NCPT-Diagnosis

Definition
Energy intake that is less than energy expenditure, established reference standards, or recommendations based on physiological needs. 

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, 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.)

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:

• 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
• Food insecurity
• Limited access to nutrition related supplies (eg, artificial nutrition)
• 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

Definition
Energy intake that exceeds energy expenditure, established reference standards, or recommendations based on physiological needs.

Note: May not be appropriate nutrition diagnosis when weight gain is desired.

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:

• Belief finding that hinders food and/or nutrition behavior change
• Attitude finding that hinders food and/or nutrition behavior change  
• Food-and nutrition-related knowledge deficit concerning energy intake
• Food insecurity 
• 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
• Limited interest in reducing energy intake
• Limited adjustment for lifestyle changes and decreased metabolism (eg, aging) 
• Limited adjustment for restricted mobility due to recovery from injury, surgical procedure, other 
• Resolution of prior hypermetabolism without reduction in intake
• Limited food and nutrition related skill

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.

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 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

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.

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:

• 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

Definition
Oral food/beverage intake that is less than 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 the goal is weight loss, during end-of-life care, upon initiation of feeding, or during combined oral/EN/PN therapy. 

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.)

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:

• 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
• Food insecurity 
• Limited food acceptance
• Belief finding that hinders food and/or nutrition behavior change
• Attitude finding that hinders food and/or nutrition behavior change 
• Cultural practices that affect ability to access food
• Food- and nutrition-related knowledge deficit concerning appropriate oral food/beverage intake
• Psychological causes such as depression and disordered eating

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.

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:

• Belief finding that hinders food and/or nutrition behavior change
• Attitude finding that hinders food and/or nutrition behavior change
• Food- and nutrition-related knowledge deficit concerning appropriate oral food/beverage 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
• 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
• Psychological causes such as depression and disordered eating
• Unwilling or disinterested in reducing intake

Definition
Enteral 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). 

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.)

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:

• 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
• Limited food and nutrition related skill

Definition
Enteral infusion that provides more calories/kcal/kJ or nutrients compared to 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:

• 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
• Limited food and nutrition related skill

Definition
Enteral nutrition formula that varies from 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:

• Physiological causes, eg, improvement in 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 client or family does not desire nutrition support

Definition
Enteral nutrition provision that varies from 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:

• Physiological causes, eg, improvement in client status, allowing return to total or partial oral diet; changes in the course of disease resulting in changes in feeding
• Food and nutrition-related knowledge deficit concerning EN product provision
• End-of-life care if client or family does not desire nutrition support
• Limited food and nutrition related skill

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). 

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.)

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:

• 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
• Limited food and nutrition related skill

Definition
Parenteral infusion that provides more calories/kcal/kJ or nutrients compared to 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:

• 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 parenteral nutrition
• Limited food and nutrition related skill

Definition
Parenteral nutrition solution that varies from 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:

• Physiological causes, eg, improvement in 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 parenteral nutrition (PN) composition 
• End-of-life care if client or family does not desire nutrition support

Definition
Parenteral nutrition provision that varies from 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:

• Physiological causes, eg, improvement in 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 parenteral nutrition (PN) provision 
• End-of-life care, client or family does not desire nutrition support

Definition
Food (ie, solid, liquid) intake, representative of usual food intake, that is inconsistent with dietary reference intake standards (eg, Dietary Reference Intakes, reference intakes by country), national food guidelines (eg, U.S. Dietary Guidelines, country diet guidelines), diet quality index standards (eg, Healthy Eating Index) or as defined in the nutrition prescription..

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:

• Limited exposure to accurate nutrition-related information
• Cultural belief that contributes to unbalanced diet
• Limited cognitive ability, including learning differences
• Fatigue or side effect of treatment
• Food insecurity
• Perception that limited resources (eg, time, financial, or interpersonal) prevent balanced food intake 
• Food allergies, food intolerance
• Limited motivation and/or readiness to apply or support systems change
• Limited interest in learning information and/or applying skills
• Psychological causes such as depression 
• Limited social support in personal or broader social environment to support food choices
• Limited physical ability to obtain varied food consistently
• Biological differences in food preference
• Physiological causes, eg, pain, discomfort, functional issues in the GI tract, neurological changes
• Behavioral concerns, eg, caregiver issues, eating behavior that serves another purpose
• Belief finding that hinders food and/or nutrition behavior change
• Attitude finding that hinders food and/or nutrition behavior change

Definition
Lower intake of fluid-containing foods or substances compared to established reference standards or recommendations based on physiological needs. 

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. (Dietary Reference Intakes: Applications in Dietary Assessment. Institute of Medicine. Washington, D.C.: National Academies Press; 2000.)

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:

• 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
• Limited access to potable water, 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
• Limited food and nutrition related skill

Definition
Higher intake of fluid compared to 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:

• 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
• Psychological causes such as depression and disordered eating
• Limited food and nutrition related skill

Definition
Lower intake of bioactive substances compared to established reference standards or recommendations based on physiological needs. 

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, nutrition and dietetics practitioners 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. 

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:

• 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
• Limited food and nutrition related skill

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

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, nutrition and dietetics practitioners 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. 

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:

• 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 
• Alteration in gastrointestinal tract structure and/or function
• Lack of or limited access to appropriate foods, eg, inadequate markets with labeled food
• Limited food and nutrition related skill

Definition
Intake more than the suggested limits for alcohol.

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:

• Belief finding that hinders food and/or nutrition behavior change
• Attitude finding that hinders food and/or nutrition behavior change 
• Food and nutrition related knowledge deficit concerning appropriate alcohol intake
• Limited value for behavior change, competing values
• Alcohol addiction
• Limited food and nutrition related skill

Definition
Increased need for a specific nutrient compared to 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:

• 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

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

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.)

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:

• Physiological causes increasing nutrient needs due to catabolic illness, malabsorption
• Decreased ability to consume sufficient protein and/or energy
• Food insecurity 
• 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
• Psychological causes such as depression and disordered eating
• Limited food and nutrition related skill

Definition
Decreased need for a specific nutrient compared to 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:

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

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. 

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. (Dietary Reference Intakes: Applications in Dietary Assessment. Institute of Medicine. Washington, D.C: National Academies Press; 2000).

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:

• Alteration in gastrointestinal tract structure and/or function
• 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
• Psychological causes such as depression and disordered eating
• Limited food and nutrition related skill

Definition
Higher fat intake compared to 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:

• Food and nutrition related knowledge deficit concerning appropriate amount of dietary fat
• Belief finding that hinders food and/or nutrition behavior change 
• Attitude finding that hinders food and/or nutrition behavior change
• Food insecurity 
• Changes in taste and appetite or preference 
• Limited value for behavior change, competing values
• Physiological causes decreasing total fat needs or recommendations
• Limited food and nutrition related skill 

Definition
Intake of wrong type or quality of fats compared to 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:

• Food and nutrition related knowledge deficit concerning type of fat (eg, fats added to food, formula/breastmilk)
• Belief finding that hinders food and/or nutrition behavior change
• Attitude finding that hinders food and/or nutrition behavior change 
• Food insecurity
• Changes in taste and appetite or preference 
• Limited value for behavior change, competing values
• Physiological causes altering fatty acid needs or recommendations
• Limited food and nutrition related skill