The purpose of nutrition problem identification is to document specific nutrition-related problems that require nutrition intervention. These are identified and prioritized based on findings from the nutrition assessment, current problems that compromise UCD metabolic stability, normal growth and development, overall health and/or quality of life.

Table 4 includes common nutrition diagnoses associated with UCDs based on the Academy of Nutrition and Dietetics Nutrition Care Process. The table is organized in the PES (problem, etiology, signs and symptoms) problem statement format developed by the Academy of Nutrition and Dietetics to support the Nutrition Care Process.

TABLE 4 - Nutrition Problem Identification for UCDs

Nutrition Diagnosis1 (Problem)	Related to (Etiology)	As Evidenced By (Signs and Symptoms)
Based on assessment findings, specify the current nutrition-related problem(s) to be addressed through nutrition management.	Identify the most pertinent underlying cause(s) or contributing risk factors for the specific problem. The etiology is commonly the target of nutrition intervention.	List subjective and objective data that characterize the specific problem and are also used to monitor nutrition intervention and outcomes
Examples of specific nutrition problems:	Examples of underlying causes of the problem:	Examples of data used to determine and monitor the problem:
Intake Domain Predicted excessive energy intake Predicted suboptimal energy intake Excessive protein intake Inadequate protein intake Predicted inadequate nutrient intake (specify) Intake of type of protein inconsistent with needs (specify, e.g., excessive low biological quality protein, inadequate EAA or high biological value protein) Inadequate essential amino acid intake Excessive enteral nutrition infusion Inadequate enteral nutrition infusion Enteral nutrition composition inconsistent with needs Excessive duration between feeds (fasting) Clinical Domain Impaired nutrient utilization Altered nutrition-related lab values Food-medication interaction (specify) Growth rate below expected Underweight Overweight/obesity Behavioral-Environmental Domain Food and nutrition-related knowledge deficit Limited adherence to nutrition-related recommendations Limited access to food Limited access to medical food2	Consumption Factors Lack of medical food2 consumption Suboptimal medical food2 consumption Excessive intake of (specify food or beverage) Inadequate intake of (specify food or beverage) Long duration between feedings Provider Factors Nutrition prescription no longer meets protein needs Nutrition prescription no longer meets energy needs Underlying Disease Factors New diagnosis of (specify UCD subtype) Protein restriction necessary for UCD treatment Acute illness or infection Poor appetite due to (specify) Patient/Caretaker Knowledge and Behavior Factors Food choices suboptimal Lack of knowledge Limited adherence to nutrition-related recommendations Presentation to clinic for initial nutrition education Presentation to clinic for revised nutrition education (specify, e.g., illness, growth, pregnancy) Change in nutrient needs (specify, e.g, energy) due to new or increased physical activity Access Factors Lack of financial resources for medical food2 Lack of medical insurance Inadequate third-party or denial of coverage for medical foods2 Lack of access to resources for care	From Biochemical Tests Laboratory value compared to norm or goal (specify, e.g., plasma glutamine >1000 µmol/L) Abnormal plasma amino acids (specify) From Anthropometrics Growth pattern, weight, weight-for-height or BMI compared to standards (specify) Weight gain/loss (specify weight change) over the past (specify time frame) From Clinical/Medical Exam or History New diagnosis of (specify UCD subtype) Micronutrient deficiency (physical sign or lab value) Essential fatty acid deficiency (physical sign or lab value) From Diet History Estimated or calculated intake from diet record or dietary recall, compared to recommendation or individual's nutrition prescription (specify) Incomplete/inadequate/missing diet history or recall From Patient Report Verbalized lack of skill or understanding to implement nutrition recommendations Lack of appreciation for the importance of making nutrition-related changes Lack of social or familial support

¹Table content is based on Nutrition Care Process (NCP) terminology developed by the Academy of Nutrition and Dietetics. NCP uses the following structure for documenting nutrition problems: nutrition diagnosis (Problem), related to (Etiology), and as evidenced by (Signs and Symptoms). Examples listed identify concerns particular to UCDs and are grouped in domains of: Intake, Clinical, and Behavioral-Environmental. Problems identified may relate to any Etiology and be evidenced by any Signs and Symptoms within a domain.

²Essential amino acid-based medical food.