: Food
and nutrition-related knowledge deficit
Client Example
of the indicators)
Indicator Selected
Total caffeine estimated intake in 24 hours (mg/day)

1. Reference Standard：Client’s intake is approximately 600 mg of caffeine per day, which is above the
reference standard of 400 mg caffeine/day.
3. Goal: Client’s total caffeine estimated intake in 24 hours is above the goal the client established of less
than 400 mg caffeine/day.
Based on recalls, client total caffeine estimated intake in 24 hours is 600 mg of

caffeine/day, which is above the reference standard of 400 mg/day. Will monitor
with client
change in caffeine intake at next encounter.
Reassessment after No progress toward the client’s goal of 400 mg of caffeine/day. Based on diet
12/15/21, 9:21 AM Caffeine Intake
nutrition intervention records, client still consuming 600 mg of caffeine/day.
References
1. McCusker RR, Goldberger BA, Cone EJ. Caffeine content of specialty coffees. J Anal Toxicol.
2003;27(7):520-522.
2. McCusker RR, Goldberger BA, Cone EJ. Caffeine content of energy drinks, carbonated sodas, and other
beverages. J Anal Toxicol. 2006;30(2):112-114.
3. Institute of Medicine. Caffeine in food and dietary supplements: Examining safety: Workshop summary.
Washington, DC: National Academies Press. 2014.
4. Nawrot P, Jordan S, Eastwood J, Rotstein J, Hugenholtz A, Feeley M. Effects of caffeine on human
health. Food Addit Contam. 2003;20(1): 1-30.
5. Winkelmayer WC, Stampfer MJ, Willett WC, Curhan, GC. Habitual caffeine intake and the risk of
hypertension in women. JAMA.2005;294(18):2330-2335.
2020 EDITION
12/15/21, 9:23 AM Fat Intake
FAT INTAKE
Food/Nutrition-Related History – Macronutrient Intake
Fat Intake (FH-1.5.1)

Definition
Fat consumption from all sources including food, beverages, supplements, and via enteral and parenteral routes
Press; 2000.)

Indicators
Estimated fat intake
Total fat estimated intake in 24 hours (g/day)—defined as the approximate intake in one day of all types
of fat
Saturated fat estimated intake in 24 hours (g/day)—defined as the approximate intake in one day of a fat
that has no double bonds between carbon molecules
Trans fatty acid estimated intake in 24 hours (g/day)—defined as the approximate intake in one day of an
unsaturated fatty acid that is hydrogenated with the trans arrangement of the hydrogen atoms adjacent to
its double bonds
Polyunsaturated fat estimated intake in 24 hours (g/day)—defined as the approximate intake in one day of
a fatty acid that contains more than one double bond
Linoleic acid (LA) estimated intake in 24 hours (g/day)—defined as the approximate intake in one
day of a polyunsaturated, omega 6 and essential fatty acid with an 18 carbon chain length and two
cis double bonds (18:2)
Monounsaturated fat estimated intake in 24 hours (g/day)—defined as the approximate intake in one day
of a fatty acid with one unsaturated (double) carbon bond
Omega 3 fatty acid estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day
of a polyunsaturated fatty acid with a double bond at the third carbon atom from the methyl end of the
carbon chain
Alpha linolenic acid estimated intake in 24 hours (mg/day)--defined as the approximate intake in
one day of a polyunsaturated and essential omega 3 fatty acid with an 18-carbon chain and three
cis double bonds (18:3)
Eicosapentaenoic acid (EPA) estimated intake in 24 hours (mg/day)—defined as the approximate
intake in one day of a polyunsaturated, omega 3 fatty acid with a 20-carbon chain and five cis
double bonds
Docosahexaenoic acid estimated intake in 24 hours (mg/day)—defined as the approximate intake
in one day of a polyunsaturated, omega 3 fatty acid with a 22-carbon chain and six cis double
bonds
Essential fatty acid estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day
of a fatty acid (Linoleic acid [18:2] and Alphalinolenic acid [18:3]) that must be provided in the diet or
enteral or parenteral nutrition because the human body cannot synthesize it
12/15/21, 9:23 AM Fat Intake
Medium chain triglyceride estimated intake in 24 hours (g/day—defined as the approximate intake in one
day of a triglyceride molecule with fatty acids having a carbon chain length of 6-12
Fat estimated intake in one meal (g/meal)—defined as the approximate intake in one meal of all types of
fat
Percent saturated fat estimated intake in 24 hours (percent/day)—defined as the approximate energy
intake in one day from fat that has no double bonds between carbon molecules as a portion of total energy
intake
Fat estimated intake from oral nutrition in 24 hours (g/day)—defined as the estimated intake of fat in
grams in one day derived from oral intake
Fat estimated intake from enteral nutrition in 24 hours (g/day)—defined as the estimated intake of fat in
grams in one day derived from enteral nutrition infusion
Fat estimated intake from parenteral nutrition in 24 hours (g/day)—defined as the estimated intake of fat
in grams in one day derived from parenteral nutrition infusion
Fat estimated intake from intravenous fluids in 24 hours (g/day)—defined as the estimated intake of fat in
grams in one day derived from intravenous fluid (IV) infusion
Fat additive estimated intake in 24 hours (mL/day)—defined as the approximate intake in one day of fat
additive
Percent fat estimated intake in 24 hours (percent/day)—defined as the approximate energy intake in one
day from fat intake
Measured fat intake
Total fat measured intake in 24 hours (g/day)—defined as the known quantity of intake in one day of all
types of fat
Saturated fat measured intake in 24 hours (g/day)—defined as the known quantity of intake in one day of
a fat that has no double bonds between carbon molecules
Trans fatty acid measured intake in 24 hours (g/day)—defined as the known quantity of intake in one day
of an unsaturated fatty acid that is hydrogenated with the trans arrangement of the hydrogen atoms
adjacent to its double bonds
Polyunsaturated fat measured intake in 24 hours (g/day)—defined as the known quantity of intake in one
day of a fatty acid that contains more than one double bond
Linoleic acid (LA) measured intake in 24 hours (g/day)—defined as the known quantity of intake
in one day of a polyunsaturated, omega 6 and essential fatty acid with an 18 carbon chain length
and two cis double bonds (18:2)
Monounsaturated fat measured intake in 24 hours (g/day)—defined as the known quantity of intake in
one day of a fatty acid with one unsaturated (double) carbon bond
Omega 3 fatty acid measured intake in 24 hours (mg/day)—defined as the known quantity of intake in
one day of a polyunsaturated fatty acid with a double bond at the third carbon atom from the methyl end
of the carbon chain
Alpha linolenic acid measured intake in 24 hours (mg/day)--defined as the known quantity of
intake in one day of a polyunsaturated and essential omega 3 fatty acid with an 18-carbon chain
and three cis double bonds (18:3)
Eicosapentaenoic acid (EPA) measured intake in 24 hours (mg/day)—defined as the known
quantity of intake in one day of a polyunsaturated, omega 3 fatty acid with a 20-carbon chain and
five cis double bonds
Docosahexaenoic acid (DHA) measured intake in 24 hours (mg/day)—defined as the known
quantity of intake in one day of a polyunsaturated, omega 3 fatty acid with a 22-carbon chain and
12/15/21, 9:23 AM Fat Intake
six cis double bonds
Essential fatty acid measured intake in 24 hours (mg/day)—defined as the known quantity of intake in
one day of a fatty acid (Linoleic acid [18:2] and Alphalinolenic acid [18:3]) that must be provided in the
diet or enteral or parenteral nutrition because the human body cannot synthesize it
Medium chain triglyceride measured intake in 24 hours (g/day)—defined as the known quantity of intake
in one day of a triglyceride molecule with fatty acids having a carbon chain length of 6-12
Fat measured intake in one meal (g/meal)—defined as the known quantity of intake in one meal of all
types of fat
Percent saturated fat measured intake in 24 hours (percent/day)—defined as the known quantity of intake
in one day of fat that has no double bonds between carbon molecules as a portion of total energy intake
Fat measured intake from oral nutrition in 24 hours (g/day)—defined as the known quantity of intake of
fat in grams in one day derived from oral intake
Fat measured intake from enteral nutrition in 24 hours (g/day)—defined as the known quantity of intake
of fat in grams in one day derived from enteral nutrition infusion
Fat measured intake from parenteral nutrition in 24 hours (g/day)—defined as the known quantity of
intake of fat in grams in one day derived from parenteral nutrition infusion
Fat measured intake from intravenous fluids in 24 hours (g/day)—defined as the known quantity of intake
of fat in grams in one day derived from intravenous fluid (IV) infusion
Fat additive measured intake in 24 hours (mL/day)—defined as the known quantity of intake in one day
of fat additive
Percent fat measured intake in 24 hours (percent/day)—defined as the known quantity of energy intake in
one day from fat intake
Note: Plant sterol and stanol esters can be found on the Bioactive Substance Intake Reference sheet.
24-hour recalls, food frequency questionnaires, qualitative intake assessment, menu analysis, fat and cholesterol
targeted questionnaires and monitoring devices
education, nutrition counseling
Typically used to determine and to monitor and evaluate change in the following nutrition diagnoses: Inadequate
and excessive fat intake, intake of types of fats inconsistent with needs, overweight/obesity, altered nutrition-
related lab values, altered food and nutrition-related knowledge deficit
Client Example
Example(s) of one of the Nutrition Care Indicators (includes sample initial and reassessment documentation for
Indicator Selected
Total fat estimated intake in 24 hours (g/day)

12/15/21, 9:23 AM Fat Intake

3. Goal: Client's total fat estimated intake in 24 hours is 120 g. Client's goal is to decrease total fat estimated
intake in 24 hours to less than 80 g.
Based on food diary, client’s total fat estimated intake in 24 hours is 120 g. Client’s
Initial encounter goal is to decrease total fat estimated intake in 24 hours to less than 80 g. Will
monitor fat intake at next appointment.
Significant progress toward the goal intake of less than 80 g of total fat estimated
Reassessment after intake in 24 hours. Based on food diary client’s total fat estimated intake in 24 hours
nutrition intervention decreased from 120g to 85 g of fat in one day. Will continue to monitor progress at
next encounter in 6 weeks.
References

2. Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guideline on lifestyle management to reduce
cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task
Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S76-99.
February 20, 2019.
2020 EDITION
12/15/21, 9:23 AM Cholesterol Intake
CHOLESTEROL INTAKE
Cholesterol Intake (FH-1.5.2)

Definition
Dietary cholesterol consumption from all sources including food, beverages, supplements, and via enteral and
parenteral routes
Note: Whenever possible, nutrient intake data should be considered in combination with clinical, biochemical,
anthropometric information, medical diagnosis, clinical status, and/or other factors to provide a valid
assessment of nutritional status based on a totality of the evidence. (Institute of Medicine. Dietary Reference
Intakes: Applications in Dietary Assessment. Washington, DC: National Academies Press; 2000.)

Indicators
Cholesterol estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day of
cholesterol
Cholesterol measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one day of
cholesterol
Note: Plant sterol and stanol esters can be found on the Bioactive Substance Intake Reference sheet.
24-hour recalls, food frequency questionnaires, qualitative intake assessment, menu analysis, fat and cholesterol
targeted questionnaires and monitoring devices
diagnoses: Excessive fat intake, excessive cholesterol intake, overweight/obesity, altered nutrition related lab
values, altered food and nutrition-related knowledge deficit
Client Example
Indicator Selected
Cholesterol estimated intake in 24 hours (mg/day)


2. Recommendation:Not applicable
3. Goal: Client cholesterol estimated intake is 24 hours is 350 mg/day. Client’s goal is to decrease intake to
within Healthy US-Style Eating Pattern (100-300 mg/day).
12/15/21, 9:23 AM Cholesterol Intake
Based on food diary, client’s cholesterol estimated intake in 24 hours is 350 mg/day.
Initial nutrition assessment Client’s goal is to reduce cholesterol estimated intake in 24 hours to 100-300
mg/day. Will monitor cholesterol intake at next appointment.
Progress toward the goal of 100-300 mg/day of cholesterol. Based on food diary,
Reassessment after
client’s cholesterol estimated intake in 24 hours decreased from 350 mg/day to 250
mg/day. Will continue to monitor progress at next encounter in 6 weeks.
References
1. Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Energy, Carbohydrate,
Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids. Washington, DC: National Academies
Press; 2002.
2. US Department of Health and Human Services and US Department of Agriculture. 2015-2020 Dietary
February 9, 2018.
4. Academy of Nutrition and Dietetics. Evidence Analysis Library: Disorders of Lipid Metabolism.
5. Stone NJ, Robinson J, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood
cholesterol to reduce atherosclerotic cardiovascular risk in adults: A report of the American College of
Cardiology/American Heart Association. J Am Coll Cardiol. 2014;63(25 Pt B):2889-2934.
6. Van Horn L, McCoin M, Kris-Etherton PM, et al. The evidence for dietary prevention and treatment of
cardiovascular disease. J Am Diet Assoc. 2008;108(2):287-331.
2020 EDITION
12/15/21, 9:25 AM Protein Intake
PROTEIN INTAKE
Protein Intake (FH-1.5.3)

Definition
Protein intake from all sources including food, beverages, supplements, and via enteral and parenteral routes.
Press; 2000.)

Indicators
Estimated protein intake
Total protein estimated intake in 24 hours (g/day)—defined as the approximate intake in one day of all
protein
High biological value protein estimated intake in 24 hours (g/day)—defined as the approximate intake in
one day from proteins which contain a ratio of essential amino acids that are needed for humans
Casein estimated intake in 24 hours (g/day)—defined as the approximate intake in one day from the
phosphoprotein component in milk and milk products that can also be an ingredient in food
Whey estimated intake in 24 hours (g/day)—defined as the approximate intake in one day of the complete
protein component in milk and milk products that can also be an ingredient in food
Gluten estimated intake in 24 hours (g/day)—defined as the approximate intake in one day of the protein
found primarily in cereal grains and contains gliadin and a glutenin
Protein estimated intake per kg in 24 hours (g/kg/day)—defined as the approximate intake per kg of body
weight in one day of all protein
Natural protein estimated intake in 24 hours (specify, g/day)—defined as the approximate intake of the
portion of total protein that comes from food sources
Protein estimated intake in one meal (g/meal)—defined as the approximate intake in one meal of all types
of protein
Percent protein estimated intake in 24 hours (percent/day)—defined as the approximate intake in one day
from protein intake
Protein estimated intake from oral nutrition in 24 hours (specify, g/day)—defined as the approximate
intake of protein in grams per day derived from oral intake
Protein estimated intake from enteral nutrition in 24 hours (specify, g/day)—defined as the approximate
intake of protein in grams per day derived from intact or semi-elemental protein enteral nutrition infusion
Protein additive estimated intake in 24 hours (g/day and mL/day)—defined as the approximate intake in
one day of protein additive
Measured protein intake
Total protein measured intake in 24 hours (g/day)—defined as the known quantity of intake in one day of
all protein
High biological value protein measured intake in 24 hours (g/day)—defined as the known quantity of
intake in one day from proteins which contain a ratio of essential amino acids that are needed for humans
Casein measured intake in 24 hours (g/day)—defined as the known quantity of intake in one day from the
phosphoprotein component in milk and milk products that can also be an ingredient in food
Whey measured intake in 24 hours (g/day)—defined as the known quantity of intake in one day of the
complete protein component in milk and milk products that can also be an ingredient in food
Gluten measured intake in 24 hours (g/day)—defined as the known quantity of intake in one day of the
protein found primarily in cereal grains and contains gliadin and a glutenin
Protein measured intake in 24 hours (g/kg/day)—defined as the known quantity of intake per kg of body
weight in one day of all protein
Natural protein measured intake in 24 hours (specify, g/day)—defined as the known quantity of intake of
the portion of total protein that comes from food sources
Protein measured intake in one meal (g/meal)—defined as the known quantity of intake in one meal of all
types of protein
Percent protein measured intake in 24 hours (percent/day)—defined as the known quantity of intake in
one day from protein intake
Protein measured intake from oral nutrition in 24 hours (specify, g/day)—defined as the known quantity
of intake of protein in grams per day derived from oral intake
Protein measured intake from enteral nutrition in 24 hours (specify, g/day)—defined as the known
quantity of intake of protein in grams per day derived from intact or semi-elemental protein enteral
nutrition infusion
Protein additive measured intake in 24 hours (g/day and mL/day)—defined as the known quantity of
intake in one day of protein additive
Note: Soy protein can be found on the Bioactive Substance Intake reference sheet. Amino acid intake from
elemental enteral nutrition, parenteral nutrition, or intravenous (IV) fluids can be documented using
terms on the Amino Acid Intake (FH-1.5.4) reference sheet.
24-hour recalls, food frequency questionnaires, qualitative protein intake collection tools, nutrition fact labels,
other product information, nutrient composition tables
diagnoses: Inadequate and excessive protein intake, intake of types of proteins or amino acids inconsistent with
needs, malnutrition, inadequate protein-energy intake, altered GI function, limited adherence to nutrition-related
recommendations
Judgment must be used to select indicators and determine the appropriate measurement techniques and reference
standards for a given client population and setting. Once identified, these indicators, measurement techniques,
and reference standards should be identified in policies and procedures or other documents for use in client
records, quality or performance improvement, or in formal research projects.
Client Example
Indicator Selected
Total protein estimated intake in 24 hours (g/day)

1. Reference Standard: Client’s total protein estimated intake in 24 hours of 25 g/ day is less than the
Dietary Reference Intake of 53 g/day (0.8 g/kg body weight).
2. Recommendation: 55-65 g/day (1 to 1.2 g/kg body weight).
3. Goal: Client’s goal is to increase enteral nutrition feeding to provide at least 45 g/day protein.
Enteral feeding currently providing 25 g/day of protein, below the recommended

level of 55 to 65 g/day (1 to 1.2 g/kg BW). Client established a goal to increase
Initial encounter
enteral nutrition feeding to provide total protein estimated intake in 24 hours of at
least 45 g/day. Will continue to monitor protein intake daily.
Some progress toward goal intake of 45g protein/day. Current total protein
Reassessment after
estimated intake in 24 hours is 30 g protein/day. Will continue to monitor protein
intake daily.
References

February 20, 2019.
6. Mehta NM, Skillman HE, Irving SY, et al. Guidelines for the provision and assessment of nutrition
support therapy in the pediatric critically ill patient: Society of Critical Care Medicine and American
Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr. 2017;41(5):706-742.
8. KDOQI Clinical Practice Guideline for Diabetes and CKD: 2012 Update. Am J Kidney Dis.
2012;60(5):850-886.
10. Singh RH, Rohr F, Frazier D, et al. Recommendations for the nutrition management of phenylalanine
hydroxylase deficiency. Genet Med. 2014;16(2):121-131.
2020 EDITION
12/15/21, 9:25 AM Amino Acid Intake
AMINO ACID INTAKE
Amino Acid Intake (FH-1.5.4)

Definition
Amino acid intake from all sources including food, beverages, supplements, and via enteral and parenteral routes
Press; 2000.)

Indicators
Estimated amino acid intake
Total amino acid estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day of
total amino acids
Essential amino acid estimated intake in 24 hours (mg/day)—defined as the approximate intake in one
day of amino acids that cannot be synthesized by humans and must be provided by the diet or by enteral
or parenteral nutrition
Histidine estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day of
an essential amino acid with the formula C6H9N3O2
Methionine estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day
of an essential amino acid with the formula C5H11NO2S
Isoleucine estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day of
an essential amino acid and branched-chain amino acid with the formula C6H13NO2
Leucine estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day of
an essential amino acid and branched-chain amino acid with the formula C6H13NO2
Lysine estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day of an
essential amino acid with the formula C5H11NO2
Threonine estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day of
an essential amino acid with the formula C4H9NO3
Tryptophan estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day
of an essential amino acid with the formula C11H12N2O2
Phenylalanine estimated intake in 24 hours (mg/day)—defined as the approximate intake in one

day of an essential amino acid with the formula C9H11NO2
Valine estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day of an
essential amino acid and branched-chain amino acid with the formula C5H11NO2
Nonessential amino acid estimated intake in 24 hours (mg/day)—defined as the approximate intake in one
day of amino acids that can be synthesized by humans
Arginine estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day of
a nonessential amino acid with the formula C6H14N4O2
Glutamine estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day
of a nonessential amino acid with the formula C5H10N2O3
Homocysteine estimated intake in 24 hours (mg/day)—defined as the approximate intake in one

day of a nonessential amino acid with the formula C4H9NO2S
Tyramine estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day of
a nonessential amino acid with the formula C8H11NO
Measured amino acid intake
Total amino acid measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one
day of total amino acids
Essential amino acid measured intake in 24 hours (mg/day)—defined as the known quantity of intake in
one day of amino acids that cannot be synthesized by humans and must be provided by the diet or by
enteral or parenteral nutrition
Histidine measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one
day of an essential amino acid with the formula C6H9N3O2
Methionine measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one
day of an essential amino acid with the formula C5H11NO2S
Isoleucine measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one
day of an essential amino acid and branched-chain amino acid with the formula C6H13NO2
Leucine measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one
day of an essential amino acid and branched-chain amino acid with the formula C6H13NO2
Lysine measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one day
of an essential amino acid with the formula C5H11NO2
Threonine measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one
day of an essential amino acid with the formula C4H9NO3
Tryptophan measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one
day of an essential amino acid with the formula C11H12N2O2
Phenylalanine measured intake in 24 hours (mg/day)—defined as the known quantity of intake in

one day of an essential amino acid with the formula C9H11NO2
Valine measured intake in 24 hours (mg/day)—defined as the approximate intake in one day of an
essential amino acid and branched-chain amino acid with the formula C5H11NO2
Nonessential amino acid measured intake in 24 hours (mg/day)—defined as the known quantity of intake
in one day of amino acids that can be synthesized by humans
Arginine measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one
day of a nonessential amino acid with the formula C6H14N4O2
Glutamine measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one
day of a nonessential amino acid with the formula C5H10N2O3
Homocysteine measured intake in 24 hours (mg/day)—defined as the known quantity of intake in

one day of a nonessential amino acid with the formula C4H9NO2S
Tyramine measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one
day of a nonessential amino acid with the formula C8H11NO
Amino acids from enteral nutrition (specify g/day)—defined as the estimated intake of amino acids in grams in
one day derived from elemental enteral nutrition infusion
Amino acids from parenteral nutrition (specify g/day)—defined as the estimated intake of amino acids in grams
in one day derived from parenteral nutrition infusion
Amino acids from intravenous fluids (specify g/day)—defined as the estimated intake of amino acids in grams in
one day derived from intravenous (IV) infusion
24-hour recalls, food frequency questionnaires, qualitative amino acid intake collection tools, nutrition fact
labels, other product information, nutrient composition tables
Typically used to determine and monitor and evaluate change in the following nutrition diagnoses: Intake
of types of amino acids inconsistent with needs, malnutrition, inadequate protein-energy intake, altered GI
function, limited adherence to nutrition-related recommendations
Client Example
Histidine estimated intake in 24 hours (mg/kg/day)

1. Reference Standard：Client’s current intake of histidine per day is 520 mg/day (8 mg/kg/day) below the
EAR level of 11 mg/kg/day of histidine.
3. Goal：Client established a goal of histidine estimated intake in 24 hours of at least 715 mg/day (11
mg/kg/day).
Histidine estimated intake in 24 hours averages 520 mg/day(8 mg/kg/day) which is

Initial nutrition assessment below the EAR of 715 mg/day (11 mg/kg/day) for a person 19 years of age or older.
Will continue to monitor histidine intake daily.
Histidine estimated intake in 24 hours averages 675 mg/day. Significant progress
Reassessment after
toward goal intake of 715 mg/day (11 mg/kg/day) for a person 19 years of age or
older.
References
Press; 2002.
2. Young VR, Borgouha S. Adult human amino acid requirements. Curr Opin Clin Metab Care. 1999;2:39-
45.

February 9, 2018.
canada/services/food-nutrition/healthy-eating/dietary-reference-intakes.html. Accessed December 18,
2017.
December 18, 2017.
Accessed December 17, 2017.
7. Nordic Council of Ministers. Nordic Nutrition Recommendations 2012: integrating nutrition and physical
activity. http://www.norden.org/en/theme/former-themes/themes-2016/nordic-nutrition-
recommendation/nordic-nutrition-recommendations-2012. Updated 2012. Accessed December 17, 2017.
2020 EDITION
12/15/21, 9:26 AM Carbohydrate Intake
CARBOHYDRATE INTAKE
Carbohydrate Intake (FH-1.5.5)

Definition
Carbohydrate consumption from all sources including food, beverages, supplements, and via enteral and
parenteral routes, including relative measures of the quantity and/or type of carbohydrate consumed.
Press; 2000.)

Indicators
Estimated carbohydrate intake
Total carbohydrate estimated intake in 24 hours (g/day)—defined as the approximate intake in one day of
total carbohydrate
Complex carbohydrate estimated intake in 24 hours (g/day)– defined as the approximate intake in one day
of a polysaccharide that is comprised of three or more sugars; also called starch
Simple carbohydrate estimated intake in 24 hours (g/day)—defined as the approximate intake in one day
of mono- and disaccharides
Galactose estimated intake in 24 hours (g/day)—defined as the approximate intake in one day of a
monosaccharide which is a common component of lactose
Lactose estimated intake in 24 hours (g/day)—defined as the approximate intake in one day of a
disaccharide sugar of galactose and glucose; present in milk
Fructose estimated intake in 24 hours (g/day)—defined as the approximate intake in one day of a
monosaccharide sugar found in fruit and honey
Carbohydrate estimated intake per kg in 24 hours (g/kg/day)—defined as the approximate intake per kg
of body weight in one day of all carbohydrate
Carbohydrate estimated intake in one meal (g/meal)—defined as the approximate intake in one meal of
all types of carbohydrate
Percent carbohydrate estimated intake in 24 hours (percent/day)—defined as the approximate energy

intake in one day from carbohydrate intake
Carbohydrate estimated intake from oral nutrition in 24 hours (g/day)—defined as the estimated intake of
carbohydrate in grams in one day derived from oral intake
Carbohydrate estimated intake from enteral nutrition in 24 hours (g/day)—defined as the estimated intake
of carbohydrate in grams in one day derived from enteral nutrition infusion
Carbohydrate estimated intake from parenteral nutrition in 24 hours (g/day)—defined as the estimated
intake of carbohydrate in grams in one day derived from parenteral nutrition infusion
Carbohydrate estimated intake from intravenous fluids in 24 hours (g/day)—defined as the estimated
intake of carbohydrate in grams in one day derived from intravenous (IV) infusion
Carbohydrate additive estimated intake in 24 hours (g/day)—defined as the approximate intake in one day
of carbohydrate additive
Estimated daily glycemic index value (number)—defined as the estimated measure in one day reflecting
the consumption of all carbohydrate
Estimated daily glycemic load (number)—defined as the estimated measure in one day reflecting the
quantity and type of all carbohydrate consumed
Insulin to carbohydrate ratio (ratio)—defined as the estimated number of grams of carbohydrate covered
by one unit of rapid-acting (or short-acting) insulin
Measured carbohydrate intake
Total carbohydrate measured intake in 24 hours (g/day)—defined as the known quantity of intake in one
day of total carbohydrate
Complex carbohydrate measured intake in 24 hours (g/day)– defined as the known quantity of intake in
one day of a polysaccharide that is comprised of three or more sugars; also called starch
Simple carbohydrate measured intake in 24 hours (g/day)—defined as the known quantity of intake in
one day of mono- and disaccharides
Galactose measured intake in 24 hours (g/day)—defined as the known quantity of intake in one day of a
monosaccharide which is a common component of lactose
Lactose measured intake in 24 hours (g/day)—defined as the known quantity of intake in one day of a
disaccharide sugar of galactose and glucose; present in milk
Fructose measured intake in 24 hours (g/day)—defined as the known quantity of intake in one day of a
monosaccharide sugar found in fruit and honey
Carbohydrate measured intake per kg in 24 hours (g/kg/day)—defined as the known quantity of intake
per kg of body weight in one day of all carbohydrate
Carbohydrate measured intake in one meal (g/meal)—defined as the known quantity of intake in one
meal of all types of carbohydrate
Percent carbohydrate measured intake in 24 hours (percent/day)—defined as the known quantity of

energy intake in one day from carbohydrate intake
Carbohydrate measured intake from oral nutrition in 24 hours (g/day)—defined as the known quantity of
intake of carbohydrate in grams in one day derived from oral intake
Carbohydrate measured intake from enteral nutrition (g/day)—defined as the known quantity of intake of
carbohydrate in grams in one day derived from enteral nutrition infusion
Carbohydrate measured intake from parenteral nutrition (g/day)—defined as the known quantity of intake
of carbohydrate in grams in one day derived from parenteral nutrition infusion
Carbohydrate measured intake from intravenous fluids (g/day)—defined as the known quantity of intake
of carbohydrate in grams in one day derived from intravenous (IV) infusion
Carbohydrate additive measured intake in 24 hours (g/day)—defined as the known quantity of intake in
one day of carbohydrate additive
Note: Fiber intake can be found on the Fiber Intake reference sheet.
Psyllium and beta glucan can be found on the Bioactive Substance Intake reference sheet.
24-hour or typical day’s recalls, food frequency questionnaires, qualitative intake assessment, menu analysis,
carbohydrate counting tools, intake/output sheets (for tube feeding or parenteral nutrition)
Inadequate and excessive carbohydrate intake, intake of types of carbohydrate inconsistent with needs,
inconsistent carbohydrate intake, altered nutrition related laboratory values, food medication interaction
Client Example
of the indicators)
Indicator Selected
Total carbohydrate estimated intake in 24 hours (g/day)

Comparison to Reference Standard, Recommendation, or Goal}:

2. Recommendation: Client’s total carbohydrate estimated intake in 24 hours averages 295 g/day.
3. Goal: Client’s goal intake is 225 g/day.
Based on 3-day diet records, client’s total carbohydrate estimated intake in 24 hours
Initial encounter
averages 295 g/day, above the client’s goal of 225 g/day.
Reassessment after Good progress made toward goal. Client’s total carbohydrate estimated intake in 24
nutrition intervention hours averages 245 g/day. Will monitor carbohydrate intake at next encounter.
References
1. Academy of Nutrition and Dietetics. Evidence Analysis Library: Diabetes type 1 and 2.
2. Academy of Nutrition and Dietetics. Evidence Analysis Library: Diabetes prevention.
4. American Diabetes Association. Standards of Medical Care in Diabetes.
http://care.diabetesjournals.org/content/42/Supplement_1. Accessed February 4, 2019.
5. Flood A, Subar AF, Hull SG, Zimmerman TP, Jenkins DJ, Schatzkin A. Methodology for adding
glycemic load values to the National Cancer Institute Diet History Questionnaire database. J Am Diet
Assoc. 2006;106(3):393-402.
7. Lin CS, Kimokoti RW, Brown LS, Kaye EA, Nunn ME, Millen BE. Methodology for adding glycemic
index to the National Health and Nutrition Examination Survey nutrient database. J Acad Nutr Diet.
2012;112(11):1843-1851.
Academy of Nutrition and Dietetics. Diabetes Prevention. Evidence Analysis Library:

9. Lin C, Kimokoti RW, Brown LS, Kaye EA, Nunn ME, Millen BE. Methodology for adding glycemic
index to the National Health and Nutrition Examination Survey nutrient database. J Acad Nutr Diet.
2012;112(11):1843-1851.
2020 EDITION
12/15/21, 9:26 AM Fiber Intake
FIBER INTAKE
Fiber Intake (FH-1.5.6)

Definition
Amount and/or type of plant source matter consumed that is not completely digested but may be at least partially
fermented in the distal bowel and is derived from all sources, including food, beverages, supplements, and via
enteral routes
Press; 2000.)

Indicators
Estimated fiber intake
Total fiber estimated intake in 24 hours (g/day)—defined as the approximate intake in one day of total
fiber
Soluble fiber estimated intake in 24 hours (g/day)—defined as the approximate intake in one day of
soluble fiber
Insoluble fiber estimated intake in 24 hours (g/day)—defined as the approximate intake in one day of
insoluble fiber
Fiber estimated intake from oral intake in 24 hours (g/day)—defined as the approximate intake of fiber in
grams in one day derived from oral intake
Fiber estimated intake from enteral nutrition in 24 hours (g/day)—defined as the approximate intake of
fiber in grams in one day derived from enteral nutrition infusion
Fiber additive estimated intake in 24 hours (g or mL/day)—defined as the approximate intake in one day
of fiber additive
Measured fiber intake
Total fiber measured intake in 24 hours (g/day)—defined as the known quantity of intake in one day of
total fiber
Soluble fiber measured intake in 24 hours (g/day)—defined as the known quantity of intake in one day of
soluble fiber
Insoluble fiber measured intake in 24 hours (g/day)—defined as the known quantity of intake in one day
of insoluble fiber
Fiber measured intake from oral nutrition in 24 hours (g/day)—defined as the known quantity of intake of
fiber in grams in one day derived from oral intake
Fiber measured intake from enteral nutrition (g/day)—defined as the known quantity of intake of fiber in
grams in one day derived from enteral nutrition infusion
Fiber additive measured intake in 24 hours (g or mL/day)—defined as the known quantity of intake in
one day of fiber additive
Note: Psyllium and beta glucan can be found on the Bioactive Substance Intake reference sheet
24-hour recalls, food frequency questionnaires, qualitative intake assessment, menu analysis, fiber counting
tools, nutrition fact labels, other product information, nutrient composition tables
Inadequate and excessive fiber intake, altered GI function, disordered eating pattern, inadequate bioactive
substance intake
Client Example
of the indicators)
Indicator Selected
Total fiber estimated intake in 24 hours (g/day)

1. Reference Standard: Client’s total fiber estimated intake in 24 hours averages15 g/day, which is below the
Dietary Reference Intake of 25 g/day for a 40-year-old woman.
3. Goal: Client’s goal is to increase fiber intake to approximately 25 g/day.
Based on food diary, client’s total fiber estimated intake in 24 hours averages 15
Initial encounter
g/day. Will monitor fiber intake at next encounter in three weeks.
Goal achieved. Client’s total fiber estimated intake in 24 hours averages 27 g/day,
Reassessment after
which meets the goal intake of 25 g/day. Will continue to monitor to ensure that
success is sustained.
References

2. Dahl WJ, Stewart ML. Position of the Academy of Nutrition and Dietetics: health implications of dietary
fiber. J Acad Nutr Diet. 2015;115(11):1861-1870.
2017.
February 20, 2019.

6. Research Council. Nutrient Reference Values for Australia and New Zealand.
https://www.health.govt.nz/publication/nutrient-reference-values-australia-and-new-zealand. Accessed
February 4, 2019.
2020 EDITION
12/15/21, 9:27 AM Vitamin Intake
VITAMIN INTAKE
Food/Nutrition-Related History – Micronutrient Intake
Vitamin Intake (FH-1.6.1)

Definition
Vitamin intake from all sources including food, beverages, supplements, and via enteral and parenteral routes
Press; 2000.)

Indicators
Estimated vitamin intake
Vitamin A estimated intake in 24 hours (µg/day)—defined as the approximate intake in one day of
vitamin A
Vitamin C estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day of
vitamin C
Vitamin D estimated intake in 24 hours (µg/day)—defined as the approximate intake in one day of
vitamin D;
Vitamin E estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day of
vitamin E;
Vitamin K estimated intake in 24 hours (µg/day)—defined as the approximate intake in one day of
vitamin K;
Thiamin estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day of thiamin
Riboflavin estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day of
riboflavin
Niacin estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day of niacin
Folate estimated intake in 24 hours (µg/day)—defined as the approximate intake in one day of folate
Vitamin B6 estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day of
vitamin B6
Vitamin B12 estimated intake in 24 hours (µg/day)—defined as the approximate intake in one day of
vitamin B12
Pantothenic acid estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day of
pantothenic acid
Biotin estimated intake in 24 hours (µg/day)—defined as the approximate intake in one day of biotin
Multivitamin estimated intake in 24 hours (yes/no)—defined as the approximate intake in one day of a
multivitamin
Measured vitamin intake
Vitamin A measured intake in 24 hours (µg/day)—defined as the known quantity of intake in one day of
vitamin A
Vitamin C measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one day of
vitamin C
Vitamin D measured intake in 24 hours (µg/day)—defined as the known quantity of intake in one day of
vitamin D;
Vitamin E measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one day of
vitamin E;
Vitamin K measured intake in 24 hours (µg/day)—defined as the known quantity of intake in one day of
vitamin K;
Thiamin measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one day of
thiamin
Riboflavin measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one day of
riboflavin
Niacin measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one day of
niacin
Folate measured intake in 24 hours (µg/day)—defined as the known quantity of intake in one day of
folate
Vitamin B6 measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one day of
vitamin B6
Vitamin B12 measured intake in 24 hours (µg/day)—defined as the known quantity of intake in one day
of vitamin B12
Pantothenic acid measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one
day of pantothenic acid
Biotin measured intake in 24 hours (µg/day)—defined as the known quantity of intake in one day of
biotin
Multivitamin measured intake in 24 hours (yes/no)—defined as the known quantity of intake in one day
of a multivitamin
Note: Laboratory measures associated with body vitamin status can be found on the Vitamin Profile
reference sheet.
Examples of the measurement methods or data sources for these outcome indicators: Client report or
recalls, food frequency, qualitative intake assessment, home evaluation, supplement use questionnaire
diagnoses: Excessive or inadequate intake of vitamins, parenteral, or enteral nutrition
Client Example
Example of one or two of the Nutrition Care Indicators (includes sample initial and reassessment documentation
for one of the indicators)
Vitamin D estimated intake in 24 hours (µg/day)

1. Reference Standard: Client’s Vitamin D estimated intake in 24 hours is 4 µg/day (160 IU), which is
below the estimated average requirement (EAR) of 10 µg (400 IU) and the RDA of 15 µg (600 IU) for a
15-year-old male.
3. Goal: Client established a goal to resume vitamin D supplement 4 out of 7 days per week.
Based on recalls, client with cystic fibrosis has Vitamin D estimated intake in 24
hours of 4 µg/day, which is below the Estimated Average Requirement of 10 µg
(400 IU) and the RDA of 15 ug (600 IU) per day for Vitamin D for a 15-year old
Initial nutrition assessment male. Client has also discontinued fat-soluble vitamin supplement, but has
established a goal to take supplement 4 out of 7 days per week. Will monitor
Vitamin D intake at next encounter and intake of fat-soluble vitamin supplement
and request 25 Hydroxy, vitamin D level (Vitamin Profile reference sheet).
25 Hydroxy, vitamin D level below expected range (from Vitamin Profile). Progress
toward the EAR of 10 µg (400 IU) and RDA of 15 ug (600 IU). Based on diet
record, client’s Vitamin D estimated intake in 24 hours from food sources is 5-7
Reassessment after
µg/day (200-280 IU), and client is taking fat-soluble vitamin supplement 5 days per
week on average. Despite progress, because client has cystic fibrosis, client will
need to continue fat-soluble vitamin supplementation in addition to food sources.
Repeat lab in 3 months.
References

February 12, 2018.
2017.
December 18, 2017.
recommendation/nordic-nutrition-recommendations-2012. Updated 2012. Accessed December 17, 2017.
6. Institute of Medicine. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and
Fluoride. Washington, DC: National Academies Press; 1997.
7. Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National
Academies Press; 2010.
8. Institute of Medicine. Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B6, Folate,
Vitamin B12, Pantothenic acid, Biotin,and Choline. Washington, DC: National Academies Press; 1998.
9. Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium,
Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC:
National Academies Press; 2001.
10. Institute of Medicine. Dietary Reference Intakes: Vitamin C, Vitamin E, Selenium, and Carotenoids.
11. Marra MV, Boyer AP. Position of the American Dietetic Association; Nutrient supplementation. J Am
Diet Assoc. 2009; 109(12):2073-2085.
2020 EDITION
12/15/21, 9:27 AM Mineral/Element Intake
MINERAL/ELEMENT INTAKE
Food/Nutrition-Related History – Micronutrient Intake
Mineral/Element Intake (FH-1.6.2)

Definition
Mineral/element intake from all sources including food, beverages, supplements, and via enteral and parenteral
routes
Press; 2000.)

Indicators
Estimated mineral intake
Calcium estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day of calcium
Chloride estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day of calcium
Iron estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day of iron
Magnesium estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day of
magnesium
Potassium estimated intake in 24 hours (g/day)—defined as the approximate intake in one day of
potassium
Phosphorus estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day of
phosphorus
Sodium estimated intake in 24 hours (g/day)—defined as the approximate intake in one day of sodium
Zinc estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day of zinc
Sulfate estimated intake in 24 hours (g/day)—defined as the approximate intake in one day of sulfate
Fluoride estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day of fluoride
Copper estimated intake in 24 hours (µg/day)—defined as the approximate intake in one day of copper
Iodine estimated intake in 24 hours (µg/day)—defined as the approximate intake in one day of iodine
Selenium estimated intake in 24 hours (µg/day)—defined as the approximate intake in one day of
selenium
Manganese estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day of
manganese
Chromium estimated intake in 24 hours (µg/day)—defined as the approximate intake in one day of
chromium
Molybdenum estimated intake in 24 hours (µg/day)—defined as the approximate intake in one day of
molybdenum
Boron estimated intake in 24 hours (mg/day)—defined as the approximate intake in one day of boron
Cobalt estimated intake in 24 hours (µg/day)—defined as the approximate intake in one day of cobalt
Multimineral estimated intake in 24 hours (yes/no)—defined as the approximate intake in one day of a
multimineral
Multitrace element estimated intake in 24 hours (yes/no)—defined as the approximate intake in one day
of a multitrace element
Measured mineral intake
Calcium measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one day of
calcium
Chloride measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one day of
calcium
Iron measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one day of iron
Magnesium measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one day of
magnesium
Potassium measured intake in 24 hours (g/day)—defined as the known quantity of intake in one day of
potassium
Phosphorus measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one day of
phosphorus
Sodium measured intake in 24 hours (g/day)—defined as the known quantity of intake in one day of
sodium
Zinc measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one day of zinc
Sulfate measured intake in 24 hours (g/day)—defined as the known quantity of intake in one day of
sulfate
Fluoride measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one day of
fluoride
Copper measured intake in 24 hours (µg/day)—defined as the known quantity of intake in one day of
copper
Iodine measured intake in 24 hours (µg/day)—defined as the known quantity of intake in one day of
iodine
Selenium measured intake in 24 hours (µg/day)—defined as the known quantity of intake in one day of
selenium
Manganese measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one day of
manganese
Chromium measured intake in 24 hours (µg/day)—defined as the known quantity of intake in one day of
chromium
Molybdenum measured intake in 24 hours (µg/day)—defined as the known quantity of intake in one day
of molybdenum
Boron measured intake in 24 hours (mg/day)—defined as the known quantity of intake in one day of
boron
Cobalt measured intake in 24 hours (µg/day)—defined as the known quantity of intake in one day of
cobalt
Multimineral measured intake in 24 hours (yes/no)—defined as the known quantity of intake in one day
of a multimineral
Multitrace element measured intake in 24 hours (yes/no)—defined as the known quantity of intake in one
day of a multitrace element
Examples of the measurement methods or data sources for these outcome indicators: Client report or
recalls, food frequency, qualitative intake assessment, home evaluation, home care or pharmacy report,
supplement use questionnaire
diagnoses: Excessive or inadequate intake of minerals, food medication interaction, altered nutrition related
laboratory values, impaired nutrient utilization, undesirable food choices, limited adherence to nutrition related
recommendations
Client Example
of the indicators)
Indicator Selected
Calcium estimated intake in 24 hours (mg/day)

1. Reference Standard: The client’s calcium estimated intake in 24 hours averages 500 mg/day, which is
50% of the recommended dietary allowance for women 31 to 50 years of age.
2. Recommendation:Not applicable
3. Goal: Client’s goal is to increase calcium intake via food to 1,000 mg/day.
Based on recalls, client’s calcium estimated intake in 24 hours is 500 mg/day, which
Initial nutrition assessment is below the RDA for women 31 to 50 years of age. Client’s goal is to increase
with client intake of calcium to 1,000 mg/day via calcium-rich foods. Will monitor calcium
intake at next encounter.
Reassessment after Significant progress toward RDA. Based on diet record, client’s calcium estimated
nutrition intervention intake in 24 hours is 750 mg/day, 75% of the RDA.
References
1. Academy of Nutrition and Dietetics. Nutrition Care

Manual.https://www.nutritioncaremanual.org/index.cfm. Accessed Accessed February 27, 2020.
https://www.nutritioncaremanual.org/. Accessed February 26, 2020

canada/services/food-nutrition/healthy-eating/dietary-reference-intakes.html. Accessed March 2, 2020.
March 2, 2020.
Accessed March 2, 2020.
recommendation/nordic-nutrition-recommendations-2012. Published 2012. Accessed March 2, 2020.
Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, Zinc. Washington, DC:
10. Institute of Medicine. Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids.
11. Institute of Medicine. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate,
Washington DC: National Academies Press; 2004.
12. Marra MV, Boyar AP. Position of the American Dietetic Association; Nutrient supplementation. J Am
Diet Assoc. 2009; 109(12):2073-2085.
13. National Academies of Science Engineering Medicine. Dietary Reference Intakes for Sodium and
Potassium. Washington, DC: National Academies Press; 2019
2020 EDITION
12/15/21, 9:28 AM Consistency Modifier Intake
CONSISTENCY MODIFIER INTAKE
Food/Nutrition Related History Domain –Food and Nutrition Component Intake
Consistency Modifier Intake (FH-1.7.1)

Definition
Intake of substances used to change the consistency of food, fluids, and breastmilk and infant formula feedings

Indicators
Estimated consistency modifier intake

Thickener additive estimated intake in 24 hours (g/day and mL/day)—defined as the approximate
intake in one day of thickener additive
Measured consistency modifier intake

Thickener additive measured intake in 24 hours (g/day and mL/day)—defined as the known quantity
of intake in one day of thickener additive
24-hour recalls, intake records, qualitative intake assessment
interventions: Food and/or nutrient delivery, nutrition education, nutrition counseling, coordination of nutrition
care by nutrition professional
Typically used to determine and to monitor and evaluate change in the following nutrition diagnoses:
Swallowing difficulty; inadequate oral intake; inadequate energy, macronutrient or micronutrient intake
Client Example(s)
Thickener additive estimated intake in 24 hours (g/day and mL/day)

1. Reference Standard: Not applicable.

2. Recommendation: Add 128 g/day of thickener to fluids each day or 16 g (4 teaspoons) to each 240 mL (8
oz) serving of water, juice, coffee, and tea.
3. Goal: Client goal is to consistently and accurately add thickener to oral fluids
Based on recalls, client is adding 16 g of thickener to each 240 mL (8 oz) serving of

Initial encounter water, juice, coffee, and tea. This meets the recommendation by the speech language
pathologist.
Reassessment after
Client continues to meet goal and recommendation to accurately thicken oral fluids.
12/15/21, 9:28 AM Consistency Modifier Intake
References
1. International Dysphagia Diet Standardisation Initiative. http://iddsi.org/Documents/IDDSIFramework-

CompleteFramework.pdf. Accessed February 21, 2019.
2. The International Dysphagia Diet Standardisation Initiative: Drink testing methods.
https://iddsi.org/framework/drink-testing-methods/. Accessed February 4, 2019.
3. The International Dysphagia Diet Standardisation Initiative: Food testing methods.
https://iddsi.org/framework/food-testing-methods/. Accessed February 4, 2019.
2020 EDITION
12/15/21, 10:03 AM Diet Order
DIET ORDER
Food/Nutrition-Related History –Food and Nutrient Administration
Diet Order (FH-2.1.1)

Definition
A general or modified diet prescribed and documented in a client medical record by a credentialed provider as
part of a medical treatment plan
Nutrition Assessment
Indicators
General healthful diet order
Modified diet order (eg, type, amount of energy and/or nutrients/day, distribution, texture)
Enteral nutrition order (eg, formula, rate/schedule, access)
Parenteral nutrition order (eg, solution, access, rate)
Examples of the measurement methods or data sources for these outcome indicators: Medical record,
referring health care provider or agency, client history
diagnoses: Inadequate or excessive energy, macronutrient or micronutrient intake, inadequate or excessive oral
intake, swallowing difficulty
Client Example
Example of one (or more) of the Nutrition Care Indicators (includes sample initial assessment documentation for
Modified diet order

comparison-to-reference-standard-rec-goal:
1. Reference Standard: No validated standard exists.

2. Recommendation: Customized to client.
3. Goal: Not applicable.
Client prescribed a 2,400 calorie or kcal (11,000 kJ)

Initial encounter
diet.
12/15/21, 10:03 AM Diet Order
References
1. Academy of Nutrition and Dietetics. CMS rules on therapeutic diet orders.

https://www.eatrightpro.org/advocacy/licensure/therapeutic-diet-orders. Accessed February 20, 2019.
4. Andersen D, Baird S, Bates T, et al. Academy of Nutrition and Dietetics: Revised 2017 Scope of Practice
for the Nutrition and Dietetics Technician, Registered. J Acad Nutr Diet.118(2):327-342.
5. Andersen D, Baird S, Bates T, et al. Academy of Nutrition and Dietetics: Revised 2017 Scope of Practice
for the Registered Dietitian Nutritionist. J Acad Nutr Diet.118(1):141-165.
2020 EDITION
12/15/21, 10:04 AM Diet Experience
DIET EXPERIENCE
Food/Nutrition-Related History – Food and Nutrient Administration
Diet Experience (FH-2.1.2)

Definition
Previous nutrition/diet orders, diet education/counseling, and diet characteristics that influence patient/client’s
dietary intake
Indicators
Previously prescribed diets
Previous modified diet (specify, e.g., type, amount of energy and/or nutrients/day, distribution,
texture)
Enteral nutrition order (specify)
Parenteral nutrition order (specify)
Previous diet/nutrition education/counseling (specify, e.g., type, year)
Self-selected diets followed (specify, e.g., commercial diets, diet books, culturally directed)
Dieting attempts
Number of past diet attempts (number)

Results (specify, e.g., successful/unsuccessful, pounds or kg lost)
Successful strategies (specify, e.g., no snacking, self-monitoring)
Food allergies
Previous modified diet (specify, e.g., type and/or foods/food group) followed as a result of
diagnosed or reported food allergy
Food intolerance
Previous modified diet (specify, e.g., type and/or foods/food group) followed as a result of
diagnosed or reported food intolerance
Examples of the measurement methods or data sources for these outcome indicators: Patient/client report,
medical record, patient/client history, food and nutrition delivery coordination of care
counseling
Disordered eating pattern, not ready for diet/lifestyle change, excessive oral intake, food- and nutrition-related
knowledge deficit, unsupported beliefs/attitudes about food- or nutrition-related topics, undesirable food choices,
swallowing difficulty, intake of unsafe food
Evaluation
12/15/21, 10:04 AM Diet Experience


OR
Client Example
Example(s) of one or two of the Nutrition Care Indicators (includes sample initial assessment documentation for
Previous diet/nutrition education/counseling

1. Goal: Not generally used

OR
2. Reference Standard: No validated standard exists

Patient/client completed a 6-week diabetic education class two years ago.
with client
References
1. Hager M. Hospital therapeutic diet orders and the Centers for Medicare & Medicaid Services: steering
through regulations to provide quality nutrition care and avoid survey citations. J Am Diet Assoc. 2006;
106 (2):198-204.
June 17, 2015.
4. Hager M. Therapeutic diet order writing: current issues and considerations. Topic Clin Nutr. 2007;22:28-
36.
2020 EDITION
12/15/21, 10:04 AM Eating Environment
EATING ENVIRONMENT
Eating Environment (FH-2.1.3)

Definition
The aggregate of surrounding things, conditions, or influences that affect food intake
Nutrition-Assessment-and-Monitoring-and-Evaluation
Indicators
Location (specify, e.g., home, school, day care, restaurant, nursing home, senior center)
Atmosphere
Acceptable noise level (yes/no)

Appropriate lighting (yes/no)
Appropriate room temperature (yes/no)
Appropriate table height (yes/no)
Appropriate table service (e.g., plates, napkins)/meal service (type of service, e.g., table service,
buffet)/set-up (make food accessible for consumption) (yes/no)
Eats at designated eating location (does not wander) (yes/no)
Eats without distractions (e.g., watching TV/reading) (yes/no)
No unpleasant odors (yes/no)
Caregiver/companion
Allowed to select foods (often, sometimes, never)

Caregiver influences/controls what client eats (e.g., encourages, forces) (yes/no)
Caregiver models expected eating behavior (yes/no)
Caretaker presence (present/not present)
Favorite food is offered or withheld to influence behavior (reward/punishment) (yes/no)
Has companionship while eating (another or others present) (yes/no)
Meal/snacks offered at consistent times (“grazing” discouraged) (yes/no)
Appropriate breastfeeding accommodations/facility (yes/no)
Eats alone (specify reason, frequency)
medical record, referring health care provider or agency, observation
diagnoses: Inadequate oral intake, self-feeding difficulty, poor nutrition quality of life, limited access to food
Evaluation


OR
Client Example
Eats at designated eating location

1. Goal: Two-year-old child with inadequate intake of calories/kcal/kJ and/or nutrients. Goal is to improve
intake through modifications in feeding environment and meal pattern.
OR
Caregiver completed 3-day food record indicating multiple (10) feeding

opportunities throughout the day. Child consumes mostly juice, dry cereal, and
Initial nutrition assessment chips. Prefers foods that can be consumed from bottle or finger foods. Child does
with client not sit at the table to eat, but wanders the house and is allowed to request and
receive snacks ad lib. Energy and nutrient intake is less than 75% of standard.
Referral to behavioral specialist offered.
Caregiver completed follow-up 3-day food record indicating reduced number of
feeding opportunities throughout the day (6 to 7). States child resisted at first, but
Reassessment after
now eats at table at regular meal/snack times. Caregiver is continuing to work with
behavioral specialist for both mealtime and other behavior issues. Energy and
nutrient intake have improved to 85 to 90% of standard.
References
1. Spruijt-Metz D, Lindquist CH, Birch LL, Fisher JO, Goran MI. Relation between mothers’ child-feeding
practices and children’s adiposity. Am J Clin Nutr. 2002;75:581-586.
2. Boutelle KN, Birnbaum AS, Lytle LA, Murray DM, Story M. Associations between perceived family meal
environment and parent intake of fruit, vegetables and fat. J Nutr Educ Behav. 2003;35:24-29.
3. Birch LL, Fisher JO. Development of eating behaviors among children and adolescents. Pediatrics.
1998;101:539-549.
4. O’Dea JA. Why do kids eat healthful food? Perceived benefits of and barriers to healthful eating and
physical activity among children and adolescents. J Am Diet Assoc. 2003;103(4):497-501.
5. Birch LL, Fisher JO. Mothers’ child-feeding practices influence daughters’ eating and weight. Am J Clin
Nutr. 2000; 71:1054-1061.
6. Birch LL. Development of food preferences. Annu Rev Nutr. 1999;19:41-62.
7. Campbell K, Crawford, D. Family food environments as determinants of preschool-aged children’s eating
behaviours: implications for obesity prevention policy. Aust J Nutr Diet. 2005;58:19-25.
8. Hurtsi UK. Factors influencing children’s food choice. Ann Med. 1999;31(Suppl 1):26-32.
9. Birch LL, Fisher JO, Davison KK. Learning to overeat: maternal use of restrictive feeding practices
promotes girls’ eating in the absence of hunger. 2003. Am J Clin Nutr. 78:215-220.
10. Wansink B, Cheney MM. Super bowls: serving bowl size and food consumption. JAMA. 2005;293:1727-
1728.
11. Wansink B. Environmental factors that increase the food intake and consumption volume of unknowing
consumers. Annu Rev Nutr. 2004;24:455-479.
12. Rozin P, Kabnick K, Pete E, Fischler C, Shields C. The ecology of eating: smaller portion sizes in France
than in the United States help explain the French paradox. Psychol Sci. 2003;14:450-454.
13. Rozin P. The meaning of food in our lives: a cross-cultural perspective on eating and well-being. J Nutr
Educ Behav. 2005;37(suppl): 107-112.
14. Birch LL, Davison KK. Family environmental factors influencing the developing behavioral controls of
food intake and childhood over weight. Pediatr Clin North Am. 2001;48(4):893-907.
15. Hetherington MM. Cues to overeat: psychological factors influencing overconsumption. Proc Nutr Soc.
2007;66(1):113-23.
2020 EDITION
12/15/21, 10:04 AM Enteral and Parenteral Nutrition Administration
ENTERAL AND PARENTERAL NUTRITION ADMINISTRATION
Enteral and Parenteral Nutrition Administration (FH-2.1.4)

Definition
Delivery of enteral and/or parenteral nutrition.

Indicators
Enteral access, specify, e.g., nasoentric, oroenteric, percutaneous, or surgical access with gastric,
duodenal or jejunal placement
Parenteral access, specify, e.g., peripheral, central, and/or type of catheter
Body position, enteral nutrition (EN), specify, e.g., degree angle
Examples of the measurement methods or data sources for these outcome indicators: Patient/client
report/recalls, patient/client record, patient/client nutrition-focused physical exam, provider referral
diagnoses: Inadequate or excessive enteral or parenteral nutrition infusion, inadequate fluid intake, predicted
food–medication interaction
Evaluation


OR
Client Example
Enteral access (nasocentric)

1. Goal: Patient/client’s enteral nutrition is delivered via nasoenteric feeding tube which will remain patent
so patient/client can receive feeding to meet estimated nutrition requirements.
OR
2. Reference Standard: There is no reference standard for this outcome.
12/15/21, 10:04 AM Enteral and Parenteral Nutrition Administration
Patient/client’s enteral nutrition is delivered via nasoenteric feeding tube which will
remain patent so patient/client can receive feeding to meet estimated nutrition
with client
requirements. Monitor enteral nutrition feeding access for patency.
Reassessment after Enteral nutrition via nasoenteric feeding tube is blocked requiring replacement of
nutrition intervention feeding tube.
References
1. Academy of Nutrition and Dietetics. Critical illness evidence-based nutrition guideline, 2012.
http://andevidencelibrary.com/topic.cfm?cat=4800.. Accessed June 17, 2015.
administration of specialized nutrition support—issues unique to pediatrics. J Parenter Enteral Nutr.
2002;26(Suppl):S97-S110.
access for administration of nutrition support. J Parenter Enteral Nutr. 2002;26(1 Suppl):33SA-41SA.
4. Kovacevich DS, Frederick A, Kelly D, Nishikawa R, Young L, American Society for Parenteral and
Enteral Nutrition Board of Directors Standards for Specialized Nutrition Support Task Force. Standards
6. McMahon MM, Nystrom E, Braunschweig C, Miles J, Compher C, American Society for Parenteral and
Enteral Nutrition (A.S.P.E.N.) Board of Directors. A.S.P.E.N. clinical guidelines: nutrition support of
adult patients with hyperglycemia. J Parenter Enteral Nutr. 2013;37:23-36.
7. Arsenault D, Brenn M, Kim S, Gura K, Compher C, Simpser E, American Society for Parenteral and
Enteral Nutrition Board of Directors, Puder M. A.S.P.E.N. clinical guidelines: hyperglycemia and
hypoglycemia in the neonate receiving parenteral nutrition. J Parenter Enteral Nutr. 2012;36:81-95.
2020 EDITION
12/15/21, 10:04 AM Fasting
FASTING
Fasting (FH-2.1.5)
Definition
Absence of nutrient administration from all sources.

Indicators
Fasting pattern in one calendar day, reported--defined as the timing within one calendar day when the
patient/client does not take in or infuse nutrients (e.g., overnight fast, fast between meals)
Fasting pattern in one calendar week, reported --defined as the timing within one calendar week when the
patient/client does not take in or infuse nutrients (e.g., Friday evening)
Fasting pattern in one calendar month, reported--defined as the timing within one calendar month when
the patient/client does not take in or infuse nutrients (e.g., every Sabbath)
Fasting pattern in one calendar year, reported --defined as the timing within one calendar year when the
patient/client does not take in or infuse nutrients (e.g., Lent, Passover, Ramadan, occasional fasting)
Fasting tolerance, reported—defined as the length of time a patient/client can endure a lack of nutrient
intake or nutrient infusion without physiological consequence (specify in hours)
medical record, patient/client history, food and nutrition delivery coordination of care
counseling
diagnoses: Inadequate oral intake, inadequate carbohydrate intake, food- and nutrition-related knowledge
deficit, unsupported beliefs/attitudes about food- or nutrition-related topics
Evaluation


OR
Client Example
Fasting tolerance, reported
12/15/21, 10:04 AM Fasting

1. Goal：Limit or avoid fasting longer than five hours because longer periods result in physiological
consequence
OR
2. Reference Standard：No validated standard exists
The patient/client's (with an inborn error of metabolism) reported fasting tolerance

Initial nutrition assessment is approximately five hours at which time, the patient/client must take in nutrients to
with client avoid hypoglycemia. Goal established to fast no longer than four hours, seven of
seven nights per week.
Reassessment after Meeting goal. Patient/client limiting fasts to no longer than four hours on seven of
nutrition intervention seven nights per week.
References
1. Genetic Metabolic Dietitians International. Nutrition guidelines. http://www.gmdi.org/Resources/Clinical-

Practice-Tools/Nutrition-Guidelines. Accessed June 16, 2015.
2020 EDITION
12/15/21, 10:06 AM Medications
MEDICATIONS
Food/Nutrition-Related History – Medication and Complementary/Alternative Medicine Use
Medications (FH-3.1)
Definition
Prescription and over-the-counter (OTC) medications that may impact nutritional status

Indicators
Prescription medication use
Current prescriptions with nutrient/food–medication interactions, specify

Insulin or insulin secretagogues, specify
Insulin sensitivity factor (mg/dL)—defined as the estimated reduction in blood
glucose in mg/dL per unit of rapid-acting (or short-acting) insulin, al referred to as
the correction insulin
Medication, alter blood pressure, specify
Medication, alter breastmilk production, specify
Medication, lipid lowering, specify
Medications, alter glucose levels, specify
Other, specify
Over-the-counter (OTC) medications use
Current OTC products with nutrient/food-medication implications, specify

Medication, alter blood pressure, specify
Medication, alter breastmilk production, specify
Medication, lipid lowering, specify
Medications, alter glucose levels, specify
Other, specify
Misuse of medications (e.g., accidental overdose, illegal drugs, laxatives, diuretics, drug use
during pregnancy), specify
Note: Vitamin and mineral supplements can be found on the vitamin and mineral intake reference sheets.
Alcohol is found on the Alcohol Intake reference sheet
medical record, referring health care provider or agency
Typically used to determine and monitor and evaluate change in the following nutrition diagnoses: Food–
medication interaction, increased energy expenditure, malnutrition (undernutrition), inadequate or excessive
energy, oral, fluid, carbohydrate, protein, fat, vitamin and mineral intake, unintended weight gain or loss,
overweight/obesity, underweight, disordered eating pattern
https://www.ncpro.org/pubs/2020-encpt-en/codeFH-3-1 1/2
12/15/21, 10:06 AM Medications
Evaluation


OR
Client Example
Prescription medication with nutrient/food–medication interactions—Prednisone

1. Goal：Patient/client with prescription for 50 mg/d prednisone and concerned about concurrent weight
gain caused by increased appetite and fluid retention. Goal is to minimize weight gain and maintain good
nutritional status during prednisone therapy.
OR
2. Reference Standard：Not applicable
Patient/client’s prescription medication is 50 mg/d prednisone for rheumatoid

arthritis. Current weight 182 lb (83 kg). Long-term therapy may result in a need for
protein, calcium, potassium, phosphorus, folate and vitamin A, C, and D
with client
supplementation. Patient/client currently taking a vitamin/mineral supplement and
concerned about weight gain caused by increased appetite and fluid retention.
Patient/client’s prescription medication prednisone dose reduced to 25 mg/d.
Reassessment after
Currently taking a one-a-day multivitamin/multimineral and snacking on raw
vegetables between meals. Weight stable.
References
2. Position of the American Dietetic Association: Integration of medical nutrition therapy and
pharmacotherapy. J Am Diet Assoc. 2010;110:950-956.
3. Pronksy ZM. Food–Medication Interactions. 16th ed. Birchrunville, PA: Food–Medication Interactions;
2010.
June 17, 2015.
5. American Diabetes Association. Standards of Medical Care in Diabetes (Position Statement)–2015.
Diabetes Care. 2015;38:S1-S94.
2020 EDITION
12/15/21, 10:16 AM Complementary/Alternative Medicine
COMPLEMENTARY/ALTERNATIVE MEDICINE
Food/Nutrition-Related History – Medication and Complementary/Alternative Medicine Use
Complementary/Alternative Medicine (FH-3.2)

Definition
Complementary and alternative medicine products, including herbal preparations that may impact nutritional
status

Indicators
Nutrition-related complementary/alternative medicine use (e.g., gingko, St. John’s Wart, elderberry,
garlic, ephedra, probiotics)
Note: Vitamin and mineral supplements can be found on the vitamin and mineral intake reference sheets.
Alcohol is found on the Alcohol Intake reference sheet
medical record, referring health care provider or agency
Typically used to determine and monitor and evaluate change in the following nutrition diagnoses: Food–
medication interaction, increased energy expenditure, malnutrition (undernutrition), unintended weight gain or
loss, overweight/obesity, intake of unsafe foods, disordered eating pattern
Evaluation


OR
Client Example
Complementary/alternative medicine use—ephedra

1. Goal：Patient/client taking ephedra with the hope that it will promote weight loss. Goal is to have
patient/client eliminate ephedra for safety reasons and engage in nutrition counseling for weight
12/15/21, 10:16 AM Complementary/Alternative Medicine
management
OR
2. Reference Standard：Not applicable
Initial nutrition assessment Patient/client complementary/alternative medicine use of ephedra is for weight loss.
with client Patient/client reports being unaware of safety concerns.
Reassessment after Patient/client complementary/alternative medicine use of ephedra has stopped and
nutrition intervention success with weight loss as a result of nutrition counseling.
References
2. Pronksy ZM. Food–Medication Interactions. 16th ed. Birchrunville, PA: Food–Medication Interactions;
2010.
June 17, 2015.
4. Pediatric Weight Management Evidence Based Nutrition Practice Guideline, Adjunct Therapies.
Academy of Nutrition and Dietetics Evidence Analysis Library.
http://www.andevidencelibrary.com/topic.cfm?cat=2724. Accessed June 17, 2015.
5. National Institutes of Health and the National Center for Complementary and Alternative Medicine.
http://nccam.nih.gov/. Accessed June 17, 2015.
2020 EDITION
12/15/21, 10:17 AM Food and nutrition knowledge
FOOD AND NUTRITION KNOWLEDGE
Food/Nutrition-Related History – Knowledge/Beliefs/Attitudes
Food and Nutrition Knowledge (FH-4.1)

Definition
Level of understanding about food, nutrition, and health or nutrition related information and guidelines relevant to client needs

Indicators
Nutrition knowledge of community (no knowledge, minimal knowledge, basic knowledge, intermediate knowledge, advanced knowledge)—defined as the
assessed level of knowledge of a community, subpopulation, or population
Nutrition knowledge of supportive individuals (eg, family, caregivers) (no knowledge, minimal knowledge, basic knowledge, intermediate knowledge, advanced
knowledge)—defined as the assessed level of knowledge of those who give or support care
Nutrition knowledge of individual client (no knowledge, minimal knowledge, basic knowledge, intermediate knowledge, advanced knowledge)—defined as the
assessed level of knowledge of an individual client
Examples of the measurement methods or data sources for these indicators: Pre- and/or posttests administered orally, on paper, or by computer, scenario
discussions, client restates key information, review of food records, practical demonstration/test, survey, nutrition quotient, nutrition questionnaire, nutrition
assessment inventory
Typically used with the following domains of nutrition interventions: Nutrition education, nutrition counseling, population based nutrition action
Typically used to determine and to monitor and evaluate change in the following nutrition diagnoses: Food and nutrition related knowledge deficit, limited
adherence to nutrition related recommendations, undesirable food choices, breastfeeding difficulty, overweight/obesity, intake domain nutrition diagnoses.
Judgment must be used to select indicators and determine the appropriate measurement techniques and reference standards for a given client population and
setting. Once identified, these indicators, measurement techniques, and reference standards should be identified in policies and procedures or other documents for
use in client records, quality or performance improvement, or in formal research projects.
Client Example
Example of one of the Nutrition Care Indicators (includes sample initial and reassessment documentation for one of the indicators)
Nutrition knowledge of individual client

1. Recommendation: Not applicable.

2. Goal: Client established a goal to learn how to accuratel read a food label and identify the total number of grams of carbohydrate per serving of food.
Initial nutrition assessment Individual client with newly diagnosed diabetes with no knowledge of carbohydrate counting. Client established a goal to learn how
with client to accurately read a food label and identify the total number of grams of carbohydrate per serving of food
Client has intermediate knowledge of how to read food labels and state grams of carbohydrate in individual food items. Client has
Reassessment after
basic knowledge of how to consistently apply this knowledge to food intake and distribution of carbohydrate throughout the day. Will
continue to monitor at next encounter.
References
The following are some suggested references for indicators, measurement techniques, and reference standards for the outcome; other references may be
appropriate.
1. Academy of Nutrition and Dietetics. Evidence Analysis Library: Effectiveness of Nutrition Intervention Methods. https://www.andeal.org/topic.cfm?
cat=4756&evidence_summary_id=251212&highlight=breastfeeding&home=1. Updated 2010. Accessed February 13, 2018.
2. Snetselaar LG. Nutrition Counseling Skills for Medical Nutrition Therapy. 2nd ed. Gaithersburg, MD: Aspen Press; 2007.
3. Kessler H, Wunderlich SM. Relationship between use of food labels and nutrition knowledge of people with diabetes. Diabetes Educ. 1999;25(4):549-559
4. Chapman-Novakofski K, Karduck J. Improvement in knowledge, social cognitive theory variables, and movement through stages of change after a
community-based diabetes education program. J Am Diet Assoc. 2005;105(10):1613-1616.
2020 EDITION
12/15/21, 10:17 AM Food and Nutrition Skill
FOOD AND NUTRITION SKILL
Food and Nutrition Skill (FH-4.2)

Definition
Level of food, nutrition, and health or nutrition-related skills relevant to client needs

Indicators
Nutrition skill of community (no skill, minimal skill, basic skill, intermediate skill, advanced skill)—
defined as the assessed level of skill of a community, subpopulation, or population
Nutrition skill of supportive individuals (eg, family, caregivers) (no skill, minimal skill, basic skill,
intermediate skill, advanced skill)—defined as the assessed level of skill of family and those who give or
support care
Nutrition skill of individual client (no skill, minimal skill, basic skill, intermediate skill, advanced skill)—
defined as the assessed level of skill of an individual client
Examples of the measurement methods or data sources for these outcome indicators: Pre- and/or post-tests
administered orally, on paper, or by computer, scenario discussions, client restates key information, review of
food records, practical demonstration, survey, nutrition questionnaire, nutrition assessment inventory
Typically used to determine and monitor and evaluate change in the following domains of nutrition
interventions: : Nutrition education, nutrition counseling, population based nutrition action
Typically used to determine and to monitor and evaluate change in the following nutrition diagnoses: :
Food and nutrition related knowledge deficit, limited adherence to nutrition related recommendations, self-
feeding difficulty, breastfeeding difficulty, intake domain nutrition diagnoses.
Client Example
of the indicators)
Nutrition skill of individual client


3. Goal: Individual client established a goal to learn to guide baby's lips and mouth for a successful latch.
Intitial nutrition assessment Individual client with newborn infant and no nutrition skill related to breastfeeding.
12/15/21, 10:17 AM Food and Nutrition Skill
Individual client established a goal to guide baby's lips and mouth for a sucessful
latch.
individual client with basic skill guiding baby's lips and mouth for successful latch.
Reassessment after
Able to demonstrate successful latch 3 out of 5 times. Will continue to monitor at
next encounter.
References
1. 1. Academy of Nutrition and Dietetics. Evidence Analysis Library: Effectiveness of Nutrition

Intervention Methods. https://www.andeal.org/topic.cfm?
cat=4756&evidence_summary_id=251212&highlight=breastfeeding&home=1. Updated 2010. Accessed
February 13, 2018.
2. 2. Academy of Nutrition and Dietetics. Nutrition Care Manual.
3. 3. Academy of Nutrition and Dietetics. Pediatric Nutrition Care Manual.
2020 EDITION
12/15/21, 10:17 AM Beliefs and Attitudes
BELIEFS AND ATTITUDES
Beliefs and Attitudes (FH-4.3)

Definition
Acceptance of the truth about (belief) or way of thinking or feeling about (attitude) food- or nutrition-related
phenomenon or behavior, which influences food or nutrition-related behavior

Indicators
Nutrition priority of individual client (present/absent)—defined as the individual client’s beliefs and
attitudes about food and nutrition that are believed to be of prime concern
Nutrition priority of client’s supportive individuals (present/absent)—defined as the client’s supportive

individuals (eg, family, caregiver) beliefs and attitudes about food and nutrition that are believed to be of
prime concern
Nutrition priority of client’s supportive structures (present/absent)—defined as the client’s supportive

structures’ (eg, social service agencies and faith-based organizations) beliefs and attitudes about food and
nutrition that are believed to be of prime concern
Nutrition priority of client’s stakeholders (present/absent)—defined as the client’s stakeholders’ (eg,

constituencies with impact on client nutrition) beliefs and attitudes about food and nutrition that are
believed to be of prime concern
Conflict with individual client’s value system (present/absent)—defined as the individual client’s beliefs
and attitudes that are incongruent with the client’s values
Conflict with client’s supportive individuals’ value system (present/absent)—defined as the client’s
beliefs and attitudes that are incongruent with the values of the client’s supportive individuals (eg, family
and caregivers)
Conflict with client supportive structures’ value system (present/absent)—defined as the client’s beliefs
and attitudes that are incongruent with the values of the client’s supportive structures (eg, social service
agencies and faith based organizations)
Conflict with stakeholders’ value system (present/absent)—defined as the client’s beliefs and attitudes
that are incongruent with the values of stakeholders (eg, constituencies with impact on client nutrition)
Behavioral beliefs—defined as factors (motivation, control, norms, readiness) that influence the client’s
food- and nutrition-related behaviors
Perceived susceptibility to nutrition related health problems score (self-rated, 1=very low to 7 =
very high perceived susceptibility)—defined as a client’s belief that they have a health condition
or are at high-risk for developing a health condition
Perceived severity of risk to health score (self-rated, 1=very low to 7= very high perceived
severity of risk)—defined as a client’s belief about the severity of their risk of a health condition
Perceived benefit of nutrition related change score (self-rated, 1=very low to 7=very high
perceived benefit)—defined as the acceptance that the rewards are worth the sacrifice and effort
Likelihood of performing nutrition related behavior score (self- rated, 1 = unlikely to perform
behavior to 7 = very likely to perform behavior)—defined as the probability of the client
performing the behavior(s)
Perceived control over nutrition related behavior score (self-rated, 1=very low to 7=very high
perceived control)—defined as the client’s belief in their power to change nutrition related
behavior(s)
Nutrition self efficacy score (self-rated, 1=very low confidence to 7 = very high confidence in
ability)—defined as the client’s confidence in their ability to change nutrition related behavior(s)
Perceived barrier to nutrition related behavior score (self-rated, 1=very low to 7=very high
perceived barriers)—defined as the client’s belief about barriers to adopting nutrition related
behaviors
Readiness to change nutrition related behavior stage

Precontemplation stage for readiness to change (present/absent)
Contemplation stage for readiness to change (present/absent)
Preparation stage for readiness to change (present/absent)
Action stage for readiness to change (present/absent)
Maintenance stage for readiness to change (present/absent)
Relapse stage for readiness to change (present/absent)
Readiness to change nutrition related behavior score (self-rated on scale of 1 to 10; 1 = not ready
to 10 = fully ready to change)—defined as a client assessment of their preparedness to change
nutrition related behaviors
Negative emotions about food and nutrition (present/absent)—defined as negative feelings about food
and/or nutrition
Positive emotions about food and nutrition (present/absent)—defined as positive feelings about food
and/or nutrition
Unrealistic nutrition related goals (present/absent)—defined as client food and/or nutrition expectations
that are may not be achievable
Unscientific nutrition beliefs/attitudes (present/absent)—defined as client acceptance of the truth about

food and/or nutrition that is incongruent with scientific evidence
Body image disturbance (present/absent)—defined as client’s distressing or impairing preoccupation

with defects in their body that are not apparent to others
Preoccupation with food (present absent)—defined as thoughts about food that dominate the client’s
thinking
Preoccupation with weight (present/absent)—defined as thoughts about body weight that dominate the
client’s thinking
Preoccupation with body shape (present/absent)—defined as thoughts about body shape that dominate the
client’s thinking
Negative nutrition self talk (present/absent)—defined as negative thoughts about oneself related to food
and nutrition
Positive nutrition self talk (present/absent)—defined as positive thoughts about oneself related to food
and nutrition
Preference for food (yes/no)—defined as a liking of specific food stuffs consumed
Preferences for beverages (yes/no)—defined as a liking of specific liquids consumed
Examples of the measurement methods or data sources for these outcome indicators: Client self-report,
client assessment questionnaire or interview, medical record, referring health care provider or agency, survey
data
Typically used to monitor and evaluate change in the following domains of nutrition interventions: Food
and/or nutrient delivery, nutrition education, nutrition counseling, population based nutrition action
Unsupported beliefs/attitudes about food- or nutrition-related topics; not ready for diet/lifestyle change; inability
to manage self-care; self-monitoring deficit, excessive or inadequate oral, energy, macronutrient, micronutrient
or bioactive substance intake; imbalance of nutrients; intake of types of fats inconsistent with needs; intake of
types of proteins inconsistent with needs; intake of types of carbohydrate inconsistent with needs;
inadequate/excessive fiber intake; undesirable food choices; underweight; overweight/obesity; disordered eating
pattern; physical inactivity; excess physical activity; limited access to food or water
Client Example
Readiness to change nutrition related behavior stage


3. Goal: Client is currently in the precontemplation stage of change. Client goal is to move to the
preparation stage of change within 3 months
Assessment results indicate client is currently in the precontemplation stage of

Initial nutrition assessment change related to need for nutrition changes. Will initiate motivational interviewing
and reassess in two weeks.
Significant progress toward goal. Reassessment indicates that client has moved from
Reassessment after
the precontemplation stage to the contemplation stage related to need for nutrition
changes. Will reassess in two weeks.
References
1. Academy of Nutrition and Dietetics. Evidence Analysis Library. Academy of Nutrition and Dietetics.
https://www.andeal.org/?auth=1. Accessed February 13, 2020.
2. Bandura A. Human agency in social cognitive theory. Am Psychol. 1989;44(9):1175-1184.
3. Case Western Reserve University. Readiness Ruler.
https://www.centerforebp.case.edu/resources/tools/readiness-ruler. Accessed February 28, 2020.
4. de Jersey SJ, Mallan KM, Callaway LK, Daniels LA, Nicholson JM. Prospective relationships
between health cognitions and excess gestational weight gain in a cohort of healthy and overweight
pregnant women. J Acad Nutr Diet. 2017;117(8):1198-1209.

5. Evers C, De Ridder DT, Adriaanse MA. Assessing yourself as an emotional eater: mission
impossible? Health Psychol. 2009;28:717-725.
6. Harrison A, Sullivan S, Tchanturia K, Treasure J. Emotional functioning in eating disorders:
attentional bias, emotion recognition and emotion regulation. Psychol Med. 2010;1:1-11.
7. Health Belief Model. https://www.sciencedirect.com/topics/medicine-and-dentistry/health-belief-
model. Accessed February 28, 2020.
8. Keith JF, Stastny S, Brunt A, Agnew W. Barriers and Strategies for Healthy Food Choices among
American Indian Tribal College Students: A Qualitative Analysis. J Acad Nutr Diet. 2018;118(6):1017-
1026.
9. McDermott MS, Oliver M, Simnadis T, et al. The Theory of Planned Behaviour and dietary patterns:
A systematic review and meta-analysis. Prev Med. 2015;81:150-156.
10. McQueen A, Vernon SW, Rothman AJ, Norman GJ, Myers RE, Tilley BC. Examining the role of
perceived susceptibility on colorectal cancer screening intention and behavior. Ann Behav Med.
2010;40(2):205-217.
11. National Institutes of Health Division of Cancer Control & Population Sciences. Perceived severity.
https://cancercontrol.cancer.gov/brp/research/constructs/perceived_severity.html. Accessed February 28,
2020.
12. Nolan LJ, Halperin LB, Geliebter A. Emotional appetite questionnaire: construct validity and
relationship with BMI. Appetite 2010;54: 314-319.
13. Ohri-Vachaspati P, Dachenhaus E, Gruner J, Mollner K, Hekler EB, Todd M. Fresh Fruit and
Vegetable Program and Requests for Fruits and Vegetables Outside School Settings. J Acad Nutr Diet.
2018;118(8):1408-1416.
14. Otten JJ, Hirsch T, Lim C. Factors Influencing the Food Purchases of Early Care and Education
Providers. J Acad Nutr Diet. 2017;117(5):725-734.
15. Prochaska JO, DiClemente CC. Transtheoretical therapy: Toward a more integrative model of
change. Psychotherapy: Theory, Research & Practice. 1982;19(3):276-288.
16. Raynor HA, Champagne CM. Position of the Academy of Nutrition and Dietetics: Interventions for
the Treatment of Overweight and Obesity in Adults. J Acad Nutr Diet. 2016;116(1):129-147.
17. Thompson JK, Stice E. Thin-ideal internalization: Mounting evidence for a new risk factor for
body-image disturbance and eating pathology. Curr Dir Psychol Sci. 2001;10(5):181-183.
18. Tylka TL, Kroon Van Diest AM. The Intuitive Eating Scale-2: item refinement and psychometric
evaluation with college women and men. J Couns Psychol. 2013;60(1):137-153.
19. Van Strien T, Frijters JE, Bergers GP, Defares PB. The Dutch Eating Behavior Questionnaire
(DEBQ) for assessment of restrained, emotional, and external eating behavior. Int J Eat Disord.
1986;5(2):295-315.
20. van Strien T, Oosterveld P. The children's DEBQ for assessment of restrained, emotional, and
external eating in 7- to 12-year-old children. Int J Eat Disord. 2008;41(1):72-81.
2020 EDITION
12/15/21, 10:22 AM Adherence
ADHERENCE
Food/Nutrition-Related History – Behavior
Adherence (FH-5.1)
Definition
Level of congruence with nutrition-related recommendations or behavioral changes agreed upon by client to
achieve nutrition-related goals

Indicators
Self reported nutrition adherence score (self rated on scale of 1 to 10; 1 = not adherent to 10 = completely
adherent)—defined as a client assessment of their congruence to agreed upon nutrition related goals
Nutrition encounter ratio (ratio) —defined as the ratio of actual nutrition encounters to the total planned
nutrition encounters
Ability to recall nutrition goals (very able to recall goals, somewhat able to recall goals, unable to recall
goals)—defined as the degree to which a client can describe previously agreed upon nutrition objectives
Nutrition self monitoring at agreed upon rate (self rated on scale of 1 to 10; 1 = not adherent to 10 =
completely adherent)—defined as a client assessment of their congruence to agreed upon nutrition related
self monitoring
Nutrition self management as agreed upon (self rated on scale of 1 to 10; 1 = not adherent to 10 =
completely adherent) —defined as a client assessment of their congruence with agreed upon nutrition
related self management
Note: Use in conjunction with appropriate Food and Nutrition Intake, Anthropometric Data, and
Biochemical Data reference sheets.
May be useful in relapse prevention treatment (analyze and control factors that caused the lapse).
Examples of the measurement methods or data sources for these outcome indicators: Nutrition encounter
attendance, self-monitoring records (eg, food record to evaluate fat, sodium, calories/kcal/kJ, diet quality, binge-
eating), client self-report, adherence tools or questionnaires, provider assessment, self efficacy assessment,
readiness to change assessment
education, nutrition counseling, population based nutrition action
Typically used to determine and monitor and evaluate change in the following nutrition diagnoses: Limited
adherence to nutrition-related recommendations, self monitoring deficity, not ready for diet/lifestyle change
Client Example
Self reported nutrition adherence score (self rated on scale of 1 to 10)
12/15/21, 10:22 AM Adherence

Comparison to Reference Standard, Recommendations, or Goal

2. Recommendations: Not applicable
3. Goal: Client rates self 4/10 (1 = not adherent to 10 = completely adherent) on ability to adhere to meal
plan.
Client rates self 4/10 on ability to adhere to meal plan developed in collaboration
with dietitian. Discussions with client regarding barrier(s) to achieving goals and
Initial encounter
strategies to improve adherence. Goal set to adhere to meal plan 5 days per week.
Client will evaluate progress toward goal at the next encounter and rate adherence.
Some progress toward goal. Client rated self 6/10 on ability to adhere to meal plan 5
Reassessment after days per week. Is doing well on weekdays, but verbalizes need to improve on
nutrition intervention weekends. Discussed strategies to improve adherence to meal plan on the weekends.
Client will monitor progress and adherence at next encounter.
References
1. Asaad G, Sadegian M, Lau R, et al. The Reliability and Validity of the Perceived Dietary Adherence
Questionnaire for People with Type 2 Diabetes. Nutrients. 2015;7(7):5484-5496.
2. Bosworth H, Weinberger M, Oddone EZ. Patient Treatment Adherence: Concepts, Interventions, and
Measurement. Mahwah, NJ: Psychology Press; 2005.
3. Crowley MJ, Grubber JM, Olsen MK, Bosworth HB. Factors associated with non-adherence to three
hypertension self-management behaviors: preliminary data for a new instrument. J Gen Intern Med.
2013;28(1):99-106.
4. DiMatteo MR, Giordani PJ, Lepper HS, Croghan TW. Patient adherence and medical treatment outcomes:
a meta-analysis. Med Care. 2002;40(9):794-811.
5. Haynes RB. Improving patient adherence: State of the art, with a special focus on medication taking for
cardiovascular disorders. In: Burke LE, Ockene IS, eds. Compliance in Healthcare and Research.
Armonk, NY: Futura Publishing Company; 2001.
6. Jones CD, Holmes GM, DeWalt DA, et al. Self-reported recall and daily diary-recorded measures of
weight monitoring adherence: associations with heart failure-related hospitalization. BMC Cardiovasc
Disord. 2014;14(1):12.
7. Khalil AA, Darawad MW. Objectively measured and self-reported nonadherence among Jordanian
patients receiving hemodialysis. Hemodialysis international International Symposium on Home
Hemodialysis. 2014;18(1):95-103.
8. Lambert K, Mullan J, Mansfield K. An integrative review of the methodology and findings regarding
dietary adherence in end stage kidney disease. BMC Nephrol. 2017;18(1):318.
9. Milas NC, Nowalk MP, Akpele L, et al. Factors associated with adherence to the dietary protein
intervention in the Modification of Diet in Renal Disease Study. J Am Diet Assoc. 1995;95(11):1295-
1300.
10. Raj GD, Hashemi Z, Soria Contreras DC, et al. Adherence to diabetes dietary guidelines assessed using a
validated questionnaire predicts glucose control in adults with type 2 diabetes. Canadian journal of
diabetes. 2018;42(1):78-87.
11. Rushe H, McGee HM. Assessing adherence to dietary recommendations for hemodialysis patients: the
Renal Adherence Attitudes Questionnaire (RAAQ) and the Renal Adherence Behaviour Questionnaire
(RABQ). J Psychosom Res. 1998;45(2):149-157.
12. Sharma S, Murphy SP, Wilkens LR, et al. Adherence to the food guide pyramid recommendations among
Japanese Americans, Native Hawaiians, and whites: results from the multiethnic cohort study. J Am Diet
Assoc. 2003;103(9):1195-1198.
12/15/21, 10:22 AM Adherence
13. Song EK, Moser DK, Kang SM, Lennie TA. Self-reported adherence to a low-sodium diet and health
outcomes in patients with heart failure. J Cardiovasc Nurs. 2016;31(6):529-534.
14. Thomson JL, Landry AS, Zoellner JM, et al. Participant adherence indicators predict changes in blood
pressure, anthropometric measures, and self-reported physical activity in a lifestyle intervention: HUB
city steps. Health education & behavior : the official publication of the Society for Public Health
Education. 2015;42(1):84-91.
15. Tinker LF, Perri MG, Patterson RE, et al. The effects of physical and emotional status on adherence to a
low-fat dietary pattern in the Women's Health Initiative. J Am Diet Assoc. 2002;102(6):789-800, 888.
16. Villa L, Sun D, Denhaerynck K, et al. Predicting blood pressure outcomes using single-item physician-
administered measures: a retrospective pooled analysis of observational studies in Belgium. Br J Gen
Pract. 2015;65(630):e9-e15.
17. Warren-Findlow J, Basalik DW, Dulin M, Tapp H, Kuhn L. Preliminary validation of the Hypertension
Self-Care Activity Level Effects (H-SCALE) and clinical blood pressure among patients with
hypertension. J Clin Hypertens (Greenwich). 2013;15(9):637-643.
18. Williamson DA, Anton SD, Han H, et al. Adherence is a multi-dimensional construct in the POUNDS
LOST trial. J Behav Med. 2010;33(1):35-46.
2020 EDITION
12/15/21, 10:22 AM Avoidance Behavior
AVOIDANCE BEHAVIOR
Avoidance Behavior (FH-5.2)

Definition
Keeping away from something or someone to postpone an outcome or perceived consequence

Indicators
Avoidance
Specific foods (specify, e.g., grapefruit, seeds)

Food groups (specify, e.g., milk/milk products)
Fluids (specify)
Textures (specify)
Social situations (specify)
Other (specify)
Restrictive eating (yes/no)
Cause of avoidance behavior (e.g., personal choice, prescribed dietary restriction, GI distress, suspected
allergy, eating disorder, cancer treatment side effects, medications, mental illness, Parkinson’s disease)
Examples of the measurement methods or data sources for these outcome indicators: Self-monitoring
records, patient/client interview
Typically used with the following domains of nutrition interventions: Nutrition counseling
diagnoses: Disordered eating pattern, overweight/obesity, underweight, altered GI function
Evaluation


OR
Client Example
Avoidance of social situations

1. Goal：Patient/client avoiding social situations in an effort to avoid overeating. Goal is to learn strategies
to control eating in social situations.
OR
2. Reference Standard：No validated standard exists
個Patient/client avoids social situations because she is afraid she will overeat.
Reviewed client’s food diary and client brainstormed strategies which may help her
control eating in social situations. Patient/client will preplan food intake on days she
with client
has social engagements, will have a piece of fruit before going to help curb her
appetite and will maintain a food diary.
Patient/client made some progress toward goal. Attended 2 of 4 social engagements
Reassessment after where food was served, and successfully controlled food intake both times.
nutrition intervention Patient/client will continue to use strategies. Will reevaluate avoidance behavior at
next encounter.
References
1. Susan H. Barriers to effective nutritional care for older adults. Nurs Stand [serial online]. 2006;21:50-54.
2. Susan H. Nutrition matters for older adults. J Commun Nurs [serial online]. 2006;20:24,26,28-30.
3. Zutavern A, Brockow I, Schaaf B, Bolte G, von Berg A, Diez U, Borte M, Herbarth O, Wichmann HE,
Heinrich J, LISA Study Group. Timing of solid food introduction in relation to atopic dermatitis and
atopic sensitization: Results from a prospective birth cohort study. Pediatrics [serial online].
2006;117:401-411.
4. Ogden J, Karim L, Choudry A, Brown K. Understanding successful behaviour change: the role of
intentions, attitudes to the target and motivations and the example of diet. Health Educ Res [serial online].
2007;22:397-405.
5. Watson L, Leslie W, Hankey C. Under-nutrition in old age: diagnosis and management. Rev Clin
Gerontol [serial online]. 2006;16:23-34.
6. Brisbois TD, Hutton JL, Baracos VE, Wismer WV. Taste and smell abnormalities as an independent cause
of failure of food intake in patients with advanced cancer-an argument for the application of sensory
science. J Palliativ Care [serial online]. 2006;22:111-114.
7. Cassens D, Johnson E, Keelan S. Enhancing taste, texture, appearance, and presentation of pureed food
improved resident quality of life and weight status. Nutr Rev [serial online]. 1996;54:S51.
8. Reed PS, Zimmerman S, Sloane PD, Williams CS, Boustani M. Characteristics associated with low food
and fluid intake in long-term care residents with dementia. Gerontologist. [serial online]. 2005;45:74-80.
9. Joo SH, Wood RA. The impact of childhood food allergy on quality of life. Pediatrics: Synopsis Book:
Best Articles Relevant to Pediatric Allergy [serial online]. 2003;112:459.
10. Fält B, Granérus A, Unosson M. Avoidance of solid food in weight losing older patients with Parkinson’s
disease. J Clin Nurs. 2006;15(11):1404-1412.
11. Nowak-Wegrzyn A, Sampson HA. Adverse reactions to foods. Med Clin N Am. January 2006;90(1):97-
127.
12. Meyer C, Serpell L, Waller G, Murphy F, Treasure J, Leung N. Cognitive avoidance in the strategic
processing of ego threats among eating-disordered patients. Int J Eat Disord. July 2005;38(1):30-36.
13. Talley NJ. Irritable bowel syndrome. Gastroenterol Clin N Am. 2005;34(2):xi-xii,173-354.
14. Sverker A, Hensing G, Hallert C. Controlled by food—lived experiences of coeliac disease. J Hum Nutr
Diet. 2005;18(3):171-180.
15. Smith CM, Kagan SH. Prevention of systemic mycoses by reducing exposure to fungal pathogens in
hospitalized and ambulatory neutropenic patients. Oncol Nurs Forum. 2005;32(3):565-579.
16. Millson DS, Tepper SJ. Migraine treatment. Headache. J Head Face Pain. 2004;44(10):1059-61.
17. Brown AC, Hairfield M, Richards DG, McMillin DL, Mein EA, Nelson CD. Medical nutrition therapy as
a potential complementary treatment for psoriasis—five case reports. Alt Med Rev. 2004; 9(3):297-307.
18. Biddle J, Anderson J. Report on a 12-month trial of food exclusion methods in a primary care setting. J
Nutr Environ Med. 2002;12(1):11 17.
2020 EDITION
12/15/21, 10:23 AM Bingeing and Purging Behavior
BINGEING AND PURGING BEHAVIOR
Bingeing and Purging Behavior (FH-5.3)

Definition
Eating a larger amount of food than normal for the individual during a short period of time (within any two-hour
period) accompanied by a lack of control over eating during the binge episode (i.e., the feeling that one cannot
stop eating). This may be followed by compensatory behavior to make up for the excessive eating, referred to as
purging.

