Nutrition Intervention includes identifying an individualized Nutrition Prescription which stipulates the patient’s optimal nutrition intake and physical activity level. It also includes the method used by the dietitian to assist the patient in moving toward or achieving the Nutrition Prescription.
The Nutrition Prescription is necessary to frame key recommendations and to communicate nutrition information to other members of the health-care team, including other dietitians the patient may see on follow-up consultations. In communicating with the patient and their family, practitioners should avoid using specialized language or technical terminology about nutrient and energy targets. The Nutrition Prescription needs to reflect the Comparative Standards in the NCP Step 1. Remember to consider individual- and family-centered short- and long-term goals.
Select the Nutrition Intervention domain below to go directly to that section.
- Identify Nutrition Intervention Goals (CG)
- Nutrition Prescription (NP)
- Food and/or Nutrient Delivery (ND)
- Nutrition Education (E)
- Nutrition Counseling (C)
- Coordination of Nutrition Care by a Nutrition Professional (RC)
| NUTRITION INTERVENTION PLANNING |
| IDENTIFY NUTRITION INTERVENTION GOAL(S) (CG) |
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Identify goal description (CG-1.1) Identify goal target value (CG-1.2) Identify goal timeframe (CG-1.3) Identify goal subject (CG-1.4) Identify goal setter (CG-1.5) |
| NUTRITION PRESCRIPTION (NP) |
| Sample related to Cystic Fibrosis |
| Nutrition Prescription (NP-1.1) The patient’s individual recommended dietary intake of energy and/or selected foods or nutrients based on current reference standards and dietary guidelines and the patient/client’s health and nutrition diagnosis (cystic fibrosis). · A target energy level; short term for weight gain (as required) and long term for weight maintenance · Specific macronutrient targets; protein, fat and carbohydrate (if CFRD) · Specific micronutrient targets, vitamins - A, D, E K; minerals - iron, calcium · Target servings per food group category · A reduction in alcohol consumption to meet the national dietary guidelines · A meal plan, if that is deemed helpful · A target physical activity level |
| AIMS OF MEDICAL NUTRITION THERAPY |
| Cystic Fibrosis · Achieve a balance between food intake, medication, metabolic requirements and energy expenditure to attain and maintain optimum weight · Create an energy balance that maintains current weight or causes weight gain. Consider energy in (dietary intake) and energy out (physical activity, coughing, breathing) · Achieve/maintain healthy eating behaviors consistent with national dietary guidelines · Achieve/maintain normalized eating behaviors and attitudes to food and weight · Achieve/maintain improvements in CF-related outcomes including: - Capacity for physical activity - Psychosocial and emotional health - Biochemical parameters - Age-appropriate healthy body weight · Achieve a balance between food intake, medication, metabolic requirements and energy expenditure to attain optimum weight · Regular monitoring of anthropometric measurements to confirm normal growth in infants and children · Emplace self-management strategies that enable responsibility for weight management, physical activity, medication |
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NUTRITION INTERVENTION IMPLEMENTATION |
| FOOD AND/OR NUTRIENT DELIVERY (ND) |
| Individualized approach for food /nutrient provision. MEALS AND SNACKS (ND-1) Regular eating episode (meal); food served between regular meals (snack). The “Meals and Snacks” Intervention is used only if the dietitian or dietetics department is providing or prescribing foods or supplements. This intervention is used if the patient is in a program, such as an inpatient facility that provides meals, or if they are receiving vitamin/mineral supplements, meal replacements or meals at home. General/healthful diet (ND-1.1), following the national dietary guideline recommendations Modify composition of meals/snacks (ND-1.2) · Texture-modified diet - Easy to chew diet · Energy-modified diet, if in institutional setting or at home receiving meals - Increased energy diet · Protein-modified diet - Consistent protein diet - Increased protein diet - Amino acid modified diet, research suggests that muscle mass and function can be better maintained with an increased intake of essential amino acids, thereby reducing mortaility and improving