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Public Health -Community Nutrition-Weight Management Nutrition Diagnosis Mind Map


Step 2 Nutrition Diagnosis

After taking the Nutrition Assessment, the dietitian formulates some preliminary Nutrition Diagnoses, and considers which Nutrition Interventions to propose for the patient/client’s consideration. The initial Nutrition Diagnoses can be modified as the patient supplies more information and the true underlying causes or etiologies of their condition become clear. The dietitian’s final understanding of the nutrition problems will be outlined in the Nutritional Diagnosis Statement, consisting of the Problem/Etiology/Signs and Symptoms (PES) documented in the nutrition progress note or chart entry. The dietitian may have identified several possible Nutrition Diagnoses during the course of the consultation. However, if the patient is unwilling to address a particular Nutrition Diagnosis during counseling, the practitioner may discuss another. 

Not all Nutrition Diagnoses are of equal importance. Examples of criteria dietitians might use to select the most important Diagnosis are included in the Introduction chapter. If the dietitian identifies other nutrition problems with lower priority (suboptimal intake of nutrients of concern such as calcium, iron, iodine, or excess intake of nutrients of concern such as sodium or saturated fat) these should be included in the progress notes as items to be addressed in subsequent consultations. 

Hint — use the eNCPT Diagnosis Reference Sheets at ncrpro.org to identify the Signs and Symptoms (Potential Indicators) necessary to document that a Nutrition Diagnosis applies to your patient.

Explanatory additions to the NCP Mind Map are in blue font. NCP terms and codes are in black font.
 

INTAKE NUTRITION DIAGNOSES (NI)

ENERGY BALANCE NUTRITION DIAGNOSES (NI-1)


Excessive energy intake (NI-1.3)
·   Compare energy intake to either estimated energy requirements based on basal rates and physical activity levels OR to nutrition prescription for weight loss

Predicted excessive energy intake (NI-1.5)


ORAL OR NUTRITION SUPPORT INTAKE NUTRITION DIAGNOSES (NI-2)

Excessive oral intake (NI-2.2)


FLUID INTAKE NUTRITION DIAGNOSES (NI-3)

Inadequate fluid intake (NI-3.1)
Excessive fluid intake (NI-3.2)


BIOACTIVE CONSTITUENT INTAKE NUTRITION DIAGNOSES (NI-4)

Excessive alcohol intake (NI-4.3)

 

NUTRIENT INTAKE NUTRITION DIAGNOSES (NI-5)
Fat and cholesterol intake nutrition diagnoses (NI-5.5)
·   Excessive fat intake (NI-5.5.2)
 

Protein intake nutrition diagnoses (NI-5.6)
·   Excessive protein intake (NI-5.6.2)
 

Carbohydrate and fiber intake nutrition diagnoses (NI-5.8)
·   Inadequate carbohydrate intake (NI-5.8.1)
·   Excessive carbohydrate intake (NI-5.8.2)
·   Inadequate fiber intake (NI-5.8.5), even though energy intake may be high, fiber intake may be low
 

Vitamin intake nutrition diagnoses (NI-5.9)
·   Inadequate vitamin intake (specify) (NI-5.9.1), not directly associated with obesity but energy-dense foods may be of low nutrient (vitamin) density
 

Mineral intake nutrition diagnoses (NI-5.10)
·   Inadequate mineral intake (specify) (NI-5.10.1), not directly associated with obesity but energy-dense foods may be of low nutrient (mineral) density
    –   Calcium (NI-5.10.1.1), obesity associated with low calcium intake(3)
CLINICAL NUTRITION DIAGNOSES (NC)

BIOCHEMICAL NUTRITION DIAGNOSES (NC-2)
Altered Nutrition Related Laboratory Values (specify) (NC-2.2) 
NHanes population data for related co-morbidities (cardiovascular disease)

 