Indicators
Binge eating behavior (present/absent)
Number of binge episodes (e.g., number/day, number/week, number/month)
Purging behavior (present/absent)
Self-induced vomiting (number/day, number/week, number/month)

Fasting (yes/no)
Other (specify)
Note: Misuse of laxatives, diuretics or other drugs is found on the Medication and
Complementary/Alternative Medicine reference sheets. Amount and type of physical activity is found on
the Physical Activity reference sheet.
Examples of the measurement methods or data sources for these outcome indicators: Patient/client
interview, medical record, referring health care provider or agency, self-monitoring records
Excessive oral intake, disordered eating pattern, overweight/obesity
Evaluation


OR
Client Example
Number of binge episodes

1. Goal：Patient/client reports 3 binge eating episodes per week. Goal is to reduce binge eating to one
episode per week.
OR
2. Reference Standard：No validated standard exists.
Initial encounter with

Patient/client reports 3 binge-eating episodes this week.
patient/client
Reassessment after Some progress toward goal. Patient/client reported 2 binge eating episodes this
nutrition intervention week. Will continue to monitor at next encounter.
References
1. Fairburn CG, Wilson GT. Binge Eating:Nature, Assessment and Treatment. New York: Guilford Press;
1993.
2. Snetselaar LG. Nutrition Counseling Skills for Medical Nutrition Therapy. 2nd ed. Gaithersburg, MD:
Aspen Press; 2007.
3. Kellogg M. Counseling Tips for Nutrition Therapists: Practice Workbook. Philadelphia, PA: Kg Press;
2006.
4. Wonderlich SA, de Zwaan M, Mitchell JE, Peterson C, Crow S. Psychological and dietary treatments of
binge eating disorder: conceptual implications. Int J Eat Disord. 2003;34 Suppl:S58-S73.
5. Telch CF, Agras WS, Linehan MM. Dialectical behavior therapy for binge eating disorder. J Consult Clin
Psychol. 2001;69(6):1061-1065.
6. Safer DL, Lively TJ, Telch CF, Agras WS. Predictors of relapse following successful dialectical behavior
therapy for binge eating disorder. Int J Eat Disord. 2002;32(2):155-163.
7. Devlin MJ, Goldfein JA, Petkova E, Liu L, Walsh BT. Cognitive behavioral therapy and fluoxetine for
binge eating disorder: two-year follow-up. Obesity. 2007;15(7):1702-1709.
8. Peterson CB, Mitchell JE, Engbloom S, Nugent S, Mussell MP, Miller JP. Group cognitive-behavioral
treatment of binge eating disorder: a comparison of therapist-led versus self-help formats. Int J Eat
Disord. 1998;24(2):125-136.
9. Gorin AA, Le Grange D, Stone AA. Effectiveness of spouse involvement in cognitive behavioral therapy
for binge eating disorder. Int J Eat Disord. 2003;33(4):421-433.
10. Ljotsson B, Lundin C, Mitsell K, Carlbring P, Ramklint M, Ghaderi A. Remote treatment of bulimia
nervosa and binge eating disorder: a randomized trial of Internet-assisted cognitive behavioural
therapy. Behav Res Ther. 2007;45(4):649-661. Epub 2006.
11. Celio AA, Wilfley DE, Crow SJ, Mitchell J, Walsh BT. A comparison of the binge eating scale,
questionnaire of eating and weight patterns-revised, and eating disorder examination with instructions
with the eating disorder examination in the assessment of binge eating disorder and its symptoms. Int J
Eat Disord. 2004;36:434-444.
12. Position of the American Dietetic Association. Nutrition intervention in the treatment of eating
disorders. J Am Diet Assoc. 2011;111:1236-1241.
13. Practice Paper of the Academy of Nutrition and Dietetics: Nutrition intervention in the treatment of eating
disorders. http://www.eatrightpro.org/resource/practice/position-and-practice-papers/practice-
papers/practice-paper-nutrition-intervention-in-the-treatment-of-eating-disorders. Accessed June 17,
2015.
2020 EDITION
12/15/21, 10:23 AM Mealtime Behavior
MEALTIME BEHAVIOR
Mealtime Behavior (FH-5.4)

Definition
Manner of acting, participating, or behaving at mealtime which influences patient/client’s food and beverage
intake

Indicators
Meal duration (minutes)

Patient/client/caregiver fatigue during feeding process,
Percent of meal time spent eating (percent)
resulting in inadequate intake (yes/no)
Preference to drink rather than eat (yes/no)
Willingness to try new foods (yes/no)
Refusal to eat/chew (specify, e.g., meal, food type)
Limited number of accepted foods (specify)
Spitting food out (specify, e.g., food type, frequency)
Rigid sensory preferences (flavor, temperature, texture)
Rumination (yes/no)
Examples of the measurement methods or data sources for these outcome indicators: Observation, medical
record, referring health care provider or agency, caregiver observation, patient/client interview
Typically used with the following domains of nutrition interventions: Food and/or nutrient delivery,
coordination of nutrition care by nutrition professional
Typically used to determine and monitor and evaluate change in the following nutrition diagnoses: Self-
feeding difficulty, inadequate and excessive oral intake
Evaluation


OR
Client Example
Percent of meal spent eating (percentage)

12/15/21, 10:23 AM Mealtime Behavior
1. Goal:Four-year-old patient/client with inadequate food/beverage intake. Lunch meal observation revealed
less than 10% of mealtime was spent eating. Goal is to reduce environmental distractions and increase
percent of meal spent eating to 55%.
OR
Initial nutrition assessment Lunch meal observation revealed that patient/client is highly distracted and spends
with client less than 10% of the mealtime eating.
Significant progress toward goal. Environmental distractions were minimized and
Reassessment after
caregiver eats meals with patient/client. Observation reveals that approximately
40% of mealtime is spent eating. Will monitor at next encounter.
References
1. Powers SW, Patton SR, Byars KC, Mitchell MJ, Jelalian E, Mulvihill MM, Hovell MF, Stark LJ. Caloric
intake and eating behavior in infants and toddlers with cystic fibrosis. Diabetes Care. 2002;109(5):e75.
2. Wardle J, Guthrie CA, Sanderson S, Rapoport L. Development of the Children’s Eating Behaviour
Questionnaire. J Child Psychol Psychiat. 2001;42(7):963-970.
3. Chial HJ, Camilleri M, Williams DE, Litzinger K, Perrault J. Rumination Syndrome in children and
adolescents: diagnosis, treatment and prognosis. Pediatrics. 2003;111:158-162.
4. Fung EB, Samson-Fang L, Stallings VA, Conaway M, Liptak G, Henderson RC, Worley G, O’Donnell M,
Calvert B, Rosenbaum P, Chumlea W, Stevenson RD. Feeding dysfunction is associated with poor growth
and health status in children with cerebral palsy. J Am Diet Assoc. 2002;102:361-368,373.
5. Lucas B, Pechstein S, Ogata B. Nutrition concerns of children with autism spectrum disorders. Nutr
Focus. 2002;17:1-8.
6. Adams RA, Gordon C, Spangler AA. Maternal stress in caring for children with feeding disabilities:
implications for health care providers. J Am Diet Assoc. 1999;99:962-966.
7. Ramsay M, Gisel EG, Boutry M. Non-organic failure to thrive: growth failure secondary to feeding-skills
disorder. Develop Med Child Neurol. 1993;35:285-297.
2020 EDITION
12/15/21, 10:23 AM Social Network
SOCIAL NETWORK
Social Network (FH-5.5)

Definition
Ability to build and utilize a network of family, friends, colleagues, health professionals, and community
resources for encouragement, emotional support, and to enhance one’s environment to support behavior change
Indicators
Ability to build and utilize social networks (e.g., may include perceived social support, social integration,
and assertiveness)
Examples of the measurement methods or data sources for these outcome indicators: Self-monitoring
records, client/patient self-report, goal-tracking tools
domain nutrition diagnoses, underweight, overweight/obesity, disordered eating pattern, undesirable food
choices, inability to manage self-care, breastfeeding difficulty, not ready for diet/lifestyle change, limited
adherence to nutrition-related recommendations
Evaluation


OR
Client Example
Ability to build and utilize social support (e.g., may include perceived social support, social integration, and
assertiveness)

1. Goal：Overweight patient/client’s wife adds fat to all foods prepared at home. Goal is to reduce the
amount of fat in meals prepared at home by asking wife to not dress the salad or add fat seasoning to
vegetables before serving.
OR
12/15/21, 10:23 AM Social Network
Patient/client states that he rarely verbalizes his nutrition-related desires/needs in

family or social situations and rates his ability to elicit social support a 3 on a scale
with client
of 1 to 10. Will evaluate at the next encounter.
Some progress toward goal. Patient/client rated himself a 5, on a scale of 1to10, on
Reassessment after his ability to elicit social support. Has begun to verbalize his needs and plans to
nutrition intervention research restaurants that meet his needs that others will enjoy. Will monitor at next
encounter in two weeks.
References
1. Barrera M, Toobert D, Angell K, Glasgow R, Mackinnon D. Social support and social-ecological

resources as mediators of lifestyle intervention effects for type 2 diabetes. J Health Psychol. 2006;11:483-
495.
2. Sherbourne CD, Stewart AI. The MOS Social Support Survey. Social Sci Med. 1991;32:706-714.
3. Barrera M Jr, Glasgow RE, McKay HG, Boles SM, Feil E. Do internet-based support interventions
change perceptions of social support?: an experimental trial of approaches for supporting diabetes self-
management. Am J Comm Psychol. 2002; 30:637-654.
4. LaGreca AM, Bearman KJ. The diabetes social support questionnaire-family version: evaluating
adolescents’ diabetes-specific support from family members. J Pediatr Psychol. 2002;27:665-676.
5. Glasgow RE, Strycker LA, Toobert DJ, Eakin E. A social-ecologic approach to assessing support for
disease self-management: the Chronic Illness Resources Survey. J Behav Med. 2000;23:559-583.
2020 EDITION
12/15/21, 10:27 AM Food/Nutrition Program Participation
FOOD/NUTRITION PROGRAM PARTICIPATION
Food/Nutrition-Related History – Factors Affecting Access to Food and/or Food and Nutrition Related Supplies
Food and Nutrition Program Participation (FH-6.1)

Definition
Client participation in supportive food and nutrition programs for which the client may be eligible

Indicators
Eligibility for government nutrition programs (yes/no)—defined as qualification status for national,
provincial, regional, or state-based nutrition programs that offer food support and/or nutrition intervention
Enrollment in government nutrition programs (yes/no)—defined as active recipient of or involvement in

services from national, provincial, regional, or state-based nutrition programs that offer food support
and/or nutrition intervention
Eligibility for community nutrition programs (yes/no)—defined as qualification status for nutrition
programs that offer food support and/or nutrition intervention
Enrollment in community nutrition programs (yes/no)—defined as active recipient of or involvement in

services from nutrition programs that offer food support and/or nutrition intervention
Awareness of programs offering food support and nutrition intervention (yes/no)—defined as client
ability to name or recognize programs related to the client’s needs
Examples of the measurement methods or data sources for these outcome indicators: Client report of
eligibility and enrollment, program referral completion information, client setting evaluation, survey data on
program participation rates among eligible households
nutrition action
access to food, limited access to potable water, limited access to nutrition related supplies, inadequate or
excessive energy intake, inadequate protein intake, inadequate vitamin intake, inadequate mineral intake, food
and nutrition related knowledge deficit
Client Example
Enrollment in government nutrition programs

12/15/21, 10:27 AM Food/Nutrition Program Participation

2. Recommendation: Recommend enrollment in government nutrition program because client is eligible and
willing to enroll.
3. Goal: Client was unaware of eligibility requirement and is willing to complete required documentation to
allow enrollment in government nutrition program (school lunch).
The client’s parent was not aware of required documentation for enrollment in
Initial nutrition assessment government nutrition program (school lunch) and parent aims to complete them.
with client Will follow-up with parent and monitor change in school lunch program
participation at next encounter.
Reassessment after Progress toward goal as client’s family/guardian has completed and submitted
nutrition intervention school lunch program forms. Review for enrollment in program at future encounter.
References
1. Australian Red Cross. Breakfast Club - School Program. https://www.redcross.org.au/about/how-we-

help/food-security/australian-red-cross-breakfast-clubs. Accessed February 14, 2020.
2. Australian Red Cross. FoodREDi Community Nutrition Education.
https://www.redcross.org.au/about-us/how-we-help/foodredi-education-programs. Accessed February 14,
2020.
3. Bazerghi C, McKay FH, Dunn M. The role of food banks in addressing food insecurity: A systematic
review. J Community Health. 2016;41(4):732-740.
4. Holben DH, Marshall MB. Position of the Academy of Nutrition and Dietetics: Food insecurity in the
United States. J Acad Nutr Diet. 2017;117(12):1991-2002.
5. Lee A, Mhurchu CN, Sacks G, et al. Monitoring the price and affordability of foods and diets
globally. Obes Rev. 2013;14 Suppl 1:82-95.
6. Singh-Peterson L, Shoebridge A, Lawrence G. Food pricing, extreme weather and the rural/urban
divide: A case study of northern NSW, Australia. J Food Secur. 2013;1(2):42-48.
7. US Department of Agriculture Economic Research Service. Food Security in the U.S.
https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us. Accessed February 14,
2020.
8. U.S. Department of Health & Human Services. U.S. Federal Poverty Guidelines.
https://aspe.hhs.gov/poverty-guidelines. Accessed February 14, 2020.
9. United States Department of Agriculture. National Agriculture Library. US Food Assistance
Programs. https://www.nal.usda.gov/fnic/nutrition-assistance-programs. Accessed February 14, 2020.
10. Wetherill MS, White KC, Rivera C. Food insecurity and the nutrition care process: Practical
applications for dietetics practitioners. J Acad Nutr Diet. 2018;118(12):2223-2234.
2020 EDITION
12/15/21, 10:27 AM Safe Food/Meal Availability
SAFE FOOD/MEAL AVAILABILITY
Safe food availability (FH-6.2)

Definition
Reliable acquisition of safe and acceptable food to meet nutrition needs for an active, healthy life

Indicators
Availability of shopping facilities (yes/no) defined as access to affordable sources of acceptable and safe
food to meet nutrition needs
Ability to procure safe food (yes/no)—defined as the capacity to source (eg, grocery stores, growing,
hunting, fishing, food relief agencies) acceptable and safe foods to select a wide variety of food to meet
nutrition needs
Access to food preparation equipment (yes/no)—defined as ability to obtain and use equipment necessary
to prepare food to meals or snacks
Availability of food refrigeration (yes/no)—defined as access to cold food storage
Ability to store food safely (yes/no)—defined as the capacity to keep food safe for consumption
Ability to identify safe food (yes/no)—defined as the capacity to select foods for consumption that are
free from spoilage or contaminants
Individual client food security level (high, marginal, low, and very low)—defined as the degree to which
an individual client in the household has reliable availability of food to meet nutrition needs from socially
acceptable sources without running out
Household food security level (high, marginal, low, and very low)—defined as the degree to which the
household has reliable availability of food to meet nutrition needs from socially acceptable sources
without running out
Situational food insecurity (present/absent)—defined as short-term instability in food security
Chronic food insecurity (present/absent)—defined as medium- to long-term instability in food security
Examples of the measurement methods or data sources for these outcome indicators: Client report overall
food availability/food consumed during the week, referral information, setting evaluation, survey data
Typically used with the following domains of nutrition interventions: Food and/or nutrition delivery,
nutrition education, nutrition counseling, coordination of nutrition care by nutrition professional, population
based nutrition action
access to food, intake of unsafe food, inadequate or excessive energy intake, inadequate or excessive oral intake,
inadequate vitamin and mineral intake
Client Example
Access to food preparation equipment (yes/no)

1. Reference Standard：Not applicable.

2. Recommendation: Reliable Access to food preparation equipment.
3. Goal: Client establishes goal to complete appointment with relevant professional regarding Access to
food preparation equipment.
Initial nutrition
The client’s Access to food preparation equipment is not reliable. Will monitor change in
assessment with
access at next encounter after coordination of nutrition care with relevant professional.
client
Reassessment after
nutrition Achieved goal as client has reliable Access to food preparation equipment.
intervention
References
The following are some suggested references for indicators, measurement techniques, and reference standard;
1. Australian Red Cross. Food Security. https://www.redcross.org.au/about/how-we-help/food-security.

2. Cafiero C, Melgar-Quinonez HR, Ballard TJ, Kepple AW. Validity and reliability of food security
measures. Ann N Y Acad Sci. 2014;1331:230-248.
3. De Marchis EH, Torres JM, Fichtenberg C, Gottlieb LM. Identifying food insecurity in health care
settings: A systematic scoping review of the evidence. Fam Community Health. 2019;42(1):20-29.
4. Food and Agriculture Association of the United Nations. Coming to Terms with Terminology: Food
Security, Nutrition Security, Food Security and Nutrition, Food and Nutrition Security.
http://www.fao.org/3/MD776E/MD776E.pdf. Published 2012. Accessed February 14, 2020.
5. Holben DH, Marshall MB. Position of the Academy of Nutrition and Dietetics: Food insecurity in the
United States. J Acad Nutr Diet. 2017;117(12):1991-2002.
6. McKechnie R, Turrell G, Giskes K, Gallegos D. Single-item measure of food insecurity used in the
National Health Survey may underestimate prevalence in Australia. Aust N Z J Public Health.
2018;42(4):389-395.
7. Government of Australia. National Health and Medical Research Council. Food Safety.
https://www.eatforhealth.gov.au/eating-well/food-safety. Accessed February 14, 2020.
8. US Department of Agriculture Economic Research Service. Food Security in the U.S.
https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us. Accessed February 14,
2020.
9. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015-2020
Dietary Guidelines for Americans. https://health.gov/dietaryguidelines/2015/. Accessed February 13,
2020.
10. Vidgen HA, Gallegos D. Defining food literacy and its components. Appetite. 2014;76:50-59.
applications for dietetics practitioners. J Acad Nutr Diet. 2018;118(12):2223.
2020 EDITION
12/15/21, 10:27 AM Safe Water Availability
SAFE WATER AVAILABILITY
Safe Water Availability (FH-6.3)

Definition
Reliable acquisition of water that can be safely consumed

Indicators
Availability of potable water (yes/no)—defined as ready access to water that meets guidelines for safe
drinking water
Ability to decontaminate water (yes/no)—defined as the capacity to interpret public health warnings and
use of strategies to treat water for consumption
Awareness of public health water alert (yes/no)—defined as attentiveness of warnings issued by public
health authorities regarding drinking water
Examples of the measurement methods or data sources for these outcome indicators: Client report of
potable water availability and/or decontamination strategies, referral information, setting evaluation, survey data,
government issued reports and warnings
counseling, coordination of nutrition care by nutrition professional, population based nutrition action
access to potable water, Inadequate fluid intake, intake of unsafe water
Client Example
Awareness of public health water alert (yes/no)


2. Recommendation: Awareness of public health water alert
3. Goal: Client reports limited awareness of water decontamination public health warnings.
Initial nutrition assessment The client has limited awareness of the current public health alert for water
decontamination (eg, community has a boil water alert for water used for drinking
12/15/21, 10:27 AM Safe Water Availability
and cooking). Education provided. Client establishes goal to decontaminate water

for duration of alert. Will monitor change in decontamination practices.
Reassessment after Substantial progress toward goal as client is decontaminating water consistent with
nutrition intervention public health alert.
References
1. US Environmental Protection Agency. Ground Water and Drinking Water.

https://www.epa.gov/ground-water-and-drinking-water. Accessed February 14, 2020.
2. National Health and Medical Research Council. Australian Drinking Water Guidelines.
https://www.nhmrc.gov.au/about-us/publications/australian-drinking-water-guidelines. Accessed February
14, 2020.
3. World Health Organization. Guidelines for Drinking-Water Quality. 4th ed. Geneva, Switzerland:
World Health Organization; 2017.
2020 EDITION
12/15/21, 10:27 AM Food and Nutrition Related Supplies Availability
FOOD AND NUTRITION RELATED SUPPLIES AVAILABILITY
Food and Nutrition Related Supplies Availability (FH-6.4)

Definition
Reliable ability to obtain necessary supplies to support food consumption and nutrition needs

Indicators
Access to food and nutrition related supplies (yes/no)—defined as ability to obtain nutrition related
supplies for providing, assessing, and monitoring and evaluating nutrition interventions to administer,
self-monitor, and meet food and nutrition needs (eg, glucose monitor, monitoring strips, lancets,
pedometer, PN/EN supplies, thickeners, blood pressure-related devices)
Access to assistive eating devices (equipment or utensils), specify, e.g., modified utensils, plates, bowls,
gavage feeding supplies)
Access to assistive food preparation devices (specify, e.g., modified utensils for food preparation, electric
can openers, rocking knives, one-handed devices)
Examples of the measurement methods or data sources for these outcome indicators: Client report, referral
information, setting evaluation
nutrition action
availability to nutrition related supplies, inability to manage self care, inadequate oral intake, self feeding
difficulty, limited adherence to nutrition related recommendations, not ready for diet/lifestyle change, self
monitoring deficit
Client Example
Access to food and nutrition related supplies (yes/no)

1. Reference Standard American Diabetes Association Standards of Care (2019).

2. Recommendation: Client does not have access to nutrition related supplies for regular glucose
monitoring.
3. Goal: Client establishes goal to attend appointment with relevant professional who will assist with
obtaining glucose monitoring supplies.
12/15/21, 10:27 AM Food and Nutrition Related Supplies Availability
The client does not have access to nutrition related supplies (glucose monitoring
strips). Referral to relevant professional. Will monitor change in access to nutrition
with client
related supplies (glucose monitoring strips) availability at next encounter.
Reassessment after Goal met as client met with relevant professional and has access to nutrition related
nutrition intervention supplies (glucose monitoring strips).
References
1. American Diabetes Association. Standards of Medical Care in Diabetes-2020.

https://care.diabetesjournals.org/content/43/Supplement_1. Accessed February 14, 2020.
2. Gramlich L, Hurt RT, Jin J, Mundi MS. Home enteral nutrition: Towards a standard of care.
Nutrients. 2018;10(8).
3. Holben DH. Position of the American Dietetic Association: food insecurity in the United States. J Am
Diet Assoc. 2010;110(9):1368-1377.
4. National Foundation for Swallowing Disorders. Adaptive Feeding Devices.
https://swallowingdisorderfoundation.com/adaptive-feeding-devices/. Accessed February 17, 2020.
applications for dietetics practitioners. J Acad Nutr Diet. 2018;118(12):2223-2234.
6. U.S. Department of Health & Human Services. U.S. Federal Poverty Guidelines.
https://aspe.hhs.gov/poverty-guidelines. Accessed February 14, 2020.
2020 EDITION
12/15/21, 10:28 AM Food and Nutrition Sanitation
FOOD AND NUTRITION SANITATION
Food and Nutrition Sanitation (FH-6.5)

Definition
Reliable and accessible sanitation and hygiene to keep food, water, and nutrition related supplies safe and reduce
spread of disease

Indicators
Availability of suitable sanitation facilities (yes/no)–defined as the availability of suitable sanitation

facilities and the capacity to use these facilities to ensure that waste (ie, human and animal) is kept
separate and does not contaminate food, water, and nutrition related supplies
Ability to wash hands with soap and water (yes/no)–defined as the availability of handwashing facilities
and the capacity to use these facilities to reduce contamination and the spread of disease to food, water,
and nutrition related supplies
Examples of the measurement methods or data sources for these outcome indicators: Client report referral
information, setting evaluation, survey data, microorganism culture results
Typically used with the following domains of nutrition interventions: Food and/or nutrition delivery,
nutrition education, nutrition counseling, coordination of nutrition care by nutrition professional, population
based nutrition action
access to food, intake of unsafe food, limited access to potable water, food and nutrition related knowledge
deficit
Client Example
Ability to wash hands with soap and water (yes/no) and Availability of suitable sanitation facilities (yes/no)

1. Reference Standard International and national standards for hand washing.

2. Recommendation: Ability to wash hands with soap and water and Availability of suitable sanitation
facilities.
3. Goal: Client establishes goal to identify suitable sanitation facility during work to use for washing
hands prior to eating.
Initial nutrition assessment The client has limited Ability to wash hands with soap and water prior to eating due
12/15/21, 10:28 AM Food and Nutrition Sanitation
with client to limited Availability of suitable sanitation facilities. Soap is lacking in working
environment. Client will identify suitable sanitation facility during work and use
prior to eating.
Reassessment after Client has identified suitable sanitation facilities during working hours and reports
nutrition intervention consistent Ability to wash hands with soap and water prior to eating.
References
1. Australian Government Department of Health. How to Wash and Dry Hands.

https://www1.health.gov.au/internet/main/publishing.nsf/Content/how-to-wash-and-dry-hands. Accessed
March 2, 2020.
2. Centers for Disease Control and Prevention. When and How to Wash Your Hands.
https://www.cdc.gov/handwashing/when-how-handwashing.html. Accessed March 2, 2020.
3. UNICEF. Water, Sanitation and Hygiene. https://www.unicef.org/wash/. Accessed March 2, 2020.
4. World Health Organization. WASH in the 2030 Agenda New Global Indicators for Drinking Water,
Sanitation and Hygiene. https://www.who.int/water_sanitation_health/monitoring/coverage/jmp-2017-
wash-in-the-2030-agenda.pdf?ua=1. Accessed March 2, 2020.
2020 EDITION
12/15/21, 10:29 AM Breastfeeding Assessment
BREASTFEEDING ASSESSMENT
Food/Nutrition-Related History – Physical Activity and Function
Breastfeeding Assessment (FH-7.1)

Definition
Evaluation of breastfeeding ability and capacity to support the nutritional and other needs of the infant and
mother

Indicators
Initiation of breastfeeding
Start breastfeeding (date)—defined as the day breastfeeding was initiated

Stop breastfeeding (date)—defined as the day breastfeeding ceased
Breastfeeding approach
Exclusive breastfeeding (yes/no)—defined as nourishment, all nutrients and fluid, provided via
breastfeeding for the first 6 months of life; permits oral vitamin and mineral supplements and
medicines
Predominant breastfeeding (yes/no)—defined as nourishment primarily from breastmilk, including
expressed mother’s or donor breastmilk; permits infant formula and other liquids, oral vitamin and
mineral supplements and medicines
Partial breastfeeding (yes/no)—defined as nourishment partially from breastmilk, including
expressed mother’s or donor breastmilk, with nourishment from infant formula and other sources
Breastfeeding Difficulties
Infant able to latch on to breast for feeding (yes/no)

Infant unable to latch on to breast for feeding (yes/no)
Difficulty latching on to breast for feeding (yes/no)
Abscess of breast associated with lactation (yes/no)
Cracked nipple associated with lactation (yes/no)
Infection of nipple associated with lactation (yes/no)
Non purulent mastitis associated with lactation (yes/no)
Retracted nipple associated with lactation (yes/no)
Inversion of nipple associated with lactation (yes/no)
Breast engorgement associated with lactation (yes/no)
Previous breast surgery associated with lactation (yes/no)
Breast abnormality associated with lactation (yes/no)
Inadequate flow of breastmilk (yes/no)
Finding related to infant’s ability to suck
Infant able to suck (yes/no)

Infant unable to suck (yes/no)
Difficulty sucking (yes/no)
Note: Infant/child growth can be found on the Body Composition/Growth/Weight History reference sheet.
Breastfeeding self-efficacy and intention to breastfeed can be found on the Beliefs and Attitudes reference
sheet.
Examples of the measurement methods or data sources for these outcome indicators: Client report,
practitioner observation of breastfeeding, self-monitoring records, infant weight trends
counseling, coordination of nutrition care by nutrition professional, population based nutrition action
diagnoses: Breastfeeding difficulty, predicted breastfeeding difficulty, food and nutrition related knowledge
deficit, unsupported beliefs/attitudes about food or nutrition related topics, unintended weight loss, inadequate
fluid intake
Client Example
Exclusive breastfeeding (yes/no)


3. Goal: Client fears breastfeeding will be difficult upon return to work. Client goal is exclusive
breastfeeding until returning to work when client will add supplemental infant formula to breastfeeding.
Postpartum client states goal of exclusive breastfeeding and then a combination of

formula and breastfeeding upon return to work. Will provide nutrition education,
Initial encounter
promotion of exclusive breastfeeding and discussing with employer accommodation
for pumping breastmilk at work, and refer to lactation support group.
Reassessment after Client reports exclusive breastfeeding for three months. Promotion of exclusive
nutrition intervention breastfeeding and nutrition education. Continue to monitor.
References
1. Alianmoghaddam N, Phibbs S, Benn C. Reasons for stopping exclusive breastfeeding between three and
six months: A qualitative study. J Pediatr Nurs. 2018;39:37-43.
2. Altuntas N, Turkyilmaz C, Yildiz H, et al. Validity and reliability of the infant breastfeeding assessment
tool, the mother baby assessment tool, and the LATCH scoring system. Breastfeed Med. 2014;9(4):191-
195.
3. Arslanoglu S, Corpeleijn W, Moro G, et al. Donor human milk for preterm infants: current evidence and
research directions. J Pediatr Gastroenterol Nutr. 2013;57(4):535-542.
4. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827-841.
5. Carolina Global Breastfeeding Institute. https://sph.unc.edu/cgbi/publications/. Accessed February 18,

2019.
6. Ferreira H, Oliveira MF, Bernardo EBR, Almeida PC, Aquino PS, Pinheiro AKB. Factors associated with
adherence to the exclusive breastfeeding. Ciencia & saude coletiva. 2018;23(3):683-690.
7. Fewtrell M, Bronsky J, Campoy C, et al. Complementary feeding: A position paper by the European
Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition.
J Pediatr Gastroenterol Nutr. 2017;64(1):119-132.
8. Kent JC, Hepworth AR, Sherriff JL, Cox DB, Mitoulas LR, Hartmann PE. Longitudinal changes in
breastfeeding patterns from 1 to 6 months of lactation. Breastfeed Med. 2013;8(4):401-407.
9. Kent JC, Mitoulas LR, Cregan MD, Ramsay DT, Doherty DA, Hartmann PE. Volume and frequency of
breastfeedings and fat content of breast milk throughout the day. Pediatrics. 2006;117(3):e387-395.
10. Labbok MH, Starling A. Definitions of breastfeeding: call for the development and use of consistent
definitions in research and peer-reviewed literature. Breastfeed Med. 2012;7(6):397-402.
11. Lessen R, Kavanagh K. Position of the Academy of Nutrition and Dietetics: Promoting and supporting
12. World Health Organization. Indicators for assessing infant and young child feeding practices. Part I:
definition. https://www.who.int/maternal_child_adolescent/documents/9789241596664/en/. Accessed
February 19, 2019.
2020 EDITION
12/15/21, 10:29 AM Nutrition Related Activities of Daily Living and Instrumental Activities of Daily Living
NUTRITION RELATED ACTIVITIES OF DAILY LIVING AND INSTRUMENTAL ACTIVITIES OF DAILY LIVING
Nutrition Related Activities of Daily Living and Instrumental Activities of

Daily Living (FH-7.2)
Definition
Level of cognitive and physical ability to perform nutrition-related activities of daily living and instrumental
activities of daily living by older and/or disabled persons

Indicators
Physical ability to complete tasks for meal preparation (plan meals, shop for meals, finances, meal
preparation) (yes/no)
Physical ability to self-feed (yes/no)
Ability to position self in relation to plate (within 12 to 18 inches (30-45 cm) from mouth to plate)
(yes/no)
Receives assistance with intake (yes/no)
Ability to use adaptive eating devices (those that have been deemed necessary and that improve self-
feeding skills) (yes/no)
Cognitive ability to complete tasks for meal preparation (planning meals, shopping for meals, finances,
meal preparation) (yes/no)
Remembers to eat (yes/no)
Recalls eating (yes/no)
Mini Mental State Examination Score (score)
Nutrition-related activities of daily living (ADL) score (score)
Nutrition-related instrumental activities of daily living (IADL) score (score)
Note:Sufficient intake of food can be found on the Food Intake reference sheet.
Sufficient intake of fluid can be found on the Fluid/Beverage Intake reference sheet.
Food security and ability to maintain sanitation can be found on the Safe Food/Meal Availability
reference sheet.
Ability to maintain weight can be found on the Body Composition/Growth/Weight History reference sheet.
Examples of the measurement methods or data sources for these outcome indicators: Self-report, caregiver
report, home visit, targeted questionnaires and monitoring devices, ADL and/or IADL measurement tool,
congregate meal site attendance records
Typically used with the following domains of nutrition interventions: Coordination of nutrition care by
nutrition professional
diagnoses: Inability to manage self-care, impaired ability to prepare foods/meals
Evaluation


OR
Client Example
Nutrition-related instrumental activities of daily living (IADL) score

1. Goal：Patient/client with decreased food intake due to an inability to drive, no close relatives living in
the vicinity, and difficulty in performing meal preparation tasks due to weakness
OR
Patient/client with inadequate food intake due to inability to drive, no close relative
living in vicinity, subsequent weight loss and difficulties in performing ADLs and
Initial encounter with IADLs due to weakness. Patient/client is to use new strategies and community
patient/client resources to facilitate attendance at senior center congregate meals 5 times per
week, use of community-provided transportation offered to grocery store 1 x per
week, and attendance in strength training at senior center.
Significant progress in nutrition-related activities of daily living. Patient/client able
Reassessment after to attend senior center for meals and strength training 3 times this week. Goal is 5
nutrition intervention times. Will continue to assess at next encounter. Patient/client going to grocery store
1 x per week.
References
1. Kretser A, Voss T, Kerr W, Cavadini C, Friedmann J. Effects of two models of nutritional intervention on
homebound older adults at nutritional risk. J Am Diet Assoc. 2003;103:329-336.
2. Sorbye LW, Schroll M, Finne Soveri H, Jonsson PV, Topinkova E, Ljunggren G, Bernabei R. Unintended
weight loss in the elderly living at home: the Aged in Home Care Project (AdHOC). J Nutr Health Aging.
2008;12:10-16.
3. Folstein M, Folstein SE, McHugh PR. Mini-mental state: a practical method for grading the cognitive
state of patients for the clinician. J Psychiatr Res. 1975;12(3):189-198.
4. Russell C. Dining Skills: Practical Interventions for Caregivers of Older Adults with Eating Problems.
Chicago, IL: Consultant Dietitians in Health Care Facilities, A Dietetic Practice Group of the American
2020 EDITION
12/15/21, 10:29 AM Physical Activity
PHYSICAL ACTIVITY
Physical Activity (FH-7.3)

Definition
Level of physical activity and/or amount of exercise performed
Indicators
Physical activity history (e.g., activities, preferences, attitudes)
Consistency (yes/no)
Frequency (number times/week)
Duration (number minutes/session, number of total minutes/day)
Intensity (e.g., talk test, Borg Rating of Perceived Exertion, % of predetermined max heart rate)
Type of physical activity (e.g., cardiovascular, muscular strength/endurance, flexibility; lifestyle,

programmed)
Strength (e.g., handgrip strength or other muscle strength measure)
Handgrip strength (Normal, Measurably Reduced) defined as a proxy measure of upper extremity
muscle function
TV/screen time (minutes/day)
Other sedentary activity time (e.g., commuting; sitting at desk, in meetings, at sporting or arts events)
(minutes/day)
Involuntary physical movement (present/absent)
Non exercise activity thermogensis (NEAT) (present/absent, level)
Examples of the measurement methods or data sources for these outcome indicators: History
interview/questionnaire, physical activity log, step counter, accelerometer, attendance at strength training,
balance training (for older adults), and/or aerobic classes, caretaker records, medical record, dynamometer
counseling
Physical inactivity, excessive exercise, underweight, overweight/obesity, unintended weight loss or weight gain
Evaluation


OR
Client Example
Consistency and duration

1. Goal：Patient/client typically walks approximately 10 minutes, twice per week. Patient/client goal is to
walk approximately 15 minutes, 5 days per week.
OR
2. Reference Standard：Patient/client’s typical 10-minute walk, twice a week is well below the
recommended at least 30 minutes of moderate-intensity physical activity (in bouts 10 minutes or longer),
5 days per week or at least 20 minutes of vigorous intensity physical activity (in bouts 10 minutes or
longer), 3 days per week (ACSM/AHA Physical Activity Guidelines for Public Health for adults and
seniors)
Based on exercise log, patient/client doing moderate-intensity physical activities 30

Initial encounter with minutes/day, 2 days/week. Goal is to do at least 30 minutes/day (in bouts 10 minutes
patient/client or longer), moderate-intensity activities, 5 or more days/wk. Will monitor physical
activity level at next appointment.
Significant progress toward goal of exercising at 30 minutes/day, moderate-intensity
Reassessment after
activities, 5 or more days/wk. Patient/client reports doing moderate-intensity
activities 30 minutes per day, 4 days/week.
References
1. Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA, Heath GW, Thompson
PD, Bauman A. Physical activity and public health: updated recommendation for adults from the
American College of Sports Medicine and the American Heart Association. Med Sci Sports Exer.
2007;39:8:1423-1434.
2. Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, Macera CA, Castaneda-Sceppa C.
Physical activity and public health in older adults: recommendation from the American College of Sports
Medicine and the American Heart Association. Med Sci Sports Exer. 2007;39:8:1435-1445.
3. American College of Sports Medicine Position Stands. http://www.acsm.org/access-public-
information/position-stands. Accessed June 17, 2015.
4. Department of Health and Human Services, Centers for Disease Control and Prevention. Growing
Stronger–Strength Training for Older Adults.
http://www.cdc.gov/physicalactivity/growingstronger/index.html. Accessed June 17, 2015.
5. American College of Sports Medicine. Exercise and the older adult. https://www.acsm.org/docs/current-
comments/exerciseandtheolderadult.pdf. Accessed June 17, 2015.
6. Exercise Guidelines During Pregnancy. American Pregnancy Association.
http://www.americanpregnancy.org/pregnancyhealth/exerciseguidelines.html. Accessed June 17, 2015.
7. Fabricatore AN. Behavior therapy and cognitive-behavioral therapy of obesity: is there a difference? J Am
Diet Assoc. 2007:107:92-99.
8. American Society of Hand Therapists. Clinical Assessment Recommendations, 3rd Edition. 2013.
9. Aging In Motion Coalition Announces Establishment of ICD-10-CM Code for Sarcopenia by the Centers
for Disease Control and Prevention [press release]. Washington, DC: Aging in Motion Coalition; 2016.
http://aginginmotion.org/news/2388-2/. Accessed February 15, 2017.
10. Becker PJ, Nieman Carney L, Corkins MR, Monczka J, Smith E, Smith SE, Spear BA, White JV.
Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and
Enteral Nutrition: Indicators recommended for identification and documentation of pediatric malnutrition
(undernutrition). J Acad Nutr Diet. 2014;114:1988-2000.
11. Bohannon, R. W., Bear-Lehman, J., Desrosiers, J., Massy-Westropp, N., & Mathiowetz, V. (2007).
Average grip strength: a meta-analysis of data obtained with a Jamar dynamometer from individuals 75
years or more of age. Journal of Geriatric Physical Therapy (2001), 30(1), 28–30. Retrieved from
http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?
dbfrom=pubmed&id=19839178&retmode=ref&cmd=prlinks%5Cnpapers2://publication/uuid/1BFC0354-
A179-431C-B0AF-46CE8F748F75. Accessed February 15, 2017.
2020 EDITION
12/15/21, 10:29 AM Factors Affecting Access to Physical Activity
FACTORS AFFECTING ACCESS TO PHYSICAL ACTIVITY
Factors Affecting Access to Physical Activity (FH-7.4)

Definition
Factors influencing access to physical activity opportunities and physical activity participation

Indicators
Neighborhood safety (the client’s perception of crime and traffic, presence of gangs, witness to physical
attacks, presence of community members walking or playing outside and feeling it is safe to walk outside.
Client rate on a scale of 1 to 10, 1=Unsafe, 10=Safe)
Walkability of neighborhood (the client’s perception on his/her ability to walk in a neighborhood related
to street connectivity, road type, dwelling density, and land use attributes (i.e., residential, commercial,
institutional or industrial land use). Client rate on a scale of 1 to 10, 1=Not walkable, 10=Very walkable)
Proximity to parks/green space (the client’s perception of the distance from the client's home/workplace
to the nearest park/green space. Client rate on a scale of 1 to 10, 1=Large distance to nearest park/green
space, 10=Small distance to nearest park/green space)
Access to physical activity facilities/programs (the client’s perception of the availability of physical
activity facilities/programs in the client’s environment. Client rate on a scale of 1 to 10, 1=No availability
of facilities/programs, 10=Excellent availability of facilities/programs)
Note: Physical disability, mobility and socioeconomic factors affecting physical activity can be
documented in the in Personal data (CH-1.1) and Social history (CH-3.1).
Examples of the measurement methods or data sources for these outcome indicators: Client perception,
neighborhood crime statistics, neighborhood traffic statistics, geographic information systems data to map a
neighborhood, availability of retail establishments within walking distance
counseling and coordination of care
overweight/obesity, physical inactivity, not ready for diet/lifestyle change
Client Example
Neighborhood safety

Comparison to Goal or Reference Standard, Recommendation, or Goal:
12/15/21, 10:29 AM Factors Affecting Access to Physical Activity
1. Reference Standard:Not applicable.

3. Goal: Client rated neighborhood as unsafe when increased physical activity is client’s goal.
Client perceives that the neighborhood is unsafe (rating of a 2) for an individual to

engage in outdoor exercise alone because of environmental factors (e.g. crime,
Initial encounter
traffic, gang presence, witness to physical attack) and has limited ability to adhere to
goal of increasing physical activity.
Client has joined a neighborhood outdoor exercise group and now rates
Reassessment after
neighborhood safety as a 7 and has increasing adherence with regular physical
activity.
References
1. Academy of Nutrition and Dietetics. Evidence Analysis Library. Childhood obesity and the built
environment. https://www.andeal.org/topic.cfm?
cat=4558&evidence_summary_id=251313&highlight=environment&home=1. Accessed February 12,
2018.
2020 EDITION
12/15/21, 10:30 AM Nutrition Quality of Life
NUTRITION QUALITY OF LIFE
Food/Nutrition-Related History – Nutrition Related Patient/Client Centered Measures
Nutrition Quality of Life (FH-8.1)

Definition
Extent to which the Nutrition Care Process impacts a patient/client’s physical, mental, and social well-being
related to food and nutrition

Indicators
Nutrition quality of life responses
Examples of the measurement methods or data sources for these outcome indicators: Nutrition Quality of
Life measurement tool, other quality of life tools
supplements, nutrition education, nutrition counseling, coordination of nutrition care by nutrition professional
Typically used to determine and monitor and evaluate change in the following nutrition diagnoses:Poor
nutrition quality of life, inadequate or excessive energy or macronutrient intake, underweight, unintended weight
loss, overweight/obesity, unintended weight gain, disordered eating pattern, inability to manage self-care,
swallowing difficulty, chewing difficulty, self-feeding difficulty, altered GI function, limited access to food.
Evaluation


OR
Client Example
Nutrition quality of life score

1. Goal：Patient/client with chronic renal disease currently reports poor nutrition quality of life, especially
decreased walking ability (physical) and limited food choices on renal diet (food impact). The goal of
medical nutrition therapy is to educate and coach patient and his family on options and strategies to
significantly enhance his nutrition quality of life.
2. OR
12/15/21, 10:30 AM Nutrition Quality of Life
Patient/client with chronic renal disease reports poor nutrition quality of life,
Initial encounter with particularly in physical and food impact aspects. Patient/client to receive intensive
patient/clientx medical nutrition therapy with a goal to improve client’s overall nutrition quality of
life over a 6-month period. Will monitor nutrition quality of life in 6 months.
Some progress toward goal. Patient/client’s nutrition quality of life is increased, but
Reassessment after
further improvement is desired in the physical dimension. Will continue medical
nutrition therapy and reassess in 3 months.
References
1. Barr JT, Schumacher GE. The need for a nutrition-related quality-of-life measure. J Am Diet Assoc.
2003;103:177–180.
2. Barr JT, Schumacher GE. Using focus groups to determine what constitutes quality of life in clients
receiving medical nutrition therapy: first steps in the development of a nutrition quality-of-life survey. J
Am Diet Assoc. 2003;103:844-851.
3. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36), I: conceptual framework
and item selection. Med Care. 1992;30:473-483.
4. Moorehead M, Ardelt-Gattinger E, Lechner H, Oria H. The validation of the Moorehead-Ardelt Quality
of Life Questionnaire II. Obes Surg. 2003;13:684-692.
5. Groll D, Vanner S, Depew W, DaCosta L, Simon J, Groll A, Roblin N, Paterson W. The IBS-36: a new
quality of life measure for irritable bowel syndrome. Am J Gastroenterol. 2002;97:962-971.
6. Diabetes Control and Complications Trial Research Group. Reliability and validity of a diabetes quality
of life measure for the Diabetes Control and Complications Trial (DCCT). Diabetes Care. 1988;11:725-
732.
7. Position of the American Dietetic Association. Individualized nutrition approaches for older adults in
health care communities. J Am Diet Assoc. 2010;110:1554-1563.
* This nutrition indicator is included to encourage further research.
2020 EDITION
12/15/21, 10:35 AM Body Composition/Growth/Weight History
BODY COMPOSITION/GROWTH/WEIGHT HISTORY
Anthropometric Measures Domain - Anthropometric Data
Body Composition/Growth/Weight History (AD-1.1)

Definition
Measures of the body, including fat, muscle, and bone components and growth

Indicators
Height
Defined as measures of a body’s length, typically from head to foot.
Measured height (in/cm). Defined as measured standing height.

Measured length (in/cm). Defined as measured recumbent length
Birth length (in/cm). Defined as measured recumbent length at birth.
Pre-amputation measured height (in/cm). Defined as body height prior to removal of a limb or
part of a limb.
Pre-amputation estimated height (in/cm). Defined as estimated body height prior to removal of
a limb or part of a limb.
Estimated height (in/cm). Defined as estimated body height.
Stated height (in/cm). Defined as stated body height.
Measured peak adult height (in/cm). Defined as tallest measured height recorded in adulthood.
Stated peak adult height (in/cm). Defined as stated body height at age 25.
Knee height (in/cm). The measured distance from the posterior surface of the thigh, just
proximal to the patella, to the sole of the foot when the knee is bent at a 90 degree angle
(adapted from the Journal of the American Dietetic Association. Chumlea, et.al.
1994;94:1385-1391.).
Tibia length (cm). Defined as the measured distance from the superomedial edge of the tibia to
the inferior edge of the medial malleolus (Stevenson RD. Arch Pediatr Adolesc Med.
1995;149:658-62.).
Arm span (in/cm). Defined as the measured distance of outstretched arms between the tip of
the middle finger to the tip of the other middle finger with arms parallel to the ground (adapted
Nutrition Care Manual 2016).
Arm demispan (cm). Defined as the measured distance from the midline at the sternal notch to
the web between the middle and ring fingers along outstretched arm (Mini Nutrition
Assessment).
Arm halfspan (cm). Defined as the measured distance from the midline at the sternal notch to
the tip of the middle finger (Mini Nutrition Assessment).
Height measurement device. Defined as the tool used to measure height or length.
Weight
Defined as measures of a body’s mass, heaviness or lightness of a body.
Measured weight (lb, oz, kg, g). Defined as measured body weight.
Stated weight (lb, oz, kg, g). Defined as reported body weight.
Stated peak weight (lb, kg). Defined as reported maximum body weight.
Measured peak weight (lb, kg). Defined as the measured maximum body weight.
Usual stated body weight (UBW) (lb, oz, kg, g). Defined as the reported body weight that is
typical for the individual.
UBW percentage (%). Defined as the calculation using actual body weight divided by usual
weight and then multiplied by 100.
https://www.ncpro.org/pubs/2020-encpt-en/codeAD-1-1 1/6
Birth weight (lb, oz, kg, g). Defined as the measured body weight at birth.
Stated pre-pregnancy weight (lb, oz, kg, g). Defined as the reported weight prior to pregnancy.
Dosing weight (lb, oz, kg, g). Defined as the calculated body weight that may be used to
determine the appropriate dose for medications, enteral nutrition, parenteral nutrition, and IVs.
Estimated dry weight (lb, oz, kg, g). Defined as the estimated body weight without excess
fluid volume (euvolemic).
Pre-amputation measured weight (lb, oz, kg, g). Defined as the measured body weight prior to
removal of a limb or part of a limb.
Pre-amputation estimated weight (lb, oz, kg, g). Defined as the estimated body weight prior to
Post-amputation measured weight (lb, oz, kg, g). Defined as the measured body weight after
Post-amputation estimated weight (lb, oz, kg, g). Defined as the estimated body weight after
Pre-dialysis weight (lb, oz, kg, g). Defined as measured body weight prior to dialysis.
Post-dialysis weight (lb, oz, kg, g). Defined as measured body weight after dialysis.
Frame
Defined as estimate of a body frame based upon height and wrist measure.
Frame size (small/medium/large). Defined as calculation using measured wrist circumference

and measured height to estimate frame size.
Wrist circumference (in/cm). Defined as the measured circumference of the wrist.
Weight change
Defined as measures of the difference in body weight typically over time.
Weight gain (lb, kg, oz, g). Defined as the measured increase in body weight over a specified
period of time.
Weight loss (lb, kg, oz, g). Defined as the measured decrease in body weight over a specified
period of time.
Weight change percentage (%). Defined as the weight change value divided by the original
weight and multiplied by 100.
Measured interdialytic weight gain (lb, oz, kg, g). Defined as the measured increase in body
weight between dialysis treatments.
Measured interdialytic weight loss (lb, oz, kg, g). Defined as the measured decrease in body
weight between dialysis treatments.
Weight change intent (intentional/unintentional). Defined as the purpose of weight gain or
weight loss.
Measured gestational weight gain (lb, oz, kg, g). Defined as measured weight increase during
pregnancy.
Measured gestational weight loss (lb, oz, kg, g) Defined as measured weight decrease during
pregnancy.
Body mass
Defined as measures of a body’s weight relative to height.
Body mass index (BMI) (kg/m2). Defined as weight in kilograms divided by the square height
in meters.
BMI prime ratio (ratio). Defined as the ratio of actual BMI to the upper limit BMI of 25.
Growth pattern indices

Defined as measures used to monitor growth.
BMI-for-age percentile (percentile). Defined as weight in kilograms divided by the square of

height in meters at the child’s age.
BMI-for-age z score. Defined as the standard deviation score for BMI at the child’s age.
Head circumference (in/cm). Defined as the largest occipital-frontal circumference.
Birth head circumference (in/cm). Defined as the largest occipital-frontal circumference at

birth.
Head circumference-for-age percentile (percentile). Defined as attained head circumference at
the child’s age.
Head circumference-for-age z score. (z score). Defined as the standard deviation score for
attained head circumference at the child’s age.
Length-for-age percentile (percentile). Defined as attained growth in recumbent length at the
child’s age.
Length-for-age z score (z score). Defined as the standard deviation score for attained length at
the child’s age.
Stature-for-age percentile (percentile). Defined as attained growth in standing height at the
child’s age.
Stature-for-age z score (z score). Defined as the standard deviation score for attained height at
the child’s age
Weight-for-length percentile (percentile). Defined as body weight in proportion to attained
growth in recumbent length.
Weight-for-length z score (z score). Defined as the standard deviation score for body weight in
proportion to attained growth in recumbent length.
Weight-for-age percentile (percentile). Defined as body weight relative to the child’s age.
Weight-for-age z score (z score). Defined as the standard deviation score for attained body
weight at the child’s age.
Weight-for-stature percentile (percentile). Defined as body weight in proportion to attained
growth in standing height.
Weight-for-stature z score (z score). Defined as the standard deviation score for body weight in
proportion to attained growth in height.
Mid parental height comparator (in/cm). Defined as the parental heights used to predict a
child’s expected adult height centile)
Body compartment estimates

Defined as measures of fat, muscle, and bone components of a body.
Body fat percentage (%). Defined as the portion of the body attributed to body fat and
excludes muscle, fluids, bone, or organs.
Body fat percentage technique. Defined as the tool used to estimate body fat.
Body surface area (m2). Defined as the measured surface area of a human body.
Calculated body surface area (m2). Defined at the calculated surface area of a human body.
Bone age (years). Defined as the degree of maturation of a child’s skeleton.
Bone mineral density t score (t score). Defined as the measure of minerals in bone compared
with a healthy young adult of the same sex.
Bone mineral density z score (z score). Defined as the measure of minerals in bone compared
with a person of the same age, sex, weight, and ethnic or racial origin.
Bone mineral density technique. Defined as the test to measure bone mineral density.
Mid arm muscle circumference (in/cm). Defined as the measure of the muscle area of the
upper arm.
Mid arm muscle circumference percentile (percentile). Defined as the rank of the muscle area
of the upper arm.
Triceps skin fold thickness (in/cm). Defined as measure of the fold of skin taken over the
tricep muscle.
Triceps skin fold percentile (percentile). Defined as the percentile rank of the skin fold
thickness over the tricep muscle.
Triceps skin fold z score (z score). Defined as the standard deviation score for the skin fold
thickness over the tricep muscle.
Waist circumference (in/ cm). Defined as the circumference around the waist measured at the
umbilicus.
Waist circumference narrowest point (in/ cm). Defined as the circumference around the waist
measured at the narrowest point.
Waist circumference iliac crest (in/ cm). Defined as the circumference around the waist
measured at the midpoint between the lower margin of the least palpable rib and the top of the
iliac crest.
Hip circumference (in/cm). Defined as the circumference of the hips measure at the widest
portion of the buttocks.
Waist to hip ratio (ratio). Defined as the calculated waist circumference measurement divided
by the hip measurement.
Mid upper arm circumference (in/cm). Defined as the circumference of the upper right arm
measured between the tip of the shoulder and the tip of the elbow.
Mid upper arm circumference, left arm (in/cm). Defined as the circumference of the upper left
arm measured between the tip of the shoulder and the tip of the elbow.
Mid upper arm circumference z score (z score). Defined as the standard deviation score for
mid upper arm circumference.
Examples of the measurement methods or data sources for these outcome indicators:Referring health care
provider or agency, direct measurement, patient/client report, medical record
Typically used with the following domains of nutrition interventions: Food and nutrient delivery, nutrition
Excessive or inadequate intake of energy, fat, protein, carbohydrate, alcohol, and/or mineral intake; underweight,
overweight, physical inactivity, excessive exercise
Client Example
Weight change/day
BMI percentile/age

1. Goal: The infant is only gaining, on average, 10 grams per day compared with a goal weight gain of 20 to
30 grams per day.
OR
2. Reference Standard: Child’s (> age 3 years) BMI percentile/age per growth curves has crossed 2
percentile channels from 50% to 10% in last 6 months.
Child’s BMI percentile/age per growth curves has crossed 2 percentile channels
from 50% to 10% in last 6 months. Will monitor BMI percentile/age at next
with client
encounter.
Reassessment after
Child’s BMI percentile/age per growth curves is unchanged from baseline measure.
nutrition intervention\
References
1. McDowell MA, Fryar CD, Hirsch R, Ogden CL. Anthropometric Reference Data for Children and
Adults: US Population, 2007-2010. Hyattsville, MD: National Center for Health Statistics. 2012.
http://www.cdc.gov/nchs/data/series/sr_11/sr11_252.pdf. Accessed June 16, 2015.

2. Centers for Disease Control, National Center for Health Statistics. CDC Growth Charts: United States.
http://www.cdc.gov/growthcharts. Accessed June 16, 2015.
3. ACSM’s Guidelines for Exercise Testing and Prescription. 6th ed. Indianapolis, IN: American College of
Sports Medicine; 2000.
5. Academy of Nutrition and Dietetics. Adult Weight Management Evidence-Based Nutrition Practice
Guideline, 2014. https://www.andeal.org/topic.cfm?menu=5276&cat=4688. Accessed June 16, 2015.
6. Barlow SE and the Expert Committee. Expert committee recommendations regarding the prevention,
assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics.
2007;120:S164-S192.
7. Callaway CW et al. Circumferences. In: Lohman TG et al. Anthropometric Standardization Reference
Manual. Champaign, IL: Human Kinetics; 1988:39-54.
8. Frankel HM. Body mass index graphic for children. Pediatrics. 2004; 113:425-426.
9. Going S. Optimizing techniques for determining body composition. Gatorade Sports Science Institute,
Sports Science Exchange. 2006; 19:1-6.
Normal requirements—adults. J Parenter Enteral Nutr. 2002; 26(Suppl):S22-S24.
Normal requirements—pediatrics. J Parenter Enteral Nutr. 2002; 26(Suppl):S25-S32.
12. Heyward V, Wagner D, eds. Applied Body Composition and Assessment. 2nd ed. Champaign, IL: Human
Kinetics; 2004.
13. The Johns Hopkins Hospital. The Harriet Lane Handbook: A Manual for Pediatric House Officers. 17th
ed. St. Louis, MO: Mosby; 2005.
14. Kleinman RE, ed. Pediatric Nutrition Handbook. 6th ed. Chicago, IL: American Academy of Pediatrics;
2009.
15. Leonberg BL. Academy of Nutrition and Dietetics Pocket Guide to Pediatric Nutrition Assessment. 2nd
Ed. Chicago, IL: Academy of Nutrition and Dietetics; 2013.
16. Modlesky CM. Assessment of body size and composition. In: Dunford M. Sports Nutrition: A Practice
Manual for Professionals. 4th ed. Chicago, IL: American Dietetic Association; 2006.
19. NIDDK Weight control information network. http://win.niddk.nih.gov/. Accessed June 16, 2015.
20. NHLBI Guidelines on Overweight and Obesity, Electronic Textbook: http://www.nhlbi.nih.gov/health-
pro/guidelines/current/obesity-guidelines/e_textbook/ratnl/20.htm. Accessed June 16, 2015.
21. Centers for Disease Control, National Center for Health Statistics. CDC Growth Charts: United States.
http://www.cdc.gov/growthcharts. Accessed June 16, 2015.
23. World Health Organization, Child Growth Standards. http://www.cdc.gov/growthcharts. Accessed June
16, 2015.
24. Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent JP, Nicolis I, Benazeth S, Cynober L, Aussel
C. Geriatric Nutritional RiskvIndex: a new index for evaluating at-risk elderly medical patients. Am J
Clin Nutr. 2005;82:777-783.
25. Cogil B. Anthropometric Indicators Measurement Guide. Washington, DC: Food and Nutrition Technical
Assistance Project, Academy of Educational Development; 2003.
26. Samson-Fang LJ, Stevenson RD. Identification of malnutrition in children with cerebral palsy: poor
performance of weight-for-height centiles. Developmental Medicine & Child Neurology. 2000;42:162-
168.
27. Zemel BS, Riley EM, Stallings VA. Evaluation of methodology for nutritional assessment in children:
anthropometry, body composition, and energy expenditure. Ann Rev Nutr. 1997;17:211-235.
28. Mitchell CO, Lipschitz DA. Arm length measurement as an alternative to height in the nutrition
assessment of the elderly.JPEN J Parenter Enteral Nutr. 1982;6:226-229.
29. Cronk CE, Stallings VA, Spender Q, Ross JL, Widdoes HD. Measurement of short-term growth with a
new knee height-measuring device. Am J Hum Biol. 1989;31(2):206-14.
2020 EDITION
12/15/21, 10:41 AM Acid Base Balance
ACID BASE BALANCE
Biochemical Data, Medical Tests and Procedures– Biochemical and Medical Tests
Acid Base Balance(BD-1.1)

Definition
Balance between acids and bases in the body fluids. The pH (hydrogen ion concentration) of the arterial blood
provides an index for the total body acid-base balance.
Indicators
pH (number
Arterial bicarbonate, HCO3 (mmol/L)
Partial pressure of carbon dioxide in arterial blood, PaCO2 (mmHg)
Partial pressure of oxygen in arterial blood, PaO2 (mmHg)
Venous pH (number)
Venous bicarbonate, CO2 (mmol/L)
Note: Sodium and chloride can be found on the Electrolyte and Renal Profile reference sheet
Examples of the measurement methods or data sources for these outcome indicators: Biochemical
measurement, laboratory report
Typically used to determine and monitor and evaluate change in the following nutrition diagnoses: Altered
nutrition-related laboratory values
Client Example
pH, serum (number)

1. Goal: Not generally used.

OR
2. Reference Standard: The patient/client pH is 7.48 which is above (above, below, or within expected
range) the reference standard (7.35 to 7.45).
Initial nutrition assessment Patient/client’s pH is 7.48, which is above expected range. Will monitor change in
https://www.ncpro.org/pubs/2020-encpt-en/codeBD-1-1 1/2
12/15/21, 10:41 AM Acid Base Balance
with client pH at next arterial blood gas.

Reassessment after Significant progress toward reference standard. Patient/client’s pH is 7.40, within
nutrition intervention expected range.
References
2020 EDITION
12/15/21, 10:42 AM Electrolyte and Renal Profile
ELECTROLYTE AND RENAL PROFILE
Biochemical Data, Medical Tests and Procedures – biochemical-and-medical-tests
Electrolyte and Renal Profile (BD-1.2)

Definition
Laboratory measures associated with electrolyte balance and kidney function

Indicators
BUN (mg/dL or mmol/L)
Creatinine (mg/dL or µmol/L) Magnesium (mEq/L or mmol/L)
BUN: creatinine/ratio (ratio number) Calcium, serum (mg/dL or mmol/L)
Glomerular filtration rate (mL/min/1.73 Calcium, ionized (mg/dL or mmol/L)

m2) Phosphorus (mg/dL or mmol/L)
Sodium (mEq/L or mmol/L) Serum osmolality (mOsm/kg or mmol/kg)
Chloride (mEq/L or mmol/L) Parathyroid hormone (pg/mL or ng/L
Potassium (mEq/L or mmol/L)
Note: Bicarbonate can be found on the Acid Base Balance reference sheet.
Serum albumin can be found on the Protein Profile reference sheet for adjustment of serum calcium.
diagnoses: Excessive or inadequate intake of protein or minerals
Client Example
Potassium (mEq/L)

1. Goal: A goal of serum K+ 3.5 to 5.5 mEq/L in patient/client on medications that block the renin-
angiotensin system.
OR
2. Reference Standard: The patient/client’s potassium is 2.9 mEq/L, which is below (above, below, within
expected range) the expected range (3.5 to 5.0 mEq/L).
Initial nutrition assessment Patient/client’s serum potassium is 2.9 mEq/L, which is below the expected range.
12/15/21, 10:42 AM Electrolyte and Renal Profile
with client Will monitor change in potassium at next encounter.

Reassessment after Regression from reference standard. Patient/client’s potassium is 2.7 mEq/L, below
nutrition intervention the expected range.
References
June 16, 2015.
3. National Kidney Foundation K/DOQI. Clinical practice guidelines for nutrition in chronic renal failure.
Am J Kidney Dis. 2000;35(6):S1-S104.
4. National Kidney Foundation K/DOQI Workgroup. National Kidney Foundation K/DOQI Guidelines on
bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003;42(4 Suppl 3):S1-S201.
5. National Kidney Foundation K/DOQI. Clinical practice guidelines on hypertension and antihypertensive
agents in chronic kidney disease. Am J Kidney Dis. 2004;43(5 Suppl 1)S1-S290).
2020 EDITION
12/15/21, 10:42 AM Essential Fatty Acid Profile
ESSENTIAL FATTY ACID PROFILE
Essential Fatty Acid Profile (BD-1.3)

Definition
Laboratory measures of essential fatty acids

Indicators
Triene:Tetraene ratio (ratio number)
measurement, laboratory report/record
diagnoses: Inadequate intake of fat, parenteral nutrition; parenteral nutrition composition inconsistent with
needs; parenteral nutrition administration inconsistent with needs; altered nutrition-related laboratory values;
impaired nutrient utilization
Evaluation


OR
Client Example
Triene:Tetraene ratio (ratio number)

1. Goal: Not generally used.

OR
2. Reference Standard: The patient/client Triene:Tetraene ratio is 0.45, which is (above, below, or within
expected range) above expected range (> 0.2-0.4 essential fatty acid deficiency).
Initial nutrition assessment Patient/client’s Triene:Tetraene ratio is 0.45, above the expected range (essential
12/15/21, 10:42 AM Essential Fatty Acid Profile
with client fatty acid deficiency). Will monitor change in Triene:Tetraene ratio at next
encounter.
Reassessment after Significant progress toward the expect range. Patient/client’s Triene:Tetraene ratio is
nutrition intervention 0.1.
References
2. Hise ME, Brown JC. Lipids. In: Gottschlich MM, ed. The ASPEN Nutrition Support Core Curriculum: A
Case-Based Approach—The Adult Patient. Silver Spring, MD:ASPEN;2007:48-70.
2020 EDITION
12/15/21, 10:45 AM Gastrointestinal Profile
GASTROINTESTINAL PROFILE
Gastrointestinal Profile (BD-1.4)

Definition
Laboratory measures and medical tests associated with function of the gastrointestinal tract and related organs

Indicators
Alkaline phosphatase (U/L) Fructose hydrogen breath test(ppm above

baseline/by report)
Alanine aminotransferase, ALT (U/L)
Glucose hydrogen breath test (ppm above
Aspartate aminotransferase, AST (U/L)
baseline/by report)
Gamma glutamyl transferase, GGT (U/L)
Urea hydrogen breath test (ppm above
Gastric residual volume (mL) baseline/by report)
Bilirubin, total (mg/dL or µmol/L) Intestinal biopsy (by report)
Ammonia, serum (µg/dL or µmol/L) Stool culture (by report)
Toxicology report, including alcohol (by report) Gastric emptying time (minutes)
Prothrombin time, PT (seconds) Small bowel transit time (minutes, hours)
Partial thromboplastin time, PTT (seconds) Abdominal X-ray (by report)
INR (ratio) Abdominal CT (by report)
Amylase (U/L) Abdominal ultrasound (by report)
Lipase (U/L) Endoscopic ultrasound [EUS] (by report)
Fecal fat, 24 hour (g/24 hours) Pelvic CT scan (by report)
Fecal fat, 72 hour (g/24 hours)x Modified barium swallow (by report)
Fecal fat, qualitative (by report) Barium swallow (by report)
Fecal calprotectin (µg/g stool Esophagogastroduodenoscopy (EGD) (by

report)
Fecal lactoferrin (ordinal)
ERCP [endoscopic retrograde
Pancreatic elastase (µg/g stool)
cholangiopancreatography] (by report)
5'-nucleotidase (U/L)
Capsule endoscopy (by report)
D-xylose (mg/dL)
Esophageal manometry (by report)
Lactulose hydrogen breath test (ppm
Esophageal pH test (pH)
above baseline/by report)
Gastroesophageal reflux monitoring (by
Lactose hydrogen breath test (ppm above
report)
baseline/by report)
Gastrointestinal sphincter monitoring (by
report)
Urate (mg/dL or µmol/L)
Altered nutrition-related laboratory values, excess intake of protein or fat
Evaluation


OR
Client Example
documentation for one of the indicators
Ammonia, serum (µg/dL)

1. {GLT:goal)?The patient/client’s serum ammonia is 105 µg/dL, which is above the goal (< 75 µg/dL) for
this patient/client with end-stage liver disease.
OR
2. Reference Standard: The patient/client serum ammonia is 85 µg/dL which is above (above, below, or
percent of) the expected range (11-35 µg/dL).
Initial nutrition assessment Patient/client’s serum ammonia is 85 µg/dL, above the expected range. Will monitor
with client change in serum ammonia at next encounter.
Reassessment after Significant progress toward expected range. Patient/client’s serum ammonia 45
nutrition intervention µg/dL.
References

May 9, 2014.
2020 EDITION
12/15/21, 10:45 AM Glucose/Endocrine Profile
GLUCOSE/ENDOCRINE PROFILE
Glucose/Endocrine Profile (BD-1.5)

Definition
Laboratory measures associated with glycemic control and endocrine findings

Indicators
Glucose, fasting (mg/dL, mmol/L)
Glucose, casual* (mg/dL, mmol/L)
HgbA1c (%, mmol/mol)
Preprandial capillary plasma glucose (mg/dL, mmol/L)
Peak postprandial capillary plasma glucose (mg/dL, mmol/L)
Glucose tolerance test (mg/dL, mmol/L)
Cortisol level (µg/dL, mmol/L)
IGF-binding protein (ng/mL, mg/L)
Thyroid stimulating hormone (µmol/mL, mIU/L)
Thyroxine test or T4 (?g/dL, pmol/L)
Triiodothyronine or T3 (ng/dL, pmol/L)
Adrenocorticotropic hormone (pg/mL, pmol/L)
Follicle-stimulating hormone (mU/mL, IU/L)
Growth hormone (ng/mL, µg/L)
Luteinizing hormone (mU/mL, IU/L)
Typically used with the following domains of nutrition interventions: Biochemical measurement, laboratory
report
diagnoses: Excessive or inadequate intake of carbohydrate, energy; less than optimal intake of types of
carbohydrate; or inconsistent carbohydrate intake
Evaluation
12/15/21, 10:45 AM Glucose/Endocrine Profile
Criteria for Evaluation/b>


OR
Client Example
HgbA1c (%, mmol/mol)

1. Goal: The patient/client’s HgbA1c is 7.8% (60 mmol/mol), which is above the expected limit, but is an
acceptable goal in a pediatric patient.
OR
2. Reference Standard:The patient/client’s HgbA1c is 11% (97 mmol/mol), which is above (above, below,
expected limit or range) the expected limit (< 6%, 42 mmol/mol).
Sample Nutrition Patient/client’s HgbA1c is 9% (75 mmol/mol), which is above the expected limit.
Assessment Documentation Will monitor change in HgbA1c at next encounter.
Reassessment after
Regression from the expected limit. Patient/client’s HgbA1c is 10% (86 mmol/mol).
* If a synonym for the term “Glucose, casual” is helpful or needed, an approved alternative is “Glucose,
random.”
References
1. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care; 2012;35:S11-
S63.
2. Academy of Nutrition and Dietetics. Critical illness evidence-based nutrition guideline.
http://andevidencelibrary.com/topic.cfm?cat=4800. Accessed May 13, 2014.. Accessed June 16,
2015.
3. International Diabetes Center. Global guideline for type 2 diabetes. 2012. http://www.idf.org/global-
guideline-type-2-diabetes-2012. Accessed May 13, 2014.. Accessed June 16, 2015.
4. Joslin Diabetes Center. Clinical Guidelines. https://www.joslin.org/info/joslin-clinical-
guidelines.html. Accessed June 16, 2015.
2020 EDITION
12/15/21, 10:45 AM Inflammatory Profile
INFLAMMATORY PROFILE
Inflammatory Profile (BD-1.6)

Definition
Laboratory measures of inflammatory proteins
Indicators
C-reactive protein, highly sensitive or hs-CRP (mg/L) [cardiovascular disease]
Examples of the measurement methods or data sources for these outcome indicators:Direct measurement,
medical record
Typically used with the following domains of nutrition interventions: Food and/or nutrient delivery
Typically used with the following domains of nutrition interventions: Increased nutrient need; less than
optimal intake of types of fats inconsistent with needs; excessive physical activity
Evaluation


OR
Client Example
C-reactive protein (mg/L)

Comparison to Goal or Reference Standard?
1. Goal?Not generally used.

OR
2. Reference Standard?A patient/client has a C-reactive protein level of 4.0 mg/L, which is above (above,
below, within expected range) the expected range of 1.0 to 3.0 mg/L.
Nutrition assessment with ?Patient/client’s C-reactive protein level is 4.0 mg/L, which is above (above, below,
patient/client within expected range) the expected range of 1.0 to 3.0 mg/L.
References:
12/15/21, 10:45 AM Inflammatory Profile
1. NHLBI Workshop Report. C-Reactive Protein: Basic and Clinical Research Needs.
http://www.nhlbi.nih.gov/research/reports/2006-crp. Accessed June 16, 2015.
2. Position of the Academy of Nutrition and Dietetics: Dietary fatty acids for healthy adults. J Acad Nutr
Diet. 2014;114:136-153.
2020 EDITION
12/15/21, 10:49 AM Lipid Profile
LIPID PROFILE
Lipid Profile (BD-1.7)

Definition
Laboratory measures associated with lipid disorders

Indicators
Cholesterol, serum (mg/dL or mmol/L)
Cholesterol, HDL (mg/dL or mmol/L)
Cholesterol, LDL (mg/dL or mmol/L)
Cholesterol, non-HDL (mg/dL or mmol/L)
Total cholesterol:HDL cholesterol (ratio)
LDL:HDL (ratio)
Triglycerides, serum (mg/ dL or mmol/L)
measurement, laboratory report, patient/client report
counseling
diagnoses: Excessive or inadequate intake of fat, energy
Evaluation

Comparison to Goal or Reference Standard

OR
Client Example
LDL cholesterol (mg/dL)

1. Goal?The patient/client’s LDL cholesterol is 200 mg/dL, compared to a goal of < 100 mg/dL. (Note:
While reference standards are generally used for laboratory measures, a goal might be used in a special
situation such as this example. The patient/client has a familial hypercholesterolemia where a normal
reference standard may not be realistic.)
OR
2. Reference Standard?The patient/client’s LDL cholesterol is 159 mg/dL, which is above the expected limit
of the NHLBI recommendation of < 100 mg/dL.
The patient/client LDL cholesterol is 159 mg/dL compared to the reference standard
(e.g., National Heart, Lung and Blood Institute) recommended level of < 100
with client
mg/dL. Will monitor LDL cholesterol at next encounter.
Reassessment after Some progress toward goal/reference standard as patient/client’s LDL cholesterol is
nutrition intervention 145 mg/dL.
References
1. Grundy S, Cleeman JI, Bairey Merz CN, Brewer HB, Clark LT, Hunninghake DB, Pasternak RC, Smith
SC, Stone NJ, for the Coordinating Committee of the National Cholesterol Education Program, Endorsed
by the National Heart, Lung, and Blood Institute, American College of Cardiology Foundation, and
American Heart Association. Implications of recent clinical trials for the National Cholesterol
Education Program Adult Treatment Panel III guidelines. Circulation. 2004;110:227-239.
2. Ingelsson E, Schaefer EJ, Contois JH, McNamara JR, Sullivan L, Keyes MJ, Pencina MJ, Schoonmaker
C, Wilson PW, D’Agostino RB, Vasan RS. Clinical utility of different lipid measures for prediction of
coronary heart disease in men and women. JAMA. 2007; 298(7): 776-785.
3. Nam BH, Kannel WB, D’Agostino RB. Search for an optimal atherogenic lipid risk profile: from the
Framingham Study. Am J Cardiol. February 1, 2006;97(3):372-5.
4. National Institutes of Health, National Heart, Lung, and Blood Institute (NHLBI). Third Report of the
Expert Panel on Detection, Evaluation, and Treatment of High Cholesterol in Adults, May 2001.
http://www.nhlbi.nih.gov/health-pro/guidelines/current/cholesterol-guidelines/final-report. Accessed June
16, 2015.
5. National Kidney Foundation, K/DOQI Guidelines.
https://www.kidney.org/professionals/guidelines/guidelines_commentaries. Accessed June 16, 2015
6. Onder G, Landi F, Volpato S, Fellin R, Carbonin P, Gambassi G, Bernabei R. Serum cholesterol levels
and in-hospital mortality in the elderly. Am J Med. 2003;115:265-271.
7. Position of the American Dietetic Association. Nutrition Intervention and Human Immunodeficiency
Virus Infection. J Am Diet Assoc. 2010;110:1105-1119.
8. Ridker PM, Rifai N, Cook NR, Bradwin G, Buring JE. Non-HDL cholesterol, apolipoproteins A-I and
B100, standard lipid measures, lipid ratios, and CRP as risk factors for cardiovascular disease in
women. JAMA. 2005;294(3):326-333.
9. Wang TD, Chen WJ, Chien KL, Seh-Yi Su SS, Hsu HC, Chen MF, Liau CS, Lee YT. Efficacy of
cholesterol levels and ratios in predicting future coronary heart disease in a Chinese population. Am J
Cardiol. 2001;88(7):737-743.
Diet. 2014;114:136-153.
2020 EDITION
12/15/21, 10:49 AM Metabolic Rate Profile
METABOLIC RATE PROFILE
Metabolic Rate Profile (BD-1.8)

Definition
Measures associated with or having implications for assessing metabolic rate
Indicators
Resting metabolic rate, measured (calories, kcal or kJ/day)
Respiratory quotient, measured (RQ = CO2 produced/O2 consumed)
Note: Use of RQ is considered valid if respiratory factors (hyper- or hypoventilation), equipment failure,
measurement protocol violations, or operator errors have not occurred.
Examples of the measurement methods or data sources for these outcome indicators: Direct measurement
(indirect calorimetry), medical record
Typically used with the following domains of nutrition interventions: Food and/or nutrient delivery
Excessive or inadequate intake of parenteral/enteral nutrition; enteral/parenteral nutrition composition or
administration inconsistent with needs; excessive energy intake; excessive mineral intake; disordered eating
pattern; excessive exercise, increased energy expenditure, increased nutrient needs (energy), inadequate protein-
energy intake.
Client Example
Example of one (or more) of the Nutrition Care Indicators (includes sample initial and reassessment
Respiratory quotient

comparison-to-reference-standard-rec-or-goal-19
1. Reference Standard: A client on parenteral nutrition support with an RQ of 1.04, which is above (above,
below, within expected range) the expected range (0.7 to 1.0) with no apparent errors in the measurement
Client’s RQ is 1.04, with energy intake from parenteral nutrition 400 kcal (1700 kJ)
higher than measured metabolic rate. No apparent respiratory factors (hyper- or
Initial encounter
hypoventilation), equipment failure, measurement protocol violations, or operator
errors. Will adjust content of parenteral nutrition and re-measure RQ.
12/15/21, 10:49 AM Metabolic Rate Profile
Reassessment after RQ has dropped to 0.92 with no apparent measurement error. Metabolic rate and
nutrition intervention calorie/ kcal/kJ intake are matched. Parenteral nutrition has been appropriately
adjusted to equal client’s energy requirement.
References
1. Academy of Nutrition and Dietetics. Evidence Analysis Library. Adult weight management guideline
(2014). https://www.andeal.org/topic.cfm?menu=5276. Accessed February 20, 2019.
resting metabolic rate in adults: a systematic review. J Am Diet Assoc. 2006;106(6):881-903.
3. McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the provision and assessment of nutrition
support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American
Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2016;40(2):159-
211.
5. McClave SA, Lowen CC, Kleber MJ, McConnell JW, Jung LY, Goldsmith LJ. Clinical use of the
respiratory quotient obtained from indirect calorimetry. JPEN J Parenter Enteral Nutr. 2003;27(1):21-26.
2020 EDITION
12/15/21, 10:49 AM Mineral Profile
MINERAL PROFILE
Mineral Profile (BD-1.9)

Definition
Laboratory measures associated with body mineral status
Indicators
Copper, serum or plasma (µg/dL or µmol/L)
Iodine, urinary excretion (µg/24hr)
Zinc, serum or plasma (µg/dL or µmol/L)
Boron, serum or plasma (µg/L)
Chromium, serum (ng/mL or nmol/L), urinary (µg/L)
Fluoride, plasma (µmol/L)
Manganese, urinary excretion (µg/L or nmol/L), blood (µg/L or nmol/L), plasma (µg/L or nmol/L
Molybdenum, serum (ng/mL)
Selenium, serum (µmol/L), urinary excretion (µg/L or µg/day)
Note: Other measures of body mineral status, such as urinary manganese excretion, are provided to offer
complete information in the reference sheet. These are rarely used in practice, but may be warranted in
limited circumstances.
Serum calcium, magnesium, phosphorus, and potassium can be found on the Electrolyte and Renal
Profile reference sheet.
Serum iron, serum ferritin, and transferrin saturation can be found on the Nutritional Anemia Profile
reference sheet.
Thyroid stimulating hormone ( ↑ TSH as an indicator of excess iodine supplementation) can be found on
the Glucose/ Endocrine Profile reference sheet.
measurement, laboratory record
Excessive or inadequate intake of minerals, parenteral nutrition
Evaluation
12/15/21, 10:49 AM Mineral Profile


OR
Client Example
Zinc, plasma (µg/dL

1. Goal:There is no goal generally associated with mineral status.

OR
2. Reference Standard: The patient/client’s plasma zinc is 40 µg/dL, which is below (above, below, within
expected range) the expected range (66 to 110 µg/dL) for adults.
Initial nutrition assessment Patient/client’s plasma zinc is 40 µg/dL, which is below the expected range for
with client adults. Will monitor change in plasma zinc at next encounter.
Reassessment after
Goal/reference standard achieved as patient/client’s plasma zinc is 90 µg/dL.
References
2020 EDITION
12/15/21, 10:49 AM Nutritional Anemia Profile
NUTRITIONAL ANEMIA PROFILE
Nutritional Anemia Profile (BD-1.10)

Definition
Laboratory measures associated with nutritional anemias
Indicators
Hemoglobin (g/dL g/L or mmol/L) Serum folate (ng/mL or nmol/L)

Hematocrit (% or proportion of one (1)) Serum homocysteine (µmol/L)
Mean corpuscular volume, MCV (fL) Serum ferritin (ng/mL or pmol/L
RBC folate (ng/mL or nmol/L) Serum iron (µg/dL or µmol/L)
Red cell distribution width, RDW (%) Total iron-binding capacity (µg/dL or
Serum B12 (pg/mL or pmol/L) µmol/L)
Methylmalonic acid, serum (nmol/L) Transferrin saturation (%)
measurement, patient/client laboratory record; national/state/local nutrition monitoring and surveillance data
Excessive or inadequate intake of vitamins or minerals (e.g., iron, B12, folate); altered nutrition-related
laboratory values; impaired nutrient utilization
Evaluation


OR
Client Example
Hemoglobin (gm/dL)
Serum ferritin (ng/mL)
12/15/21, 10:49 AM Nutritional Anemia Profile

1. {GLT:goal: The patient/client’s hemoglobin and hematocrit are below the expected limits for adult males,
but are within the goal range for a patient/client receiving hemodialysis.
OR
2. Reference Standard: The patient/client’s serum ferritin is 8 ng/mL, which is below (above, below, or
within expected range) the expected range for adult females.
Initial nutrition assessment Patient/client’s serum ferritin is 8 ng/mL, which is below the expected range for
with client adult females. Will monitor change in serum ferritin at next encounter.
Reassessment after
Patient/client’s serum ferritin is 10.9 ng/mL, within the expected range.
References
2. Centers for Disease Control and Prevention. Recommendations to prevent and control iron deficiency
anemia in the United States. MMWR. 2002;51:897-899.
3. Johns Hopkins Hospital. The Harriet Lane Handbook: A Manual for Pediatric House Officers. 17th ed.
St. Louis, MO: Mosby; 2005.
4. National Kidney Foundation, Dialysis Outcomes Quality Initiative. Anemia in chronic kidney disease.
http://www.kidney.org/professionals/KDOQI/guidelines_commentaries.cfm. Accessed June 16, 2015.
2020 EDITION
12/15/21, 10:53 AM Protein Profile
PROTEIN PROFILE
Protein Profile (BD-1.11)

Definition
Laboratory measures associated with hepatic and circulating proteins and protein metabolism
Albumin (g/dL or g/L)
Prealbumin (mg/dL or mg/L)
Transferrin (mg/dL or g/L)
Phenylalanine, plasma (mg/dL or µmol/L)
Tyrosine, plasma (mg/dL or µmol/L)
Amino acid panel (by report)
Phenylalanine, dried blood spot (ordinal)
Tyrosine, dried blood spot (ordinal)
Phenylalanine: tyrosine (ratio)
Hydroxyproline (mg/dL or µmol/L)
Threonine (mg/dL or µmol/L)
Serine (mg/dL or µmol/L)
Asparagine (mg/dL or µmol/L)
Glutamate (mg/dL or µmol/L)
Glutamine (mg/dL or µmol/L)
Proline (mg/dL or µmol/L)
Glycine (mg/dL or µmol/L)
Alanine (mg/dL or µmol/L)
Citrulline (mg/dL or µmol/L)
Valine (mg/dL or µmol/L)
Cysteine (mg/dL or µmol/L)
Methionine (mg/dL or µmol/L)
Isoleucine (mg/dL or µmol/L)
Leucine (mg/dL or µmol/L)
Ornithine (mg/dL or µmol/L)
Lysine (mg/dL or µmol/L)
Histidine (mg/dL or µmol/L)
Arginine (mg/dL or µmol/L)
Lysine:arginine (ratio)
Tryptophan, plasma or serum
Plasma organic acid panel (by report)
Organic acids/creatinine (mmol/mol creatinine)
3-hydroxybutyrate (mg/dL or µmol/L)
3-hydroxyisovalerate (mg/dL or µmol/L)
Acetoacetate (mg/dL or µmol/L)
Ethylmalonate (mg/dL or µmol/L)
Succinate (mg/dL or µmol/L)
Fumarate (mg/dL or µmol/L)
Glutarate (ng/dL or nmol/L)
3-methylglutarate (mg/dL or µmol/L)
Adipate (mg/dL or µmol/L)
2-hydroxyglutarate (mg/dL or µmol/L)
3-hydroxypheylacetate (mg/dL or µmol/L)
2-ketoglutarate (mg/dL or µmol/L)
Citrate (mg/dL or µmol/L)
Propionate (mg/dL or µmol/L)
Methylcitrate (mg/dL or µmol/L)
3-hydroxy propionate (mg/dL or µmol/L)
ß-hydroxy butyrate (mg/dL or µmol/L)-
Creatine kinase (U/L)
Troponin I. cardiac (ng/mL)
Troponin T.cardiac (ng/mL)
B-type natriuretic peptide (pg/mL)
Succinylacetone (mg/dL or µmol/L)
Total serum immunoglobulin A (IgA)(mg/dL or µmol/L)
Tissue transglutaminase antibodies (IgA) (U/mL)
Tissue transglutaminase antibodies (IgG) (U/mL)
Deamidated gliadin peptide antibodies (IgG) (U/mL)
Endomysial antibodies (ordinal)
Carbohydrate-deficient transferrin (mg/dL or %)
Note: Methylmalonic acid can be found on the Nutritional Anemia Profile reference sheet. Also, In the
past, hepatic transport protein measures (e.g. albumin and prealbumin) were used as indicators of
malnutrition. See the Evidence Analysis Library questions on this topic

at:https://www.andevidencelibrary.com/topic.cfm?cat=4302
diagnoses: Increased nutrient needs, malnutrition, inadequate enteral/parenteral nutrition infusion
Evaluation


OR
Client Example
Prealbumin (mg/dL)

1. Goal:Not generally used.

OR
2. Reference Standard: The patient/client’s prealbumin is 7 mg/dL, which is below (above, below, or within
the expected range) the expected range (16 to 40 mg/dL) for adults.
Initial nutrition assessment Patient/client’s prealbumin is 7.0 mg/dL, below the expected range (16 to 40
with client mg/dL) for adults. Will monitor change in prealbumin at next encounter.
Reassessment after Significant progress toward expected range as patient/client’s serum prealbumin is
nutrition intervention 13.0 mg/dL.
References
June 16, 2015.
3. Academy of Nutrition and Dietetics. Celiac Disease Evidenced-based Nutrition Practice Guideline.
http://andevidencelibrary.com/topic.cfm?cat=1403. Accessed June 16, 2015.
4. Fuhrman MP, Charney P, Mueller CM. Hepatic proteins and nutrition assessment. J Am Diet Assoc.
2004;104:1258-1264.
5. Garcia-Cazorla A, Pyruvate carboxylase deficiency: metabolic characteristics and new neurological
aspects, Ann Neurol. 2006;59:121-127.
6. Kerr DS The pyruvate dehydrogenase complex and tricarboxylic acid cycle in Fernandes J, Saudubray
JM, Tada K (eds): Inborn metabolic diseases, diagnosis and treatment; 2nd edition; Berlin, Springer
Verlag 1996; :109-119.
7. National Kidney Foundation, Clinical Practice Guidelines for Nutrition in Chronic Renal Failure, 2000.
https://www.kidney.org/professionals/guidelines/guidelines_commentaries. Accessed June 16, 2015.
8. Tanaka KR, Pyruvate kinase and other enzymopathies of the erythrocyte, The metabolic and molecular
bases of inherited disease, 7th Ed; Editors: C.R.Scriver, A.L.Beaudet, W.S.Sly, D.Valle; McGraw-Hill Inc.
1995;2:3485-3511.
2020 EDITION
12/15/21, 10:53 AM Urine Profile
URINE PROFILE
Urine Profile (BD-1.12)

Definition
Physical and/or chemical properties of urine

Indicators
Urine color (by visualization)
Urine osmolality (mOsm/kg H2O)
Urine specific gravity (number)
Urine volume (mL/24 hours; however, in certain populations, eg, infants, this indicator may be reported
in number of wet diapers/day)
Urine calcium, 24 hour (mg/24 hours or mmol/24hours)
Urine d-xylose (mg/dL or mmol/L)
Urine glucose (ordinal)
Urine ketones (ordinal)
Urine sodium (mg/dL or mmol/L)
Urine microalbumin (mg/dL or mmol/L)
Urine protein, random (mg/dL or mmol/L)
Urine protein, 24-hour (mg/24 hours or mmol/24 hours)
Urine uric acid, random (mg/dL or µmol/L)
Urine uric acid, 24 hour (mg/24 hours or mmol/24 hours)
Urine organic acid panel (by report)
Urine glutarate (ordinal)
Urine methylmalonate (µg/dL)
Urine acylglycines/creatinine (mg/g creatinine or mmol/mol creatinine)
Urine argininosuccinate (mmol/L)
Urine succinylacetone/creatinine (µmol/mmol creatinine)
Urine orotate (µmol/L)
Urine orotate/creatinine (µmol/mmol creatinine)
Urine 2-hydroxyisovalerate (ordinal)
Urine 2-oxoisovalerate (ordinal)
Urine galactitol (ordinal)
Urine reducing substances (ordinal)

Urine porphyrins (ordinal)
Urine creatinine, 24 hour (mg/24hours or mmol/24hours)
Urine citrate, 24 hour (mg/24 hours or mmol/24 hours)
Urine phosphorus, 24 hour (mg/24 hours or mmol/24 hours)
Urine pH, random (number)
Urine pH, 24 hour (number)
Urine sodium, 24 hour (mEq/24 hours or mmol/24 hours)
Urine urea nitrogen, 24 hour (mg/24 hours or mmol/24 hours)
Urine oxalate, 24 hour (mg/24 hours or mmol/24 hours)
Urine chloride, 24 hour (mEq/24 hours or mmol/24 hours)
Urine ammonium, 24 hour (mg/24 hours or mmol/24 hours)
Urine magnesium, 24 hour (mg/24 hours or mmol/24 hours)
Urine potassium, 24 hour (mEq/24 hours or mmol/24 hours)
Urine sulfate, 24 hour (mg/24 hours or mmol/24 hours)
Urine cystine, 24 hour (mg/24 hours or µmol/24 hours)
Calcium oxalate supersaturation in 24 hour urine (number)
Calcium phosphate supersaturation in 24 hour urine (number)
Brushite supersaturation in 24 hour urine (number)
Uric acid supersaturation in 24 hour urine (number)
Examples of the measurement methods or data sources for these outcome indicators: Observation,
biochemical measurement, laboratory report, client report
diagnoses: Inadequate or excessive fluid intake; inadequate or excessive enteral/parenteral nutrition infusion;
inadequate or excessive mineral intake; inadequate or excessive bioactive substance intake
Client Example
Urine specific gravity (number)

comparison-to-reference-standard-rec-or-goal-19:
1. Reference Standard: The client’s urine specific gravity is 1.050, which is above (above, below, within
expected range) the expected range (1.003 to 1.030).