QOL(4) · Carbohydrate-modified diet, CFRD · Fat-modified diet - Increased fat diet - Omega 3 fatty acid modified diet - Increased omega 3 fatty acid diet - Increased alphalinolenic acid diet - Increased eicosapentaenoic acid diet - Increased docosahexaenoic acid - Decreased omega 3 fatty acid diet - Decreased alphalinolenic acid diet - Decreased eicosapentaenoic acid diet - Decreased docosahexaenoic acid diet - Medium chain triglyceride modified diet - Increased medium chain triglyceride diet - Decreased medium chain triglyceride 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 · Diets modified for specific foods or ingredients · Vitamin-modified diet - Vitamin A modified diet - Increased vitamin A diet - Vitamin D modified diet - Increased vitamin D diet - Vitamin E modified diet - Increased vitamin E diet - Vitamin K modified diet - Increased vitamin K diet · Mineral-modified diet - Calcium modified diet - Increased calcium diet - Iron modified diet - Increased iron diet - Sodium modified diet - Increased sodium diet Modify schedule of food/fluids (ND-1.3) · Modify schedule of intake to limit fasting Other (specify) (ND-1.5) ENTERAL AND PARENTERAL NUTRITION MANAGEMENT (ND-2) Nutrition provided through the GI tract via tube, catheter, or stoma (enteral) or intravenously, centrally or peripherally (parenteral). Enteral Nutrition Management (ND-2.1), enteral feeding should be considered if age-appropriate rates of growth or nutritional status are not achieved despite focus on energy and nutrient intake from oral diet and optimum PERT(3) Nutrition provided through the GI tract. · Modify concentration of enteral nutrition · Modify rate of enteral nutrition · Modify volume of enteral nutrition · Modify schedule of enteral nutrition · Modify route of enteral nutrition · Insert enteral feeding tube · Enteral nutrition site care · Feeding tube flush Parenteral Nutrition/IV Fluids Management (ND-2.2) Nutrition and fluids provided intravenously. · Modify composition of parenteral nutrition · Modify concentration of parenteral nutrition · Modify rate of parenteral nutrition · Modify volume of parenteral nutrition · Modify schedule of parenteral nutrition · Modify route of parenteral nutrition · Parenteral nutrition site care · IV fluid delivery NUTRITION SUPPLEMENT THERAPY (ND-3) Medical food supplement therapy (ND-3.1) · Commercial beverage medical food supplement therapy, meal replacements, oral nutrition support · Commercial food medical food supplement therapy, pre-packaged, high-energy meals or pre-packaged, high-energy meals · Modified beverage · Modified food · Purpose Vitamin and mineral supplement therapy (ND-3.2) Supplemental vitamins or minerals. · May need vitamin/mineral supplement · Multivitamin mineral supplement therapy · Multitrace element supplement therapy · Vitamin supplement therapy - A - D - E - K · Mineral supplement therapy - Calcium - Chloride - Iron - Magnesium - Sodium - Zinc Bioactive Constituent Management (ND-3.3) Addition or change in provision of bioactive substances · Psyllium management · Alcohol management · Caffeine management MANAGE FEEDING ENVIRONMENT (ND-5) Adjustment of the factors where food is served that impact food consumption. Feeding environment lighting management (ND-5.1) Feeding environment odor management (ND-5.2) Feeding environment distraction management (ND-5.3) Feeding environment table height management (ND-5.4) Feeding environment table service management (ND-5.5) Feeding environment room temperature management (ND-5.6) Feeding environment meal service management (ND-5.7) Feeding environment meal location management (ND-5.8) NUTRITION RELATED MEDICATION MANAGEMENT (ND-6) Modification of a medication or complementary/alternative medicine to optimize patient/client nutritional or health status. Management of nutrition related prescription medication (ND-6.1) Management of nutrition related over the counter (OTC) medication (ND-6.2) Management of nutrition related complementary/alternative medicine (ND-6.3) |
| NUTRITION EDUCATION (E) |
