Nutrition Interventions and the Nutrition

Prescription
the The Nutrition Intervention, sometimes called the “nutrition prescription,” is the third
and perhaps most crucial step in the Nutrition Care Process (NCP). The intervention is
where the RDN aims to make a clinical impact in the patient’s health status and outcome.

This blog will cover:

 The Definition of a Nutrition Intervention
 What the Dietitian Needs to Know About the Nutrition Intervention
 The Intervention Domains, Classes, and Subclasses
 Nutrition Intervention Examples
As a review, these are the 4 Steps of the Nutrition Care Process:
(click on any of the links below to learn more!)
Nutrition Assessment
A Guide to the Nutrition-Focused Physical Exam
Nutrition Diagnosis and PES Statements
NUTRITION INTERVENTION
Nutrition Monitoring/Evaluation

What Is The Nutrition Intervention?

The nutrition intervention is the third step in the Nutrition Care Process and it
involves both planning and implementing an intervention to improve the
patient’s nutritional health outcome, specifically targeted at the nutrition
diagnosis.
According to the Academy of Nutrition and Dietetics (2014): ”The purpose of a
nutrition intervention is to resolve or improve the nutrition diagnosis or
nutrition problem by provision of advice, education, or delivery of the food
component of a specific diet or meal plan tailored to the patient/client’s*
needs.”

What The Dietitian Needs To Know

 Interventions should be specific - stating what, where, when, and how.

 The goal of the intervention should be “fixing" the nutrition diagnosis,
addressing the root cause (or etiology) of the nutrition diagnosis, AND
reducing the signs/symptoms. These should already be identified listed in the
PES statement, which you wrote in step 2 of the Nutrition Care Process:
Nutrition Diagnosis.
 The intervention is selected from Nutrition Care Process Terminology (NCPT),
which is broken down into Domains, Classes, and Subclasses. Using this
official NCPT terminology, you will write the “nutrition prescription” in your
patient assessment/record. (Don’t worry - I have included several
examples below!)
 The intervention should specify the amount/duration/frequency of care. For
example, if the intervention is nutrition education in the outpatient setting, you
 might specific once per week for 8 weeks. If the intervention is a protein
supplement for wound healing, you might specify once per day for 30 days.
 Nutrition intervention strategies should be matched with the patient’s needs,
and it should be appropriate for the clinical setting.
 When you have selected the intervention, be sure to discuss it with the patient
and explain the reasoning. For example, if you are prescribing a supplement,
you want to let the patient know why and have their agreement to take it. You
will also inform the appropriate members of the patient’s care team.

Nutrition Intervention Domains and Classes

There are 4 domains to the nutrition intervention. Having said that, the first,
“Food and/or Nutrient Delivery” is the most commonly used and often the
most appropriate, especially in the clinical setting. *Note that you may use
more than one intervention if you believe that is the best course of action!

1. Food and/or Nutrient Delivery

This is the most commonly used domain for nutrition interventions, and it
entails an individual approach for providing food or nutrients to the patient.
There are 6 classes in this domain:
 Meals and Snacks
 Enteral and Parenteral Nutrition
 Nutrition Supplements
 Feeding Assistance
 Manage Feeding Environment
 Nutrition-Related Medication Management
*This domain is most often used in the clinical setting, such as in hospitals and
rehabilitation centers.

2. Nutrition Education
This is the process of instructing the patient with skills/knowledge to help
them voluntarily improve their food, activity, and lifestyle choices and
behaviors.

There are 2 classes in this domain:

 Nutrition Education - Content
 Nutrition Education - Application
*This domain is often used in the outpatient setting, where you have more time and
multiple sessions to education and train your patient. You may also do nutrition
education before a patient is discharged from the hospital. For example, you may
educate a diabetes patient or a heart attack patient on dietary patterns to follow
before they go home.

3. Nutrition Counseling
This domain involves a collaborative nutrition counselor-patient relationship
where priorities, goals, and action plans for diet and lifestyle change are put in
place. The emphasis is on goal setting and behavior modification. Note how
this differentiates from simply educating the patient. Both counseling and
education are often necessary for nutrition-related behavior change.

There are 2 classes:

 Theoretical basis/approach
 Strategies
*Like Nutrition Education, Nutrition Counseling is often used in the outpatient setting
as well community settings, where you have more time and multiple follow up
appointments with your patient.

4. Coordination of Nutrition Care

When additional expertise is required as part of the patient’s care team in
order to address the nutrition diagnosis, an intervention from this domain may
be used. Sometimes, such as in the case of a suspected eating disorder, help
from other healthcare professionals or institutions may be needed.
There are 2 classes:
 Collaboration and referral of nutrition care
 Discharge and transfer of nutrition care to a new setting or provider
Examples of Nutrition Interventions

Since “Food and/or Nutrient Delivery” is the most commonly used domain,
let’s look at some examples of interventions for each of the classes within it!

