The “problem” is the diagnostic label that describes the patient’s response to a nutrition-related practice or habit. The approved terminology supports identification of the three components of the nutrition diagnosis: problem, etiology, and signs and symptoms (PES). Confirming the appropriate nutrition diagnosis is critical because it is the pathway to appropriate nutrition intervention and evaluation.Īs earlier noted, the IDNT has terms for stating nutrition diagnoses related to food and/or nutrient intake, clinical diagnoses, and behavioral/environmental issues. A nutrition diagnosis can change over time as the patient and/or his/her risk factors for disease progression or recurrence changes. A nutrition diagnosis identifies an aberrant dietary practice or habit that is contributory to a patient’s medical diagnosis. A medical diagnosis does not change until the disease has resolved. A medical diagnosis, usually made by a MD or other advanced practice medical provider, identifies a diseased organ or body system or an aberrant metabolic process that can be treated and/or prevented. A nutrition diagnosis is not a medical diagnosis. The purpose of the nutrition diagnosis is to link the findings from diet assessment with the manifestations or exacerbation of a disease or medical condition.
The second step of the NCP is the nutrition diagnosis: the identification and labeling of a nutrition-related problem that can be treated independently. In addition to dietary assessment, the patient’s past medical history, surgical history, social history, and readiness to change are assessed. FFQs and food screeners may be appropriate in identifying patients whose medical and nutritional needs are more complex and who would benefit from the involvement of a RDN to obtain and interpret their dietary intake and nutritional risk factors. While there are an abundance of validated FFQs available for use, their accuracy in assessing the intake of specific nutrients and dietary habits has been questioned. The RDN may collect dietary data from the patient via detailed, multiple-day diet records, a 24-h dietary recall (asking the patient to recall everything he/she ate or drank in the last 24 h), a brief diet history (querying about usual dietary patterns, food frequency, and food propensity), or a food screener or food frequency questionnaire (FFQ). The RDN assesses the patient’s past and present food intake, factors that influence food intake (such as food security, access to cooking and food storage facilities, transportation, dentition, and cultural and religious observances), and food and nutrition knowledge.
The patient interview may be the best source of information related to the patient’s food and nutrition history.
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