| Formal process to instruct or train patients/clients in a skill or to impart knowledge to help patients/clients voluntarily manage or modify food, nutrition and physical activity choices and behavior to maintain or improve health. NUTRITION EDUCATION CONTENT (E-1) Instruction or training intended to lead to nutrition-related knowledge. Content related nutrition education (E-1.1) Defined as instruction intended to lead to nutrition-related knowledge. · Base Content related nutrition education on patient's preferences, Food and Nutrition Related History (FH) and estimates of nutrient needs - Base energy requirements on resting metabolic rate (RMR). Measure RMR using indirect calorimetry where possible - When indirect calorimetry is unavailable, apply the Mifflin-St Jeor equation using actual weight; or - Estimate energy requirements according to national expert guidelines - Apply the appropriate physical activity factor to estimate total energy needs - Energy-deficit recommendations vary · Meet normal nutrition requirements for key nutrients · Meeting normal nutrition requirements for key minerals (calcium, iron, iodine) and vitamins (B-group, A and D) · Discuss protein requirements of 15 to 20 percent of total energy intake(3) · High-energy diet is achieved by: - Increasing fat consumption - Increasing frequency of consuming energy-dense foods · Increase nutrient-dense foods, fruits, vegetables, wholegrains (cereals) and low-fat dairy products · Strategies are selected using clinical judgment on a case-by-case basis - It is advisable to use a combination of strategies to bring about energy increases · Improving access to healthy food choices - Visible storage of healthier foods · Strategies to increase sodium - Include high-salt processed snacks, foods and meals including takeout - Add salt in cooking and at the table - Avoid selecting products labeled "low salt", "reduced sodium" or "no added salt" - Add processed meats, poultry and fish · Changing food-related behaviors - Serving size, mindful eating, dedicated mealtimes, snacks · Establishing consistent meal patterns - Distribution of energy intake throughout the day in six eating occasions (weekday versus weekend eating) · Alcohol within national guidelines; for example, in the United States, for men no more than two standard drinks per day and for women no more than one standard drink per day · Increases in physical activity need to be approved by medical practitioners involved in patient care Education on nutrition's influence on health (E-1.2) · Explain the diet-disease relationship · Explain health consequences of weight loss · Explain health consequences of dehydration · Explain benefits of cystic fibrosis management · Provided information about approaches to weight gain · Explain energy, protein, sodium and other nutrients in favorite foods and alternative options · Explain use and effectiveness of self-monitoring tools Physical activity guidance (E-1.3) Defined as instruction intended to lead to physical activity–related knowledge and change physical activity related knowledge and change. · Discuss importance of maintaining physical activity - Provide information on physical-activity guidelines with approval from family and other practitioners involved NUTRITION EDUCATION APPLICATION (E-2) Instruction or training leading to nutrition-related result interpretation or skills. Nutrition related laboratory result interpretation education (E-2.1) Defined as instruction or training leading to nutrition-related laboratory result interpretation. Nutrition related skill education (E-2.2) Defined as instruction or training leading to nutrition-related skill development. · Instruction on: - Evaluating diet history and daily activity logs - Assessing food group servings compared to recommended plan - Monitoring and evaluation of weight - Evaluating physical activity and ways to increase intensity physical activity - Procedures to modify recipes to - Higher-calorie versions as required for weight reduction - High sodium content - Shopping, food preparation and cooking - Electronic tools, such as phone apps, to aid in decision making Technical nutrition education (E-2.3) Defined as instruction or training leading to nutrition-related result interpretation or skills. · Instruction on: - Heart-rate goals and physical activity - Strategies to increase physical activity intensity and duration within patient's physical restrictions |
| NUTRITION COUNSELING (C) |