Client’s urine specific gravity is 1.050, which is above the expected range. Will
Initial encounter
monitor change in urine specific gravity at next encounter.
Reassessment after Significant progress toward goal, client’s urine specific gravity is 1.035, which is
nutrition intervention within the expected range.
References

2. Charney P, Malone A. Academy of Nutrition and Dietetics Pocket Guide to Nutrition Assessment. 3rd ed.
Chicago, IL: Academy of Nutrition and Dietetics; 2015.
2020 EDITION
12/15/21, 10:53 AM Vitamin Profile
VITAMIN PROFILE
Vitamin Profile (BD-1.13)

Definition
Laboratory measures associated with body vitamin status
Indicators
Vitamin A, serum or plasma retinol (µg/dL or µmol/L)
Vitamin C, plasma or serum (mg/dL or µmol/L)
Vitamin D, 25-hydroxy (ng/mL or nmol/L)
Vitamin E, plasma alpha-tocopherol (mg/dL or µmol/L)
Thiamin, activity coefficient for erythrocyte transketolase activity (µg/mL/hr)
Riboflavin, activity coefficient for erythrocyte glutathione reductase activity (IU/g hemoglobin)
Niacin, urinary N’methyl-nicotinamide concentration (µmol/day)
Vitamin B6, plasma or serum pyridoxal 5’phosphate concentration (ng/mL or nmol/L)
Pantothenic acid, urinary pantothenate excretion (mg/day), plasma (ng/mL or nmol/L)
Biotin, urinary 3-hydroxyisovaleric acid excretion (mmol/mmol creatinine)
Biotin, lymphocyte propionyl-CoA carboxylase in pregnancy [pmol/(min × mg)], serum (ng/mL or

nmol/L)
Biotinidase (U/L)
Protein induced by vitamin K absence or antagonist II (PIVKA-II) ng/mL or nmol/L)
Note: Other measures of body vitamin status, such as urinary pantothenate excretion, are provided to
offer complete information in the reference sheet. These are rarely used in practice, but may be warranted
in limited circumstances.
Measures for folate and Vitamin B12 can be found on the Nutritional Anemia Profile reference sheet.
Measures related to Vitamin K (PT, PTT, INR) can be found on the GI Profile reference sheet.
A test for Choline is not available. According to the DRIs, it should be evaluated in light of serum alanine
amino transferase (ALT) levels which can be found on the GI Profile (BD-1.4).
measurement, patient/client record
typically-used-with: Food and/or nutrient delivery, coordination of nutrition care by nutrition professional
diagnoses: Excessive or inadequate intake of vitamins
Evaluation


OR
Client Example
Indicator(s) Selected:
Vitamin A, serum retinol (µg/dL)

1. Goal: Not generally used for this indicator.

OR
2. Reference Standard: The patient/client’s serum retinol is 95 µg/dL which is above (above, below, within
expected range) the expected range (10 to 60 µg/dL).
Patient/client’s serum retinol is 95 µg/dL, which is above the expected range. Will
monitor change in serum retinol at next encounter, along with vitamin A and beta-
with client
carotene intake.
Reassessment after
Significant progress toward expected range. Patient/client’s retinol is 70 µg/dL.
References

June 16, 2015.
2. Grooper SS, Smith JL, Groff JL. Advanced Nutrition and Human Metabolism. Belmost, CA: Thomson
Wadsorth, 2005.
3. American Society for Parenteral and Enteral Nutrtion Board of Directors and the Clinical Guidelines Task
Force. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients: normal
requirements—adults. J Parenter Enteral Nutr. 2002;26(Suppl):S22-S24.
normal requirements—pediatrics. J Parenter Enteral Nutr. 2002;26(Suppl):S25-S32.
5. McMahon RJ. Biotin in metabolism and molecular biology. Annu Rev Nutr. 2002;22:221-239.
6. Monsen ER. Dietary Reference Intakes for the antioxidant nutrients: Vitamin C, vitamin E, selenium, and
carotenoids. J Am Diet Assoc. 2000;100:637-640.
9. Institute of Medicine. Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B6, Folate,
Vitamin B12, Pantothenic acid, Biotin, and Choline. Washington, DC: National Academies Press;1998.
11. Institute of Medicine. Dietary Reference Intakes: Vitamin C, Vitamin E, Selenium, and Carotenoids.
2020 EDITION
12/15/21, 10:53 AM Carbohydrate Metabolism Profile
CARBOHYDRATE METABOLISM PROFILE
Carbohydrate Metabolism Profile (BD-1.14)

Definition
Laboratory measures associated with carbohydrate metabolism
Indicators
Galactose 1 phosphate in red blood cells (mg/dL or µmol/L)
Galactose 1 phosphate uridyl transferase (U/g Hgb)
Fructose (mg/dL or µmol/L)
Lactate (mg/dL or µmol/L)
Pyruvate (mg/dL or µmol/L)
Lactate/pyruvate (ratio)
Note: Other measures of metabolic conditions, such as, Pyruvate are listed on the Protein profile (BD-
1.11) reference sheet.
Nutrition education, nutrition counseling
Typically used to determine and monitor and evaluate change in the following nutrition diagnoses:Intake
of types of carbohydrate inconsistent with needs, Inadequate energy intake
Evaluation


OR
Client Example
Galactose 1 phosphate in red blood cells (mg/dL or µmol/L)

12/15/21, 10:53 AM Carbohydrate Metabolism Profile
1. Goal: The patient/client’s galactose-1-phosphate in RBCs is 165 mg/dL, which is above the goal for
patients with galactosemia on diet (> 125 mg/dL ). (Note: While reference standards are generally used
for laboratory measures, a goal might be used in a special situation such as this example where a
population reference standard may not be realistic.)
OR
2. Reference Standard: The patient/client’s galactose-1-phosphate in RBCs is 165 mg/dL, which is above the
upper limit for patients with galactosemia on diet (>125 mg/dL).
The patient/client’s galactose-1-phosphate in RBCs is 165 mg/dL, which is above

the goal for patients with galactosemia on diet (> 125 mg/dL). Will monitor at next
with client
encounter.
Reassessment after Significant progress toward expected range. Patient/client’s galactose-1-phosphate
nutrition intervention in RBCs is 135 mg/dL
References
1. Bosch AM, Classical galactosaemia revisited J Inher Met Dis. 2006;29:516-525.

2. Glycogen storage diseases: The metabolic and molecular bases of inherited disease, 7/e; Editors:
C.R.Scriver, A.L.Beaudet, W.S.Sly, D.Valle; McGraw-Hill Inc. 1995;1:935-965.
3. Walter JH, Recommendations for the management of galactosemia Arch Dis Child. 1999;80:93-96.
2020 EDITION
12/15/21, 10:53 AM Fatty Acid Profile
FATTY ACID PROFILE
Fatty Acid Profile (BD-1.15)

Definition
Laboratory measures associated with fatty acid metabolism
Indicators
Acylcarnitine panel (µmol/L)
Acylcarnitine, plasma (µmol/L)
Free carnitine, plasma (µmol/L)
Total carnitine, plasma (µmol/L)
Free carnitine: total carnitine (ratio)
Fatty acid panel mitochondrial C8-C18, serum or plasma (µmol/L)
Fatty acid panel essential C12-C22, serum or plasma (µmol/L)
Fatty acid panel peroxisomal C22-C26, serum or plasma (µmol/L)
MCAD enzyme assay in fibroblasts or other tissues (confirmatory)
Fatty acid ß-oxidation in fibroblasts (confirmatory)
Nutrition education, nutrition counseling
of types of fat inconsistent with needs, Inadequate energy intake
Evaluation


OR
Client Example
12/15/21, 10:53 AM Fatty Acid Profile
Fatty acid panel mitochondrial C8-C18 (specifically Octanoylcarnitine [C8] and Octanoylcarnitine
[C8]:Decanoylcarnitine [C10] ratio)

1. Goal: The patient/client’s Octanoylcarnitine is 0.8 µmol/L, which is above the goal of 0.3 µmol/L and a
ratio of Octanoylcarnitine:Decanoylcarnitine is 10, which is above the goal of 5 for this patient/client with
MCAD. (Note: While reference standards are generally used for laboratory measures, a goal might be
used in a special situation such as this example where a population reference standard may not be
realistic.)
OR
2. Reference Standard: The patient/client’s Octanoylcarnitine is 0.8 µmol/L, which is above the expected
upper limit (>0.3µmol/L) and ratio of Octanoylcarnitine:Decanoylcarnitine is 10, which is above the
upper limit (>5).
The patient/client’s Octanoylcarnitine is 0.8 µmol/L, which is above the reference

Initial nutrition assessment standard upper limit (>0.3µmol/L) and ratio of Octanoylcarnitine:
with client Decanoylcarnitine is 10, which is above the upper limit (>5). Will monitor at next
encounter.
Reassessment after Significant progress toward expected range. Patient/client’s Octanoylcarnitine
nutrition intervention concentration is 0.4, ratio of Octanoylcarnitine: Decanoylcarnitine is 7.
References
1. Abdenur JE. MCAD deficiency. Acylcarnitines (AC) by tandem mass spectrometry (MS-MS) are useful
to monitor dietary treatment. Adv Exp Med Biol 1999;466:353-363.
2. Iafolla, AK. Medium chain acyl-coenzyme A dehydrogenase deficiency: Clinical course in 120 affected
children J Pediatr 1994;124:409-415.
3. MorrisAM, Spiekerkoetter U. .Disorders of Mitochondrial Fatty Acid Oxidation and Related Metabolic
Pathways". In Saudubray JM; van den Berghe G, Walter JH.. Inborn MetabolicDiseases: Diagnosis and
Treatment (5th ed.). 2012. New York: Springer. pp. 201–216.
4. Rinaldo P, O'Shea JJ, Coates PM, Hale DE, Stanley CA, Tanaka K. Medium-Chain Acyl-CoA
Dehydrogenase Deficiency". New Eng J Med. 1988; 319: 1308–1313.
5. Walter JH. Tolerance to fast: Rational and practical evaluation in children with hypoketonaemia. J Inherit
Metab Dis. 2009; 32: 214–217.
2020 EDITION
12/15/21, 10:55 AM Nutrition Focused Physical Findings
NUTRITION FOCUSED PHYSICAL FINDINGS
Nutrition-Focused Physical Findings Domain – Nutrition Focused Physical Findings
Nutrition Focused Physical Findings (PD-1.1)

Definition
Nutrition-related physical signs or symptoms associated with pathophysiological states derived from a nutrition-
focused physical exam, interview, and/or the health record.

Indicators (Note: Presence or absence unless otherwise specified)
Overall findings
Asthenia (weakness)
Buffalo hump
Cachexia
Cushingoid appearance
Ectomorph
Endomorph
Lethargic
Mesomorph
Neglect of personal hygiene
Obese
Short stature for age
Tall stature
Body language that may suggest discomfort with interaction (eg, frowning, crossed arms, limited eye
contact)
Adipose
Atrophy of orbital fat
Excess subcutaneous fat
Loss of subcutaneous fat
Central adiposity
Loss of subcutaneous triceps fat
Loss of subcutaneous biceps fat
Loss of subcutaneous fat overlying the ribs
Lipodystrophy
Bones
Bow legs
Frontal bossing
Harrison’s sulcus
Rachitic rosary
Rickets
Scoliosis
Acromion abnormal prominence
Bone widening at ends
Clavicle abnormal prominence
Rib abnormal prominence
Scapula abnormal prominence
Spine abnormal prominence
https://www.ncpro.org/pubs/2020-encpt-en/codePD-1-1 1/10
Iliac crest abnormal prominence

Patella abnormal prominence
Lordosis
Cardiovascular-pulmonary system
Absent breath sounds
Bradycardia
Bradypnea (slow respiration)
Decreased breath sounds
Dyspnea ( shortness of breath)
Increased breath sounds
Normal breath sounds
Tachypnea
Tachycardia
Respiratory crackles (rales)
Digestive system
Abdominal bloating
Abdominal cramping
Abdominal distension
Abdominal pain
Absence of bowel sounds
Anorexia (loss of appetite)
Ascites
Bulky stool
Constipation
Decrease in appetite
Diarrhea
Early satiety
Epigastric pain
Excessive appetite
Excessive belching
Excessive flatus
Fatty stool
Heartburn
Hyperactive bowel sounds
Hypoactive bowel sounds
Increased appetite
Liquid stool
Loose stool
Nausea
Normal bowel sounds
Retching
Vomiting
Gastrointestinal drainage volume
Gastric drainage volume
Bile duct drainage volume
Pancreatic drainage volume
Chylous drainage volume
Wound drainage volume
Intestinal fistula drainage volume
Normal stool
Edema
+1 pitting edema
+2 pitting edema
+3 pitting edema
+4 pitting edema
Anasarca
Ankle edema
Edema of calf
Edema of eyelid
Edema of foot
Edema of the hand
Edema of the scrotum
Edema of thigh
Edema of the vulva
Mucosal edema
Sacral edema
Extremities
Amputated foot
Amputated hand
Amputated leg
Athetoid movement
Decreased range of ankle movement
Decreased range of cervical spine movement
Decreased range of elbow movement
Decreased range of finger movement
Decreased range of foot movement
Decreased range of hip movement
Decreased range of knee movement
Decreased range of lumbar spine movement
Decreased range of shoulder movement
Decreased range of subtalar movement
Decreased range of thumb movement
Decreased range of toe movement
Decreased range of thoracic spine movement
Decreased range of wrist movement
Hypertonia
Hypotonia
Joint arthralgia (joint pain)
Lower limb spasticity
Peripheral cyanosis
Spasticity
Tetany
Upper limb spasticity
Pes planus
Eyes
Abnormal vision
Angular blepharitis
Bitot’s spots
Circles under eyes
Corneal arcus
Conjunctival discoloration
Conjunctival hemorrhage
Conjunctival keratinization
Excessive tear production
Keratomalacia
Jaundiced sclera
Night blindness
Ophthalmoplegia
Sunken eyes
Xerophthalmia
Xanthelasma
Pale conjunctiva
Genitourinary
Amenorrhea
Anuria
Delay in sexual development and/or puberty
Menorrhagia
Oliguria
Polyuria
Hair
Abnormal keratinization of hair follicle
Alopecia
Brittle hair
Corkscrew hairs
Dry hair
Fine hair
Follicular hyperkeratosis
Hair changes due to malnutrition
Hair lacks luster
Hypertrichosis
Increased loss of hair
Nutritional hair color change
White hair
Easily pluckable hair
Lanugo hair formation
Head
Altered olfactory sense
Anosmia (loss of sense of smell)
Bulging fontanelle
Epistaxis
Headache
Hyposmia (decreased sense of smell)
Macrocephaly
Microcephaly
Nasal mucosa dry
Sunken fontanelle
Hand and nails
Beau's lines
Clubbing of nail
Flaking of nails
Koilonychia (spoon shaped nails)
Leukonychia
Longitudinal grooving of nails
Muehrcke’s lines
Nail changes
Palmar erythema
Ridged nails
Splits in nails
Thin nails
Trachyonychia (brittle nails)
Splinter hemorrhages under nail
White flecks in nails
Blue nail bed

Pale nail bed
Russell’s sign
Mouth
Ageusia (loss of taste)
Angular stomatitis
Aphthous ulcer of mouth
Aptyalism (xerostomia)
Blue lips
Blue line on gingiva
Candidiasis of the mouth
Cheilosis (dry lips)
Cheilitis
Cleft palate
Cracked lips
Drooling
Dry mucous membranes
Dysgeusia
Excessive salivation
Excessive thirst
Gingival hypertrophy
Gingivitis
Halitosis (breath smells unpleasant)
Hemorrhagic gingivitis (bleeding gums)
Hypogeusia
Ketotic breath
Micrognathia
Swollen gums
Oral candidiasis
Oral lesion
Parotid swelling
Poor oral hygiene
Retains food in mouth
Stomatitis
Uremic breath
Pale gums
Cleft lip
Muscles
Muscle atrophy
Muscle contracture
Muscle cramp
Muscle pain
Muscle weakness
Quadricep muscle atrophy
Deltoid muscle atrophy
Gastrocnemius (calf) muscle atrophy
Gluteal muscle atrophy
Interosseous hand muscle atrophy
Latissimus dorsi muscle atrophy
Pectoral muscle atrophy
Temporalis muscle atrophy
Trapezius muscle atrophy
Neck
Goiter (thyroid enlargement)
Nerves, cognition, and feeling

Abnormal gait
Absent reflex
Asterixis
Ataxia
Clouded consciousness (confusion)
Cranial nerve finding
Decreased vibratory sense
Delirious
Dementia
Depressed mood
Disoriented
Dizziness
Feels cold
Flat affect
Hyperreflexia (exaggeration of deep reflexes)
Hyporeflexia (diminished reflexes)
Inappropriate affect
Many seizures a day
Numbness of foot
Numbness of hand
Peripheral nerve disease
Tremor of outstretched hand
Tingling of foot
Tingling of hand
Skin
Acanthosis nigricans
Calcinosis
Carotenemia
Cutaneous xanthoma
Decreased skin turgor
Dermatitis
Diaper rash
Dry skin
Ecchymosis
Erythema
Eczema
Flushing
Hirsutism
Hyperpigmentation of skin
Impaired skin integrity
Jaundice
Keratinization of skin
Pale complexion
Peeling skin
Petechiae
Impaired wound healing
Pressure injury of ankles
Pressure injury of back
Pressure injury of breast
Pressure injury of buttock
Pressure injury of dorsum of foot
Pressure injury of elbow
Pressure injury of head
Pressure injury of heel
Pressure injury of hip

Pressure injury of knee
Pressure injury of natal cleft
Pressure injury of shoulder
Pressure injury stage 1
Pruritus of the skin
Psoriasis
Scaly skin
Seborrheic dermatitis
Skin rash
Stasis ulcer
Yellow skin
Perifollicular hemorrhages
Pressure injury of the coccyx
Pressure injury of the sacrum
Vesiculobullous rash
Acne
Intertrigo
Pannus
Striae
Teeth
Baby bottle tooth decay
Broken denture
Broken teeth
Dental caries
Dental fluorosis
Dental plaque
Denture loose
Denture lost
Denture present
Edentulous
Erosion of teeth
Impaired dentition
Ill fitting denture
Mottling of enamel
Partially edentulous mandible
Partially edentulous maxilla
Rampant dental caries
Throat and swallowing

Choking during swallowing
Cough
Dysphagia
Esophageal lesion
Food sticks on swallowing
Gagging
Hoarse voice
Hypoactive gag reflex
Odynophagia (painful swallowing)
Swallow impairment
Suck, swallow, breath incoordination (infants)
Wet voice
Tongue
Atrophy of tongue papillae
Beefy red tongue
Difficulty moving tongue
Dry tongue
Glossitis
Glossodynia (painful tongue)
Hypertrophy of tongue papillae
Lesion of the tongue
Macroglossia
Strawberry tongue
Short frenulum of tongue
Split frenulum of tongue
Blue tongue
Cracked tongue
Magenta tongue
Pale tongue
Vital signs
Blood pressure, systolic
Blood pressure, diastolic
Blood pressure, systolic, reported
Blood pressure, diastolic, reported
Heart rate
Jugular venous pressure
Mean arterial pressure
Pulse rate
Respiratory rate
Temperature
Examples of the measurement methods or data sources for these outcome indicators: Direct observation,
client report, health record, physician referral
Typically used with the following domains of nutrition interventions: Food and nutrient delivery, nutrition
education, nutrition counseling, coordination of care, population based nutrition action
Excessive or inadequate intake of vitamins/minerals, fiber, fluid, parenteral/enteral nutrition; overweight/obesity,
underweight, unintended weight loss, malnutrition (undernutrition)
Client Example
Muscle atrophy
Loss of subcutaneous fat

1. Reference Standard: The client’s muscle atrophy and subcutaneous fat loss are consistent with mild
undernutrition in the context of acute illness or injury, which is consistent with the nutrition diagnosis of
non-severe (moderate) malnutrition. Normal reference standard is no muscle atrophy and fat pads slightly
bulged.
2. Recommendation: The client maintains or gains muscle and subcutaneous fat (as appropriate) as
determined by a nutrition focused physical exam.
3. Goal: Client establishes goal to consume a mid-afternoon snack of whole milk yogurt on 5 of 7 days per
week.
Client’s muscle atrophy and subcutaneous fat loss is mild, which is consistent with
non-severe (moderate) malnutrition. Client establishes goal to consume a mid-
Initial encounter
afternoon snack of whole milk yogurt on 5 of 7 days per week. Will review client
intake log. Will monitor changes in muscle and subcutaneous fat status in 3 months.
Progress toward maintaining or gaining of muscle mass and (as appropriate)
Reassessment after
subcutaneous fat. Nutrition focused physical exam reveals client’s muscle and
subcutaneous fat status is improved over the last 3 months.
References
1. Al-Dabagh A, Milliron BJ, Strowd L, Feldman SR. A disease of the present: scurvy in "well-
nourished" patients. J Am Acad Dermatol. 2013;69(5):e246-e247.
2. Armstrong S, Lazorick S, Hampl S, et al. Physical examination findings among children and
adolescents with obesity: An evidence-based review. Pediatrics. 2016;137(2):e20151766.
3. Brescoll J, Daveluy S. A review of vitamin B12 in dermatology. Am J Clin Dermatol. 2015;16(1):27-
33.Charney P, Malone A. Academy of Nutrition and Dietetics Pocket Guide to Nutrition Assessment. 3rd
ed. Chicago, IL: Academy of Nutrition and Dietetics; 2015.
4. Detsky AS, McLaughlin JR, Baker JP, et al. What is subjective global assessment of nutritional
status? JPEN J Parenter Enteral Nutr. 1987;11(1):8-13.
5. Etani Y, Nishimoto Y, Kawamoto K, et al. Selenium deficiency in children and adolescents nourished
by parenteral nutrition and/or selenium-deficient enteral formula. J Trace Elem Med Biol.
2014;28(4):409-413.
6. Esper DH. Utilization of nutrition-focused physical assessment in identifying micronutrient
deficiencies. Nutr Clin Pract. 2015;30(2):194-202.
7. Fossitt DD, Kowalski TJ. Classic skin findings of scurvy. Mayo Clin Proc. 2014;89(7):e61.
8. Green Corkins K. Nutrition-focused physical examination in pediatric patients. Nutr Clin Pract.
2015;30(2):203-209.
9. Jimenez M, Giovannucci E, Krall Kaye E, Joshipura KJ, Dietrich T. Predicted vitamin D status and
incidence of tooth loss and periodontitis. Public Health Nutr. 2014;17(4):844-852.
10. Lai KL, Ng JY, Srinivasan S. Xerophthalmia and keratomalacia secondary to diet-induced vitamin
A deficiency in Scottish adults. Can J Ophthalmol. 2014;49(1):109-112.
11. Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J
Gastroenterol. 1997;32(9):920-924.
12. Mordarski BA, Hand RK, Wolff J, Steiber AL. Increased knowledge, self-reported comfort, and
malnutrition diagnosis and reimbursement as a result of the nutrition-focused physical exam hands-on
training workshop. J Acad Nutr Diet. 2017;117(11):1822-1828.
13. Pailhous S, Lamoureux S, Caietta E, et al. Scurvy, an old disease still in the news: two case reports.
Arch Pediatr. 2015;22(1):63-65.
14. Pipkorn R, Leon C, Crouse J, et al. Role of nutrition focused physical exam (NFPE) in the
identification of malnutrition in pediatric patients. J Acad Nutr Diet. 2017;117(9):A13.
15. Radler DR, Lister T. Nutrient deficiencies associated with nutrition-focused physical findings of the
oral cavity. Nutr Clin Pract. 2013;28(6):710-721.
16. Robinson GE, Cryst S. Academy of Nutrition and Dietetics: Revised 2018 standards of practice and
standards of professional performance for registered dietitian nutritionists (competent, proficient, and
expert) in post-acute and long-term care nutrition. J Acad Nutr Diet. 2018;118(9):1747-1760.e1753.
17. Schroth RJ, Levi JA, Sellers EA, Friel J, Kliewer E, Moffatt ME. Vitamin D status of children with
severe early childhood caries: a case-control study. BMC Pediatr. 2013;13:174.
2020 EDITION
12/15/21, 10:59 AM Personal Data
PERSONAL DATA
Client History Domain– Personal History
Personal Data (CH-1.1)

Definition
General client information such as age, gender, sex, race, ethnicity, occupation, tobacco use, and physical
disability
Nutrition Assessment:
Indicators
Age*** Language***
Age in days (neonates)*** English***
Age in months (up to 36 months)*** Spanish***
Age in years*** Other (specify)***
Other (e.g., age adjusted)***
Literacy factors***
Gender*** Language barrier***
(as the behavioral, cultural, or psychological Low literacy***
traits typically associated with one sex)
Education***
Female***
Years of education (Year of
Male***
education)***
Sex***
Role in family***
(as female or male based upon reproductive
Specify***(client's reported role, e.g.,
organs and structures)
mother, cousin, in the description of
Female***
his/her family)
Male***
Tobacco use***
Race ***
Yes***
(A group of people connected by common
Average number cigarettes
descent or origin)
smoked per day
American Indian or Alaska Native***
(number/day)***
Asian***
Total number of other
Black or African American***
tobacco products used/day
Native Hawaiian or Other Pacific
(number/day)***
Islander***
Number years tobacco
White***
products used on a regular
Other***
basis (years)***
Ethnicity*** No***
(pertaining to or having common racial, cultural,
Physical disability***
religious, or linguistic characteristics)
Eyesight impaired***
Hispanic or Latino***
Hearing impaired***
Not Hispanic or Latino***
Other (specify)***
Other***
Mobility***
House bound***
Bed or chair bound***
Tremors (Parkinson’s)***
https://www.ncpro.org/pubs/2020-encpt-en/codeCH-1-1 1/2
12/15/21, 10:59 AM Personal Data
Other (specify)***
***Denotes indicator is used for nutrition assessment only. Other indicators are used for both nutrition
assessment and nutrition monitoring and evaluation.
Examples of the measurement methods or data sources for these outcome indicators: Client report, health
record, referring health care provider or agency, surveys, administrative data sets
Typically used to determine and monitor and evaluate change in the following nutrition diagnoses: N/A
Client Example
Example(s) of one or more of the Nutrition Care Indicators (includes sample initial assessment documentation
for one of the indicators)
Age, sex and education level

Goal: Not applicable
Client is a 40-year-old male with new onset type 2 diabetes, 7th grade education
level
References
1. Charney P, Malone A. Academy of Nutrition and Dietetics Pocket Guide to Nutrition Assessment, 3rd Ed.
3rd ed. Chicago: Academy of Nutrition and Dietetics; 2015.
2. Leonberg BL. Academy of Nutrition and Dietetics Pocket Guide to Pediatric Nutrition Assessment. 2nd
ed. Chicago: Academy of Nutrition and Dietetics; 2013.
3. National Institutes of Health. NIH Policy on Reporting Race and Ethnicity Data: Subjects in Clinical
Research. http://grants.nih.gov/grants/guide/notice-files/not-od-01-053.html. Accessed March 5, 2020.
4. Johnson-Askew WL, Gordon L, Sockalingam S. Practice paper of the American Dietetic Association:
addressing racial and ethnic health disparities. J Am Diet Assoc. 2011;111(3):446-456.
2020 EDITION
12/15/21, 10:59 AM Patient/Client or Family Nutrition-Oriented Medical/Health History
PATIENT/CLIENT OR FAMILY NUTRITION-ORIENTED MEDICAL/HEALTH HISTORY
Client History Domain–Patient/Client/Family Medical/Health History
Patient/Client or Family Nutrition-Oriented Medical/Health History (CH-

2.1)
Definition
Patient/client or family member disease states, conditions, and illnesses that may impact nutritional status
Indicators
Patient/client chief nutrition complaint Hematology/oncology***

(specify)***
Anemia (specify)***
Cardiovascular*** Cancer (specify)***
Other (specify)***
Cardiovascular disease***
Congestive heart failure*** Immune***
Hyperlipidemia***
AIDS/HIV***
Hypertension***
Food allergies***
Stroke***
Sepsis/severe infection***
Other***
Other (specify)***
Endocrine/metabolism***
Integumentary***
Cystic fibrosis***
Burns***
Diabetes mellitus***
Other (specify)***
Diabetes, gestational***
Inborn errors*** Musculoskeletal***
Malnutrition/failure to thrive***
Multiple trauma/fractures***
Metabolic syndrome***
Osteoporosis***
Obesity***
Other (specify)***
Overweight (specify duration)***
Other (specify)*** Neurological***
Excretory*** Developmental delay***

Other (specify) ***
Dehydration***
Renal failure, acute*** Psychological***
Renal failure, chronic***
Alcoholism***
Other (specify)***
Cognitive impairment***
Gastrointestinal*** Dementia/Alzheimer’s***
Depression***
Crohn’s disease***
Eating disorder (specify)***
Diverticulitis/osis***
Psychosis***
Dyspepsia***
Other (specify)***
Inflammatory bowel disease***
Lactase deficiency*** Respiratory***
Liver disease***
Chronic obstructive pulmonary
Pancreatic disease (specify)***
disease***
Other (specify)***
Gynecological*** Other (specify)***
Amenorrhea*** Other***
Lactating***
Mastitis***
Perimenopausal/postmenopausal***
Pregnant***
Gestational age
(weeks)***
Single fetuses***
Multiple fetus (specify)***
Other (specify)***
Examples of the measurement methods or data sources for these outcome indicators: Medical record,
referring health care provider or agency
counseling
Typically used to determine and monitor and evaluate change in the following nutrition diagnoses: All
Client Example
Example(s) of one of the Nutrition Care Indicators (includes sample initial assessment documentation for one of
the indicators)
Cardiovascular disease (CVD)

1. Reference Standard: No reference standard exists.

2. reccomendation: Not applicable.
3. Goal: Not typically used.
Initital Nutrition Client with history of cardiovascular disease. Recommend the diet in accordance
Assessment with client preference and values, the reference standards, and health condition.
References
3. Charney P, Malone A. Academy of Nutrition and Dietetics Pocket Guide to Nutrition Assessment. 3rd
ed. Chicago, IL: Academy of Nutrition and Dietetics; 2015.
4. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015-2020
Dietary Guidelines for Americans. https://health.gov/dietaryguidelines/2015/. Accessed February 13,
2020.
2020 EDITION
12/15/21, 10:59 AM Treatments/Therapy
TREATMENTS/THERAPY
Client History Domain – Patient/Client/Family Medical/Health History
Treatments/Therapy (CH-2.2)
Definition
Documented medical or surgical treatments that may impact nutritional status of the client
Indicators
Medical treatment/therapy***
Chemotherapy***
Dialysis***
Mechanical ventilation/oxygen therapy***
Ostomy (specify)***
Radiation therapy***
Other (specify, eg, speech, Occupational Therapy, Physical Therapy)***
Surgical treatment***
Coronary artery bypass graft (CABG)***

Gastric bypass (specify type)***
Intestinal resection***
Joint/orthopedic surgery/replacement***
Limb amputation***
Organ transplant (specify)***
Total gastrectomy***
Other (specify)***
Palliative/end-of-life care (care of client with terminal or life-threatening conditions)***
Examples of the measurement methods or data sources for these outcome indicators: Client interview,
health record, referring health care provider or agency
Impaired nutrient utilization, increased nutrient needs, altered gastrointestinal function, biting/chewing
(masticatory) difficulty, unintended weight loss.
Client Example
Example(s) of one of the Nutrition Care Indicators (includes sample initial assessment documentation for one of
the indicators)
12/15/21, 10:59 AM Treatments/Therapy
Radiation therapy


3. Goal: Client receiving radiation therapy for lung cancer, experiencing decreased appetite and pain with
eating. Goal is to optimize nutrition during radiation therapy.
Client receiving radiation therapy for lung cancer, experiencing decreased appetite
due to fatigue and pain with eating.
References
2020 EDITION
12/15/21, 10:59 AM Social History
SOCIAL HISTORY
Client History Domain– Social History
Social History (CH-3.1)

Definition
Client socioeconomic status, housing situation, medical support, and involvement in social groups
Indicators
Socioeconomic factors*** Occupation***
Economic constraints (major/minor)*** Stay-at-home mother***

Access to medical care Student***
(full/limited/none)*** Retired***
Diverts food money to other needs*** Specify***
Other (specify)***
Religion***
Living/housing situation***
Catholic***
Lives alone*** Jewish***
Lives with family member/caregiver*** Protestant***
Homeless***
Specify***
Domestic issues***
Islam***
Specify*** Specify***
Social and medical support*** History of recent crisis***
Family members*** Job loss***

Caregivers*** Family member death***
Community group/senior Trauma, surgery***
center/church*** Other (specify)***
Support group attendance (eg, weight
Daily stress level (high, moderate, low bodily or
control, substance abuse, etc.)***
mental tension)***
Other (specify)***
Geographic location of home***
Urban***
Rural***
Limited exposure to sunlight (vitamin
D)***
Other (specify)***
record, referring health care provider or agency
12/15/21, 10:59 AM Social History
Typically used to determine and monitor and evaluate change in the following nutrition diagnoses: All
Client Example
Living/housing situation and Geographic location of home


Client is house bound, lives in a rural area, and receives one meal/day from home
delivery program.
References
2. Academy of Nutrition and Dietetics. Evidence Analysis Library. Academy of Nutrition and
Dietetics. https://www.andeal.org/?auth=1. Accessed February 13, 2020.
2020 EDITION
12/15/21, 11:09 AM Nutrition Assessment, Monitoring and Evaluation Tool Ratings
NUTRITION ASSESSMENT, MONITORING AND EVALUATION TOOL RATINGS
Assessment, Monitoring and Evaluation Tools Domain
Nutrition Assessment, Monitoring and Evaluation Tool Ratings (AT-1)

Definition
Validated tool ratings or scores that provide data for the purpose of evaluating nutrition status

Indicators
Subjective global assessment (SGA) rating (A Well nourished, B Moderately [or suspected of being]
malnourished, C Severely malnourished)—defined as a nutrition assessment rating reflecting a valid
assessment of overall nutrition status and the risk of or presence of malnutrition in adults of all ages based
upon recent change in intake, weight change, gastrointestinal symptoms, functional status, metabolic
demand of disease, and physical exam parameters, related to fat and muscle mass loss, and fluid retention
Patient generated subjective global assessment (PG-SGA) rating (Stage A Well nourished, Stage B
Moderate/Suspected malnutrition, Stage C Severely malnourished)—defined as a nutrition assessment
rating reflecting a valid assessment of overall nutrition status and the risk of or presence of malnutrition
in adults of all ages based upon recent change in intake, weight change, gastrointestinal symptoms,
functional status, clinical symptoms, metabolic demand of disease, and physical exam parameters. The
tool includes both client and practitioner components
Patient generated subjective global assessment (PG-SGA) score (number)—defined as an additive

numerical score based on intake, weight change, gastrointestinal symptoms, functional status, clinical
symptoms, metabolic demand of disease, and physical exam parameters that are used for triaging
nutrition intervention rather than determining the PG-SGA rating
Mini nutritional assessment long form (MNA-LF) rating (Normal nutritional status, At risk of
malnutrition, Malnourished)—defined as a nutrition assessment rating reflecting a valid assessment of
overall nutrition status and the risk of or presence of malnutrition in adults aged > 65 years based upon
weight change, intake, functional status, psychological stressors or problems, and clinical exam
parameters
Subjective global nutritional assessment (SGNA) for children rating (normal nutrition, moderate
malnutrition, severe malnutrition)—defined as a nutrition assessment rating reflecting a valid assessment
of nutritional status of children+
+ Alternate approaches to interpretation of anthropometric measurements are recommended for children.
Therefore, this tool should be used in conjunction with the evidence-based anthropometric measurement
assessment criteria.
records, practitioner observation, nutrition focused physical findings, self-monitoring records, survey data
diagnoses: Acute disease or injury related malnutrition, chronic disease or injury related malnutrition, starvation
related malnutrition, unintended weight loss, disordered eating pattern, inadequate intake diagnoses
https://www.ncpro.org/pubs/2020-encpt-en/codeAT-1 1/3
Client Example(s)
Example of one (or more) of the Nutrition Care Indicators (includes sample initial and reassessment of
Patient generated subjective global assessment (PG-SGA) rating and Patient generated subjective global
assessment (PG-SGA) score

1. Reference Standard: Refer to specific tool.

Oncology client Patient generated subjective global assessment (PG-SGA) rating B

Initial encounter
and Patient generated subjective global assessment (PG-SGA) score 9.
Client Patient generated subjective global assessment (PG-SGA) rating B and
Reassessment after
Patient generated subjective global assessment (PG-SGA) score 5 with
improvement in some parameters.
References
1. Baker JP, Detsky AS, Wesson DE, et al. Nutritional assessment: a comparison of clinical judgement and
objective measurements. N Engl J Med. 1982;306(16):969-972.
2. Baker JP, Detsky AS, Whitwell J, Langer B, Jeejeebhoy KN. A comparison of the predictive value of
nutritional assessment techniques. Hum Nutr Clin Nutr. 1982;36(3):233-241
3. Belanger V, McCarthy A, Marcil V, et al. Assessment of malnutrition risk in Canadian pediatric hospitals:
A multicenter prospective cohort study. J Pediatr. 2019;205:160-167.e166.
4. Canadian Malnutrition Task Force. Subjective Global Assessment Form.
http://nutritioncareincanada.ca/sites/default/uploads/files/SGA%20Tool%20EN%20colour_2017(1).pdf.
Accessed March 2, 2020.
5. Compan B, di Castri A, Plaze JM, Arnaud-Battandier F. Epidemiological study of malnutrition in elderly
patients in acute, sub-acute and long-term care using the MNA. J Nutr Health Aging. 1999;3(3):146-151
6. Detsky AS, McLaughlin JR, Baker JP, et al. What is subjective global assessment of nutritional status?
JPEN J Parenter Enteral Nutr. 1987;11(1):8-13.
7. Guigoz Y, Vellas B, Garry PJ. Mini Nutritional Assessment: A practical assessment tool for grading the
nutritional state of elderly patients. Facts Res Gerontol. 1994;4(suppl 2):15-59.
8. Kuzuya M, Kanda S, Koike T, Suzuki Y, Satake S, Iguchi A. Evaluation of Mini-Nutritional Assessment
for Japanese frail elderly. Nutrition. 2005;21(4):498-503.
9. Kwon YE, Kee YK, Yoon CY, et al. Change of nutritional status assessed using subjective global
assessment is associated with all-cause mortality in incident dialysis patients. Medicine (Baltimore).
2016;95(7):e2714.
10. Matsuyama M, Bell K, White M, et al. Nutritional assessment and status of hospitalized infants. J Pediatr
Gastroenterol Nutr. 2017;65(3):338-342.
11. Minocha P, Sitaraman S, Choudhary A, Yadav R. Subjective global nutritional assessment: A reliable
screening tool for nutritional assessment in cerebral palsy children. Indian J Pediatr. 2018;85(1):15-19.
12. Ong SH, Chee WSS, Lapchmanan LM, Ong SN, Lua ZC, Yeo JX. Validation of the subjective global
nutrition assessment (SGNA) and screening tool for the assessment of malnutrition in paediatrics
(STAMP) to identify malnutrition in hospitalized malaysian children. J Trop Pediatr. 2019;65(1):39-45.
13. Secker DJ, Jeejeebhoy KN. Subjective global nutritional assessment for children. Am J Clin Nutr.
2007;85(4):1083-1089.
14. Secker DJ, Jeejeebhoy KN. How to perform subjective global nutritional assessment in children. J Acad
Nutr Diet. 2012;112(3):424-431.
15. Vermilyea S, Slicker J, El-Chammas K, et al. Subjective global nutritional assessment in critically ill
children. JPEN J Parenter Enteral Nutr. 2013;37(5):659-666.
2020 EDITION
12/15/21, 11:09 AM Household Food Security Assessment Tool Scores
HOUSEHOLD FOOD SECURITY ASSESSMENT TOOL SCORES
Household Food Security Assessment Tool Scores (AT-2)

Definition
Tool scores that provide data for the purpose of evaluating household food security

Indicators
US household food security module six item short form raw score (0-6)—defined as the sum of
affirmative household responses to the six questions in the module
US household food security module six item short form scale score (0 = NA, 1 = 2.86, 2 = 4.19, 3 = 5.27,
4 = 6.30, 5 = 7.54, 6 [evaluated at 5.5] = 8.48)—defined as the degree to which a client is food secure
based on the overall pattern of responses to the set of indicator questions
Food insecurity experience scale (FIES) raw score (numerical score)—defined as an interval measure of
the severity of food insecurity and makes it possible to produce measures of food insecurity at the
individual or household level that are comparable across countries and contexts
Examples of the measurement methods or data sources for these outcome indicators:Survey data, program
records
education, nutrition counseling, coordination and referral of nutrition care, population based nutrition action
diagnoses: Underweight, overweight/obesity, growth rate below expected, limited food acceptance, undesirable
food choices, intake of unsafe food, limited access to food
Client Example(s)
US household food security module six item short form raw score (0-6)


US household food security module six item short form raw score of 2, low food
Initial encounter
security. Tool was administered to client at public health center.
Reassessment after US household food security module six item short form raw score of 1, marginal
12/15/21, 11:09 AM Household Food Security Assessment Tool Scores
nutrition intervention food security. Tool was administered to client at public health center. Client’s food
security has improved.
References
1. Ballard TJ, Kepple AW, Cafiero C. The food insecurity experience scale: development of a global
standard for monitoring hunger worldwide. Technical Paper. Rome, Italy: FAO;2013.
2. Food insecurity experience scale: Developing a global standard for monitoring hunger worldwide.
http://www.fao.org/fileadmin/templates/ess/voh/FIES_Technical_Paper_v1.1.pdf. Accessed February 15,
2019.
3. Harrison GG, Sharp M, Manolo-LeClair G. Food security among California’s low-income adults
improves, but most severely affected do not share in improvement. UCLA Center for Health Policy
Research. https://escholarship.org/uc/item/36b7k2sb. Accessed February 15, 2019.
4. Measuring Food Security in the United States. https://fns-
prod.azureedge.net/sites/default/files/FSGuide.pdf. Accessed February 15, 2019.
5. U.S. Household Food Security Survey Module: Six-Item Short Form, Economic Research Service,
USDA, September 2012. https://www.ers.usda.gov/media/8282/short2012.pdf. Accessed February 15,
2019.
2020 EDITION
12/15/21, 11:10 AM Food Variety Assessment Tool Scores
FOOD VARIETY ASSESSMENT TOOL SCORES
Food Variety Assessment Tool Scores (AT-3)

Definition
Tool scores that provide data for the purpose of evaluating food variety for an individual, household, or
population

Indicators
Minimum dietary diversity for women (MDD-W) indicator score (0-10)— defined as a dichotomous
indicator of whether or not women of reproductive age (15–49) years have consumed at least five out of
ten defined food groups the previous day or night. The proportion of women in a population who reach
this minimum can be used as a proxy indicator for micronutrient adequacy. Scores are aggregated for a
population of women rather than used as measures for an individual
Examples of the measurement methods or data sources for these outcome indicators:Survey data, program
records, client report
education, nutrition counseling, coordination and referral of nutrition care, population based nutrition action
diagnoses: Underweight, overweight/obesity, growth rate below expected, food and nutrition related knowledge
deficit, limited food acceptance, undesirable food choices, intake of unsafe food, limited access to food
Client Example(s)
Minimum dietary diversity for women (MDD-W) indicator score


Client (population) survey responses Minimum dietary diversity for women (MDD-
Initial encounter
W) indicator score 4, diversity not achieved.
Client (population) survey responses Minimum dietary diversity for women (MDD-
Reassessment after
W) indicator score 6, diversity achieved. Client has shown improvement in dietary
diversity indicator.
12/15/21, 11:10 AM Food Variety Assessment Tool Scores
References
1. Chakona G, Shackleton C. Minimum dietary diversity scores for women indicate micronutrient adequacy
and food insecurity status in South African towns. Nutrients. 2017;9(8):812.
2. Food and Agricultural Association of the United Nations. Minimum dietary diversity for women: A guide
to measurement. http://www.fao.org/3/a-i5486e.pdf. Accessed February 15, 2019.
3. Savy M, Martin-Prevel Y, Sawadogo P, Kameli Y, Delpeuch F. Use of variety/diversity scores for diet
quality measurement: relation with nutritional status of women in a rural area in Burkina Faso. Eur J Clin
Nutr. 2005;59(5):703-716.
2020 EDITION
12/15/21, 11:15 AM Nutrition Diagnosis Etiology Category Identification
NUTRITION DIAGNOSIS ETIOLOGY CATEGORY IDENTIFICATION
Etiology Category Domain
Nutrition Diagnosis Etiology Category Identification (EY-1)

Definition
Assessing the etiology category to communicate the cause or contributing factor of a nutrition diagnosis
(problem)
Purpose
To ensure clear communication of the known root cause of a nutrition diagnosis and to link an effective nutrition
intervention resolve or mitigate the problem.
Indicators
Beliefs–Attitudes Etiology— defined as a cause or contributing risk factors related to the conviction of
the truth of some nutrition-related statement or phenomenon; feelings or emotions toward that truth or
phenomenon and activities.
Cultural Etiology—defined as a cause or contributing risk factors related to the client’s values, social
norms, customs, religious beliefs, and/or political systems.
Knowledge Etiology— defined as a cause or contributing risk factors impacting the level of
understanding about food, nutrition and health, or nutrition-related information and guidelines.
Physical Function Etiology— defined as a cause or contributing risk factors related to physical ability to
engage in specific tasks; may be cognitive in nature.
Physiologic–Metabolic Etiology— defined as a cause or contributing risk factors related to

medical/health status that may have a nutritional impact (excludes psychological etiologies—see separate
category).
Psychological Etiology—defined as a cause or contributing risk factors related to a diagnosed or

suspected mental health/psychological problem (Diagnostic and Statistical Manual of Mental Disorders
[DSM]).
Social–Personal Etiology—defined as a cause or contributing risk factors associated with the client’s
personal and/or social history.
Treatment Etiology—defined as a cause or contributing risk factors related to medical or surgical

treatment or other therapies and management or care.
Access Etiology—defined as a cause or contributing risk factors that affect intake and the availability of
safe, healthful food, water, and food/nutrition-related supplies. A more specific root cause of Access
Etiologies may not be known but may eventually reveal Beliefs-Attitudes, Cultural, Knowledge, Physical
Function, Psychological, Social–Personal, or Treatment Etiologies.
Behavior Etiology—defined as a cause or contributing risk factors related to actions which influence
achievement of nutrition-related goals. A more specific root cause of Behavior Etiologies may not be
known but may eventually reveal Beliefs-Attitudes, Cultural, Knowledge, Physical Function,
Psychological, Social-Personal, or Treatment Etiologies.
Examples of the measurement methods or data sources for these outcome indicators: Client report, survey
data
Education, Counseling, Coordination of nutrition care by nutrition professional, Population based nutrition
action
https://www.ncpro.org/pubs/2020-encpt-en/codeEY-1 1/3
Typically used to determine and to monitor and evaluate change in the following nutrition diagnoses: all
nutrition diagnoses
Client Example(s)
Accompanying nutrition diagnoses should be assessment and communication of the etiology category. This aids
in evaluation of the appropriateness of the nutrition intervention planned and executed. Examples below show
the etiology category clearly associated with the PES statement or included in the PES statement. Either
approach is acceptable.
Inadequate oral intake related to reduced appetite, altered taste, pain, and sore mucosa due to radiotherapy
treatment as evidenced by 4% weight loss in 3 weeks and consuming < ½ of meals.
Please indicate the etiology category: Treatment etiology
Self monitoring deficit related to limited adherence with insulin regimen and blood glucose readings [behavior
etiology] as evidenced by skipping mealtime insulin and no blood glucose values/readings documented.
Food and nutrition related knowledge deficit related to recent relocation [knowledge etiology] as evidenced by
community survey revealing 40% of population reports not knowing where to purchase fresh fruits and
vegetables.
References
1. Chui TK, Proano GV, Raynor HA, Papoutsakis C. A nutrition care process audit of the national
quality improvement dataset: Supporting the improvement of data quality using the ANDHII platform. J
Acad Nutr Diet. 2019.
2. Enrione EB, Reed D, Myers EF. Limited agreement on etiologies and signs/symptoms among
registered dietitian nutritionists in clinical practice. J Acad Nutr Diet. 2016;116(7):1178-1186.
3. Murphy WJ, Yadrick MM, Steiber AL, Mohan V, Papoutsakis C. Academy of Nutrition and Dietetics
Health Informatics Infrastructure (ANDHII): A pilot study on the documentation of the nutrition care
process and the usability of ANDHII by registered dietitian nutritionists. J Acad Nutr Diet.
2018;118(10):1966-1974.
4. Swan WI, Pertel DG, Hotson B, et al. Nutrition care process (NCP) update part 2: Developing and
using the NCP terminology to demonstrate efficacy of nutrition care and related outcomes. J Acad Nutr
Diet. 2019;119(5):840-855.
5. Swan WI, Vivanti A, Hakel-Smith NA, et al. Nutrition Care Process and Model Update: Toward
Realizing People-Centered Care and Outcomes Management. J Acad Nutr Diet. 2017;117(12):2003-2014.
6. Thompson KL, Davidson P, Swan WI, et al. Nutrition care process chains: the "missing link"
between research and evidence-based practice. J Acad Nutr Diet. 2015;115(9):1491-1498.
2020 EDITION
12/15/21, 11:17 AM Intervention goal status
INTERVENTION GOAL STATUS
Progress Evaluation Domain
Intervention Goal Status (EV-1)

Definition
Evaluation of progress toward meeting goals set in the course of nutrition intervention

Indicators
New goal identified—defined as the goal identified in Nutrition Intervention planning and was not
identified in the previous Nutrition Intervention planning
Goal achieved—defined as the goal has been met
Goal discontinued—defined as the need for the goal no longer exists because the conditions or situation
has changed and goal is no longer appropriate
Goal not achieved—defined as there is no overall progress toward or away from a goal
Some progress toward goal—defined as any progress toward the goal
Some digression away from goal—defined as no overall progress toward the goal and progress overall is
worsening
Examples of the measurement methods or data sources for these outcome indicators: Client report, survey
data
Education, Counseling, Coordination of nutrition care by nutrition professional, Population based nutrition
action
Typically used to determine and to monitor and evaluate change in the following nutrition diagnoses: all
nutrition diagnoses
Client Example(s)
New goal and Some progress toward goal

1. Reference Standard:Varies depending on the target value (eg, intake, behavior change) of the goal.
2. Recommendation: Varies depending on the target value (eg, intake, behavior change) of the goal.
3. Goal: Varies depending on the client preference.
Initial Client identified a goal that they will increase estimated vegetable serving intake in 24 hours
https://www.ncpro.org/pubs/2020-encpt-en/codeEV-1 1/2
12/15/21, 11:17 AM Intervention goal status
encounter (FH-1.1.2.1.1.3) to two vegetable servings with lunch on five of seven days per week by next
encounter in 3 weeks. [New goal].
Reassessment Client identified that they have made some progress toward goal of increasing estimated
after nutrition vegetable serving intake in 24 hours (FH-1.1.2.1.1.3) by eating two vegetable servings with
intervention lunch on three of seven days per week. [Some progress toward goal]
References
1. Chui TK, Proano GV, Raynor HA, Papoutsakis C. A nutrition care process audit of the national
quality improvement dataset: Supporting the improvement of data quality using the ANDHII platform. J
Acad Nutr Diet. 2019.
2020 EDITION
12/15/21, 11:18 AM Nutrition diagnosis status
NUTRITION DIAGNOSIS STATUS
Progress Evaluation Domain
Nutrition Diagnosis Status (EV-2)

Definition
Evaluation of the status of a nutrition diagnosis.
Purpose
To ensure clear communication of the progress toward resolution of each nutrition diagnosis.

Indicators
New nutrition diagnosis—a nutrition diagnosis identified that 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.
Examples of the measurement methods or data sources for these outcome indicators: Not applicable
Typically used with the following domains of nutrition interventions: Not applicable
Typically used to determine and to monitor and evaluate change in the following nutrition diagnoses: All
Client Example
New nutrition diagnosis; Active nutrition diagnosis

1. Reference Standard:Not applicable.

Examples
Altered nutrition related laboratory values: decreased serum potassium related to Severe illness related pediatric
malnutrition as evidenced by serum potassium 2.9 mEq/L. [New nutrition diagnosis] (Physiologic metabolic
etiology)
12/15/21, 11:18 AM Nutrition diagnosis status
Altered nutrition related laboratory values: decreased serum magnesium related to Severe illness related
pediatric malnutrition as evidenced by serum magnesium 1.1 mEq/L. [New nutrition diagnosis] (Physiologic
metabolic etiology)
Growth rate below expected related to insufficient enteral nutrition and oral feeding prior to admission (PTA) as
evidenced by Length for age z score -4.0, Weight for age z score -5.1, and Weight for length z score -2. [Active
nutrition diagnosis] (Treatment etiology)
References
Diet. 2019;119(5):840-855.
2020 EDITION
Nutrition Diagnostic Terminology
Each term is designated with an alpha-numeric NCPT hierarchical code, followed by a five-digit (e.g., 99999) Academy SNOMED CT/LOINC unique identifier
(ANDUID). Neither should be used in nutrition documentation. The ANDUID is for data tracking purposes in electronic health records.
INTAKE (NI) ❑ Intake of types of fats inconsistent with needs NI-5.5.3 10854
Actual problems related to intake of energy, nutrients, fluids, bioactive substances through (specify) _______________________________
oral diet or nutrition support Protein (5.6)
Energy Balance (1) ❑ Inadequate protein intake NI-5.6.1 10666
Actual or estimated changes in energy (calorie/kcal/kJ) balance ❑ Excessive protein intake NI-5.6.2 10667
❑ Increased energy expenditure NI-1.1 10633 ❑ Intake of types of proteins inconsistent with NI-5.6.3 10855
❑ Inadequate energy intake NI-1.2 10634 needs
❑ Excessive energy intake NI-1.3 10635 (specify) _______________________________
❑ Predicted inadequate energy intake NI-1.4 10636 Amino Acid (5.7)
❑ Predicted excessive energy intake NI-1.5 10637 ❑ Intake of types of amino acids inconsistent with NI-5.7.1 12007
Oral or Nutrition Support Intake (2) needs
Actual or estimated food and beverage intake from oral diet or nutrition support compared (specify) _______________________________
with client goal Carbohydrate and Fiber (5.8)
❑ Inadequate oral intake NI-2.1 10639 ❑ Inadequate carbohydrate intake NI-5.8.1 10670
❑ Excessive oral intake NI-2.2 10640 ❑ Excessive carbohydrate intake NI-5.8.2 10671
❑ Inadequate enteral nutrition infusion NI-2.3 10641 ❑ Intake of types of carbohydrate inconsistent with NI-5.8.3 10856
❑ Excessive enteral nutrition infusion NI-2.4 10642 needs
❑ Enteral nutrition composition inconsistent with NI-2.5 11142 (specify) _______________________________
needs ❑ Inconsistent carbohydrate intake NI-5.8.4 10673
❑ Enteral nutrition administration inconsistent with NI-2.6 11143 ❑ Inadequate fiber intake NI-5.8.5 10675
needs ❑ Excessive fiber intake NI-5.8.6 10676
❑ Inadequate parenteral nutrition infusion NI-2.7 10644 Vitamin (5.9)
❑ Excessive parenteral nutrition infusion NI-2.8 10645 ❑ Inadequate vitamin intake (specify) NI-5.9.1 10678
❑ Parenteral nutrition composition inconsistent NI-2.9 11144 ❑ A (1) 10679
with needs
❑ C (2) 10680
❑ Parenteral nutrition administration inconsistent NI-2.10 11145
with needs ❑ D (3) 10681
❑ Limited food acceptance NI-2.11 10647 ❑ E (4) 10682
Fluid Intake (3) ❑ K (5) 10683
❑ Thiamin (6) 10684
Actual or estimated fluid intake compared with client goal
❑ Riboflavin (7) 10685
❑ Inadequate fluid intake NI-3.1 10649
❑ Niacin (8) 10686
❑ Excessive fluid intake NI-3.2 10650
❑ Folate (9) 10687
Bioactive Substances (4)
❑ B6 (10) 10688
Actual or estimated intake of bioactive substances, including single or multiple functional
food components, ingredients, dietary supplements, alcohol ❑ B12 (11) 10689
❑ Inadequate bioactive substance intake NI-4.1 10859 ❑ Pantothenic acid (12) 10690
❑ Inadequate plant stanol ester intake NI-4.1.1 11077 ❑ Biotin (13) 10691
❑ Inadequate plant sterol ester intake NI-4.1.2 11078 ❑ Excessive vitamin intake (specify) NI-5.9.2 10693
❑ Inadequate soy protein intake NI-4.1.3 11080 ❑ A (1) 10694
❑ Inadequate psyllium intake NI-4.1.4 11079 ❑ C (2) 10695
❑ Inadequate beta glucan intake NI-4.1.5 11076 ❑ D (3) 10696
❑ Excessive bioactive substance intake NI-4.2 10653 ❑ E (4) 10697
❑ Excessive plant stanol ester intake NI-4.2.1 11084 ❑ K (5) 10698
❑ Excessive plant sterol ester intake NI-4.2.2 11085 ❑ Thiamin (6) 10699
❑ Excessive soy protein intake NI-4.2.3 11087 ❑ Riboflavin (7) 10700
❑ Excessive psyllium intake NI-4.2.4 11086 ❑ Niacin (8) 10701
❑ Excessive beta glucan intake NI-4.2.5 11081 ❑ Folate (9) 10702
❑ Excessive food additive intake NI-4.2.6 11083 ❑ B6 (10) 10703
❑ Excessive caffeine intake NI-4.2.7 11082 ❑ B12 (11) 10704
❑ Excessive alcohol intake NI-4.3 10654 ❑ Pantothenic acid (12) 10705
Nutrient (5) ❑ Biotin (13) 10706
Actual or estimated intake of specific nutrient groups or single nutrients as compared with Mineral (5.10)
desired levels ❑ Inadequate mineral intake (specify) NI-5.10.1 10709
❑ Increased nutrient needs NI-5.1 10656 ❑ Calcium (1) 10710
(specify) _______________________________ ❑ Chloride (2) 10711
❑ Inadequate protein energy intake NI-5.2 10658 ❑ Iron (3) 10712
❑ Decreased nutrient needs NI-5.3 10659 ❑ Magnesium (4) 10713
(specify) _______________________________ ❑ Potassium (5) 10714
❑ Imbalance of nutrients NI-5.4 10660 ❑ Phosphorus (6) 10715
Fat and Cholesterol (5.5) ❑ Sodium (7) 10716
❑ Inadequate fat intake NI-5.5.1 10662 ❑ Zinc (8) 10717
❑ Excessive fat intake NI-5.5.2 10663 ❑ Sulfate (9) 10718
❑ Fluoride (10) 10719
1
❑ Copper (11) 10720 ❑ Obese, Class II NC-3.3.4 10818

❑ Iodine (12) 10721 ❑ Obese, Class III NC-3.3.5 10819
❑ Selenium (13) 10722 ❑ Unintended weight gain NC-3.4 10770
❑ Manganese (14) 10723 ❑ Growth rate below expected NC-3.5 10802
❑ Chromium (15) 10724 ❑ Excessive growth rate NC-3.6 10803
❑ Molybdenum (16) 10725 Malnutrition Disorders (4)
❑ Boron (17) 10726 Health consequences resulting from insufficient or excessive energy and/or nutrient intake
❑ Cobalt (18) 10727 compared to physiologic needs and/or utilization
❑ Excessive mineral intake (specify) NI-5.10.2 10729 ❑ Malnutrition (undernutrition) NC-4.1 10657
❑ Calcium (1) 10730 ❑ Starvation related malnutrition NC-4.1.1 11130
❑ Chloride (2) 10731 ❑ Moderate starvation related NC-4.1.1.1 13210
❑ Iron (3) 10732 malnutrition
❑ Magnesium (4) 10733 ❑ Severe starvation related malnutrition NC-4.1.1.2 13211
❑ Potassium (5) 10734 ❑ Chronic disease or condition related NC-4.1.2 11131
malnutrition
❑ Phosphorus (6) 10735
❑ Moderate chronic disease or condition NC-4.1.2.1 13212
❑ Sodium (7) 10736 related malnutrition
❑ Zinc (8) 10737 ❑ Severe chronic disease or condition NC-4.1.2.2 13213
❑ Sulfate (9) 10738 related malnutrition
❑ Fluoride (10) 10739 ❑ Acute disease or injury related malnutrition NC-4.1.3 11132
❑ Copper (11) 10740 ❑ Moderate acute disease or injury related NC-4.1.3.1 13214
❑ Iodine (12) 10741 malnutrition
❑ Selenium (13) 10742 ❑ Severe acute disease or injury related NC-4.1.3.2 13215
malnutrition
❑ Manganese (14) 10743
❑ Non illness related pediatric malnutrition NC-4.1.4 13017
❑ Chromium (15) 10744
❑ Mild non illness related pediatric NC-4.1.4.1 13216
❑ Molybdenum (16) 10745
malnutrition
❑ Boron (17) 10746
❑ Moderate non illness related pediatric NC-4.1.4.2 13217
❑ Cobalt (18) 10747 malnutrition
Multinutrient (5.11) ❑ Severe non illness related pediatric NC-4.1.4.3 13218
❑ Predicted inadequate nutrient intake NI-5.11.1 10750 malnutrition
(specify) _______________________________ ❑ Illness related pediatric malnutrition NC-4.1.5 13018
❑ Predicted excessive nutrient intake NI-5.11.2 10751 ❑ Mild illness related pediatric NC-4.1.5.1 13219
malnutrition
(specify) _______________________________
❑ Moderate illness related pediatric NC-4.1.5.2 13220
malnutrition
❑ Severe illness related pediatric NC-4.1.5.3 13221
CLINICAL (NC) malnutrition
Nutritional findings/problems identified that relate to medical or physical conditions
Functional (1)
Change in physical or mechanical functioning that interferes with or prevents desired BEHAVIORAL-ENVIRONMENTAL (NB)
nutritional consequences Nutritional findings/problems identified that relate to knowledge, attitudes/beliefs,
❑ Swallowing difficulty NC-1.1 10754 physical environment, access to food, or food safety
❑ Biting/Chewing (masticatory) difficulty NC-1.2 10755 Knowledge and Beliefs (1)
❑ Breastfeeding difficulty NC-1.3 10756 Actual knowledge and beliefs as related, observed, or documented
❑ Altered GI function NC-1.4 10757 ❑ Food and nutrition related knowledge deficit NB-1.1 10773
❑ Predicted breastfeeding difficulty NC-1.5 11146 ❑ Unsupported beliefs/attitudes about food or NB-1.2 10857
Biochemical (2) nutrition related topics (use with caution)
Change in capacity to metabolize nutrients as a result of medications, surgery, or as ❑ Not ready for diet/lifestyle change NB-1.3 10775
indicated by altered laboratory values ❑ Self monitoring deficit NB-1.4 10776
❑ Impaired nutrient utilization NC-2.1 10759 ❑ Disordered eating pattern NB-1.5 10777
❑ Altered nutrition related laboratory values NC-2.2 10760 ❑ Limited adherence to nutrition related NB-1.6 10778
(specify) _______________________________ recommendations
❑ Food medication interaction NC-2.3 10761 ❑ Undesirable food choices NB-1.7 10779
(specify) _______________________________ Physical Activity and Function (2)
❑ Predicted food medication interaction NC-2.4 10762 Actual physical activity, self care, and quality of life problems as reported, observed, or
(specify) _______________________________ documented
Weight (3) ❑ Physical inactivity NB-2.1 10782
Chronic weight or changed weight status when compared with usual or desired body ❑ Excessive physical activity NB-2.2 10783
weight ❑ Inability to manage self care NB-2.3 10780
❑ Underweight NC-3.1 10764 ❑ Impaired ability to prepare foods/meals NB-2.4 10785
❑ Unintended weight loss NC-3.2 10765 ❑ Poor nutrition quality of life NB-2.5 10786
❑ Overweight/obesity NC-3.3 10766 ❑ Self feeding difficulty NB-2.6 10787
❑ Overweight, adult or pediatric NC-3.3.1 10767
❑ Obese, pediatric NC-3.3.2 10768
❑ Obese, Class I NC-3.3.3 10769
2
Food Safety and Access (3)

Actual problems with food safety or access to food, water, or nutrition related supplies Other (NO)
❑ Intake of unsafe food NB-3.1 10789 Nutrition findings that are not classified as intake, clinical or behavioral-environmental
❑ Limited access to food NB-3.2 12009 problems.
❑ Limited access to nutrition related supplies NB-3.3 10791 Other (1)
❑ Limited access to potable water NB-3.4 12010 ❑ No nutrition diagnosis at this time NO-1.1 10795
3
12/13/21, 11:50 AM Predicted Inadequate Nutrient Intake (Specify)
PREDICTED INADEQUATE NUTRIENT INTAKE (SPECIFY)
Intake Domain – Multinutrient
Predicted Inadequate Nutrient Intake (Specify) (NI-5.11.1)

Definition
Future intake of one or more nutrients that is anticipated, based on observation, experience, or scientific reason,
to fall short of estimated nutrient requirements, established reference standards, or recommendations based on
physiological needs.
Etiology (Cause/Contributing Risk Factors)

Factors gathered during the nutrition assessment process that contribute to the existence or the maintenance of
pathophysiological, psychosocial, situational, developmental, cultural, and/or environmental problems:
Scheduled or planned medical therapy or medication that is predicted to increase nutrient requirements
Scheduled or planned medical therapy or medication that is predicted to decrease ability to consume
sufficient nutrients
Physiological condition associated with increased need for a nutrient due to altered metabolism
Cultural or religious practices that will affect nutrient intake
Anticipated isolated living/housing situation without routine access to a variety of nutritious foods
Danger for environmental emergency or catastrophe/disaster
Etiology Category
Etiologies are grouped by the type of cause or contributing risk factor. Communicate the etiology category by
selecting the appropriate Nutrition Assessment, Monitoring and Evaluation term:
NCP Term NCPT Code ANDUID

Knowledge etiology EY-1.3 14569
Physical function etiology EY-1.4 14570
Physiologic metabolic etiology EY-1.5 14571
Psychological etiology EY-1.6 14572
Social personal etiology EY-1.7 14573
Treatment etiology EY-1.8 14574
Visit the Nutrition Diagnosis Etiology Category Identification reference sheet for more details on etiology
categories. An additional useful resource to determine the etiology category is the Nutrition Diagnosis Matrix.
Signs/Symptoms (Defining Characteristics)

A typical cluster of subjective and objective signs and symptoms gathered during the nutrition assessment
process that provide evidence that a problem exists; quantify the problem and describe its severity.
Nutrition
Assessment Potential Indicators of This Nutrition Diagnosis (one or more must be present)
Category
Biochemical Data, Population-based biochemical parameters indicating inadequate nutrient intake
Medical Tests and
https://www.ncpro.org/pubs/2020-encpt-en/codeNI-5-11-1 1/3
Procedures
Anthropometric Population-based anthropometric data indicating inadequate nutrient intake
Measurements
Nutrition Focused Population-based data on acute and chronic disease prevalence indicating
Physical Findings inadequate nutrient intake
Reports or observations of:
Estimated nutrient(s) intake from all sources less than projected needs
History of marginal or inadequate nutrient(s) intake
Projected change in ability to shop, prepare, and/or consume sufficient nutrient(s)
Food/Nutrition- Medications that decrease appetite and/or affect ability to consume sufficient
Related History nutrient(s)
No prior knowledge of need for food- and nutrition-related recommendations
Religious or cultural practices that will affect nutrient intake
Low supplies in home in preparation for environmental emergency or
catastrophe/disaster
Scheduled surgical procedure or medical therapy known to increase nutrient(s)

need or change ability to consume sufficient nutrient(s)
History or presence of a condition for which research shows an increased
Client History*** prevalence of insufficient nutrient(s) intake in a similar population
Isolated living/housing situation
Geographic location of home in location with danger for environmental emergency
or catastrophe/disaster
Assessment,
Monitoring and
Evaluation Tools
*** Client History terms are used for Nutrition Assessment, but not for Nutrition Monitoring and Evaluation.
Progress Evaluation
Communicate the progress toward the resolution of a nutrition diagnosis by selecting the appropriate nutrition
diagnosis status value from the Nutrition Assessment, Monitoring, and Evaluation terms:

New nutrition diagnosis EV-2.1 14586
Active nutrition diagnosis EV-2.2 14587
Resolved nutrition diagnosis EV-2.3 14588
Discontinued nutrition diagnosis EV-2.4 14589
For details on these terms, visit the Nutrition Diagnosis Status reference sheet.
References
1. Larson NI, Story MT, Nelson MC. Neighborhood environments: disparities in access to healthy foods in
the US. Am J Prev Med. 2009;36:74-81.
2. McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, Ochoa JB, Napolitano L,
Cresci G, the ASPEN Board of Directors and the American College of Critical Care Medicine. Guidelines
for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of
Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). J
Parenter Enteral Nutr. 2009;33:296-300.
3. McElroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion
programs. Health Educ Q. 1988;5:351-377.
4. Position of the American Dietetic Association: Health implications of dietary fiber. J Am Diet Assoc.
2008; 108:1716-1731.
5. Position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports
Medicine: Nutrition and athletic performance. J Am Diet Assoc. 2009;109:509-527.
6. Position of the American Dietetic Association and American Society for Nutrition: Obesity, reproduction,
and pregnancy outcomes. J Am Diet Assoc. 2009;109:918-927.
7. Position of the American Dietetic Association: Nutrient Supplementation. J Am Diet Assoc.
2009;109:2073-2085.
2020 EDITION
12/13/21, 11:51 AM Predicted Excessive Nutrient Intake (Specify)
PREDICTED EXCESSIVE NUTRIENT INTAKE (SPECIFY)
Intake Domain – Multinutrient
Predicted Excessive Nutrient Intake (Specify) (NI-5.11.2)

Definition
Future intake of one or more nutrients that is anticipated, based on observation, experience, or scientific reason,
to be more than estimated nutrient requirements, established reference standards, or recommendations based on

Scheduled or planned medical therapy or medication that is predicted to decrease nutrient requirements
Anticipated physiological condition associated with reduced need for or altered metabolism of nutrients
Scheduled or planned medical therapy or medication that is predicted to alter metabolism of nutrients
Etiology Category


Nutrition
Category
Biochemical Data,
Medical Tests and Population-based biochemical parameters indicating excessive nutrient intake
Procedures
Anthropometric Population-based anthropometric data indicating excessive nutrient intake
Measurements
12/13/21, 11:51 AM Predicted Excessive Nutrient Intake (Specify)
Physical Findings excessive nutrient
Food/Nutrition- Estimated nutrient(s) intake from all sources more than projected needs
Related History History of excessive nutrient(s) intake
Scheduled surgical procedure or medical therapy known to reduce nutrient(s) need

or alter metabolism of a nutrient(s)
Client History*** History or presence of a condition for which research shows an increased
prevalence of excessive nutrient(s) intake in a similar population
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
1. Position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports
Medicine: Nutrition and athletic performance. J Am Diet Assoc. 2009;109:509-527.
2. Position of the American Dietetic Association: Nutrient supplementation. J Am Diet Assoc.
2009;109:2073-2085.
2020 EDITION
12/13/21, 10:42 AM Increased Energy Expenditure
INCREASED ENERGY EXPENDITURE
Intake Domain – Energy Balance
Increased Energy Expenditure (NI-1.1)

Definition
Resting metabolic rate (RMR) more than predicted requirements due to body composition; medications; or
endocrine, neurologic, or genetic changes.
Note: RMR is the sum of metabolic processes of active cell mass related to the maintenance of normal
body functions and regulatory balance during rest.

Physiological causes increasing nutrient needs due to anabolism, growth, maintenance of body
temperature
Voluntary or involuntary physical activity/movement
Etiology Category


Nutrition
Category
Biochemical Data,
Medical Tests, and
Procedures
Anthropometric Unintentional weight loss of ≥ 10% in 6 months, ≥ 5% in 1 month (adults and
Measurements pediatrics), and > 2% in 1 week (pediatrics)
https://www.ncpro.org/pubs/2020-encpt-en/codeNI-1-1 1/2
12/13/21, 10:42 AM Increased Energy Expenditure
Evidence of need for accelerated or catch-up growth or weight gain in children;

absence of normal growth
Increased proportion of lean body mass
Nutrition Focused Fever

Physical Findings Measured RMR > estimated or expected RMR
Food/Nutrition- Increased physical activity, eg, endurance athlete

Related History Medications that increase energy expenditure
Conditions associated with a diagnosis or treatment, eg, Parkinson’s disease,

Client History*** cerebral palsy, Alzheimer’s disease, cystic fibrosis, chronic obstructive pulmonary
disease (COPD)
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
1. Frankenfield D, Roth-Yousey L, Compher C. Comparison of predictive equations to measured resting

metabolic rate in healthy nonobese and obese individuals, a systematic review. J Am Diet Assoc.
2005;105:775-789.
2. Academy of Nutrition and Dietetics Evidence Analysis Library. Energy expenditure , 2013-14.
http://andevidencelibrary.com/topic.cfm?cat=4320. Accessed June 12, 2015.
2020 EDITION
12/13/21, 10:45 AM Inadequate Energy Intake
INADEQUATE ENERGY INTAKE
Inadequate Energy Intake (NI-1.2)

Definition
Energy intake that is less than energy expenditure, established reference standards, or recommendations based on
Note: May not be an appropriate nutrition diagnosis when the goal is weight loss, during end-of-life care,
upon initiation of EN/PN, or acute stressed state (eg, surgery, organ failure).
Whenever possible, nutrient intake data should be considered in combination with clinical, biochemical,
assessment of nutritional status based on a totality of the evidence. (Institute of Medicine. Dietary
Reference Intakes: Applications in Dietary Assessment. Washington, DC: National Academies Press;
2000.)
Etiology Cause/Contributing Risk Factors

Pathological or physiological causes that result in increased energy requirements, eg, increased nutrient
needs due to prolonged catabolic illness
Decreased ability to consume sufficient energy
Lack of or limited access to food or artificial nutrition, eg, economic constraints, restricting food given to
elderly and/or children
Cultural practices that affect ability to access food
Food and nutrition related knowledge deficit concerning energy intake
Psychological causes such as depression and disordered eating
Etiology Category


Nutrition
Category
Biochemical Data,
Medical Tests, and
Procedures
Anthropometric Failure to gain or maintain appropriate weight
Measurements
Nutrition Focused Poor dentition
Physical Findings
Estimated energy intake from diet less than needs based on estimated or measured
resting metabolic rate
Restriction or omission of energy-dense foods from diet
Food avoidance and/or lack of interest in food
Food/Nutrition-
Limited ability to independently consume foods/fluids (diminished joint mobility
Related History
of wrist, hand, or digits)
Estimated parenteral or enteral nutrition intake insufficient to meet needs based on
estimated or measured resting metabolic rate
Excessive consumption of alcohol or other drugs that reduce hunger
Medications that affect appetite
Conditions associated with diagnosis or treatment, eg, mental illness, eating

Client History*** disorders, dementia, alcoholism, substance abuse, and acute or chronic pain
management
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
2020 EDITION
12/13/21, 10:45 AM Excessive Energy Intake
EXCESSIVE ENERGY INTAKE
Excessive Energy Intake (NI-1.3)

Definition
Energy intake that exceeds energy expenditure, established reference standards, or recommendations based on
Note: May not be appropriate nutrition diagnosis when weight gain is desired.

Unsupported beliefs/attitudes about food, nutrition, and nutrition-related topics

Food-and nutrition-related knowledge deficit concerning energy intake
Limited access to healthful food choices, eg, healthful food choices not provided as an option by
caregiver or parent, homeless
Limited value for behavior change, competing values
Medications that increase appetite, eg, steroids, antidepressants
Overfeeding of parenteral/enteral nutrition (PN/EN)
Calories/kcal/kJ unaccounted for from IV infusion and/or medications
Unwilling or disinterested in reducing energy intake
Failure to adjust for lifestyle changes and decreased metabolism (eg, aging)
Failure to adjust for restricted mobility due to recovery from injury, surgical procedure, other
Resolution of prior hypermetabolism without reduction in intake
Etiology Category


Nutrition Potential Indicators of This Nutrition Diagnosis (one or more must be present)
Assessment
Category
Biochemical Data, Abnormal liver function tests after prolonged exposure (3 to 6 weeks) to parenteral
Medical Tests, and nutrition
Procedures ↑ Respiratory quotient >1.0
Body fat percentage > 25% for men and > 32% for women
Anthropometric BMI > 25 (adults); BMI > 95th percentile (pediatrics)
Measurements Weight gain
Nutrition Focused Increased body adiposity

Physical Findings Increased respiratory rate
Intake of energy in excess of estimated or measured energy needs

Food/Nutrition-
Intake of high caloric density or large portions of foods/beverages
Related History
EN/PN more than estimated or measured (eg, indirect calorimetry) energy
expenditure
Client History***
Assessment,
Monitoring and
Evaluation Tools
Arrows used with laboratory values: ↑ represents above reference standard and ↓ represents below reference
standard.
Progress Evaluation

References
1. Boullata J, Williams J, Cottrell F, Hudson L, Compher C. Accurate determination of energy needs in

hospitalized patients. J Am Diet Assoc. 2007;107:393-401.
respiratory quotient obtained from indirect calorimetry. J Parenter Enteral Nutr. 2003;27:21-26.
3. McClave SA, Lowen CC, Kleber MJ, Nicholson JF, Jimmerson SC, McConnell JW, Jung LY. Are patients
fed appropriately according to their caloric requirements? J Parenter Enteral Nutr. 1998;22:375-381.
4. Patt PL, Agena SM, Vogel LC, Foley S, Anderson CJ. Estimation of resting energy expenditure in
children with spinal cord injuries. J Spinal Cord Med. 2007; 30:S83-S87.
2020 EDITION
12/13/21, 10:46 AM Predicted Inadequate Energy Intake
PREDICTED INADEQUATE ENERGY INTAKE
Predicted Inadequate Energy Intake (NI-1.4)

Definition
Future energy intake that is anticipated, based on observation, experience, or scientific reason, to be less than
estimated energy expenditure, established reference standards, or recommendations based on physiological
needs.
Note: May not be an appropriate nutrition diagnosis during weight loss. Use Inadequate Energy Intake
(NI-1.2) when current energy intake is less than energy expenditure.

Scheduled or planned procedure or medical therapy that is predicted to increase energy requirements
Scheduled or planned medical therapy or medication that is predicted to decrease ability to consume
sufficient energy
Anticipated change in physical demands of work or leisure activities (eg, job change, training for
competitive sports)
Stressful life event or living situation (eg, death in family, divorce, loss of home) that, in the past, resulted
in inadequate energy intake
Etiology Category


Nutrition
Category
Biochemical Data,
Medical Tests, and

Procedures
Anthropometric Population-based anthropometric data indicating inadequate energy intake
Measurements
Physical Findings inadequate energy intake
Estimated energy intake from all sources less than projected needs
History of marginal or inadequate energy intake
Food/Nutrition- Projected change in ability to shop, prepare, and/or consume sufficient energy
Related History Medications that are anticipated to decrease appetite or affect ability to consume
sufficient energy
Projected increase in level of physical activity
Scheduled procedure or therapy known to increase energy need or change ability

to consume sufficient energy
Client History*** incidence of increased energy expenditure
incidence of inadequate energy intake
Client report of recent or anticipated life stress or change
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
1. Larson N, Story M. A review of environmental influences on food choices. Ann Behav Med.
2009;38:S56-S73.
2020 EDITION
12/13/21, 10:47 AM Predicted Excessive Energy Intake
PREDICTED EXCESSIVE ENERGY INTAKE
Predicted Excessive Energy Intake (NI-1.5)

Definition
Future energy intake that is anticipated, based on observation, experience, or scientific reason, to exceed
estimated energy expenditure, established reference standards, or recommendations based on physiological
needs.
Note: May not be appropriate nutrition diagnosis when weight gain is desired. Use Excessive Energy
Intake (NI-1.3) when current energy intake is more than energy expenditure.

Anticipated change in physical demands with periods of immobility or reduced physical activity
Family or social history or culture of overeating
Genetic predisposition to overweight/obesity
Physiological condition associated with altered metabolism
Scheduled or planned medical therapy or medication that is predicted to reduce metabolic
rate/metabolism
Stressful life event or living situation (eg, death in family, divorce, loss of home) that, in the past, resulted
in excessive energy intake
Etiology Category


Assessment
Category
Biochemical Data,
Medical Tests, and
Procedures
Anthropometric Population-based anthropometric data indicating excessive energy intake
Measurements
Physical Findings excessive energy intake
Estimated energy intake from all sources more than projected needs at new lower
metabolic level
Estimated energy intake from all sources more than projected needs at new lower
physical activity level
Food/Nutrition- History of excessive energy intake at previous metabolic level
Related History History of excessive energy intake at previous physical activity level
Recent or planned change in mobility and/or ability to engage in physical activity
Projected change in ability to shop and/or prepare food
Medications that increase appetite
Recent or planned change in physical activity
Scheduled surgical procedure or medical therapy known to decrease energy need

Client History*** incidence of decreased energy expenditure
incidence of excessive energy intake
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
1. Larson N, Story M. A review of environmental influences on food choices. Ann Behav Med.
2009;38:S56-S73.

4. Position of the American Dietetic Association and American Society for Nutrition: Obesity, reproduction,
and pregnancy outcomes. J Am Diet Assoc. 2009;109:918-927.
5. Position of the American Dietetic Association: Weight management. J Am Diet Assoc. 2009;109:330-346.
2020 EDITION
12/13/21, 10:51 AM Inadequate Oral Intake
INADEQUATE ORAL INTAKE
Intake Domain – Oral or Nutrition Support Intake
Inadequate Oral Intake (NI-2.1)

Definition
Oral food/beverage intake that is less than established reference standards or recommendations based on
Note: This nutrition diagnosis does not include intake via oroenteric tube.
May not be an appropriate nutrition diagnosis when the goal is weight loss, during end-of-life care, upon
initiation of feeding, or during combined oral/EN/PN therapy.
2000.)

Physiological causes increasing nutrient needs, eg, due to prolonged catabolic illness
Decreased ability to consume sufficient energy, eg, increased nutrient needs due to prolonged catabolic
illness
Lack of or limited access to food, eg, economic constraints, restricting food given to elderly and/or
children
Limited food acceptance due to physiological or behavioral issues, aversion, or unsupported
beliefs/attitudes
Food- and nutrition-related knowledge deficit concerning appropriate oral food/beverage intake
Etiology Category


Nutrition
Category
Biochemical Data,
Medical Tests, and
Procedures
Anthropometric Weight loss, insufficient growth velocity
Measurements
Dry skin, mucous membranes, poor skin turgor
Nutrition Focused Anorexia, nausea, or vomiting
Physical Findings Change in appetite or taste
Clinical evidence of vitamin/mineral deficiency
Estimates of insufficient intake of energy or high-quality protein from diet when

compared to requirements
Economic constraints that limit food availability
Food/Nutrition-
Related History
Medications that cause anorexia
Limited food/beverage intake inconsistent with nutrition reference standards for
type, variety, diet quality
Less than optimal reliance on foods, food groups, supplements or nutrition support
Conditions associated with a diagnosis or treatment of catabolic illness such as

AIDS, tuberculosis, anorexia nervosa, sepsis or infection from recent surgery,
Client History depression, acute or chronic pain
Protein and/or nutrient malabsorption
Assessment,
Monitoring and
Evaluation Tools
***Client History terms are used for Nutrition Assessment, but not for Nutrition Monitoring and Evaluation.
Progress Evaluation

References
1. Dunitz-Scheer M, Levine A, Roth Y, Kratky E, Beckenbach H, Braegger C, Hauer A, Wilken M,

Wittenberg J, Trabi T, Scheer PJ. Prevention and treatment of tube dependency in infancy and early
childhood. ICAN: Infant, Child, & Adolescent Nutrition. 2009;1:72-82.
2. Miller CK. Updates on pediatric feeding and swallowing problems. Curr Opin Otolaryngol Head Neck
Surg. 2009;17:194-199.
3. Rommel N, De Meyer A, Feenstra L, Veereman-Wauters G. The complexity of feeding problems in 700
infants and young children presenting to a tertiary care institution. J Pediatr Gastroenterol Nutr.
2003;37:75-84.
4. Schwarz SM, Corredor J, Fisher-Medina J, Cohen J, Rabinowitz S. Diagnosis and treatment of feeding
disorders in children with developmental disabilities. Pediatrics. 2001;108(3):671-676.
5. Skinner JD, Carruth BR, Bounds W, Ziegler PJ. Children’s food preferences: a longitudinal analysis, J
Am Diet Assoc. 2002;102:1638-1647.
6. Wardle J, Carnell S, Cooke L. Parental control over feeding and children’s fruit and vegetable intake: how
are they related? J Am Diet Assoc. 2005;105:227-232.
2020 EDITION
12/13/21, 10:51 AM Excessive Oral Intake
EXCESSIVE ORAL INTAKE
Excessive Oral Intake (NI-2.2)

Definition
Oral food/beverage intake that exceeds estimated energy needs, established reference standards, or
recommendations based on physiological needs.
Note: This nutrition diagnosis does not include intake via oroenteric tube.
May not be an appropriate nutrition diagnosis when weight gain is desired.


