Nutrition Diagnosis

Key Points:

• Nutrition Diagnosis is the second step in the Nutrition Care Process.
• Nutrition Diagnosis is communicated through a PES statement.
• The Nutrition Diagnosis can be resolved or improved by a nutrition intervention.

The purpose of Nutrition Diagnosis is to identify and label existing nutrition problems that the RDN is responsible for treating.

During nutrition diagnosis, the RDN identifies the nutrition problem, determines the etiology and lists the corresponding signs and symptoms using critical thinking skills to identify and prioritize problems that can most likely be resolved or improved by the RDN. They also evaluate if the etiology or “root cause” can be addressed with a nutrition intervention and select signs and symptoms from assessment data that will indicate if a problem is resolved or improved.

Nutrition diagnosis terminology is categorized into 3 domains:

• Intake consists of terms that describe nutrition problems related to intake of energy, nutrients, fluids, and bioactive substances through oral diet or nutrition support.
• Clinical includes nutrition diagnoses that capture nutrition problems related to medical or physical conditions.
• Behavioral-Environmental includes nutrition diagnoses that describe nutritional problems related to knowledge, attitudes/beliefs or physical environment.

The nutrition diagnosis is communicated as a structured sentence called a “PES Statement.” The PES statement includes three distinct parts—Problem (Nutrition Diagnosis Term, Etiology (root cause of the problem) and Signs and Symptoms (proof of the problem and evidence from nutrition assessment data)—and follows the format “[Problem] related to [Etiology] as evidenced by [Signs and Symptoms].”

Specific questions RDNs should ask when evaluating each section of the PES statements include:

For the problem, can the RDN resolve or improve the client’s nutrition diagnosis?
For the etiology, is this the most specific root cause that the RDN can resolve or improve with a nutrition intervention?
For the signs and symptoms, will measuring the signs and symptoms indicate if the problem is resolved or improved? Are the signs and symptoms specific?

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