WEIGHT NUTRITION DIAGNOSES (NC-3)
Overweight/obesity (NC-3.3)
·   Overweight, adult or pediatric (NC-3.3.1)
·   Obese, adult or pediatric (NC-3.3.2)
·   Obese, Class I (NC-3.3.2.2)
·   Obese, Class II (NC-3.3.2.3)
·   Obese, Class III (NC-3.3.2.4)

Unintended weight gain (NC-3.4), involuntary
BEHAVIORAL-ENVIRONMENTAL NUTRITION DIAGNOSES (NB)

KNOWLEDGE AND BELIEFS NUTRITION DIAGNOSES (NB-1)
Food and nutrition related knowledge deficit (NB-1.1), limited food and nutrition related knowledge
·   Lack of knowledge about energy-dense foods, estimated energy needs, benefits of healthy weight and physical activity
 

Belief finding that hinders food and/or nutrition behavior change (use with caution) (NB-1.2)
·   Misunderstanding of the energy balance principles such as the amount of activity required for weight control
 

Not ready for nutrition related behavior change (NB-1.3)
·   Resistance to making changes and concerns about the impact of lifestyle changes on family members 
 

Limited adherence to nutrition related recommendations (NB-1.6)
·   Differences between intake and Dietary Guidelines
 

Limited food acceptance (NB-1.7)
 


PHYSICAL ACTIVITY AND FUNCTION NUTRITION DIAGNOSES (NB-2)
Physical inactivity (NB-2.1)
·   Sedentary lifestyle, low Physical Activity Levels (PAL)


FOOD SAFETY AND ACCESS NUTRITION DIAGNOSES (NB-3)
Food insecurity (NB-3.2)
·   Limited access to healthy, low-energy food and beverages

 


Example PES Statements for Adult Weight Management(1,2)

 

DOMAIN TERMS PES
INTAKE NUTRITION DIAGNOSES (NI) ENERGY BALANCE NUTRITION DIAGNOSES (NI-1)
Excessive energy intake (NI-1.3)

Excessive energy intake (NI-1.3) (P)


related to few community resources or programs focusing on supporting attaining and maintaining healthy weight


as evidenced by community needs assessment indicating interest weight management classes and state NHANES data indicating energy intake ~300 kcal above reference values (S)
CLINICAL NUTRITION DIAGNOSES (NC) WEIGHT NUTRITION DIAGNOSES (NC-3)
Overweight/obesity (NC-3.3)

Overweight/obesity (NC-3.3) (P)


related to limited access to healthy foods (food desert) and low walkability (E)


as evidenced by census tract BMI of 31 kg/m2 and City Health Dashboard rating of 75% of residents having limited access to food versus national average of 69.1% and a walkability score of 42.8 vs national average of 62.5 (S)
BEHAVIORAL-ENVIRONMENTAL NUTRITION DIAGNOSES (NB)
KNOWLEDGE AND BELIEFS NUTRITION DIAGNOSES (NB-1)
 


Limited adherence to nutrition related recommendations (NB-1.6) (P)



related to limited access to fruits and vegetables (E)


as evidenced by mREI score of 4 (poor access), fruit and vegetable intake less than Dietary Guidelines CDC data reporting 45% of adults have less than 1 serving of fruit and 23% report less than 1 serving of vegetables per day (S)
FOOD SAFETY AND ACCESS NUTRITION DIAGNOSES (NB-3)

Limited Access to nutrition related supplies (NB-1.3) (P)


related to few grocery stores or retail stores offering healthy food (E)


as evidenced by City Health Dashboard rating of 75% of residents having limited access to food versus national average of 69.1%  and modified retail food environment index (mREI)of 4 (poor access) (S)

 


References
1.   Academy of Nutrition and Dietetics. Nutrition Terminology Reference Manual (eNCPT): Dietetics Language for Nutrition Care. 2023. Accessed 23 May 2024. Available from: https://www.ncpro.org/. 
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3.  Evidence Analysis Library. AWM: High Calcium (2006). Accessed 14 August 2017. Available at: https://www.andeal.org/topic.cfm?cat=2890&evidence_summary_id=250142&highlight=calcium&home=1.
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Updated May 23, 2024

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