(1) Meals and Snacks

Examples:
 Modify composition of meals/snacks: Texture-modified diet: Pureed diet (ND-
1.2.1.3)
 Modify composition of meals/snacks: Energy-modified diet: Decreased energy
diet (ND-1.2.2.2)
 Modify composition of meals/snacks: Fat-modified diet: decreased fat diet
(ND-1.2.5.2)
 Fluid modified diet: Fluid-restricted diet (ND-1.2.8.2)
(2) Enteral and Parenteral Nutrition
Examples:
 Enteral nutrition: Modify volume of enteral nutrition (ND-2.1.4)
 Enteral nutrition: Modify route of enteral nutrition (ND-2.1.6)
 Parenteral nutrition/IV fluids: Modify schedule of parenteral nutrition (ND-
2.2.5)
(3) Nutrition Supplement Therapy
Examples:
 Vitamin supplement therapy: B12 (ND-3.2.3)
 Mineral supplement therapy: Zinc (ND-3.2.4)
  Medical food supplement therapy: Commercial beverage (ND-3.1.1)
(4) Feeding Assistance
 Adaptive eating device (ND-4.1)
 Menu selection assistance (ND-4.5)
 Meal set up (ND-4.3)
(5) Manage Feeding Environment
 Table height (ND-5.4)
 Meal location (ND-5.8)
(6) Nutrition-Related Medication Management
 Over the counter (OTC) medication (ND-6.2)

Putting It All Together: The Nutrition Prescription!

At this point, you have conducted a thorough Nutrition Assessment, you have
determined a Nutrition Diagnosis and PES (Problem, Etiology, Signs/symptoms)
Statement, and you have selected the best Intervention(s) to solve the nutrition-
related diagnosis for your patient. In the clinical notes for your patient, you will now
tie it all together by writing a Nutrition Prescription.

The Nutrition Prescription is the product of the hard work you already did in
selecting the appropriate Nutrition Diagnosis, PES Statement, and Intervention(s) for
your patient. Your nutrition prescription is 1-2 sentences that provide a context in
which the intervention will now be implemented.

Nutrition Prescription refers to the patient/client’s individual recommended dietary

intake of energy and/or selected foods or nutrients based on current reference
standard and dietary guidelines and the patient/client’s health and nutrition
diagnosis. (Academy of Nutrition and Dietetics, 2015).

When writing your Nutrition Prescription, you will take into consideration the nutrition
diagnosis, the estimated energy and nutrition needs you calculated, the overall
assessment, and the intervention. It is essentially exactly what it sounds like: a
prescription for nutritional wellness based on everything you have learned about the
patient. It incorporates the official intervention terminology and puts it into a nice
packaged statement.

Take a look at these sample Nutrition Prescriptions based on some of the PES
Statement examples we provided in the Nutrition Diagnosis blog:

Example 1: Cancer Treatment

PES Statement:
Predicted suboptimal energy intake RT increased nutrient needs from chemotherapy
treatment, AEB current caloric intake at 60% of estimated needs with treatment.

Nutrition Prescription:
 Medical food supplement therapy: Commercial beverage (ND-3.1.1): Ensure
Vanilla per patient preference, 8 oz TID (3x per day) between meals to
provide an additional 750 kcal, 27 g protein per day.

*Note: We cannot cure cancer nor can we remove the chemotherapy treatment (the
etiology), but notice what we can do: We can increase the caloric intake to meet the
patient’s estimated energy requirements (EER) by adding supplemental nutrition.
When doing so, first discuss the intervention with your patient/patient’s family
members to let them know why you are adding it and to ask which flavors they might
prefer. There are puddings, ice creams, and shakes in various flavors and textures,
so part of your intervention is to determine which supplement meets the patient’s
needs and preferences. This example does not show you the exact calorie needs
determined in the assessment, but we can assume that 750 kcal makes up the
missing 40% of caloric needs as statement in the PES statement (putting total EER
at 1875 kcal/d). Hence, you are addressing the nutrition problem (P) by targeting
correction of the signs/symptoms (S).
Example 3: Type II Diabetes
PES Statement:
Excessive carbohydrate intake RT limited diet compliance and diagnosis of Type 2
Diabetes, AEB reported intake of 80% calories from carbohydrates, HbA1C 8.2%,
and blood sugar 240.

Nutrition Prescription:
 Energy-modified diet: Decreased carbohydrate diet (ND-1.2.4.3).
Carbohydrates to be decreased to 50% of total daily caloric intake, distributed
with no more than 40-60 g CHO per meal and 15-30 g for snacks.
 Nutrition Education: Recommended Modifications (E-1.5): consult with RD
before discharge to discuss carbohydrate intake reduction, carbohydrate
counting, and blood sugar monitoring education.