Food- and nutrition-related knowledge deficit concerning appropriate oral food/beverage intake
Inability to limit or refuse offered foods
Limited food planning, purchasing, and preparation skills
Loss of appetite awareness
Medications that increase appetite, eg, steroids, antidepressants
Unwilling or disinterested in reducing intake
Etiology Category


Nutrition
Category
Biochemical Data,
Medical Tests, and
Procedures
Anthropometric Weight gain not attributed to fluid retention or normal growth
Measurements
Nutrition Focused
Physical Findings
Intake of high caloric-density foods/beverages (juice, soda, or alcohol) at meals

and/or snacks
Food/Nutrition- Intake of large portions of foods/beverages, food groups, or specific food items
Related History Estimated intake that exceeds estimated or measured energy needs
Highly variable estimated daily energy intake
Binge eating patterns
Frequent, excessive fast food or restaurant intake
Conditions associated with a diagnosis or treatment, eg, obesity, overweight, or

Client History metabolic syndrome, depression, anxiety disorder
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
1. Chabas D, Foulon C, Gonzalez J, Nasr M, Lyon-Caen O, Willer JC, Derenne JP, Arnulf I. Eating disorder
and metabolism in narcoleptic patients. Sleep. 2007;30:1267-73.
2. Fortuyn HA, Swinkels S, Buitelaar J, Renier WO, Furer JW, Rijnders CA, Hodiamont PP, Overeem S.
High prevalence of eating disorders in narcolepsy with cataplexy: a case-control study. Sleep.
2008;31:335-41.
3. Position of the American Dietetic Association: Weight management. J Am Diet Assoc. 2009;109:330-346.
4. Position of the Academy of Nutrition and Dietetics: Total diet approach to healthy eating. J Acad Nutr
Diet. 2013;113:307-317.
5. Position of the Academy of Nutrition and Dietetics: The role of nutrition in health promotion and chronic
disease prevention. J Acad Nutr Diet. 2013;113:972-979.
6. Siega-Riz AM, Haugen M, Meltzer HM, Von Holle A, Hamer R, Torgersen L, Knopf-Berg C, Reichborn-
Kjennerud T, Bulik CM. Nutrient and food group intakes of women with and without bulimia nervosa and
binge eating disorder during pregnancy. Am J Clin Nutr. 2008; 87:1346-55.
2020 EDITION
12/13/21, 10:55 AM Inadequate Enteral Nutrition Infusion
INADEQUATE ENTERAL NUTRITION INFUSION
Inadequate Enteral Nutrition Infusion (NI-2.3)

Definition
Enteral infusion that provides fewer calories/kcal/kJ or nutrients compared to established reference standards or
Note: May not be an appropriate nutrition diagnosis when recommendation is for weight loss, during
end-of-life care, upon initiation of feeding, or during acute stressed states (eg, surgery, organ failure).
2000.)

Altered absorption or metabolism of nutrients, eg, medications

Food- and nutrition-related knowledge deficit concerning appropriate formula/formulation given for EN
Lack of, compromised, or incorrect access for delivering EN
Physiological causes increasing nutrient needs, eg, due to accelerated growth, wound healing, chronic
infection, multiple fractures
Intolerance of EN
Infusion volume not reached or schedule for infusion interrupted
Etiology Category


Nutrition
Category
↓ Metabolic cart/indirect calorimetry measurement, eg, respiratory quotient < 0.7
Vitamin/mineral abnormalities:
↓ Calcium < 9.2 mg/dL (2.3 mmol/L)
Biochemical Data, Vitamin K—abnormal international normalized ratio (INR)
Medical Tests, and ↓ Copper < 70 µg/dL (11 µmol/L)
Procedures ↓ Zinc < 78 µg/dL (12 µmol/L)
↓ Iron < 50 µg/dL (8.9 nmol/L); iron-binding capacity < 250 µg/dL (44.8
µmol/L)
Growth failure, based on reference growth standards, eg National Center for

Health Statistics (NCHS) and fetal growth failure
Insufficient maternal weight gain
Anthropometric Limited planned weight gain
Measurements Unintentional weight loss of ≥ 5% in 1 month or ≥ 10% in 6 months (not attributed
to fluid) in adults
Any weight loss in infants or children
Underweight (BMI < 18.5)
Clinical evidence of vitamin/mineral deficiency (eg, hair loss, bleeding gums, pale
nail beds, neurologic changes)
Nutrition Focused Evidence of dehydration, eg, dry mucous membranes, poor skin turgor
Physical Findings Loss of skin integrity, delayed wound healing, or pressure ulcers
Loss of muscle mass and/or subcutaneous fat
Nausea, vomiting, diarrhea
Reports or observations of：
Inadequate EN volume compared to estimated or measured (indirect calorimetry)

requirements
Food/Nutrition-
Feeding tube in wrong position or removed
Related History
Altered capacity for desired levels of physical activity or exercise, easy fatigue
with increased activity
Suboptimal feeding position
Conditions associated with a diagnosis or treatment, eg, intestinal resection,

Client History*** Crohn’s disease, HIV/AIDS, burns, preterm birth, malnutrition
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation


References
1. McClave SA, Spain DA, Skolnick JL, Lowen CC, Kieber MJ, Wickerham PS, Vogt JR, Looney SW.
Achievement of steady state optimizes results when performing indirect calorimetry. J Parenter Enteral
Nutr. 2003;27:16-20.
3. McClave SA, Snider HL. Clinical use of gastric residual volumes as a monitor for patients on enteral tube
feeding. J Parenter Enteral Nutr. 2002;26(Suppl):S43-S48; discussion S49-S50.
4. McClave SA, DeMeo MT, DeLegge MH, DiSario JA, Heyland DK, Maloney JP, Metheny NA, Moore
FA, Scolapio JS, Spain DA, Zaloga GP. North American Summit on Aspiration in the Critically Ill
Patient: consensus statement. J Parenter Enteral Nutr. 2002;26(Suppl):S80-S85.
5. McClave SA, McClain CJ, Snider HL. Should indirect calorimetry be used as part of nutritional
assessment? J Clin Gastroenterol. 2001;33:14-19.
6. McClave SA, Sexton LK, Spain DA, Adams JL, Owens NA, Sullins MB, Blandford BS, Snider HL.
Enteral tube feeding in the intensive care unit: factors impeding adequate delivery. Crit Care Med.
1999;27:1252-1256.
8. Spain DA, McClave SA, Sexton LK, Adams JL, Blanford BS, Sullins ME, Owens NA, Snider HL.
Infusion protocol improves delivery of enteral tube feeding in the critical care unit. J Parenter Enteral
Nutr. 1999;23:288-292.
2020 EDITION
12/13/21, 10:55 AM Excessive Enteral Nutrition Infusion
EXCESSIVE ENTERAL NUTRITION INFUSION
Excessive Enteral Nutrition Infusion (NI-2.4)

Definition
Enteral infusion that provides more calories/kcal/kJ or nutrients compared to established reference standards or

Physiological causes, eg, decreased needs related to low activity levels with critical illness or organ
failure
Food- and nutrition-related knowledge deficit concerning appropriate amount of enteral nutrition
Etiology Category


Nutrition
Category
Biochemical Data, ↑ BUN:creatinine ratio (protein)
Medical Tests, and Hyperglycemia (carbohydrate)
Procedures Hypercapnia
Anthropometric Weight gain in excess of lean tissue accretion

Measurements
Nutrition Focused Edema with excess fluid administration
12/13/21, 10:55 AM Excessive Enteral Nutrition Infusion
Physical Findings
Estimated intake from enteral nutrients that is consistently more than

Food/Nutrition- recommended intake for carbohydrate, protein, and fat
Related History Use of drugs that reduce requirements or impair metabolism of energy, protein, fat,
or fluid.
Unrealistic expectations of weight gain or ideal weight
Client History***
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References
3. Aarsland A, Chinkes D, Wolfe RR. Hepatic and whole-body fat synthesis in humans during carbohydrate
overfeeding. Am J Clin Nutr. 1997;65:1774-1782.
2020 EDITION
12/13/21, 10:59 AM Enteral Nutrition Composition Inconsistent with Needs
ENTERAL NUTRITION COMPOSITION INCONSISTENT WITH NEEDS
Enteral Nutrition Composition Inconsistent with Needs (NI-2.5)

Definition
Enteral nutrition formula that varies from established reference standards or recommendations based on

Physiological causes, eg, improvement in patient/client status, allowing return to total or partial oral diet;
changes in the course of disease resulting in changes in feeding and/or nutrient requirements
Food and nutrition-related knowledge deficit concerning EN product
End-of-life care if patient/client or family does not desire nutrition support
Etiology Category


Nutrition
Category
Biochemical Data, Abnormal levels of markers specific for various nutrients, eg, hyperphosphatemia
Medical Tests, and in patient/client receiving feedings with a high phosphorus content, hypokalemia
Procedures in patient/client receiving feedings with low potassium content

Measurements Weight loss

Physical Findings Loss of subcutaneous fat and muscle stores
Diarrhea, constipation
Estimated intake from enteral nutrients that is consistently more or less than
recommended intake for carbohydrate, proteins or amino acids, fat or fatty acids,
and/or micronutrients–
Food/Nutrition-
Formula composition that is inconsistent with ability to digest and absorb nutrients
Related History
Formula composition or concentration that is inconsistent with evidence-based
practice
Verbalizations or written responses that are inaccurate or incomplete for enteral
nutrition formula prescribed
Improved or diminished GI function

Conditions associated with a diagnosis or treatment, eg, major elective surgery,
Client History*** trauma, burns, head and neck cancer, and critically ill patients, acute lung injury,
acute respiratory distress syndrome, treatments/therapy requiring interruption of
infusion, transfer of nutrition care to a new setting or level of care, end-of-life care
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society
of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral
Nutrition (ASPEN). J Parenter Enteral Nutr. 2009;33:296-300.
5. Institute of Medicine. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate,
9. Bankhead, R, Boullata J, Brantley S, Corkins M, Guenter P, Krenitsky J, Lyman B, Metheny NA, Mueller
C, Robbins S, Wessel J, and the A.S.P.E.N. Board of Directors. Enteral nutrition practice
recommendations. J Parenter Enteral Nutr. 2009;33122-167.
10. Russell M, Stieber M, Brantley S, Freeman AM, Lefton J, Malone AM, Roberts S, Skates J, Young LS,
A.S.P.E.N. Board of Directors and ADA Quality Management Committee. American Society for
Parenteral and Enteral Nutrition and American Dietetic Association: Standards of practice and standards
of professional performance for registered dietitians (generalist, specialty, and advanced) in nutrition
support. J Am Diet Assoc. 2007;1815-1822.
11. Position of the Academy of Nutrition and Dietetics: Ethical and legal issues in feeding and hydration. J
Acad Nutr Diet. 2013;113:828-833.
2020 EDITION
12/13/21, 11:00 AM Enteral Nutrition Administration Inconsistent with Needs
ENTERAL NUTRITION ADMINISTRATION INCONSISTENT WITH NEEDS
Enteral Nutrition Administration Inconsistent with Needs (NI-2.6)

Definition
Enteral nutrition provision that varies from established reference standards or recommendations based on
physiological needs

changes in the course of disease resulting in changes in feeding
Food and nutrition-related knowledge deficit concerning EN product provision

changes in the course of disease resulting in changes in feeding and/or nutrient requirements
Food and nutrition-related knowledge deficit concerning EN product
Etiology Category


Assessment
Category
Biochemical Data,
Medical Tests, and ↑ or ↓ serum glucose
Procedures
Anthropometric
Measurements
Nutrition Focused Nausea, vomiting, diarrhea, high gastric residual volume
Physical Findings Satiety
Access route that may warrant modification

Access type that may warrant modification
Administration that may conflict with oral intake
Administration that may conflict with therapies (including medications) or
Food/Nutrition- procedures
Related History Enteral nutrition that may contribute to poor nutrition quality of life
Intolerance of bolus feeding
Intolerance of rate of delivery
Verbalizations or written responses that are inaccurate or incomplete regarding
enteral nutrition administration
History of enteral nutrition intolerance
Improved/diminished GI function
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral
Nutrition (ASPEN). J Parenter Enteral Nutr. 2009;33:296-300.
recommendations. J Parenter Enteral Nutr. 2009;33122-167. Russell M, Stieber M, Brantley S, Freeman
AM, Lefton J, Malone AM, Roberts S, Skates J, Young LS, A.S.P.E.N. Board of Directors and ADA
Quality Management Committee. American Society for Parenteral and Enteral Nutrition and American
Dietetic Association: Standards of practice and standards of professional performance for registered
dietitians (generalist, specialty, and advanced) in nutrition support. J Am Diet Assoc. 2007;1815-1822.
2020 EDITION
12/13/21, 11:00 AM Inadequate Parenteral Nutrition Infusion
INADEQUATE PARENTERAL NUTRITION INFUSION
Inadequate Parenteral Nutrition Infusion (NI-2.7)

Definition
Parenteral infusion that provides fewer calories/kcal/kJ or nutrients compared to established reference standards
or recommendations based on physiological needs.
Note: May not be an appropriate nutrition diagnosis when recommendation is for weight loss, during
end-of-life care, upon initiation of feeding, or during acute stressed states (eg, surgery, organ failure).
2000.)

Altered absorption or metabolism of nutrients, eg, medications

Food- and nutrition-related knowledge deficit concerning appropriate formula/formulation given for PN
Lack of, compromised, or incorrect access for delivering PN
Physiological causes increasing nutrient needs, eg, due to accelerated growth, wound healing, chronic
infection, multiple fractures
Intolerance of PN
Infusion volume not reached or schedule for infusion interrupted
Etiology Category


Potential Indicators of This Nutrition Diagnosis (one or more must be present)
Category
↓ Metabolic cart/indirect calorimetry measurement, eg, respiratory quotient
< 0.7
Vitamin/mineral abnormalities:
↓ Calcium < 9.2 mg/dL (2.3 mmol/L)
Biochemical Data, Medical Vitamin K—abnormal international normalized ratio (INR)
Tests, and Procedures ↓ Copper < 70 µg/dL (11 µmol/L)
↓ Zinc < 78 µg/dL (12 µmol/L)
↓ Iron < 50 µg/dL(nmol/L); iron-binding capacity < 250 µg/dL (44.8
µmol/L)

Health Statistics (NCHS) and fetal growth failure
Anthropometric Lack of planned weight gain
Measurements Unintentional weight loss of 5% in 1 month or 10% in 6 months (not
attributed to fluid) in adults
Any weight loss in infants or children
Clinical evidence of vitamin/mineral deficiency (eg, hair loss, bleeding

gums, pale nail beds, neurologic changes)
Nutrition Focused Physical Evidence of dehydration, eg, dry mucous membranes, poor skin turgor
Findings Loss of skin integrity, delayed wound healing, or pressure ulcers
Loss of muscle mass and/or subcutaneous fat
Nausea, vomiting, diarrhea
Inadequate PN volume compared to estimated or measured (indirect

Food/Nutrition-Related calorimetry) requirements
History Feeding tube or venous access in wrong position or removed
Altered capacity for desired levels of physical activity or exercise, easy
fatigue with increased activity

Client History*** Crohn’s disease, HIV/AIDS, burns, pre-term birth, malnutrition
Assessment, Monitoring and

Evaluation Tools
standard.
Progress Evaluation

References
1. McClave SA, Spain DA, Skolnick JL, Lowen CC, Kieber MJ, Wickerham PS, Vogt JR, Looney SW.
Achievement of steady state optimizes results when performing indirect calorimetry. J Parenter Enteral
Nutr. 2003;27:16-20.
3. McClave SA, Snider HL. Clinical use of gastric residual volumes as a monitor for patients on enteral tube
feeding. J Parenter Enteral Nutr. 2002;26(Suppl):S43-S48; discussion S49-S50.
4. McClave SA, DeMeo MT, DeLegge MH, DiSario JA, Heyland DK, Maloney JP, Metheny NA, Moore
FA, Scolapio JS, Spain DA, Zaloga GP. North American Summit on Aspiration in the Critically Ill
Patient: consensus statement. J Parenter Enteral Nutr. 2002;26(Suppl):S80-S85.
5. McClave SA, McClain CJ, Snider HL. Should indirect calorimetry be used as part of nutritional
assessment? J Clin Gastroenterol. 2001;33:14-19.
2020 EDITION
12/13/21, 11:01 AM Excessive Parenteral Nutrition Infusion
EXCESSIVE PARENTERAL NUTRITION INFUSION
Excessive Parenteral Nutrition Infusion (NI-2.8)

Definition
Parenteral infusion that provides more calories/kcal/kJ or nutrients compared to established reference standards

Physiological causes, eg, decreased needs related to low activity levels with critical illness or organ
failure
Food- and nutrition-related knowledge deficit concerning appropriate amount of PN
Etiology Category


Nutrition
Category
↑ BUN:creatinine ratio (protein)
Biochemical Data, Hyperglycemia (carbohydrate)
Medical Tests, and Hypercapnia
Procedures ↑ liver enzymes

Measurements
12/13/21, 11:01 AM Excessive Parenteral Nutrition Infusion

Physical Findings
Estimated intake from parenteral nutrients that is consistently more than

Food/Nutrition- recommended intake for carbohydrate, protein, and fat
Related History Use of drugs that reduce requirements or impair metabolism of energy, protein, fat,
or fluid.
Unrealistic expectations of weight gain or ideal weight
Client History
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References
6. Wolfe RR, O’Donnell TF Jr, Stone MD, Richmand DA, Burke JF. Investigation of factors determining the
optimal glucose infusion rate in total parenteral nutrition. Metabolism. 1980;29:892-900.
7. Jensen GL, Mascioli EA, Seidner DL, Istfan NW, Domnitch AM, Selleck K, Babayan VK, Blackburn
GL, Bistrian BR. Parenteral infusion of long- and medium-chain triglycerides and reticulothelial system
function in man. J Parenter Enteral Nutr. 1990;14:467-471.
2020 EDITION
12/13/21, 11:04 AM Parenteral Nutrition Composition Inconsistent with Needs
PARENTERAL NUTRITION COMPOSITION INCONSISTENT WITH NEEDS
Intake Domain– Oral or Nutrition Support Intake
Parenteral Nutrition Composition Inconsistent with Needs (NI-2.9)

Definition
Parenteral nutrition solution that varies from established reference standards or recommendations based on

Physiological causes, eg, improvement in patient/client status, allowing return to total or partial oral diet
or enteral nutrition; changes in the course of disease resulting in changes in feeding and/or nutrient
requirements
Food and nutrition-related knowledge deficit concerning PN composition
Etiology Category


Nutrition
Category
↑ liver function tests in patient/client on long-term (more than 3 to 6 weeks)
Biochemical Data, nutrition support
Medical Tests, and Abnormal levels of markers specific for various nutrients, eg, hyperphosphatemia
Procedures in patient/client receiving feedings with a high phosphorus content, hypokalemia
in patient/client receiving feedings with low potassium content

Measurements Weight loss
Edema with excess fluid administration

Nutrition Focused Loss of subcutaneous fat and muscle stores
Physical Findings Nausea
Estimated intake from parenteral nutrients that is consistently more or less than
recommended intake for carbohydrate, protein or amino acids, fat or fatty acids,
vitamins, and/or minerals—
Food/Nutrition- Estimated intake of other nutrients that is consistently more or less
Related History than recommended
Formula composition or type that is inconsistent with evidence-based practice
Verbalizations or written responses that are inaccurate or incomplete regarding PN
solution
History of parenteral nutrition intolerance
Complications such as fatty liver in the absence of other causes

Resolving or improved GI function
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References
of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition
(ASPEN). J Parenter Enteral Nutr. 2009;33:296-300.
10. Wolfe RR, O’Donnell TF, Jr., Stone MD, Richmand DA, Burke JF. Investigation of factors determining
the optimal glucose infusion rate in total parenteral nutrition. Metabolism. 1980;29:892-900.
2020 EDITION
12/13/21, 11:05 AM Parenteral Nutrition Administration Inconsistent with Needs
PARENTERAL NUTRITION ADMINISTRATION INCONSISTENT WITH NEEDS
Parenteral Nutrition Administration Inconsistent with Needs (NI-2.10)

Definition
Parenteral nutrition provision that varies from established reference standards or recommendations based on
physiological needs

Physiological causes, eg, improvement in patient/client status, allowing return to total or partial oral diet
or enteral nutrition; changes in the course of disease resulting in changes in feeding provision
Food and nutrition-related knowledge deficit concerning PN provision
Etiology Category


Nutrition
Category
Biochemical Data, ↑ liver function tests in patient/client on long-term (more than 3 to 6 weeks)
Medical Tests, and nutrition support
Procedures
Anthropometric
Measurements
Nutrition Focused Infusion site compromise
Physical Findings Nausea
Access route that may warrant modification

Access type that may warrant modification
Parenteral nutrition that may conflict with oral or enteral nutrition intake
Food/Nutrition- Parenteral nutrition that may conflict with therapies or procedures
Related History Parenteral nutrition that may contribute to poor nutrition quality of life
Intolerance of rate of delivery
Verbalizations or written responses that are inaccurate or incomplete regarding
parenteral nutrition administration
History of parenteral nutrition intolerance
Complications such as fatty liver in the absence of other causes

Resolving or improved GI function
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References
of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN).
J Parenter Enteral Nutr. 2009;33:296-300.
2. Wolfe RR, O’Donnell TF, Jr., Stone MD, Richmand DA, Burke JF. Investigation of factors determining
the optimal glucose infusion rate in total parenteral nutrition. Metabolism. 1980;29:892-900.
2020 EDITION
12/13/21, 11:05 AM Limited Food Acceptance
LIMITED FOOD ACCEPTANCE
Limited Food Acceptance (NI-2.11)

Definition
Oral food/beverage intake that is inconsistent with reference standard intake for type, variety, or quality.
Note: May not be an appropriate nutrition diagnosis for individuals with anorexia nervosa, bulimia
nervosa, binge eating disorder, or eating disorder not otherwise specified (EDNOS). Please consider
using Disordered Eating Pattern (NB-1.5).

Physiological causes, eg, pain, discomfort, or functional issues in the GI tract, developmental
delay, neurological disorders
Aversion to food/beverages in mouth, throat, or hands
Self-limitation of foods/food groups due to food preference
Behavioral issues including caregiver issues and eating behavior that serves a purpose other than
nourishment
Unsupported beliefs and attitudes
Etiology Category


Nutrition
Category
Biochemical Data,
Medical Tests and

Procedures
Anthropometric Weight loss, insufficient growth velocity, weight gain due to reliance on low-
Measurements variety or less than optimal intake
Nutrition Focused Clinical evidence of vitamin/mineral deficiency

Physical Findings Erratic appetite
Limited food/beverage intake inconsistent with nutrition reference standards for

Food/Nutrition-
type, variety, diet quality
Related History
Less than optimal reliance on foods, food groups, supplements, or nutrition
support
Conditions associated with a diagnosis or treatment, eg, developmental disabilities,

sensory processing issues, autism, dental caries, long-term nutrition support,
Client History*** prematurity, neurological disorders, altered mental state, affected brain studies
(MRI)
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
1. Burklow KA, Phelps AN, Schultz JR, McConnell K, Rudolph C. Classifying complex pediatric feeding
disorders. J Pediatr Gastroenterol Nutr. 1998;27:143-147.
2. Chatoor I. Feeding disorders in infants and toddlers: diagnosis and treatment. Child Adolesc Psychiatr
Clin N Am. 2002;11:163-183.
3. Dunitz-Scheer M, Levine A, Roth Y, Kratky E, Beckenbach H, Braegger C, Hauer A, Wilken M,
Wittenberg J, Trabi T, Scheer PJ. Prevention and treatment of tube dependency in infancy and early
childhood. ICAN: Infant, Child, & Adolescent Nutrition. 2009;1:72-82.
4. Falciglia GA, Couch SC, Siem Gribble L, Pabst SM, Frank R. Food neophobia in childhood affects
dietary variety. J Am Diet Assoc. 2000;100:1474-1481.
5. Galloway AT, Lee Y, Birch LL. Predictors and consequences of food neophobia and pickiness in young
girls. J Am Diet Assoc. 2003;103:692-698.
6. Miller CK. Updates on pediatric feeding and swallowing problems. Curr Opin Otolaryngol Head Neck
Surg. 2009;17:194-199.
7. Position of the Academy of Nutrition and Dietetics: Nutrition services for individuals with intellectual
and developmental disabilities and special health care needs. J Acad Nutr Diet. 2015;115:593-608.
8. Rommel N, De Meyer A, Feenstra L, Veereman-Wauters G. The complexity of feeding problems in 700

infants and young children presenting to a tertiary care institution. J Pediatr Gastroenterol Nutr.
2003;37:75-84.
9. Schwarz SM, Corredor J, Fisher-Medina J, Cohen J, Rabinowitz S. Diagnosis and treatment of feeding
disorders in children with developmental disabilities. Pediatrics. 2001;108(3):671-676.
10. Skinner JD, Carruth BR, Bounds W, Ziegler PJ. Children’s food preferences: a longitudinal analysis. J
Am Diet Assoc. 2002;102: 1638-1647.
11. Wardle J, Carnell S, Cooke L. Parental control over feeding and children’s fruit and vegetable intake: how
are they related? J Am Diet Assoc. 2005;105:227-232.
2020 EDITION
12/13/21, 11:06 AM Inadequate Fluid Intake
INADEQUATE FLUID INTAKE
Intake Domain– Fluid Intake
Inadequate Fluid Intake (NI-3.1)

Definition
Lower intake of fluid-containing foods or substances compared to established reference standards or
provide a valid assessment of nutritional status based on a totality of the evidence. (Dietary Reference
Intakes: Applications in Dietary Assessment. Institute of Medicine. Washington, D.C.: National
Academies Press; 2000.)

Physiological causes increasing fluid needs due to climate/temperature change, increased exercise
or conditions leading to increased fluid losses, fever causing increased insensible losses, decreased
thirst sensation, or use of drugs that reduce thirst
Lack of or limited access to fluid, eg, economic constraints, unable to access fluid independently such as
elderly or children
Cultural practices that affect the ability to access fluid
Food and nutrition related knowledge deficit concerning appropriate fluid intake
Psychological causes, eg, depression or disordered eating
Impaired cognitive ability, including learning disabilities, neurological or sensory impairment, and/or
dementia
Etiology Category


Nutrition
Category
Plasma or serum osmolality greater than 290 mOsm/kg
Biochemical Data, Abnormal BUN, Na
Medical Tests, and ↓ Urine volume
Procedures ↑ Urine specific gravity
Hyperglycemia in diabetic client
Anthropometric Acute weight loss

Measurements
Dry skin and mucous membranes, poor skin turgor, tachycardia and normal or
hypotensive blood pressure, fever, increased respirations, flattened neck veins
Nutrition Focused Thirst
Physical Findings Difficulty swallowing
Increased insensible loss
Food/Nutrition- Estimated intake of fluid less than requirements (eg, per body surface area for
Related History pediatrics)
Use of drugs that reduce thirst
Conditions associated with a diagnosis or treatment, eg, dementia resulting in

Client History*** decreased recognition of thirst, dehydration, diabetes mellitus, alterations in renal
function, diarrhea, vomiting, ileostomy, colostomy, infection
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References
2. Grandjean AC, Campbell SM. Hydration: Fluids for Life. Monograph Series. Washington DC:
International Life Sciences Institute North America; 2004.
3. Grandjean AC, Reimers KJ, Buyckx ME. Hydration: issues for the 21st century. Nutr Rev. 2003;61:261-
271.
2020 EDITION
12/13/21, 11:06 AM Excessive Fluid Intake
EXCESSIVE FLUID INTAKE
Intake Domain – Fluid Intake
Excessive Fluid Intake (NI-3.2)

Definition
Higher intake of fluid compared to established reference standards or recommendations based on physiological
needs.

Physiological causes, eg, kidney, liver, cardiac, endocrine, neurological, and/or pulmonary dysfunction;
diminished water and sodium losses due to changes in exercise or climate, syndrome of inappropriate
antidiuretic hormone (SIADH)
Food- and nutrition-related knowledge deficit concerning appropriate fluid intake
Etiology Category


Nutrition
Category
↓ Plasma osmolality (270-280 mOsm/kg), only if positive fluid balance is in
Biochemical Data, excess of positive sodium balance
Medical Tests, and ↓ Serum sodium in SIADH
Procedures ↓ Urine specific gravity
Anthropometric Weight gain

12/13/21, 11:06 AM Excessive Fluid Intake
Measurements
Edema in the skin of the legs, sacral area, or diffusely; weeping of fluids from
lower legs
Ascites
Nutrition Focused Pulmonary edema as evidenced by shortness of breath; orthopnea; crackles or rales
Physical Findings Nausea, vomiting, anorexia, headache, muscle spasms, convulsions
Shortness of breath or dyspnea with exertion or at rest
Providing medications in large amounts of fluid
Use of drugs that impair fluid excretion
Food/Nutrition- Estimated intake of fluid more than requirements (eg, per body surface area for
Related History pediatrics)
Estimated salt intake in excess of recommendations
Conditions associated with a diagnosis or treatment, eg, end-stage renal disease,

Client History*** nephrotic syndrome, heart failure, or liver disease
Coma (SIADH)
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References
2. Schirer RW, ed. Renal and Electrolyte Disorders. Philadelphia, PA: Lipincott Williams and Willkins;
2003.
3. Hyponatremia. http://www.nlm.nih.gov/medlineplus/ency/article/000394.htm. Accessed June 12, 2015.
2020 EDITION
12/13/21, 11:08 AM Inadequate Bioactive Substance Intake (specify)
INADEQUATE BIOACTIVE SUBSTANCE INTAKE (SPECIFY)
Intake Domain – Bioactive Substances
Inadequate Bioactive Substance Intake (specify) (NI-4.1)

Definition
Lower intake of bioactive substances compared to established reference standards or recommendations based
on physiological needs.
established minimum requirements or Tolerable Upper Intake Levels. However, nutrition and dietetics
practitioners can assess whether estimated intakes are adequate or excessive using the client goal or
nutrition prescription for comparison.

Food- and nutrition-related knowledge deficit concerning recommended bioactive substance intake
Lack of or limited access to food that contains a bioactive substance
Alteration in gastrointestinal tract structure and/or function
Etiology Category


Nutrition
Category
12/13/21, 11:08 AM Inadequate Bioactive Substance Intake (specify)
Biochemical Data,
Medical Tests, and
Procedures
Anthropometric
Measurements
Nutrition Focused
Physical Findings
Estimated intake of plant foods containing the following lower than recommended:
Soluble fiber, eg, psyllium (↓ total and LDL cholesterol)
Soy protein (↓ total and LDL cholesterol)
Food/Nutrition- Beta glucan, eg, whole oat products (↓ total and LDL cholesterol)
Related History Plant sterol and stanol esters, eg, fortified margarines (↓ total and LDL
cholesterol)
Other substances (for which scientific evidence exists and a recommended
intake level has been established)
Verbalizes inaccurate or incomplete knowledge about bioactive substances
Conditions associated with a diagnosis or treatment, eg, cardiovascular disease,

Client History*** elevated cholesterol
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References
1. Crowe KM, Francis C. Position of the Academy of Nutrition and Dietetics: Functional foods. J Acad Nutr
Diet. 2013;113(6):1096-1103.
2020 EDITION
12/13/21, 11:08 AM Excessive Bioactive Substance Intake (specify)
EXCESSIVE BIOACTIVE SUBSTANCE INTAKE (SPECIFY)
Excessive Bioactive Substance Intake (specify) (NI-4.2)

Definition
Higher intake of bioactive substances compared to established reference standards or recommendations based on
established minimum requirements or Tolerable Upper Intake Levels. However, nutrition and dietetics
practitioners can assess whether estimated intakes are adequate or excessive using the client goal or
nutrition prescription for comparison.

Food- and nutrition-related knowledge deficit concerning recommended bioactive substance intake
including food additives
Contamination, misname, mislabel or lack of labeling, misuse, recent brand change, recent dose increase,
recent formulation change of substance consumed
Frequent intake of foods containing bioactive substances
Lack of or limited access to appropriate foods, eg, inadequate markets with labeled food
Etiology Category


Nutrition
Category
Lab values indicating excessive intake of the specific substance, such as rapid ↓ in
Biochemical Data, cholesterol from intake of stanol or sterol esters and a statin drug and related
Medical Tests, and dietary changes or medications
Procedures ↑ Hepatic enzyme reflecting hepatocellular damage
Anthropometric Weight loss as a result of malabsorption or maldigestion

Measurements
Constipation, diarrhea, nausea, stomach pain, gas, cramps or bloating, vomiting,
heartburn
Neurologic changes, eg, anxiety, mental status changes
Cardiovascular changes, eg, heart rate, blood pressure
Nutrition Focused Discomfort or pain associated with intake of foods rich in bioactive substances, eg,
Physical Findings soluble fiber, beta glucan, soy protein
Headache/migraine
Hives, flushing
Irritability or nervousness
High intake of plant foods containing:

Soy protein (↓ total and LDL cholesterol)
Beta glucan, eg, whole oat products (↓ total and LDL cholesterol)
Plant sterol and stanol esters, eg, fortified margarines (↓ total and LDL
cholesterol) or other foods based on dietary substance, concentrate,
metabolite, constituent, extract, or combination
Substances that interfere with digestion or absorption of foodstuffs
Food/Nutrition-
Ready access to available foods/products with bioactive substance, eg, as
Related History
from dietary supplement vendors
Attempts to use supplements or bioactive substances for weight loss, to
treat constipation, or to prevent or cure chronic or acute disease
Other substances (for which scientific evidence exists and a recommended
intake level has been established)
Intake of food additives for which client is intolerant, eg, yellow 5, yellow
6, safrole, FD&C Red #4, carmine, monosodium glutamate, sulfites
Verbalizes inaccurate or incomplete knowledge about bioactive substances
Conditions associated with a diagnosis or treatment, eg, cardiovascular disease,

Client History*** elevated cholesterol, hypertension, asthma
Cardiovascular changes, eg, electrocardiogram changes
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References
1. Institute of Medicine. Dietary Supplements: A Framework for Evaluating Safety. Washington, DC:
2. Crowe KM, Frances C. Position of the Academy of Nutrition and Dietetics: Functional foods. J Acad
Nutr Diet. 2013;113(8):1096-1103.
2020 EDITION
12/13/21, 11:09 AM Excessive Alcohol Intake
EXCESSIVE ALCOHOL INTAKE
Excessive Alcohol Intake (NI-4.3)

Definition
Intake more than the suggested limits for alcohol.


Food- and nutrition-related knowledge deficit concerning appropriate alcohol intake
Alcohol addiction
Etiology Category


Nutrition
Category
Biochemical Data, ↑ aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT),
Medical Tests and carbohydrate-deficient transferrin, mean corpuscular volume, blood alcohol levels
Procedures
Anthropometric
Measurements
Nutrition Focused
Physical Findings
Food/Nutrition- Reports or observations of:
12/13/21, 11:09 AM Excessive Alcohol Intake
Related History Intake of > 2 drinks*/day (men)

Intake of > 1 drink*/day (women)
Binge drinking
Consumption of any alcohol when contraindicated, eg, during pregnancy
*1 drink = 5 oz (150 mL) wine, 12 oz (350 mL) beer, 1.5 oz (45 mL) distilled
alcohol
Conditions associated with a diagnosis or treatment, eg, severe

hypertriglyceridemia, elevated blood pressure, depression, liver disease,
pancreatitis
Client History*** New medical diagnosis or change in existing diagnosis or condition
History of estimated alcohol intake in excess of recommended
Giving birth to an infant with fetal alcohol syndrome
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References
2. National Institute on Alcohol Abuse and Alcoholism. http://www.niaaa.nih.gov/alcohol-health. Accessed
June 12, 2015.
2020 EDITION
12/13/21, 11:15 AM Increased Nutrient Needs (Specify)
INCREASED NUTRIENT NEEDS (SPECIFY)
Intake Domain – Nutrient
Increased Nutrient Needs (Specify) (NI-5.1)

Definition
Increased need for a specific nutrient compared to established reference standards or recommendations based

Altered absorption or metabolism of nutrient, eg, from medications

Compromise of organs related to GI function, eg, pancreas, liver
Decreased functional length of intestine, eg, short-bowel syndrome
Decreased or compromised function of intestine, eg, celiac disease, Crohn’s disease
Increased demand for nutrient, eg, accelerated growth, wound healing, chronic infection
Etiology Category


Nutrition
Potential Indicators of This Nutrition Diagnosis (Potential Indicators of This Nutrition
Assessment
Diagnosis)
Category
↓ total cholesterol < 160 mg/dL, albumin, prealbumin, C-reactive protein,
Biochemical Data, indicating increased stress and increased metabolic needs
Medical Tests, and Electrolyte/mineral (eg, potassium, magnesium, phosphorus) abnormalities
Procedures Urinary or fecal losses of specific or related nutrient (eg, fecal fat, d-xylose test)
Vitamin and/or mineral deficiency
12/13/21, 11:15 AM Increased Nutrient Needs (Specify)
Anthropometric Growth failure, based on reference growth standards, eg National Center for
Measurements Health Statistics (NCHS) and fetal growth failure
Unintentional weight loss of ≥ 5% in 1 month or ≥ 10% in 6 months
Low percent body fat and muscle mass
Clinical evidence of vitamin/mineral deficiency (eg, hair loss, bleeding gums, pale
Nutrition Focused nail beds)
Physical Findings Loss of skin integrity, delayed wound healing, or pressure ulcers
Loss of muscle mass, subcutaneous fat
Estimated intake of foods/supplements containing needed nutrient less than

estimated requirements
Intake of foods that do not contain sufficient quantities of available nutrient (eg,
Food/Nutrition-
overprocessed, overcooked, or stored improperly)
Related History
Food- and nutrition-related knowledge deficit (eg, lack of information, incorrect
information or noncompliance with intake of needed nutrient)
Medications affecting absorption or metabolism of needed nutrient
Athletes or active individuals engaged in intense physical activity

Client History*** Crohn’s disease, HIV/AIDS, burns, pre-term birth, malnutrition
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References
1. Beyer P. Gastrointestinal disorders: roles of nutrition and the dietetics practitioner. J Am Diet Assoc.
1998;98:272-277.
2. Position of the American Dietetic Association: Nutrition intervention and human immunodeficiency virus
infection. J Am Diet Assoc. 2010;110:1105-1119.
2020 EDITION
12/13/21, 11:15 AM Inadequate Protein Energy Intake
INADEQUATE PROTEIN ENERGY INTAKE
Inadequate Protein Energy Intake (NI-5.2)

Definition
Inadequate intake of protein and/or energy compared to established reference standards or recommendations
based on physiological needs of short or recent duration.
Press; 2000.)

Physiological causes increasing nutrient needs due to catabolic illness, malabsorption

Decreased ability to consume sufficient protein and/or energy
Lack of or limited access to food, eg, economic constraints, restricting food given or food selected
Cultural or religious practices that affect ability to access food
Food and nutrition related knowledge deficit concerning appropriate amount and type of dietary fat and/or
protein
Etiology Category


Assessment
Category
Biochemical Data, Normal albumin (in the setting of normal liver function despite decreased protein-
Medical Tests, and energy intake)
Procedures
Inadequate maternal weight gain (mild but not severe)
Anthropometric Weight loss of 7% in 3 months, >5% in 1 month, or 1% to 2% in 1 week in adults;
Measurements any weight loss or failure to gain weight in children
Growth failure in children
Nutrition Focused Slow wound healing in pressure ulcer or surgical site

Physical Findings
Estimated energy intake from diet less than estimated or measured RMR or
recommended levels
Restriction or omission of food groups such as dairy or meat group foods
Food/Nutrition-
(protein); bread or milk group foods (energy)
Related History
Recent food avoidance and/or lack of interest in food
Lack of ability to prepare meals
Hunger in the face of inadequate access to food supply
Conditions associated with a diagnosis or treatment of mild protein-energy

malnutrition, recent illness (eg, pulmonary or cardiac failure, flu, infection,
Client History*** surgery)
Nutrient malabsorption (eg, bariatric surgery, diarrhea, steatorrhea)
Lack of funds for purchase of appropriate foods
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
1. Centers for Disease Control and Prevention. Body mass index.

http://www.cdc.gov/nccdphp/dnpa/bmi/bmi-adult.htm. Accessed June 12, 2015.
2. Fuhrman MP, Charney P, Mueller CM. Hepatic proteins and nutrition assessment. J Am Diet Assoc.
2004;104:1258-1264.
2020 EDITION
12/13/21, 11:16 AM Decreased Nutrient Needs (Specify)
DECREASED NUTRIENT NEEDS (SPECIFY)
Decreased Nutrient Needs (Specify) (NI-5.3)

Definition
Decreased need for a specific nutrient compared to established reference standards or recommendations based on

Renal dysfunction
Liver dysfunction
Altered cholesterol metabolism/regulation
Heart failure
Food intolerances, eg, irritable bowel syndrome
Etiology Category


Nutrition
Category
Biochemical Data, ↑ Total cholesterol > 200 mg/dL (5.2 mmol/L), ↑ LDL cholesterol > 100 mg/dL
Medical Tests, and (2.59 mmol/L), ↓ HDL cholesterol < 40 mg/dL (1.036 mmol/L), ↑ triglycerides >
Procedures 150 mg/dL (1.695 mmol/L)
↑ Phosphorus > 5.5 mg/dL (1.78 mmol/L)
↓ Glomerular filtration rate (GFR) < 90 mL/min/1.73 m2
↑ BUN, creatinine, potassium

↑ Liver function tests indicating severe liver disease
Anthropometric Interdialytic weight gain greater than expected

Measurements
Nutrition Focused Edema/fluid retention
Physical Findings
Food/Nutrition-
Estimated intake higher than recommended for fat, phosphorus, sodium, protein,
Related History
fiber
Conditions associated with a diagnosis or treatment that require a specific type

and/or amount of nutrient, eg, cardiovascular disease (fat), early renal disease
(protein, phos), ESRD (phos, sodium, potassium, fluid), advanced liver disease
Client History*** (protein), heart failure (sodium, fluid), irritable bowel disease/Crohn’s flare up
(fiber)
Diagnosis of hypertension, confusion related to liver disease
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References
1. Aparicio M, Chauveau P, Combe C. Low protein diets and outcomes of renal patients. J Nephrol.
2001;14:433-439.
2. Beto JA, Bansal VK. Medical nutrition therapy in chronic kidney failure: integrating clinical practice
guidelines. J Am Diet Assoc. 2004;104:404-409.
3. Cupisti A, Morelli E, D’Alessandro C, Lupetti S, Barsotti G. Phosphate control in chronic uremia: don’t
forget diet. J Nephrol. 2003;16:29-33.
4. Durose CL, Holdsworth M, Watson V, Przygrodzka F. Knowledge of dietary restrictions and the medical
consequences of noncompliance by patients on hemodialysis are not predictive of dietary compliance. J
Am Diet Assoc. 2004;104:35-41.
5. Floch MH, Narayan R. Diet in the irritable bowel syndrome. Clin Gastroenterol. 2002;35:S45-S52.
6. Kato J, Kobune M, Nakamura T, Kurojwa G, Takada K, Takimoto R, Sato Y, Fujikawa K, Takahashi M,
Takayama T, Ikeda T, Niitsu Y. Normalization of elevated hepatic 8-hydroxy-2’-deoxyguanosine levels in
chronic hepatitis C patients by phlebotomy and low iron diet. Cancer Res. 2001;61:8697-8702.
7. Lee SH, Molassiotis A. Dietary and fluid compliance in Chinese hemodialysis patients. Int J Nurs Stud.
2002;39:695-704.
8. Poduval RD, Wolgemuth C, Ferrell J, Hammes MS. Hyperphosphatemia in dialysis patients: is there a
role for focused counseling? J Ren Nutr. 2003;13:219-223.
9. Tandon N, Thakur V, Guptan RK, Sarin SK. Beneficial influence of an indigenous low-iron diet on serum
indicators of iron status in patients with chronic liver disease. Br J Nutr. 2000;83:235-239.
10. Zrinyi M, Juhasz M, Balla J, Katona E, Ben T, Kakuk G, Pall D. Dietary self-efficacy: determinant of
compliance behaviours and biochemical outcomes in haemodialysis patients. Nephrol Dial Transplant.
2003;19:1869-1873.
2020 EDITION
12/13/21, 11:16 AM Imbalance of Nutrients
IMBALANCE OF NUTRIENTS
Imbalance of Nutrients (NI-5.4)

Definition
An undesirable combination of nutrients, such that the amount of one nutrient interferes with or alters absorption
and/or utilization of another nutrient.

Consumption of high-dose nutrient supplements

Food- and nutrition-related knowledge deficit concerning nutrient interactions
Unsupported beliefs/attitudes about food, nutrition, and nutrition-related information
Food faddism
Insufficient electrolyte replacement when initiating feeding (PN/EN, including oral)
Etiology Category


Nutrition
Category
Biochemical Data, Severe hypophosphatemia (in the presence of increased carbohydrate)
Medical Tests, and Severe hypokalemia (in the presence of increased protein)
Procedures Severe hypomagnesemia (in the presence of increased carbohydrate)
Anthropometric
Measurements
12/13/21, 11:16 AM Imbalance of Nutrients
Nutrition Focused Diarrhea or constipation (iron supplements)

Physical Findings Epigastric pain, nausea, vomiting, diarrhea (zinc supplements)
Estimated intake of iron supplements (decreased zinc absorption) higher

Food/Nutrition- than recommended
Related History Estimated intake of zinc supplements (decreased copper status) higher
than recommended
Estimated intake of manganese (decreased iron status) higher than recommended
Client History*** Refeeding syndrome
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
2020 EDITION
12/13/21, 11:20 AM Inadequate Fat Intake
INADEQUATE FAT INTAKE
Intake Domain – Fat and Cholesterol
Inadequate Fat Intake (NI-5.5.1)

Definition
Lower fat intake compared to established reference standards or recommendations based on physiological
needs.
Note: May not be an appropriate nutrition diagnosis when the goal is weight loss or during end-of-life
care.
assessment of nutritional status based on a totality of the evidence. (Dietary Reference Intakes:
Applications in Dietary Assessment. Institute of Medicine. Washington, D.C: National Academies Press;
2000).

{Factors gathered during the nutrition assessment process that contribute to the existence or the maintenance of

Less than optimal food choices, eg, economic constraints, restricting food given to elderly and/or
children, specific food choices
Cultural practices that affect ability to make appropriate food choices
Food and nutrition related knowledge deficit concerning appropriate amount of dietary fat
Etiology Category


12/13/21, 11:20 AM Inadequate Fat Intake
Nutrition
Category
Biochemical Data,
Medical Tests, and ↑ Triene:tetraene ratio > 0.2
Procedures
Anthropometric Impaired growth
Measurements Weight loss if insufficient calories/kcal/kJ consumed
Nutrition Focused Scaly skin and dermatitis consistent with essential fatty acid deficiency
Physical Findings
Estimated intake of essential fatty acids less than 10% of energy (primarily
Food/Nutrition-
associated with parenteral nutrition)
Related History
Verbalizes inaccurate or incomplete knowledge
Cultural or religious practices that affect intake
Conditions associated with a diagnosis or treatment, eg, prolonged catabolic illness

(eg, AIDS, tuberculosis, anorexia nervosa, sepsis or severe infection from recent
Client History*** surgery)
Severe fat malabsorption with bowel resection, pancreatic insufficiency, or hepatic
disease accompanied by steatorrhea
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References
2020 EDITION
12/13/21, 11:20 AM Excessive Fat Intake
EXCESSIVE FAT INTAKE
Intake Domain– Fat and Cholesterol
Excessive Fat Intake (NI-5.5.2)

Definition
Higher fat intake compared to established reference standards or recommendations based on physiological needs.

Food- and nutrition-related knowledge deficit concerning appropriate amount of dietary fat
Changes in taste and appetite or preference
Physiological causes decreasing total fat needs or recommendations
Etiology Category


Nutrition
Category
Biochemical Data, ↑ Cholesterol > 200 mg/dL (5.2 mmol/L), ↑ LDL cholesterol > 100 mg/dL (2.59
Medical Tests, and mmol/L), ↓ HDL cholesterol < 40 mg/dL (1.036 mmol/L), ↑ triglycerides > 150
Procedures mg/dL (1.695 mmol/L)
↑ Serum amylase and/or lipase
↑ LFTs, T. bilirubin
↑ Fecal fat > 7g/24 hours
Anthropometric
Measurements
Nutrition Focused Evidence of xanthomas
Physical Findings Diarrhea, cramping, steatorrhea, epigastric pain
Frequent or large portions of high-fat foods

Frequent food preparation with added fat
Frequent consumption of high-risk lipids (i.e., saturated fat, trans fat, cholesterol)
Food/Nutrition-
Report of foods containing fat more than diet prescription
Related History
Medication, eg, pancreatic enzymes, cholesterol- or other lipid-lowering
medications
Verbalizes unsupported beliefs and attitudes
Conditions associated with a diagnosis or treatment, eg, hyperlipidemia; cystic

fibrosis; angina; artherosclerosis; pancreatic; liver; and biliary diseases; post-
Client History*** transplantation, chyle fluid leak
Family history of hyperlipidemia, atherosclerosis, or pancreatitis
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References
2. Position of the Academy of Nutrition and Dietetics: Interventions for the prevention and treatment
of pediatric overweight and obesity. J Acad Nutr Diet. 2013;113:1375-1394.
Diet. 2013;113:307-317.
2020 EDITION
12/13/21, 11:20 AM Intake of Types of Proteins Inconsistent with Needs (Specify)
INTAKE OF TYPES OF PROTEINS INCONSISTENT WITH NEEDS (SPECIFY)
Intake Domain – Fat and Cholesterol
Intake of Types of Fats Inconsistent with Needs (Specify) (NI-5.5.3)

Definition
Intake of wrong type or quality of fats compared to established reference standards or recommendations based

Food- and nutrition-related knowledge deficit concerning type of fat (eg, fats added to food,
formula/breastmilk)
Changes in taste and appetite or preference
Physiological causes altering fatty acid needs or recommendations
Etiology Category


Nutrition
Category
Biochemical Data, ↑ Cholesterol > 200 mg/dL (5.2 mmol/L), ↑ LDL cholesterol > 100 mg/dL (2.59
Medical Tests, and mmol/L), ↓ HDL cholesterol < 40 mg/dL (1.036 mmol/L) men, ↓ HDL cholesterol
Procedures < 50 mg/dL (1.3 mmol/L) women, ↑ triglycerides > 150 mg/dL (1.695 mmol/L)
↑ Serum amylase and/or lipase
↑ LFTs, T. bilirubin, C-reactive protein
Altered acylcarnitine, carnitine, and other measures of fatty acid metabolism
Elevated triene:tetraene ratio (>0.2)
Altered fatty acid panel mitochondrial C8-C18, serum or plasma (µmol/L)
Anthropometric
Measurements
Nutrition Focused Evidence of dermatitis
Physical Findings Diarrhea, cramping, steatorrhea, epigastric pain
Frequent food preparation with added fat that is not of desired type for condition
Frequent consumption of fats that are undesirable for condition (eg, saturated
Food/Nutrition- fat, trans fat, cholesterol, n-6 fatty acids, fatty acid chain length)
Related History Estimated intake of monounsaturated, polyunsaturated, n-3 fatty acids, or
DHA/ARA, fatty acid chain length less than recommended or in suboptimal ratio
Conditions associated with a diagnosis or treatment, eg, diabetes, cardiac diseases,

obesity, liver or biliary disorders, chyle fluid leak, inborn errors of metabolism
Client History*** Family history of diabetes-related heart disease, hyperlipidemia, atherosclerosis, or
pancreatitis
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References
1. Abdenur JE. MCAD deficiency. Acylcarnitines (AC) by tandem mass spectrometry (MS-MS) are useful
to monitor dietary treatment. Adv Exp Med Biol 1999;466:353-363.
2. de Lorgeril M, Salen P, Martin J-L, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk
factors, and the rate of cardiovascular complications after myocardial infarction: Final report of the Lyon
Diet Heart Study. Circulation. 1999;99:779-785.

3. Franz MJ, Bantle JP, Beebe CA, Brunzell JD, Chiasson J-L, Garg A, Holzmeister LA, Hoogwerf B,
Mayer-Davis E, Mooradian AD, Purnell JQ, Wheeler M. Technical review. Evidence-based nutrition
principles and recommendations for the treatment and prevention of diabetes and related
complications. Diabetes Care. 2002;202:148-198.
4. Knoops KTB, de Grott LC, Kromhout D, Perrin A-E, Varela M-V, Menotti A, van Staveren WA.
Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women. JAMA.
2004;292:1433-1439.
5. Kris-Etherton PM, Harris WS, Appel LJ, for the Nutrition Committee. AHA scientific statement. Fish
consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation. 2002;106:2747-2757.
6. Iafolla, AK. Medium chain acyl-coenzyme A dehydrogenase deficiency: Clinical course in 120 affected
children J Pediatr 1994;124:409-415.
8. MorrisAM, Spiekerkoetter U. .Disorders of Mitochondrial Fatty Acid Oxidation and Related Metabolic
Pathways". In Saudubray JM; van den Berghe G, Walter JH.. Inborn MetabolicDiseases: Diagnosis and
Treatment (5th ed.). 2012. New York: Springer. pp. 201–216.
9. Panagiotakos DB, Pitsavos C, Polychronopoulos E, Chrysohoou C, Zampelas A, Trichopoulou A. Can a
Mediterranean diet moderate the development and clinical progression of coronary heart disease? A
systematic review. Med Sci Monit. 2004;10:RA193-RA198.
Diet. 2013;113:307-317.
Diet. 2014;114:136-153.
14. Rinaldo P, O'Shea JJ, Coates PM, Hale DE, Stanley CA, Tanaka K. Medium-Chain Acyl-CoA
Dehydrogenase Deficiency". New Eng J Med. 1988; 319: 1308–1313.
15. Walter JH. Tolerance to fast: Rational and practical evaluation in children with hypoketonaemia. J Inherit
Metab Dis. 2009; 32: 214–217.
16. Zhao G, Etherton TD, Martin KR, West SG, Gilles PJ, Kris-Etherton PM. Dietary alpha-linolenic acid
reduces inflammatory and lipid cardiovascular risk factors in hypercholesterolemic men and women. J
Nutr. 2004;134:2991-2997.
2020 EDITION
12/13/21, 11:35 AM Inadequate Protein Intake
INADEQUATE PROTEIN INTAKE
Intake Domain – Protein
Inadequate Protein Intake (NI-5.6.1)

Definition
Lower intake of protein compared to established reference standards or recommendations based on physiological
needs.
biochemical, anthropometric information, medical diagnosis, clinical status, and/or other factors
to provide a valid assessment of nutritional status based on a totality of the evidence. (Institute of
Medicine. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: National
Academies Press; 2000.)

Physiological causes increasing nutrient needs due to prolonged catabolic illness, malabsorption, age, or
condition
Decreased ability to consume sufficient protein
children
Cultural practices that affect the ability to access food
Food and nutrition related knowledge deficit concerning amount of protein
Etiology Category


12/13/21, 11:35 AM Inadequate Protein Intake
Assessment
Category
Biochemical Data,
Medical Tests, and
Procedures
Anthropometric
Measurements
Nutrition Focused Edema, failure to thrive (infants/children), poor musculature, dull skin, thin and
Physical Findings fragile hair
Reports or observation of:
Estimated intake of protein insufficient to meet requirements

Food/Nutrition- Cultural or religious practices that limit protein intake
Related History Economic constraints that limit food availability
Prolonged adherence to a very low-protein weight-loss diet
Conditions associated with a diagnosis or treatment, eg, severe

Client History*** protein malabsorption such as bowel resection
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
Cholesterol, Protein, and Amino Acids. Washington DC: National Academies Press; 2002.
2020 EDITION
12/13/21, 11:37 AM Excessive Protein Intake
EXCESSIVE PROTEIN INTAKE
Excessive Protein Intake (NI-5.6.2)

Definition
Intake more than the recommended level of protein compared to established reference standards or

Liver dysfunction
Renal dysfunction
Food and nutrition-related knowledge deficit
Lack of, or limited access to specialized protein products
Metabolic abnormality
Food faddism
Etiology Category


Nutrition
Category
Biochemical Data, Altered laboratory values, eg, ↑ BUN, ↓ glomerular filtration rate (altered renal
Medical Tests, and status)
Procedures
Anthropometric Growth stunting or failure based on National Center for Health Statistics growth
Measurements charts (metabolic disorders)
Nutrition Focused
Physical Findings
Estimated total protein intake higher than recommended, eg, early renal disease,
Food/Nutrition- advanced liver disease with confusion
Related History Less than optimal supplementation
Conditions associated with a diagnosis or treatment, eg, early renal disease or

Client History advanced liver disease with confusion
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References
2. Brandle E, Sieberth HG, Hautmann RE. Effect of chronic dietary protein intake on the renal function in
healthy subjects. Eur J Clin Nutr. 1996;50:734-740.
3. Frassetto LA, Todd KM, Morris RC Jr, Sebastian A. Estimation of net endogenous noncarbonic acid
production in humans from diet, potassium and protein contents. Am J Clin Nutr. 1998;68:576-583.
4. Friedman N, ed. Absorption and Utilization of Amino Acids. Vol. I. Boca Raton, FL: CRC Press;
1989:229-242.
5. Hoogeveen EK, Kostense PJ, Jager A, Heine RJ, Jakobs C, Bouter LM, Donker AJ, Stehower CD. Serum
homocysteine level and protein intake are related to risk of microalbuminuria: the Hoorn study. Kidney
Int. 1998;54:203-209.
6. Rudman D, DiFulco TJ, Galambos JT, Smith RB, Salam AA, Warren WD. Maximum rate of excretion
and synthesis of urea in normal and cirrhotic subjects. J Clin Invest. 1973;52:2241-2249.
2020 EDITION
INTAKE OF TYPES OF PROTEINS INCONSISTENT WITH NEEDS (SPECIFY)
Intake of Types of Proteins Inconsistent with Needs (Specify) (NI-5.6.3)

Definition
Intake of an amount of a specific type of protein compared to established reference standards or

Liver dysfunction
Renal dysfunction
Misused specialized protein products
Food faddism
Inborn errors of metabolism
Celiac disease, dermatitis herpetiformis, or other GI disease
Cultural or religious practices that affect the ability to regulate types of protein or amino acids consumed
Food- and nutrition-related knowledge deficit concerning an appropriate amount of a specific types
of proteins or amino acids
Food and nutrition adherence limitations
Insufficient access to appropriate protein sources
Etiology Category


Assessment
Category
Altered laboratory values, eg, ↑ BUN, ↓ glomerular filtration rate (altered renal
status)
Biochemical Data, ↑ specific amino acids (inborn errors of metabolism)
Medical Tests, and ↑ homocysteine or ammonia
Procedures Positive autoantibody levels (Anti-tTG antibodies, EmA IgA tissue
transglutaminase [tTG] and IgA endomysial antibodies [EMA])
Positive small bowel biopsy for celiac or other GI disease
Anthropometric Weight loss, inability to gain weight, delayed growth

Measurements
Physical or neurological changes (inborn errors of metabolism)
Nutrition Focused Diarrhea in response to certain types of protein in specific carbohydrate rich foods,
Physical Findings supplements, and medications
Abdominal pain, distention, constipation, reflux, GERD, vomiting
Estimated protein intake from all sources higher or lower than recommended
Food/Nutrition- Estimated energy intake from all sources lower than recommended
Related History Less than optimal supplementation of specific types of protein
Limited knowledge of protein composition or of protein metabolism
Chronic use of medications containing proteins not recommended
Conditions associated with a diagnosis or treatment of illness that requires EN/PN

therapy, celiac disease, dermatitis herpetiformis, allergies, inborn errors of
Client History*** metabolism
Uremia, azotemia (clients with renal conditions)
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References
1. Academy of Nutrition and Dietetics. Celiac Disease Evidenced-based Nutrition Practice Guideline.
http://www.andevidencelibrary.com/topic.cfm?cat=3677. Accessed June 12, 2015.

June 12, 2015.
4. Catassi C, Fabiani E, Iacono G, et al. A prospective, double-blind, placebo-controlled trial to establish a
safe gluten threshold for patients with celiac disease. Am J Clin Nutr 2007;85:160-166.
5. Camp KM, Lloyd-Puryear MA, Huntington KL. Nutritional treatment for inborn errors of metabolism:
Indications, regulations, and availability of medical foods and dietary supplements using phenylketonuria
as an example. Mol Genet Metab. 2012;107: 3–9.
6. Green PH, Cellier C. Celiac disease. N Engl J Med. 2007;357:1731-1743.
7. Humphrey M, Truby H, Boneh A. New ways of defining protein and energy relationships in inborn errors
of metabolism. Mol Genet Metab. 2014;112:247-58.
8. Hutchinson JM, Robins G, Howdle PD. Advances in coeliac disease. Curr Opin Gastroenterol.
2008;24:129-134.
9. National Kidney Foundation, Clinical Practice Guidelines for Nutrition in Chronic Renal Failure, 2000.
http://www.kidney.org/professionals/kdoqi/guidelines/doqi_nut.html. Accessed April 30, 2014.
10. Singh RH, Rohr F, Frazier D, Cunningham A, Mofidi S, Ogata B, Splett PL, Moseley K, Huntington K,
Acosta PB, Vockley J, Van Calcar SC. Recommendations for the nutrition management of phenylalanine
hydroxylase deficiency. Genet Med. 2014 Feb;16(2):121-31. doi: 10.1038/gim.2013.179. Epub 2014 Jan
2.
2020 EDITION
12/13/21, 11:37 AM Intake of Types of Amino Acids Inconsistent with Needs (Specify)
INTAKE OF TYPES OF AMINO ACIDS INCONSISTENT WITH NEEDS (SPECIFY)
Intake of Types of Amino Acids Inconsistent with Needs (Specify) (NI-

5.7.1)
Definition
Intake of an amount of a specific type of amino acid compared to established reference standards or

Liver dysfunction
Renal dysfunction
Misused specialized amino acid products
Metabolic demand or abnormality
Medication with an amino acid interaction
Food- and nutrition-related knowledge deficit concerning an appropriate amount of specific amino acids
Limited adherence to recommendation to modify amino acid intake
Insufficient access to appropriate amino acid sources
Etiology Category


Nutrition
Category
Biochemical Data, ↑ or ↓ specific amino acids, serum, plasma or urine

Medical Tests, and ↑ ammonia, serum
Procedures
Measurements
Physical or neurological changes
Nutrition Focused Vomiting
Physical Findings Diarrhea
Fever
Estimated amino acid intake higher or lower than recommended via all routes
Food/Nutrition-
Less than optimal amino acid supplementation
Related History
Incomplete knowledge of amino acid composition or of amino acid metabolism
Estimated energy intake from all sources lower than recommended
Conditions associated with a diagnosis or treatment of illness that requires EN/PN

Client History*** therapy, food allergy or intolerance, inborn errors of metabolism, liver disease,
kidney disease
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References

June 15, 2015.
3. Camp KM, Lloyd-Puryear MA, Huntington KL. Nutritional treatment for inborn errors of metabolism:
Indications, regulations, and availability of medical foods and dietary supplements using phenylketonuria
as an example. Mol Genet Metab. 2012;107(1-2): 3–9.
4. Fouque D, Vennegoor M, Wee PT, Wanner C, Basci A, Canaud B, Haage P, Konner K, Kooman J,
Martin-Malo A, Pedrini L, Pizzarelli F, Tattersal J, Tordoir J, Vanholder R. EBPG guideline on nutrition.
Nephrol Dial Transplant. 2007;22:ii45-ii87.
5. Garcia-Cazorla A, Pyruvate carboxylase deficiency: metabolic characteristics and new neurological
aspects, Ann Neurol. 2006;59:121-127.
6. Humphrey M, Truby H, Boneh A. New ways of defining protein and energy relationships in inborn errors
of metabolism. Mol Genet Metab. 2014;112:247-258.
Cresci G, the A.S.P.E.N. Board of Directors and the American College of Critical Care Medicine.
Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill
patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral
Nutrition (A.S.P.E.N.) J Parenter Enteral Nutr. 2009;33:277-316.
8. Singh RH, Rohr F, Frazier D, Cunningham A, Mofidi S, Ogata B, Splett PL, Moseley K, Huntington K,
Acosta PB, Vockley J, Van Calcar SC. Recommendations for the nutrition management of phenylalanine
hydroxylase deficiency. Genet Med. 2014. 16:121-131.
2020 EDITION
12/13/21, 11:38 AM Inadequate Carbohydrate Intake
INADEQUATE CARBOHYDRATE INTAKE
Intake Domain – Carbohydrate and Fiber
Inadequate Carbohydrate Intake (NI-5.8.1)

Definition
Lower intake of carbohydrate compared to established reference standards or recommendations based on
Press; 2000.)

Physiological causes, eg, increased energy needs due to increased activity level or metabolic change,
malabsorption
children
Cultural practices that affect the ability to access food
Food and nutrition related knowledge deficit concerning appropriate amount of dietary carbohydrate
Etiology Category


12/13/21, 11:38 AM Inadequate Carbohydrate Intake
Assessment
Category
Biochemical Data,
Medical Tests, and
Procedures
Anthropometric
Measurements
Nutrition Focused Ketone smell on breath
Physical Findings
Estimated carbohydrate intake less than recommended amounts

Food/Nutrition-
Limited ability to independently consume foods/fluids, eg, diminished mobility in
Related History
hand, wrist, or digits
Conditions associated with a diagnosis or treatment, eg, pancreatic insufficiency,

Client History*** hepatic disease, celiac disease, seizure disorder, or carbohydrate malabsorption
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
2020 EDITION
12/13/21, 11:38 AM Excessive Carbohydrate Intake
EXCESSIVE CARBOHYDRATE INTAKE
Excessive Carbohydrate Intake (NI-5.8.2)

Definition
Intake more than the recommended level and type of carbohydrate compared to established reference standards

Physiological causes requiring modified carbohydrate intake, eg, diabetes mellitus, lactase deficiency,
sucrase-isomaltase deficiency, aldolase-B deficiency
Cultural practices that affect the ability to reduce carbohydrate intake
Food- and nutrition-related knowledge deficit concerning appropriate amount of carbohydrate intake
Limited adherence with recommendations to modify carbohydrate intake
Etiology Category


Nutrition
Category
Biochemical Data, Hyperglycemia (↑ fasting blood glucose > 126 mg/dL)
Medical Tests, and ↑ Hemoglobin A1C > 6%
Procedures ↑ Oral glucose tolerance test (2-hour post load glucose > 200 mg/dL)
Anthropometric
Measurements
Nutrition Focused Dental caries
Physical Findings Diarrhea
Cultural or religious practices that do not support modification of dietary

carbohydrate intake
Food/Nutrition-
Estimated carbohydrate intake that is consistently more than recommended
Related History
amounts
Chronic use of medications that cause hyperglycemia, eg, steroids
Conditions associated with a diagnosis or treatment, eg, diabetes mellitus, inborn

errors of carbohydrate metabolism, lactase deficiency, severe infection, sepsis, or
Client History obesity
Pancreatic insufficiency resulting in reduced insulin production
Economic constraints that limit availability of appropriate foods
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References
1. Clement S, Braithwaite SS, Magee MF, Ahmann A, Smith EP, Schafer RG, Hirsch IB, American Diabetes
Association Diabetes in Hospitals Writing Committee. Management of diabetes in hospitals. Diabetes
Care. 2004;27:553-592.
https://professional.diabetes.org/content-page/standards-medical-care-diabetes. Accessed February 9,
2018.
2020 EDITION
12/13/21, 11:38 AM Intake of Types of Carbohydrate Inconsistent with Needs (Specify)
INTAKE OF TYPES OF CARBOHYDRATE INCONSISTENT WITH NEEDS (SPECIFY)
Intake of Types of Carbohydrate Inconsistent with Needs (Specify) (NI-

5.8.3)
Definition
Intake of an amount of a specific type of carbohydrate compared to the established reference standards or
Note: Intolerance to the protein component of grains (eg, gluten) should be documented using the Intake
of types of proteins inconsistent with needs (NI-5.6.3) reference sheet.

Physiological causes altering carbohydrate digestion or metabolism, eg, intolerance, inborn errors of
carbohydrate metabolism.
Note. Although research does not support restriction of individual types of carbohydrate for
glycemic control, nutrition and dietetics practitioners may determine that restriction is warranted
in unique client situations for glycemic control and/or for other reasons, such as promotion of
healthful eating.
Cultural or religious practices that affect the ability to regulate types of carbohydrate consumed
Food- and nutrition-related knowledge deficit concerning an appropriate amount of a specific type of
carbohydrate
Limited adherence to recommendation to modify type of carbohydrate intake
Etiology Category


Nutrition
Category
Biochemical Data, Hypoglycemia or hyperglycemia
Medical Tests, and ↓ galactose-1-phosphate in red blood cells, ↓ galactose-1-phosphate uridyl
Procedures transferase, ↓ fructose

Measurements Weight gain
Nutrition Focused Diarrhea in response to certain types of carbohydrates

Physical Findings Abdominal pain, distention, constipation, reflux, GERD
Carbohydrate intake that is a different type or exceeds amount recommended for

that specific type of carbohydrate
Limited knowledge of carbohydrate composition of foods or of carbohydrate
Food/Nutrition-
metabolism
Related History
Chronic use of medications that cause altered glucose levels, eg, steroids, diabetes
medication, antidepressants, antipsychotics, or contains a type of carbohydrate not
recommended
Conditions associated with a diagnosis or treatment, eg, intolerance, inborn errors

of metabolism
Client History*** Allergic reactions or intolerance to certain carbohydrate foods or food groups
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References
1. Evert AB, Boucher JL, Cypress M, et al. Nutrition therapy recommendations for the management of
adults with diabetes. Diabetes Care. 2013;36(11):3821-3842.
2. Academy of Nutrition and Dietetics. Evidence Analysis Library. https://www.andeal.org/?auth=1.
2018.
6. Bosch AM, Classical galactosaemia revisited J Inher Met Dis. 2006;29:516-525.
8. Teff KL, Elliott SS, Tschöp M, Kieffer TJ, Rader D, Heiman M, Townsend RR, Keim NL, D’Alessio D,
Havel PJ. Dietary fructose reduces circulating insulin and leptin, attenuates postprandial suppression of
ghrelin, and increases triglycerides in women. J Clin Endocrinol Metab. 2004;89:2963-2972.
2020 EDITION
12/13/21, 11:39 AM Inconsistent Carbohydrate Intake
INCONSISTENT CARBOHYDRATE INTAKE
Inconsistent Carbohydrate Intake (NI-5.8.4)

Definition
Inconsistent timing of carbohydrate intake throughout the day, day to day, or a pattern of carbohydrate intake that
is not consistent with recommended pattern based on physiological or medication needs.

Physiological causes requiring careful timing and consistency in the amount of carbohydrate, eg, diabetes
mellitus, hypoglycemia, PN/EN delivery
Cultural practices that affect the ability to regulate timing of carbohydrate consumption
Food- and nutrition-related knowledge deficit concerning appropriate timing of carbohydrate intake
Limited adherence to recommendations to modify carbohydrate timing
Etiology Category


Nutrition
Category
Biochemical Data, Hypoglycemia or hyperglycemia documented on regular basis associated with
Medical Tests and inconsistent carbohydrate intake
Procedures Wide variations in blood glucose levels
Anthropometric
12/13/21, 11:39 AM Inconsistent Carbohydrate Intake
Measurements
Nutrition Focused
Physical Findings
Estimated carbohydrate intake that is different from recommended types or

ingested on an irregular basis
Food/Nutrition- Use of insulin or insulin secretagogues
Related History Chronic use of medications that cause altered glucose levels, eg, steroids,
antidepressants, antipsychotics
Conditions associated with a diagnosis or treatment, eg, diabetes mellitus, obesity,

Client History*** metabolic syndrome, hypoglycemia
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
1. Academy of Nutrition and Dietetics. Evidence Analysis Library: Diabetes type 1 and 2.
2018.
3. Evert AB, Boucher JL, Cypress M, et al. Nutrition therapy recommendations for the management of
adults with diabetes. Diabetes Care. 2013;36(11):3821-3842.
2020 EDITION
12/13/21, 11:39 AM Inadequate Fiber Intake
INADEQUATE FIBER INTAKE
Inadequate Fiber Intake (NI-5.8.5)

Definition
Lower intake of fiber compared to established reference standards or recommendations based on physiological
needs.
Press; 2000.)

Lack of or limited access to fiber-containing foods/fluids

Food and nutrition related knowledge deficit concerning desirable quantities of fiber
Prolonged adherence to a low-fiber or low-residue diet
Difficulty chewing or swallowing high-fiber foods
Economic constraints that limit availability of higher fiber foods
Limited ability or limited motivation to purchase or consume fiber-containing foods
Less than optimal food preparation practices, eg, reliance on overprocessed, overcooked foods
Etiology Category


12/13/21, 11:39 AM Inadequate Fiber Intake
Assessment
Category
Biochemical Data,
Medical Tests and
Procedures
Anthropometric
Measurements
Nutrition Focused Inadequate fecal bulk
Physical Findings
Food/Nutrition- Estimated intake of fiber that is insufficient when compared to recommended

Related History amounts (38 g/day for men and 25 g/day for women)
Conditions associated with a diagnosis or treatment, eg, ulcer disease,

Client History inflammatory bowel disease, or short-bowel syndrome treated with a low-fiber diet
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
1. DiPalma JA. Current treatment options for chronic constipation. Rev Gastroenterol Disord. 2004;2:S34-
S42.
2. Higgins PD, Johanson JF. Epidemiology of constipation in North America: a systematic review. Am J
Gastroenterol. 2004;99:750-759.
3. Lembo A, Camilieri M. Chronic constipation. New Engl J Med. 2003;349:360-368.
5. Talley NJ. Definition, epidemiology, and impact of chronic constipation. Rev Gastroenterol Disord.
2004;2:S3-S10.
2020 EDITION
12/13/21, 11:39 AM Excessive Fiber Intake
EXCESSIVE FIBER INTAKE
Excessive Fiber Intake (NI-5.8.6)

Definition
Higher intake of fiber compared to recommendations based on patient/client condition.

Food- and nutrition-related knowledge deficit concerning desirable quantities of fiber

Unsupported beliefs or attitudes about food- or nutrition-related topics, eg, obsession with bowel
frequency and habits
Lack of knowledge about appropriate fiber intake for condition
Food preparation or eating patterns that involve only high-fiber foods to the exclusion of other nutrient-
dense foods
Etiology Category


Nutrition
Category
Biochemical Data,
Medical Tests, and
Procedures
Anthropometric
Measurements
12/13/21, 11:39 AM Excessive Fiber Intake
Nutrition Focused Nausea, vomiting, excessive flatulence, diarrhea, abdominal cramping, high stool
Physical Findings volume or frequency that causes discomfort to the individual
Estimated fiber intake higher than tolerated or generally recommended for current
Food/Nutrition-
medical condition
Related History
Conditions associated with a diagnosis or treatment, eg, ulcer disease, irritable

bowel syndrome, inflammatory bowel disease, short-bowel syndrome,
Client History*** diverticulitis, obstructive constipation, prolapsing hemorrhoids, gastrointestinal
stricture, eating disorders, or mental illness with obsessive-compulsive tendencies
Obstruction, phytobezoar
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
1. DiPalma JA. Current treatment options for chronic constipation. Rev Gastroenterol Disord. 2004;2:S34-
S42.
2. Higgins PD, Johanson JF. Epidemiology of constipation in North America: a systematic review. Am J
Gastroenterol. 2004;99:750-759.
3. Lembo A, Camilieri M. Chronic constipation. New Engl J Med. 2003;349:360-368.
2008;108:1716-1731.
6. Talley NJ. Definition, epidemiology, and impact of chronic constipation. Rev Gastroenterol Disord.
2004;2:S3-S10.
7. van den Berg H, van der Gaag M, Hendriks H. Influence of lifestyle on vitamin bioavailability. Int J
Vitam Nutr Res. 2002;72:53-55.
8. Wald A. Irritable bowel syndrome. Curr Treat Options Gastroenterol. 1999;2:13-19.
2020 EDITION
12/13/21, 11:49 AM Inadequate Vitamin Intake (Specify)
INADEQUATE VITAMIN INTAKE (SPECIFY)
Intake Domain – Vitamin
Inadequate Vitamin Intake (Specify) (NI-5.9.1)

Definition
Lower intake of one or more vitamins compared to established reference standards or recommendations based on
Press; 2000.)

Physiological causes increasing nutrient needs, eg, due to prolonged catabolic illness, disease state,
malabsorption, or medications
Decreased ability to consume sufficient amount of a vitamin(s)
children
Food and nutrition related knowledge deficit concerning food and supplemental sources of vitamins
Psychological causes, eg, depression or eating disorders
Access causes including season, geography, limited access to sunlight
Etiology Category


Nutrition
Category
Vitamin A: ↓ serum retinol < 10 µg/dL (0.35 µmol/L)
Vitamin C: ↓ plasma concentrations < 0.2 mg/dL (11.4 µmol/L)
Vitamin D: ↓ 25(OH)D <50 nmol/L, ↓ ionized calcium < 3.9 mg/dL (0.98 mmol/L)
with ↑ parathyroid hormone, normal serum calcium, and ↓ serum phosphorus < 2.6
mg/dL (0.84 mmol/L)
Vitamin E: ↓ plasma alpha-tocopherol < 18 µmol/g (41.8 µmol/L)
Vitamin K: ↑ prothrombin time; altered INR (without anticoagulation therapy)
Biochemical Data, Thiamin: ↑ erythrocyte transketolase activity > 1.20 µg/mL/h
Medical Tests and Riboflavin: ↑ erythrocyte glutathione reductase > 1.2 IU/g hemoglobin
Procedures Niacin: ↓ N’methyl-nicotinamide excretion < 5.8 µmol/day
Vitamin B-6: ↓ plasma pryrdoxal 5’phosphate <5 ng/mL (20 nmol/L)
Vitamin B-12: ↓ serum concentration < 24.4 ng/dL (180 pmol/L); ↑ homocysteine
Folic acid: ↓ serum concentration < 0.3 µg/dL (7 nmol/L); ↓ red cell folate < 315
nmol/L
Pantothenic acid: ↓ plasma
Biotin: ↓ serum
Anthropometric
Measurements
Vitamin A: night blindness, Bitot’s spots, xerophthalmia, follicular hyperkeratosis
Vitamin C: follicular hyperkeratosis, petichiae, ecchymosis, coiled hairs, inflamed
and bleeding gums, perifolicular hemorrhages, joint effusions, arthralgia, and
impaired wound healing
Vitamin D: widening at ends of long bones
Riboflavin: sore throat, hyperemia, edema of pharyngeal and oral mucous
membranes, cheilosis, angular stomatitis, glossitis, magenta tongue, seborrheic
dermatitis, and normochromic, normocytic anemia with pure erythrocyte
cytoplasia of the bone marrow
Nutrition Focused Niacin: symmetrical, pigmented rash on areas exposed to sunlight; bright red
Physical Findings tongue
Vitamin B-6: seborrheic dermatitis, stomatitis, cheilosis, glossitis, confusion,
depression
Vitamin B-12: tingling and numbness in extremities, diminished vibratory and
position sense, motor disturbances including gait disturbances
Pantothenic acid: irritability and restlessness, fatigue, apathy, malaise, sleep
disturbances, nausea, vomiting, abdominal cramps, numbness, muscle cramps,
hypoglycemia, sensitivity to insulin
Biotin: dermatitis, conjunctivitis, alopecia, depression, lethargy, hallucinations and
paresthesia, hypotonia, developmental delays

Related History
Estimated intake of foods containing specific vitamins less than requirements or
recommended level
Intake of foods that do not contain available vitamins, eg, over processed,
overcooked, or improperly stored foods
Prolonged use of substances known to increase vitamin requirements or reduce
vitamin absorption
Lack of interest in foods
Conditions associated with a diagnosis or treatment, eg, malabsorption as a result

of celiac disease, short-bowel syndrome, or inflammatory bowel
Certain environmental conditions, eg, infants exclusively fed breastmilk with
limited exposure to sunlight (Vitamin D)
Client History*** History of chronic kidney disease (decreased conversion of 25(OH)D
Premature infant, extremely low-birth-weight infant (vitamin D)
Rachitic rosary in children, rickets, osteomalacia
Pellegra
Vitamin/mineral deficiency
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References
2. Institute of Medicine. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate,
Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, DC: National Academies Press; 2000.
2020 EDITION
12/13/21, 11:49 AM Excessive Vitamin Intake (Specify)
EXCESSIVE VITAMIN INTAKE (SPECIFY)
Intake Domain – Vitamin
Excessive Vitamin Intake (Specify) (NI-5.9.2)

Definition
Higher intake of one or more vitamins compared to established reference standards or recommendations based

Physiological causes decreasing nutrient needs due to prolonged immobility or chronic renal disease
Access to foods and supplements in excess of needs, eg, cultural or religious practices; less-than-optimal
food and supplements given to pregnant women, elderly, or children
Food- and nutrition-related knowledge deficit concerning food and supplemental sources of vitamins
Accidental overdose from oral and supplemental forms, enteral or parenteral sources
Etiology Category


Nutrition
Category
Biochemical Data, Vitamin D: ↑ 25(OH) D, ↑ ionized calcium > 5.4 mg/dL (1.35 mmol/L)
Medical Tests and with ↑ parathyroid hormone, normal or ↑ serum calcium, and ↑ serum phosphorus
Procedures > 2.6 mg/dL (0.84 mmol/L)
Vitamin K: ↓ prothrombin time or altered INR
Niacin: ↑ N’methyl-nicotinamide excretion > 7.3 µmol/day

Vitamin B-6: ↑ plasma pryrdoxal 5’phosphate > 15.7 ng/mL (94 nmol/L)
Vitamin A: ↑ serum retinol concentration > 60 µg/dL (2.09 µmol/L)
Pantothenic acid: ↑ plasma
Biotin: ↑ serum
Anthropometric Vitamin D: growth retardation

Measurements
Vitamin A: changes in the skin and mucous membranes; dry lips (cheilitis); early
—dryness of the nasal mucosa and eyes; later—dryness, erythema, scaling and
peeling of the skin, hair loss, and nail fragility. Headache, nausea, and vomiting.
Infants may have bulging fontanelle; children may develop bone alterations.
Vitamin D: calcification of soft tissues (calcinosis), including the kidney, lungs,
Nutrition Focused heart, and even the tympanic membrane of the ear, which can result in deafness.
Physical Findings Headache and nausea. Infants given excessive amounts of vitamin D may have
gastrointestinal upset, bone fragility.
Vitamin K: hemolytic anemia in adults or severe jaundice in infants have been
noted on rare occasions
Niacin: histamine release, which causes flushing, aggravation of asthma, or liver
disease
Estimated intake reflects excessive intake of foods and supplements containing

vitamins as compared to estimated requirements, including fortified cereals, meal
replacements, vitamin-mineral supplements, other dietary supplements (eg, fish
Food/Nutrition- liver oils or capsules), tube feeding, and/or parenteral solutions
Related History Estimated intake > more than Tolerable Upper Limit (UL) for vitamin A based
upon reference intake standard
Estimated intake more than UL for vitamin D based upon reference
intake standard
Estimated intake more than UL for niacin based upon reference intake standard
Conditions associated with a diagnosis or treatment, eg, chronic liver or kidney

Client History*** diseases, heart failure, cancer
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
1. Allen LH, Haskell M. Estimating the potential for vitamin A toxicity in women and young children. J Nutr.
2002;132:S2907-S2919.
2. Croquet V, Pilette C, Lespine A, Vuillemin E, Rousselet MC, Oberti F, Saint Andre JP, Periquet B,
Francois S, Ifrah N, Cales P. Hepatic hyper-vitaminosis A: importance of retinyl ester level
determination. Eur J Gastroenterol Hepatol. 2000;12:361-364.
3. Krasinski SD, Russell RM, Otradovec CL, Sadowski JA, Hartz SC, Jacob RA, McGandy RB. Relationship
of vitamin A and vitamin E intake to fasting plasma retinol, retinol-binding protein, retinyl esters,
carotene, alpha-tocopherol, and cholesterol among elderly people and young adults: increased plasma
retinyl esters among vitamin A-supplement users. Am J Clin Nutr. 1989;49:112-120.
5. Institute of Medicine. Dietary Reference Intakes for Thiamine, Riboflavin, Niacin, Vitamin B6, Folate,
Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, DC: National Academies Press; 2000.
7. Russell RM. New views on RDAs for older adults. J Am Diet Assoc. 1997;97:515-518.
2009;109:2073-2085.
2020 EDITION
12/13/21, 11:49 AM Inadequate Mineral Intake (Specify)
INADEQUATE MINERAL INTAKE (SPECIFY)
Intake Domain – Mineral
Inadequate Mineral Intake (Specify) (NI-5.10.1)

Definition
Lower intake of one or more minerals compared to established reference standards or recommendations based on
Press; 2000.)