| A supportive process, characterized by a collaborative counselor–patient/client relationship to establish food, nutrition and physical activity priorities, goals, and individualized action plans that acknowledge and foster responsibility for self-care to treat an existing condition and promote health. Using the terminology for counseling intervention, select both the Theoretical Basis/Approach and Strategies. Refer to the Tool Kit for examples of counseling theories and strategies. NUTRITION COUNSELING THEORETICAL BASIS/APPROACH (C-1) The theories or models used to design and implement an intervention. No single behavioral approach is better than another in the treatment of cystic fibrosis. Using various approaches in combination is most likely to support long-term management of cystic fibrosis. In any consultation the dietitian can apply one or more of the theoretical approaches depending on their assessment of the individual’s needs.(4) Nutrition counseling based on cognitive behavioral theory approach (C-1.1) · The goal is behavior modification - Antecedents to undereating or physical inactivity behaviors, consequences of behaviors - Develop thoughts and behaviors that lead to increased energy and protein intake and increased physical activity Nutrition counseling based on health belief model theory (C-1.2) · Strengthen understanding of personal susceptibility to co-morbidities and the potential impact on quality of life · Strengthen perception of the benefits of weight gain/management on quality of life · Identify cues to action · Enhance self-efficacy in making changes that will lead to weight reduction sufficient to produce health benefits Nutrition counseling based on social learning theory approach (C-1.3) · Explore interaction of the personal characteristics, environment, and actual behavior being changed such as analytical ability, with restaurant menus and otherwise making more energy/protein-dense food choices · Strengthen belief that choosing foods higher in energy will influence outcomes important to them · Identify role models who have been successful in similar situations · Plan reinforcement for desired behaviors or negative reinforcement for behaviors being eliminated (self rewards for reaching small behavior or weight goals) Nutrition counseling based on transtheoretical model/stages of change approach (C-1.4) Determine stage of change prior to initiating any change talk or goal setting · Precontemplation and contemplation - Encourage acceptance of the need to make lifestyle changes for high-energy, high-protein diet - Encourage acceptance of the need to increase physical activity and confidence in ability to make these changes in earlier stages of change · Preparation - Reinforce established changes already made · Action - Engaging the patient in skill training · Maintenance - Identify social support and problem solving NUTRITION COUNSELING STRATEGIES (C-2) Nutrition counseling draws on various theoretical approaches in contemporary psychology. Certain counseling strategies are closely linked to a particular perspective or theory; for example Problem solving is linked with Cognitive-behavioral theory. Others, like Motivational interviewing, can be used with all approaches. See the matrix included in the Tool Kit, Counseling Strategies, that shows which of the following counseling strategies are most commonly used with the various theoretical approaches. Nutrition counseling based on motivational interviewing strategy (C-2.1) · Address and resolve ambivalence regarding the way in which the patient perceives the benefits of making changes to gain/maintain weight · Address self-efficacy and resolve ambivalence regarding the way in which the patient perceives their ability to make and sustain changes · Clarify the impact of firstly gaining weight and secondly continuing to lose weight and how it may affect aspects of life that the patient values most · After receiving permission from the patient, offer guidance in identifying solutions to overcoming barriers to successful weight gain Nutrition counseling based on goal setting strategy (C-2.2) · Patients goals for diet and behavior change need to be realistic · Identify specific goals around how and when the changes will start · Avoid temptation to set goals that are too large or to set too many goals at once Nutrition counseling based on self monitoring strategy (C-2.3) · Logs of dietary intake (complete, or specific to one food category), create awareness and support changes · Logs of environment and emotions can identify triggers leading to positive and negative food choices · Logs of physical activity used to reinforce self-efficacy and identify opportunities for increasing physical activity Nutrition counseling based on problem solving strategy (C-2.4) · Brainstorm possible approaches for increasing high-energy and high-protein food choices · Identify ways of increasing frequency, duration and intensity of physical activity · Weigh the pros and cons of various approaches. Select one approach