Tuesday, March 17, 2015

Comparative Standards...why are they part of nutrition assessment?

The Nutrition Assessment Terminology includes a domain called Comparative Standards as an additional resource.  To understand why they are included we can go back to the description of nutrition assessment itself.
The Nutrition Assessment Component Summary identifies the following three activities in Nutrition Assessment:

  • Reviewing data collected for the purpose of identifying factors that influence nutritional status or health status
  • Clustering the data collected to identify a nutrition diagnosis (using the signs and symptoms on the nutrition diagnosis reference sheets as a guide)
  • Identifying which standard will be used to compare the data against to determine if it is "unusual", for example either higher than expected or lower than expected.

One type of critical thinking that takes place during the Nutrition Assessment step is to identify what standards should be used to compare the data against, e.g. what is the appropriate comparative standard. How much energy is too much?  to little?  How much Vitamin B6 is too much or too little for this patient?

To assist the dietitian in explaining the care that is being provided we have Comparative Standards.  The E-NCPT includes a sixth domain as an addendum to the Nutrition Assessment terminology that is to be used to document how the dietitian "evaluated" the data collected from the patient or medical record during the nutrition assessment data collection.  These terms allow the dietitian to enter data into fields in the following categories:

Class/Category
Each allows the dietitian to identify both the estimated need as well as method to measure of estimate the need/requirement
Energy Needs
Kcal
Specify formula and activity/injury factors used
Macronutrient Needs
Daily intake in grams of fat, protein, carbohydrate (type and total quantity), or fiber
Method of estimating (for example if national reference standards are used such as Dietary Reference Intakes or disease related standards)
Fluid Needs
Fluid
Method of estimating
Micronutrient Needs
Vitamins
(A, C, D, E, K, Thiamin, Riboflavin, Niacin, Folate, B6, B12, Pantothenic acid, Biotin)
Minerals
(Calcium, Chloride, Chromium, Cobalt, Copper, Fluoride, iodine, Iron, Magnesium, Manganese, Molybdenum, Phosphorus, Potassium, Selenium, Sodium Sulfate, Zinc)
Method of estimating needs
Weight and Growth Recommendations
Ideal body weight parameters, BMI, or growth patterns for children (weight for age, length of age, head circumference or weight for stature, or BMI for age)

In addition the Comparative Standards includes additional reference material that addresses concerns that dietitians may have when using national reference standards that were developed for groups of "healthy" people and then applying these standards to individuals who may not be "healthy".

 While the E-NCPT includes the Dietary Reference Intakes (DRI) used in the United States and Canada, it also addresses using other country's national reference standard when they are available.

If you have access/subscription to the E-NCPT the following pages address the information summarized in this blog.

Nutrition Assessment Component Summary in ENCPT

Nutrition Assessment - Identify relevant data by comparing to standards in ENCPT

Guidance for interpreting national reference standards - both US and Internationally in ENCPT

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