Physiological causes increasing nutrient needs due to prolonged catabolic illness, malabsorption,
hyperexcretion, nutrient/drug and nutrient/nutrient interaction, growth and maturation
Decreased ability to consume sufficient amount of a mineral(s)
children
Food and nutrition related knowledge deficit concerning food and supplemental sources of minerals
Misdiagnosis of lactose intolerance/lactase deficiency; perception of conflicting nutrition messages; less
than optimal reliance on supplements
Environmental causes, eg, inadequately tested nutrient bioavailability of fortified foods, beverages, and
supplements; less than optimal marketing of fortified foods/beverages/supplements as a substitute for
natural food source of nutrient(s)
Etiology Category


Nutrition
Category
Calcium: bone mineral content (BMC) ↓ the young adult mean. Hypocalciuria,
serum 25(OH)D < 32 ng/mL
↓ Phosphorus, < 2.6 mg/dL (0.84 mmol/L)
↓ Ferritin in patient/client with a ↓ Mean Corpuscular Volume (MCV)
↓ Zinc, plasma
↓ Magnesium, <1.8 mg/dL (0.7 mmol/L)
Iron: ↓ hemoglobin < 13 g/L (2 mmol/L) (males); < 12 g/L (1.86 mmol/L)
Biochemical Data, (females)
Medical Tests and Iodine: ↓ urinary excretion < 100 µg/L (788 nmol/L)
Procedures Copper: ↓ serum copper < 64 µg/dL (10 µmol/L)
↓ Selenium, plasma
↓ Fluoride, plasma
↓ Manganese, serum
↓ Molybdenum, serum
↓ Boron, serum or plasma
Changes in urine labs associated with kidney stones
Calcium: height loss

Anthropometric Iodine: growth abnormalities
Measurements Chromium: unintentional weight loss
Calcium: hypertension, acute – hyperactive reflexes, tetany, muscle spasm,

irregular heart rhythm
Iron: pallor of face, mucosa, pale gums, tachycardia, fatigue
Potassium – weakness, constipation, hypoactive reflexes
Phosphorous: fatigue, myalgia, ataxia, confusion, parasthesias
Nutrition Focused Zinc: dysgeusia, poor wound healing, skin lesions (buttocks, perianal area, mouth,
Physical Findings nose, eyes), alopecia
Copper: depigmentation of hair and skin, osteoporosis
Selenium:depigmentation of hair and skin
Iodine: enlarged thyroid
Fluoride: dental caries
Manganese: dermatitis
Estimated mineral intake from diet less than recommended intake

Food avoidance and/or elimination of whole food group(s) from diet
Food/Nutrition-
Lack of interest in food
Related History
Less than optimal food choices and/or chronic dieting behavior
Client History*** Conditions associated with a diagnosis or treatment, eg, malabsorption as a result
of celiac disease, short bowel syndrome, inflammatory bowel disease, or post-
menopausal women without estrogen supplementation and increased calcium

need, bariatric surgery, parenteral nutrition
Polycystic ovary syndrome, premenstrual syndrome, kidney stones, colon polyps
Other significant medical diagnoses and therapies
Geographic latitude and history of Ultraviolet-B exposure/use of sunscreen
Change in living environment/independence
Calcium: obesity
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References
1. Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, Bray GA, Vogt TM, Cutler JA,
Windhauser MM, Lin P-H, Karanja N. A clinical trial of the effects of dietary patterns on blood
pressure. N Engl J Med. 1997;336:1117-1124.
2. Bermejo F, Garcia-Lopez S. A guide to diagnosis of iron deficiency and iron deficiency anemia in
digestive diseases. World J Gastroenterol. 2009; 15: 4638–4643.
3. Heaney RP. Role of dietary sodium in osteoporosis. J Am Coll Nutr. 25(3 suppl):S271-S276. 2006.
4. Heaney RP. Nutrients, interactions, and foods: the Importance of Source. In Burckhardt P, Dawson-
Hughes B, Heaney RP, eds. Nutritional Aspects of Osteoporosis. 2nd ed. San Diego, CA: Elsevier;
2004:61-76.
5. Heaney RP. Nutrients, interactions, and foods. Serum 25-hydroxy-vitamin D and the health of the calcium
economy. In Burckhardt P, Dawson-Hughes B, Heaney RP, eds. Nutritional Aspects of Osteoporosis. 2nd
ed. San Diego, CA: Elsevier; 2004:227-244.
6. Heaney RP, Rafferty K, Bierman J. Not all calcium-fortified beverages are equal. Nutr Today.
2005;40:39-41.
7. Heaney RP, Dowell MS, Hale CA, Bendich A. Calcium absorption varies within the reference range for
serum 25-hydroxyvitamin D. J Am Coll Nutr. 2003;22:142-146.
8. Heaney RP, Dowell MS, Rafferty K, Bierman J. Bioavailability of the calcium in fortified soy imitation
milk, with some observations on method. Am J Clin Nutr. 2000;71:1166-1169.
9. Hedera P, Peltier A, Fink JK, Wilcock S, London Z, Brewer GJ. Myelopolyneuropathy and pancytopenia
due to copper deficiency and high zinc levels of unknown origin II. The denture cream is a primary cause
of excessive zinc. Neurotoxicology. 2009;30:996-999.
10. Holick MF. Functions of vitamin D: importance for prevention of common cancers, Type I diabetes and
heart disease. In Burckhardt P, Dawson-Hughes B, Heaney RP, eds. Nutritional Aspects of Osteoporosis.
2nd ed. San Diego, CA: Elsevier Inc.; 2004:181-201
12. Lim LS, Hoeksema LJ, Sherin K, ACPM Prevention Practice Committee. Screening for Osteoporosis in
the Adult U.S. Population: ACPM Position Statement on Preventive Practice. Am J Prev Med.
2009;36:366-375.
13. Massey LK, Whiting SJ. Dietary salt, urinary calcium, and bone loss. J Bone Miner Res. 1996;11:731-
736.
14. Suaraz FL, Savaiano D, Arbisi P, Levitt MD. Tolerance to the daily ingestion of two cups of milk by
individuals claiming lactose intolerance. Am J Clin Nutr. 1997;65:1502-1506.
15. Tezvergil-Mutluay A, Carvalho R, Pashley DH. Hyperzincemia from ingestion of denture adhesives. J
Prosthet Dent.2010;103:380-383.
16. Thys-Jacobs S, Donovan D, Papadopoulos A, Sarrel P, Bilezikian JP. Vitamin D and calcium
dysregulation in the polycystic ovarian syndrome. Steroids. 1999;64:430-435.
17. Thys-Jacobs S, Starkey P, Bernstein D, Tian J. Calcium carbonate and the premenstrual syndrome: effects
on premenstrual and menstrual symptomatology. Am J Obstet Gynecol. 1998;179:444-452.
18. Zemel MB, Thompson W, Milstead A, Morris K, Campbell P. Calcium and dairy acceleration of weight
and fat loss during energy restriction in obese adults. Obesity Res. 2004;12:582-590.
2020 EDITION
12/13/21, 11:50 AM Excessive Mineral Intake (Specify)
EXCESSIVE MINERAL INTAKE (SPECIFY)
Intake Domain – Mineral
Excessive Mineral Intake (Specify) (NI-5.10.2)

Definition
Higher intake of one or more minerals compared to established reference standards or recommendations based

Food- and nutrition-related knowledge deficit concerning food and supplemental sources of minerals
Food faddism
Accidental oversupplementation
Overconsumption of a limited variety of foods
Lack of knowledge about management of a disorder altering mineral homeostasis
Lack of knowledge about management of a disease state requiring mineral restriction
Etiology Category


Nutrition
Category
Biochemical Data, Changes in appropriate laboratory values, such as:
Medical Tests and
↑ TSH (excessive iodine intake)
Procedures
↓ HDL (excessive zinc intake)
↑ Serum ferritin and transferrin saturation (iron overload or excessive intake)

↑ Phosphorus, serum
↑ Magnesium, serum
↓ Copper, serum (excessive zinc intake)
↑ Fluoride, plasma
↑ Selenium, serum
↑ Manganese, serum
↑ Molybdenum, serum
↑ Boron, serum or plasma
Anthropometric
Measurements
Hair and nail changes
Extraskeletal calcifications, affecting vasculature or skin
Puritis
Anorexia
Nutrition Focused GI disturbances
Physical Findings Enamel or skeletal fluorosis
Central nervous system effects

Food/Nutrition-
Estimated intake containing high amounts of mineral compared to reference intake
Related History
standard (eg, DRIs)
Heart failure
Kidney disease
Client History*** Liver damage
Parenteral nutrition
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References

4. Martin KJ, Gonzalez EA. Metabolic bone disease in chronic kidney disease. J Am Soc Nephrol. 2007;
18:875-885.
5. McCann L, ed. Pocket Guide to Nutrition Assessment of the Patient with Chronic Kidney Disease, 4th Ed.
New York, NY: National Kidney Foundation, 2009.
6. Position of the American Dietetic Association: Nutrient Supplementation. J Am Diet Assoc.
2009;109:2073-2085.
2020 EDITION
12/14/21, 8:31 AM Swallowing Difficulty
SWALLOWING DIFFICULTY
Clinical Domain – Functional
Swallowing Difficulty (NC-1.1)

Definition
Impaired or difficult movement of food and liquid within the oral cavity to the stomach

Mechanical causes, eg, inflammation, surgery, stricture; or oral, pharyngeal and esophageal tumors; prior
mechanical ventilation
Motor causes, eg, neurological or muscular disorders, such as cerebral palsy, stroke, multiple sclerosis,
scleroderma; or prematurity, altered suck, swallow, breathe patterns
Etiology Category


Nutrition
Category
Biochemical Data,
Medical Tests and Radiological findings, eg, abnormal swallow study
Procedures
Anthropometric
Measurements
Nutrition Focused Evidence of dehydration, eg, dry mucous membranes, poor skin turgor
Physical Findings
https://www.ncpro.org/pubs/2020-encpt-en/codeNC-1-1 1/2
12/14/21, 8:31 AM Swallowing Difficulty
Non-normal findings in cranial nerves and (CN VII) muscles of facial expression,
(Nerve IX) gag reflex, swallow (Nerve X) and tongue range of motions (Nerve
XII), cough reflex, drooling, facial weakness, and ability to perform and wet and
dry swallow
Coughing, choking, prolonged chewing, pouching of food, regurgitation, facial
expression changes during eating, drooling, noisy wet upper airway sounds,
feeling of “food getting stuck,” pain while swallowing
Prolonged feeding time

Food/Nutrition-
Decreased estimated food intake
Related History
Avoidance of foods
Mealtime resistance
Conditions associated with a diagnosis or treatment, eg, dysphagia, achalasia

Client History*** Repeated upper respiratory infections and or pneumonia
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
1. Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, ed. Harrison’s Principles of
Internal Medicine. 15th ed. New York, NY: McGraw-Hill; 2001.
2. Brody R, Touger-Decker R, O’Sullivan-Maillet J. The effectiveness of dysphagia screening by an RD on
the determination of dysphagia risk. J Am Diet Assoc. 2000;100:1029-1037.
3. Huhmann M, Touger-Decker R, Byham-Gray L, O’Sullivan-Maillet J, Von Hagen S. Comparison of
dysphagia screening by a registered dietitian in acute stroke patients to speech language pathologist’s
evaluation. Topics in Clinical Nutrition. 2004;19:239-249.
4. Groher ME. Dysphagia Diagnosis and Management. 3rd ed. Boston: Butterworth-Heinemann; 1997.
2020 EDITION
12/14/21, 8:35 AM Biting/Chewing (Masticatory) Difficulty
BITING/CHEWING (MASTICATORY) DIFFICULTY
Biting/Chewing (Masticatory) Difficulty (NC-1.2)

Definition
Impaired ability to bite or chew food in preparation for swallowing.

Craniofacial malformations
Oral surgery
Neuromuscular dysfunction
Partial or complete edentulism
Soft tissue disease (primary or oral manifestations of a systemic disease)
Xerostomia
Etiology Category


Nutrition
Category
Biochemical Data,
Medical Tests and
Procedures
Anthropometric
Measurements
Nutrition Focused Partial or complete edentulism

Physical Findings Alterations in cranial nerve function (V, VII, IX, X, XII)
Dry mouth
Oral lesions interfering with eating ability
Impaired tongue movement
Ill-fitting dentures or broken dentures
Decreased estimated food intake

Alterations in estimated food intake from usual
Food/Nutrition-
Decreased estimated intake or avoidance of food difficult to form into a bolus, eg,
Related History
nuts, whole pieces of meat, poultry, fish, fruits, vegetables
Avoidance of foods of age-appropriate texture
Spitting food out or prolonged feeding time
Conditions associated with a diagnosis or treatment, eg, alcoholism; Alzheimer’s;

head, neck or pharyngeal cancer; cerebral palsy; cleft lip/palate; oral soft tissue
infections (eg, candidiasis, leukoplakia); limited developmental readiness; oral
manifestations of systemic disease (eg, rheumatoid arthritis, lupus, Crohn’s
Client History*** disease, penphigus vulgaris, HIV, diabetes)
Recent major oral surgery
Wired jaw
Chemotherapy with oral side effects
Radiation therapy to oral cavity
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
1. Bailey R, Ledikwe JH, Smiciklas-Wright H, Mitchell DC, Jensen GL. Persistent oral health problems
associated with comorbidity and impaired diet quality in older adults. J Am Diet Assoc. 2004;104:1273-
1276.
2. Chernoff R, ed. Oral health in the elderly. Geriatric Nutrition. Gaithersburg, MD: Aspen Publishers;
1999.
3. Dormenval V, Mojon P, Budtz-Jorgensen E. Association between self-assessed masticatory ability,
nutritional status and salivary flow rate in hospitalized elderly. Oral Diseases. 1999;5:32-38.
4. Hildebrand GH, Dominguez BL, Schork MA, Loesche WJ. Functional units, chewing, swallowing and
food avoidance among the elderly. J Prosthet Dent. 1997;77:585-595.
5. Hirano H, Ishiyama N, Watanabe I, Nasu I. Masticatory ability in relation to oral status and general health
in aging. J Nutr Health Aging. 1999;3:48-52.
6. Huhmann M, Touger-Decker R, Byham-Gray L, O’Sullivan-Maillet J, Von Hagen S. Comparison of
dysphagia screening by a registered dietitian in acute stroke patients to speech language pathologist’s
evaluation. Top Clin Nutr. 2004;19:239-249.
7. Kademani D, Glick M. Oral ulcerations in individuals infected with human immunodeficiency virus:
clinical presentations, diagnosis, management and relevance to disease progression. Quintessence
International. 1998;29:1103-1108.
8. Keller HH, Ostbye T, Bright-See E. Predictors of dietary intake in Ontario seniors. Can J Public Health.
1997;88:303-309.
9. Krall E, Hayes C, Garcia R. How dentition status and masticatory function affect nutrient intake. J Am
Dent Assoc. 1998;129:1261-1269.
10. Joshipura K, Willett WC, Douglass CW. The impact of edentulousness on food and nutrient intake. J Am
Dent Assoc. 1996;127:459-467.
11. Mackle T, Touger-Decker R, O’Sullivan Maillet J, Holland B. Registered dietitians’ use of physical
assessment parameters in practice. J Am Diet Assoc. 2004;103:1632-1638.
12. Mobley C, Saunders M. Oral health screening guidelines for nondental healthcare providers. J Am Diet
Assoc. 1997;97:S123-S126.
13. Morse D. Oral and pharyngeal cancer. In: Touger-Decker R, Sirois D, Mobley C, eds. Nutrition and oral
medicine. Totowa, NJ: Humana Press; 2005:205-222.
14. Moynihan P, Butler T, Thomason J, Jepson N. Nutrient intake in partially dentate patients: the effect of
prosthetic rehabilitation. J Dent. 2000;28:557-563.
15. Position of the Academy of Nutrition and Dietetics: Oral health and nutrition. J Acad Nutr Diet.
2013;113:693-701.
16. Sayhoun NR, Lin CL, Krall E. Nutritional status of the older adult is associated with dentition status. J
Am Diet Assoc. 2003;103:61-66.
17. Sheiham A, Steele JG. The impact of oral health on stated ability to eat certain foods: finding from the
national diet and nutrition survey of older people in Great Britain. Gerodontology. 1999;16:11-20.
18. Ship J, Duffy V, Jones J, Langmore S. Geriatric oral health and its impact on eating. J Am Geriatr Soc.
1996;44:456-464.
19. Touger-Decker R. Clinical and laboratory assessment of nutrition status. Dent Clin North Am.
2003;47:259-278.
20. Touger-Decker R, Sirois D, Mobley C, eds. Nutrition and Oral Medicine. Totowa, NJ: Humana Press;
2005.
21. Walls AW, Steele JG, Sheiham A, Marcenes W, Moynihan PJ. Oral health and nutrition in older people. J
Public Health Dent. 2000;60:304-307.
2020 EDITION
12/14/21, 8:35 AM Breastfeeding Difficulty
BREASTFEEDING DIFFICULTY
Breastfeeding Difficulty (NC-1.3)

Definition
Inability to sustain infant nutrition through breastfeeding.

Mother:
Infant:
Painful breasts, nipples
Difficulty latching on
Breast or nipple abnormality
Poor sucking ability
Mastitis
Oral pain
Perception of or actual inadequate breastmilk*
Malnutrition/ malabsorption
supply
Lethargy, sleepiness
Limited social or environmental support
Irritability
Cultural practices that affect the ability to
Introduction of feeding via bottle or other route
breastfeed
that may affect breastfeeding
Introduction of feeding via bottle or other route
Swallowing difficulty
that may affect breastfeeding
Etiology Category


Assessment
Category
Biochemical Data, Laboratory evidence of dehydration (infant)
Medical Tests and Fewer than reference standard, eg, six wet diapers in 24 hours (infant)
Procedures
Anthropometric Any weight loss or limited weight gain (infant)
Measurements
Frenulum abnormality (infant)
Nutrition Focused Vomiting or diarrhea (infant)
Physical Findings Hunger, limited satiety after feeding (infant)
Reports or observations of (infant):
Coughing
Crying, latching on and off, pounding on breasts
Decreased feeding frequency/duration, early cessation of feeding, and/or feeding
resistance
Lethargy
Reports or observations of (mother):
Small amount of breastmilk* when pumping

Food/Nutrition-
Limited confidence in ability to breastfeed
Related History
Doesn’t hear infant swallowing
Limited support of mother’s choice to breastfeed
Limited knowledge of breastfeeding
Limited knowledge of infant hunger/satiety signals
Limited support for engaging employer in discussions about breastfeeding
facilities
Limited facilities or accommodations at place of employment or in community for
breastfeeding
Feeding via bottle or other route
Conditions associated with a diagnosis or treatment (infant), eg, cleft lip/palate,

thrush, premature birth, malabsorption, infection
Client History*** Conditions associated with a diagnosis or treatment (mother), eg, mastitis,
candidiasis, engorgement, history of breast surgery
Social or personal considerations of the mother
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
1. Batista CLC, Ribeiro VS, Nascimento M, Rodrigues VP. Association between pacifier use and bottle-
feeding and unfavorable behaviors during breastfeeding. J Pediatr (Rio J). 2018;94(6):596-601.
2. Brill H. Approach to milk protein allergy in infants. Canadian family physician Medecin de famille
canadien. 2008;54(9):1258-1264.
2019.
4. Collins CT, Makrides M, Gillis J, McPhee AJ. Avoidance of bottles during the establishment of breast
feeds in preterm infants. The Cochrane database of systematic reviews. 2008(4):Cd005252.
5. Fleurant E, Schoeny M, Hoban R, et al. Barriers to human milk feeding at discharge of very-low-birth-
weight infants: Maternal goal setting as a key social factor. Breastfeed Med. 2017;12:20-27.
6. Jaafar SH, Ho JJ, Jahanfar S, Angolkar M. Effect of restricted pacifier use in breastfeeding term infants
for increasing duration of breastfeeding. The Cochrane database of systematic reviews.
2016(8):Cd007202.
7. Kair LR, Colaizy TT. Association between in-hospital pacifier use and breastfeeding continuation and
exclusivity: Neonatal intensive care unit admission as a possible effect modifier. Breastfeed Med.
2017;12:12-19.
8. Larson-Nath C, Biank VF. Clinical review of failure to thrive in pediatric patients. Pediatr Ann.
2016;45(2):e46-49.
9. Lessen R, Kavanagh K. Position of the academy of nutrition and dietetics: Promoting and supporting
10. Newman J. Breastfeeding problems associated with the early introduction of bottles and pacifiers. J Hum
Lact. 1990;6(2):59-63.
11. Rollins NC, Bhandari N, Hajeebhoy N, et al. Why invest, and what it will take to improve breastfeeding
practices? Lancet. 2016;387(10017):491-504.
12. Sinha B, Chowdhury R, Sankar MJ, et al. Interventions to improve breastfeeding outcomes: a systematic
review and meta-analysis. Acta Paediatr. 2015;104(467):114-134.
13. Walker M. Conquering common breast-feeding problems. J Perinat Neonatal Nurs. 2008;22(4):267-274.
2020 EDITION
12/14/21, 8:42 AM Altered Gastrointestinal (GI) Function
ALTERED GASTROINTESTINAL (GI) FUNCTION
Altered Gastrointestinal (GI) Function (NC-1.4)

Definition
Changes in digestion, absorption, or elimination.


Changes in the GI tract motility, eg, gastroparesis
Compromised exocrine function of related GI organs, eg, pancreas, liver
Decreased functional length of the GI tract, eg, short-bowel syndrome
Etiology Category


Nutrition
Category
Biochemical Data, Abnormal digestive enzyme and fecal studies
Medical Tests and Abnormal hydrogen breath test, d-xylose test, stool culture, and gastric emptying
Procedures and/or bowel transit time
Endoscopic or colonoscopy examination, abdominal scan, biopsy results
Abnormal pH, sphincter, motility, morphology or reflux studies
Abnormal anemia profile
Abnormal vitamin, mineral, fatty acid, trace element, and PTH results
Abnormal tissue transglutaminase antibodies (IgA/IgG)
Weight loss of ≥ 5% in one month, ≥ 10% in six months

Anthropometric Growth stunting or failure in children
Measurements Abnormal bone mineral density tests
Abdominal distension
Increased (or sometimes decreased) bowel sounds
Wasting due to malnutrition in severe cases
Nutrition Focused Anorexia, nausea, vomiting, diarrhea, steatorrhea, constipation, abdominal pain,
Physical Findings reflux, gas, belching, flatus, bloating, fecal incontinence
Evidence of vitamin and/or mineral deficiency, eg, glossitis, cheilosis, mouth
lesions, skin rashes, hair loss
Food/Nutrition- Avoidance or limitation of estimated total intake or intake of specific foods/food

Related History groups due to GI symptoms, eg, bloating, cramping, pain, diarrhea, steatorrhea
(greasy, floating, foul-smelling stools) especially following ingestion of food
Conditions associated with a diagnosis or treatment, eg, malabsorption,

maldigestion, steatorrhea, obstruction, constipation, diverticulitis, Crohn’s disease,
inflammatory bowel disease, cystic fibrosis, celiac disease, cancers, irritable bowel
Client History*** syndrome, infection, dumping syndrome
Surgical procedures, eg, esophagectomy, dilatation, fundoplication, gastrectomy,
vagotomy, gastric bypass, bowel resections
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
1. Beyer P. Gastrointestinal disorders: roles of nutrition and the dietetics practitioner. J Am Diet Assoc.
1998;98:272-277.
2008;108:1716-1731.
2020 EDITION
12/14/21, 8:42 AM Predicted Breastfeeding Difficulty
PREDICTED BREASTFEEDING DIFFICULTY
Predicted Breastfeeding Difficulty (NC-1.5)

Definition
Future hindrance to breastfeeding, or lactation, is anticipated, based on observation, experience, or scientific
reason.

Scheduled or planned procedure, therapy or medication (mother[s] or infant[s])

Condition (mother[s] or infant[s]) that may hinder breastfeeding
Cultural or religious norms or practices that may hinder breastfeeding
Presence or absence of organizational, community, and/or societal procedure or policy that may hinder
breastfeeding
Anticipated increased psychological/life stress
Food and nutrition knowledge deficit
Unsupported beliefs/attitudes about food, nutrition, and nutrition-related information
Lack of social support for breastfeeding
Etiology Category


Nutrition
Category
Biochemical Data, Population-based biochemical data that may hinder breastfeeding
Medical Tests and

Procedures
Anthropometric Population-based anthropometric data that may hinder breastfeeding
Measurements
Nutrition Focused Population-based data anticipated physical exam finding that may hinder
Physical Findings breastfeeding
History of impediment to breastfeeding or breastfeeding difficulty

Food/Nutrition-
Medications that may hinder breastfeeding
Related History
Inaccurate or incomplete food and nutrition knowledge
Unsupported food and nutrition beliefs and attitudes
Anticipated procedure or therapy for which research shows a hindrance to

breastfeeding
History or presence of a condition for which research shows a hindrance to
breastfeeding
Client History*** Presence or absence of a policy that may hinder breastfeeding
Cultural or religious norms or practices
Absent or limited family and/or social breastfeeding support
Anticipated life stress or change
Social or personal considerations of the mother
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
1. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827-841.

2019.
3. Gomez-Pomar E, Blubaugh R. The Baby Friendly Hospital Initiative and the ten steps for successful
breastfeeding. a critical review of the literature. J Perinatol. 2018;38(6):623-632.
4. Lessen R, Kavanagh K. Position of the academy of nutrition and dietetics: Promoting and supporting
5. McFadden A, Gavine A, Renfrew MJ, et al. Support for healthy breastfeeding mothers with healthy term
babies. The Cochrane database of systematic reviews. 2017;2:Cd001141.
6. Nordin SM, Boyle M, Kemmer TM. Position of the academy of nutrition and dietetics: nutrition security
in developing nations: sustainable food, water, and health. J Acad Nutr Diet. 2013;113(4):581-595.
7. Organization WH. Guideline: Protecting, promoting and supporting breastfeeding in facilities providing
maternity and newborn services. https://www.who.int/nutrition/publications/guidelines/breastfeeding-
facilities-maternity-newborn/en/. Accessed February 18, 2019.
2020 EDITION
12/14/21, 8:42 AM Impaired Nutrient Utilization
IMPAIRED NUTRIENT UTILIZATION
Clinical Domain – Biochemical
Impaired Nutrient Utilization (NC-2.1)

Definition
Changes in ability to metabolize nutrients and bioactive substances.

Compromised endocrine function of related GI organs, eg, pancreas, liver, pituitary, parathyroid
Metabolic disorders, including inborn errors of metabolism
Medications that affect nutrient metabolism
Alcohol or drug addiction
Etiology Category


Nutrition
Category
Biochemical Data, Abnormal protein, fatty acid or carbohydrate metabolism profile tests
Medical Tests, and Abnormal liver function tests
Procedures Abnormal anemia profile
Abnormal pituitary hormones (growth hormone [GH], adrenocorticotropic
hormone [ACTH], luteinizing hormone [LH] and follicle-stimulating hormone
[FSH])
Vitamin and/or mineral deficiency
12/14/21, 8:42 AM Impaired Nutrient Utilization
Hypoglycemia, hyperglycemia
Abnormal PTH
Positive result for urine porphyrins
Weight loss of ≥ 5% in one month, ≥ 10% in six months

Anthropometric Growth stunting or failure in children
Measurements Abnormal bone mineral density tests
Evidence of vitamin and/or mineral deficiency, eg, glossitis, cheilosis, mouth

Nutrition Focused lesions
Physical Findings Thin, wasted appearance
Food/Nutrition- Avoidance or limitation of intake of specific foods/food groups due to physical

Related History symptoms
Alcohol or drug use
Conditions associated with a diagnosis or treatment, eg, cystic fibrosis, celiac

disease, Crohn’s disease, infection, radiation therapy, inborn errors of metabolism,
Client History*** endocrine disorders, pituitary disorders, renal failure, liver failure, acute or
inherited porphyria, short-bowel syndrome
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
1. Filippatos TD, Derdemezis CS, Gazi IF, Nakou ES, Mikhailidis DP, Elisaf MS. Orlistat-associated
adverse effects and drug interactions: a critical review. Drug Saf. 2008;31:53-65.
2. Ke ZJ, Wang X, Fan Z, Luo J. Ethanol promotes thiamine deficiency-induced neuronal death:
involvement of double-stranded MA-activated protein kinase. Alcohol Clin Exp Res. 2009;33:1097-103
2020 EDITION
12/14/21, 8:43 AM Altered Nutrition Related Laboratory Values (Specify)
ALTERED NUTRITION RELATED LABORATORY VALUES (SPECIFY)
Altered Nutrition Related Laboratory Values (Specify) (NC-2.2)

Definition
Changes in lab values due to body composition, medications, body system changes or genetics, or changes in
ability to eliminate byproducts of digestive and metabolic processes.

Kidney, liver, cardiac, endocrine, neurologic, and/or pulmonary dysfunction

Prematurity
Other organ dysfunction that leads to biochemical changes
Metabolic disorders, including inborn errors of metabolism
Etiology Category


Nutrition
Category
Biochemical Data, ↑ AST, ALT, T. bili, serum ammonia (liver disorders)
Medical Tests ↑ BUN, ↑ Cr, ↑ K, ↑ phosphorus, ↓ glomerular filtration rate (GFR) (kidney
and Procedures disorders)
Altered pO2 and pCO2 (pulmonary disorders)
↑ Serum lipids
↑ Plasma glucose and/or HgbA1c levels
Inadequate blood glucose control

↑ Urine microalbumin
Abnormal protein, fatty acid or carbohydrate metabolism profile
Other findings of acute or chronic disorders that are abnormal and of nutritional
origin or consequence
Anthropometric Rapid weight changes

Measurements Other anthropometric measures that are altered
Jaundice, edema, ascites, pruritis (liver disorders)

Nutrition Focused Edema, shortness of breath (cardiac disorders)
Physical Findings Blue nail beds, clubbing (pulmonary disorders)
Anorexia, nausea, vomiting
Estimated intake of foods high in or overall excess intake of protein, potassium,

phosphorus, sodium, fluid
Food/Nutrition-
Estimated intake of micronutrients less than recommendations
Related History
Food- and nutrition-related knowledge deficit, eg, lack of information, incorrect
information
Limited adherence to modified diet
Conditions associated with a diagnosis or treatment, eg, renal or liver disease,

Client History*** alcoholism, cardiopulmonary disorders, diabetes, inborn errors of metabolism
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References
2. Davern II TJ, Scharschmidt BF. Biochemical liver tests. In Feldman M, Scharschmidt BF, Sleisenger MH,
eds. Sleisenger and Fordtran’s Gasrointestinal and Liver Disease, 6th ed, vol 2. Philadelphia, PA: WB
Saunders; 1998: 1112-1122.
3. Durose CL, Holdsworth M, Watson V, Przygrodzka F. Knowledge of dietary restrictions and the medical
consequences of noncompliance by patients on hemodialysis are not predictive of dietary compliance. J
Am Diet Assoc. 2004;104:35-41.

4. Kassiske BL, Lakatua JD, Ma JZ, Louis TA. A meta-analysis of the effects of dietary protein restriction
on the rate of decline in renal function. Am J Kidney Dis. 1998;31:954-961.
5. Knight EL, Stampfer MJ, Hankinson SE, Spiegelman D, Curhan GC. The impact of protein intake on
renal function decline in women with normal renal function or mild renal insufficiency. Ann Intern Med.
2003;138:460-467.
6. Nakao T, Matsumoto, Okada T, Kanazawa Y, Yoshino M, Nagaoka Y, Takeguchi F. Nutritional
management of dialysis patients: balancing among nutrient intake, dialysis dose, and nutritional
status. Am J Kidney Dis. 2003;41:S133-S136.
7. National Kidney Foundation, Inc. Part 5. Evaluation of laboratory measurements for clinical assessment
of kidney disease. Am J Kidney Dis. 2002;39:S76-S92.
8. National Kidney Foundation, Inc. Guideline 9. Association of level of GFR with nutritional status. Am J
Kidney Dis. 2002;39:S128-S142.
2020 EDITION
12/14/21, 8:43 AM Food Medication Interaction (Specify)
FOOD MEDICATION INTERACTION (SPECIFY)
Food Medication Interaction (Specify) (NC-2.3)

Definition
Undesirable/harmful interaction(s) between food and over the counter (OTC) medications, prescribed
medications, herbals, botanicals, and/or dietary supplements that diminishes, enhances, or alters the effect of
nutrients and/or medications.

Combined ingestion or administration of medication and food that results in undesirable/harmful

interaction
Etiology Category


Nutrition
Category
Biochemical Data,
Medical Tests and Alterations of biochemical tests based on medication affect and client condition
Procedures
Anthropometric Alterations of anthropometric measurements based on medication effect and client
Measurements conditions, eg, weight gain and corticosteroids
Nutrition Focused Changes in appetite or taste
12/14/21, 8:43 AM Food Medication Interaction (Specify)
Physical Findings
Intake that is problematic or inconsistent with OTC, prescribed drugs, herbals,

botanicals, or dietary supplements, such as:
fish oils and prolonged bleeding
coumadin and vitamin K-rich foods
high-fat diet while on cholesterol-lowering medications
Food/Nutrition-
iron supplements, constipation, and low-fiber diet
Related History
Intake that does not support replacement or mitigation of OTC, prescribed drugs,
herbals, botanicals, and dietary supplements effects
Multiple drugs (OTC, prescribed drugs, herbals, botanicals, or dietary
supplements) that are known to have food medication interactions
Medications that require nutrient supplementation that can not be accomplished
via food intake, eg, isoniazid and vitamin B-6
Client History***
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
1. McCabe-Sellers BJ, Skipper A. Position of the American Dietetic Association: Integration of medical
nutrition therapy and pharmacotherapy. J Am Diet Assoc. 2010;110(6):950-956.
2020 EDITION
12/14/21, 8:43 AM Predicted Food Medication Interaction (Specify)
PREDICTED FOOD MEDICATION INTERACTION (SPECIFY)
Predicted Food Medication Interaction (Specify) (NC-2.4)

Definition
Potential undesirable/harmful interaction(s) between food and over the counter (OTC) medications, prescribed
medications, herbals, botanicals, and/or dietary supplements that diminishes, enhances, or alters the effect of
nutrients and/or medications.
Note: Appropriate nutrition diagnosis when food–medication interaction is predicted, but has not yet
occurred. This nutrition diagnosis is used when the practitioner wants to prevent a nutrient-medication
interaction. Observed food medication interactions should be documented using Food Medication
Interaction (NC-2.3.1).

Combined ingestion or administration of medication and food that results in undesirable/harmful

interaction
Etiology Category


Nutrition
Category
Biochemical Data,
Medical Tests and
Procedures
12/14/21, 8:43 AM Predicted Food Medication Interaction (Specify)
Anthropometric
Measurements
Nutrition Focused
Physical Findings

Intake that is expected to be problematic or inconsistent with OTC, prescribed
drugs, herbals, botanicals, or dietary supplements, such as:
fish oils and prolonged bleeding
coumadin and vitamin K-rich foods
Food/Nutrition- high-fat diet while on cholesterol-lowering medications
Related History iron supplements, constipation, and low fiber diet
Intake that may not support replacement or mitigation of OTC, prescribed drugs,
herbals, botanicals, and dietary supplements effects
Multiple drugs (OTC, prescribed drugs, herbals, botanicals, or dietary
supplements) that are known to have food medication interactions
Medications that require nutrient supplementation that cannot be accomplished via
food intake, eg, isoniazid and vitamin B6
Client History***
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
1. McCabe-Sellers BJ, Skipper A. Position of the American Dietetic Association: Integration of medical
nutrition therapy and pharmacotherapy. J Am Diet Assoc. 2010;110(6):950-956.
2020 EDITION
12/14/21, 8:50 AM Underweight
UNDERWEIGHT
Clinical Domain – Weight
Underweight (NC-3.1)
Definition
Low body weight compared to established reference standards or recommendations.

Disordered eating pattern

Excessive physical activity
Inadequate energy intake
Increased energy needs
Lack of or limited access to food
Small for gestational age, intrauterine growth retardation/restriction and/or lack of progress/appropriate
weight gain per day
Etiology Category


Nutrition
Category
Biochemical Data,
Medical Tests and ↑ Measured resting metabolic rate (RMR) higher than expected and/or estimated
Procedures
Anthropometric Decreased skinfold thickness and mid-arm muscle circumference

Measurements BMI < 18.5 (adults)
BMI for older adults (older than 65 years) < 23
Birth to 2 years
Weight for age < 5th percentile
Weight for length < 5th percentile
Ages 2 to 20 years
Weight for stature < 5th percentile
BMI < 5th percentile (for children 2 to 20)
Weight for age < 5th percentile
Nutrition Focused Decreased muscle mass, muscle wasting (gluteal and temporal)
Physical Findings Hunger
Estimated intake of food less than estimated or measured needs

Limited supply of food in home
Food/Nutrition-
Dieting, food faddism
Related History
Refusal to eat
Physical activity more than recommended amount
Medications that affect appetite, eg, stimulants for ADHD
Malnutrition
Illness or physical disability
Client History*** Mental illness, dementia, confusion
Athlete, dancer, gymnast
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References
1. Assessment of nutritional status. In: Kleinman R, ed. Pediatric Nutrition Handbook. 5th ed. Elk Grove
Village, IL: American Academy of Pediatrics; 2004:407-423.
2. Beck AM, Ovesen LW. At which body mass index and degree of weight loss should hospitalized elderly
patients be considered at nutritional risk? Clin Nutr. 1998;17:195-198.
3. Blaum CS, Fries BE, Fiatarone MA. Factors associated with low body mass index and weight loss in
nursing home residents. J Gerontol A Biol Sci Med Sci. 1995;50A:M162-M168.
4. Cook Z, Kirk S, Lawrenson S, Sandford S. Use of BMI in the assessment of undernutrition in older
subjects: reflecting on practice. Proc Nutr Soc. Aug 2005;64:313-317.
5. Position of the American Dietetic Association: Food insecurity in the United States. J Am Diet Assoc.
2010;110:1368-1377.
6. Position of the Academy of Nutrition and Dietetics: Nutrition security in developing nations: Sustainable
food, water, and health. J Acad Nutr Diet. 2013;113:581-595.
7. Position of the American Dietetic Association: Nutrition intervention in the treatment of eating
8. Ranhoff AH, Gjoen AU, Mowe M. Screening for malnutrition in elderly acute medical patients: the
usefulness of MNA-SF. J Nutr Health Aging. Jul-Aug 2005;9:221-225.
9. Reynolds MW, Fredman L, Langenberg P, Magaziner J. Weight, weight change, and mortality in a
random sample of older community-dwelling women. J Am Geriatr Soc. 1999;47:1409-1414.
10. Schneider SM, Al-Jaouni R, Pivot X, Braulio VB, Rampal P, Hebuerne X. Lack of adaptation to severe
malnutrition in elderly patients. Clin Nutr. 2002;21:499-504.
11. Spear BA. Adolescent growth and development. J Am Diet Assoc. 2002;102(suppl):S23- S29.
12. Sullivan DH, Walls RC. Protein-energy undernutrition and the risk of mortality within six years of
hospital discharge. J Am Coll Nutr. 1998;17:571-578.
2020 EDITION
12/14/21, 8:51 AM Unintended* Weight Loss
UNINTENDED* WEIGHT LOSS
Unintended* Weight Loss (NC-3.2)

Definition
Decrease in body weight that is not planned or desired.
Note: May not be an appropriate nutrition diagnosis when changes in body weight are due to fluid.

Physiological causes increasing nutrient needs, eg, due to prolonged catabolic illness, trauma,
malabsorption
children
Prolonged hospitalization
Lack of self-feeding ability
Etiology Category


Nutrition
Category
Biochemical Data,
Medical Tests and

Procedures
Weight loss of ≥ 5% within 30 days, ≥ 7.5% in 90 days, or ≥ 10% in 180 days
(adults)
Anthropometric Not gaining weight as expected; 5% weight loss in 6 months and/or a shift
Measurements downward in growth percentiles, crossing two or more percentile channels on
reference growth standard charts (pediatrics)
Fever
Decreased senses, ie, smell, taste, vision
Increased heart rate
Nutrition Focused Increased respiratory rate
Physical Findings Loss of subcutaneous fat and muscle stores
Change in way clothes fit
Changes in mental status or function (eg, depression)
Food/Nutrition- Normal or usual estimated intake in face of illness

Related History Poor intake, change in eating habits, early satiety, skipped meals
Medications associated with weight loss, such as certain antidepressants x
Conditions associated with a diagnosis or treatment, eg, AIDS/HIV, burns, chronic

obstructive pulmonary disease, dysphagia, hip/long bone fracture, infection,
Client History*** surgery, trauma, hyperthyroidism (pre- or untreated), some types of cancer or
metastatic disease (specify), substance abuse
Cancer chemotherapy
Assessment,
Monitoring and
Evaluation Tools
*If a synonym, or alternate word with the same meaning, for the term “unintended” is helpful or needed, an
approved alternate is the word “involuntary.”
Progress Evaluation

References
1. Collins N. Protein-energy malnutrition and involuntary weight loss: nutritional and pharmacologic
strategies to enhance wound healing. Expert Opin Pharmacother. 2003;7:1121-1140.
2. Splett PL, Roth-Yousey LL, Vogelzang JL. Medical nutrition therapy for the prevention and treatment of
unintentional weight loss in residential healthcare facilities. J Am Diet Assoc. 2003;103:352-362.
3. Wallace JL, Schwartz RS, LaCroix AZ, Uhlmann RF, Pearlman RA. Involuntary weight loss in older
patients: incidence and clinical significance. J Am Geriatr Soc. 1995;43:329-337.
4. Academy of Nutrition and Dietetics. Unintended weight loss in older adults evidence-based nutrition
practice guideline. http://www.andevidencelibrary.com/topic.cfm?cat=3651&library=EBG. Accessed
June 12, 2015.
2020 EDITION
12/14/21, 8:51 AM Overweight/Obesity
OVERWEIGHT/OBESITY
Overweight/Obesity (NC-3.3)
Definition
Increased adiposity compared to established reference standards or recommendations, ranging from overweight
to morbid obesity.

Decreased energy needs

Disordered eating pattern
Excessive energy intake
Food- and nutrition-related knowledge deficit
Not ready for diet/lifestyle change
Physical inactivity
Increased psychological/life stress
Etiology Category


Nutrition
Category
Biochemical Data,
Medical Tests and ↓ Measured resting metabolic rate (RMR) less than expected and/or estimated
Procedures
Anthropometric BMI more than normative standard for age and sex:
Measurements Overweight: 25 to 29.9 (adults), 85th to 94th percentiles (pediatrics)
Obese Class I: 30 to 34.9 (adults)
Obese Class II: 35 to 39.9 (adults)
Obese Class III: 40+* (adults)
Obese > 95th percentile (pediatrics)
Waist circumference more than normative standard for age and sex
Increased skinfold thickness
Body fat percentage >25% for men and >32% for women
Weight for height more than normative standard for age and sex
Nutrition Focused Increased body adiposity

Physical Findings
Overconsumption of high-fat and/or energy-dense food or beverage

Large portions of food (portion size more than twice than recommended)
Estimated excessive energy intake
Infrequent, low-duration and/or low-intensity physical activity, factors affecting
physical activity access
Food/Nutrition- Large amounts of sedentary activities, eg, TV watching, reading, computer use in
Related History both leisure and work/school
Uncertainty regarding nutrition-related recommendations
Inability to apply nutrition-related recommendations
Unwillingness or disinterest in applying nutrition-related recommendations
Inability to lose a significant amount of excess weight through conventional
weight loss intervention
Medications that impact RMR, eg, midazolam, propranalol, glipizide
Conditions associated with a diagnosis or treatment, eg, hypothyroidism,

metabolic syndrome, eating disorder not otherwise specified, depression
Physical disability or limitation
Client History*** History of familial obesity
History of childhood obesity
History of physical, sexual, or emotional abuse
Assessment,
Monitoring and
Evaluation Tools
standard.
*If a synonym for the term “Obese Class III” is helpful or needed, an approved alternate is “morbid obesity.”
Progress Evaluation

References

June 12, 2015.
3. Crawford S. Promoting dietary change. Can J Cardiol. 1995;11(suppl A):14A-15A.
4. Dickerson RN, Roth-Yousey L. Medication effects on metabolic rate: a systematic review. J Am Diet
Assoc. 2005;105:835-843.
5. Kumanyika SK, Van Horn L, Bowen D, Perri MG, Rolls BJ, Czajkowski SM, Schron E. Maintenance of
dietary behavior change. Health Psychol. 2000;19(1 suppl):S42-S56.
6. NHLBI Guidelines on Overweight and Obesity, Electronic Textbook.
http://www.nhlbi.nih.gov/guidelines/obesity/e_txtbk/index.htm. Accessed May 16, 2014.
7. Pateyjohns IR, Brinkorth GD, Buckley JD, Noakes M, Clifton PM. Comparison of three bioelectrical
impedance methods with DXA in overweight and obese men. Obesity. 2006;14(11):2064-70.
Diet. 2013;113:307-317.
12. Shepherd R. Resistance to changes in diet. Proc Nutr Soc. 2002;61:267-272.
13. Sun G, French CR, Martin GR, Younghusband B, Green RD, Xie YG, Mathews M, Barron JR,
Fitzpatrick DG, Gulliver W, Zhang. Comparison of multifrequency bioelectrical impedance analysis with
dual-energy x-ray absorptiometry for assessment of percentage body fat in a large, healthy
population. Am J Clin Nutr. 2005;81(1):74-8.
14. Thompson R, Brinkworth GD, Buckley JD, Noakes M, Clifton PM. Good agreement between
bioelectrical impedance and dual-energy x-ray absorptiometry for estimating changes in body
composition during weight loss in overweight young women. Clin Nutr. 2007;26(6):771-7.
15. US Preventive Services Task Force. Behavioral counseling in primary care to promote a healthy diet. Am
J Prev Med. 2003;24:93-100.
2020 EDITION
12/14/21, 8:52 AM Unintended* Weight Gain
UNINTENDED* WEIGHT GAIN
Unintended* Weight Gain (NC-3.4)

Definition
Weight gain more than that which is desired or planned.

Illnesses or conditions causing unexpected weight gain because of eg, head trauma, immobility, paralysis
or related condition, Cushings's syndrome, hypothyroidism, other endocrine disorders
Chronic use of medications known to cause weight gain, such as use of certain antidepressants,
antipsychotics, corticosteroids, certain HIV medications
Condition leading to excessive fluid weight gains
Etiology Category


Nutrition
Category
Biochemical Data, ↓ Serum albumin
Medical Tests and ↓ Sodium, serum
Procedures ↑ Fasting serum lipid levels
↑ Fasting glucose levels
Fluctuating hormone levels
Cortisol
↑ Growth hormone
↑ Thyroid stimulating hormone
↓ Thyroxine (T4)
Increased weight, any increase in weight more than planned or desired

Anthropometric Weight gain of > 5% within 30 days, > 7.5% in 90 days, or > 10% in 180 days
Measurements (adults)
Fat accumulation, excessive subcutaneous fat stores, noticeable change in body fat
distribution
Extreme hunger with or without palpitations, tremor, and sweating
Nutrition Focused Edema
Physical Findings Shortness of breath
Muscle weakness
Fatigue
Estimated intake inconsistent with estimated or measured energy needs

Changes in recent estimated food intake level
Food/Nutrition-
Fluid administration more than requirements
Related History
Use of alcohol, narcotics
Medications associated with increased appetite
Physical inactivity or change in physical activity level
Conditions associated with a diagnosis or treatment of asthma, psychiatric

Client History*** illnesses, rheumatic conditions, Cushing’s syndrome, obesity, Prader-Willi
syndrome, Down's syndrome, spina bifida, hypothyroidism, pituitary conditions
Assessment,
Monitoring and
Evaluation Tools
standard.
**If a synonym, or alternate word with the same meaning, for the term “unintended” is helpful or needed, an
approved alternate is the word “involuntary.”
Progress Evaluation

References
1. Kaiser LL, Campbell CG. Practice paper of the Academy of Nutrition and Dietetics abstract: nutrition and
lifestyle for a healthy pregnancy outcome. J Acad Nutr Diet. 2014;114(9):1447
2. Procter SB, Campbell CG. Position of the Academy of Nutrition and Dietetics: nutrition and lifestyle for
a healthy pregnancy outcome. J Acad Nutr Diet. 2014;114(7):1099-1103.
3. Ogata BN, Hayes D. Position of the Academy of Nutrition and Dietetics: nutrition guidance for healthy
children ages 2 to 11 years. J Acad Nutr Diet. 2014;114(8):1257-1276.
2020 EDITION
12/14/21, 8:52 AM Growth Rate Below Expected
GROWTH RATE BELOW EXPECTED
Growth Rate Below Expected (NC-3.5)

Definition
Rate of growth or growth velocity slower than expected, or weight gain that is suboptimal in comparison with
goal or reference standard.

Physiological impetus for increased nutrient needs (eg, critical illness or trauma; pregnancy; metabolic
illness, eg, type 1 diabetes; malabsorption)
Lack of or limited access to food
Psychological causes, such as depression or disordered eating pattern
Limited food acceptance
Small for gestational age, intrauterine growth restriction/retardation, lack of appropriate weight gain,
hyperemesis gravidarum
Etiology Category


Nutrition
Category
Biochemical Data, Positive urine ketones, ↑ fasting (or postprandial) glucose level
Medical Tests and Fluctuating hormone levels during pregnancy
Procedures Zinc deficiency
Iron deficiency
Abnormal protein, fatty acid or carbohydrate metabolism profile
Weight-for-age decrease in 2 or more percentile channels

Weight-gain velocity less than expected, based on established reference standard
Anthropometric and/or guideline
Measurements Length- or height-for-age decrease in 2 or more percentile channels
Length- or height-gain velocity less than expected, based on established reference
standard and/or guideline
Decreased muscle mass, muscle wasting (gluteal and temporal)

Nutrition Focused Hunger
Physical Findings Decreased fat mass
Estimated energy intake inconsistent with estimated or measured needs.

Restricted fluids decreasing ability to meet nutritional needs
Difficulty breastfeeding, eg, poor latch
Limited food acceptance, eg, not progressing to foods as expected or
Food/Nutrition-
recommended
Related History
Medications associated with decreased appetite or weight loss
Use of alcohol or narcotics during pregnancy
Increase in physical activity levels
Normal or usual intake in presence of illness
Poor intake, change in eating habits, early satiety, or skipped meals
Conditions associated with a diagnosis or treatment impacting growth, including

AIDS/HIV, burns, pulmonary disease, dysphagia, long bone fracture, infection,
Client History*** surgery, trauma, hyperthyroid, hypothyroid, substance abuse, some types of cancer
or metastatic disease, inborn errors of metabolism.
Food insecurity
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References

Village, IL: American Academy of Pediatrics; 2009:559-576, 733-782.
3. Health Canada. Prenatal Guidelines Nutrition Guidelines for Health Professionals: Gestational Weight
Gain, 2010. http://www.hc-sc.gc.ca/fn-an/nutrition/prenatal/index-eng.php. Accessed June 12, 2015.
4. Institute of Medicine, Weight Gain During Pregnancy: Reexamining the Guidelines2009.
http://www.iom.edu/~/media/Files/Report%20Files/2009/Weight-Gain-During-Pregnancy-Reexamining-
the-Guidelines/Report%20Brief%20-%20Weight%20Gain%20During%20Pregnancy.pdf. Accessed June
12, 2015.
2020 EDITION
12/14/21, 8:52 AM Excessive Growth Rate
EXCESSIVE GROWTH RATE
Excessive Growth Rate (NC-3.6)

Definition
Rate of growth or growth velocity, during a period of growth (childhood, adolescence, pregnancy), that is higher
in comparison with a goal, reference standard, or physiological needs.

Physiological change resulting in decreased energy needs or unexpected growth rate

Frequent intake of energy-dense foods
Physical inactivity
Chronic use of medications, eg, antidepressants, antipsychotics and corticosteroids
Etiology Category


Nutrition
Category
Biochemical Data, ↑ Cortisol
Medical Tests and ↑ Growth hormone
Procedures ↑ Thyroid stimulating hormone
↓ Thyroxine (T4)
Weight gain greater than expected based on reference standard, recommendations,

or understanding of growth pattern
Weight gain velocity greater than expected, based on reference standard and/or
Anthropometric guidelines
Measurements Weight-for-length or BMI-for-age increase greater than expected
Rate of weight gain during pregnancy greater than expected
Fundal height greater than number of weeks of gestation
Nutrition Focused
Physical Findings
Estimated energy intake inconsistent with estimated or measured needs

Food/Nutrition-
Medications associated with increased appetite or weight gain
Related History
Decrease in physical activity
Beliefs, attitudes and behaviors that do not represent readiness to change
Conditions associated with a diagnosis or treatment impacting growth, eg, Prader-

Willi syndrome, Down syndrome, spina bifida, giantism, pituitary tumor,
Client History*** Cushing's syndrome, hypothyroidism, and neurological conditions that impact
satiety
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References

Village, IL: American Academy of Pediatrics; 2009:559-576, 733-782.
3. Health Canada. Prenatal Guidelines Nutrition Guidelines for Health Professionals: Gestational Weight
Gain, 2010. http://www.hc-sc.gc.ca/fn-an/nutrition/prenatal/index-eng.php. Accessed June 12, 2015.
4. Institute of Medicine, Weight Gain During Pregnancy: Reexamining the Guidelines 2009.
http://www.iom.edu/~/media/Files/Report%20Files/2009/Weight-Gain-During-Pregnancy-Reexamining-
the-Guidelines/Report%20Brief%20-%20Weight%20Gain%20During%20Pregnancy.pdf. Accessed June
12, 2015.
5. Morse K, et al. Fetal growth screening by fundal height measurement. Best Practice & Research Clinical
Obstetrics and Gynecology. 2009; 23: 809-818.
2020 EDITION
12/14/21, 9:06 AM Malnutrition (undernutrition)
MALNUTRITION (UNDERNUTRITION)
Clinical Domain – Malnutrition Disorders
Malnutrition (undernutrition) (NC-4-1)

Definition
Inadequate intake of protein and/or energy sufficient to negatively impact growth/development, and/or to result
in loss of fat and or muscle stores.
Adult malnutrition notes. There is an ongoing international effort to harmonize the definitions of adult
malnutrition.1 At present, the eNCPT malnutrition indicator criteria provided in the adult malnutrition
reference sheets reflect the malnutrition clinical characteristics (MCC) Academy/ASPEN Adult
Malnutrition Consensus Statement.2 Three additional validated nutrition assessment approaches, the
Subjective Global Assessment, the Patient Generated Subjective Global Assessment, and the Mini-
Nutritional Assessment Long Form, to identify malnutrition are also in a chart that follows the MCC in
the adult malnutrition reference sheets and may be used to identify malnutrition*.
The Academy/ASPEN Adult Malnutrition Consensus Statement recommends a minimum of two clinical
characteristics or indicators be present for diagnosis of malnutrition. For additional information please
visit the Academy’s Web page at: http://www.eatrightpro.org/resources/practice/practice-
resources/malnutrition.
Pediatric malnutrition note. The Academy/ASPEN Pediatric Malnutrition Consensus Statement

recommends specific indicators when only one indicator is present and additional indicators when two or
more indicators are present for diagnosis of malnutrition.

Please refer to the reference sheets for the type and severity of adult or pediatric malnutrition
(undernutrition) etiologies
Nutrition
Potential Indicators of This Nutrition Diagnosis (two or more adult MCC indicators
Assessment
recommended to be present; one or more pediatric indicators)
Category
Biochemical Data,
Medical Tests and
Procedures
Please refer to the reference sheets for the type and severity of adult or pediatric
Anthropometric
malnutrition (undernutrition) indicators
Measurements
Nutrition Focused
malnutrition (undernutrition) indicators
Physical Findings
Food/Nutrition- Please refer to the reference sheets for the type and severity of adult or pediatric
Related History malnutrition (undernutrition) indicators
Client History malnutrition (undernutrition) indicators
12/14/21, 9:06 AM Malnutrition (undernutrition)
References
Please refer to the reference sheets for the type and severity of adult or pediatric malnutrition
(undernutrition) indicators
2020 EDITION
12/14/21, 9:06 AM Starvation Related Malnutrition (undernutrition)
STARVATION RELATED MALNUTRITION (UNDERNUTRITION)
Starvation Related Malnutrition (undernutrition) (NC-4.1.1)

Definition
Inadequate intake of protein and/or energy over a period of time sufficient to result in loss of fat and/or muscle
mass without apparent inflammation and in the context of environmental and/or social circumstances. Indicators
for identifying Moderate (non severe) and Severe starvation related malnutrition characteristics are included
here.
Note: There is an ongoing international effort to harmonize the definitions of adult malnutrition.1 At
present, the eNCPT malnutrition indicator criteria provided reflect the malnutrition clinical
characteristics (MCC) Academy/ASPEN Adult Malnutrition Consensus Statement.2 Three additional
validated nutrition assessment approaches, the Subjective Global Assessment, the Patient Generated
Subjective Global Assessment, and the Mini-Nutritional Assessment Long Form, to identify malnutrition
are also in a chart that follows the MCC and may be used to identify malnutrition*.
The Academy/ASPEN Adult Malnutrition Consensus Statement recommends a minimum of two clinical
characteristics or indicators be present for diagnosis of malnutrition. For additional information please
visit the Academy’s Web page at: https://www.eatrightpro.org/practice/practice-resources/malnutrition.

children, neglect or abuse, recent immigration/refugee from poorly resourced or war-torn countries
Cultural or religious practices that affect the ability to access food
Food- and nutrition-related knowledge deficit concerning amount of energy and amount and type of
dietary protein
Behavioral/psychological causes, eg, depression or eating disorders
Oral health limitations
Impaired sensory perception impacting food consumption
Etiology Category

https://www.ncpro.org/pubs/2020-encpt-en/codeNC-4-1-1 1/5

Nutrition
Potential Indicators of This Nutrition Diagnosis (two or more MCC indicators
Assessment
recommended to be present)
Category
Biochemical Data,
Medical Tests, and
Procedures
Malnutrition can occur at any weight/BMI
Inadequate maternal weight gain
Anthropometric Moderate (non severe) malnutrition: Unintentional weight loss, adults, of 20% in 1
Measurements year; 10% in 6 months; 7.5% in 3 months; 5% in 1 month
Severe malnutrition: Unintentional weight loss, adults, of >20% in 1 year; >10%
in 6 months; >7.5% in 3 months; or >5% in 1 month
Moderate (non severe) malnutrition

Mild loss of subcutaneous fat, eg, orbital, triceps, fat overlying the ribs
Mild muscle loss, eg, wasting of the temples (temporalis muscle), clavicles
(pectoralis & deltoids), shoulders (deltoids), interosseous muscles, scapula
(latissimus dorsi, trapezious, deltoids), thigh (quadriceps) and calf (gastrocnemius)
Mild localized or generalized fluid accumulation (extremities, vulvar/scrotal,
ascites)
Nutrition Focused
Physical Findings Severe malnutrition
Severe loss of subcutaneous fat, eg, orbital, triceps, fat overlying the ribs
Severe muscle loss, eg, wasting of the temples (temporalis muscle), clavicles
Severe localized or generalized fluid accumulation (extremities, vulvar/scrotal,
ascites)

Estimated energy intake < 75% of estimated energy requirement for ≥ 3 months
Severe malnutrition
Food/Nutrition- Estimated energy intake ≤ 50% of estimated energy requirement for ≥ 1 months
Related History Measurably reduced changes in grip strength or other functional indicators
Note. Handgrip strength in adults: norms are device dependent; can identify presence of
malnutrition but not quantify the degree of the deficit; may not be able to perform on
certain clients. Please refer to the Academy/ASPEN Adult and Pediatric Malnutrition
Consensus Statements for further information.
Client History*** Reports or observations of the following, for example:
Anorexia nervosa, benign esophageal stricture, abuse, neglect, poverty, frailty, and
anything that results in limited access to food (associated with malnutrition in the
context of environmental and social circumstances
Existing medical diagnosis of malnutrition including malnutrition
Genetic or acquired conditions: Cerebral Palsy, cystic fibrosis, seizure disorders,
metabolic disease, IBD
Subjective global assessment (SGA) rating

Assessment,
Patient generated subjective global assessment (PG-SGA) rating
Monitoring and
Patient generated subjective global assessment (PG-SGA) score
Evaluation Tools
Mini nutritional assessment long form (MNA-LF) rating
* In the past, hepatic transport protein measures (eg, albumin and prealbumin) were used as indicators of
malnutrition. See the Evidence Analysis Library questions on this topic at
https://www.andevidencelibrary.com/topic.cfm?cat=4302. Accessed April 3, 2017.
*Nutrition Assessment Tools for Identifying Malnutrition
MCC's
Assessment Parameter SGA PG-SGA MNA-LF (this tool is not

validated)
Ottery, F. 2015 Guigoz, Y et al. AND/ASPEN

Detsky, A.S. et al.
Name/Author/Year http://pt- 1994 http://mna- Consensus Statement
19874
global.org/18 elderly.com/ 19, 20 20122
Weight loss/BMI± X X X X
Dietary Intake± X X X X
GI Symptoms X X
Co-morbidity X X
Metabolic demand X
Functional capacity± X X X X
Fluid status
X X X
(edema/ascites)
Mid Arm
Fat stores± X X X
Circumference, Calf
Muscle stores± X X X
Circumference
Neuropsychological X
Rating: Rating: Numerical score: 2 or more
SGA A (well SGA A/B/C No nutritional risk characteristics
nourished) (assessed per SGA) Risk of malnutrition demonstrated out of 6
Method of SGA B (mild- Scores for triaging Malnourished identifies malnutrition;
categorization moderate nutrition Severity defined by
malnutrition) interventions specific thresholds
SGA C (severe
malnutrition)
Acute Acute Acute
Rehabilitation Rehabilitation
Validated: Setting Community Community
Residential Aged Long term care
Care
Surgery Oncology Geriatric
Geriatric Renal
Validated: Client Group
Oncology Stroke
Renal
Validated: Ages Adults of all ages Adults of all ages Adults ≥ 65 years
± Parameters that most influence the rating
Progress Evaluation

References
1. Cederholm T, Jensen G. To create a consensus on malnutrition diagnostic criteria: A report from the
global leadership initiative on malnutrition (GLIM) meeting at the ESPEN congress 2016. J Parent
Enteral Nutr. 2017; 36(1):7-10.
2. White JV, Guenter P, Jensen G, Malone A, Schofield M, the Academy Malnutrition Work Group; the
A.S.P.E.N. Malnutrition Task Force; and the A.S.P.E.N. Board of Directors. Consensus statement of the
Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition:
Characteristics recommended for the identification and documentation of adult malnutrition
(undernutrition). J Acad Nutr Diet. 2012;112(5):730-738.
3. Blackburn GL, Bistrian BR, Maini BS, Schlamm HT, Smith MF. Nutritional and metabolic assessment of
the hospitalized patient. JPEN J Parenter Enteral Nutr. 1977;1(1):11-22.
4. Detsky AS, McLaughlin JR, Baker JP et al. What is subjective global assessment of nutritional status?
JPEN J Parenter Enteral Nutr. 1987;11(1):8-13.
5. Hagan JC. Acute and Chronic Diseases. In: RM M, ed. Encyclopedia of Health Services Research. Vol 1.
Thousand Oaks, CA: Sage; 2009:25.
6. Jensen GL, Mirtallo J, Compher C, et al. Adult starvation and disease-related malnutrition: a proposal for
etiology-based diagnosis in the clinical practice setting from the International Consensus Guideline
Committee. JPEN J Parenter Enteral Nutr. 2010;34(2):156-159.
7. Klein S, Kinney J, Jeejeebhoy K, et al. Nutrition support in clinical practice: Review of published data
and recommendations for future research directions. National Institutes of Health, American Society for
Parenteral and Enteral Nutrition, and American Society for Clinical Nutrition. JPEN J Parenter Enteral
Nutr. 1977;21(3):133-156.
8. Keys A. Chronic undernutrition and starvation with notes on protein deficiency. J Amer Med Assoc.
1948;138:500-511.
9. Kondrup J. Can food intake in hospitals be improved? Clin Nutr. 2001;20:153-160.
10. Norman K, Stobaus N, Gonzalez MC, Schulzke J-D, Pirlich M. Hand grip strength : Outcome predictor
and marker of nutritional status. Clin Nutr. 2011;30(2):135-142.
11. Rosenbaum K, Wang J, Pierson RN, Kotler DP. Time-dependent variation in weight and body
composition in healthy adults. JPEN J Parenter Enteral Nutr. 2000;24(2):52-55.
February12, 2018.
13. Academy of Nutrition and Dietetics. Evidence Analysis Library: Serum proteins. 2009;
cat=4302&conclusion_statement_id=251265&highlight=serum%20proteins&home=1. Accessed
February 12, 2018.
14. Academy of Nutrition and Dietetics Evidence Analysis Library. Does serum prealbumin correlate with
nitrogen balance? http://www.andevidencelibrary.com/conclusion.cfm?
conclusion_statement_id=251315&highlight=prealbumin&home=1. Accessed February 12, 2018.
15. Fisher S, Ottenbacher KJ, Goodwin JS, Graham JE, Ostir GV. Short physical performance battery in
hospitalized older adults. Aging Clin Exp Res. 2009;21(6):445-452.
16. Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower
extremity function: Association with self-reported disability and prediction of mortality and nursing home
admission. J Gerontol. 1994;49(2):M85-M94.

17. 17. Hand RK, Murphy WJ, Field LB, et al. Validation of the Academy/A.S.P.E.N. malnutrition clinical
characteristics. J Acad Nutr Diet. 2016;116(5):856–864.
18. Scored Patient Generated Subjective Global Assessment. Available at http://pt-global.org/. February 12,
2018.
19. Guigoz, Y., Vellas, B., & Garry, P.J. Mini Nutritional Assessment: A practical assessment tool for grading
the nutritional state of elderly patients. Facts Res Gerontol. 1994;4(suppl 2):15-59.
20. Mini-Nutrition Assessment Long Form. Available at http://mna-elderly.com/. Accessed February 12,
2018.
21. Cederholm T, Bosaeus I, Barazzoni R, et al. Diagnostic criteria for malnutrition - An ESPEN consensus
statement. Clin Nutr. 2015;34(3):335-340.
2020 EDITION
12/14/21, 9:06 AM Chronic Disease or Condition Related Malnutrition (undernutrition)
CHRONIC DISEASE OR CONDITION RELATED MALNUTRITION (UNDERNUTRITION)
Chronic Disease or Condition Related Malnutrition (undernutrition) (NC-4.1.2)

Definition
Inadequate intake of protein and/or energy over a period of time sufficient to result in loss of fat and/or muscle mass with apparent mild to moderate inflammation
and in the context of chronic illness or condition. Indicators for identifying Moderate (non severe) and Severe chronic disease or condition related malnutrition
characteristics are included here.
Note: There is an ongoing international effort to harmonize the definitions of adult malnutrition.1 At present, the eNCPT malnutrition indicator criteria
provided reflect the malnutrition clinical characteristics (MCC) Academy/ASPEN Adult Malnutrition Consensus Statement.2 Three additional validated
nutrition assessment approaches, the Subjective Global Assessment, the Patient Generated Subjective Global Assessment, and the Mini-Nutritional
Assessment Long Form, to identify malnutrition are also in a chart that follows the MCC and may be used to identify malnutrition*.
The Academy/ASPEN Adult Malnutrition Consensus Statement recommends a minimum of two clinical characteristics or indicators be present for diagnosis
of malnutrition. For additional information please visit the Academy’s Web page at: https://www.eatrightpro.org/practice/practice-resources/malnutrition.

Factors gathered during the nutrition assessment process that contribute to the existence or the maintenance of pathophysiological, psychosocial, situational,
developmental, cultural, and/or environmental problems:
Physiological causes increasing nutrient needs due to illness or condition

Physiological causes resulting in anorexia or diminished intake
Etiology Category
Etiologies are grouped by the type of cause or contributing risk factor. Communicate the etiology category by selecting the appropriate Nutrition Assessment,
Monitoring and Evaluation term:

Visit the Nutrition Diagnosis Etiology Category Identification reference sheet for more details on etiology categories. An additional useful resource to determine
the etiology category is the Nutrition Diagnosis Matrix.

A typical cluster of subjective and objective signs and symptoms gathered during the nutrition assessment process that provide evidence that a problem exists;
quantify the problem and describe its severity.
Potential Indicators of This Nutrition Diagnosis (two or more MCC indicators recommended to be present)
Category
Biochemical Data, Medical
Tests and Procedures
Moderate (non severe) malnutrition: Unintentional weight loss, adults, of 20% in 1 year; 10% in 6 months; 7.5% in 3
Anthropometric Measurements months; 5% in 1 month
Severe malnutrition: Unintentional weight loss, adults, of >20% in 1 year; >10% in 6 months; >7.5% in 3 months; or >5%
in 1 month

Mild muscle loss, eg, wasting of the temples (temporalis muscle), clavicles (pectoralis & deltoids), shoulders (deltoids),
interosseous muscles, scapula (latissimus dorsi, trapezious, deltoids), thigh (quadriceps) and calf (gastrocnemius)
Mild localized or generalized fluid accumulation (extremities, vulvar/scrotal, ascites)
Nutrition Focused Physical
Findings Severe malnutrition
Severe muscle loss, eg, wasting of the temples (temporalis muscle), clavicles (pectoralis & deltoids), shoulders (deltoids),
Severe localized or generalized fluid accumulation (extremities, vulvar/scrotal, ascites)
Food/Nutrition-Related History Reports or observations of:
Estimated energy intake < 75% of estimated energy requirement for ≥ 1 months
Severe malnutrition
Estimated energy intake < 75% of estimated energy requirement for ≥ 1 month
Measurably reduced changes in grip strength or other functional indicators
Note. Handgrip strength in adults: norms are device dependent; can identify presence of malnutrition but not quantify the degree
of the deficit; may not be able to perform on certain clients. Please refer to the Academy/ASPEN Adult and Pediatric Malnutrition
Reports or observations of the following, for example:
Organ failure, malignancies, rheumatoid diseases, gastrointestinal diseases, sarcopenic obesity, malabsorptive syndromes,
and other etiologies including but not limited to diabetes, congestive heart failure, chronic kidney disease, and chronic
Client History***
obstructive pulmonary disease (associated with malnutrition in the context of chronic disease/condition)
Existing medical diagnosis of malnutrition including malnutrition
Genetic or acquired conditions: Cerebral Palsy, cystic fibrosis, seizure disorders, metabolic disease, IBD

Assessment, Monitoring and Patient generated subjective global assessment (PG-SGA) rating
Evaluation Tools Patient generated subjective global assessment (PG-SGA) score
+ In the past, hepatic transport protein measures (eg, albumin and prealbumin) were used as indicators of malnutrition. See the Evidence Analysis Library
questions on this topic at https://www.andevidencelibrary.com/topic.cfm?cat=4302. Accessed April 3, 2017.
MCC's
Assessment Parameter SGA PG-SGA MNA-LFF
(this tool is not validated)
Ottery, F. 2015 http://pt- Guigoz, Y et al. 1994 AND/ASPEN Consensus

Name/Author/Year Detsky, A.S. et al. 19874
global.org/18 http://mna-elderly.com/ 19, 20 Statement 20122
GI Symptoms X X
Co-morbidity X X
Metabolic demand X
Fluid status (edema/ascites) X X X
Fat stores± X X Mid Arm Circumference, Calf X
Muscle stores± X X Circumference X
Rating: Rating: Numerical score: 2 or more characteristics
SGA A (well nourished) SGA A/B/C No nutritional risk demonstrated out of 6 identifies
Method of categorization SGA B (mild- moderate (assessed per SGA) Risk of malnutrition malnutrition;
malnutrition) Scores for triaging nutrition Malnourished Severity defined by specific
SGA C (severe malnutrition) interventions thresholds
Acute Acute Acute
Validated: Setting
Community Community
Residential Aged Care Long term care
Geriatric Renal
Oncology Stroke
Renal
Progress Evaluation
Communicate the progress toward the resolution of a nutrition diagnosis by selecting the appropriate nutrition diagnosis status value from the Nutrition
Assessment, Monitoring, and Evaluation terms:

References
1. Cederholm T, Jensen G. To create a consensus on malnutrition diagnostic criteria: A report from the global leadership initiative on malnutrition (GLIM)
meeting at the ESPEN congress 2016. J Parent Enteral Nutr. 2017; 36(1):7-10.
2. White JV, Guenter P, Jensen G, Malone A, Schofield M. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral
and Enteral Nutrition: Characteristics Recommended for the identification and documentation of adult malnutrition (undernutrition). J Acad Nutr Diet.
2012;112(5):730-738.
3. Blackburn GL, Bistrian BR, Maini BS, Schlamm HT, Smith MF. Nutritional and metabolic assessment of the hospitalized patient. JPEN J Parenter Enteral
Nutr. 1977;1(1):11-22.
4. Detsky AS, McLaughlin JR, Baker JP et al. What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr. 1987;11(1):8-13.
5. Hagan JC. Acute and Chronic Diseases. In: RM M, ed. Encyclopedia of Health Services Research. Vol 1. Thousand Oaks, CA: Sage; 2009:25.
6. Jensen GL, Mirtallo J, Compher C, et al. Adult starvation and disease-related malnutrition: a proposal for etiology-based diagnosis in the clinical practice
setting from the International Consensus Guideline Committee. JPEN J Parenter Enteral Nutr. 2010;34(2):156-159.
7. Klein S, Kinney J, Jeejeebhoy K, et al. Nutrition support in clinical practice: Review of published data and recommendations for future research directions.
National Institutes of Health, American Society for Parenteral and Enteral Nutrition, and American Society for Clinical Nutrition. JPEN J Parenter Enteral
Nutr. 1977;21(3):133-156.
8. Keys A. Chronic undernutrition and starvation with notes on protein deficiency. J Amer Med Assoc. 1948;138:500-511.
10. Norman K, Stobaus N, Gonzalez MC, Schulzke J-D, Pirlich M. Hand grip strength : Outcome predictor and marker of nutritional status. Clin Nutr.
2011;30(2):135-142.
11. Rosenbaum K, Wang J, Pierson RN, Kotler DP. Time-dependent variation in weight and body composition in healthy adults. JPEN J Parenter Enteral Nutr.
2000;24(2):52-55.
12. Academy of Nutrition and Dietetics. Nutrition Care Manual. www.nutritioncaremanual.org. Accessed February 12, 2018.
13. Academy of Nutrition and Dietetics. Evidence Analysis Library: Serum proteins. 2009; http://www.andeal.org/topic.cfm?
cat=4302&conclusion_statement_id=251265&highlight=serum%20proteins&home=1. Accessed February 12, 2018.
14. Academy of Nutrition and Dietetics Evidence Analysis Library. Does serum prealbumin correlate with nitrogen balance?
http://www.andevidencelibrary.com/conclusion.cfm?conclusion_statement_id=251315&highlight=prealbumin&home=1. Accessed February 12, 2018.
15. Fisher S, Ottenbacher KJ, Goodwin JS, Graham JE, Ostir GV. Short physical performance battery in hospitalized older adults. Aging Clin Exp Res.
2009;21(6):445-452.
16. Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: Association with self-reported
disability and prediction of mortality and nursing home admission. J Gerontol. 1994:40(2):M85-M94.
17. Hand RK, Murphy WJ, Field LB, et al. Validation of the Academy/A.S.P.E.N. malnutrition clinical characteristics. J Acad Nutr Diet. 2016;116(5):856–864.
18. Scored Patient Generated Subjective Global Assessment. Available at http://pt-global.org/. Accessed February 12, 2018.
19. Guigoz Y, Vellas B, Garry PJ. Mini Nutritional Assessment: A practical assessment tool for grading the nutritional state of elderly patients. Facts Res
Gerontol. 1994;4(suppl 2):15-59.
20. Mini-Nutrition Assessment Long Form. Available at http://mna-elderly.com/. Accessed February 12, 2018.
21. Cederholm T, Bosaeus I, Barazzoni R, et al. Diagnostic criteria for malnutrition - An ESPEN consensus statement. Clin Nutr. 2015;34(3):335-340
2020 EDITION
12/14/21, 9:11 AM Acute Disease or Injury Related Malnutrition (undernutrition)
ACUTE DISEASE OR INJURY RELATED MALNUTRITION (UNDERNUTRITION)
Acute Disease or Injury Related Malnutrition (undernutrition) (NC-4.1.3)

Definition
Inadequate intake of protein and/or energy resulting in loss of fat and/or muscle mass with apparent marked inflammatory response and in the context of acute
illness or injury. Indicators for identifying Moderate (non severe) and Severe acute disease or injury related malnutrition are included here.
Note: There is an ongoing international effort to harmonize the definitions of adult malnutrition.1 At present, the eNCPT malnutrition indicator criteria
provided reflect the malnutrition clinical characteristics (MCC) Academy/ASPEN Adult Malnutrition Consensus Statement.2 Three additional validated
nutrition assessment approaches, the Subjective Global Assessment, the Patient Generated Subjective Global Assessment, and the Mini-Nutritional
Assessment Long Form, to identify malnutrition are also in a chart that follows the MCC and may be used to identify malnutrition*.
The Academy/ASPEN Adult Malnutrition Consensus Statement recommends a minimum of two clinical characteristics or indicators be present for diagnosis
of malnutrition. For additional information please visit the Academy’s Web page at: https://www.eatrightpro.org/practice/practice-resources/malnutrition.

Factors gathered during the nutrition assessment process that contribute to the existence or the maintenance of pathophysiological, psychosocial, situational,
developmental, cultural, and/or environmental problems:
Physiological causes increasing nutrient needs due to acute illness or injury/trauma
Physiological causes resulting in anorexia or diminished intake
Food- and nutrition-related knowledge deficit concerning amount of energy and amount and type of dietary protein
Etiology Category
Etiologies are grouped by the type of cause or contributing risk factor. Communicate the etiology category by selecting the appropriate Nutrition Assessment,
Monitoring and Evaluation term:

Visit the Nutrition Diagnosis Etiology Category Identification reference sheet for more details on etiology categories. An additional useful resource to determine
the etiology category is the Nutrition Diagnosis Matrix.

A typical cluster of subjective and objective signs and symptoms gathered during the nutrition assessment process that provide evidence that a problem exists;
quantify the problem and describe its severity.
Potential Indicators of This Nutrition Diagnosis (two or more MCC indicators recommended to be present)
Category
Biochemical Data, Medical
Tests, and Procedures
Anthropometric Measurements Moderate (non severe) malnutrition: Unintentional weight loss, adults, of 7.5% in 3 months; 5% in 1 month; or 1-2% in 1
week
Severe malnutrition: Unintentional weight loss, adults, of >7.5% in 3 months; or >5% in 1 month; or >2% in 1 week

Mild loss of subcutaneous fat, e.g., orbital, triceps, fat overlying the ribs
Mild muscle loss, e.g., wasting of the temples (temporalis muscle), clavicles (pectoralis & deltoids), shoulders (deltoids),
Mild localized or generalized fluid accumulation (extremities, vulvar/scrotal, ascites)
Nutrition Focused Physical
Severe malnutrition
Findings
Moderate loss of subcutaneous fat, e.g., orbital, triceps, fat overlying the ribs
Moderate muscle loss, e.g., wasting of the temples (temporalis muscle), clavicles (pectoralis & deltoids), shoulders
(deltoids), interosseous muscles, scapula (latissimus dorsi, trapezious, deltoids), thigh (quadriceps) and calf
(gastrocnemius)
Moderate to severe localized or generalized fluid accumulation (extremities, vulvar/scrotal, ascites)
Food/Nutrition-Related History Reports or observations of:
Estimated energy intake < 75% of estimated energy requirement for > 7 days
Severe malnutrition
Estimated energy intake ≤ 50% of estimated energy requirement for ≥ 5 days
Measurably reduced changes in grip strength or other functional indicators
Note. Handgrip strength in adults: norms are device dependent; can identify presence of malnutrition but not quantify the degree
of the deficit; may not be able to perform on certain clients. Please refer to the Academy/ASPEN Adult and Pediatric Malnutrition
Major infections such as sepsis, pneumonia, peritonitis, and wound infections, major burns, trauma, closed head injury,
Client History*** acute lung injury, adult respiratory distress syndrome, and selected major surgeries (associated with malnutrition in the
context of acute injury/illness)
Preexisting medical diagnosis of malnutrition

Assessment, Monitoring and Patient generated subjective global assessment (PG-SGA) rating
Evaluation Tools Patient generated subjective global assessment (PG-SGA) score
* In the past, hepatic transport protein measures (eg, albumin and prealbumin) were used as indicators of malnutrition. See the Evidence Analysis Library
questions on this topic at https://www.andevidencelibrary.com/topic.cfm?cat=4302. Accessed April 3, 2017.
MCC's
Assessment Parameter SGA PG-SGA MNA-LFALF
(this tool is not validated)
Ottery, F. 2015 http://pt- Guigoz, Y et al. 1994 AND/ASPEN Consensus

Name/Author/Year Detsky, A.S. et al. 19874
global.org/18 http://mna-elderly.com/ 19, 20 Statement 20122
GI Symptoms X X
Co-morbidity X X
Metabolic demand X
Fluid status (edema/ascites) X X X
Fat stores± X X Mid Arm Circumference, Calf X
Muscle stores± X X Circumference X
Rating: Rating: Numerical score: 2 or more characteristics
SGA A (well nourished) SGA A/B/C No nutritional risk demonstrated out of 6 identifies
Method of categorization SGA B (mild- moderate (assessed per SGA) Risk of malnutrition malnutrition;
malnutrition) Scores for triaging nutrition Malnourished Severity defined by specific
SGA C (severe malnutrition) interventions thresholds
Acute Acute Acute
Validated: Setting
Community Community
Residential Aged Care Long term care
Geriatric Renal
Oncology Stroke
Renal
Progress Evaluation
Communicate the progress toward the resolution of a nutrition diagnosis by selecting the appropriate nutrition diagnosis status value from the Nutrition
Assessment, Monitoring, and Evaluation terms:

References
1. Cederholm T, Jensen G. To create a consensus on malnutrition diagnostic criteria: A report from the global leadership initiative on malnutrition (GLIM)
meeting at the ESPEN congress 2016. J Parent Enteral Nutr. 2017; 36(1):7-10.
2. White JV, Guenter P, Jensen G, Malone A, Schofield M. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral
and Enteral Nutrition: Characteristics Recommended for the identification and documentation of adult malnutrition (undernutrition). J Acad Nutr Diet.
2012;112(5):730-738.
3. Blackburn GL, Bistrian BR, Maini BS, Schlamm HT, Smith MF. Nutritional and metabolic assessment of the hospitalized patient. JPEN J Parenter Enteral
Nutr. 1977;1(1):11-22.
4. Detsky AS, McLaughlin JR, Baker JP et al. What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr. 1987;11(1):8-13.
5. Hagan JC. Acute and Chronic Diseases. In: RM M, ed. Encyclopedia of Health Services Research. Vol 1. Thousand Oaks, CA: Sage; 2009:25.
6. Jensen GL, Mirtallo J, Compher C, et al. Adult starvation and disease-related malnutrition: a proposal for etiology-based diagnosis in the clinical practice
setting from the International Consensus Guideline Committee. JPEN J Parenter Enteral Nutr. 2010;34(2):156-159.
7. Klein S, Kinney J, Jeejeebhoy K, et al. Nutrition support in clinical practice: Review of published data and recommendations for future research directions.
National Institutes of Health, American Society for Parenteral and Enteral Nutrition, and American Society for Clinical Nutrition. JPEN J Parenter Enteral
Nutr. 1977;21(3):133-156.
8. Keys A. Chronic undernutrition and starvation with notes on protein deficiency. J Amer Med Assoc. 1948;138:500-511.
10. Norman K, Stobaus N, Gonzalez MC, Schulzke J-D, Pirlich M. Hand grip strength : Outcome predictor and marker of nutritional status. Clin Nutr.
2011;30(2):135-142.
11. Rosenbaum K, Wang J, Pierson RN, Kotler DP. Time-dependent variation in weight and body composition in healthy adults. JPEN J Parenter Enteral Nutr.
2000;24(2):52-55.
12. Academy of Nutrition and Dietetics. Nutrition Care Manual. www.nutritioncaremanual.org. Accessed February 12, 2018.
13. Academy of Nutrition and Dietetics. Evidence Analysis Library: Serum proteins. 2009; http://www.andeal.org/topic.cfm?
cat=4302&conclusion_statement_id=251265&highlight=serum%20proteins&home=1. Accessed February 12, 2018.
14. Academy of Nutrition and Dietetics Evidence Analysis Library. Does serum prealbumin correlate with nitrogen balance?
http://www.andevidencelibrary.com/conclusion.cfm?conclusion_statement_id=251315&highlight=prealbumin&home=1. Accessed February 12, 2018.
15. Fisher S, Ottenbacher KJ, Goodwin JS, Graham JE, Ostir GV. Short physical performance battery in hospitalized older adults. Aging Clin Exp Res.
2009;21(6):445-452.
16. Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: Association with self-reported
disability and prediction of mortality and nursing home admission. J Gerontol. 1994:40(2):M85-M94.
17. Hand RK, Murphy WJ, Field LB, et al. Validation of the Academy/A.S.P.E.N. malnutrition clinical characteristics. J Acad Nutr Diet. 2016;116(5):856–864.
18. Scored Patient Generated Subjective Global Assessment. Available at http://pt-global.org/. Accessed February 12, 2018.
19. Guigoz Y, Vellas B, Garry PJ. Mini Nutritional Assessment: A practical assessment tool for grading the nutritional state of elderly patients. Facts Res
Gerontol. 1994;4(suppl 2):15-59.
20. Mini-Nutrition Assessment Long Form. Available at http://mna-elderly.com/. Accessed February 12, 2018.
21. Cederholm T, Bosaeus I, Barazzoni R, et al. Diagnostic criteria for malnutrition - An ESPEN consensus statement. Clin Nutr. 2015;34(3):335-340
2020 EDITION
12/14/21, 9:11 AM Non Illness Related Pediatric Malnutrition (undernutrition)
NON ILLNESS RELATED PEDIATRIC MALNUTRITION (UNDERNUTRITION)
Non Illness Related Pediatric Malnutrition (undernutrition) (NC-4.1.4)

Definition
Inadequate nutrient intake due to environmental or behavioral factors which may negatively affect growth,
development, and/or other outcomes. Indicators for identifying Mild, Moderate, and Severe non illness related
pediatric malnutrition are included here.
The Academy/ASPEN Pediatric Malnutrition Consensus Statement recommends specific indicators when
only one indicator is present and additional indicators when two or more indicators are present for
diagnosis of malnutrition.
For additional information please visit the Academy’s Web page at:
https://www.eatrightpro.org/practice/practice-resources/malnutrition.

Lack of or limited access to food, eg, economic constraints, restricting food/feedings given to children,
neglect or abuse, adoption/immigration/refugee from or in poorly resourced or war-torn countries
Interruptions of or intolerance to feedings
Social, economic, behavioral, cultural or religious practices that affect the ability to access food
Etiology Category


Nutrition
Category
Biochemical Data,
Medical Tests, and
Procedures
When a single data point is available
Mild malnutrition
-1 to -1.9 weight for length z score
-1 to -1.9 body mass index for age z score
-1 to -1.9 mid upper arm circumference z score
Moderate malnutrition
-2 to -2.9 mid-upper arm circumference z score
Severe malnutrition
-3 weight for length z score or below
-3 body mass index for age z score or below
-3 length/height for age z score or below
-3 mid-upper arm circumference z score or below
Note: For further information on z score data interpretation refer to:

http://www.who.int/childgrowth/training/module_c_interpreting_indicators.pdf?ua=1.
Anthropometric
Measurements When two or more data points are available the following additional indicators may then
be assessed
Mild malnutrition
<75% of the norm for expected weight gain velocity (< 2 y of age)
5% usual body weight loss (2-20 y of age)
Decline of 1 z score in weight for length or BMI for age z score
<50 % of the norm for expected weight gain velocity (< 2 y of age)
7.5% usual body weight loss (2-20 y of age)
Severe malnutrition
10 % usual body weight loss (2-20 y of age)
Note: Proxy measures described in the Academy/ASPEN Pediatric Malnutrition

Consensus Statement can be used when typical anthropometric measures cannot be
obtained.
Nutrition Focused Stagnation in Tanner staging
Physical Findings
ascites)
Severe malnutrition
ascites)
Change in functional indicators, eg, handgrip strength or other measures of

physical activity and/or strength
Note: Handgrip strength in children > 6 years of age: norms are device dependent; can
identify presence of malnutrition but not quantify the degree of the deficit; may not be
able to perform on certain client. Please refer to the Academy/ASPEN Pediatric
Malnutrition Consensus Statement for further information.
Food/Nutrition-
When two or more data points are available
Related History
Mild malnutrition
Inadequate nutrient intake of 51% to 75% estimated energy/protein need
Inadequate nutrient intake 26% to 50% estimated energy/protein need
Severe malnutrition
Inadequate nutrient intake of ≤25% estimated energy/protein need
Anorexia nervosa, abuse, neglect, poverty, frailty, and anything that results in
Client History*** limited access to food (associated with malnutrition in the context of
environmental and social circumstances)
Existing medical diagnosis of malnutrition
Assessment,
Monitoring and Subjective global nutritional assessment (SGNA) for children rating+
Evaluation Tools

Progress Evaluation

References
1. Academy of Nutrition and Dietetics. Evidence Analysis Library: Serum Proteins.

cat=4302&conclusion_statement_id=251265&highlight=serum%20proteins&home=1. Published 2009.
2. Becker PJ, Nieman Carney L, Corkins MR, et al. Consensus statement of the Academy of Nutrition
and Dietetics/American Society for Parenteral and Enteral Nutrition: indicators recommended for the
identification and documentation of pediatric malnutrition (undernutrition). J Acad Nutr Diet.
2014;114(12):1988-2000.
1948;138:500-511.
4. Mehta NM, Corkins MR, Lyman B, et al. Defining pediatric malnutrition: a paradigm shift toward
etiology-related definitions. JPEN J Parenter Enteral Nutr. 2013;37(4):460-481.
2007;85(4):1083-1089.
6. Secker DJ, Jeejeebhoy KN. How to perform subjective global nutritional assessment in children. J
Acad Nutr Diet. 2012;112(3):424-431.
2020 EDITION
12/14/21, 9:12 AM Illness Related Pediatric Malnutrition (undernutrition)
ILLNESS RELATED PEDIATRIC MALNUTRITION (UNDERNUTRITION)
Illness Related Pediatric Malnutrition (undernutrition) (NC-4.1.5)

Definition
Nutrient deficit or imbalance due to disease or injury which may negatively affect growth, development, and/or
other outcomes. Indicators for identifying Mild, Moderate, and Severe illness related pediatric malnutrition are
included here.
The Academy/ASPEN Pediatric Malnutrition Consensus Statement recommends specific indicators when
only one indicator is present and additional indicators when two or more indicators are present for
diagnosis of malnutrition.
For additional information please visit the Academy’s Web page at:
https://www.eatrightpro.org/practice/practice-resources/malnutrition.

Physiological causes increasing nutrient needs due to prematurity, genetic/congenital disorders, illness,
injury, or trauma
Inadequate intake related to anorexia or feeding intolerance
Altered utilization of nutrients
Food- and nutrition-related knowledge deficit concerning amount of energy and amount and type of
dietary protein
Etiology Category


Assessment
Category
Biochemical Data,
Medical Tests and
Procedures
When a single data point is available
Mild malnutrition
Severe malnutrition
-3 weight for length z score or below
-3 body mass index for age z score or below
-3 length/height for age z score or below
-3 mid-upper arm circumference z score or below
Note: For further information on z score data interpretation refer to:

http://www.who.int/childgrowth/training/module_c_interpreting_indicators.pdf?ua=1.
Anthropometric
Measurements When two or more data points are available the following additional indicators may then
be assessed
Mild malnutrition
<75% of the norm for expected weight gain velocity (< 2 y of age)
5% usual body weight loss (2-20 y of age)
7.5% usual body weight loss (2-20 y of age)
Severe malnutrition
10 % usual body weight loss (2-20 y of age)
Note: Proxy measures described in the Academy/ASPEN Pediatric Malnutrition

Consensus Statement can be used when typical anthropometric measures cannot be
obtained.
Nutrition Focused Stagnation in Tanner staging
Physical Findings

ascites)
Severe malnutrition
ascites)
Change in functional indicators, eg, handgrip strength or other measures of

physical activity and/or strength
Note: Handgrip strength in children > 6 years of age: norms are device dependent; can
identify presence of malnutrition but not quantify the degree of the deficit; may not be
able to perform on certain clients. Please refer to the Academy/ASPEN Pediatric
Malnutrition Consensus Statement for further information.
Food/Nutrition-
When two or more data points are available
Related History
Mild malnutrition
Inadequate nutrient intake of 51% to 75% estimated energy/protein need
Inadequate nutrient intake 26% to 50% estimated energy/protein need
Severe malnutrition
Inadequate nutrient intake of ≤25% estimated energy/protein need
Organ failure, malignancies, rheumatoid diseases, gastrointestinal diseases, growth

failure, malabsorptive syndromes, and other etiologies including but not limited to
congenital birth defects, genetic anomalies such as spinal muscular atrophy
Sepsis, pneumonia, peritonitis, and wound infections, burns, trauma, closed head
injury, acute lung injury, respiratory distress syndrome, and surgeries
Client History***
Existing medical diagnosis of malnutrition
History of prematurity, congenital birth defects
(cardiac/renal/gastrointestinal/neurological/pulmonary)
Genetic or acquired conditions: Cerebral Palsy, cystic fibrosis, seizure disorders,
metabolic disease, irritable bowel syndrome
Feeding difficulty, food allergy, eosinophilic enteritis
Assessment,
Monitoring and Subjective global nutritional assessment (SGNA) for children rating+
Evaluation Tools

Progress Evaluation

References
1. Academy of Nutrition and Dietetics. Evidence Analysis Library: Serum Proteins.

cat=4302&conclusion_statement_id=251265&highlight=serum%20proteins&home=1. Published 2009.
3. Becker PJ, Nieman Carney L, Corkins MR, et al. Consensus statement of the Academy of Nutrition
and Dietetics/American Society for Parenteral and Enteral Nutrition: indicators recommended for the
identification and documentation of pediatric malnutrition (undernutrition). J Acad Nutr Diet.
2014;114(12):1988-2000.
1948;138:500-511.
5. Klein S, Kinney J, Jeejeebhoy K, et al. Nutrition Support in Clinical Practice: Review of Published
Data and Recommendations for Future Research Directions: Summary of a Conference Sponsored by the
National Institutes of Health, American Society for Parenteral and Enteral Nutrition, and American
Society for Clinical Nutrition. JPEN J Parent Ent Nutr. 1997;21(3):133-156.
6. Kondrup J. Can food intake in hospitals be improved? Clin Nutr. 2001;20:153-160.Mehta NM,
Corkins MR, Lyman B, et al. Defining pediatric malnutrition: a paradigm shift toward etiology-related
definitions. JPEN J Parenter Enteral Nutr. 2013;37(4):460-481.
2007;85(4):1083-1089.
8. Secker DJ, Jeejeebhoy KN. How to perform subjective global nutritional assessment in children. J
Acad Nutr Diet. 2012;112(3):424-431.
2020 EDITION
12/15/21, 8:53 AM Food and Nutrition Related Knowledge Deficit*
FOOD AND NUTRITION RELATED KNOWLEDGE DEFICIT*
Behavioral-Environmental Domain – Knowledge and Beliefs
Food and Nutrition Related Knowledge Deficit* (NB-1.1)

Definition
Incomplete or inaccurate knowledge about food, nutrition, or nutrition related information and guidelines.