to try first · Establish how and when patient will measure his or her success. Adjust strategy if necessary Nutrition counseling based on social support strategy (C-2.5) · Identify sources of support, such as family, friendship groups and co-workers · Identify the type of support most helpful. Some prefer verbal support and acknowledgment, others prefer actions such as not offering energy-dense foods at social gatherings · Role-play ways to ask for support Nutrition counseling based on stress management strategy (C-2.6) · If stress is leading to the consumption of less desirable foods, explore ways to relieve stress, such as meditation/progressive muscle relaxation · Facilitate development of time-management skills · Promote seven to eight hours of sleep per day Nutrition counseling based on stimulus control strategy (C-2.7) · Eliminate or reduce triggers or cues leading to overeating or making poor food selections · Increase triggers or cues/situations leading to increased physical activity · Avoid shopping for food when hungry · Remove unhealthy choices from the home or desk Nutrition counseling based on cognitive restructuring strategy (C-2.8) · Teach patient ways to change self-talk. This may involve focusing on successes rather than failures Nutrition counseling based on relapse prevention strategy (C-2.9) · Identify high-risk situations for making low energy/protein choices or selecting small servings · Determine the skills required to support better food choices and how to acquire those skills · Identify situations where physical activity is likely to be overlooked and what can be done to ensure that physical activity occurs; for example the patient could use exercise strategies as a social activity Nutrition counseling based on rewards/contingency management strategy (C-2.10) · Select non-food rewards such as new clothes or entertainment, to celebrate small behavior changes or small weight-loss goals · Establish a system to ensure that rewards are truly contingent on achieving specified goals |
| COORDINATION OF NUTRITION CARE BY A NUTRITION PROFESSIONAL (RC) |
| Consultation with, referral to, or coordination of nutrition care with other providers, institutions, or agencies that can assist in treating or managing nutrition-related problems. COLLABORATION AND REFERRAL TO NUTRITION CARE (RC-1) Facilitating services with other professionals, institutions, or agencies during nutrition care. Team meeting involving nutrition professional (RC-1.1) · Consider the benefits of multidisciplinary management of cystic fibrosis Referral to nutrition professional to another nutrition professional with different expertise (RC-1.2) · A general-practice dietitian may choose to refer on to a specialized dietitian Collaboration by nutrition professional with other providers (RC-1.4) · Interdisciplinary involvement—consider referral to family doctor/psychologist/physical therapist Referral by nutrition professional to community agencies/programs (RC-1.6) · Identify local providers and clinical and community-based programs · Identify peer-support groups, cystic fibrosis support groups, walking groups, exercise classes DISCHARGE AND TRANSFER OF NUTRITION CARE TO NEW SETTING OR PROVIDER (RC-2) Discharge and transfer of nutrition care to other providers (RC-2.1) Discharge and transfer of nutrition care to community agencies and programs (RC-2.2) Discharge and transfer of nutrition care from nutrition professional to another nutrition professional (RC-2.3) |
References:
1. Academy of Nutrition and Dietetics. Nutrition Terminology Reference Manual (eNCPT): Dietetics Language for Nutrition Care. 2023. Accessed 2 May 2024. Available from: https://www.ncpro.org/
2. Academy of Nutrition and Dietetics. Nutrition Terminology Reference Manual (eNCPT): Dietetics Language for Nutrition Care. NCP Step 3: Nutrition Intervention. 2020; Accessed 21 January 2020. Available from: https://www.ncpro.org/pubs/2020-encpt-en/page-055
3. The Thoracic Society, Nutrition Guidelines for Cystic Fibrosis in Australia and New Zealand; 2017. Accessed: 12 February 2020. Available from: https://www.thoracic.org.au/documents/item/1045
4. Academy of Nutrition and Dietetics. Nutrition Terminology Reference Manual (eNCPT): Dietetics Language for Nutrition Care. Nutrition Counseling - Nutrition Counseling Based on Rewards and Contingency Management Strategy (C-2.10). Chicago, USA 2019. Accessed 19 December 2019. Available from https://www.ncpro.org/pubs/encpt-en/codeC-2-RCM
Updated May 02, 2024