Lack of or limited prior nutrition-related education
Limited understanding of infant/child cues to indicate hunger
Cultural beliefs that affect ability to learn/apply information
dementia
Prior exposure to incorrect information
Limited interest in learning/applying information
Uncertainty how to apply nutrition information
Etiology Category


Nutrition
Category
Biochemical Data,
Medical Tests and
https://www.ncpro.org/pubs/2020-encpt-en/codeNB-1-1 1/3
Procedures
Anthropometric
Measurements
Nutrition Focused
Physical Findings
Verbalizes inaccurate or incomplete information

Provides inaccurate or incomplete written response to questionnaire/written tool or
is unable to read written tool
Food/Nutrition-
No prior education provided on how to apply food and nutrition related
Related History
information
Demonstrates limited ability to apply food and nutrition related information, eg,
select food based on nutrition therapy or prepare infant feeding as instructed
Relates concerns about previous attempts to learn information
Verbalizes unwillingness or disinterest in learning information
Conditions associated with a diagnosis or treatment

Ethnic or cultural related issues impacting application of information
Assessment,
Monitoring and
Evaluation Tools
*If a synonym for the term “Food and nutrition related knowledge deficit” is helpful or needed, an approved
alternate is “Limited food and nutrition related knowledge.”
Progress Evaluation

References

Diet. 2013;113:307-317.
J Prev Med. 2003;24:93-100.
2020 EDITION
12/15/21, 8:54 AM Unsupported Beliefs/Attitudes About Food or Nutrition Related Topics
UNSUPPORTED BELIEFS/ATTITUDES ABOUT FOOD OR NUTRITION RELATED TOPICS
Unsupported Beliefs/Attitudes About Food or Nutrition Related Topics

(NB-1.2)
Use with caution: Be sensitive to client concerns.
Definition
Beliefs/attitudes or practices about food, nutrition, and nutrition-related topics that are incompatible with sound
nutrition principles, nutrition care, or disease/condition (excluding disordered eating patterns and eating
disorders).

Disbelief in science-based food and nutrition information

Lack of prior exposure to accurate nutrition-related information
Eating behavior serves a purpose other than nourishment (eg, pica)
Desire for a cure for a chronic disease through the use of alternative therapy
Etiology Category


Nutrition
Category
Biochemical Data,
Medical Tests and
Procedures
Anthropometric
Measurements
Nutrition Focused
Physical Findings
Food faddism
Estimated intake that reflects an imbalance of nutrients/food groups
Food/Nutrition-
Avoidance of foods/food groups (eg, sugar, wheat, cooked foods)
Related History
Intake of nonfood items
Intake of complementary and alternative medicine products and dietary
supplements that may be unsupported for health
Conditions associated with a diagnosis or treatment, eg, obesity, diabetes, cancer,

cardiovascular disease, mental illness
Client History*** Pica
Food fetish
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
1. Chapman GE, Beagan B. Women’s perspectives on nutrition, health, and breast cancer. J Nutr Educ
Behav. 2003;35:135-141.
2. Gonzalez VM, Vitousek KM. Feared food in dieting and non-dieting young women: a preliminary
validation of the Food Phobia Survey. Appetite. 2004;43:155-173.
3. Jowett SL, Seal CJ, Phillips E, Gregory W, Barton JR, Welfare MR. Dietary beliefs of people with
ulcerative colitis and their effect on relapse and nutrient intake. Clin Nutr. 2004;23:161-170.
4. Madden H, Chamberlain K. Nutritional health messages in women’s magazines: a conflicted space for
women readers. J Health Psychol. 2004;9:583-597.
5. NIH Office of Dietary Supplements: Dietary Supplement Fact sheets.
http://ods.od.nih.gov/factsheets/list-all/. Accessed June 17, 2015.
6. Peters CL, Shelton J, Sharma P. An investigation of factors that influence the consumption of dietary
supplements. Health Mark Q. 2003;21:113-135.
2009;109:2073-2085.
8. Povey R, Wellens B, Conner M. Attitudes towards following meat, vegetarian and vegan diets: an
examination of the role of ambivalence. Appetite. 2001;37:15-26.
9. Putterman E, Linden W. Appearance versus health: does the reason for dieting affect dieting behavior? J
Behav Med. 2004;27:185-204.
10. Salminen E, Heikkila S, Poussa T, Lagstrom H, Saario R, Salminen S. Female patients tend to alter their
diet following the diagnosis of rheumatoid arthritis and breast cancer. Prev Med. 2002;34:529-535.
2020 EDITION
12/15/21, 8:54 AM Not Ready for Diet/Lifestyle Change
NOT READY FOR DIET/LIFESTYLE CHANGE
Behavioral-Environmental Domain– Knowledge and Beliefs
Not Ready for Diet/Lifestyle Change (NB-1.3)

Definition
Lack of perceived value of nutrition-related behavior change compared to costs (consequences or effort required
to make changes); conflict with personal value system; preceding event, condition or cause to behavior change.


Limited social support for implementing changes
Limited cognitive ability, including learning disabilities, neurological or sensory impairment, and/or
dementia
Limited acceptance of need to change
Perception that time, interpersonal, or financial constraints prevent changes
Limited interest in learning/applying information
Limited self-efficacy for making change or demoralization from previous challenges associated with
change
Etiology Category


Nutrition
Category
Biochemical Data,
Medical Tests and

Procedures
Anthropometric
Measurements
Nutrition Focused Negative body language, eg, frowning, limited eye contact, defensive posture,
Physical Findings limited focus, fidgeting (Note: body language varies by culture.)
Denial of need for food- and nutrition-related changes

Inability to understand required changes
Challenges keeping appointments/scheduling follow-up appointments or engaging
Food/Nutrition-
in counseling
Related History
Previous challenges effectively changing target behavior
Resistance to change
Limited self efficacy to make change or to overcome barriers to change
Factors affecting physical activity access
Client History***
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
1. Crawford S. Promoting dietary change. Can J Cardiol. 1995;11:14A-15A.

2. Greene GW, Rossi SR, Rossi JS, Velicer WF, Fava JS, Prochaska JO. Dietary applications of the Stages
of Change Model. J Am Diet Assoc. 1999;99:673-678.
dietary behavior change. Health Psychol. 2000;19:S42-S56.
4. Prochaska JO, Velicer WF. The Transtheoretical Model of behavior change. Am J Health Promotion.
1997;12:38-48.
Diet. 2013;113:307-317.
7. Resnicow K, Jackson A, Wang T, De A, McCarty F, Dudley W, Baronowski T. A motivational
interviewing intervention to increase fruit and vegetable intake through black churches: results of the Eat
for Life trial. Am J Public Health. 2001;91:1686-1693.
J Prev Med. 2003;24:93-100.
2020 EDITION
12/15/21, 8:56 AM Self Monitoring Deficit*
SELF MONITORING DEFICIT*
Self Monitoring Deficit* (NB-1.4)

Definition
Lack of data recording to track personal progress.

Food and nutrition related knowledge deficit concerning self-monitoring

Limited value for behavior change or competing values
Perception that limited resources (eg, time, financial, or interpersonal) prevent self-monitoring
Cultural practices that affect the ability to track personal progress
Prior exposure to incompatible information
dementia
Unwilling or disinterested in tracking progress
Limited focus and attention to detail, difficulty with time management and/or organization
Etiology Category


Nutrition
Category
Biochemical Data, Recorded data inconsistent with biochemical data, eg, estimated dietary intake is
Medical Tests and not consistent with biochemical data
Procedures
Anthropometric
Measurements
Nutrition Focused
Physical Findings
Incomplete self-monitoring records, eg, glucose, food, fluid intake, weight,

physical activity, ostomy output records
Estimated food intake data inconsistent with weight status or growth pattern data
Embarrassment or anger regarding need for self-monitoring
Food/Nutrition-
Uncertainty of how to complete monitoring records
Related History
Uncertainty regarding changes that could/should be made in response to data in
self-monitoring records
No self-management equipment, eg, no blood glucose monitor, pedometer
Diagnoses associated with self-monitoring, eg, diabetes mellitus, obesity, new

ostomy
Limited social and/or familial support
Assessment,
Monitoring and
Evaluation Tools
*If a synonym for the term “Self-monitoring deficit” is helpful or needed, an approved alternate is “Limited self-
monitoring.”
Progress Evaluation

References
1. Academy of Nutrition and Dietetics. Evidence Analysis Library. Behavior change strategies.
cat=3946&evidence_summary_id=250723&highlight=self%20monitoring&home=1. Accessed February
26, 2019.. 2004;27:S91-S93.
http://care.diabetesjournals.org/content/42/Supplement_1. Accessed February 4, 2019.
2020 EDITION
12/15/21, 8:56 AM Disordered Eating Pattern
DISORDERED EATING PATTERN
Behavioral-Environmental Domain –Knowledge and Beliefs
Disordered Eating Pattern (NB-1.5)

Definition
Beliefs, attitudes, thoughts, and behaviors related to food, eating, body composition and weight, including classic
eating disorders as well as similar conditions that negatively impact health or quality of life.
Notes: May not be an appropriate nutrition diagnosis for individuals with Limited food acceptance NI-
2.11.
A resource that may be helpful for Classification of eating disorders is the Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition (DSM-5).

Cultural, societal, biological/genetic, and/or environmental-related fear of weight gain

Weight regulation/preoccupation
Obsessive desire to be healthy or have a specific body shape
Physiological causes that put emphasis on food, weight, or shape
Psychological causes that put emphasis on food, weight, or shape
Personality characteristics or temperament associated with eating disorders
Traumatic event(s) that causes a physical or psychological stress reaction
Etiology Category


Assessment
Category
↓ or ↑ cholesterol, abnormal lipid profiles
Hypoglycemia
Hyperglycemia, ↑ HgbA1c
Hypokalemia and hypochloremic alkalosis
Hypophosphatemia
Hypomagnesemia
↓serum Vitamin D
Hyponatremia
Biochemical Data, Hypothyroid
Medical Tests and ↑ blood urea nitrogen (BUN)
Procedures ↑ carbon dioxide (CO2)
Urine positive for ketones
Laboratory data indicating anemia
Abnormal electrocardiogram (ECG)
↑ liver function tests
Hyperosmolarity, hypoosmolarity
Low luteinizing hormone, follicle stimulating hormone, estradiol, or testosterone
levels
Low bone mineralization findings
BMI < 17.5

Arrested growth and development
Failure to gain weight according to predicted growth trajectory, weight less than
Anthropometric 85% of expected
Measurements Significant weight fluctuation
Significant weight loss or significant weight gain
Frequent weighing or measuring of oneself
Nutrition Focused Normal or depleted adipose and somatic protein stores

Physical Findings Cachexia
Lethargy
Lanugo hair formation
Brittle listless hair
Dry skin
Damaged tooth enamel
Enlarged parotid glands
Peripheral and central edema
Skeletal muscle loss
Low body temperature
Inability to concentrate
Reports of always feeling cold
Bradycardia (heart rate < 60 beats/min for adults, < 50 beats/min pediatrics),
Hypotension (systolic blood pressure < 90 mm HG)
Orthostatic hypotension
Postural tachycardia
Cyanosis of hands and feet
Delayed capillary refill
Self-induced vomiting
Positive Russell’s sign, callous on back of hand from self-induced vomiting
Gastroesophageal reflux disease
Diarrhea
Bloating, flatulence
Constipation
Blood in vomit
Blood in stool
Muscle weakness
Muscle or joint pain
Dry mucus membranes
Absence of hunger cues
Acanthosis nigricans
Amenorrhea or disruption of menstrual cycle
Delay in sexual development and/or puberty

Related History
Body image disturbance
Limited recognition of low body weight
Self-evaluation is based upon body shape and/or weight
Avoidance of food or energy-containing beverages
Avoidance of social events at which food is served
Fear of foods or dysfunctional thoughts regarding food or food experiences
Food and weight preoccupation
Conflict with individual client value system
Conflict with client’s supportive individuals value system
Preoccupation with energy or nutrient content of foods
Avoidance of specific food textures or consistencies
Knowledgeable about current diet fads
Fasting for long periods of time during typical eating hours
Estimated intake of larger quantity of food in a defined time period, a sense of
limited control over eating
Ritualized eating behavior
Excessive physical activity
Eating much more rapidly than normal, until feeling uncomfortably full
Consuming large amounts of food when not feeling physically hungry
Eating more slowly than usual to delay eating
Hiding food
Distorted perception of appropriate amounts to eat
Eating alone because of embarrassment
Eats in private
Feeling unpleasant emotions, such as, guilt, disgust, shame, anger, or depression
after eating
Pattern of chronic dieting
Previous food restriction (intentional or unintentional)
Recent change in food or nutrient intake pattern
Excessive reliance on nutrition terming, including placing labels on foods that rank
the superiority of one food over another
Inflexibility with food selection
Use of laxatives, enemas, diuretics, stimulants, metabolic enhancers, medications,
performance enhancing products
In clients with diabetes, purposeful omission of insulin
Night eating
Perceived control around nutrition intake through calorie counting, macronutrient
monitoring, record keeping
Chewing and spitting of food
Persistent behavior that interferes with weight gain
Persistent use of a mirror
Excessive time spent sourcing food
Excessive time spent preparing food

Avoidance of food deemed to be too processed or unhealthy
Excessive use of condiments and food mixing
Diagnosis, eg, anorexia nervosa, bulimia nervosa, binge eating disorder, other
specified feeding or eating disorder
History of mental health condition, depression, anxiety, obsessive/compulsive
disorder (OCD), personality disorders, substance abuse disorders, self injury
Family history of mental health condition, eating disorder, depression, OCD,
anxiety disorders
Osteoporosis, osteopenia
Client History*** Social isolation
Sexual abuse
Previous traumatic event(s)
Infertility
Gall bladder disease
Competitive or professional athlete
Bariatric surgery
Cardiac arrhythmias, bradycardia
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References
1. Academy for Eating Disorders. Eating disorders: A guide to medical care.

https://higherlogicdownload.s3.amazonaws.com/AEDWEB/05656ea0-59c9-4dd4-b832-
07a3fea58f4c/UploadedImages/AED_Medical_Care_Guidelines_English_04_03_18_a.pdf. Accessed
February 4, 2019.
2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Arlington, VA:
American Psychiatric Publishing; 2013.
3. Allison KC, Tarves EP. Treatment of night eating syndrome. The Psychiatric clinics of North America.
2011;34(4):785-796.
4. Bora E, Kose S. Meta-analysis of theory of mind in anorexia nervosa and bulimia nervosa: A specific
Impairment of cognitive perspective taking in anorexia nervosa? Int J Eat Disord. 2016;49(8):739-740.
5. Costin C. The Eating Disorder Sourcebook: A Comprehensive Guide to the Causes, Treatments, and
Prevention of Eating Disorders. 3rd ed. New York, NY: McGraw-Hill Education; 2007.
6. Gaudiani JL. Sick Enough: A Guide to the Medical Complications of Eating Disorders. New York, NY:
Routledge; 2019.
7. Gorwood P, Blanchet-Collet C, Chartrel N, et al. New Insights in Anorexia Nervosa. Front Neurosci.
2016;10:256.
8. Herrin M. Larkin M. Nutrition Counseling in the Treatment of Eating Disorders. New York, NY:
Routledge; 2012.
9. The International Association of Eating Disorders Professionals Foundation. The CEDRD in Eating
Disorders Care.
http://www.iaedp.com/upload/Certification/Overview/General/iaedp_CEDRD_Booklet2018_with_TW_.p
df. Accessed February 4, 2019.
10. The International Association of Eating Disorders Professionals Foundation. Medical Management
Professionals in Eating Disorders Care.
http://www.iaedp.com/upload/iaedp_Medical_Management_Profess.pdf. Accessed February 4, 2019.
11. Keys A BJ, Henschel A, Mickelson O, Taylor HL. The Biology of Human Starvation. Vol 2nd.
Minneapolis, MN: University of Minnesota Press; 1950.
12. Mehler PS, Brown C. Anorexia nervosa – medical complications. J Eat Disord. 2015;3(1):11.
13. Mehler PS, Rylander M. Bulimia Nervosa – medical complications. J Eat Disord. 2015;3(1):12.
14. Mehler PS, Walsh K. Electrolyte and acid-base abnormalities associated with purging behaviors. Int J Eat
Disord. 2016;49(3):311-318.
15. Metro North Hospital and Health Service Queensland Eating Disorder Service. A guide to admission and
inpatient treatment for people with eating disorders in Queensland
https://metronorth.health.qld.gov.au/rbwh/wp-content/uploads/sites/2/2017/07/guide-to-admission-and-
inpatient-treatment-eating-disorder.pdf. Accessed February 4, 2019.
16. Nazar BP, Bernardes C, Peachey G, Sergeant J, Mattos P, Treasure J. The risk of eating disorders
comorbid with attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. Int J Eat
Disord. 2016;49(12):1045-1057.
17. Ozier AD, Henry BW. Position of the American Dietetic Association: nutrition intervention in the
treatment of eating disorders. J Am Diet Assoc. 2011;111(8):1236-1241.
18. Setnick J. Academy of Nutrition and Dietetics Pocket Guide to Eating Disorders. 2nd ed. Chicago, IL:
Academy of Nutrition and Dietetics; 2016.
2020 EDITION
12/15/21, 8:57 AM Limited Adherence to Nutrition Related Recommendations
LIMITED ADHERENCE TO NUTRITION RELATED RECOMMENDATIONS
Limited Adherence to Nutrition Related Recommendations (NB-1.6)

Definition
Lack of nutrition related changes as per intervention agreed on by client.


Limited confidence in ability to change
Perception that limited resources (eg, time, financial, or interpersonal) prevent changes
Previous limited success in making health-related changes
Food and nutrition-related knowledge deficit concerning how to make nutrition-related changes
Limited interest in applying/learning information
Unsupported beliefs or attitudes about food or nutrition-related topics
Etiology Category

Signs/Symptoms(Defining Characteristics)
Potential Indicators of This Nutrition Diagnosis (one or more must be present)

Biochemical Data,
Medical Tests and Expected laboratory outcomes are not achieved
Procedures
Anthropometric Expected anthropometric outcomes are not achieved
Measurements
12/15/21, 8:57 AM Limited Adherence to Nutrition Related Recommendations
Nutrition Focused Negative body language, eg, frowning, limited eye contact, fidgeting, defensive
Physical Findings posture, crying (Note: body language varies by culture)
Expected food/nutrition-related outcomes are not achieved

Limited ability to recall changes agreed upon
Limited adherence completing any agreed upon homework
Limited or inconsistent adherence with plan
Challenges keeping appointments or scheduling follow-up appointments
Food/Nutrition-
Limited understanding of the importance of making recommended nutrition-
Related History
related changes
Uncertainty as to how to consistently apply food/nutrition information
Verbalizes frustration with attempts to apply food/nutrition information
Verbalizes previous challenges effectively changing target behavior
Presence of a limited self-efficacy or confidence to make changes
Notes internal and/or external barriers to change
Client History*** Limited social and/or familial support
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
1. Anderson ES, Winett RA, Wojcik JR. Self-regulation, self-efficacy, outcome expectations, and social
support: Social cognitive theory and nutrition behavior. Ann Behav Med. 2007;34(3):304-312.
Diet. 2013;113:307-317.
J Prev Med. 2003;24:93-100.
2020 EDITION
12/15/21, 8:57 AM Undesirable Food Choices*
UNDESIRABLE FOOD CHOICES*
Undesirable Food Choices*(NB-1.7)

Definition
Food and/or beverage choices that are inconsistent with dietary reference intake standards (eg, Dietary Reference
Intakes), national food guidelines (eg, U.S. Dietary Guidelines, MyPlate), diet quality index standards (eg,
Healthy Eating Index) or as defined in the nutrition prescription.

Lack of prior exposure to accurate nutrition-related information

Cultural practices that affect the ability to learn/apply information
dementia
High level of fatigue or other side effect of medical, surgical, or radiological therapy
Lack of or limited access to recommended foods
Perception that lack of resources (eg, time, financial, or interpersonal) prevent selection of food choices
consistent with recommendations
Food allergies and aversions impeding food choices consistent with guidelines
Lacks motivation and/or readiness to apply or support systems change
Unwilling or disinterested in learning/applying information
Etiology Category


Assessment
Category
Biochemical Data,
Medical Tests and ↑ lipid panel
Procedures
Anthropometric
Measurements
Nutrition Focused Findings consistent with vitamin/mineral deficiency or excess
Physical Findings
Estimated intake inconsistent with dietary reference intake standards (eg, DRIs),
national food guidelines (eg, US Dietary Guidelines, MyPlate), diet quality index
Food/Nutrition- standards (eg, Healthy Eating Index), or nutrition prescription
Related History Inaccurate or incomplete understanding of the guidelines
Inability to apply guideline information
Inability to select (eg, access), or unwillingness or disinterest in selecting, food
consistent with the guidelines
Client History*** Conditions associated with a diagnosis or treatment, eg, mental illness
Assessment,
Monitoring and
Evaluation Tools
standard.
*If a synonym for the term “Undesirable food choices” is helpful or needed, an approved alternate is
“Unbalanced diet.”
Progress Evaluation

References
1. Birch LL, Fisher JA. Appetite and eating behavior in children. Pediatr Clin North Am.1995;42:931-953.
2. Butte N, Cobb K, Dwyer J, Graney L, Heird W, Richard K. The start healthy feeding guidelines for
infants and toddlers. J Am Diet Assoc. 2004:104:3:442-454.
4. Dolecek TA, Stamlee J, Caggiula AW, Tillotson JL, Buzzard IM. Methods of dietary and nutritional
assessment and intervention and other methods in the multiple risk factor intervention trial. Am J Clin
Nutr. 1997;65(suppl):196S-210S.
5. Epstein LH, Gordy CC, Raynor HA, Beddome M, Kilanowski CK, Paluch R. Increasing fruit and
vegetable intake and decreasing fat and sugar intake in families at risk for childhood obesity. Obesity Res.
2001;9:171-178.
6. Freeland-Graves J, Nitzke S. Total diet approach to communicating food and nutrition information. J Am
Diet Assoc. 2002;102:100-108.
7. French SA. Pricing effects on food choices. J Nutr. 2003;133:S841-S843.
8. Glens K, Basil M, Mariachi E, Goldberg J, Snyder D. Why Americans eat what they do: taste, nutrition,
cost, convenience and weight control concerns as influences on food consumption. J Am Diet Assoc.
1998;98:1118-1126.
9. Hampl JS, Anderson JV, Mullis R. The role of dietetics professionals in health promotion and disease
prevention. J Am Diet Assoc. 2002;102:1680-1687.
10. Lin SH, Guthrie J, Frazao E. American childrens’ diets are not making the grade. Food Review.
2001;24:8-17.
11. Satter E. Feeding dynamics: helping children to eat well. J Pediatr Health Care. 1995;9:178-184.
12. Story M, Holt K, Sofka D, eds. Bright Futures in Practice: Nutrition. 2nd ed. Arlington, VA: National
Center for Education in Maternal Child Health; 2002.
13. Pelto GH, Levitt E, Thairu L. Improving feeding practices, current patterns, common constraints and the
design of interventions. Food Nutr Bull. 2003;24:45-82.
14. US Department of Agriculture Human Nutrition Information Service. MyPlate. 2011.
http://www.choosemyplate.gov. Accessed June 12, 2015.
2020 EDITION
12/15/21, 9:00 AM Physical Inactivity*
PHYSICAL INACTIVITY*
Behavioral-Environmental Domain – Physical Activity and Function
Physical Inactivity* (NB-2.1)

Definition
Low level of activity or sedentary behavior to the extent that it reduces energy expenditure and impacts health.

Unsupported beliefs/attitudes about physical activity

Injury, lifestyle change, condition (eg, advanced stages of cardiovascular disease, obesity, kidney disease),
physical disability or limitation that reduces physical activity or activities of daily living
Food and nutrition related knowledge deficit concerning health benefits of physical activity
Limited prior exposure to accurate nutrition-related information
Limited role models, eg, for children
Limited or limited access to safe exercise environment and/or equipment
Time constraints
Financial constraints that may prevent sufficient level of activity (eg, cost of equipment or shoes or club
membership to gain access)
Etiology Category


Nutrition
Category
Biochemical Data,
Medical Tests and
Procedures
Anthropometric Obesity: BMI > 30 (adults), BMI > 95th percentile (pediatrics > 3 years)
Measurements
Nutrition Focused Excessive subcutaneous fat and low muscle mass
Physical Findings
Infrequent, low-duration and/or low-intensity physical activity

Large amounts of sedentary activities, eg, TV watching, reading, computer use in
both leisure and work/school
Food/Nutrition-
Low level of NEAT (non-exercise activity thermogenesis) expended by physical
Related History
activities other than planned exercise, eg, sitting, standing, walking, fidgeting
Low cardiorespiratory fitness and/or low muscle strength
Medications that cause somnolence and decreased cognition
Factors affecting physical activity access
Medical diagnoses that may be associated with or result in decreased activity, eg,
Client History*** arthritis, chronic fatigue syndrome, morbid obesity, knee surgery
Psychological diagnosis, eg, depression, anxiety disorders
Assessment,
Monitoring and
Evaluation Tools
*If a synonym for the term “Physical inactivity” is helpful or needed, an approved alternate is “Limited physical
activity.”
Progress Evaluation

References
Diet. 2013;113:307-317.
4. Levine JA, Lanninghav-Foster LM, McCrady SK, Krizan AC, Olson LR, Kane PH, Jensen MD, Clark
MM. Interindividual variation in posture allocation: Possible role in human obesity. Science.
2005;307:584-586.
2020 EDITION
12/15/21, 9:01 AM Excessive Physical Activity
EXCESSIVE PHYSICAL ACTIVITY
Excessive Physical Activity (NB-2.2)

Definition
Involuntary or voluntary physical activity or movement that interferes with energy needs, growth, or exceeds that
which is necessary to achieve optimal health.

Disordered eating
Irrational beliefs/attitudes about food, nutrition, and fitness
“Addictive” behaviors/personality
Etiology Category


Nutrition
Category
↑ Liver enzymes, eg, LDH, AST
Biochemical Data, Altered micronutrient status, eg, ↓ serum ferritin, zinc, and insulin-like growth
Medical Tests and factor-binding protein
Procedures ↑ Hematocrit
Possibly ↑ cortisol levels
Anthropometric Weight loss, arrested growth and development, failure to gain weight during period
Measurements of expected growth (related usually to disordered eating)
Nutrition Focused Depleted adipose and somatic protein stores (related usually to disordered eating)
Physical Findings Chronic muscle soreness
Continued/repeated high levels of exercise exceeding levels necessary to improve

health and/or athletic performance
Food/Nutrition-
Exercise daily without rest/rehabilitation days
Related History
Exercise while injured/sick
Forsaking family, job, social responsibilities to exercise
Overtraining
Conditions associated with a diagnosis or treatment, eg, anorexia nervosa, bulimia

nervosa, binge eating, eating disorder not otherwise specified, amenorrhea, stress
fractures
Client History*** Chronic fatigue
Evidence of addictive, obsessive, or compulsive tendencies
Suppressed immune function
Frequent and/or prolonged injuries and/or illnesses
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References
1. Aissa-Benhaddad A, Bouix D, Khaled S, Micallef JP, Mercier J, Bringer J, Brun JF. Early hemorheologic
aspects of overtraining in elite athletes. Clin Hemorheol Microcirc. 1999;20:117-125.
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed.
Washington, DC: American Psychiatric Association; 1994.
3. Davis C, Brewer H, Ratusny D. Behavioral frequency and psychological commitment: necessary
concepts in the study of excessive exercising. J Behav Med. 1993;16:611-628.
4. Davis C, Claridge G. The eating disorder as addiction: a psychobiological perspective. Addict Behav.
1998;23:463-475.
5. Davis C, Kennedy SH, Ravelski E, Dionne M. The role of physical activity in the development and
maintenance of eating disorders. Psychol Med. 1994;24:957-967.
6. Klein DA, Bennett AS, Schebendach J, Foltin RW, Devlin MJ, Walsh BT. Exercise “addiction” in
anorexia nervosa: model development and pilot data. CNS Spectr. 2004;9:531-537.
7. Lakier-Smith L. Overtraining, excessive exercise, and altered immunity: is this a helper-1 vs helper-2
lymphocyte response? Sports Med. 2003;33:347-364.
9. Shephard RJ, Shek PN. Acute and chronic over-exertion: do depressed immune responses provide useful
markers? Int J Sports Med. 1998;19:159-171.
10. Smith LL. Tissue trauma: the underlying cause of overtraining syndrome? J Strength Cond Res.
2004;18:185-193.
11. Urhausen A, Kindermann W. Diagnosis of overtraining: what tools do we have. Sports Med. 2002;32:95-
102.
2020 EDITION
12/15/21, 9:01 AM Inability to Manage Self Care*
INABILITY TO MANAGE SELF CARE*
Inability to Manage Self Care* (NB-2.3)

Definition
Limited of capacity or willingness to implement methods to support healthful food and nutrition related
behavior.

Food and nutrition related knowledge deficit concerning self-care

Limited developmental readiness to perform self management tasks, eg, pediatrics
Perception that limited resources (eg, time, financial, or interpersonal) prevent self care
Cultural practices that affect ability to manage self care
dementia
Prior exposure to incompatible information
Unwilling or disinterested in learning/applying information
Limited or limited access to self management tools or decision guides
Etiology Category


Assessment
Category
Biochemical Data,
Medical Tests and
Procedures
Anthropometric
Measurements
Nutrition Focused
Physical Findings
Inability to interpret data or self management tools

Food/Nutrition-
Embarrassment or anger regarding need for self monitoring
Related History
Uncertainty regarding changes could/should be made in response to data in self
monitoring records
Diagnoses that are associated with self management, eg, diabetes mellitus, obesity,
cardiovascular disease, renal or liver disease
Client History*** Conditions associated with a diagnosis or treatment, eg, cognitive or emotional
impairment
New medical diagnosis or change in existing diagnosis or condition
Assessment,
Monitoring and
Evaluation Tools
*If a synonym for the term “Inability to manage self care” is helpful or needed, an approved alternate is
“Limited ability to manage self care.”
Progress Evaluation

References
References
1. Position of the Academy of Nutrition and Dietetics: Nutrition services for individuals with intellectual
and developmental disabilities and special health care needs. J Acad Nutr Diet. 2015;115:593-608.
3. Falk LW, Bisogni CA, Sobal J. Diet change processes of participants in an intensive heart program. J Nutr
Educ. 2000;32:240-250.
4. Glasgow RE, Hampson SE, Strycker LA, Ruggiero L. Personal-model beliefs and social-environmental
barriers related to diabetes self-management. Diabetes Care. 1997;20:556-561.
5. Keenan DP, AbuSabha R, Sigman-Grant M, Achterberg C, Ruffing J. Factors perceived to influence

dietary fat reduction behaviors. J Nutr Educ. 1999;31:134-144.
7. Sporny, LA, Contento, Isobel R. Stages of change in dietary fat reduction: Social psychological
correlates. J Nutr Educ. 1995;27:191.
2020 EDITION
12/15/21, 9:07 AM Impaired Ability to Prepare Foods/Meals*
IMPAIRED ABILITY TO PREPARE FOODS/MEALS*
Impaired Ability to Prepare Foods/Meals* (NB-2.4)

Definition
Cognitive or physical impairment that prevents preparation of foods/fluids.

dementia
Loss of mental or cognitive ability, eg, dementia
Physical disability
High level of fatigue or other side effect of therapy
Etiology Category


Nutrition
Category
Biochemical Data,
Medical Tests and
Procedures
Anthropometric
Measurements
Nutrition Focused
Physical Findings

Decreased overall estimated intake
Food/Nutrition- Excessive consumption of convenience foods, pre-prepared meals, and foods
Related History prepared away from home resulting in an inability to adhere to nutrition
prescription
Uncertainty regarding appropriate foods to prepare based on nutrition prescription
Inability to purchase and transport foods to one’s home
Conditions associated with a diagnosis or treatment, eg, cognitive impairment,

Client History*** cerebral palsy, paraplegia, vision problems, rigorous therapy regimen, recent
surgery
Assessment,
Monitoring and
Evaluation Tools
*If a synonym for the term “Impaired ability to prepare foods/meals” is helpful or needed, an approved alternate
is “Limited ability to prepare food and meals.”
Progress Evaluation

References
1. Andren E, Grimby G. Activity limitations in personal, domestic and vocational tasks: a study of adults
with inborn and early acquired mobility disorders. Disabil Rehabil. 2004;26:262-271.
2. Andren E, Grimby G. Dependence in daily activities and life satisfaction in adult subjects with cerebral
palsy or spina bifida: a follow-up study. Disabil Rehabil. 2004;26:528-536.
3. Fortin S, Godbout L, Braun CM. Cognitive structure of executive deficits in frontally lesioned head
trauma patients performing activities of daily living. Cortex. 2003;39:273-291.
4. Godbout L, Doucet C, Fiola M. The scripting of activities of daily living in normal aging: anticipation
and shifting deficits with preservation of sequencing. Brain Cogn. 2000;43:220-224.
5. Position of the American Dietetic Association: Providing nutrition services for people with
developmental disabilities and special health care needs. J Am Diet Assoc. 2010;110: 296-307.
6. Position of the Academy of Nutrition and Dietetics: Food insecurity in the United States. J Acad Nutr
Diet. 2015;115:593-608.J Am Diet Assoc. 2006;106:446-458.
8. Sandstrom K, Alinder J, Oberg B. Descriptions of functioning and health and relations to a gross motor
classification in adults with cerebral palsy. Disabil Rehabil. 2004;26:1023-1031.
2020 EDITION
12/15/21, 9:07 AM Poor Nutrition Quality of Life (NQOL)
POOR NUTRITION QUALITY OF LIFE (NQOL)
Poor Nutrition Quality of Life (NQOL) (NB-2.5)

Definition
Diminished patient/client perception of quality of life in response to nutrition problems and recommendations.

Food and nutrition knowledge-related deficit

Negative impact of current or previous medical nutrition therapy (MNT)
Food or activity behavior-related difficulty
Poor self-efficacy
Altered body image
Food insecurity
Lack of social support for implementing changes
Etiology Category


Nutrition
Category
Biochemical Data,
Medical Tests and
Procedures
Anthropometric
Measurements
Nutrition Focused
Physical Findings
Unfavorable NQOL rating

Unfavorable ratings on measure of QOL, such as SF-36 (multipurpose health
survey form with 36 questions) or EORTC QLQ-C30 (quality of life tool
developed for patient/clients with cancer)
Food insecurity/unwillingness to use community services that are available
Food/Nutrition-
Frustration or dissatisfaction with MNT recommendations
Related History
Frustration over lack of control
Inaccurate or incomplete information related to MNT recommendations
Inability to change food- or activity-related behavior
Concerns about previous attempts to learn information
MNT recommendations affecting socialization
Unwillingness or disinterest in learning information
New medical diagnosis or change in existing diagnosis or condition

Recent other lifestyle or life changes, eg, quit smoking, initiated exercise, work
Client History*** change, home relocation
Lack of social and familial support
Ethnic and cultural related issues
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
1. Aaronson NK, Ahmedzai S, Bullinger M. The EORTC core quality of life questionnaire: interim results
of an international field study. In: Osoba D, ed. Effect of Cancer on Quality of Life. Boca Raton, FL: CRC
Press; 1991:185-203.
2. Barr JT, Schumacher GE. The need for a nutrition-related quality-of-life measure. J Am Diet Assoc.
2003;103:177-180.
3. Barr JT, Schumacher GE. Using focus groups to determine what constitutes quality of life in clients
receiving medical nutrition therapy: first steps in the development of a nutrition quality-of-life survey. J
Am Diet Assoc. 2003;103:844-851.
4. Ware JE. SF-36 Health Survey: Manual and Interpretation Guide. Lincoln, RI: Quality Metric Inc; 2003
5. Position of the American Dietetic Association on food insecurity in the United States. J Am Diet Assoc.
2010;110:1368-1377.
2020 EDITION
12/15/21, 9:08 AM Self Feeding Difficulty
SELF FEEDING DIFFICULTY
Self Feeding Difficulty (NB-2.6)

Definition
Impaired actions to place food or beverages in mouth.

Physiological difficulty causing inability to physically grasp cups and utensils, support and/or control
head and neck, coordinate hand movement to mouth, close lips (or any other suckling issue), bend elbow
or wrist, sit with hips square and back straight
Limited physical strength or range of motion
Limited access to foods and/or adaptive eating devices conducive for self feeding
Limited vision
dementia
Reluctance or avoidance of self feeding
Etiology Category


Nutrition
Category
Biochemical Data,
Medical Tests and
Procedures
Anthropometric Weight loss
Measurements
Dry mucous membranes, hoarse or wet voice, tongue extrusion
Nutrition Focused Poor lip closure, drooling
Physical Findings Shortness of breath
Being provided with foods that may not be conducive to self feeding, eg, peas,
broth type soups
Dropping of cups, utensils
Emotional distress, anxiety, or frustration surrounding mealtimes
Challenges recognizing foods
Food/Nutrition- Forgets to eat
Related History Less than optimal use of food
Refusal to eat or chew
Dropping of food from utensil (splashing and spilling of food) on repeated
attempts to feed
Limited strength or stamina to lift utensils and/or cup
Utensil biting
Absence of recommended adaptive eating devices
Conditions associated with a diagnosis or treatment, eg, neurological disorders,

Parkinson’s, Alzheimer’s, Tardive dyskinesia, multiple sclerosis, stroke, paralysis,
developmental delay
Physical limitations, eg, fractured arms, traction, contractures
Client History*** Surgery requiring recumbent position
Dementia/organic brain syndrome
Dysphagia
Tremors
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
1. Consultant Dietitians in Healthcare Facilities. Dining Skills Supplement: Practical Interventions for
Caregivers of Eating Disabled Older Adults. Pensacola, FL: American Dietetic Association; 1992.
2. Morley JE. Anorexia of aging: physiological and pathologic. Am J Clin Nutr. 1997;66:760-773.
3. Position of the Academy of Nutrition and Dietetics: Providing nutrition services for people with
developmental disabilities and special health care needs. J Acad Nutr Diet. 2015;115:593-608.
4. Sandman P, Norberg A, Adolfsson R, Eriksson S, Nystrom L. Prevalence and characteristics of persons
with dependency on feeding at institutions. Scand J Caring Sci. 1990;4:121-127.
5. Siebens H, Trupe E, Siebens A, Cooke F, Anshen S, Hanauer R, Oster G. Correlates and consequences of
feeding dependency. J Am Geriatr Soc. 1986;34:192-198.
6. Vellas B, Fitten LJ, eds. Research and Practice in Alzheimer’s Disease. New York, NY: Springer
Publishing Company; 1998.
2020 EDITION
12/15/21, 9:08 AM Intake of Unsafe Food
INTAKE OF UNSAFE FOOD
Behavioral-Environmental Domain – Food Safety and Access
Intake of Unsafe Food (NB-3.1)

Definition
Intake of food and/or fluids intentionally or unintentionally contaminated with toxins, poisonous products,
infectious agents, microbial agents, additives, allergens, and/or agents of bioterrorism.

Food and nutrition-related knowledge deficit concerning potentially unsafe food

Lack of knowledge about proper food/feeding, (infant and enteral formula, breastmilk*) storage, and
preparation
Exposure to contaminated water or food, eg, community outbreak of illness documented by surveillance
and/or response agency
Mental illness, confusion, or altered awareness
Lack of or limited access to food storage equipment/facilities, eg, refrigerator
Lack of or limited access to safe food supply, eg, inadequate markets with safe, uncontaminated food
Etiology Category


Nutrition
Category
Biochemical Data, Positive stool culture for infectious causes, such as listeria, salmonella, hepatitis A,
Medical Tests and E. coli, cyclospora
Procedures Toxicology reports for drugs, medicinals, poisons in blood or food samples
Anthropometric
Measurements
Evidence of dehydration, eg, dry mucous membranes, damaged tissues
Nutrition Focused Diarrhea, cramping, bloating, fever, nausea, vomiting, vision problems, chills,
Physical Findings dizziness, headache
Fish suspected to contain mercury (pregnant and lactating women)

Nonfood items (pregnant and lactating women)
Raw eggs, unpasteurized milk products, soft cheeses, undercooked meats (infants,
children, immunocompromised persons, pregnant and lactating women, and
elderly)
Food/Nutrition-
Wild plants, berries, mushrooms
Related History
Unsafely stored and prepared foods or products (enteral and infant formula,
breastmilk)
Mislabeled or unlabeled foods
Availability of suitable sanitation facilities
Ability to wash hands with soap and water
Conditions associated with a diagnosis or treatment, eg, foodborne illness such as

bacterial, viral, or parasitic infection, mental illness, dementia
Client History*** Poisoning by drugs, medicinals, and biological substances
Poisoning from poisonous food stuffs and poisonous plants
Cardiac, neurologic, respiratory changes
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
1. Centers for Disease Control and Prevention. Diagnosis and Management of Foodborne Illnesses: A
Primer for Physicians and Other Health Care Professionals.
www.cdc.gov/mmwr/preview/mmwrhtml/rr5304a1.htm. Accessed June 12, 2015.
2. Partnership for Food Safety Education. http://www.fightbac.org. Accessed June 12, 2015.
3. Position of the Academy of Nutrition and Dietetics: Food and water safety. J Acad Nutr Diet.
2014;114:1819-1829.
2020 EDITION
12/15/21, 9:08 AM Limited Access to Food
LIMITED ACCESS TO FOOD
Limited Access to Food (NB-3.2)

Definition
Diminished ability to acquire a sufficient quantity and variety of healthful food based on dietary reference intake
standards (eg, Dietary Reference Intakes), national food guidelines (eg, U.S. Dietary Guidelines, MyPlate) or as
defined in the nutrition prescription.

Caregiver intentionally or unintentionally not providing access to food, eg, unmet needs for food or eating
assistance, excess of poor nutritional quality food, abuse/neglect
Community and geographical constraints for shopping and transportation
Food and nutrition-related knowledge deficit concerning sufficient quantity or variety of culturally
appropriate healthful food
Limited financial resources or limited access to financial resources to purchase a sufficient quantity or
variety of culturally appropriate healthful foods
Limited food planning, purchasing, and preparation skills
Limited, absent, or limited participation in community supplemental food or other programs, eg, food
pantries, emergency kitchens, or shelters
Failure to participate in federal food programs, eg, WIC, National School Breakfast/Lunch Program, food
stamps
Schools lacking nutrition/wellness policies or application of policies ensuring convenient, appetizing,
competitively priced culturally appropriate healthful foods at meals, snacks, and school-sponsored
activities.
Physical or psychological limitations that diminish ability to shop, eg, walking, sight, mental/emotional
health
Limitation to food because of concerns about weight or aging
Factors contributing to a contaminated food supply
Etiology Category


Nutrition
Category
Biochemical Data, Indicators of macronutrient or vitamin/mineral status as indicated by biochemical
Medical Tests and findings
Procedures
Growth failure, based on reference growth standards, eg, National Center for
Health Statistics (NCHS)
Anthropometric Underweight: BMI < 18.5 (adults)
Measurements Unintentional weight loss: adults, of > 10% in 6 months, > 5% in 1 month; any
unintentional weight loss in children
Overweight/obesity: BMI > 25 (adults), > 95 percentile (pediatrics)
Nutrition Focused Findings consistent with vitamin/mineral deficiency

Physical Findings Hunger
Food faddism or unsupported beliefs and attitudes of patient/client

Belief that aging can be slowed by dietary limitations and extreme exercise
Estimated inadequate intake of food and/or specific nutrients
Limited supply of food in home
Limited variety of foods
Limited resources for food
Food/Nutrition- Limited transportation or other community constraints limiting availability of food
Related History Limited knowledge or skills on how to use food
Limited knowledge or skills on how to apply and/or participate in food assistance
programs
Behaviors consistent with food insecurity (eg, skipping meals, buying low-cost
food items, changes in eating patterns, rituals, or customs)
Limited knowledge how to identify, store, or prepare safe food
Conditions that contribute to food contamination
Fasting pattern
Malnutrition, vitamin/mineral deficiency

Client History*** Conditions associated with a diagnosis or treatment, eg, mental illness, dementia
Limited suitable support systems
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation


References
2010;110:1368-1377.
2014;114:1819-1829.
5. US Department of Agriculture and Health and Human Services. Dietary Guidelines for Americans, 2010.
http://www.cnpp.usda.gov/dietaryguidelines.htm. Accessed June 12, 2015.
2020 EDITION
12/15/21, 9:09 AM Limited Access to Nutrition Related Supplies
LIMITED ACCESS TO NUTRITION RELATED SUPPLIES
Limited Access to Nutrition Related Supplies (NB-3.3)

Definition
Diminished ability to acquire nutrition related supplies based on identified needs.

Caregiver intentionally or unintentionally not providing access to nutrition related supplies, eg, unmet
needs, abuse/neglect
Community and geographical constraints for shopping and transportation to obtain nutrition related
supplies
Food and nutrition related knowledge deficit concerning nutrition related supplies
Limited financial resources or limited access to financial resources to purchase nutrition related supplies
Reluctance to participate in community or other programs that provide access to nutrition related supplies
health
Etiology Category


Nutrition
Category
Biochemical Data, Abnormal biochemical findings consistent with vitamin/mineral deficiency
Medical Tests and
Procedures
Health Statistics (NCHS)
Anthropometric Underweight: BMI <18.5 (adults)
Measurements Unintentional weight loss: adults, of > 10% in 6 months, > 5% in 1 month; any
unintentional weight loss in children
Findings consistent with vitamin/mineral deficiency

Nutrition Focused Hunger, thirst
Physical Findings Evidence of dehydration, eg, dry mucous membranes, poor skin turgor
Food faddism or unsupported beliefs and attitudes of parent or caregiver

Limited supply of nutrition related supplies (eg, glucose testing strips, meter,
assistive eating devices, assistive cooking devices) in home
Food/Nutrition-
Transportation or other community constraints limiting availability of nutrition
Related History
related supplies
Limited knowledge or skills on how to use nutrition related supplies
Limited knowledge or skills on how to apply and/or participate in nutrition-related
supply assistance programs
Malnutrition, vitamin/mineral deficiency

Client History*** Conditions associated with a diagnosis or treatment, eg, mental illness, dementia
Limited support systems
Resource constraints for obtaining nutrition related supplies
Assessment,
Monitoring and
Evaluation Tools
Progress Evaluation

References
1. Holben DH. Position of the American Dietetic Association: Food insecurity in the United States. J Am
Diet Assoc. 2010;110(9):1368-1377.
2. Nordin SM, Boyle, Kemmer TM. Position of the Academy of Nutrition and Dietetics: Nutrition security
in developing nations: Sustainable food, water, and health. J Acad Nutr Diet. 2013;113(4):581-595.
2020 EDITION
12/15/21, 9:09 AM Limited Access to Potable Water
LIMITED ACCESS TO POTABLE WATER
Limited Access to Potable Water (NB-3.4)

Definition
Diminished ability to acquire a sufficient quantity of safe drinking water based on dietary reference intake
standards (eg, Dietary Reference Intakes), national food guidelines (eg, U.S. Dietary Guidelines, MyPlate) or as
defined in the nutrition prescription.

Caregiver intentionally or unintentionally not providing access to water, eg, unmet needs for food or
eating assistance, abuse/neglect
Community and geographical constraints for shopping and transportation
Food and nutrition-related knowledge deficit concerning of safe drinking water
Limited financial resources or limited access to financial resources to purchase a sufficient quantity of
water
Schools lacking nutrition/wellness policies or application of policies ensuring convenient, appetizing,
competitively priced culturally appropriate healthful foods at meals, snacks, and school-sponsored
activities.
health
Factors contributing to a contaminated water supply
Factors contributing to insufficient water access
Etiology Category


Assessment
Category
↓ Urine volume
Biochemical Data, Urine color reflecting concentration of urine
Medical Tests and ↑ Urine specific gravity
Procedures Abnormal stool study results
Anthropometric Weight loss

Measurements
Thirst
Nutrition Focused Evidence of dehydration, eg, dry mucous membranes, poor skin turgor, cognitive
Physical Findings changes
Diarrhea, vomiting, abdominal pain
Unsupported beliefs and attitudes of parent or caregiver

Limited access to water
Limited resources for water
Limited transportation or other community constraints limiting availability of
water
Food/Nutrition- Limited knowledge or skills related to safe water
Related History Limited knowledge or skills on how to apply and/or participate in water assistance
programs
Conditions that contribute to water contamination
Geographic or other factors contributing to insufficient water access
Fasting pattern that restricts safe water access or a sufficient amount of water
Availability of suitable sanitation facilities
Ability to wash hands with soap and water
Malnutrition
Physical disability
Client History*** Conditions associated with a diagnosis or treatment that impacts water intake
Limited support systems
Assessment,
Monitoring and
Evaluation Tools
standard.
Progress Evaluation

References
2010;110:1368-1377.
2014;114:1819-1829.
5. US Department of Agriculture and Health and Human Services. Dietary Guidelines for Americans, 2010.
http://www.cnpp.usda.gov/dietaryguidelines.htm. Accessed June 15, 2015.
2020 EDITION
12/15/21, 10:36 AM No Nutrition Diagnosis At This Time
NO NUTRITION DIAGNOSIS AT THIS TIME
Other Domain
No Nutrition Diagnosis At This Time (NO-1.1)

Definition
Absence of a current nutrition problem warranting a nutrition intervention. This determination results from a
nutrition assessment.
Note: This nutrition diagnostic term is not appropriate if additional information for the nutrition
assessment is needed or pending.

Not applicable

Nutrition
Category
Biochemical Data,
Medical Tests and Not applicable
Procedures
Anthropometric
Not applicable
Measurements
Nutrition Focused
Not applicable
Physical Findings
Food/Nutrition-
Not applicable
Related History
Client History*** Conditions associated with a diagnosis or treatment, e.g., palliative/end-of-life care
Assessment,
Monitoring and
Evaluation Tools
• May not be applicable. Communicate etiology category from NA/ME

Etiology Category terminology list as appropriate. A useful resource to determine the etiology
category is the Nutrition Diagnosis Matrix.
• May not be applicable. Communicate nutrition diagnosis progress using the

Progress Evaluation terms from the NA/ME terminology list only as appropriate.
References
https://www.ncpro.org/pubs/2020-encpt-en/codeNO-1-1 1/2
12/15/21, 10:36 AM No Nutrition Diagnosis At This Time
Diet. 2019;119(5):840-855.
2. Swan WI, Vivanti A, Hakel-Smith NA, et al. Nutrition care process and model update: Toward
realizing people-centered care and outcomes management. J Acad Nutr Diet. 2017;117(12):2003-2014.
2020 EDITION
https://www.ncpro.org/pubs/2020-encpt-en/codeNO-1-1 2/2
Nutrition Diagnosis Etiology Matrix
Below are the etiology categories and their definitions. Etiologies are grouped by the type of cause or contributing risk
factor. In two specific instances, Access and Behavior etiologies, these alone may be the cause or contributing risk factor of
the nutrition diagnosis or the practitioner may determine a more specific root cause, eg, Belief-Attitudes of the problem.
Etiology Category Definition
Beliefs–Attitudes Etiologies Cause or contributing risk factors related to the conviction of the truth of some
nutrition-related statement or phenomenon; feelings or emotions toward that truth or
phenomenon and activities.
Cultural Etiologies Cause or contributing risk factors related to the client’s values, social norms,
customs, religious beliefs and/or political systems.
Knowledge Etiologies Cause or contributing risk factors impacting the level of understanding about food,
nutrition and health, or nutrition-related information and guidelines.
Physical Function Etiologies Cause or contributing risk factors related to physical ability to engage in specific
tasks, may be cognitive in nature.
Physiologic–Metabolic Etiologies Cause or contributing risk factors related to medical/health status that may have a
nutritional impact (excludes psychological etiologies—see separate category).
Psychological Etiologies Cause or contributing risk factors related to a diagnosed or suspected mental
health/psychological problem (Diagnostic and Statistical Manual of Mental
Disorders, DSM)
Social–Personal Etiologies Cause or contributing risk factors associated with the client’s personal and/or social
history.
Treatment Etiologies Cause or contributing risk factors related to medical or surgical treatment or other
therapies and management or care.
Access Etiologies Cause or contributing risk factors that affect intake and the availability of safe,
healthful food, water, and food/nutrition-related supplies. A more specific root cause
of Access Etiologies may not be known but may eventually reveal
Beliefs-Attitudes, Cultural, Knowledge, Physical Function, Psychological, Social-
Personal, or Treatment Etiologies.
Behavior Etiologies Cause or contributing risk factors related to actions which influence achievement of
nutrition-related goals. A more specific root cause of Behavior Etiologies may not
be known but may eventually reveal Beliefs-Attitudes, Cultural, Knowledge,
Physical Function, Psychological, Social-Personal, or Treatment Etiologies.
Category Etiology Diagnosis
Beliefs-Attitudes Altered body image Poor nutrition quality of life (NB-2.5)

Obsessive desire to be healthy or have Disordered eating pattern (NB-1.5)
Beliefs-Attitudes
a specific body shape
Limited food acceptance (NI-2.11), Excessive fat intake
Beliefs-Attitudes Food preference (NI-5.5.2), Intake of types of fats inconsistent with needs
(specify) (NI-5.5.3), Undesirable food choices (NB-1.7)
Beliefs-Attitudes Denial of need to change Not ready for diet/lifestyle change (NB-1.3)
Desire for a cure for a chronic disease Unsupported beliefs/attitudes about food or nutrition
Beliefs-Attitudes
through the use of alternative therapy related topics (NB-1.2)
Disbelief in science-based food and Unsupported beliefs/attitudes about food or nutrition
Beliefs-Attitudes
nutrition information related topics (NB-1.2)
Enteral nutrition composition inconsistent with needs (NI-
End-of-life care if client or supportive 2.5), Enteral nutrition administration inconsistent with
Beliefs-Attitudes individuals do not desire nutrition needs (NI-2.6), Parenteral nutrition composition
support inconsistent with needs (NI-2.9), Parenteral nutrition
administration inconsistent with needs (NI-2.10)
Cultural, societal, biological/genetic, Disordered eating pattern (NB-1.5)
Beliefs-Attitudes and/or environmental related to fear
of weight gain
Imbalance of nutrients (NI-5.4), Excessive protein intake
(NI-5.6.2), Intake of types of proteins inconsistent with
Beliefs-Attitudes Food faddism
needs (specify) (NI-5.6.3), Excessive mineral intake
(specify) (NI-5.10.2)
Limited food acceptance due to food Inadequate oral intake (NI-2.1), Limited food acceptance
Beliefs-Attitudes
aversion (NI-2.11),
Excessive energy intake (NI-1.3), Inadequate oral intake
(NI-2.1), Excessive oral intake (NI-2.2), Limited food
acceptance (NI-2.11), Excessive alcohol intake (NI-4.3),
Imbalance of nutrients (NI-5.4), Excessive fat intake (NI-
5.5.2), Intake of types of fats inconsistent with needs
(specify) (NI-5.5.3), Excessive protein intake (NI-5.6.2),
Intake of types of proteins inconsistent with needs
(specify) (NI-5.6.3), Intake types of amino acids
Unsupported beliefs/attitudes about
inconsistent with needs (specify) (NI-5.7.1), Excessive
Beliefs-Attitudes food, nutrition, and nutrition related
fiber intake (NI-5.8.6), Excessive mineral intake (specify)
information
(NI-5.10.2), Predicted breastfeeding difficulty (NC-1.5),
Underweight (NC-3.1), Growth rate below expected (NC-
3.5), Food and nutrition related knowledge deficit (NB-
1.1), Not ready for diet/lifestyle change (NB-1.3), Limited
adherence to nutrition related recommendations (NB-1.6),
Physical inactivity (NB-2.1), Excessive physical activity
(NB-2.2), Limited access to food (NB-3.2), Limited access
to potable water (NB-3.4)
Beliefs-Attitudes Irritability Breastfeeding difficulty (NC-1.3)
Lack of or limited self efficacy for Not ready for diet/lifestyle change (NB-1.3), Limited
Beliefs-Attitudes making change or demoralization adherence to nutrition related recommendations (NB-1.6),
from previous failures at change Poor nutrition quality of life (NB-2.5)
Lack of or limited confidence in Limited adherence to nutrition related recommendations
Beliefs-Attitudes
ability to change (NB-1.6)
Excessive energy intake (NI-1.3), Excessive oral intake
(NI-2.2), Excessive alcohol intake (NI-4.3), Excessive fat
intake (NI-5.5.2), Intake of types of fats inconsistent with
Lack of or limited value for behavior
Beliefs-Attitudes needs (specify) (NI-5.5.3), Self monitoring deficit (NB-
change or competing values
1.4), Limited adherence to nutrition related
recommendations (NB-1.6), Physical inactivity (NB-2.1),
Inability to manage self care (NB-2.3)
Lacks motivation and/or readiness to Undesirable food choices (NB-1.7)
Beliefs-Attitudes
apply or support systems change
2
Supplemental material for the electronic Nutrition Care Process Terminology (eNCPT). Copyright 2019 Academy of Nutrition and Dietetics.
Negative impact of current or Poor nutrition quality of life (NB-2.5)

Beliefs-Attitudes previous medical nutrition therapy
(MNT)
Overweight, adult or pediatric (NC-3.3.1), Obese, pediatric
(NC-3.3.2), Obese, Class I (NC-3.3.3), Obese, Class II
(NC-3.3.4), Obese, Class III (NC-3.3.5), Unintended
Beliefs-Attitudes Not ready for diet/lifestyle change
weight gain (NC-3.4), Excessive growth rate (NC-3.6),
Self monitoring deficit (NB-1.4), Inability to manage self
care (NB-2.3), Poor nutrition quality of life (NB-2.5)
Breastfeeding difficulty (NC-1.3), Predicted breastfeeding
Beliefs-Attitudes Perception of inadequate milk supply
difficulty (NC-1.5)
Perception that lack of or limited
resources (eg, time, financial, or
interpersonal) prevent:
 Selection/food choices Undesirable food choices (NB-1.7)
consistent with
Beliefs-Attitudes recommendations
Not ready for diet/lifestyle change (NB-1.3), Limited
 Changes
adherence to nutrition related recommendations (NB-1.6)
 Sufficient level of activity Physical inactivity (NB-2.1)
Self monitoring deficit (NB-1.4), Inability to manage self
 Self monitoring
care (NB-2.3)
Unwilling or disinterested in:
Food and nutrition related knowledge deficit (NB-1.1), Not
ready for diet/lifestyle change (NB-1.3), Limited adherence
 Learning/applying
to nutrition related recommendations (NB-1.6), Undesirable
information
food choices (NB-1.7), Inability to manage self care (NB-
2.3)
 Reducing energy intake Excessive energy intake (NI-1.3)
 Reducing intake Excessive oral intake (NI-2.2)
Beliefs-Attitudes Intake of types of proteins inconsistent with needs
 Modify protein or amino
acid intake
inconsistent with needs (specify) (NI-5.7.1)
 Tracking progress Self monitoring deficit (NB-1.4)
 Unwillingness to purchase Inadequate fiber intake (NI-5.8.5)
or consume fiber-containing
foods
 Weight Disordered eating pattern (NB-1.5)
regulation/preoccupation
Cultural Culture of overeating Predicted excessive energy intake (NI-1.5)
Cultural Practices that affect nutrient intake Predicted inadequate nutrient intake (specify) (NI-5.11.1)
Cultural practices that affect ability
to:
Inadequate energy intake (NI-1.2), Inadequate oral intake
(NI-2.1), Inadequate fluid intake (NI-3.1), Moderate
starvation related malnutrition (undernutrition) (NC-
4.1.1.1), Severe starvation related malnutrition
(undernutrition) (NC-4.1.1.2), Inadequate protein–energy
 Access to food, fluid,
intake (NI-5.2), Inadequate protein intake (NI-5.6.1),
nutrients
Inadequate carbohydrate intake (NI-5.8.1), Inadequate
Cultural vitamin intake (specify) (NI-5.9.1), Inadequate mineral
intake (specify) (NI-5.10.1), Unintended weight loss (NC-
3.2), Limited access to food (NB-3.2), Limited access to
potable water (NB-3.4)
 Make appropriate food Inadequate fat intake (NI-5.5.1)
choices
 Breastfeed
difficulty (NC-1.5)
Food and nutrition related knowledge deficit (NB-1.1),
 Learn/apply information
Undesirable food choices (NB-1.7)
3
 Manage self care Inability to manage self care (NB-2.3)

 Reduce carbohydrate intake Excessive carbohydrate intake (NI-5.8.2)
 Regulate types of protein or
amino acids consumed
 Regulate timing of Inconsistent carbohydrate intake (NI-5.8.4)
carbohydrate consumption
 Regulate types of Intake of types of carbohydrate inconsistent with needs
carbohydrate consumed (specify) (NI-5.8.3)
 Track personal progress Self monitoring deficit (NB-1.4)
Inadequate energy intake (NI-1.2), Excessive energy
intake (NI-1.3), Excessive oral intake (NI-2.2), Inadequate
fluid intake (NI-3.1), Excessive fluid intake (NI-3.2),
Inadequate bioactive substance intake (specify) (NI-4.1),
Excessive bioactive substance intake (specify) (NI-4.2),
Excessive alcohol intake (NI-4.3), Moderate starvation
related malnutrition (undernutrition) (NC-4.1.1.1), Severe
4.1.1.2), Moderate acute disease or injury related
malnutrition (undernutrition) (NC-4.1.3.1), Severe acute
disease or injury related malnutrition (undernutrition)
(NC-4.1.3.2), Inadequate protein–energy intake (NI-5.2),
Imbalance of nutrients (NI-5.4), Excessive fat intake (NI-
Knowledge Food and nutrition knowledge deficit
5.5.2), Inadequate protein intake (NI-5.6.1), Excessive
protein intake (NI-5.6.2), Inadequate carbohydrate intake
(NI-5.8.1), Inadequate fiber intake (NI-5.8.5), Excessive
mineral intake (specify) (NI-5.10.2), Predicted
breastfeeding difficulty (NC-1.5), Overweight, adult or
pediatric (NC-3.3.1), Obese, pediatric (NC-3.3.2), Obese,
Class I (NC-3.3.3), Obese, Class II (NC-3.3.4), Obese,
Class III (NC-3.3.5), Excessive growth rate (NC-3.6), Self
monitoring deficit (NB-1.4), Inability to manage self care
(NB-2.3), Poor nutrition quality of life (NB-2.5), Limited
access to food (NB-3.2), Limited access to nutrition
related supplies (NB-3.3), Limited access to potable water
(NB-3.4)
Food and nutrition knowledge deficit
concerning:
 Sufficient oral Inadequate oral intake (NI-2.1)
food/beverage intake
 Consumption of an Excessive mineral intake (specify) (NI-5.10.2)
appropriate variety of foods
 Potentially unsafe food Intake of unsafe food (NB-3.1)
 Proper infant feeding, Intake of unsafe food (NB-3.1)
food/feeding preparation and
storage
 Adequate energy intake Underweight (NC-3.1)
Knowledge Mild non illness related pediatric malnutrition
(undernutrition) (NC-4.1.4.1), Moderate non illness
related pediatric malnutrition (undernutrition) (NC-
 Appropriate amount or types 4.1.4.2), Severe non illness related pediatric malnutrition
of dietary protein or amino (undernutrition) (NC-4.1.4.3), Inadequate protein–energy
acids intake (NI-5.2), Inadequate protein intake (NI-5.6.1),
Inadequate protein–energy intake (NI-5.2), Inadequate fat
 Appropriate amount or type intake (NI-5.5.1), Excessive fat intake (NI-5.5.2), Intake
of dietary fat of types of fats inconsistent with needs (specify) (NI-
5.5.3)
4
 Appropriate amount and Excessive carbohydrate intake (NI-5.8.2), Intake of types

types of dietary of carbohydrate inconsistent with needs (specify) (NI-
carbohydrate 5.8.3)
 Appropriate timing of Inconsistent carbohydrate intake (NI-5.8.4)
carbohydrate intake
 Physiological causes Inconsistent carbohydrate intake (NI-5.8.4)
requiring careful timing and
consistency in the amount of
carbohydrate
 Physiological causes altering Intake of types of carbohydrate inconsistent with needs
carbohydrate digestion or (specify) (NI-5.8.3)
metabolism
 Physiological causes Excessive carbohydrate intake (NI-5.8.2)
requiring use of modified
carbohydrate intake
Inadequate fiber intake (NI-5.8.5), Excessive fiber intake
 Desirable quantities of fiber
(NI-5.8.6)
 Correct enteral formula Inadequate enteral nutrition infusion (NI-2.3)
needed
 Food and supplemental Inadequate vitamin intake (specify) (NI-5.9.1), Excessive
sources of vitamins vitamin intake (specify) (NI-5.9.2)
 Food and supplemental Inadequate mineral intake (specify) (NI-5.10.1)
sources of minerals
 Recommended dose of Imbalance of nutrients (NI-5.4)
vitamin and mineral
supplements
 Management of diagnosis Excessive mineral intake (specify) (NI-5.10.2)
requiring mineral restriction
 Management of diagnosed Excessive mineral intake (specify) (NI-5.10.2)
genetic disorder altering
mineral homeostasis
 Correct amount of Excessive energy intake (NI-1.3)
enteral/parenteral formula Excessive parenteral nutrition infusion (NI-2.8)
Inadequate parenteral nutrition infusion (NI-2.7),
 Correct parenteral nutrition
Parenteral nutrition composition inconsistent with needs
components or
(NI-2.9), Parenteral nutrition administration inconsistent
administration
with needs (NI-2.10)
Inadequate enteral nutrition infusion (NI-2.3), Inadequate
 Appropriate/correct access
parenteral nutrition infusion (NI-2.7), Parenteral nutrition
for delivering EN/PN
administration inconsistent with needs (NI-2.10)
 Health benefits of physical Physical inactivity (NB-2.1)
activity
 How to make nutrition Limited adherence to nutrition related recommendations
related changes (NB-1.6)
Food medication interaction (NC-2.3), Predicted food
 Food drug interactions
medication interaction (NC-2.4)
Excessive enteral nutrition infusion (NI-2.4), Excessive
parenteral nutrition infusion (NI-2.8), Enteral nutrition
composition inconsistent with needs (NI-2.5), Enteral
 On the part of the caregiver nutrition administration inconsistent with needs (NI-2.6),
Parenteral nutrition composition inconsistent with needs
(NI-2.9), Parenteral nutrition administration inconsistent
with needs (NI-2.10)
 Consumption of high-dose Imbalance of nutrients (NI-5.4)
nutrient supplements
 Infant/child hunger cues Food and nutrition related knowledge deficit (NB-1.1)
Lack of or limited prior exposure or Food and nutrition related knowledge deficit (NB-1.1),
exposure to inaccurate nutrition Unsupported beliefs/attitudes about food or nutrition
Knowledge
related information related topics (NB-1.2), Self monitoring deficit (NB-1.4),
5
Undesirable food choices (NB-1.7), Inability to manage

self care (NB-2.3)
Lack of or limited prior exposure to Physical inactivity (NB-2.1)
Knowledge accurate information regarding
physical activity
Failure to adjust for lifestyle changes Excessive energy intake (NI-1.3)
Knowledge or restricted mobility and decreased
metabolism
Physical function Irritability Breastfeeding difficulty (NC-1.3)
Inability to physically: Self feeding difficulty (NB-2.6)
 Bend elbow at wrist
 Grasp cups and utensils
 Sit with hips square and
Physical function back straight
 Support neck and/or control
head and neck
 Coordinate hand movement
to mouth
Physical function Lack of or limited self feeding ability Unintended weight loss (NC-3.2)
Limited access to food (NB-3.2), Limited access to
Physical function Diminished ability to shop nutrition related supplies (NB-3.3), Limited access to
potable water (NB-3.4)
Limited physical strength or range of Self feeding difficulty (NB-2.6)
Physical function
motion
Physical function Physical inactivity
(NC-3.3.4), Obese, Class III (NC-3.3.5), Excessive growth
rate (NC-3.6)
Change in physical activity Predicted inadequate energy intake (NI-1.4), Predicted
Physical function
anticipated excessive energy intake (NI-1.5)
Voluntary or involuntary physical Increased energy expenditure (NI-1.1)
Physical function
activity/movement
Physiologic- Inadequate protein intake (NI-5.6.1), Growth rate below
Age-related demands
Metabolic expected (NC-3.5)
Alteration in gastrointestinal tract:
Increased nutrient needs (specify) (NI-5.1), Moderate
(undernutrition) (NC-4.1.1.2), Moderate chronic disease
or condition related malnutrition (undernutrition) (NC-
4.1.2.1), Severe chronic disease or condition related
malnutrition (NC-4.1.2.2), Moderate acute disease or
 Decreased functional length
injury related malnutrition (undernutrition) (NC-4.1.3.1),
of GI tract
Severe acute disease or injury related malnutrition
(undernutrition) (NC-4.1.3.2), Mild illness related
pediatric malnutrition (undernutrition) (NC-4.1.5.1),
Physiologic-
Moderate illness related pediatric malnutrition (NC-
Metabolic
4.1.5.2), Severe illness related pediatric malnutrition (NC-
4.1.5.3), Altered GI function (NC-1.4), Growth rate below
expected (NC-3.5)
Increased nutrient needs (specify) (NI-5.1), Moderate
(undernutrition) (NC-4.1.1.2), Moderate chronic disease
 Alteration in GI anatomical
or condition related malnutrition (undernutrition) (NC-
structure
malnutrition (NC-4.1.2.2),Moderate acute disease or
6
(undernutrition) (NC-4.1.3.2), Mild illness related

pediatric malnutrition (undernutrition) (NC-4.1.5.),
Moderate illness related pediatric malnutrition
(undernutrition) (NC-4.1.5.2), Severe illness related
Altered GI function (NC-1.4), Inadequate fat intake (NI-
5.5.1), Growth rate below expected (NC-3.5)
Limited food acceptance (NI-2.11), Inadequate bioactive
substance intake (specify) (NI-4.1), Excessive bioactive
substance intake (specify) (NI-4.2), Increased nutrient
needs (specify) (NI-5.1), Moderate starvation related
malnutrition (undernutrition) (NC-4.1.1.1), Severe
4.1.1.2), Moderate chronic disease or condition related
malnutrition (undernutrition) (NC-4.1.2.1), Severe chronic
disease or condition related malnutrition (NC-
 Alteration in GI function 4.1.2.2),Moderate acute disease or injury related
malnutrition (undernutrition) (NC-4.1.3.1), Severe acute
disease or injury related malnutrition (undernutrition)
(NC-4.1.3.2), Mild illness related pediatric malnutrition
(undernutrition) (NC-4.1.5.), Moderate illness related
Severe illness related pediatric malnutrition
(undernutrition) (NC-4.1.5.3),, Inadequate fat intake (NI-
5.5.1), Altered GI function (NC-1.4), Growth rate below
expected (NC-3.5)
 Change in GI tract motility Altered GI function (NC-1.4)
 Change in GI related organ Increased nutrient needs (specify) (NI-5.1), Altered GI
function function (NC-1.4), Growth rate below expected (NC-3.5)
 Compromised endocrine Impaired nutrient utilization (NC-2.1), Growth rate below
function expected (NC-3.5)
Physiologic- Altered cholesterol Decreased nutrient needs (specify) (NI-5.3)
Metabolic metabolism/regulation
Physiologic- Breastfeeding difficulty (NC-1.3), Predicted breastfeeding
Breast or nipple abnormality
Metabolic difficulty (NC-1.5)
Physiologic- Excessive fat intake (NI-5.5.2), Intake of types of fats
Changes in taste, appetite
Metabolic inconsistent with needs (specify) (NI-5.5.3)
Physiologic- Inadequate fluid intake (NI-3.1)
Conditions leading to excess fluid loss
Metabolic
Physiologic- Biting/Chewing (masticatory) difficulty (NC-1.2)
Craniofacial malformations
Metabolic
Physiologic- (NC-3.3.2), Obese, Class I (NC-3.3.3), Obese, Class II
Decreased energy needs
Metabolic (NC-3.3.4), Obese, Class III (NC-3.3.5), Excessive growth
rate (NC-3.6)
(NI-2.1), Inadequate protein–energy intake (NI-5.2),
Physiologic- Decreased ability to consume Inadequate protein intake (NI-5.6.1), Inadequate vitamin
Metabolic sufficient energy, nutrients intake (specify) (NI-5.9.1), Inadequate mineral intake
(specify) (NI-5.10.1), Unintended weight loss (NC-3.2),
Growth rate below expected (NC-3.5)
Decreased nutrient needs related to Excessive enteral nutrition infusion (NI-2.4), Excessive
Physiologic-
low activity levels due to chronic parenteral nutrition infusion (NI-2.8), Excessive vitamin
Metabolic
disease or organ failure intake (specify) (NI-5.9.2)
Physiologic- Decreased total fat need or Excessive fat intake (NI-5.5.2)
Metabolic recommendation
Physiologic- Altered fatty acid need or Intake of types of fats inconsistent with needs (specify)
Metabolic recommendation (NI-5.5.3)
Physiologic- Limited food acceptance (NI-2.11)
Developmental delay
Metabolic
7
Physiologic- Difficulty chewing or swallowing Inadequate fiber intake (NI-5.8.5)

Metabolic high-fiber foods
Physiologic- Breastfeeding difficulty (NC-1.3)
Difficulty latching on
Metabolic
Physiologic- (NC-3.3.2), Obese, Class I (NC-3.3.3), Obese, Class II
Metabolic (NC-3.3.4), Obese, Class III (NC-3.3.5), Excessive growth
rate (NC-3.6)
Food allergies and aversions impeding Undesirable food choices (NB-1.7)
Physiologic-
food choices consistent with
Metabolic
guidelines
Physiologic- Decreased nutrient needs (specify) (NI-5.3)
Food intolerances
Metabolic
Physiologic- Genetic predisposition to Predicted excessive energy intake (NI-1.5)
Metabolic overweight/obesity
Physiologic- Decreased nutrient needs (specify) (NI-5.3)
Heart failure
Metabolic
Illness causing unexpected weight Unintended weight gain (NC-3.4)
Physiologic- gain because of head trauma,
Metabolic immobility, paralysis or related
condition
Inadequate fluid intake (NI-3.1), Moderate starvation
related malnutrition (undernutrition) (NC-4.1.1.1), Severe
4.1.1.2), Food and nutrition related knowledge deficit
Impaired cognitive ability, including
Physiologic- (NB-1.1), Not ready for diet/lifestyle change (NB-1.3),
learning disabilities, neurological or
Metabolic Self monitoring deficit (NB-1.4), Undesirable food
sensory impairment, and dementia
choices (NB-1.7), Inability to manage self care (NB-2.3),
Impaired ability to prepare foods/meals (NB-2.4), Self
feeding difficulty (NB-2.6), Limited access to food (NB-
3.2)
Underweight (NC-3.1), Moderate chronic disease or
condition related malnutrition (undernutrition) (NC-
Physiologic-
Inadequate energy intake malnutrition (NC-4.1.2.2), Moderate acute disease or
Metabolic
(undernutrition) (NC-4.1.3.2),
Inadequate milk supply
Metabolic
Physiologic- Underweight (NC-3.1)
Increased energy needs
Metabolic
Physical inactivity (NB-2.1), Mild illness related pediatric
Injury, condition, physical disability malnutrition (undernutrition) (NC-4.1.5.), Moderate
Physiologic-
or limitation that reduces physical illness related pediatric malnutrition (undernutrition) (NC-
Metabolic
activity or activities of daily living 4.1.5.2), Severe illness related pediatric malnutrition
parenteral nutrition infusion (NI-2.7), Mild non illness
4.1.4.1), Moderate non illness related pediatric
malnutrition (undernutrition) (NC-4.1.4.2), Severe non
Physiologic-
Intolerance of EN/PN illness related pediatric malnutrition (undernutrition) (NC-
Metabolic
4.1.4.3), Mild illness related pediatric malnutrition
8
Limited food acceptance (NI-2.11), Excessive fluid intake

Kidney, liver, cardiac, endocrine,
Physiologic- (NI-3.2), Biting/ Chewing (masticatory) difficulty (NC-
neurologic, and/or pulmonary
Metabolic 1.2), Altered nutrition related laboratory values (specify)
dysfunction
(NC-2.2), Growth rate below expected (NC-3.5)
Lack of or limited developmental Inability to manage self care (NB-2.3)
Physiologic-
readiness to perform self management
Metabolic
tasks
Lethargy, sleepiness
Metabolic
Physiologic- Self feeding difficulty (NB-2.6)
Limited vision
Metabolic
Physiologic- Inadequate oral intake (NI-2.1), Growth rate below
Limited food acceptance
Metabolic expected (NC-3.5)
Decreased nutrient needs (specify) (NI-5.3), Excessive
Physiologic- protein intake (NI-5.6.2), Intake of types of proteins
Liver dysfunction
Metabolic inconsistent with needs (specify) (NI-5.6.3), Intake types
of amino acids inconsistent with needs (specify) (NI-5.7.1)
Physiologic- Excessive oral intake (NI-2.2)
Loss of appetite awareness
Metabolic
Increased nutrient needs (specify) (NI-5.1), Breastfeeding
Physiologic-
Malnutrition/malabsorption difficulty (NC-1.3), Predicted breastfeeding difficulty
Metabolic
(NC-1.5), Growth rate below expected (NC-3.5)
Physiologic- Mastitis and/or painful breasts, Breastfeeding difficulty (NC-1.3), Predicted breastfeeding
Metabolic nipples difficulty (NC-1.5)
Mechanical issues such as Swallowing difficulty (NC-1.1), Biting/ Chewing
Physiologic- inflammation, surgery, stricture, or (masticatory) difficulty (NC-1.2)
Metabolic oral, pharyngeal and esophageal
tumors, mechanical ventilation
inconsistent with needs (specify) (NI-5.7.1), Altered
nutrition related laboratory values (specify) (NC-2.2),
Physiologic-
Inborn errors of metabolism Mild illness related pediatric malnutrition (undernutrition)
Metabolic
(NC-4.1.5.), Moderate illness related pediatric
malnutrition (undernutrition) (NC-4.1.5.2), Severe illness
4.1.5.3),
Excessive protein intake (NI-5.6.2), Intake of types of
proteins inconsistent with needs (specify) (NI-5.6.3),
Intake types of amino acids inconsistent with needs
Physiologic- (specify) (NI-5.7.1), Mild illness related pediatric
Metabolic malnutrition (undernutrition) (NC-4.1.5.), Moderate
illness related pediatric malnutrition (undernutrition) (NC-
4.1.5.2), Severe illness related pediatric malnutrition
Impaired nutrient utilization (NC-2.1), Intake types of
amino acids inconsistent with needs (specify) (NI-5.7.1),
Mild illness related pediatric malnutrition (undernutrition)
Physiologic-
Metabolic disorders (NC-4.1.5.), Moderate illness related pediatric
Metabolic
4.1.5.3),
Physiologic- Motor causes related to neurological Swallowing difficulty (NC-1.1)
Metabolic or muscular disorders
Oral pain
Metabolic
Physiologic- Other organ dysfunction that leads to Altered nutrition related laboratory values (specify) (NC-
Metabolic biochemical changes 2.2)
Partial or complete edentulism
Metabolic
9
Impaired ability to prepare foods/meals (NB-2.4), Limited

Physiologic-
Physical disability access to food (NB-3.2), Limited access to potable water
Metabolic
(NB-3.4)
Physiologic- Physiological causes that put Disordered eating pattern (NB-1.5)
Metabolic emphasis on food, weight, or shape
Physiologic causes requiring modified Excessive carbohydrate intake (NI-5.8.2), Intake of types
Physiologic-
amount or timing of carbohydrate of carbohydrate inconsistent with needs (specify) (NI-
Metabolic
intake 5.8.3), Inconsistent carbohydrate intake (NI-5.8.4)
Physiologic- Physiological causes increasing
Metabolic nutrient needs due to:
Increased energy expenditure (NI-1.1), Inadequate enteral
nutrition infusion (NI-2.3), Inadequate parenteral nutrition
 Accelerated growth or
infusion (NI-2.7), Increased nutrient needs (specify) (NI-
anabolism
5.1), Inadequate mineral intake (specify)(NI-5.10.1),
Inadequate fluid intake (NI-3.1), Increased nutrient needs
(specify) (NI-5.1), Inadequate protein intake (NI-5.6.1),
Inadequate carbohydrate intake (NI-5.8.1), Inadequate
vitamin intake (specify) (NI-5.9.1), Inadequate mineral
intake (specify) (NI-5.10.1), Predicted inadequate nutrient
intake (specify) (NI-5.11.1), Moderate chronic disease or
condition related malnutrition (undernutrition) (NC-
 Altered absorption or
metabolism
malnutrition (NC-4.1.2.2),Mild illness related pediatric
malnutrition (undernutrition) (NC-4.1.5.), Moderate
4.1.5.2), Severe illness related pediatric malnutrition
(undernutrition) (NC-4.1.5.3),Inadequate protein–energy
intake (NI-5.2), Unintended weight loss (NC-3.2), Growth
rate below expected (NC-3.5)
parenteral nutrition infusion (NI-2.7), Inadequate fluid
intake (NI-3.1), Increased nutrient needs (specify) (NI-
Physiologic- 5.1), Moderate chronic disease or condition related
Metabolic malnutrition (undernutrition) (NC-4.1.2.1), Severe chronic
Physiologic- disease or condition related malnutrition (NC-
Metabolic 4.1.2.2),Mild illness related pediatric malnutrition
 Disease/condition pediatric malnutrition (undernutrition) (NC-4.1.5.2),
(undernutrition) (NC-4.1.5.3), Inadequate protein–energy
intake (NI-5.2), Inadequate protein intake (NI-5.6.1),
inconsistent with needs (specify) (NI-5.7.1), Inadequate
vitamin intake (specify) (NI-5.9.1), Unintended weight
loss (NC-3.2), Growth rate below expected (NC-3.5)
 Maintenance of body Increased energy expenditure (NI-1.1), Inadequate fluid
temperature intake (NI-3.1), Growth rate below expected (NC-3.5)
(NI-2.1), Inadequate fluid intake (NI-3.1), Moderate
chronic disease or condition related malnutrition
(undernutrition) (NC-4.1.2.1), Severe chronic disease or
condition related malnutrition (NC-4.1.2.2),Mild illness
 Prolonged catabolic illness related pediatric malnutrition (undernutrition) (NC-4.1.5.),
Moderate illness related pediatric malnutrition
pediatric malnutrition (undernutrition) (NC-
4.1.5.3),Inadequate protein–energy intake (NI-5.2),
Inadequate protein intake (NI-5.6.1), Inadequate vitamin
10
intake (specify) (NI-5.9.1), Inadequate mineral intake

(specify) (NI-5.10.1), Unintended weight loss (NC-3.2),
Physiologic- Predicted excessive energy intake (NI-1.5), Predicted
Altered metabolism
Metabolic excessive nutrient intake (NI-5.11.2)
Physiologic- Breastfeeding difficulty (NC-1.3), Predicted breastfeeding
Poor sucking ability
Metabolic difficulty (NC-1.5), Growth rate below expected (NC-3.5)
Altered nutrition related laboratory values (NC-2.2),
Growth rate below expected (NC-3.5), Mild illness related
Physiologic- pediatric malnutrition (undernutrition) (NC-4.1.5.),
Prematurity
Metabolic Moderate illness related pediatric malnutrition
Physiologic- protein intake (NI-5.6.2), Intake of types of proteins
Renal dysfunction
Metabolic inconsistent with needs (specify) (NI-5.6.3), Intake types
Small for gestational age, intrauterine Underweight (NC-3.1), Growth rate below expected (NC-
growth retardation/restriction and/or 3.5)
Physiologic-
Lack of or limited
Metabolic
progress/appropriate weight gain per
day
Biting/Chewing (masticatory) difficulty (NC-1.2), Moderate
Physiologic- Soft tissue disease (primary or oral starvation related malnutrition (undernutrition) (NC-
Metabolic manifestations of a systemic disease) 4.1.1.1), Severe starvation related malnutrition
Physiologic- Swallowing difficulty, and altered Swallowing difficulty (NC-1.1), Breastfeeding difficulty
Metabolic suck and breathing patterns in infants (NC-1.3), Predicted breastfeeding difficulty (NC-1.5)
Xerostomia
Metabolic
Excessive alcohol intake (NI-4.3), Impaired nutrient
Psychological Alcohol or drug addiction
utilization (NC-2.1)
Psychological Addictive personality Excessive physical activity (NB-2.2)
Mental illness, confusion, or altered Intake of unsafe food (NB-3.1), Excessive oral intake (NI-
Psychological
awareness 2.2)
Personality characteristics or Disordered eating pattern (NB-1.5)
Psychological temperament associated with eating
disorders
Psychological causes that put Disordered eating pattern (NB-1.5)
Psychological emphasis on food, weight, or shape

(NI-2.1), Inadequate fluid intake (NI-3.1), Excessive fluid
intake (NI-3.2), Moderate starvation related malnutrition
(undernutrition) (NC-4.1.1.1), Severe starvation related
malnutrition (undernutrition) (NC-4.1.1.2), Non illness
related pediatric malnutrition (undernutrition) (NC-4.1.4),
Mild illness related pediatric malnutrition (undernutrition)
(NC-4.1.5.), Moderate illness related pediatric
Psychological causes such as
Psychological related pediatric malnutrition (undernutrition) (NC-
depression and disordered eating
4.1.5.3), Inadequate protein–energy intake (NI-5.2),
Inadequate fat intake (NI-5.5.1), Inadequate protein intake
(NI-5.6.1), Inadequate carbohydrate intake (NI-5.8.1),
Excessive carbohydrate intake (NI-5.8.2), Intake of types
of carbohydrate inconsistent with needs (specify) (NI-
5.8.3), Inconsistent carbohydrate intake (NI-5.8.4),
Inadequate fiber intake (NI-5.8.5), Inadequate vitamin
intake (specify) (NI-5.9.1), Excessive vitamin intake
(specify) (NI-5.9.2), Inadequate mineral intake (specify)
11
(NI-5.10.1), Unintended weight loss (NC-3.2), Growth

rate below expected (NC-3.5), Undesirable food choices
(NB-1.7), Excessive physical activity (NB-2.2), Limited
access to food (NB-3.2), Limited access to nutrition
related supplies (NB-3.3)
Breastfeeding difficulty (NC-1.3), Physical inactivity
Social-Personal Lack of or limited role models
(NB-2.1)
difficulty (NC-1.5), Mild non illness related pediatric
malnutrition (undernutrition) (NC-4.1.4.1), Moderate non
4.1.4.2), Severe non illness related pediatric malnutrition
Lack of or limited social support for
Social-Personal (undernutrition) (NC-4.1.4.3), Not ready for diet/lifestyle
implementing changes
change (NB-1.3), Self monitoring deficit (NB-1.4),
Limited adherence to nutrition related recommendations
(NB-1.6), Physical inactivity (NB-2.1), Inability to
manage self care (NB-2.3), Poor nutrition quality of life
(NB-2.5)
Social-Personal Family or social history of overeating Predicted excessive energy intake (NI-1.5)
Predicted breastfeeding difficulty (NC-1.5), Overweight,
adult or pediatric (NC-3.3.1), Obese, pediatric (NC-3.3.2),
Obese, Class I (NC-3.3.3), Obese, Class II (NC-3.3.4),
Social-Personal Increased psychological/life stress
Obese, Class III (NC-3.3.5), Predicted inadequate energy
intake (NI-1.4), Predicted excessive energy intake (NI-
1.5)
Traumatic event(s) that causes a Disordered eating pattern (NB-1.5)
Social-Personal physical or psychological stress
reaction
Predicted inadequate energy intake (NI-1.4), Predicted
excessive energy intake (NI-1.5), Predicted inadequate
Social-Personal Change in living situation
nutrient intake (specify) (NI-5.11.1), Predicted
breastfeeding difficulty (NC-1.5)
Living in a geographic location with Predicted inadequate nutrient intake (specify) (NI-5.11.1)
Social-Personal
danger for environmental emergency
Accidental vitamin and/or mineral Excessive vitamin intake (specify) (NI-5.9.2), Excessive
Treatment overdose from oral, enteral or mineral intake (specify) (NI-5.10.2)
parenteral sources
Calories/kcal/kJ unaccounted for from Excessive energy intake (NI-1.3)
Treatment
IV infusion and/or medications
Excessive fat intake (NI-5.5.2), Intake of types of fats
Treatment Changes in taste, appetite
Treatment Changes in GI tract motility Altered GI function (NC-1.4)
Chronic use of medications known to Unintended weight gain (NC-3.4), Excessive growth rate
cause weight gain, such as use of (NC-3.6)
Treatment certain antidepressants,
antipsychotics, corticosteroids, certain
HIV medications
Difficulty chewing or swallowing Inadequate fiber intake (NI-5.8.5)
Treatment
high-fiber foods
Treatment Excessive energy intake (NC-3.3.2), Obese, Class I (NC-3.3.3), Obese, Class II
(NC-3.3.4), Obese, Class III (NC-3.3.5),
Treatment Food intolerances Decreased nutrient needs (specify) (NI-5.3)
High level of fatigue or other side Undesirable food choices (NB-1.7), Impaired ability to
Treatment
effect of therapy prepare foods/meals (NB-2.4)
Improvement in client status, allowing Enteral nutrition composition inconsistent with needs (NI-
return to total or partial oral diet; 2.5), Enteral nutrition administration inconsistent with
Treatment changes in the course of disease needs (NI-2.6), Parenteral nutrition composition
resulting in changes in nutrient inconsistent with needs (NI-2.9), Parenteral nutrition
requirements administration inconsistent with needs (NI-2.10)
12
Treatment Inadequate energy intake Underweight (NC-3.1)

Infusion volume not reached or Inadequate enteral nutrition infusion (NI-2.3), Inadequate
Treatment
schedule for infusion interrupted parenteral nutrition infusion (NI-2.7)
Insufficient electrolyte replacement Imbalance of nutrients (NI-5.4)
Treatment when initiating feeding (PN/EN,
including oral)
Lack of or limited, compromised, or Inadequate enteral nutrition infusion (NI-2.3), Inadequate
Treatment
incorrect access for delivering EN/PN parenteral nutrition infusion (NI-2.7)
Mechanical issues such as Swallowing difficulty (NC-1.1), Biting/ Chewing
inflammation, surgery, stricture, or (masticatory) difficulty (NC-1.2)
Treatment
oral, pharyngeal and esophageal
tumors, mechanical ventilation
Treatment Medications that increase appetite
(NI-2.2),
Medications that increase nutrient Increased nutrient needs (specify) (NI-5.1)
Treatment
needs
Medications that affect nutrient Impaired nutrient utilization (NC-2.1)
Treatment
metabolism
Medications that increase fluid needs Inadequate fluid intake (NI-3.1)
Treatment
or decrease thirst
Treatment Misused specialized protein products
(specify) (NI-5.6.3)
Treatment Misused specialized amino acid Intake types of amino acids inconsistent with needs
products (specify) (NI-5.7.1)
Misdiagnosis of lactose Inadequate mineral intake (specify) (NI-5.10.1)
Treatment
intolerance/lactase deficiency
parenteral nutrition infusion (NI-2.7), Inadequate vitamin
Nutrient/nutrient interaction and/or
Treatment intake (specify) (NI-5.9.1), Inadequate mineral intake
drug/nutrient interaction
(specify) (NI-5.10.1), Food Medication Interaction (NC-
2.3), Predicted food medication interaction (NC-2.4)
Overfeeding of parenteral/enteral Excessive energy intake (NI-1.3)
Treatment
nutrition (PN/EN)
Planned procedure, therapy or Predicted inadequate energy intake (NI-1.4), Predicted
Treatment medication predicted to increase inadequate nutrient intake (specify) (NI-5.11.1)
energy expenditure or nutrient need
Planned therapy or medication Predicted excessive energy intake (NI-1.5), Predicted
Treatment predicted to reduce energy/nutrient excessive nutrient intake (NI-5.11.2)
need or metabolic rate/metabolism
Planned procedure, therapy or Predicted breastfeeding difficulty (NC-1.5)
Treatment medication predicted to hinder
breastfeeding
Planned procedure, therapy or Predicted inadequate energy intake (NI-1.4), Predicted
medication predicted to decrease inadequate nutrient intake (specify) (NI-5.11.1)
Treatment
ability to consume sufficient energy
or nutrients
Prolonged adherence to a low-fiber or Inadequate fiber intake (NI-5.8.5)
Treatment
low-residue diet
Treatment Prolonged hospitalization Unintended weight loss (NC-3.2)
protein intake (NI-5.6.2), Intake of types of proteins
Treatment Renal dysfunction
inconsistent with needs (specify) (NI-5.6.3), Intake types
Treatment Xerostomia Biting/Chewing (masticatory) difficulty (NC-1.2)
Access to foods and supplements in Excessive vitamin intake (specify) (NI-5.9.2)
Access
excess of needs
Caregiver intentionally or Limited access to food (NB-3.2), Limited access to
Access unintentionally not providing access nutrition related supplies (NB-3.3), Limited access to
to food or nutrition related supplies potable water (NB-3.4)
13
Inadequate vitamin intake (specify) (NI-5.9.1), Limited

Community and geographical access to food (NB-3.2), Limited access to nutrition
Access
constraints related supplies (NB-3.3), Limited access to potable water
(NB-3.4)
Environmental causes (eg, Inadequate vitamin intake (NI-5.9.1), Inadequate mineral
inadequately tested nutrient intake (specify) (NI-5.10.1)
bioavailability of fortified foods,
Access beverages, and supplements;
marketing of fortified foods,
beverages, supplements as a substitute
for natural food source of nutrient(s))
Exposure to contaminated water or Intake of unsafe food (NB-3.1), Limited access to food
food (eg, community outbreak of (NB-3.2), Limited access to potable water (NB-3.4)
Access
illness documented by surveillance
and/or response agency)
Failure to participate in federal food Limited access to food (NB-3.2), Limited access to
programs such as WIC, National potable water (NB-3.4)
Access
School Breakfast/Lunch Program,
food stamps
Financial constraints that may prevent Physical inactivity (NB-2.1)
sufficient level of activity (eg, to
Access
address cost of equipment or shoes or
club membership to gain access)
Lack of, or limited access to:
 Adaptive foods or eating Self feeding difficulty (NB-2.6)
devices conducive for self
feeding
 Available and safe exercise Physical inactivity (NB-2.1)
environment and/or
Access
equipment
Inadequate fluid intake (NI-3.1), Inadequate fiber intake
 Fluid
(NI-5.8.5)
 Fortified foods and Inadequate mineral intake (specify) (NI-5.10.1)
beverages
 Specialized protein products Excessive protein intake (NI-5.6.2)
(NI-2.1), Moderate starvation related malnutrition
(undernutrition) (NC-4.1.1.1), Severe starvation related
malnutrition (undernutrition) (NC-4.1.1.2), Mild non
4.1.4.3), Inadequate protein energy intake (NI-5.2),
 Food or artificial nutrition
Inadequate fat intake (NI-5.5.1), Inadequate protein intake
(NI-5.6.1), Intake of types of proteins inconsistent with
needs (NI-5.6.3), Intake of types of amino acids
inconsistent with needs (NI-5.7.2), Inadequate
carbohydrate intake (NI-5.8.1), Inadequate vitamin intake
(specify) (NI-5.9.1), Inadequate mineral intake (specify)
(NI-5.10.1), Underweight (NC-3.1), Unintended weight
loss (NC-3.2), ), Growth rate below expected (NC-3.5),
Poor nutrition quality of life (NB-2.5)
 Fiber-containing foods Inadequate fiber intake (NI-5.8.5)
 Food that contains a Inadequate bioactive substance intake (NI-4.1)
bioactive substance
 Healthy food choices (NI-2.2), Excessive fat intake (NI-5.5.2), Intake of types
of fats inconsistent with needs (specify) (NI-5.5.3)
 Recommended foods Undesirable food choices (NB-1.7)
14
 Sufficient quantity or variety Limited access to food (NB-3.2); Limited access to

of culturally appropriate potable water (NB-3.4)
healthful food or water
 Safe and/or clear and Excessive bioactive substance intake (NI-4.2)
accurately labeled food Intake of unsafe food (NB-3.1)
supply
 Food storage Intake of unsafe food (NB-3.1)
equipment/facilities
 Self management tools or Inability to manage self care (NB-2.3), Limited access to
decision guides or other nutrition related supplies (NB-3.3)
nutrition related supplies
Limited, absent, or failure to Limited access to food (NB-3.2), Limited access to
participate in community nutrition related supplies (NB-3.3), Limited access to
supplemental food programs such as potable water (NB-3.4)
Access food pantries, emergency kitchens, or
shelters, with a sufficient variety of
culturally appropriate healthful foods
or nutrition related supplies
Schools lacking nutrition/wellness Limited access to food (NB-3.2), Limited access to
policies or application of policies potable water (NB-3.4)
ensuring convenient, appetizing,
Access competitively priced culturally
appropriate healthful foods at meals,
snacks, and school sponsored
activities
Excessive physical activity (NB-2.2)
Behavior Addictive behavior
Consumption of high-dose nutrient Imbalance of nutrients (NI-5.4)

Behavior
supplements
Unsupported beliefs/attitudes about food or nutrition
Eating behavior serves a purpose related topics (NB-1.2), Limited food acceptance (NI-2.11)
Behavior
other than nourishment (eg, pica)

Behavior Excessive energy intake (NC-3.3.4), Obese, Class III (NC-3.3.5),
Behavior Excessive physical activity
Excessive carbohydrate intake (NI-5.8.2), Intake of types
Food and nutrition adherence
Behavior of carbohydrate inconsistent with needs (specify) (NI-
limitations
5.8.3), Inconsistent carbohydrate intake (NI-5.8.4)
Food or activity behavior-related Poor nutrition quality of life (NB-2.5)
Behavior
difficulty
Food preparation or eating patterns Excessive fiber intake (NI-5.8.6)
that involve only high-fiber foods to
Behavior
the exclusion of other nutrient-dense
foods
Excessive physical activity (NB-2.2), Underweight (NC-
3.1), Overweight, adult or pediatric (NC-3.3.1), Obese,
pediatric (NC-3.3.2), Obese, Class I (NC-3.3.3), Obese,
Class II (NC-3.3.4), Obese, Class III (NC-3.3.5), Mild non
Behavior Disordered eating pattern
4.1.4.3), Mild illness related pediatric malnutrition
15

(undernutrition) (NC-4.1.5.3)
Feeding via bottle or other route that Breastfeeding difficulty (NC-1.3), Predicted breastfeeding
Behavior
may affect breastfeeding difficulty (NC-1.5)
Frequent intake of foods containing Excessive bioactive substance intake (NI-4.2)
Behavior
bioactive substances
Limited food acceptance due to Inadequate oral intake (NI-2.1), Growth rate below
Behavior
behavioral issues expected (NC-3.5)
Inability to limit or refuse offered Excessive oral intake (NI-2.2)
Behavior
foods
Behavior Inadequate energy intake Underweight (NC-3.1)
Lack of or limited focus and attention Self monitoring deficit (NB-1.4)
Behavior to detail, difficulty with time
management and/or organization
Lifestyle change that reduces physical Physical inactivity (NB-2.1)
Behavior
activity or activities of daily living
Over consumption of a limited variety Excessive mineral intake (specify) (NI-5.10.2)
Behavior
of foods
Poor food planning, purchasing and Excessive oral intake (NI-2.2), Inadequate fiber intake
Behavior
preparation practices (NI-5.8.5), Limited access to food (NB-3.2)
Reluctance or avoidance of self Self feeding difficulty (NB-2.6)
Behavior
feeding
16
Nutrition Intervention Terminology
Each term is designated with an alpha-numeric NCPT hierarchical code, followed by a five-digit (eg, 99999) Academy SNOMED CT/LOINC unique identifier
NUTRITION INTERVENTION PLANNING ❑ Increased protein diet ND-1.2.3.2 10972

❑ Decreased protein diet ND-1.2.3.3 10973
The planning phase of the nutrition intervention including
prioritization of the nutrition interventions, collaboration with client ❑ Decreased casein diet ND-1.2.3.4 10999
and others to set goals, writing of the nutrition prescription, and ❑ Decreased gluten diet ND-1.2.3.5 11000
reviewing of evidence based practice guides and policies to select ❑ Gluten free diet ND-1.2.3.5.1 11027
intervention strategies consistent with current scientific evidence. ❑ Amino acid modified diet ND-1.2.3.6 10897
Identify Nutrition Intervention Goal(s) (CG) ❑ Arginine modified diet ND-1.2.3.6.1 10898
Description of a desired outcome of a nutrition intervention. ❑ Increased arginine diet ND-1.2.3.6.1.1 10974
❑ Identify goal description CG-1.1 14502 ❑ Decreased arginine diet ND-1.2.3.6.1.2 10975
❑ Identify goal target value CG-1.2 14503 ❑ Glutamine modified diet ND-1.2.3.6.2 10899
❑ Identify goal timeframe CG-1.3 14504 ❑ Increased glutamine diet ND-1.2.3.6.2.1 10976
❑ Identify goal subject CG-1.4 14505 ❑ Decreased glutamine diet ND-1.2.3.6.2.2 10977
❑ Identify goal setter CG-1.5 14506 ❑ Histidine modified diet ND-1.2.3.6.3 10900
❑ Increased histidine diet ND-1.2.3.6.3.1 10978
Nutrition Prescription (NP)
❑ Decreased histidine diet ND-1.2.3.6.3.2 10979
The client’s tailored recommended intake of energy and/or selected foods or nutrients
based on current reference standards and evidenced based practice nutrition guidelines ❑ Increased homocysteine diet ND-1.2.3.6.4 10980
and related to the client’s health and nutrition diagnosis (specify).
❑ Isoleucine modified diet ND-1.2.3.6.5 10902
❑ Nutrition Prescription NP-1.1 10794
❑ Increased isoleucine diet ND-1.2.3.6.5.1 10981
❑ Decreased isoleucine diet ND-1.2.3.6.5.2 10982
NUTRITION INTERVENTION IMPLEMENTATION ❑ Leucine modified diet ND-1.2.3.6.6 10903
The action phase of the nutrition intervention including carrying out ❑ Increased leucine diet ND-1.2.3.6.6.1 10983
and communicating the plan, continuing data collection, and revising ❑ Decreased leucine diet ND-1.2.3.6.6.2 10984
the nutrition intervention(s) based on the client response. ❑ Lysine modified diet ND-1.2.3.6.7 10904
FOOD AND/OR NUTRIENT DELIVERY (ND) ❑ Increased lysine diet ND-1.2.3.6.7.1 10985
Individualized approach for food /nutrient provision. ❑ Decreased lysine diet ND-1.2.3.6.7.2 10986
Meals and Snacks (1) ❑ Methionine modified diet ND-1.2.3.6.8 10905
Regular eating episode (meal); food served between regular meals (snack) ❑ Increased methionine diet ND-1.2.3.6.8.1 10987
❑ General healthful diet ND-1.1 10489 ❑ Decreased methionine diet ND-1.2.3.6.8.2 10988
❑ Modify composition of meals/snacks ND-1.2 10828 ❑ Phenylalanine modified diet ND-1.2.3.6.9 10906
❑ Texture modified diet (1) ND-1.2.1 10829 ❑ Increased phenylalanine diet ND-1.2.3.6.9.1 11971
❑ Easy to chew diet ND-1.2.1.1 10914 ❑ Decreased phenylalanine diet ND-1.2.3.6.9.2 10989
❑ Mechanically altered diet ND-1.2.1.2 10915 ❑ Threonine modified diet ND-1.2.3.6.10 10907
❑ Pureed diet ND-1.2.1.3 10916 ❑ Increased threonine diet ND-1.2.3.6.10.1 10990
❑ Liquid consistency thin liquids ND-1.2.1.4 10865 ❑ Decreased threonine diet ND-1.2.3.6.10.2 10991
❑ Liquid consistency nectar thick liquids ND-1.2.1.5 10866 ❑ Tryptophan modified diet ND-1.2.3.6.11 10908
❑ Liquid consistency honey thick liquids ND-1.2.1.6 10867 ❑ Increased tryptophan diet ND-1.2.3.6.11.1 10992
❑ Liquid consistency spoon thick liquids ND-1.2.1.7 10868 ❑ Decreased tryptophan diet ND-1.2.3.6.11.2 10993
❑ Soft bite sized food Level six Blue ND-1.2.1.8 12216 ❑ Decreased tyramine diet ND-1.2.3.6.12 10994
❑ Minced moist food Level five Orange ND-1.2.1.9 12217 ❑ Tyrosine modified diet ND-1.2.3.6.13 10910
❑ Pureed food Level four Green ND-1.2.1.10 12218 ❑ Increased tyrosine diet ND-1.2.3.6.13.1 10995
❑ Extremely thick liquid Level four Green ND-1.2.1.11 12219 ❑ Decreased tyrosine diet ND-1.2.3.6.13.2 10996
❑ Liquidized food Level three Yellow ND-1.2.1.12 12220 ❑ Valine modified diet ND-1.2.3.6.14 10911
❑ Moderately thick liquid Level three ND-1.2.1.13 12221 ❑ Increased valine diet ND-1.2.3.6.14.1 10997
Yellow ❑ Decreased valine diet ND-1.2.3.6.14.2 10998
❑ Mildly thick liquid Level two Pink ND-1.2.1.14 12222 ❑ Carbohydrate modified diet (4) ND-1.2.4 10832
❑ Slightly thick liquid Level one Grey ND-1.2.1.15 12223 ❑ Consistent carbohydrate diet ND-1.2.4.1 10860
❑ Energy modified diet (2) ND-1.2.2 10830 ❑ Increased carbohydrate diet ND-1.2.4.2 10930
❑ Increased energy diet ND-1.2.2.1 10935 ❑ Increased complex carbohydrate diet ND-1.2.4.2.1 11972
❑ Decreased energy diet ND-1.2.2.2 10936 ❑ Increased simple carbohydrate diet ND-1.2.4.2.2 11973
❑ Protein modified diet (3) ND-1.2.3 10831 ❑ Decreased carbohydrate diet ND-1.2.4.3 10931
❑ Consistent protein diet ND-1.2.3.1 10896 ❑ Decreased complex carbohydrate diet ND-1.2.4.3.1 11974
1
Nutrition Care Process Terminology (eNCPT), 2020 Edition. Copyright 2020 Academy of Nutrition and Dietetics
❑ Decreased simple carbohydrate diet ND-1.2.4.3.2 11975 ❑ Increased fluid diet ND-1.2.8.1 10874
❑ Galactose modified diet ND-1.2.4.4 10861 ❑ Fluid restricted diet ND-1.2.8.2 10873
❑ Increased galactose diet ND-1.2.4.4.1 11976 ❑ Clear liquid diet ND-1.2.8.3 10876
❑ Decreased galactose diet ND-1.2.4.4.2 10932 ❑ Full liquid diet ND-1.2.8.4 10877
❑ Lactose modified diet ND-1.2.4.5 10862 ❑ Diets modified for specific foods or ND-1.2.9 10836
ingredients (9)
❑ Increased lactose diet ND-1.2.4.5.1 11977
❑ Vitamin modified diet (10) ND-1.2.10 10837
❑ Decreased lactose diet ND-1.2.4.5.2 10933
❑ Vitamin A modified diet ND-1.2.10.1 10923
❑ Fructose modified diet ND-1.2.4.6 11978
❑ Increased vitamin A diet ND-1.2.10.1.1 11013
❑ Increased fructose diet ND-1.2.4.6.1 11979
❑ Decreased vitamin A diet ND-1.2.10.1.2 11014
❑ Decreased fructose diet ND-1.2.4.6.2 11980
❑ Vitamin C modified diet ND-1.2.10.2 10926
❑ Fat modified diet (5) ND-1.2.5 10833
❑ Increased vitamin C diet ND-1.2.10.2.1 11019
❑ Increased fat diet ND-1.2.5.1 10937
❑ Decreased vitamin C diet ND-1.2.10.2.2 11020
❑ Decreased fat diet ND-1.2.5.2 10938
❑ Vitamin D modified diet ND-1.2.10.3 10927
❑ Monounsaturated fat modified diet ND-1.2.5.3 10869
❑ Increased vitamin D diet ND-1.2.10.3.1 11021
❑ Increased monounsaturated fat diet ND-1.2.5.3.1 10939
❑ Decreased vitamin D diet ND-1.2.10.3.2 11022
❑ Decreased monounsaturated fat diet ND-1.2.5.3.2 10940
❑ Vitamin E modified diet ND-1.2.10.4 10928
❑ Polyunsaturated fat modified diet ND-1.2.5.4 10870
❑ Increased vitamin E diet ND-1.2.10.4.1 11023
❑ Increased polyunsaturated fat diet ND-1.2.5.4.1 10941
❑ Decreased vitamin E diet ND-1.2.10.4.2 11024
❑ Increased linoleic acid diet ND-1.2.5.4.1.1 11981
❑ Vitamin K modified diet ND-1.2.10.5 10929
❑ Decreased polyunsaturated fat diet ND-1.2.5.4.2 10942
❑ Increased vitamin K diet ND-1.2.10.5.1 11025
❑ Decreased linoleic acid diet ND-1.2.5.4.2.1 11982
❑ Decreased vitamin K diet ND-1.2.10.5.2 11026
❑ Saturated fat modified diet ND-1.2.5.5 10871
❑ Thiamine modified diet ND-1.2.10.6 10922
❑ Decreased saturated fat diet ND-1.2.5.5.1 10943
❑ Increased thiamine diet ND-1.2.10.6.1 11011
❑ Trans fat modified diet ND-1.2.5.6 10872
❑ Decreased thiamine diet ND-1.2.10.6.2 11012
❑ Decreased trans fat modified diet ND-1.2.5.6.1 10944
❑ Riboflavin modified diet ND-1.2.10.7 10921
❑ Omega 3 fatty acid modified diet ND-1.2.5.7 11983
❑ Increased riboflavin diet ND-1.2.10.7.1 11009
❑ Increased omega 3 fatty acid diet ND-1.2.5.7.1 11984
❑ Decreased riboflavin diet ND-1.2.10.7.2 11010
❑ Increased alpha linolenic acid diet ND-1.2.5.7.1.1 11985
❑ Niacin modified diet ND-1.2.10.8 10919
❑ Increased eicosapentaenoic acid ND-1.2.5.7.1.2 11986
diet ❑ Increased niacin diet ND-1.2.10.8.1 11005
❑ Increased docosahexaenoic acid ND-1.2.5.7.1.3 11987 ❑ Decreased niacin diet ND-1.2.10.8.2 11006
❑ Decreased omega 3 fatty acid diet ND-1.2.5.7.2 11988 ❑ Folic acid modified diet ND-1.2.10.9 10918
❑ Decreased alpha linolenic acid diet ND-1.2.5.7.2.1 11989 ❑ Increased folic acid diet ND-1.2.10.9.1 11003
❑ Decreased eicosapentaenoic acid ND-1.2.5.7.2.2 11990 ❑ Decreased folic acid diet ND-1.2.10.9.2 11004
diet
❑ Vitamin B6 modified diet ND-1.2.10.10 10924
❑ Decreased docosahexaenoic acid ND-1.2.5.7.2.3 11991
❑ Increased vitamin B6 diet ND-1.2.10.10.1 11015
diet
❑ Decreased vitamin B6 diet ND-1.2.10.10.2 11016
❑ Medium chain triglyceride modified diet ND-1.2.5.8 11992
❑ Vitamin B12 modified diet ND-1.2.10.11 10925
❑ Increased medium chain triglyceride ND-1.2.5.8.1 11993
diet ❑ Increased vitamin B12 diet ND-1.2.10.11.1 11017
❑ Decreased medium chain triglyceride ND-1.2.5.8.2 11994 ❑ Decreased vitamin B12 diet ND-1.2.10.11.2 11018
diet
❑ Pantothenic acid modified diet ND-1.2.10.12 10920
❑ Cholesterol modified diet (6) ND-1.2.6 10863
❑ Increased pantothenic acid diet ND-1.2.10.12.1 11007
❑ Decreased cholesterol diet ND-1.2.6.1 10934
❑ Decreased pantothenic acid diet ND-1.2.10.12.2 11008
❑ Fiber modified diet (7) ND-1.2.7 10834
❑ Biotin modified diet ND-1.2.10.13 10917
❑ Increased fiber diet ND-1.2.7.1 10945
❑ Increased biotin diet ND-1.2.10.13.1 11001
❑ Decreased fiber diet ND-1.2.7.2 10946
❑ Decreased biotin diet ND-1.2.10.13.2 11002
❑ Soluble fiber modified diet ND-1.2.7.3 10947
❑ Mineral modified diet (11) ND-1.2.11 10838
❑ Increased soluble fiber diet ND-1.2.7.3.1 10948
❑ Calcium modified diet ND-1.2.11.1 10879
❑ Decreased soluble fiber diet ND-1.2.7.3.2 10949
❑ Increased calcium diet ND-1.2.11.1.1 10953
❑ Insoluble fiber modified diet ND-1.2.7.4 10950
❑ Decreased calcium diet ND-1.2.11.1.2 10954
❑ Increased insoluble fiber diet ND-1.2.7.4.1 10951
❑ Chloride modified diet ND-1.2.11.2 10880
❑ Decreased insoluble fiber diet ND-1.2.7.4.2 10952
❑ Iron modified diet ND-1.2.11.3 10886
❑ Fluid modified diet (8) ND-1.2.8 10835
❑ Increased iron diet ND-1.2.11.3.1 10960
2
❑ Decreased iron diet ND-1.2.11.3.2 10961 ❑ Modify concentration of enteral nutrition ND-2.1.2 10502
❑ Magnesium modified diet ND-1.2.11.4 10887 ❑ Modify rate of enteral nutrition ND-2.1.3 10500
❑ Increased magnesium diet ND-1.2.11.4.1 10962 ❑ Modify volume of enteral nutrition ND-2.1.4 10501
❑ Decreased magnesium diet ND-1.2.11.4.2 10963 ❑ Modify schedule of enteral nutrition ND-2.1.5 10504
❑ Potassium modified diet ND-1.2.11.5 10891 ❑ Modify route of enteral nutrition ND-2.1.6 10792
❑ Increased potassium diet ND-1.2.11.5.1 10966 ❑ Insert enteral feeding tube ND-2.1.7 10497
❑ Decreased potassium diet ND-1.2.11.5.2 10967 ❑ Enteral nutrition site care ND-2.1.8 10498
❑ Phosphorus modified diet ND-1.2.11.6 10890 ❑ Feeding tube flush ND-2.1.9 10499
❑ Increased phosphorus diet ND-1.2.11.6.1 10964 Parenteral Nutrition/IV Fluids (2.2)
❑ Decreased phosphorus diet ND-1.2.11.6.2 10965 Nutrition and fluids provided intravenously
❑ Sodium modified diet ND-1.2.11.7 10893 ❑ Modify composition of parenteral nutrition ND-2.2.1 10511
❑ Increased sodium diet ND-1.2.11.7.1 10968 ❑ Modify concentration of parenteral nutrition ND-2.2.2 10510
❑ Decreased sodium diet ND-1.2.11.7.2 10969 ❑ Modify rate of parenteral nutrition ND-2.2.3 10509
❑ Zinc modified diet ND-1.2.11.8 10895 ❑ Modify volume of parenteral nutrition ND-2.2.4 11141
❑ Increased zinc diet ND-1.2.11.8.1 10970 ❑ Modify schedule of parenteral nutrition ND-2.2.5 10512
❑ Decreased zinc diet ND-1.2.11.8.2 10971 ❑ Modify route of parenteral nutrition ND-2.2.6 10793
❑ Sulfur modified diet ND-1.2.11.9 10894 ❑ Parenteral nutrition site care ND-2.2.7 10507
❑ Fluoride modified diet ND-1.2.11.10 10884 ❑ IV fluid delivery ND-2.2.8 10508
❑ Copper modified diet ND-1.2.11.11 10883 Nutrition Supplement Therapy (3)
❑ Increased copper diet ND-1.2.11.11.1 10956 Foods or nutrients that are not intended as a sole (only) item or a meal or diet, but that
❑ Decreased copper diet ND-1.2.11.11.2 10957 are intended to provide additional nutrients
❑ Iodine modified diet ND-1.2.11.12 10885 Medical Food Supplement Therapy (3.1)
❑ Increased iodine diet ND-1.2.11.12.1 10958 Commercial or prepared foods or beverages intended to supplement energy, protein,
carbohydrate, fiber, and/or fat intake
❑ Decreased iodine diet ND-1.2.11.12.2 10959
❑ Commercial beverage medical food ND-3.1.1 10515
❑ Selenium modified diet ND-1.2.11.13 10892 supplement therapy
❑ Manganese modified diet ND-1.2.11.14 10888 ❑ Commercial food medical food supplement ND-3.1.2 10516
❑ Chromium modified diet ND-1.2.11.15 10881 therapy
❑ Increased chromium diet ND-1.2.11.15.1 10955 ❑ Modified beverage medical food supplement ND-3.1.3 10517
therapy
❑ Molybdenum modified diet ND-1.2.11.16 10889
❑ Modified food medical food supplement ND-3.1.4 10518
❑ Boron modified diet ND-1.2.11.17 10878 therapy
❑ Cobalt modified diet ND-1.2.11.18 10882 ❑ Purpose of medical food supplement therapy ND-3.1.5 10519
❑ Modify schedule of food/fluids ND-1.3 10815 Vitamin and Mineral Supplement Therapy (3.2)
❑ Modify schedule of intake to limit fasting ND-1.3.1 11995 Supplemental vitamins or minerals
❑ Specific foods/beverages or groups ND-1.4 10492
❑ Multivitamin mineral supplement therapy ND-3.2.1 10521
❑ Fruit modified diet ND-1.4.1 11996 ❑ Multitrace element supplement therapy ND-3.2.2 10522
❑ Vegetable modified diet ND-1.4.2 11997
❑ Vitamin supplement therapy ND-3.2.3 10523
❑ Starchy vegetable modified diet ND-1.4.2.1 11998 ❑ A (1) 10524
❑ Bean and pea modified diet ND-1.4.2.2 11999
❑ C (2) 10525
❑ Grain modified diet ND-1.4.3 12000 ❑ D (3) 10526
❑ Diet modified for uncooked food starch ND-1.4.3.1 12001
❑ E (4) 10527
❑ Protein food modified diet ND-1.4.4 12002 ❑ K (5) 10528
❑ Diet with foods modified to be low in ND-1.4.4.1 12003
❑ Thiamin (6) 10529
protein
❑ Riboflavin (7) 10530
❑ Diet modified for egg ND-1.4.4.2 12004
❑ Niacin (8) 10531
❑ Raw egg free diet ND-1.4.4.2.1 12005
❑ Folate (9) 10532
❑ Other ND-1.5 10493
❑ B6 (10) 10533
(specify) ______________________________
❑ B12 (11) 10534
Enteral and Parenteral Nutrition (2)
❑ Pantothenic acid (12) 10535
Nutrition provided through the GI tract via tube, catheter, or stoma (enteral) or
intravenously, centrally or peripherally (parenteral) ❑ Biotin (13) 10536
Enteral Nutrition (2.1) ❑ Mineral supplement therapy ND-3.2.4 10538
Nutrition provided through the GI tract ❑ Calcium (1) 10539
❑ Modify composition of enteral nutrition ND-2.1.1 10503 ❑ Chloride (2) 10540
3
❑ Iron (3) 10541 ❑ Management of nutrition related ND-6.3 10799

complementary and alternative medicine
❑ Magnesium (4) 10542
❑ Potassium (5) 10543 Infant Feeding Management (7)
❑ Phosphorus (6) 10544 Actions to manage breastfeeding and/or infant formula feeding
❑ Sodium (7) 10545 ❑ Breastmilk feeding modification ND-7.1 14143
❑ Zinc (8) 10546 ❑ Modify concentration of breastmilk ND-7.1.1 14144
❑ Sulfate (9) 10547 ❑ Modify human milk fortifier additive in ND-7.1.1.1 14145
breastmilk
❑ Fluoride (10) 10548
❑ Modify carbohydrate additive in ND-7.1.1.2 14146
❑ Copper (11) 10549 breastmilk
❑ Iodine (12) 10550 ❑ Modify fat additive in breastmilk ND-7.1.1.3 14147
❑ Selenium (13) 10551 ❑ Modify protein additive in breastmilk ND-7.1.1.4 14148
❑ Manganese (14) 10552 ❑ Modify fiber additive in breastmilk ND-7.1.1.5 14149
❑ Chromium (15) 10553 ❑ Modify added infant formula in ND-7.1.1.6 14150
breastmilk
❑ Molybdenum (16) 10554
❑ Modify breastfeeding attempts ND-7.1.2 14151
❑ Boron (17) 10555
❑ Modify volume of breastmilk ND-7.1.3 14152
❑ Cobalt (18) 10556
❑ Evaluation of breastfeeding plan ND-7.1.4 14153
Bioactive Substance Management (3.3)
❑ Evaluation of breastfeeding ND-7.1.5 14154
Addition or change in provision of bioactive substances
❑ Evaluation of breastfeeding behavior ND-7.1.6 14155
❑ Plant stanol esters management ND-3.3.1 10559
❑ Promotion of exclusive breastfeeding ND-7.1.7 14156
❑ Plant sterol esters management ND-3.3.2 10816
❑ Promotion of predominant breastfeeding ND-7.1.8 14157
❑ Soy protein management ND-3.3.3 10561
❑ Promotion of partial breastfeeding ND-7.1.9 14158
❑ Psyllium management ND-3.3.4 10817
❑ Infant formula modification ND-7.2 14159
❑ Beta glucan management ND-3.3.5 10563
❑ Modify composition of infant formula ND-7.2.1 14160
❑ Food additives management ND-3.3.6 10564
❑ Modify concentration of infant formula ND-7.2.2 14161
❑ Alcohol management ND-3.3.7 10565
❑ Modify human milk fortifier additive in ND-7.2.2.1 14162
❑ Caffeine management ND-3.3.8 10566 infant formula
Feeding Assistance Management (4) ❑ Modify carbohydrate additive in infant ND-7.2.2.2 14163
Accommodation or assistance in eating formula
❑ Adaptive eating device management ND-4.1 10808 ❑ Modify fat additive in infant formula ND-7.2.2.3 14164
❑ Feeding position management ND-4.2 10570 ❑ Modify protein additive in infant formula ND-7.2.2.4 14165
❑ Meal set up management ND-4.3 10571 ❑ Modify fiber additive in infant formula ND-7.2.2.5 14166
❑ Mouth care management ND-4.4 10572 ❑ Modify infant formula feeding attempts ND-7.2.3 14167
❑ Menu selection assistance ND-4.5 10809 ❑ Modify volume of infant formula ND-7.2.4 14168
Manage Feeding Environment (5) ❑ Evaluation of infant formula feeding plan ND-7.2.5 14169
Adjustment of the factors where food is served that impact food consumption ❑ Evaluation of infant formula feeding ND-7.2.6 14170
❑ Evaluation of infant formula feeding behavior ND-7.2.7 14171
❑ Feeding environment lighting management ND-5.1 10575
❑ Feeding environment odor management ND-5.2 10576
❑ Feeding environment distraction management ND-5.3 10577 NUTRITION EDUCATION (E)
❑ Feeding environment table height management ND-5.4 10578 Formal process to instruct or train clients in a skill or to impart knowledge to help clients
voluntarily manage or modify food, nutrition and physical activity choices and behavior to
❑ Feeding environment table service ND-5.5 10849 maintain or improve health
management
Nutrition Education Content (1)
❑ Feeding environment room temperature ND-5.6 10580
management Instruction or training intended to lead to nutrition related knowledge
❑ Feeding environment meal service ND-5.7 10810 ❑ Content related nutrition education E-1.1 13223
management ❑ Education on nutrition's influence on health E-1.2 10591
❑ Feeding environment meal location ND-5.8 10811 ❑ Physical activity guidance E-1.3 12012
management
Nutrition Education Application (2)
Nutrition Related Medication Management (6)
Instruction or training leading to nutrition related result interpretation or skills
Modification of a medication or complementary/alternative medicine to optimize client
nutritional or health status ❑ Nutrition related laboratory result interpretation E-2.1 10596
education
❑ Management of nutrition related prescription ND-6.1 10839
medication ❑ Nutrition related skill education E-2.2 10597
❑ Management of nutrition related over the ND-6.2 10584 ❑ Technical nutrition education E-2.3 13222
counter (OTC) medication
4
NUTRITION COUNSELING (C) Discharge planning and transfer of nutrition care from one level or location of care to
another.
A supportive process characterized by a collaborative counselor–client relationship to
establish food, nutrition, and physical activity priorities, goals, and individualized action ❑ Discharge and transfer of nutrition care to other RC-2.1 10813
plans that acknowledge and foster responsibility for self-care to treat an existing condition providers
and promote health ❑ Discharge and transfer of nutrition care to RC-2.2 10814
Theoretical Basis/Approach (1) community agencies and programs
The theories or models used to design and implement an intervention ❑ Discharge and transfer of nutrition care from RC-2.3 10627
nutrition professional to another nutrition
❑ Nutrition counseling based on cognitive C-1.1 10601 professional
behavioral theory approach
❑ Nutrition counseling based on health belief C-1.2 10602
model POPULATION BASED NUTRITION ACTION (P)
❑ Nutrition counseling based on social learning C-1.3 10603 Interventions designed to improve the nutritional well-being of a population
theory approach
Population Theoretical Frameworks (1)
❑ Nutrition counseling based on transtheoretical C-1.4 10604
Theories, models, and approaches used to design, implement, and evaluate nutrition
model stages of change approach
interventions at the population level
❑ Other C-1.5 10605
❑ Social ecological model P-1.1 12154
Strategies (2) ❑ Community organizing P-1.2 12155
Selectively applied evidence-based methods or plans of action designed to achieve a ❑ Diffusion of innovations P-1.3 12156
particular goal
❑ Social marketing P-1.4 12157
❑ Nutrition counseling based on motivational C-2.1 10607
interviewing strategy ❑ Organizational change theory P-1.5 12158
❑ Nutrition counseling based on goal setting C-2.2 10608 ❑ Mass communications P-1.6 12159
strategy
❑ Political action P-1.7 12160
❑ Nutrition counseling based on self monitoring C-2.3 10609
strategy
Population Strategies (2)
❑ Nutrition counseling based on problem solving C-2.4 10610 Plans of action that target environmental change, organizational change, and public
strategy policy change
❑ Nutrition counseling based on social support C-2.5 10611 ❑ Environmental change P-2.1 12162
strategy ❑ Food environment change P-2.1.1 12163
❑ Nutrition counseling based on stress C-2.6 10612 ❑ Built environment change P-2.1.2 12164
management strategy
❑ Social norm change P-2.1.3 12165
❑ Nutrition counseling based on stimulus control C-2.7 10613
strategy ❑ Organizational change P-2.2 12166
❑ Nutrition counseling based on cognitive C-2.8 10614 ❑ Public policy change P-2.3 12167
restructuring strategy Population Settings (3)
❑ Nutrition counseling based on relapse C-2.9 10615 Locations where the population based nutrition intervention is implemented
prevention strategy
❑ Residential settings P-3.1 12169
❑ Nutrition counseling based on rewards and C-2.10 10616
contingency management strategy ❑ School settings P-3.2 12170
❑ Other C-2.11 10617 ❑ Worksite settings P-3.3 12171
❑ Recreation and sports settings P-3.4 12172
COORDINATION OF NUTRITION CARE BY A NUTRITION ❑ Food production and provision settings P-3.5 12173
PROFESSIONAL (RC) ❑ Service settings P-3.6 12174
Consultation with, referral to, or coordination of nutrition care with other providers, ❑ Government settings P-3.7 12175
institutions, or agencies that can assist in treating or managing nutrition-related problems
❑ Community at large settings P-3.8 12176
Collaboration and Referral of Nutrition Care (1)
Population Sectors (4)
Facilitating services with other professionals, institutions, or agencies during nutrition
care Public, private, and nonprofit entities integral to the development and implementation of
interventions that impact determinants of the nutritional well-being of the population
❑ Team meeting involving nutrition professional RC-1.1 10620
❑ Agriculture sector P-4.1 12178
❑ Referral by nutrition professional to another RC-1.2 10621
nutrition professional with different expertise ❑ Education sector P-4.2 12179
❑ Collaboration by nutrition professional with RC-1.3 10622 ❑ Government sector P-4.3 12180
other nutrition professionals ❑ Healthcare sector P-4.4 12181
❑ Collaboration by nutrition professional with RC-1.4 10812 ❑ Food and beverage sector P-4.5 12182
other providers
❑ Business and industry sector P-4.6 12183
❑ Referral by nutrition professional to other RC-1.5 10624
providers ❑ Social welfare sector P-4.7 12184
❑ Referral by nutrition professional to RC-1.6 10625 ❑ Nonprofit sector P-4.8 12185

community agencies and programs ❑ Communities, neighborhoods, families sector P-4.9 12186
Discharge and Transfer of Nutrition Care to New Setting or Provider (2)
5
Each term is designated with an alpha-numeric NCPT hierarchical code, followed by a five-digit (eg, 99999) Academy SNOMED CT/LOINC unique identifier
6
12/15/21, 9:06 PM Identify Nutrition Intervention Goal(s)
IDENTIFY NUTRITION INTERVENTION GOAL(S)
Nutrition Intervention Planning
Identify Nutrition Intervention Goal(s) (CG-1)

Definition
Description of a desired outcome of a nutrition intervention.
Purpose
To communicate specific, measurable, achievable, realistic, time-based (SMART) nutrition goals described and
planned for implementation.
Details of Intervention
A typical intervention might be further described with the following details: Nutrition and dietetics practitioners
recommend, implement, or order nutrition interventions and the action(s) may be to initiate, modify or
discontinue a nutrition intervention(s):
Identify goal description (based upon nutrition assessment/monitoring and evaluation or nutrition
intervention terms)—defined as a summary statement of the desired outcome
Identify goal target value (based upon nutrition assessment/monitoring and evaluation or nutrition
intervention terms)—defined as an indicator from nutrition assessment/monitoring and evaluation and
nutrition intervention terms that provides evidence for the goal and desired outcome
Identify goal timeframe (duration)—defined as the duration of the intervention or date by which the goal
is anticipated to be met
Identify goal subject (individual client, supportive individual, supportive structure)—defined as the
individual client, supportive individual (eg, family, caregiver), or supportive structure (eg, social service
agencies and faith-based organizations) for whom the goal is planned
Identify goal setter (individual client, supportive individual, supportive structure, professional, mutually
established between individual client and professional)—defined as the party that identified the goal
Typically Used with the Following
Nutrition Diagnostic
Terminology Used in PES Common Examples
Statements
Inadequate energy intake (NI-1.2)
Inadequate oral intake (NI-2.1)
Excessive fat intake (NI-5.5.2)
Excessive carbohydrate intake (NI-5.8.2)
Nutrition Diagnoses Inconsistent carbohydrate intake (NI-5.8.4)
Limited access to food (NB-3.2)
Etiology Lack of access to healthful food choices, eg, current food access, food
provided by caregiver
Physiological causes, eg, increased energy needs due to increased activity
level, metabolic change, malabsorption, growth, extreme weakness,
critical illness
https://www.ncpro.org/pubs/2020-encpt-en/codeCG-1-1 1/3
Psychological causes
Neurological causes, eg difficulty chewing, swallowing”
Food and nutrition knowledge deficit regarding foods being consumed
Anthropometric Measurements
Unintentional weight loss

Growth failure
Weight change
Nutrition-Focused Physical Findings
Signs and Symptoms Obvious muscle and/or fat wasting

Poor skin turgor (tenting)
Excess subcutaneous fat
Food/Nutrition-Related History
Intake less than requirements (insufficient intake)

Intake of fat more than requirements
Reports of food insecurity
Other considerations (eg, client negotiation, client needs and desires, and readiness to change)
End-of-life issues, ethical considerations, client preferences and values

Other nutrient intake (oral, enteral nutrition)
Availability/access to a qualified practitioner for follow-up and monitoring
Goal Examples
Goals are set using Nutrition Assessment/Monitoring and Evaluation or Nutrition Intervention terms; for
individuals and populations; and identified by clients, professionals, or mutually set, so examples are provided to
reflect these. The components of each goal are identified in brackets for information only and so that
professionals communicate structured and coded components for tracking in electronic health records or reports.
Using a Nutrition Assessment/Monitoring and Evaluation Term:
Individual Client Example
[Identify goal description] Increase estimated vegetable serving intake in 24 hours (FH-1.1.2.1.1.3): [Identify
goal setter] Client identified goal that [Identify goal subject] they will [Identify target value] eat two
vegetable servings with lunch on five of seven days per week [Identify goal timeframe] by next encounter in 3
weeks.
Population Example
[Identify goal description] Increase estimated vegetable serving intake in 24 hours (FH-1.1.2.1.1.3): [Identify
goal setter] Mutually established between individual client and professional that [Identify goal subject] client
will [Identify target value] increase vegetable servings to 4 per day with implementation of new community
supported agriculture incentive program [Identify goal timeframe] over the next 6 months.
Using a Nutrition Intervention Term:
Individual Client Example

[Identify goal description] Manage rate of enteral nutrition (ND-2.1.3): [Identify goal setter] Professional
identified goal to increase [Identify goal subject] client’s [Identify target value] enteral nutrition rate from 40
mL/hour to 80 mL/hour of 1 kcal/mL formula [Identify goal timeframe] within 48 hours.
Population Example
[Identify goal description] Content related nutrition education (E-1.1): [Identify goal setter] Professional
identified goal to provide [Identify goal subject] client with [Identify target value] content related education
messages on the importance of increasing vegetable servings intake during the implementation of new
community supported agriculture incentive program [Identify goal timeframe] over the next 6 months.
Note. Items in brackets [Identify goal description] or [Identify goal setter] are provided for education purposes
only to illustrate how components are coded in health records. These should not be included when
communicating goals.
References
1. Academy of Nutrition and Dietetics. Nutrition Terminology Reference Manual (eNCPT): Dietetics
Language for Nutrition Care. Nutrition Intervention Actions. https://www.ncpro.org/pubs/2020-encpt-
en/page-050. Accessed February 14, 2020.
2. Aspry K, Dunsiger S, Breault C, Stabile L, DeAngelis J, Wu WC. Effect of case management with
goal-setting on diet scores and weight loss in cardiac rehabilitation patients. J Cardiopulm Rehabil Prev.
2018;38(6):380-387.Scores and Weight Loss in Cardiac Rehabilitation Patients. J Cardiopulm Rehabil
Prev. 2018;38(6):380-387.
3. Benson GA, Sidebottom A, Hayes J, et al. Impact of ENHANCED (diEtitiaNs Helping pAtieNts
CarE for Diabetes) telemedicine randomized controlled trial on diabetes optimal care outcomes in
patients with type 2 diabetes. J Acad Nutr Diet. 2019;119(4):585-598.
4. Bowman J, Mogensen L, Marsland E, Lannin N. The development, content validity and inter-rater
reliability of the SMART-Goal Evaluation Method: A standardised method for evaluating clinical goals.
Aust Occup Ther J. 2015;62(6):420-427.
5. Fulkerson JA, Friend S, Horning M, et al. Family home food environment and nutrition-related
parent and child personal and behavioral outcomes of the healthy home offerings via the mealtime
environment (HOME) plus program: A randomized controlled trial. J Acad Nutr Diet. 2018;118(2):240-
251.
6. Horwath CC, Schembre SM, Motl RW, Dishman RK, Nigg CR. Does the transtheoretical model of
behavior change provide a useful basis for interventions to promote fruit and vegetable consumption? Am
J Health Promot. 2013;27(6):351-357.
7. HL7 FHIR Release 4. Resource Goal - Content. https://www.hl7.org/fhir/goal.html. Accessed March
2, 2020.
8. Spahn JM, Reeves RS, Keim KS, et al. State of the evidence regarding behavior change theories and
strategies in nutrition counseling to facilitate health and food behavior change. J Am Diet Assoc.
2010;110(6):879-891.
Diet. 2019;119(5):840-855.
11. Tichelaar J, Uil den SH, Antonini NF, van Agtmael MA, de Vries TP, Richir MC. A 'SMART' way
to determine treatment goals in pharmacotherapy education. Br J Clin Pharmacol. 2016;82(1):280-284.
2020 EDITION
12/15/21, 9:07 PM Nutrition Prescription
NUTRITION PRESCRIPTION
Nutrition Intervention Planning
Nutrition Intervention
Nutrition Prescription (NP-1.1)

Definition
The client’s tailored recommended dietary intake of energy and/or selected foods or nutrients based on current
reference standards and evidence based nutrition practice guidelines and related to the client’s health condition
and nutrition diagnosis
Purpose
To communicate the nutrition professional’s diet/nutrition recommendation based on a nutrition assessment.
Indicators
Recommended general, healthful diet

Recommended modified diet
Recommended texture modification (specify, eg, mechanically altered, pureed)
Recommended liquid consistency modification (specify, eg, thin, nectar thick, honey thick, spoon
thick)
Recommended energy/nutrient modification
Energy modification (specify, eg, calories, kcal, or kJ/day, calories, kcal, or kJ/kg/day)
Recommended protein modification (specify, eg, grams/day, grams/kg/day, percent of calories,
kcal, or kJ)
Recommended carbohydrate modification
Carbohydrate controlled diet (specify, eg, distribution)
Amount (specify, eg, grams/day, grams/kg/min, percent of calories, kcal, or kJ)
Other (specify, eg, no concentrated sweets)
Recommended fat modification (specify, eg, grams/day, grams/kg/day, percent of calories, kcal or
kJ)
Recommended monounsaturated fat level (specify, eg, grams/day, percent of calories, kcal,
or kJ)
Recommended polyunsaturated fat level (specify, eg, grams/day, percent of calories, kcal,
or kJ)
Recommended saturated fat level (specify, eg, grams/day, percent of calories, kcal, or kJ)
Recommended trans fat level (specify, eg, grams/day, percent of calories, kcal, or kJ)
Recommended cholesterol intake (specify, eg, mg/day)
Recommended fiber level (specify, eg, type, grams/day, grams/1,000 calories/kcal/kJ per day)
Recommended fluid level (specify, eg, oz or mL/day, mL/kg/day, mL per calories/kcal/kJ
expended, mL/m2/day, mL output)
Clear liquid
Full liquid
Recommended modifications for specific foods or ingredients
Recommended vitamin intake
Vitamin A (specify form, µg or RE,
Niacin (specify form, mg, frequency)
frequency)
Vitamin C (mg/ day, frequency) Vitamin B6 (specify form, mg, frequency)
Vitamin D (specify form, µg or IU, Folate (specify form, µg, frequency)
https://www.ncpro.org/pubs/2020-encpt-en/codeNP-1-1 1/3
frequency)
Vitamin E (specify form, mg or IU,
Vitamin B12 (µg, frequency)
frequency)
Vitamin K (µg, frequency) Pantothenic acid (mg, frequency)
Thiamin (mg, frequency) Biotin (µg, frequency)
Riboflavin (mg, frequency)
Multivitamin (yes/no, specify dose, frequency)
Recommended mineral intake
Calcium (specify form, mg, frequency) Molybdenum (µg, frequency)
Copper (µg or mg, frequency) Boron (mg, frequency)
Fluoride (mg, frequency) Cobalt (µg, frequency)
Iodine (µg, frequency) Selenium (specify form, µg, frequency)
Iron (specify form, mg, frequency) Zinc (mg, frequency)
Potassium (specify form, g or mg,
Magnesium (mg, frequency)
frequency)
Phosphorus (mg, frequency) Sodium (mg or g, frequency)
Sulfate (g or mmol, frequency) Chloride (mg, frequency)
Manganese (mg, frequency) Chromium (specify form, µg, frequency)
Multi-mineral (yes/no, specify dose,
frequency)
Multi-trace element (yes/no, specify dose,
frequency)
Recommended enteral nutrition order (specify, eg, formula, rate/schedule)
Tube feeding modulars (specify, eg, carbohydrate, protein, fat, fiber)
Recommended parenteral nutrition order (specify, eg, solution, rate, access)
Recommended level of bioactive substances (specify, eg, substance, amount)
Recommended food intake
Grain group intake (specify, eg, servings, exchanges, amounts)
Fruit and vegetable intake (specify, eg, servings, exchanges, amounts)
Meat, poultry, fish, eggs, beans, nut intake (specify, eg, servings, exchanges, amounts)
Milk and milk product intake (specify, eg, servings, exchanges, amounts)
Fat intake (specify, eg, type, servings, exchanges, amounts)
Note: The nutrition prescription can be used as a comparative standard for nutrition assessment and
nutrition monitoring and evaluation.
References
The following are some suggested references; other references may be appropriate.
1. American Diabetes Association. Standards of Medical Care in Diabetes-2020.

https://care.diabetesjournals.org/content/43/Supplement_1. Accessed February 14, 2020.
Press; 2002.
6. Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Calcium, Phosphorus,
Magnesium, Vitamin D, and Fluoride. Washington, DC: National Academies Press; 1997.
7. Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes: Thiamin, Riboflavin, Niacin,
Vitamin B6, Folate, Vitamin B12, Pantothenic acid, Biotin, and Choline. Washington, DC: National
8. Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Vitamin A, Vitamin K,
Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium,
and Zinc. Washington, DC: National Academies Press; 2001.
9. Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes: Vitamin C, Vitamin E,
Selenium, and Carotenoids. Washington, DC: National Academies Press; 2000.
10. Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Water, Potassium,
Sodium, Chloride, and Sulfate. Washington, DC: National Academies Press; 2004.
11. National Academies of Science Engineering Medicine. Dietary Reference Intakes for Sodium and
Potassium. Washington, DC: National Academies Press; 2019.
2020 EDITION
12/15/21, 9:07 PM Meals and Snacks
MEALS AND SNACKS
Nutrition Intervention Implementation
Food and/or Nutrient Delivery Domain
Meals and Snacks (ND-1)

Definition
Meals are defined as regular eating episodes that may include a variety of foods consisting of grains and/or
starches, meat and/or meat alternatives, fruits and vegetables, and milk or milk products. A snack is defined as
food served between regular meals.
A typical intervention might be further described with the following details. Nutrition and dietetics practitioners
* Used with permission from the International Dysphagia Diet Standardisation Initiative (IDDSI.org).
General/healthful diet (approved synonym, Regular food Level seven Black*)

Modify composition of meals/snacks
Texture modified diet
Easy to chew diet
Mechanically altered diet
Pureed diet
Liquid consistency thin liquids (approved synonym, Thin liquid Level zero White*)
Liquid consistency nectar thick liquids
Liquid consistency honey thick liquids
Liquid consistency spoon thick liquids
Soft bite sized food Level six Blue (*)
Minced moist food Level five Orange (*)
Pureed food Level four Green (*)
Extremely thick liquid Level four Green (*)
Liquidized food Level three Yellow (*)
Moderately thick liquid Level three Yellow (*)
Mildly thick liquid Level two Pink (*)
Slightly thick liquid Level one Grey (*)
Energy modified diet
Increased energy diet
Decreased energy diet
Protein modified diet
Consistent protein diet
Increased protein diet
Decreased protein diet
Decreased casein diet
Decreased gluten diet
Gluten free diet
Amino acid modified diet
Arginine modified diet
Increased arginine diet
https://www.ncpro.org/pubs/2020-encpt-en/codeND-1 1/7
Decreased arginine diet

Glutamine modified diet
Increased glutamine diet
Decreased glutamine diet
Histidine modified diet
Increased histidine diet
Decreased histidine diet
Increased homocysteine diet
Isoleucine modified diet
Increased isoleucine diet
Decreased isoleucine diet
Leucine modified diet
Increased leucine diet
Decreased leucine diet
Lysine modified diet
Increased lysine diet
Decreased lysine diet
Methionine modified diet
Increased methionine diet
Decreased methionine diet
Phenylalanine modified diet
Increased phenylalanine diet
Decreased phenylalanine diet
Threonine modified diet
Increased threonine diet
Decreased threonine diet
Tryptophan modified diet
Increased tryptophan diet
Decreased tryptophan diet
Decreased tyramine diet
Tyrosine modified diet
Increased tyrosine diet
Decreased tyrosine diet
Valine modified diet
Increased valine diet
Decreased valine diet
Carbohydrate modified diet
Consistent carbohydrate diet
Increased carbohydrate diet
Increased complex carbohydrate diet
Increased simple carbohydrate diet
Decreased carbohydrate diet
Decreased complex carbohydrate diet
Decreased simple carbohydrate diet
Galactose modified diet
Increased galactose diet
Decreased galactose diet
Lactose modified diet
Increased lactose diet
Decreased lactose diet
Fructose modified diet
Increased fructose diet
Decreased fructose diet

Fat modified diet
Increased fat diet
Decreased fat diet
Monounsaturated fat modified diet
Increased monounsaturated fat diet
Decreased monounsaturated fat diet
Polyunsaturated fat modified diet
Increased polyunsaturated fat diet
Increased linoleic acid diet
Decreased polyunsaturated fat diet
Decreased linoleic acid diet
Saturated fat modified diet
Decreased saturated fat diet
Trans fat modified diet
Decreased trans fat modified diet
Omega 3 fatty acid modified diet
Increased omega 3 fatty acid diet
Increased alpha linolenic acid diet
Increased eicosapentaenoic acid diet
Increased docosahexaenoic acid
Decreased omega 3 fatty acid diet
Decreased alpha linolenic acid diet
Decreased eicosapentaenoic acid diet
Decreased docosahexaenoic acid
Medium chain triglyceride modified diet
Increased medium chain triglyceride diet
Decreased medium chain triglyceride diet
Cholesterol modified diet
Decreased cholesterol diet
Fiber modified diet
Increased fiber diet
Decreased fiber diet
Soluble fiber modified diet
Increased soluble fiber diet
Decreased soluble fiber diet
Insoluble fiber modified diet
Increased insoluble fiber diet
Decreased insoluble fiber diet
Fluid modified diet
Increased fluid diet
Fluid restricted diet
Clear liquid diet
Full liquid diet
Diets modified for specific foods or ingredients
Vitamin modified diet
Vitamin A modified diet
Increased vitamin A diet
Decreased vitamin A diet
Vitamin C modified diet
Increased vitamin C diet
Decreased vitamin C diet
Vitamin D modified diet

Increased vitamin D diet
Decreased vitamin D diet
Vitamin E modified diet
Increased vitamin E diet
Decreased vitamin E diet
Vitamin K modified diet
Increased vitamin K diet
Decreased vitamin K diet
Thiamine modified diet
Increased thiamine diet
Decreased thiamine diet
Riboflavin modified diet
Increased riboflavin diet
Decreased riboflavin diet
Niacin modified diet
Increased niacin diet
Decreased niacin diet
Folic acid modified diet
Increased folic acid diet
Decreased folic acid diet
Vitamin B6 modified diet
Increased vitamin B6 diet
Decreased vitamin B6 diet
Vitamin B12 modified diet
Increased vitamin B12 diet
Decreased vitamin B12 diet
Pantothenic acid modified diet
Increased pantothenic acid diet
Decreased pantothenic acid diet
Biotin modified diet
Increased biotin diet
Decreased biotin diet
Mineral modified diet
Calcium modified diet
Increased calcium diet
Decreased calcium diet
Chloride modified diet
Iron modified diet
Increased iron diet
Decreased iron diet
Magnesium modified diet
Increased magnesium diet
Decreased magnesium diet
Potassium modified diet
Increased potassium diet
Decreased potassium diet
Phosphorus modified diet
Increased phosphorus diet
Decreased phosphorus diet
Sodium modified diet
Increased sodium diet
Decreased sodium diet

Zinc modified diet
Increased zinc diet
Decreased zinc diet
Sulfur modified diet
Fluoride modified diet
Copper modified diet
Increased copper diet
Decreased copper diet
Iodine modified diet
Increased iodine diet
Decreased iodine diet
Selenium modified diet
Manganese modified diet
Chromium modified diet
Increased chromium diet
Molybdenum modified diet
Boron modified diet
Cobalt modified diet
Modify schedule of food/fluids (eg, timing of foods/fluids, number of meals)
Modify schedule of intake to limit fasting
Specific food/beverages or groups
Fruit modified diet
Vegetable modified diet
Starchy vegetable modified diet
Bean and pea modified diet
Grain modified diet
Diet modified for uncooked food starch
Protein food modified diet
Diet with foods modified to be low in protein
Diet modified for egg
Raw egg free diet
Other, specify
Statements
Increased energy expenditure (NI-1.1)
Excessive fat intake (NI-5.5.2)
Excessive carbohydrate intake (NI-5.8.2)
Nutrition Diagnoses Inconsistent carbohydrate intake (NI-5.8.4)
Biting/chewing (masticatory) difficulty (NC-1.2)
Limited access to food (NB 3.2)
Underweight (NC 3.1)
Etiology Lack of access to healthful food choices, eg, current food access, food
provided by caregiver
Physiological causes, eg, increased energy needs due to increased activity

level, metabolic change, malabsorption, growth, extreme weakness, critical
illness
Psychological causes, eg, disordered eating
Neurological causes, eg difficulty chewing, swallowing”
Food and nutrition knowledge deficit regarding foods they are consuming
Biochemical Data, Medical Tests and Procedures
Serum cholesterol level

Hemoglobin A1C results
Weight change
Dental caries
Diarrhea
Evidence of muscle and/or fat wasting
Hunger
Signs and Symptoms
Cultural or religious practices that do not support modified food/nutrition
intake
Changes in physical activity
Intake of less than optimal foods
Food and nutrition related knowledge deficit concerning appropriate
amount or timing of carbohydrate intake
Client History
Conditions associated with diagnosis or treatment, eg, surgery, trauma,

sepsis, diabetes mellitus, inborn errors of metabolism, digestive enzyme
deficiency, obesity
Chronic use of medications that increase or decrease nutrient requirements
or impair nutrient metabolism
Adherence skills and abilities

Economic concerns with purchasing food and/or special food items
Motivation/ability to change behavior to comply with diet
Ability to prepare food
References

3. Cichero JAY, Lam P, Steele CM, et al. Development of international terminology and definitions for
texture-modified foods and thickened fluids used in dysphagia management: The IDDSI framework.
Dysphagia. 2017;32(2):293-314.
4. International Dysphagia Diet Standardisation Initiative.

https://ftp.iddsi.org/Documents/Complete_IDDSI_Framework_Final_31July2019.pdf. Accessed March 2,
2020.
5. The International Dysphagia Diet Standardisation Initiative: Testing Methods.
https://ftp.iddsi.org/Documents/Testing_Methods_IDDSI_Framework_Final_31_July2019.pdf. Accessed
March 2, 2020.
2020 EDITION
12/15/21, 9:09 PM Enteral Nutrition
ENTERAL NUTRITION
Food and/or Nutrient Delivery (ND)
Enteral Nutrition (ND-2.1)

Definition
Nutrition provided through the gastrointestinal (GI) tract via tube, catheter, or stoma that delivers nutrients distal
to the oral cavity.
Modify composition of enteral nutrition (eg, formula name or description, special additives including
supplemental fat, carbohydrate, or protein, fiber)
Modify concentration of enteral nutrition (eg, calories/kcal/kJ per mL)
Modify rate of enteral nutrition (eg, mL/hour)
Modify volume of enteral nutrition (eg, mL/day, mL/feeding)
Modify schedule of enteral nutrition (eg, number of hours per 24 hours, continuous, intermittent, bolus)
Modify route of enteral nutrition (eg, nasoentric, oroenteric, percutaneous, or surgical access with gastric,
duodenal or jejunal placement)
Insert enteral feeding tube
Enteral nutrition site care (eg, change dressings and provide enteral feeding tube site care)
Feeding tube flush (eg, type, volume mL/flush, frequency)
Note: Related nutrition interventions, eg, checking gastric residual volume or elevating the head of the
bed are documented using Coordination of Nutrition Care
Statements
Swallowing difficulty (NC-1.1)
Altered GI function (NC-1.4)
Nutrition Diagnoses Increased nutrient needs (NI-5.1)
Inadequate protein energy intake (NI-5.2)
Inadequate protein intake (NI-5.6.1)
Inadequate enteral nutrition infusion (NI-2.3)
Altered gastrointestinal tract function, inability to absorb nutrients

Inability to chew/swallow
Decreased ability to consume sufficient energy, eg, increased nutrient
Etiology needs due to catabolic illness
Respiratory or other critical illness requiring mechanical ventilation
Disease process or complication of therapy which results in excess
fluid loss or retention (eg, CHF, liver failure, renal failure)
https://www.ncpro.org/pubs/2020-encpt-en/codeND-2-1 1/2
12/15/21, 9:09 PM Enteral Nutrition
Signs and Symptoms Anthropometric Measurements
Weight loss
Growth failure
Nutrition Focused Physical Findings
Obvious muscle and/or fat wasting

Fluid retention (edema)
Intake < 75% of requirements (insufficient intake)

Existing or expected inadequate intake for 7 to 14 days
Client History
Aspiration
Coma
End-of-life issues, ethical considerations, client rights and family/caregiver issues

Other nutrient intake (oral, parenteral nutrition), medications containing energy
Enteral formulary composition and product availability
Economic constraints that limit availability of food/enteral products
References
211.
2020 EDITION
12/15/21, 9:09 PM Parenteral Nutrition/IV Fluids
PARENTERAL NUTRITION/IV FLUIDS
Food and/or Nutrient Delivery Domain
Parenteral Nutrition/IV Fluids (ND-2.2)

Definition
Administration of nutrients and fluids intravenously, centrally (delivered into a large-diameter vein, usually the
superior vena cava adjacent to the right atrium) or peripherally (delivered into a peripheral vein, usually of the
hand or forearm).
Modify composition of parenteral nutrition (formula or description)

Modify concentration of parenteral nutrition (eg, percent, grams of solute per mL)
Modify rate of parenteral nutrition (eg, mL/hour)
Modify volume of parenteral nutrition
Modify schedule of parenteral nutrition (eg, hours, timing, taper schedule)
Modify route of parenteral nutrition (eg, peripheral, central, and/or type of catheter)
Parenteral nutrition site care (eg, change dressings and provide line care for parenteral access)
IV fluid delivery (eg, type; amount mL/day, mL/hr, mL with medications)
Statements
Nutrition Diagnoses Inadequate parenteral nutrition infusion (NI-2.7)
Impaired nutrient utilization (NC-2.1)
Altered gastrointestinal tract function, inability to absorb nutrients, or

excessive loss of nutrients (eg severe vomiting, diarrhea, high fistula
Etiology output)
Decreased functional length of GI tract
Bowel obstruction
Unintentional weight loss

Growth failure

Fluid retention (edema, ascites)
Diarrhea
12/15/21, 9:09 PM Parenteral Nutrition/IV Fluids
Vomiting
Intake < requirements (insufficient intake)

Existing or expected inadequate intake for 7 to 14 days
Client History
Malabsorption, maldigestion
Emesis
Diffuse peritonitis, intestinal obstruction, paralytic ileus, gastrointestinal
ischemia, or perforated viscus, short-bowel syndrome
End-of-life issues, ethical considerations, client rights and supportive individual issues
Other nutrient intake (oral, enteral nutrition)
Parenteral formulary composition and product availability
Economic constraints that limit availability of parenteral products
References
211.
2020 EDITION
12/15/21, 9:09 PM Medical Food Supplement Therapy
MEDICAL FOOD SUPPLEMENT THERAPY
Medical Food Supplement Therapy (ND-3.1)

Definition
Commercial or prepared foods or beverages intended to supplement energy, protein, carbohydrate, fiber, and/or
fat intake that may also contribute to vitamin and mineral intake.
Commercial beverage medical food supplement therapy

Commercial food medical food supplement therapy
Modified beverage medical food supplement therapy
Modified food medical food supplement therapy
Purpose of medical food supplement therapy (eg, to supplement energy, protein, carbohydrate, fiber,
and/or fat intake)

Common Examples
Used in PES Statements
Inadequate fluid intake (NI-3.1)
Nutrition Diagnoses Increased nutrient needs (NI-5.1)
Malnutrition (undernutrition) (NC-4.1)
Neurologic deficit (stroke)

Difficulty chewing or swallowing
Food allergies or intolerance
Altered GI function
Etiology Disease or treatment-related anorexia (eg, cancer, infection,
medication side effects)
Small for gestational age, intrauterine growth restriction, lack of
appropriate weight gain, hyperemesis gravidarum
Delayed growth
Unintended weight loss

12/15/21, 9:09 PM Medical Food Supplement Therapy
Insufficient usual intake

Insufficient macro- and/or micronutrient intake
Client History
Diagnosis consistent with elevated nutrient needs

Potential for repletion of nutritional status
Oral/facial trauma
Appetite sufficient to take medical food supplements

System constraints that prevent meeting the client’s preferences for specific flavors, textures, foods, and
the timing of feedings
Economic concerns and product/food availability
Ability to procure medical food supplement
Access to medical food supplement storage
References

2. Academy of Nutrition and Dietetics. Pediatric Nutrition Care
Manual. https://www.nutritioncaremanual.org. Accessed February 26, 2020.
2020 EDITION
12/15/21, 9:09 PM Vitamin and Mineral Supplement Therapy
VITAMIN AND MINERAL SUPPLEMENT THERAPY
Vitamin and Mineral Supplement Therapy (ND-3.2)

Definition
A product that is intended to supplement vitamin or mineral intake.
Multivitamin/mineral supplement therapy (yes/no, specify dose, frequency)

Multi-trace element supplement therapy (yes/no, specify dose, frequency)
Vitamin supplement therapy:
Vitamin A (specify form, µg or RE, frequency)
Vitamin C (mg/ day, frequency)
Vitamin D (specify form, µg or IU, frequency)
Vitamin E (specify form, mg or IU, frequency)
Vitamin K (µg, frequency)
Thiamin (mg, frequency)
Riboflavin (mg, frequency)
Niacin (specify form, mg, frequency)
Vitamin B6 (specify form, mg, frequency)
Folate (specify form, µg, frequency)
Vitamin B12 (µg, frequency)
Pantothenic acid (mg, frequency)
Biotin (µg, frequency)
Mineral supplement therapy:
Calcium (specify form, mg, frequency)
Chloride (mg, frequency)
Iron (specify form, mg, frequency)
Magnesium (mg, frequency)
Potassium (specify form, g or mg, frequency)
Phosphorus (mg, frequency)
Sodium (mg or g, frequency)
Zinc (mg, frequency)
Sulfate (g or mmol, frequency)
Fluoride (mg, frequency)
Copper (µg or mg, frequency)
Iodine (µg, frequency)
Selenium (specify form, µg, frequency)
Manganese (mg, frequency)
Chromium (specify form, µg, frequency)
Molybdenum (µg, frequency)
Boron (mg, frequency)
Cobalt (µg, frequency)
12/15/21, 9:09 PM Vitamin and Mineral Supplement Therapy

Common Examples
Inadequate vitamin intake (NI-5.9.1)
Excessive vitamin intake (NI-5.9.2)
Inadequate mineral intake (NI-5.10.1)
Excessive mineral intake (NI-5.10.2)
Excessive alcohol intake (NI-4.3)
Nutrition Diagnoses Altered GI function (NC-1.4)
Predicted food–medication interaction (NC-2.4)
Food and nutrition related knowledge deficit (NB-1.1)
Poor intake of nutrient dense foods that contain vitamins and

minerals
Excessive use of vitamin and mineral supplements
Medical diagnosis or treatment impacting vitamin and mineral
Etiology requirements or utilization
Malabsorption of vitamins and minerals
Combined ingestion or administration of medication and food that
results in undesirable/harmful interaction
Long-term PN dependency
Laboratory or radiologic indexes of vitamin-mineral depletion
Abnormalities consistent with vitamin and mineral deficiency or

Signs and Symptoms
excess
Nutrient intake analysis reveals vitamin and mineral intake more

or less than recommended
Emerging scientific evidence to support the use of vitamin and mineral supplements in specific
populations, medical conditions and/or medical treatments
Availability of a qualified practitioner with additional education/training in the use of vitamin and mineral
supplements in practice
Economic considerations and product availability
References
1. Marra MV, Bailey RL. Position of the Academy of Nutrition and Dietetics: Micronutrient
supplementation. J Acad Nutr Diet. 2018;118(11):2162-2173.
2020 EDITION
12/15/21, 9:10 PM Bioactive Substance Management
BIOACTIVE SUBSTANCE MANAGEMENT
Bioactive Substance Management (ND-3.3)

Definition
Addition or change in provision of bioactive substances (eg, plant stanol and sterol esters, psyllium, food
additives, other bioactive substances).
Plant stanol esters management (specify g, form, frequency)

Plant sterol esters management (specify g, form, frequency)
Soy protein management (specify g, form, frequency)
Psyllium management (specify g, form, frequency)
Beta glucan management (specify g, form, frequency)
Food additives management (those thought to have an impact on a client’s health) (specify, eg, amount,
form, frequency, pattern)
Alcohol management (specify, oz/mL/units, form, frequency)
Caffeine management (specify, eg, mg, oz/mL, form, frequency)
Statements
Inadequate bioactive substance intake (NI-4.1)
Excessive bioactive substance intake (NI-4.2)
Nutrition Diagnoses
Food and nutrition related knowledge deficit concerning recommended

bioactive substance intake
Lack of or limited access to food that contains a bioactive substance
Contamination, misname, mislabel or lack of labeling, misuse, recent
Etiology brand change, recent dose increase, recent formulation change of
substance consumed
Combined ingestion or administration of medication and food that results
in undesirable/harmful interaction
Adverse side effect related to bioactive substance
Signs and Symptoms Food/Nutrition-Related History
Nutrient intake analysis reveals bioactive substance intake more or less

than recommended
12/15/21, 9:10 PM Bioactive Substance Management
Intake reveals consumption of food additive to which the client is

sensitive or intolerant
Client History
Medical diagnosis associated with increased bioactive substance need
Emerging scientific evidence to support the use of bioactive supplements in specific populations, specific
medical conditions and/or with medical treatments
Availability of a qualified practitioner with additional education/training in the use of bioactive
supplements in practice
References
1. Crowe KM. Frances C. Position of the Academy of Nutrition and Dietetics: Functional foods. J Acad
Nutr Diet. 2013;113(8):1096-1103.
2020 EDITION
12/15/21, 9:11 PM Feeding Assistance Management
FEEDING ASSISTANCE MANAGEMENT
Feeding Assistance Management (ND-4)

Definition
Accommodation or assistance designed to restore the client’s ability to eat independently, support adequate
nutrient intake, and reduce the incidence of unplanned weight loss and dehydration.
Adaptive eating device management (equipment or utensils) (eg, specify)

Feeding position management (eg, specify client position in relationship to eating or degree angle for
enteral feeding)
Meal set up management (eg, specify actions to make food accessible for consumption)
Mouth care management (eg specify treatment to promote oral health and hygiene)
Menu selection assistance (yes/no)
Other (specify)
Nutrition Diagnostic Terminology Used

Common Examples
in PES Statements
Nutrition Diagnoses Inadequate enteral nutrition infusion (NI-2.3)
Unintended weight loss (NC-3.2)
Self feeding difficulty (NB-2.6)
Physical disability
Poor food/nutrient intake
Etiology Neurological issues, eg, decreased memory, concentration
problems
Weight loss
Dropping the utensils or food
Client History
Signs and Symptoms
Conditions associated with a diagnosis or treatment, eg,
cerebral palsy, stroke, dementia
History of aspiration or conditions which increase risk of
aspiration
Refusal to use prescribed adaptive eating devices, or follow
prescribed positioning techniques
12/15/21, 9:11 PM Feeding Assistance Management
Limited acceptance of feeding assistance/feeding devices

Environment offers limited support to foster adequate intake
Limited assistance at meal time
Limited training in methods of feeding assistance
Limited available physical therapy, occupational therapy, or speech therapy evaluations
Limited ability to understand the reasoning behind the recommendations and desire to make personal
changes
Limited assistance when translation of menu items is needed
References
1. Academy of Nutrition and Dietetics. Unintended weight loss in older adults evidence-based nutrition
practice guideline. https://www.andeal.org/topic.cfm?menu=5294. Accessed February 25, 2019.
2. Academy of Nutrition and Dietetics. Evidence Analysis Library. Critical illness evidence-based nutrition
guideline. http://andevidencelibrary.com/topic.cfm?cat=4800. Accessed February 25, 2019..
3. Dorner B, Friedrich EK. Position of the Academy of Nutrition and Dietetics: Individualized nutrition
approaches for older adults: Long-term care, post-acute care, and other settings. J Acad Nutr Diet.
2018;118(4):724-735.
4. Partnership for Health in Aging. Position statement on interdisciplinary team training in geriatrics: An
essential component of quality healthcare for older adults.
https://www.eatrightpro.org/-/media/eatrightpro-files/practice/position-and-practice-papers/position-
papers/partnershipforhealthyagingpositionstatement.pdf. Accessed February 25, 2019.
2020 EDITION
12/15/21, 9:11 PM Manage Feeding Environment
MANAGE FEEDING ENVIRONMENT
Manage Feeding Environment (ND-5)

Definition
Adjustment of the physical environment, temperature, convenience, and attractiveness of the location where food
is served that impacts food consumption.
Feeding environment lighting management (eg, specify)

Feeding environment odors management (eg, specify, minimize or enhance)
Feeding environment distractions management (eg, specify, minimize)
Feeding environment table height management (specify)
Feeding environment table service management (eg, plates, napkins)
Feeding environment room temperature management
Feeding environment meal service management (type of service, eg, service at table, buffet)
Feeding environment meal location management (specify)

Common Examples
in PES Statements
Nutrition Diagnoses Disordered eating pattern (NB-1.5)
Dementia
Inability to stick to task/easily distracted by others
Familial, societal, biological/genetic, and/or environmental-
Etiology related obsessive desire to be thin
Avoidance behavior to strong food aromas
Lack of developmental readiness to perform self-management
tasks
Changes in appetite attributed to mealtime surroundings

Easily distracted from eating
Food sanitation and safety issues in environment
Available foods not of the client’s choosing
Decline in client ability to eat independently
Avoidance of social events at which food is served
Client History
Pacing, wandering, changes in affect
12/15/21, 9:11 PM Manage Feeding Environment
Resources available to improve/modify the feeding environment

Acceptance of feeding environment changes
References
1. Dorner B, Friedrich EK. Position of the Academy of Nutrition and Dietetics: Individualized nutrition
approaches for older adults: Long-term care, post-acute care, and other settings. J Acad Nutr Diet.
2018;118(4):724-735. J Am Diet Assoc. 2010;110:1554-1563.
2. Partnership for Health in Aging. Position Statement on Interdisciplinary Team Training in Geriatrics: An
Essential Component of Quality Healthcare for Older Adults.
https://www.eatrightpro.org/-/media/eatrightpro-files/practice/position-and-practice-papers/position-
papers/partnershipforhealthyagingpositionstatement.pdf. Accessed March 2, 2020.
2020 EDITION
12/15/21, 9:11 PM Nutrition Related Medication Management
NUTRITION RELATED MEDICATION MANAGEMENT
Nutrition Related Medication Management (ND-6)

Definition
Modification of a drug or nutrition-related complementary/alternative medicine to optimize client nutritional or
health status.
Management of nutrition related prescription medication (eg, insulin, appetite stimulants, digestive
enzymes) dose, form, schedule, route
Management of nutrition related over the counter (OTC) medication (eg, antacids, aspirin, laxatives)
dose, form, schedule, route
Management of nutrition related complementary and alternative medicine (eg, peppermint oil, probiotics),
dose, form, schedule, route
Statements
Nutrition Diagnoses Altered nutrition related laboratory values (NC-2.2)
Food medication interaction (NC-2.3)
Predicted food medication interaction (NC-2.4)
Insufficient appetite resulting in inadequate nutrient intake

Frequent hypo- or hyperglycemia
Pancreatic insufficiency
Malabsorption of fat, protein, lactose, or other carbohydrates
Etiology Polypharmacy and medication abuse
Combined ingestion or administration of medication and food that
results in undesirable/harmful interaction
Reported misuse or lack of use of medication
Signs and Symptoms Biochemical Data, Medical Tests and Procedures
Frequent hypo- or hyperglycemia
Alterations of anthropometric measurements based on medication

effect and client conditions, eg, weight gain and corticosteroids
12/15/21, 9:11 PM Nutrition Related Medication Management
Thin, wasted appearance

Diarrhea
Report of nutrition-related complementary/alternative medicine use
Client History
Diabetes with poorly controlled blood glucose

HIV, cancer
Availability/access to a clinical pharmacist

Availability of a qualified practitioner with appropriate pharmacology training and/or education
References
2020 EDITION
12/15/21, 9:11 PM Infant Feeding Management
INFANT FEEDING MANAGEMENT
Infant Feeding Management (ND-7)

Definition
Actions to alter breastfeeding and/or infant formula feeding
A typical intervention might be further described with the following details. Nutrition and dietetics practitioners recommend, implement, or order nutrition interventions and
the action(s) may be to initiate, modify or discontinue a nutrition intervention(s):
Breastmilk feeding modification

Modify concentration of breastmilk (calories/kcal/kJ per ounce)— defined as actions to alter the energy density of expressed or donor breastmilk through
additives
Modify human milk fortifier additive in breastmilk(g/day and mL/day)— defined as actions to alter the quantity of human milk
Modify carbohydrate additive in breastmilk (g/day)— defined as actions to alter the quantity of carbohydrate that is added to breastmilk
Modify fat additive in breastmilk (mL/day)—defined as actions to alter the quantity of fat that is added to breastmilk
Modify protein additive in breastmilk (g/day and mL/day)— defined as actions to alter the quantity of protein that is added to breastmilk
Modify fiber additive in breastmilk (g/day and mL/day)— defined as actions to alter the quantity of fiber that is added to breastmilk
Modify added infant formula in breastmilk (g/day and mL/day)—defined as actions to alter the quantity of infant formula that is added to breastmilk
Modify breastfeeding attempts (number per day)—defined as actions taken to alter the number of breastfeeding attempts in one day
Modify volume of breastmilk (eg, in bottle or other route of feeding) (mL/feeding)—defined as actions to alter the volume of breastmilk provided in each
feeding
Evaluation of breastfeeding plan— defined as actions to appraise the mother’s approach to support infant nourishment via breastmilk
Evaluation of breastfeeding— defined as actions to appraise the mother’s breastfeeding of the infant
Evaluation of breastfeeding behavior—defined as actions to appraise the behavior of mother and infant while breastfeeding
Promotion of exclusive breastfeeding—defined as actions to encourage nourishment of an infant via breastfeeding for the first 6 months of life while permitting
oral vitamin and mineral supplements and medicines
Promotion of predominant breastfeeding—defined as actions to encourage nourishment of an infant primarily from breastmilk, including expressed or donor
milk, while permitting other liquids, oral vitamin and mineral supplements and medicines
Promotion of partial breastfeeding—defined as actions to encourage nourishment of an infant partially from breastmilk, including expressed or donor milk, with
nourishment from other sources
Infant formula modification
Modify composition of infant formula (formula name or description)—defined as actions to alter the infant formula provided
Modify concentration of infant formula (calories/kcal/kJ per ounce)—defined as actions to alter the energy density of infant formula through additives
Modify human milk fortifier additive in infant formula (g/day and mL/day)—defined as actions to alter the quantity of human milk fortifier that is added
to infant formula
Modify carbohydrate additive in infant formula (g/day)—defined as actions to alter the quantity of carbohydrate that is added to infant formula
Modify fat additive in infant formula (mL/day)—defined as actions to alter the quantity of fat that is added to infant formula
Modify protein additive in infant formula (g/day and mL/day)—defined as actions to alter the quantity of protein that is added to infant formula
Modify fiber additive in infant formula (g/day and mL/day)—defined as actions to alter the quantity of fiber that is added to infant formula
Modify infant formula feeding attempts (number per day)—defined as actions taken to alter the number of infant formula feeding attempts in one day
Modify volume of infant formula (mL/feeding)—defined as actions to alter the volume of infant formula provided in each feeding
Evaluation of infant formula feeding plan—defined as actions to appraise the mother’s approach to support infant nourishment via infant formula
Evaluation of infant formula feeding—defined as actions to appraise the mother’s infant formula feeding of the infant
Evaluation of infant formula feeding behavior—defined as actions to appraise the behavior of mother and infant while feeding with infant formula
Nutrition Diagnostic Terminology Used in

Common Examples
PES Statements
Nutrition Diagnoses Illness related pediatric malnutrition (NC-4.1.5)
Non illness related pediatric malnutrition (NC-4.1.4)
Physiological impairment to feed infant

Diminished ability to feed infant
Diminished ability of infant to feed
Etiology Beliefs or attitudes impacting infant feeding
Cultural impact on infant feeding
Social or personal impediment to successful infant feeding
Weight loss or limited weight gain

Growth stunting or failure
Small for gestational age
Preterm birth
Fewer than 6 wet diapers per day
Muscle and/or fat wasting
12/15/21, 9:11 PM Infant Feeding Management
Decreased skin turgor
Evidence of dehydration
Intake less than estimated energy or nutrient requirements
Client History
Aspiration
Trauma, significant illness, coma
Other nutrient intake (oral, parenteral nutrition)

Medication containing energy
Economic constraints that limit availability of breastmilk, infant formula, or modifier products
References
1. Carolina Global Breastfeeding Institute. https://sph.unc.edu/cgbi/publications/. Accessed March 2, 2020.

2. Kwok TC, Ojha S, Dorling J. Feed thickener for infants up to six months of age with gastro-oesophageal reflux. The Cochrane database of systematic reviews.
2017;12:Cd003211
3. Larson-Nath C, Biank VF. Clinical review of failure to thrive in pediatric patients. Pediatr Ann. 2016;45(2):e46-49.
4. Mehta NM, Corkins MR, Lyman B, et al. Defining pediatric malnutrition: a paradigm shift toward etiology-related definitions. JPEN J Parenter Enteral Nutr.
2013;37(4):460-481.xxxx
5. Quigley M, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants. The Cochrane database of systematic reviews.
2014(4):Cd002971.
6. Shields B, Wacogne I, Wright CM. Weight faltering and failure to thrive in infancy and early childhood. BMJ. 2012;345:e5931
2020 EDITION
12/15/21, 9:13 PM Nutrition Education Content
NUTRITION EDUCATION CONTENT
Nutrition Education Domain
Nutrition Education Content (E-1)

Definition
Instruction or training intended to lead to nutrition related content knowledge.
Note: This reference sheet only refers to client nutrition education. Please use Nutrition Counseling (C)
for documentation of the Theoretical Basis/Approach (C-1) and Strategies (C-2) used for client behavior
change.
Content related nutrition education—defined as instruction intended to lead to nutrition-related

knowledge
Education on nutrition's influence on health—defined as instruction intended to lead to knowledge about
the association between nutrition and health and disease status
Physical activity guidance—defined as instruction intended to lead to physical activity–related knowledge
and change physical activity related knowledge and change

Common Examples
Overweight/obesity (NC-3.3)
Food and nutrition-related knowledge deficit (NB-1.1)
Unsupported beliefs/attitudes about food- or nutrition-related topics
(NB-1.2)
Self monitoring deficit (NB-1.4)
Limited adherence to nutrition-related recommendations (NB-1.6)
Physical inactivity (NB-2.1)
Altered nutrition related laboratory values (NC-2.2)
Other: Any diagnoses related to inadequate, excessive, or
inconsistent intake
Knowledge deficit related to newly diagnosed medical condition

and/or nutrition problem
Etiology Medical or surgical procedure requiring modified diet
Prior exposure to incorrect information
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12/15/21, 9:13 PM Nutrition Education Content
Unable to explain purpose of the nutrition prescription or rationale

for nutrition prescription in relationship to disease/health
Expresses need for additional information or clarification of
education or additional time to learn information
Unable to select appropriate foods or supplements
Unable to choose appropriate timing, volume, or
preparation/handling of foods
Uncertainty of physical activity, type and frequency
Unable to distinguish legitimate from false information
Laboratory data indicating nutrition education warranted
Met with several providers in one day and is unable or unwilling to receive more nutrition education at
this time
Profile reflects complicated situation warranting additional education/instruction
Being discharged from the hospital
Caregiver unavailable at time of nutrition education
Baseline knowledge
Learning style
Other education and learning needs, eg, new medication or other treatment administration
Diminished literacy, including ability to read, write, comprehend information, or language barrier
Potential for referral to RDN with different expertise
Promote client defined health goals and outcomes
Counseling needed for the unmotivated or pre-contemplative client.
References
https://www.andeal.org/?auth=1. Accessed February 13, 2020.Academy of Nutrition and Dietetics.
4. Andersen D, Baird S, Bates T, et al. Academy of Nutrition and Dietetics: Revised 2017 scope of practice
for the nutrition and dietetics technician, registered. J Acad Nutr Diet.118(2):327-342.
for the registered dietitian nutritionist. J Acad Nutr Diet.118(1):141-165.
6. Andersen D, Baird S, Bates T, et al. Academy of Nutrition and Dietetics: Revised 2017 standards of
practice in nutrition care and standards of professional performance for nutrition and dietetics technicians,
registered. J Acad Nutr Diet.118(2):317-326.e313.
practice in nutrition care and standards of professional performance for registered dietitian nutritionists. J
Acad Nutr Diet.118(1):132-140.e115.
2020 EDITION
12/15/21, 9:13 PM Nutrition Education Application
NUTRITION EDUCATION APPLICATION
Nutrition Education Domain
Nutrition Education Application (E-2)

Definition
Instruction or training intended to lead to nutrition related result interpretation or skills.
Note: This reference sheet only refers to patient/client nutrition education. Please use Nutrition
Counseling (C) for documentation of the Theoretical Basis/Approach (C-1) and Strategies (C-2) used for
patient/client behavior change.
Nutrition related laboratory result interpretation education—defined as instruction or training leading to

nutrition-related laboratory result interpretation (eg, medical or other results to coincide with nutrition
plan, such as such as, distribution of carbohydrates throughout the day based on blood glucose monitoring
results)
Nutrition related skill education—defined as instruction or training leading to nutrition-related skill
development (eg, glucometer use, home enteral nutrition feeding tube and feeding pump training, cooking
and food preparation, physical activity equipment use)
Technical nutrition education—defined as instruction or training leading to nutrition-related result
interpretation or skills (eg, ability to evaluate stool output from ostomy, heart rate during physical
activity)

Common Examples
in PES Statements
Unsupported beliefs/attitudes about food- or nutrition-
related topics (NB-1.2)
Other: Any diagnoses related to inadequate or excessive, or
inconsistent intake
Deficient understanding of how to interpret nutrition related

results
Etiology Exposure to incorrect food and nutrition application
information
Lack of self-management skills
Signs and Symptoms Food/Nutrition Related History
12/15/21, 9:13 PM Nutrition Education Application
Expresses desire to apply nutrition information

Food and nutrient intake tracking incomplete Biochemical
Data, Medical Tests and Procedures
Laboratory data indicating nutrition education warranted
Other Considerations (eg, client negotiation, client needs and desires, and readiness to change)
Profile reflects complicated situation warranting additional education/instruction

Counseling for precontemplative client
Quality of life may be enhanced with in-depth nutrition education and understanding
Baseline knowledge
Lifestyle factors
Education approaches that enhance skill transfer
Diminished literacy, including ability to read, write, or comprehend information
Language barrier
References
https://www.andeal.org/?auth=1. Accessed February 13, 2020.Academy of Nutrition and Dietetics.
for the nutrition and dietetics technician, registered. J Acad Nutr Diet.118(2):327-342.
for the registered dietitian nutritionist. J Acad Nutr Diet.118(1):141-165.
practice in nutrition care and standards of professional performance for nutrition and dietetics technicians,
registered. J Acad Nutr Diet.118(2):317-326.e313.
practice in nutrition care and standards of professional performance for registered dietitian nutritionists. J
Acad Nutr Diet.118(1):132-140.e115.
2020 EDITION
12/15/21, 9:14 PM Theoretical Basis/Approach
THEORETICAL BASIS/APPROACH
Nutrition Counseling Domain
Theoretical Basis/Approach (C-1)

Definition
The theories or models used to design and implement an intervention. Theories and theoretical models consist of
principles, constructs, and variables, which offer systematic explanations of the human behavior change process.
Behavior change theories and models provide a research-based rationale for designing and tailoring nutrition
interventions to achieve the desired effect. A theoretical framework for curriculum and treatment protocols, it
guides determination of: (1) what information patients/clients need at different points in the behavior change
process, (2) what tools and strategies may be best applied to facilitate behavior change, and (3) outcome
measures to assess effectiveness in interventions or components of interventions.
Application Guidance
One or more of the following theories or theoretical models may influence a practitioner’s counseling style or
approach. Practitioners are asked to identify those theories (C-1) that most influence the intervention being
documented. An intervention might also incorporate tools and strategies derived from a variety of behavior
change theories and models. The practitioner is also asked to indicate which strategies (C-2) they used in a
particular intervention session.
The following theories and models have proven valuable in providing a theoretical framework for evidence-
based individual and interpersonal level nutrition interventions. Other theories may be useful for community
level interventions (eg, Community Organization, Diffusion of Innovations, Communication Theory).
Nutrition counseling based on cognitive behavioral theory approach

Nutrition counseling based on health belief model
Nutrition counseling based on social learning theory approach
Nutrition counseling based on transtheoretical model and stages of change approach
Additional information regarding each of the above theories and models can be found within this reference sheet.

Common Examples
in PES Statements
Nutrition Diagnoses Overweight/obesity (NC-3.3)
Unsupported beliefs/attitudes about food or nutrition-
Not ready for diet/lifestyle change (NB-1.3)
Disordered eating pattern (NB-1.5)
Limited adherence to nutrition-related recommendations
(NB-1.6)
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inconsistent intake
New medical diagnosis

Unsupported beliefs/attitudes about food, nutrition, and
nutrition-related topics
Lack of value for behavior change, competing values
Cultural/religious practices that interfere with
implementation of the nutrition prescription
Lack of efficacy to make changes or to overcome barriers to
change
Etiology Lack of focus/attention to detail, difficulty with time
Perception that time, interpersonal, or financial constraints
prevent change
Prior exposure to incorrect or incompatible information
Lack of caretaker or social support for implementing changes
High level of fatigue or other side effect of medical condition
Frustration with nutrition and/or physical activity

recommendations
Previous failures to effectively change target behavior
Defensiveness, hostility, or resistance to change
Sense of lack of control of eating
Inability to apply food- and nutrition-related
Signs and Symptoms information/guidelines
(Defining Characteristics) Inability to change food- and nutrition-related behavior
Absent or incomplete self-monitoring records
Inability to problem-solve/self-manage
Irrational thoughts about self and effects of food intake
Unrealistic expectations
Evidence of excessive, inadequate, or inconsistent intake
related to needs
Lifestyle factors
Language barrier
Educational level
Culture
Socioeconomic status
References
1. Glanz K. Current theoretical bases for nutrition intervention and their uses. In Coulston AM, Rock CL,
Monsen E. Nutrition in the Prevention and Treatment of Disease. San Diego, CA: Academy Press;
2001:83-93.
2. Powers MA, Carstensen K, Colon K, Rickheim P, Bergenstal RM. Diabetes BASICS: education,
innovation, revolution. Diabetes Spectrum. 2006;19:90-98.
3. Glanz K, Rimer BK, Lewis FM. Health Behavior and Health Education: Theory Research and Practice.
3rd ed. San Francisco, CA: Jossey-Bass Publishers; 2002.
2020 EDITION
12/15/21, 9:14 PM Theoretical Basis/Approach—Cognitive-Behavioral Theory
THEORETICAL BASIS/APPROACH—COGNITIVE-BEHAVIORAL THEORY
Theoretical Basis/Approach
Nutrition Counseling Based on Cognitive Behavioral Theory Approach (C-1.1)
Description
Cognitive Behavioral Theory (CBT) is based on the assumption that all behavior is learned and is directly related
to internal factors (eg, thoughts and thinking patterns) and external factors (eg, environmental stimulus and
reinforcement) that are related to the problem behaviors. Application involves use of both cognitive and
behavioral change strategies to effect behavior change.
Implication for Counseling Interventions

CBT, derived from an educational model, is based on the assumption that most emotional and behavioral
reactions are learned and can be unlearned. The goal of CBT is to facilitate client identification of cognitions and
behaviors that lead to less-than-optimal eating or exercise habits and replace these with more rational thoughts
and actions.
The process is:
Goal directed
Process oriented
Facilitated through a variety of problem-solving tools
Behavioral and cognitive techniques to modify eating and exercise habits are taught for continuous application
by the client. Practitioners implement Cognitive Behavioral Theory by partnering with clients to study their
current environment to:
Identify determinants or antecedents to behavior that contribute to less than optimal eating/exercise
Identify resultant behavior (eg, overeating, vomiting)
Analyze consequences of this behavior (cognitions, positive and negative reinforcers and punishments,
eg, decreased anxiety, feeling over full, losing or gaining weight)
Make specific goals to modify the environment/cognitions to reduce target behaviors
Cognitive and behavioral strategies used to promote change in diet and physical activity may include:
Goal setting
Self monitoring
Problem solving
Social support
Stress management
Stimulus control
Cognitive restructuring
Relapse prevention
Rewards and contingency management
References
Diet Assoc. 2007:107:92-99.
https://www.ncpro.org/pubs/2020-encpt-en/codeC-1-CBT 1/2
12/15/21, 9:14 PM Theoretical Basis/Approach—Cognitive-Behavioral Theory
2. Brownell KD, Cohen LR. Adherence to Dietary Regimens 2: components of effective interventions.
Behav Med. 1995;20:155-163.
3. Kiy AM. Cognitive-behavioral and psychoeducational counseling and therapy. In: Helm KK, Klawitter B.
Nutrition Therapy: Advanced Counseling Skills. Lake Dallas, TX: Helms Seminars; 1995:135-154.
4. Foster GD. Clinical implications for the treatment of obesity. Obesity. 2006;14:182S-185S.
5. Berkel LA, Poston WS, Reeves RS, Foreyt JP. Behavioral interventions for obesity. J Am Diet Assoc.
2005;105:S35-S43.
2020 EDITION
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12/15/21, 9:15 PM Theoretical Basis/Approach—Health Belief Model
THEORETICAL BASIS/APPROACH—HEALTH BELIEF MODEL
Nutrition Counseling Based on Health Belief Model (C-1.2)
Description
The Health Belief Model (HBM) is a psychological model that focuses on an individual’s attitudes and beliefs to
attempt to explain and predict health behaviors. The HBM is based on the assumption that an individual will be
motivated to take health-related action if that person (1) feels that a negative health condition (eg, diabetes) can
be avoided or managed, (2) has a positive expectation that by taking a recommended action, he or she will avoid
negative health consequences (eg, good blood glucose control will preserve eye sight), and (3) believes he or she
can successfully perform a recommended health action (eg, I can use carbohydrate counting and control my diet.
I can engage in regular physical activity).

The Health Belief Model is particularly helpful to practitioners planning interventions targeted to individuals
with clinical nutrition-related risk factors, such as diabetes, high blood cholesterol, and/or hypertension. The six
major constructs of the model have been found to be important in impacting an individual’s motivation to take
health-related action. The following table provides definitions and application guidance for the key constructs of
the theory. Motivational interviewing strategies may be appropriate to address perceived susceptibility, severity,
benefits, and barriers. Behavioral strategies are most appropriate once the patient/client begins to take action to
modify his or her diet and/or physical activity.
These six constructs are useful components in designing behavior change programs. It is important for the
practitioner to understand the patient’s perception of the health threat and potential benefits of treatment.
According to the HBM, an asymptomatic diabetic may not be compliant with his or her treatment regiment if he
or she does not:
believe he or she has diabetes (susceptibility)

believe diabetes will seriously impact his or her life (perceived seriousness)
believe following the carbohydrate controlled diet will decrease the negative effects of diabetes
(perceived benefits)
believe the effort to follow the diet is worth the benefit to be gained (perceived barriers)
have stimulus to initiate action (cue to action)
have confidence in their ability to achieve success (self-efficacy)
Constr
Definition Strategies
uct
Perceiv Client’s belief or opinion of the personal threat a health Educate on disease/condition risk
ed condition represents for them; client opinion regarding factors
Suscepti whether they have the condition (eg, diabetes or Tailor information to the client
bility hypertension) or their chance of getting the disease or Ask client if they think they are at
condition risk or have the disease/condition
Guided discussions
Motivational interviewing (express
empathy, open-ended questions,
reflective listening, affirming,
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12/15/21, 9:15 PM Theoretical Basis/Approach—Health Belief Model
summarizing, and eliciting self-

motivation statements)
Educate on consequences of the

disease/condition; show graphs,
Perceiv statistics
Client’s belief about the impact a particular health threat will Elicit client response
ed
have on them and their lifestyle Discuss potential impact on client’s
Severity
lifestyle
Motivational interviewing
Clearly define benefits of nutrition

Perceiv therapy and physical activity
Client’s belief regarding benefits they will derive from
ed Role models, testimonials
taking nutrition-related action; perceived benefits versus
Benefits Explore ambivalence and barriers
barri-ers—client’s perception of whether benefits will
and Imagine the future
outweigh the sacrifices and efforts involved in behavior
Barrier Explore successes
change
s Summarize and affirm the positive
How-to education
Incentive programs
Link current symptoms to
Cues to disease/condition
Internal or external triggers that motivate or stimulate action
Action Discuss media information
Reminder phone calls/mailings
Social support
Skill training/demonstration
Introduce alternatives and choices
Self- Client confidence in their ability to successfully accomplish Behavior contracting; small,
Efficacy the necessary action incremental goals
Coaching, verbal reinforcement
References
2001:83-93.
2020 EDITION
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12/15/21, 9:15 PM Theoretical Basis/Approach—Social Learning Theory
THEORETICAL BASIS/APPROACH—SOCIAL LEARNING THEORY
Nutrition Counseling Based on Social Learning Theory Approach (C-1.3)

Description
Social Learning Theory, also known as Social Cognitive Theory, provides a framework for understanding,
predicting, and changing behavior. The theory identifies a dynamic, reciprocal relationship between
environment, the person, and behavior. The person can be both an agent for change and a responder to change. It
emphasizes the importance of observing and modeling behaviors, attitudes and emotional reactions of others.
Determinants of behavior include goals, outcome expectations, and self-efficacy. Reinforcements increase or
decrease the likelihood that the behavior will be repeated (1).

Social Learning Theory is rich in concepts applicable to nutrition counseling. The following table provides
definitions and application guidance for the key concepts of the theory.
Conce
Definition Strategies
pt
Consider multiple
behavior change strategies
targeting motivation,
Recipr action, the individual and
A person’s ability to change a behavior is influenced by characteristics the environment:
ocal
within the person (eg, beliefs), the environment, and the behavior itself Motivational interviewing
Deter
(eg, difficulty doing the behavior). All three interact to influence if the Social support
minis
behavior change will happen. Stimulus control
m
Demonstration
Skill development
training/coaching
Behavi Comprehensive education

oral The knowledge and skills that are needed for a person to change Demonstration
Capab behavior Skill development
ility training/coaching
Motivational interviewing
Expect For a person to do a behavior, they must believe that the behavior will Model positive outcomes
ations result in outcomes important to them of diet/exercise
Self- Confidence in ability to take action and persist in action Break task down to
Effica component parts
cy Demonstration/modeling
Skill development
training/coaching
Reinforcement
Small, incremental
goals/behavioral
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12/15/21, 9:15 PM Theoretical Basis/Approach—Social Learning Theory
contracting
Obser Demonstrations
vation Role modeling
When a person learns how to do a behavior by watching credible
al Group problem-solving
others do the same behavior
Learni sessions
ng
Affirm accomplishments
Encourage self-
Reinfo reward/self-reinforcement
Response to a behavior that will either increase or decrease the Incentives for process
rceme
likelihood that the behavior will be repeated components of change (eg,
nt
keeping a food diary or
physical activity log)
References
2001:83-93.
2. Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs,
NJ: Prentice-Hall; 1986.
3. Bandura A. Self-Efficacy: The Exercise of Control. New York, NY: W.H. Freeman; 1997.
2020 EDITION
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12/15/21, 9:15 PM Theoretical Basis/Approach—Transtheoretical Model Stages of Change
THEORETICAL BASIS/APPROACH—TRANSTHEORETICAL MODEL STAGES OF CHANGE
Nutrition Counseling Based on Transtheoretical Model Stages of Change

Approach (C-1.4)
Definition
A theoretical model of intentional health behavior change that describes a sequence of cognitive (attitudes and
intentions) and behavioral steps people take in successful behavior change. The model, developed by Prochaska
and DiClemente, is composed of a core concept known as Stages of Change, a series of independent variables,
the Processes of Change, and outcome measures including decision balance and self-efficacy. The model has
been used to guide development of effective interventions for a variety of health behaviors.

One of the defining characteristics of this model is that it describes behavior change not as a discrete event (eg,
today I am going to stop overeating), but as something that occurs in stages, over time. The five stages reflect an
individual’s attitudes, intentions and behavior related to change of a specific behavior and include the following:
Precontemplation – no recognition of need for change; no intention to take action within the next 6
months
Contemplation – recognition of need to change; intends to take action within the next 6 months
Preparation – intends to take action in the next 30 days and has taken some behavioral steps in that
direction
Action – has made changes in target behavior for less than 6 months
Maintenance – has changed target behavior for more than 6 months
Determination of a client stage of change is relatively simple, involving a few questions regarding intentions and
current diet. One of the appealing aspects of the theory is that the Process of Change construct describes
cognitive and behavioral activities or strategies, which may be applied at various stages to move a person
forward through the stages of change. This movement is not always linear, and clients can cycle in and out of
various stages. The model has been used to effectively tailor interventions to the needs of clients at various
stages. Knowing a client’s stage of change can help a practitioner determine:
Whether intervention now is appropriate

The type and content of intervention to use (motivational versus action oriented)
Appropriate and timely questions about past efforts, pros and cons of change, obstacles, challenges and
potential strategies
The amount of time to spend with the client
The following table provides guidance for applying stages and processes of change to the adoption of healthful
diets.
This theoretical basis/approach has also been used with regard to physical activity.
Table 3
General Guidelines for Applying Stages and Processes of Change to Adoption of Heathful Diets
State Key Strategies for Treatment Do’s at This Stage Treatment Don’ts at This Stage
of Moving to Next
https://www.ncpro.org/pubs/2020-encpt-en/codeC-1-TMSC 1/3
Read Stage
iness
Do not assume client has knowledge
Provide personalized or expect that providing information
Preco information. will automatically lead to behavior
Increased information Allow client to express change.
ntem
and awareness, emotions about his or her Do not ignore client’s emotional
platio
emotional acceptance disease or about the need to adjustment to the need for dietary
n
make dietary changes. change, which could override ability
to process relevant information.
Discuss and resolve barriers

to dietary change.
Do not ignore the potential impact of
Increased confidence Encourage support networks.
Conte family members, and others, or client’s
in one’s ability to Give positive feedback about
mplat ability to adhere.
adopt recommended a client’s abilities.
ion Do not be alarmed or critical of a
behaviors Help to clarify ambivalence
client’s ambivalence.
about adopting behavior and
emphasize expected benefits.
Encourage client to set

specific, achievable goals (eg,
Resolution of Do not recommend general behavior
use 1% milk instead of whole
Prepa ambivalence, firm changes (e.g., “Eat less fat”).
milk).
ration commitment, and Do not refer to small changes as “not
Reinforce small changes that
specific action plan good enough.”
client may have already
achieved.
Behavioral skill Refer to education program

Actio Do not refer clients to information-
training and social for self-management skills.
n only classes.
support Provide self-help materials.
Encourage client to anticipate

and plan for potential
difficulties (eg, maintaining
dietary changes on vacation).
Collect information about
Problem-solving Do not assume that initial action
Maint local resources (eg, support
skills and social and means permanent change.
enanc groups, shopping guides).
environmental Do not be discouraged or judgmental
e Encourage client to “recycle”
support about a lapse or relapse.
if they have has a lapse or
relapse.
Recommend more
challenging dietary changes if
client is motivated.
Source: Kristal AR, Glanz K, Curry S, Patterson RE. How can stages of change be best used in dietary
interventions? J Am Diet Assoc. 1999;99:683.
Prochaska recommends the following strategies, which target motivation, be used in the early stages of change:
consciousness raising, dramatic relief (eg, emotional arousal via role playing or personal testimonials),
environmental reevaluation (eg, empathy training and family interactions), social liberation (eg, advocacy,
empowerment) and self-reevaluation (eg, value clarification, healthy role models, and imagery). These strategies
are very consistent with motivational interviewing techniques. In the later stages of change, behavioral strategies
are most appropriate.
References
2001:83-93.
2. Green GW, Rossi SR, Rossi JS, Velicer WF, Fava JL, Prochaska JO. Dietary applications of the stages of
change model. J Am Diet Assoc. 1999;99:673-678.
3. Kristal AR, Glanz K, Curry S, Patterson RE. How can stages of change be best used in dietary
interventions? J Am Diet Assoc. 1999;99: 679-684.
4. Krummel DA, Semmens E, Boury J, Gordon PM, Larkin KT. Stages of Change for weight management
in postpartum women. J Am Diet Assoc. 2004;104:1102-1108.
5. Nothwehr F, Snetselaar L, Yang J, Wu H. Stage of change for healthful eating and use of behavioral
strategies. J Am Diet Assoc. 2006;106:1035-1041.
6. Prochaska JO, Norcross JC, DiClemente V. Changing for Good: A Revolutionary Six-Stage Program for
Overcoming Bad Habits and Moving Your Life Positively Forward. New York, NY: Avon Books Inc;
1994.
2020 EDITION
12/15/21, 9:14 PM Strategies
STRATEGIES
Strategies (C-2)
Definition
An evidence-based method or plan of action designed to achieve a particular goal. Application of behavior
change theories in nutrition practice has provided practitioners with a collection of evidence-based strategies to
promote behavior change. Some strategies target change in motivation and intention to change, and others target
behavior change. Nutrition and dietetics practitioners selectively apply strategies based on client goals and
objectives, and their personal counseling philosophy and skill.
An intervention typically incorporates tools and strategies derived from a variety of behavior change theories and
models. The practitioner is asked to indicate which Strategies (C-2) he or she used in a particular intervention
session along with the Theories (C-1) that most influence the intervention being documented.
The following strategies have proven valuable in providing effective nutrition-related (eg nutrition therapy,
physical activity) behavior change.
Nutrition counseling based on motivational interviewing strategy

Nutrition counseling based on goal setting strategy
Nutrition counseling based on self monitoring strategy
Nutrition counseling based on problem solving strategy
Nutrition counseling based on social support strategy
Nutrition counseling based on stress management strategy
Nutrition counseling based on stimulus control strategy
Nutrition counseling based on cognitive restructuring strategy
Nutrition counseling based on relapse prevention strategy
Nutrition counseling based on rewards and contingency management strategy
Additional information regarding each of the above strategies can be found within this reference sheet.

Common Examples
in PES Statements
Unsupported beliefs/attitudes about food or nutrition-
Not ready for diet/lifestyle change (NB-1.3)
Disordered eating pattern (NB-1.5)
Limited adherence to nutrition-related recommendations
(NB-1.6)

inconsistent intake
New medical diagnosis

Unsupported beliefs/attitudes about food, nutrition, and
nutrition-related topics
Cultural/religious practices that interfere with
implementation of the nutrition prescription
Limited efficacy to make changes or to overcome barriers to
change
Etiology Limited focus/attention to detail, difficulty with time
Perception that time, interpersonal, or financial constraints
prevent change
Prior exposure to incorrect or incompatible information
Lack of caretaker or social support for implementing changes
High level of fatigue or other side effect of medical condition
Frustration with nutrition and/or physical activity

recommendations
Previous failures to effectively change target behavior
Defensiveness, hostility, or resistance to change
Sense of lack of control of eating
Limited ability to apply food- and nutrition-related
Signs and Symptoms information/guidelines
(Defining Characteristics) Limited ability to change food- and nutrition-related behavior
Absent or incomplete self-monitoring records
Limited ability to problem-solve/self-manage
Irrational thoughts about self and effects of food intake
Unrealistic expectations
Evidence of excessive, inadequate, or inconsistent intake
related to needs
Lifestyle factors
Language barrier
Educational level
Culture
Socioeconomic status
References
2001:83-93.
2020 EDITION
12/15/21, 9:16 PM Strategy: Motivational Interviewing
STRATEGY: MOTIVATIONAL INTERVIEWING
Nutrition Counseling Based on Motivational Interviewing Strategy (C-2.1)

Strategy descriptions and application guidance
Strategy Description Implementation Tips

Motivational A directive, client-centered counseling style Tone of counseling:
Interviewing (MI) for eliciting behavior change by helping
Partnership
clients to explore and resolve ambivalence
Nonjudgmental
(1). The approach involves selective
Empathetic/supportive/encouraging
response to client speech in a way that helps
Nonconfrontational
the client resolve ambivalence and move
Quiet and eliciting
toward change. The four guiding principles
that underlie this counseling approach The client does most of the talking and the
include: counselor guides the client to explore and
resolve ambivalence by:
Express empathy
Develop discrepancy Asking open-ended questions
Roll with resistance Listening reflectively
Support self-efficacy Summarizing
Affirming
The following specific practitioner behaviors
Eliciting self-motivational
are characteristic of the MI style (2):
statements
Expressing acceptance and Shared agenda setting/decision
affirmation making
Eliciting and selectively reinforcing Allowing clients to interpret
the client’s own self-motivational information
statements, expressions of problem Rolling with resistance, rather than
recognition, concern, desire, intention confronting
to change, and ability to change Building discrepancy
Monitoring the client’s degree of Eliciting “change talk”
readiness to change, and ensuring Negotiating a change plan
that jumping ahead of the client does
Motivational interviewing is best applied in
not generate resistance
situations when a patient is not ready, is
Affirming the client’s freedom of
unwilling, or is ambivalent about changing
choice and self-direction
their diet or lifestyle.
The source of motivation is presumed to
MI integrates well with the readiness to
reside within the client and the counselor
change model to move individuals from the
encourages the client to explore
early stages to the action stage of change.
ambivalence, motivation, and possibilities to
change, so it is the client who chooses what MI is a major paradigm change from the
to change, and determines the change plan problem solving oriented counseling
and strategy. frequently employed by practitioners.
MI is an evidence-based counseling strategy MI is not a set of techniques that can be

which builds on Carl Roger’s client-centered learned quickly, but a style or approach to
counseling model, Prochaska and counseling.
https://www.ncpro.org/pubs/2020-encpt-en/codeC-2-MI 1/3
DiClemente’s transtheoretical model of

change, Milton Rokeach’s human values
theory, and Daryl Bern’s theory of self-
perception.
References
1. Miller WR, Rollnick S. Motivational Interviewing: Preparing People for Change. 2nd ed. New York:
Guilford Press; 2002.
2. Miller WR, Rollnick S. Institute for Motivation and Change. http://www.miinstitute.com/index.php?
page=resources. Accessed June 15, 2015.
3. Berg-Smith SM, Stevens VJ, Brown KM, Van Horn L, Gernhofer N, Peters E, Greenberg R, Snetselaar L,
Ahrens L, Smith K for the Dietary Intervention Study in Children (DISC) Research Group. A brief
motivational intervention to improve dietary adherence in adolescents. Health Educ Res. 1999;14:399-
410.
4. Snetselaar L. Counseling for change. In: Mahan LK, Escott-Stump S, eds. Krause’s Food, Nutrition, &
Diet Therapy. 10th ed. Philadelphia: Saunders; 2000.
5. Brug J, Spikmans F, Aartsen C, Breedbveld B, Bes R, Fereira I. Training dietitians in basic motivational
interviewing skills results in changes in their counseling style and in lower saturated fat intakes in their
patients. J Nutr Ed Behav. 2007;39:8-12.
6. DiLillo V, Siegfried NJ, West DS. Incorporating motivational interviewing into behavioral obesity
training. Cognit Behav Pract. 2003;10:120-130.
7. NHLBI Guidelines on Overweight and Obesity, Electronic Textbook. http://www.nhlbi.nih.gov/health-
pro/guidelines/current/obesity-guidelines/e_textbook/. Accessed June 15, 2015.
8. Estabrooks P, Nelson C, Xu S, King D, Bayliss E, Gaglio B, Nutting P, Glasgow R. The frequency and
behavioral outcomes of goal choices in the self-management of diabetes. Diabetes Educ. 2005;31(3):391-
400.
9. Boutelle KN, Kirschenbaum DS. Further support for consistent self-monitoring as a vital component of
successful weight control. Obes Res. 1998;52:219-224.
Behav Med. 1995; 20:155–163.
12. D’Zurilla TJ, Goldfried MR. Problem solving and behavior modification. J Abnorm Psychol.
1971;78:107-126.
13. Barrere M, Toobert D, Angell K, Glasgow R, Mackinnon D. Social support and social-ecological
495.
2005;105:S35-S43.
15. Snetselaar L. Nutritional Counseling for Lifestyle Change. New York: Taylor & Francis Group; 2007:117-
119.
Aspen Press; 2007
Diet Assoc. 2007:107:92-99.
19. Irvin JE, Bowers CA, Dunn ME, Wang MC. Efficacy of relapse prevention: a meta-analytic review. J
Consult Clin Psychol. 1999;67:563-570.
1994.
2020 EDITION
12/15/21, 9:16 PM Strategy: Goal Setting
STRATEGY: GOAL SETTING
Nutrition Counseling Based on Goal Setting Strategy (C-2.2)


Appropriate for clients ready to
make dietary and physical activity
changes
Coach on goal setting skills
Document and track progress toward
short-term and long-term goals
A collaborative activity between the client Probe client about pros and cons of
and the practitioner in which the client proposed goals
Goal Setting decides from all potential activity Assist client in gaining the knowledge
recommendations what changes he or she and skills necessary to succeed
will expend effort to implement. Encourage strategies to build
confidence (discuss realistic steps and
start with easily achievable goals)
Aid clients in building a supportive
environment
Celebrate successes
References
410.
400.
https://www.ncpro.org/pubs/2020-encpt-en/codeC-2-GS 1/2
12/15/21, 9:16 PM Strategy: Goal Setting
Behav Med. 1995; 20:155–163.
1971;78:107-126.
495.
2005;105:S35-S43.
119.
Aspen Press; 2007
Diet Assoc. 2007:107:92-99.
1994.
2020 EDITION
https://www.ncpro.org/pubs/2020-encpt-en/codeC-2-GS 2/2
12/15/21, 9:16 PM Strategy: Self-Monitoring
STRATEGY: SELF-MONITORING
Nutrition Counseling Based on Self Monitoring Strategy (C-2.3)


A technique that involves keeping a detailed
record of behaviors that influence diet and/or
weight and may include:
What, when, how much eaten

Activities during eating
Emotions and cognitions related to
Provide rationale and instructions for
meals/snacks
self monitoring
Frequency, duration, and intensity of
Review and identify patterns
exercise
Assist with problem solving and goal
Target nutrient content of foods
Self Monitoring setting
consumed (eg, calories/kcal/kJ, fat,
Celebrate successes
fiber)
The amount of feedback required
Event, thoughts about event,
typically diminishes as client skill
emotional response, behavioral
improves
response
Negative self-talk, replacement
thoughts
Blood glucose, blood pressure
Self-monitoring is associated with improved

treatment outcomes.
References
410.
https://www.ncpro.org/pubs/2020-encpt-en/codeC-2-SM 1/2
12/15/21, 9:16 PM Strategy: Self-Monitoring
400.
Behav Med. 1995; 20:155–163.
1971;78:107-126.
495.
2005;105:S35-S43.
119.
Aspen Press; 2007
Diet Assoc. 2007:107:92-99.
1994.
2020 EDITION
https://www.ncpro.org/pubs/2020-encpt-en/codeC-2-SM 2/2
12/15/21, 9:17 PM Strategy: Problem Solving
STRATEGY: PROBLEM SOLVING
Nutrition Counseling Based on Problem Solving Strategy (C-2.4)


Work collaboratively with client to:
Techniques that are taught to assist clients in Define the problem

identifying barriers to achieving goals, Brainstorm solutions
Problem solving identifying and implementing solutions, and Weigh pros/cons of potential solutions
evaluating the effectiveness of the solutions Select/implement strategy
(2). Evaluate outcomes
Adjust strategy
References
410.
400.
Behav Med. 1995; 20:155–163.
1971;78:107-126.
495.
2005;105:S35-S43.
https://www.ncpro.org/pubs/2020-encpt-en/codeC-2-PS 1/2
12/15/21, 9:17 PM Strategy: Problem Solving
119.
Aspen Press; 2007
Diet Assoc. 2007:107:92-99.
1994.
2020 EDITION
https://www.ncpro.org/pubs/2020-encpt-en/codeC-2-PS 2/2
12/15/21, 9:17 PM Strategy: Social Support
STRATEGY: SOCIAL SUPPORT
Nutrition Counseling Based on Social Support Strategy (C-2.5)


A food and nutrition professional may assist
a client by:
Establishing a collaborative
Increased availability of social support for
relationship
dietary and physical activity behavior
Identifying family/community support
change. Social support may be generated
Social Support Assisting clients in developing
among an individual’s family, church,
assertiveness skills.
school, co-workers, health club, or
Utilize modeling, skill training,
community.
respondent and operant conditioning
Conducting education in a group
Encourage family involvement
References
410.
400.
Behav Med. 1995; 20:155–163.
1971;78:107-126.
https://www.ncpro.org/pubs/2020-encpt-en/codeC-2-SS 1/2
12/15/21, 9:17 PM Strategy: Social Support
495.
2005;105:S35-S43.
119.
Aspen Press; 2007
Diet Assoc. 2007:107:92-99.
1994.
2020 EDITION
https://www.ncpro.org/pubs/2020-encpt-en/codeC-2-SS 2/2
12/15/21, 9:17 PM Strategy: Stress Management
STRATEGY: STRESS MANAGEMENT
Nutrition Counseling Based on Stress Management Strategy (C-2.6)


Two approaches may be used to manage
stress, one focuses on changing the
environment and the other focuses on
modifying the client’s response to stress.
Environmental-focused strategies may

include:
Guidance on planning ahead

Reaction to stress can cause some clients to Use of time-management skills
lose their appetite and others to overeat. Developing a support system
Food and nutrition professionals are Building skills to prepare quick and
Stress Management healthful meals, incorporate exercise
particularly interested in management of
stressful situations, which result in less- Guidance on eating on the run
than-optimal eating behaviors. Emotion-focused strategies may include:
Use of positive self-talk

Building assertiveness in expressing
eating desires
Setting realistic goals
Learning to deal appropriately with
emotion-driven eating cravings
Relaxation exercises
References
410.
https://www.ncpro.org/pubs/2020-encpt-en/codeC-2-SMGT 1/2
12/15/21, 9:17 PM Strategy: Stress Management
400.
Behav Med. 1995; 20:155–163.
1971;78:107-126.
495.
2005;105:S35-S43.
119.
Aspen Press; 2007
Diet Assoc. 2007:107:92-99.
1994.
2020 EDITION
https://www.ncpro.org/pubs/2020-encpt-en/codeC-2-SMGT 2/2
12/15/21, 9:18 PM Strategy: Stimulus Control
STRATEGY: STIMULUS CONTROL
Nutrition Counseling Based on Stimulus Control Strategy (C-2.7)


Review of self-monitoring records with
clients may help to identify triggers for
undesirable eating.
Assist client in identifying ways to modify

the environment to eliminate triggers. This
Identifying and modifying social or may include things such as:
environmental cues or triggers to act, which Keeping food out of sight
encourage undesirable behaviors relevant to Removing high sugar/high fat snacks
Stimulus Control
diet and exercise. In accordance with from the house
operant conditioning principles, attention is Bringing lunch to work
given to reinforcement and rewards. Establishing a rule—no eating in the
car
Help client establish criteria for
rewards for desirable behavior
Ensure reward (reinforcement)
received only if criteria met
References
410.
400.
https://www.ncpro.org/pubs/2020-encpt-en/codeC-2-SC 1/2
12/15/21, 9:18 PM Strategy: Stimulus Control
Behav Med. 1995; 20:155–163.
1971;78:107-126.
495.
2005;105:S35-S43.
119.
Aspen Press; 2007
Diet Assoc. 2007:107:92-99.
1994.
2020 EDITION
https://www.ncpro.org/pubs/2020-encpt-en/codeC-2-SC 2/2
12/15/21, 9:18 PM Strategy: Cognitive Restructuring
STRATEGY: COGNITIVE RESTRUCTURING
Nutrition Counseling Based on Cognitive Restructuring Strategy (C-2.8)

Strate
Description Implementation Tips
gy
Self-monitoring and techniques such as the ABC
Technique of Irrational Beliefs may help clients to
become more aware of thoughts that interfere in their
ability to meet behavioral goals.
Help clients replace dysfunctional thoughts with more

Cognit Techniques used to increase client awareness
rationale ones:
ive of their perceptions of themselves and their
Restru beliefs related to diet, weight, and weight loss Challenge shoulds, oughts, musts
cturing expectations. Decatastrophize expected outcomes
Confront faulty self-perceptions
Decenter by envisioning other perspectives
Coach clients on replacing negative self-talk with more

positive, empowering, and affirming statements.
References
410.
400.
Behav Med. 1995; 20:155–163.
https://www.ncpro.org/pubs/2020-encpt-en/codeC-2-CR 1/2
12/15/21, 9:18 PM Strategy: Cognitive Restructuring
1971;78:107-126.
495.
2005;105:S35-S43.
119.
Aspen Press; 2007
Diet Assoc. 2007:107:92-99.
1994.
2020 EDITION
https://www.ncpro.org/pubs/2020-encpt-en/codeC-2-CR 2/2
12/15/21, 9:18 PM Strategy: Relapse Prevention
STRATEGY: RELAPSE PREVENTION
Nutrition Counseling Based on Relapse Prevention Strategy (C-2.9)


Assist clients:
Assess if external circumstances are

contributing to lapse, eg, loss of job or
Techniques used to help clients prepare to
support system
address high-risk situations for relapse with
Identify high-risk situations for slips
appropriate strategies and thinking.
Relapse Prevention Analyze reactions to slips
Incorporates both cognitive and behavioral
Acquire knowledge and skills
strategies to enhance long-term behavior
necessary to address high-risk
change outcomes.
situations
Gain confidence in their ability to
succeed in high-risk situations
References
410.
400.
Behav Med. 1995; 20:155–163.
1971;78:107-126.
https://www.ncpro.org/pubs/2020-encpt-en/codeC-2-RP 1/2
12/15/21, 9:18 PM Strategy: Relapse Prevention
495.
2005;105:S35-S43.
119.
Aspen Press; 2007
Diet Assoc. 2007:107:92-99.
1994.
2020 EDITION
https://www.ncpro.org/pubs/2020-encpt-en/codeC-2-RP 2/2
12/15/21, 9:19 PM Strategy: Rewards/Contingency Management
STRATEGY: REWARDS/CONTINGENCY MANAGEMENT
Nutrition Counseling Based on Rewards and Contingency Management

Strategy (C-2.10)

Provide rewards for desired
behaviors, eg, attendance, diet
progress, consistent self-
monitoring, physical activity
Rewards and A systematic process by which behaviors can be Rewards can be monetary, prizes,
Contingency changed through the use of rewards for specific actions. parking space, gift certificates
Management Rewards may be derived from the client or the provider. Assist clients in determining
rewards for achievement
Ensure rewards are not received if
progress is not made
References
410.
400.
Behav Med. 1995; 20:155–163.
1971;78:107-126.
https://www.ncpro.org/pubs/2020-encpt-en/codeC-2-RCM 1/2
12/15/21, 9:19 PM Strategy: Rewards/Contingency Management
495.
2005;105:S35-S43.
119.
Aspen Press; 2007
Diet Assoc. 2007:107:92-99.
1994.
2020 EDITION
https://www.ncpro.org/pubs/2020-encpt-en/codeC-2-RCM 2/2
12/15/21, 9:19 PM Collaboration and Referral of Nutrition Care
COLLABORATION AND REFERRAL OF NUTRITION CARE
Coordination of Nutrition Care by a Nutrition Professional (RC)
Collaboration and Referral of Nutrition Care (RC-1)

Definition
Facilitating services or interventions with other professionals, institutions, or agencies on behalf of the
patient/client prior to discharge from nutrition care.
A typical intervention might be further described with the following details. nutrition and dietetics practitioners
Team meeting involving nutrition professional (Holding a team meeting to develop a comprehensive plan
of care)
Referral by nutrition professional to another nutrition professional with different expertise (A referral for
care by other nutrition and dietetics practitioners who provide different expertise)
Collaboration by nutrition professional with other nutrition professionals (Collaboration by nutrition and
dietetics practitioner with other nutrition and dietetics practitioners)
Collaboration by nutrition professional with other providers (Collaboration with others such as the
physician, dentist, physical therapist, social worker, occupational therapist, speech therapist, nurse,
pharmacist, or other specialist dietitian)
Referral by nutrition professional to other provider (Refer to others such as the physician, dentist,
physical therapist, social worker, occupational therapist, speech therapist, nurse, pharmacist, or other
specialist nutrition and dietetics practitioner)
Referral by nutrition profesional to community agencies and programs (Refer to an appropriate
agency/program (eg, home delivered meals), assistance programs for women, infants and children [eg,
WIC], food assistance programs [eg, food pantry, soup kitchen, food stamps], housing assistance,
shelters, rehabilitation, physical and mental disability programs, education training, and employment
programs)

Common Examples
Unintended weight loss (NC-3.2)
Etiology Physical disability with impaired feeding ability, other

impairments related to activities of daily living
https://www.ncpro.org/pubs/2020-encpt-en/codeRC-1 1/2
12/15/21, 9:19 PM Collaboration and Referral of Nutrition Care
Mental disability
Growth and development issues
Nutrient drug interactions
Transportation issues
Food acceptance issues
Developmental issues
Economic considerations impacting food/nutrient intake
Weight loss
Unacceptable growth rates compared to standard growth charts
Inability to procure food

Lack of access to food sources
Signs and Symptoms
Lack of food preparation skills
Skin breakdown and poor wound healing
Client History
Anorexia nervosa
Availability of services related to client need (specialty dietitians, clinical pharmacists, speech
pathologists, nurse practitioners, etc.)
Anticipated duration of health care encounter/hospital or long-term care discharge
Resources available for care
Availability of or access to government medical programs (eg, Medicare/Medicaid, healthcare exchanges)
insurance guidelines and restrictions
Availability of or access to food assistance program (eg, food stamp program) guidelines and regulations
References
1. McLaughlin C, Tarasuk V, Kreiger N. An examination of at-home food preparation activity among low-
income, food insecure women. J Am Diet Assoc. 2003;103:1506-1512.
2. Greger JL, Maly A, Jensen N, Kuhn J, Monson K, Stocks A. Food pantries can provide nutritionally
adequate food packets but need help to become effective referral units for public assistance programs. J
Am Diet Assoc. 2002;102:1125-1128.
2010;110:1368-1377.
4. Millen BE, Ohls JC, Ponza M, McCool AC. The elderly nutrition program: an effective national
framework for preventive nutrition interventions. J Am Diet Assoc. 2002;102:234-240.
2020 EDITION
12/15/21, 9:19 PM Discharge and Transfer of Nutrition Care to a New Setting or Provider
DISCHARGE AND TRANSFER OF NUTRITION CARE TO A NEW SETTING OR PROVIDER
Coordination of Nutrition Care by a Nutrition Professional (RC)
Discharge and Transfer of Nutrition Care to a New Setting or Provider

(RC-2)
Definition
Discharge planning and transfer of nutrition care from one level or location of care to another.
Discharge and transfer of nutrition care to other providers: Refer to others such as the physician, dentist,
physical therapist, social worker, occupational therapist, speech therapist, nurse, or pharmacist
Discharge and transfer of nutrition care to community agencies and programs: Refer to a community
agency/program (eg, home delivered meals, assistance programs for women, infants and children
[eg,WIC], food assistance programs [eg, food pantry, soup kitchen, food stamps], housing assistance,
shelters, rehabilitation, physical and mental disability programs, education, training and employment
programs)
Discharge and transfer of nutrtion care from nutrition professional to another nutrition professional:
Transfer of nutrition care to another nutrition and dietetics practitioner

Common Examples
PES Statements
Imbalance of nutrients (NI-5.4)
Nutrition Diagnoses Underweight (NC-3.1)
Impaired ability to prepare foods/meals (NB-2.4)
Long-term insufficient intake mandating home enteral or

parenteral nutrition
Etiology Growth and development considerations requiring
intervention in a new setting
Signs and Symptoms Biochemical Data, Medical Tests and Procedures
Abnormal lab values
Less than optimal weight status

Continuing weight gain or loss
12/15/21, 9:19 PM Discharge and Transfer of Nutrition Care to a New Setting or Provider
Less than optimal dietary practices

Unsupported beliefs and attitudes
Client History
Treatment failure
Readmission
Availability of discharge planning services, options for care

Preferences for the level and location of care
Resources available for care
Availability of or access to government medical programs (eg Medicare/Medicaid, health exchanges),
insurance guidelines and restrictions
Health literacy
Ability to implement treatment at home
Availability of or access to food assistance program (eg, food stamp program) guidelines and regulations
References
1. Baker EB, Wellman NS. Nutrition concerns for discharge planning for older adults: a need for
multidisciplinary collaboration. J Am Diet Assoc. 2005;105:603-607.
2. Position of the Academy of Nutrition and Dietetics: Food and Nutrition for Older Adults: Promoting
Health and Wellness. J Acad Nutr Diet. 2012;112:1255-1277.
2020 EDITION
12/15/21, 9:20 PM Population Theoretical Frameworks
POPULATION THEORETICAL FRAMEWORKS
Population Based Nutrition Action Domain
Population Theoretical Frameworks (P-1)

Definition
Theories, models and approaches used to design, implement and evaluate nutrition interventions at the
population level.
Theories and models are used to analyze and describe a process or occurrence and inform ways to address a
problem. Researchers and practitioners draw from theories and models and apply them in systematic approaches
relevant to specific situations. Theories, models and approaches are referred to generally as theoretical
frameworks. Theoretical frameworks used to guide change in institutions and society are different from those
applied to individual level change. (See Theoretical Bases/Approaches for individual change in the Nutrition
Counseling Domain reference sheet.) The theoretical frameworks, listed below are used in assessing, planning,
implementing and evaluating population-based nutrition actions. While the social ecological model provides an
overarching model for all intervention approaches, the others provide distinct approaches and concepts to guide
and inform the design of population-based interventions. Incorporating theoretical considerations into population
based nutrition actions leads to more effective outcomes and is aligned with evidence-based practice. For
example, community organizing is used to mobilize action for community gardens and farmers markets, and
organizational change theory is used when implementing evidence-based guidelines across systems. Using
standard terminology to describe the theoretical foundation for interventions is important for advancing
population-based nutrition work.
A population based nutrition action is typically described with details regarding the theoretical framework used
in its development and implementation. The aim and key concepts of commonly used theories, models and
approaches, and examples of nutrition and dietetic practitioners’ actions when they are applied are linked to each
theoretical framework.
The included theoretical frameworks represent those that are frequently applied in population-based nutrition
actions. This is not all inclusive, and nutrition practitioners may draw on other theories, models and approaches
as relevant to a particular nutrition problem and its context.
Social Ecological Model

Community Organizing
Diffusion of Innovations
Social Marketing
Organizational Change Theory
Mass Communications
Political Action

Common Examples
PES Statements
Altered nutrition-related laboratory values (NC-2.2)
https://www.ncpro.org/pubs/2020-encpt-en/codeP-1 1/2
12/15/21, 9:20 PM Population Theoretical Frameworks

Limited access to potable water (NB-3.4)
inconsistent intake

Etiology Limited access to food (NB-3.2)
Availability of shopping facilities
Lack of access to nutrition services
Biochemical indicators of at risk status
Growth, weight, BMI indicators at risk status
Signs and Symptoms
(Defining Characteristics)
Nutrient of food group data indicating inadequate intake or
excessive intake
Physical activity, type and frequency
Location, distance to, or rate per population with access to
full service grocery store
Other considerations
Scope of responsibility of the nutrition and dietetic practitioner

Material and economic resources
Constraints of grants, contracts and program regulations
Existing policies and laws
Opportunities for cross-sectoral collaboration
Interests, resources, and goals of collaborators
References
Refer to the theoretical frameworks above for references associated with each.
2020 EDITION
12/15/21, 9:21 PM Social Ecological Model
SOCIAL ECOLOGICAL MODEL
Population Theoretical Frameworks

Social Ecological Model (P-1.1)
Social Ecological Model
Theory, Model or Approach Key Concepts Nutrition and Dietetic Practitioner's Actions
The social ecological model Concepts: Nutrition and dietetic practitioner’s actions
recognizes that human behavior is a include:
Introducing changes at two or more levels
consequence of interactions among
can lead to synergy and optimize outcomes Consider the underlying determinants and
and across multiple levels of influence
the multiple influences of personal and
that are interdependent, interactive, Levels of Influence
environmental conditions that contribute to
and reinforcing. Intrapersonal: Individual characteristics such
the nutrition-related problem
as knowledge, attitudes, skills and behaviors,
Personal and environmental Identify potential opportunities at each
self-concept, health status, gender, genetics
influences are commonly defined in level to impact those conditions
and racial/ethnic identity
five levels: intrapersonal, Prioritize high-impact leverage points for
Interpersonal: Relationships and formal and
interpersonal, institutional, change at multiple levels
informal social networks and social support
community, and policy. Seek out evidence-based approaches for
systems, including family, work group, and
institutional, community, and policy level
The social ecological model facilitates friendship networks
interventions, to complement intrapersonal
a holistic examination and Institutional: Any structured and managed
and interpersonal approaches
understanding of a nutrition-related organization, business, association or
Integrate multidisciplinary perspectives in
problem and identification of potential government agency with procedures and
the design of the interventions
leverage points for corrective action policies for operation, including worksites,
Lead or collaborate with other entities to
throughout the levels of influence. schools, clinics, churches, and retail outlets
develop, fund, implement, and evaluate
Community: Relationships among formal
Aim: multi-level, multi-component interventions
and informal groups and organizations
Use appropriate methods to monitor
Social ecological interventions target within defined boundaries, including
implementation and determine progress
change strategies at more than one informational networks, community
and outcomes
level directly or indirectly, ideally associations, community leaders, non-profits
with measurable changes occurring at and businesses related to common concerns
each targeted level. such as health and safety, food access,
recreation and transportation
Policy: Local, state, national and global
laws, regulations and policies, affecting
allocation of resources, restricting or
incentivizing behaviors
References
1. Sallis JF, Owen N, Fisher EB. Ecological models of health behavior, Chapter 20 in K Glanz, BK Rimer, K Viswanath, Eds. Health
Behavior and Health Education: Theory, Research and Practice, 4th ed. San Francisco: Jossey-Bass, 2008.
2. Stokols D. Translating social ecological theory into guidelines for community health promotion. Am J Health Promot. 1996;10(4):282-
98.
3. Richard L, Gauvin L, Raine K. Ecological models revisited: their uses and evolution in health promotion over two decades. Annu Rev
Public Health. 2011;32:307-326.
https://www.ncpro.org/pubs/2020-encpt-en/codeP-1-1-SEM 1/2
12/15/21, 9:21 PM Social Ecological Model
2020 EDITION
https://www.ncpro.org/pubs/2020-encpt-en/codeP-1-1-SEM 2/2
12/15/21, 9:21 PM Community Organizing
COMMUNITY ORGANIZING

Community Organizing(P-1.2)
Nutrition and Dietetic Practitioner's

Theory, Model or ApproachKey Concepts
Actions
A participatory process of Concepts: Nutrition and dietetic practitioner’s
bringing people together, actions include:
Empowerment, community competence,
building capacity and gaining
collective power, participation, issue Identify and meet with key
power through involving
selection, critical consciousness stakeholders and change agents
constituencies to take
Convene community meetings
ownership for an issue and
Principles: Use participatory approaches to
stimulate action to bring
Self-interest and community- engage community members in
about change within the
interest (collective concern for needs assessments (including
community and in external priorities, health and safety) assets, barriers and community
organizations, policies and motivate people to come together interests), problem
practices that affect the
to gain power and use their identification, priority setting,
community.
collective power to make change and how to address them
Aim: Through experience people learn Acknowledge cultural
what is effective dimensions and develop cultural
Generate durable power for Mobilizing community volunteers and linguistic competence of self
[an organization and facilitating processes to help and staff
representing] the community them: focus on an issue, identify Help organize or serve on
to achieve positive and strengths and resources, initiate community advisory board or
collective action for actions and experience positive coalition
systematic change that results results, creates the power and the Prepare reports
in concrete measurable mechanism for the group to Share practical information
benefits for the community. advocate on their own behalf about issue
Emphasis on Capacity Building: Provide tools, education, and
Types of community
A community is best organized technical assistance to assist
organizing used in nutrition-
and strengthened by employing the community group in developing
related intervention include:
assets and strengths of community leadership, decision making and
grassroots advocacy, faith-
organizing skills, and
based community organizing, residents rather than emphasizing
their problems. formulating strategy
broad-based community
Capacity building occurs through Be a resource as they analyze
organizing, and coalition
extensive and meaningful issues, develop plan and
building.
interactions with community timeline, and identify financial
and other resources
The role of the Community experts, gatekeepers and builders.
Capacity building is facilitated Identify and describe supporters
Organizer is to educate,
and opponents
organize, empower and through the development of
practical resources, tools and Assist with media campaigns
mobilize the community to
advocate for its self and strategies for community residents
advance the cause. to identify, nurture, and mobilize
neighborhood assets.
https://www.ncpro.org/pubs/2020-encpt-en/codeP-1-2 1/2
12/15/21, 9:21 PM Community Organizing
Community organizing is
empowering the community
and working with them, not
doing it for them, nor is it
delivering services.
References
1. McKnight J, Plummer JM. Community Organizing: Theory and Practice. ANCD Institute.org
2. CTSA Community Engagement Key Function Committee Task Force on the Principles of Community
Engagement (Second Edition). Principles of Community Engagement, 2nd Edition. NIH Publication No.
11-7782, June 2011. http://www.atsdr.cdc.gov/communityengagement/pdf/PCE_Report_508_FINAL.pdf.
Accessed 2/15/2016.
3. Wilcox A, Knapp A. Building communities that create health. Public Health Rep 2000;115:139-143.
4. Grills, C., Villanueva, S., Subica, A. M., Douglas, J. A. Communities creating healthy environments:
improving access to healthy foods and safe places to play in communities of color. Preventive Medicine,
2014;69(Suppl):S117–S119.
5. Wallerstein N, Duran B. Community-based participatory research contributions to intervention research:
the intersection of science and practice to improve health equity. Am J Public Health. 2010;100(Suppl
1):S40-S46.
2020 EDITION
12/15/21, 9:21 PM Diffusion Innovations
DIFFUSION INNOVATIONS

Diffusion of Innovations (P-1.3)
Theory, Model or Nutrition and Dietetic Practitioner's

Key Concepts
Approach Actions
Theory originated by Evert Concepts: Nutrition and dietetic practitioner’s
Rodgers on how new actions include:
The innovation—idea, practice, or
technologies and
product that is perceived as new Identify and illuminate the
advancements spread
Adopters—cluster of people or “need” and innovation
through society and cultures
organizations targeted Identify and collaborate with
from introduction to wide
Communications channels— stakeholders and leaders.
adoption. Also applies to
patterns and capabilities for Strategically involve
ideas and beliefs and policy
transferring information from one collaborators and work with
change.
to another those who have the ability and
Aim: Context—influence of external knowledge to implement,
factors that facilitate or imped including: persons in positions
Integrate the innovation into acceptance and implementation of authority in formal and
the routine “ways of doing such as social networks, mass informal organizations, highly
things.” “Diffusion” is how it media and social media, respected person in social
spreads, and “adoption” is a organizational and governmental network, and “champions” who
decision. mandates, and influence of opinion stand behind the innovation and
leaders and champions can break through opposition.
Dissemination and
Adjusts tactics, messages and
implementation science is an
communication channels to help
emerging field that Attributes that determine rate of diffusion
organizations, groups and key
specifically seeks to integrate and adoption:
Relative advantage compared to individuals move through the
evidence-based approaches
current way five stages of change/adoption.
into clinical and community
settings and to understand Compatibility with pre-existing For Organizations:
the interaction between system (cultural beliefs, norms) 1. Agenda-setting
processes and social, Complexity to learn or implement 2. Matching
organizational, and cultural Testability-ability to try it out 3. Redefining/restructuring
factors that lead to adoption. without first making a commitment 4. Clarifying
to it 5. Routinizing
Observability of effects of
adoption For Individuals (especially influencers
Communicability-ease of and decision makers):
1. Awareness, knowledge about the
understanding the new way
new innovation, interest in
innovation and who is using it,
Categories of adopters: 2. Weigh advantages and
innovators, early adopters, early disadvantages, benefits-costs
majority, late majority, laggards based on felt need.
3. Implementation trial with
evaluation
12/15/21, 9:21 PM Diffusion Innovations
4. Search for additional

information to confirm or reject,
and
5. Confirmation and adoption
References
1. Rogers EM. Diffusion of Innovations 5th Ed. Simon and Schuster. 2003.
2. Reimer BK, Glanz K. Theory at a Glance: A Guide for Health Promotion Practice 2nd Edition.
DHHS:National Cancer Institute. 2005.
3. Khalil, H. Knowledge translation and implementation science: what is the difference? International
Journal of Evidence-Based Healthcare. 2016;14(2):39–40. doi: 10.1097/XEB.0000000000000086
4. Nilsen P. Making sense of implementation theories, models and frameworks. Implementation Science.
2015;10:53. DOI 10.1186/s13012-015-0242-0
2020 EDITION
12/15/21, 9:25 PM Social Marketing
SOCIAL MARKETING

Social Marketing(P-1.4)

Key Concepts
Approach Actions
A comprehensive, theory- Concepts: Nutrition and dietetic practitioner’s
based approach that applies actions include:
Consumer oriented—audience-
marketing principles to
centered approach to determine Lead or collaborate with other
advance a cause, idea or
(using qualitative and quantitative entities to develop and
behavior. It is a framework
methods) needs wants, and implement social marketing
for planning and managing
priorities that will be incorporated campaigns
effective health interventions
into the intervention Select and implement all or parts
to influence the behavior of
Voluntary exchange—the of a social marketing program
the target audience and the
perceived benefit of the product, developed by others (e.g., fruit
society of which they are a
idea or action must outweigh the and vegetable, breastfeeding,
part.
perceived costs of time, effort, physical activity promotions)
Aim: inconvenience or restriction of Incorporate social marketing
pleasure (such as limiting favorite principles into existing
Voluntary adoption of an idea foods), or conflict with precedent interventions to improve
or behavior that improves (defying social norms or audience “reach” and
health of people or leads to institutional practices) effectiveness
changes in the conditions in Market/audience segmentation—
where they make decisions homogeneous subgroups of the
Steps of the social marketing process:
and execute choices. population determined from
1. Conduct audience analysis and
characteristics such as needs,
Health marketing is the formative evaluation
concerns, age, risk factor, lifestyle,
specific application of social (assessment)
barriers, and motivations
marketing to health 2. Select messages, channels and
Message—concise set of words
promotion and health materials
and images to capture the main
protection. 3. Develop and/or select materials
idea to be disseminated; must be
and implementation methods
clear, personally relevant and
4. Implement program
memorable.
5. Assess effectiveness (monitoring
Channels—medium through which
and evaluation)
the message will be received such
6. Use feedback to refine the
as mass media campaigns, social
program
media, place-based signage,
events, word-of-mouth, influential
spokespersons
Tailoring—fit the message and the
4 Ps (product, price, place,
promotion) to the audience
segments’ characteristics; may
result in different messages and
channels for different segments
12/15/21, 9:25 PM Social Marketing
Market research—qualitative and

quantitative methods to determine
needs, wants and motivations, and
audience pretesting of materials
and messages
References
1. Lefebvre, RC . Theories and Models in Social Marketing Reference. In PN Bloom & GT Gundlach
(Eds.), Handbook of Marketing and Society, Newbury Park, CA: Sage Publications, 2000.
2. Andreasen AR. Social Marketing in the 21st Century. San Francisco: Jossey-Bass Publishers, 2006.
3. Wasan PG. Revising social marketing mix: a socio-cultural perspective. Journal of Services Research.
2014;14(2):127-144.
4. Food Forum, Food and Nutrition Board, Health and Medicine Division, National Academies of Sciences,
Engineering, and Medicine. Food Literacy: How Do Communications and Marketing Impact Consumer
Knowledge, Skills, and Behavior? Workshop Summary. Washington (DC): National Academies Press
(US); 2016.
2020 EDITION
12/15/21, 9:26 PM Organizational Change Theory
ORGANIZATIONAL CHANGE THEORY

Organizational Change Theory (P-1.5)

Key Concepts
Approach Actions
Numerous theories and
models apply to change
within organizations. Two
that are commonly applied
in nutrition initiatives are
included here.
Oranizational Concepts: Nutrition and dietetic practitioner’s
Development (OD): actions include:
Organizational Climate-The
personality of an organization. Analyze changing
Organizational development
Organizational Culture-The norms, environmental and
(OD) is any planned and
values, and behaviors that are organizational trends
managed process or activity
deeply embedded within the Identify organizational climate
to improve capacity among
members of the organization. The and culture enablers and barriers
persons within an
five elements of cultures: and incorporate them when
organization through
1. Assumptions developing strategies for change
continuous diagnoses, action
2. Values Recognize where development
planning, implementation,
3. Behavioral norms and realignment of people is
and evaluation. It involves
4. Behavioral patterns necessary to solve current and
changing and aligning
5. Artifacts emerging problems and adapt to
people with the key goals
Organizational Strategies-The changing priorities
and challenges facing the
organizational development (OD) Engage employees in problem
organization.
approach to promote organizational solving
change: Plan training and team-building
Aim:
1. Diagnosis and motivational exercises
2. Action planning Provide training to develop a
To expand knowledge,
3. Intervention culturally and linguistically
expertise, productivity and
4. Evaluation competent nutrition workforce
effectiveness of people to
Modify position description and
improve satisfaction,
performance expectations and
relationships, performance
adjust recruitment and retention
or other desired outcome for
activities
the benefit of individuals,
Use OD concepts to improve
groups, work units, or the
the capacity of healthcare
whole organization.
professionals to support
nutrition needs of clients
Model for Improvement Concepts: Nutrition and dietetic practitioner’s

The Model for Improvement Can be implemented at the program, actions include:
defines an iterative method agency, and/or system levels Preparation
for identifying areas for Utilizes a team
change in a process or Follows a defined problem solving Research and provide evidence
system and defining time- process, such as the PDSA Cycle for needed changes
specific and measurable Review best practices and
AIM Statement: Preparation step
goals for improvement, then evidence-based approaches
1. What are we trying to accomplish?
systematically planning Determine relevant process and
2. How will we know that a change is
specific actions, outcome measures
an improvement?
implementing them, Secure commitment of
3. What change can we make that will
measuring progress and resources and administrative
result in improvement?
adjusting the plan as approval for effort
necessary, and finally The AIM Statement should be clear,
Plan
standardizing and specific, measurable and time-bound.
institutionalizing successful Specify the area for
innovations and changes. PLAN: Plan a change improvement
Assemble team, and define roles
Models of improvement call 1. Identify area, problem or
and responsibilities
for engagement and opportunity for improvement
Obtain baseline data and seek
utilization of a team 2. Assemble the team
input from stakeholders to
throughout the steps of the 3. Examine the current approach
understand the current approach
improvement initiative. (baseline data, root causes, get input
and opportunities for
of customers and stakeholders)
Commonly applied in improvement
4. Identify potential solutions and
quality improvement Assess potential solutions and
select best
programs, updating pick solution most likely to
5. Develop an improvement theory
procedures (e.g., evidence- accomplish aims
(If…, then…)
based guidelines), Prepare detailed plans and
implementing new DO: Implement the plan timeline for implementation and
innovations or technology, 6. Test the change on a small scale evaluation
and/or in responding to 7. Collect data, document successes
Do
community or customer and problems, examine unintended
defined needs and side effects Oversee or provide guidance to
expectations the trial of the new way of
STUDY: Observe the results
doing things
The PDSA (Plan, Do, 8. Study the results, compare with
Collect, chart and display data
Study, Act) Cycle for baseline and intended aim
to determine effectiveness of the
Learning and Quality
ACT: Refine the change, as necessary, and test
Improvement is a widely
implement on large scale
used application of the Study
9. Continue testing and adjusting until
model for continuous
acceptable level of improvement is Bring expertise to the
quality improvement.
achieved interpretation of findings and
Aim: 10. Celebrate successes needed action steps
11. Standardize the improvement Report performance with
A deliberate and defined
12. Take steps to preserve gains and outcome measures and insights
method to bring about
sustain accomplishments for adjustments to plan
change in an organization’s
processes and outcomes to Act
improve internal operations
Standardize the improvement
and/or to be responsive to
and expand implementation,
community needs and
incorporate into procedures and
address population health
performance expectations
and nutrition issues.
Communicate accomplishments
to internal and external
stakeholders and advocate for
broader implementation
References
1. Butterfoss FD, Kegler MC, Francisco VT. Mobilizing organizations for health promotion: theories of
organizational change, companion material. Chapter 15 in K Glanz, BK Rimer, K Viswanath, Eds. Health
Behavior and Health Education: Theory, Research and Practice, 4th ed. San Francisco: Jossey-Bass, 2008
http://www.med.upenn.edu/hbhe4/index.shtml
2. Wu, Sarah. (2013). Theories of Organizational Change
http://www.sfu.ca/uploads/page/14/GERO820_FALL2013_presentation_Sarah_Wu_Theories_of_Organiz
ational_Change.pdf
3. Langley GL, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A
Practical Approach to Enhancing Organizational Performance, 2nd ed. . San Francisco: Jossey-Bass
Publishers; 2009.
4. Thomas C, Corso L, Pietz H. Evaluation, performance management, and quality improvement:
understanding the role they play to improve public health.
http://www.cdc.gov/std/products/progevalwebinar-slides.pdf
5. Institute for Healthcare Improvement. How to Improve.
http://www.ihi.org/resources/Pages/HowtoImprove/default.aspx
6. NICHQ Model for Improvement http://www.nichq.org/about/expertise/improvement-
science/model_for_improvement
7. McLean GM. Organization Development: Principles, Processes, Performance. Oakland, CA: Berrett-
Koehler Publishers 2005
8. Braillie E, Bjarnholt C, Gruber M, Hughes R. A capacity-building conceptual framework for public
health nutrition practice. Public Health Nutrition. 2009. Doi:10.1017/S1368980008003078
9. NCC DPHP Workplace Health Promotion Toolkit Planning/Workplace Governance Module. Division of
Population Health National Center for Chronic Disease Prevention and Health Promotion.
http:www.cdc.gov/workplacehealthpromotion/planning/index.html
2020 EDITION
12/15/21, 9:26 PM Mass Communication
MASS COMMUNICATION

Mass Communication (P-1.6)

Actions
A process in which an entity Concepts: Nutrition and dietetic practitioner’s
(person or organization) actions include:
Mass Media Channels-
selects and sends a message
technological systems and devices Analyze the communication
through a specialized media
that extend communication across environment related to the
or transmitting device to a
time and space. Includes radio, identified nutrition problem,
large group of anonymous
TV, print (books, magazines, including understanding salient
and heterogeneous people
pamphlets, billboards, etc.) and beliefs of the audience, context
(target audience or general
digital media (email, internet and for decision making, and barriers
public) and organizations.
interactive web sites, blogs, social to behavior change
Mass communication draws media, video games) Use media analysis to identify
from many theories that Media Literacy- ability, of competing and reinforcing
address the processes and communicator and audience, to messages, examine how those
mechanisms that allow access, analyze, evaluate and messages are framed, and
communication to take place communicate media messages consider how existing coverage
and to impact people, Cultivation of Perceptions-through of an issue could be improved
organizations and society. repeated and prolonged exposure Work with and solicit input of
to mass media, people’s beliefs, other organizations and
Aim:
values, traditions, behaviors and community groups to assure the
expectations are shaped message is relevant and
To transmit information,
Mass Media Campaign-a planned culturally sensitive to the
frame an issue, and/or shape
effort that disseminates messages intended audience, expected
perceptions to create or
to produce awareness or behavior behaviors are culturally
change knowledge, attitudes
change among the intended acceptable, and channels are
or behaviors of people,
population through channels that accessible and appropriate
societal norms, and/or to
reach broad audiences Determine message, and its
modify products and services
Media Advocacy-strategic use of framing; and pre-test with the
and structures in the
mass media to identify and frame target audience
environment.
issues, increase public awareness Create a comprehensive plan
and concern, and spur public that addresses environmental
action constraints on the target
Framing-taking a leadership role population as well as individual
to shape and influence public factors and social and cultural
understanding and discourse about influences
an issue Develop an exposure strategy to
achieve frequent and repeated
Elaboration Likelihood Model—
exposures to the message,
effectiveness of a message is a function of
through multiple channels
how people process it and the degree that
Select a variety of channels
they engage in elaboration or issue-
chosen for their ability to reach
relevant thinking
12/15/21, 9:26 PM Mass Communication
and engage the target population

Build in methods for tracking
exposure and eliciting feedback
References
1. Abroms LC, and Maibach EW. The effectiveness of mass communication to change public health
behavior. Annu Rev Public Health, 2008;29:219-234.
2. Hornik R, Kelly B. Communication and diet: an overview of experience and principles. J Nutr Educ
Behav. 2007 Mar-Apr;39(2 Suppl):S5-12.
3. Wilson BJ. Designing media messages about health and nutrition: what strategies are most effective? J
Nutr Educ Behav. 2007 Mar-Apr;39(2 Suppl):S13-9.
4. Snyder LB. Health communications campaigns and their impact on behavior. J Nutr Educ Behav. 2007
Mar-Apr; 39(2 Suppl):S32-40.
5. Making Health Communication Programs Work: A Planner’s Guide. DHHS, PHS, NIH, National Cancer
Institute, Office of Communications, 2002..
2020 EDITION
12/15/21, 9:26 PM Political Action
POLITICAL ACTION

Political Action (P-1.7)

Actions
From several theoretical
approaches important to
advancing political change,
two commonly utilized in
addressing nutrition issues
are included here.They
address
1) building advocacy
coalitions, and
2) moving to action through

the policy window and
agenda setting.
Advocacy Coalition Concepts: Nutrition and dietetic practitioner’s
Framework: actions include:
Core beliefs-individuals have core
beliefs about problems, their
Coalitions form as a result of
causes and seriousness, and how to Work with, support, and
specific core ideas and beliefs
solve them. These individuals strengthen alliances with
about policy issues and their
create coalitions with others advocacy groups and policy
interests in them. Advocacy
sharing the same ideas and beliefs. makers that share core ideas or
coalitions work with policy
Advocacy coalitions-within a beliefs
makers to affect change in
policy area, there can be several Provide research, information,
policy relevant to the core
different advocacy coalitions reports, tools, and education to
ideas of the coalition.
representing their own interests. advocacy coalitions regarding
Each coalition will have their own nutrition-related problems, their
Aim:
beliefs about issues and solutions, causes and seriousness, and
strategies and resources. potential solutions
To change policy, and
Policy makers-persons responsible Use social or mass media to
ultimately social or physical
for formulating laws, regulations, increase awareness and affect
conditions, through
or rules, or defining policies and change in public opinion on
interactions and coordinated
practices specific policies that the
activities among advocacy
Policy broker-works with both coalition is trying to change
coalitions, policy makers and
coalitions and policy makers to Use research and information
political systems.
keep levels of political conflict exchange to change perceptions
low and come to reasonable of opponents
solutions to the problems that the Prepare and disseminate policy
advocacy coalitions are working to briefs
change Write letters of support or
Resistance to change-core ideas opposition regarding specific
and beliefs are resistant to change policies to policy makers
unless major external events or Provide public comment or

new policy modifies the views of formal testimony at meetings of
the members of the coalition. New policy makers and legislative
learning can shift views of a hearings
coalition. Become a recognized and trusted
expert for nutrition-related
policy issues
Provide meeting space for
coalitions
Arrange and host policy
briefings and dialogues
Join and actively participate in
coalitions that represent food,
nutrition and physical activity
related issues.
Invite policy makers to visit
programs and events
Recognize policy makers and
coalitions for taking action to
improve nutrition and health
Policy Window & Setting Concepts: Nutrition and dietetic practitioner’s

For issues to get more Problems: social conditions that actions include:
attention in the policy have been identified by policy Take an active role in defining
process, at least two of three makers and advocates, including nutrition-related problems and
streams need to converge at a its status and causes, and potential potential policy solutions
critical time, known as a solutions Monitor indicators that
policy window. The three Policy solutions: ideas generated document the existence, causes
streams are problems, policy to solve the problem and magnitude of the problem
solutions, and Political climate: how the problem Initiate special studies to
politics/political climate. is perceived and championed by determine the local impact of the
advocates, and interest groups and issue (health impact assessment)
Agenda setting is a process in policy makers Research current and emerging
which advocacy groups, The three streams operate policies, and be prepared to
decision makers, key independently; the most success propose viable solution options
stakeholders, constituents, comes when all three streams are available
citizens, and the media aligned Frame messages about problems,
reciprocally influence one Policy windows- predicable policies, and political action to
another to get problems on (elections, planning and budget align with decision makers’
the political agenda. cycles, school years) and ideologies
unpredictable (dramatic events or Monitor local, state and national
Aim:
crisis [e.g., food borne illness policy issues and advocate to
To get nutrition-related issues outbreak], or natural disasters) appointed and elected officials
on the political agenda, and Agenda setting-to get on an before voting occurs
to influence the alignment of agenda for attention, problems Draft language for legislation
problem definition, policy must have an emotional Monitor community and
solutions, and political component, a technically feasible stakeholder perceptions and
climate in the policy window solution, be aligned with values promote constituent feedback
so action can be taken. and beliefs of decision makers, and involvement
and have high constituent Learn how to couple two
awareness different streams in order to
enact policy change, such as
Factors for success-To affect the introducing a proposition to city

policy agenda and take advantage elected officials to solve a
of policy windows, advocates problem (e.g. sugar-sweetened
must have thorough knowledge of beverage tax)
problem and solution, trusted Monitor the political process to
relationships with policy makers, recognize a policy window and
and good reputations be prepared to respond
Influence the political climate by
building coalitions, using mass
or social media, arranging
events, participating in
demonstrations, and establishing
a rapport with elected officials as
the nutrition expert
Strengthen capacity within the
organizational to work on policy
change
References
1. Stachowiak, S. (2013). Pathways for Change: 10 Theories to Inform Advocacy and Policy Change
Efforts. Retrieved from http://orsimpact.com/wp-content/uploads/2013/11/Center_Pathways_FINAL.pdf.
2. Cerna L. (2013). The Nature of Policy Change and Implementation: A Review of Different Theoretical
Approaches. Retrieved from
https://www.oecd.org/edu/ceri/The%20Nature%20of%20Policy%20Change%20and%20Implementation.
pdf.
3. Butterfoss FD, Kegler MC. Toward a Comprehensive Understanding of Community Coalitions: Moving
from Practice to Theory. In DiClemente RJ, Crosby RA, Kelger MC. (Eds.) Emerging Theories in Health
Promotion Practice and Research. San Francisco, CA: Jossey-Bass Publishers, 2002:157-193.
http://www.astdd.org/docs/BPA2attachmentcoalitionB.pdf
4. Writing Policy Briefs: A Guide to Translating Science and Engaging Stakeholders.
http://www.jhsph.edu/research/centers-and-institutes/womens-and-childrens-health-policy-
center/de/policy_brief/index.html
2020 EDITION
12/15/21, 9:20 PM Population Strategies
POPULATION STRATEGIES
Population Strategies (P-2)

Definition
Plans of action that target environmental change, organizational change, and public policy change.
Population strategies are widely used to bring about changes that are external to the individual in order to
promote and protect the population’s health. The strategies are aimed at the structural aspects of the
environment, processes within programs, organizations and systems, and the laws and regulations that are the
root causes and contributing factors for many nutrition problems. An aim of these strategies is to create
supportive environments that “make the healthy choice the easy choice.”
Strategies are classified by the target of change: the Environment including food availability and access and the
built environment, especially as it affects physical activity opportunities, and societal norms; Organizational
Change including the process, procedures and policies (formal and informal) of programs, organizations,
institutions and systems, and Public Policy (local, state and national laws and regulations).
Nutrition and dietetic practitioners select from these strategies when planning population-based nutrition actions;
and when using these strategies they typically work in collaboration with other individuals and organization on
cross-sectoral, multi-level and multi-sector initiatives. The strategy (ies) chosen are guided by the nature of the
problem and its determinants. A single initiative can be planned or several strategies may be used simultaneously
resulting in reinforcing, multicomponent programs designed to address different underlying causes of the
problem.
A population-based nutrition action is typically described by identifying the target of change, and with details
regarding the strategy used as identified in the Population Strategies Table.
Environmental Change
Food environment change
Built environment change
Social norm change
Organizational Change
Public Policy Change

Common Examples
PES Statements
Nutrition Diagnoses Undesirable food choices (NB-1.7)
Intake of unsafe food (NB-3.1)
inconsistent intake
12/15/21, 9:20 PM Population Strategies
Etiology Food and nutrition related knowledge deficit (NB-1.1)

Availability of shopping facilitiies
Biochemica of at risk status
Signs and Symptoms
exessive intake

References
Refer to the population strategies above for references associated with each.
2020 EDITION
12/15/21, 9:27 PM Population Strategies Environmental Change
POPULATION STRATEGIES ENVIRONMENTAL CHANGE
Population Strategy
Examples of Nutrition and Dietetic

Target Strategy Definitions
Practitioners' Actions
Environmental Change (P- Actions designed to alter the
2.1) environment where people live, work, (See following subcategories)
learn and play to promote and support
healthful behaviors, prevent disease
and disability, and reduce inequities.
Additional information:
In simple terms, the aim is to modify

the environment to make the healthy
choice the easy choice.
Environment is subdivided into three

areas: the food environment, the built
environment, and social norms
Food Environment Actions to improve the availability, Organize community to increase
Change accessibility and quality of food and access to community-supported
the places people access food. agriculture schemes
Work with corner stores to
Additional information: improve refrigeration equipment
to enable sale of fresh fruits and
The food environment includes the
vegetables
continuum from food production,
Work with vending companies to
processing and distribution, to places
improve food choices offered
where people access, purchase, and
Implement calorie content
consume food. Food-related facilities
signage in cafeterias and fast
and equipment are included here.
food outlets
Advocate for pricing changes to
influence food choices
Support and improve the
nutritional quality of food aid
and emergency feeding programs
Actions to modify physical features of Work with park and recreation

Built Environment indoor and outdoor places and spaces department to update lighting
Change to enable and support healthful and signage to improve access
behaviors, especially to increase and safety and increase
opportunities for safe and accessible utilization of walking trails
physical activity for all. Work with city planners to
increase sidewalks and bike
Additional information:
paths, to improve walkability to
The “built” environment refers to destinations such as grocery
structures (“bricks and mortar”) and stores, and to incorporate space
12/15/21, 9:27 PM Population Strategies Environmental Change
facilities and equipment. (Processes are for physical activity in new

covered in Organizational Change) housing developments
Work with employee committee
to obtain spaces for noon-time
exercises classes
Develop a social marketing

Social Norm Change Actions to modify generalized beliefs campaign to modify expectations
and values, attitudes and expectations regarding portion sizes of food
held by segments of the population or and beverages served
the population at large that impact Work with the community to
nutrition and health. organize support for community
gardens and locally-grown food
References
Food Environment
1. Story M, Kaphinger KM, Robinson-O’Brian R, Glanz K. Creating healthy food and eating environments: policy
and environmental approaches. Annu Rev Public Health 2008;29:253-272.
2. Gittelsohn J, Rowan M, Gadhoke P. Interventions in small food stores to change the food environment, improve
diet, and reduce risk of chronic disease. Prev Chronic Dis 2012;9:E59. Epub 2012 Feb 16.
Built Environment & Physical Activity

1. Berke EM, Vernez-Moudon A. Built environment change: a framework to support health-enhancing behaviour
through environmental policy and health research. J Epidemiol Community Health. 2014 Jun;68(6):586-90. doi:
10.1136/jech-2012-201417. Epub 2014 Jan 23
2. Sallis JF, Floyd MF, Rodríguez DA, Saelens BE. Role of built environments in physical activity, obesity, and
cardiovascular disease. Circulation. 2012; 125: 729-737.
Social Norms
1. Ball K, Jeffery RW, Abbott G, McNaughton SA, Crawford D. Is healthy behavior contagious: associations of
social norms with physical activity and healthy eating. Int J Behav Nutr Phys Act. 2010;7:86
2. McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: a review of concepts and
evidence. Soc Sci Med. 2006;63:1011–1022. doi: 10.1016/j.socscimed.2006.03.012
2020 EDITION
12/15/21, 9:27 PM Population Strategies Organizational Change
POPULATION STRATEGIES ORGANIZATIONAL CHANGE
Population Strategy

Organizational Change Actions designed to alter the Single organization examples:
(P-2.2) operations within a program,
Help worksite establish a healthy
organization, institution, or system.
eating and activity policy for meetings
Involves durable changes to operating
and events
policies, procedures and processes and
Community nutrition staff designs and
interactions among constituents.
implements a nutrition module for
Additional information: training community health workers
Dietitian takes active role as hospital
Organizational change can range in makes changes involving several
scope from actions to establish new or departments to become certified as a
different ways of operating in a single Baby (breastfeeding)-Friendly Hospital
program or site, to comprehensive
Example of collaboration of two or
actions involving many constituents to
more organizations:
establish new or different ways of
doing complex things throughout a Maternal and child health coalition
system or across sectors. works to implement cross-referrals
processes among clinics and
community-based programs
Supplemental food program
establishes a system for subsidized
purchases at area farmers markets
A school district and local producers
set up a farm to school program
System-wide examples:
Implementation of electronic medical

records, including nutrition
terminology, throughout the healthcare
system
Create new system for certification of
home care providers that includes food
and nutrition knowledge requirements
BMI screening and follow up
implemented in schools and primary
healthcare settings across the state
Country implements evidence-based
public health recommendations
regarding vitamin/mineral
supplementation
Implement healthy-eating curriculum
throughout school system
12/15/21, 9:27 PM Population Strategies Organizational Change
References
1. Riley BL, Garcia JM, Edwards, NC. Organizational change obesity prevention-perspectives, possibilities
and potential pitfalls. Chapter 12 in Handbook of Obesity Prevention. Springer, 2007, pp 239-261.
2. National Center for Chronic Disease Prevention and Health Promotion Toolkit Planning/Workplace
governance Module. Http:www.cdc.gov/workplacehealthpromotion/planning/index.html.
2020 EDITION
12/15/21, 9:27 PM Population Strategies Policy Change
POPULATION STRATEGIES POLICY CHANGE
Population Strategy

Public Policy Change (P- Actions related to local, state and The nutrition and dietetic practitioner takes an
2.3) federal laws and ordinances and active role including:
government agency regulations and
Advocating (as appropriate to
guidelines that impact factors that
position)
contribute to health and nutrition-
Drafting or modifying policies and
related outcomes of the population.
proposed legislation
Additional Information: Providing data and testimony
Organizing community support
This includes actions designed to
Building coalitions
develop, enact and/or enforce laws and
regulations. To effect changes in, for example, restaurant
codes, city gardening ordinance, zoning for
fast food near schools, taxes on sugar-
sweetened beverages, food and menu
labeling, supplemental nutrition program
regulations, school nutrition and wellness
policy, rates for social welfare benefits, and
subsidies for rural/remote food access
To advocate for a health-in-all-policies

approach
To reduce inequities in the

determinants of health
References
1. Sallis J F, Bauman A, Pratt M. Environmental and policy interventions to promote physical activity. Am J
Prev Med. 1998 Nov;15(4):379–97. doi: 10.1016/S0749-3797(98)00076-2.S0749379798000762
2. Food Security. Policy Brief. FAO Agriculture and Development Economics Division. June 2006 Issue 2.
Available at http://www.fao.org/forestry/13128-0e6f36f27e0091055bec28ebe830f46b3.pdf.
2020 EDITION
12/15/21, 9:20 PM Population Settings
POPULATION SETTINGS
Population Settings (P-3)

Definition
Locations where the population-based nutrition intervention is implemented.
The setting specifies the places where the intervention is delivered to most effectively reach and impact the
population experiencing the identified nutrition-related problem. A population-based nutrition action may be
delivered in more than one setting in a coordinated fashion (eg, school district and community recreation
centers). The intervention may involve one or more sites within the setting (eg, one child care center or all child
care centers in the county or state). The choice of setting has implications for which strategies (see P-2) to
employ.
Some of these settings may also be useful in describing and documenting the location for delivery of individual
and group nutrition interventions. Nutrition and dietetic practitioners, along with collaborators (see P-4), select
from these settings when planning how and where population-based nutrition actions will be implemented in
order to have the greatest impact on the problem and its etiology/root causes/determinants. The setting also
identifies the target location where data (assessment, monitoring and evaluation indicators) can be collected to
assess progress and determine outcomes.
A population-based nutrition action is typically described with details regarding the settings where the
intervention is implemented. The settings listed in the Population Settings Table can be used to classify and
described the locations utilized.
Residential Settings
School Settings
Worksite Settings
Recreation and Sports Settings
Food Production and Provisions Settings
Service Settings
Government Settings
Community At Large Settings

Common Examples
PES Statements
inconsistent intake
Etiology Food and nutrition related knowledge deficit (NB-1.1)

12/15/21, 9:20 PM Population Settings

Signs and Symptoms
exessive intake

References
1. Foltz JL, May AL, Belay B, et al. Population-Level Intervention Strategies and Examples for Obesity
Prevention in Children. Annu Rev Nutr 2012. 32:391–415.
2. Khan O, Sobush K, Keener D, Goodman K, Lowry A. et al. Recommended Community Strategies and
Measurements to Prevent Obesity in the United States. MMWR 2009;58(RR-7):1-26.
3. IOM (Institute of Medicine). 2015. Cross-sector responses to obesity: Models for change. Workshop
summary. Washington, DC: The National Academies Press.
2020 EDITION
12/15/21, 9:20 PM Population Sectors
POPULATION SECTORS
Population Sectors (P-4)

Definition
Public, private and non-profit entities integral to the development and implementation of interventions that
impact determinants of the nutritional well-being of the population.
Sectors are unique yet interdependent entities that have differing types of influence on and interest in healthy
food and healthy people. Considering a broader range of sectors opens new possibilities for interventions
directed to the underlying determinants of population nutrition problems. Each sector has numerous
constituencies that are potential collaborators for identifying opportunities and developing, implementing and
evaluating interventions. Through mobilizing cross-sector collaboration, awareness is raised, complementary
strengths and combined resources can be applied to problematic aspects of complex nutrition problems, and
evidence-based and promising practices can be expanded. Additionally, cross-sector interventions promote
solidarity in action, and foster transparency and public accountability. For example, food companies, researchers,
schools, farmer and producer associations, professional sports teams, government programs, and healthcare
systems have different, but coordinated roles in collaborative efforts to address underlying causes of childhood
obesity.
The sectors and constituents are frequently involved in collaborative work to tackle problems and their
underlying causes and advance population nutrition goals. Cross-sector, multi-level, multi-component programs
have been shown to be more effective than single interventions and are commonly used to address challenging
nutrition and health issues of the population. Many national and international nutrition intervention efforts
attribute success to collaborative and coordinated work that engages multiple sectors.
Other terminology related to the concept of sectors includes: stakeholders, partners, players, and affiliates who
come together in formal and informal alliances, coalitions, councils, networks, partnerships, or workgroups.
A population-based nutrition action is typically described with details regarding who is engaged in collaborative
efforts. The sectors and constituents in the Population Sectors Table can be used to identify potential
collaborators and then describe those that participate in the planning, implementation and/or evaluation of the
population-based nutrition action.
Agriculture Sector
Education Sector
Government Sector
Healthcare Sector
Food and Beverage Sector
Business and Industry Sector
Social Welfare Sector
Nonprofit Sector
Communities, Neighborhoods, Families Sector
Nutrition Diagnostic Terminology Used in Common Examples
PES Statements
inconsistent intake

Etiology Limited access to food (NB-3.2)
Signs and Symptoms
exessive intake

References
1. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020
Dietary Guidelines for Americans. 8th Edition. Chapter 3 Everyone Has a Role in Supporting Healthy
Eating Patterns. December 2015. Available at http://health.gov/dietaryguidelines/2015/guidelines/.
2. Institute of Medicine. Bridging the evidence gap in obesity prevention: a framework to inform decision
making. Washington (DC): The National Academies Press; 2010
3. UNICEF. Multi-sectoral Approaches to Nutrition: Nutrition-specific and Nutrition sensitive Interventions
to Accelerate Progress. www.unicef.org/eapro/Brief_Nutrition_Overview.pdf. Accessed 2/13/2016.
4. USAID. Multi-sectoral Nutrition Strategy 2014-2025. May 2014.
www.usaid.gov/sites/default/files/documents/1867/USAID_Nutrition_Strategy_5-09_508.pdf. Accessed
2/13/2016.
5. Levinson FJ, Balarajan Y. (2013). Addressing malnutrition multisectorally: What have we learned from
recent international experience? UNICEF Working Paper. New York: UNICEF and MDG Achievement
Fund.
6. The World Bank (2013). Improving Nutrition through Multi-sectoral Nutrition Approaches. Washington,
DC: The World Bank.
7. Black RE, et al for the Maternal and Child Nutrition Study Group. Executive Summary of the Lancet
Maternal and Child Nutrition Series. The Lancet.com
www.unicef.org/ethiopia/Lancet_2013_Nutrition_Series_Executive_Summary.pdf. Accessed 2/13/2016.

8. Wizemann T, Thompson D. Role and Potential of Community in Improving Population Health
Improvement: Workshop Summary. National Academy of Sciences; 2015.
9. Jakarta Declaration on Leading Health Promotion into the 21st Century. The Fourth International
Conference on Health Promotion, 1997.
10. Association of State and Territorial Public Health Nutrition Directors (ASTPHND). Collaboration Primer.
Available at http://www.asphn.org/frontpage_files/239/239_frontp
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Nutrition Assessment and Monitoring and Evaluation Terminology

FOOD/NUTRITION-RELATED HISTORY ❑ Liquid dairy product estimated oral FH-1.2.1.1.1.6 14017

❑ Prepared food intake FH-1.2.2.2.8 14210 Parenteral nutrition intake (1.3.2)

❑ Meal/snack pattern FH-1.2.2.3 10014 ❑ Parenteral nutrition formula/solution FH-1.3.2.1 10025

Vitamin intake (1.6.1) ❑ Boron estimated intake in 24 hours (17) 10105

❑ Waist circumference AD-1.1.7.14 12087 ❑ Fecal calprotectin BD-1.4.17 11245

Metabolic rate profile (1.8) ❑ Lysine:arginine ratio BD-1.11.29 11173

❑ Albumin BD-1.11.1 10337 ❑ Tissue transglutaminase antibodies (IgG) BD-1.11.57 11269

❑ Transferrin BD-1.11.3 10339 ❑ Endomysial antibodies BD-1.11.59 11271

❑ Phenylalanine, plasma BD-1.11.4 10340 ❑ Carbohydrate deficient transferrin BD-1.11.60 10847

❑ Tyrosine, plasma BD-1.11.5 10341 Urine profile (1.12)

Carbohydrate metabolism profile (1.14) ❑ Rickets PD-1.1.3.5 11668

❑ Bradypnea PD-1.1.4.3 11672 ❑ Edema of thigh PD-1.1.6.12 11723

❑ Polyuria PD-1.1.9.6 11777 ❑ Cheilitis PD-1.1.13.9 11828

❑ Flat affect PD-1.1.16.14 11873 ❑ Perifollicular hemorrhages PD-1.1.17.45 12127

❑ Blood pressure, systolic PD-1.1.21.1 14206 (specify) __________________________ P or F

ETIOLOGY CATEGORY (EY) ❑ Thiamin (6) 10449

Categories to communicate the type of nutrition ❑ Riboflavin (7) 10450

Psychological etiology EY-1.6 14572 Estimated mineral needs (4.2)

Estimated fat needs (2.1) ❑ Copper (11) 10471

Food/Nutrition-Related History Domain – Food and Nutrient Intake

Energy Intake (FH-1.1.1)

Nutrition Assessment and Monitoring and Evaluation

Estimated energy intake

Measured energy intake

Criteria for Evaluation

Sample Nutrition Assessment and Monitoring and Evaluation Documentation

February 20, 2019.

Food/Nutrition-Related History Domain – Food and Beverage Intake

Fluid Intake (FH-1.2.1)

Nutrition Assessment and Monitoring and Evaluation

Estimated fluid intake

Water estimated oral intake in 24 hours (mL/day)—defined as the approximate intake in

Sugar sweetened beverage estimated oral intake in 24 hours (mL/day)—defined as the

Liquid dairy product estimated oral intake in 24 hours (mL/day)—defined as the

Caffeinated beverage estimated oral intake in 24 hours (mL/day)—defined as the

Nutritionally complete liquid supplement estimated oral intake in 24 hours (mL/day)—

Liquid meal replacement estimated oral intake in 24 hours (mL/day)—defined as the

Measured fluid intake

Nutritionally complete liquid supplement measured oral intake in 24 hours (mL/day)—defined as

Sample Nutrition Assessment and Monitoring and Evaluation Documentation

per day, exceeding goal and meeting recommended intake.

Food/Nutrition-Related History Domain – Food and Beverage Intake

Food Intake (FH-1.2.2)

Nutrition Assessment and Monitoring and Evaluation

Grains servings estimated in 24 hours (number/day)

Measured amount of food

Processed food intake (present/absent)—defined as oral intake of commercial convenience foods

Estimated meal and snack pattern

Number of meals estimated in 24 hours (number/day)

Measured meal and snack pattern

Diet (food and beverages) Quality Index

Criteria for Evaluation

1. Reference Standard: Not applicable

Sample Nutrition Assessment and Monitoring and Evaluation Documentation

BREASTMILK*/INFANT FORMULA INTAKE

Food/Nutrition-Related History Domain – Food and Beverage Intake