The purpose of nutrition problem identification is to identify specific nutrition-related problems that will be the focus of nutrition intervention at the current point in time. Based on findings from the nutrition assessment, the dietitian prioritizes current problems that compromise achieving and maintaining plasma BCAA levels in the desired range and meeting nutritional needs necessary to support normal growth and development and overall health and quality of life.

Table 6 identifies common nutrition diagnoses associated with MSUD, written in the PES (problem, etiology, signs and symptoms) format developed by the Academy of Nutrition and Dietetics Nutrition Care Process.

TABLE 6 - Nutrition Problem Identification for MSUD based on the International Dietetics and Nutrition Terminology Reference Manual, 3rd Edition

Diagnosis (Problem)	Related to (Etiology)	As evidenced by (Signs and Symptoms)
INTAKE (NI) Excessive energy intake NI 1.5 Inadequate energy intake NI 1.4 Inadequate intake from enteral nutrition NI 2.3 Excessive intake from enteral nutrition NI 2.4 Inadequate fat intake NI 5.6.1 Excessive fat intake NI 5.6.2 Excessive protein intake NI 5.7.2 Inappropriate intake of (specify amino acids) NI 5.7.3 CLINICAL (NC) Impaired nutrient utilization NC 2.1 Altered nutrition-related lab values NC 2.2 BEHAVIORAL (NB) Food and nutrition-related knowledge deficit NB 1.1 Limited adherence to nutrition-related recommendations NB 1.6 Limited access to food NB 3.2 Other	Excessive intake of (specify food or beverage) Poor appetite due to (specify metabolic disorder) Nutrition prescription no longer meeting energy needs Nutrition prescription exceeding energy needs Protein restriction necessitated by MSUD LEU, VAL, and ILE restriction necessitated by MSUD Metabolic disorder (MSUD) New diagnosis of MSUD Lack of adequate insurance coverage to pay for special metabolic formulas Lack of adequate insurance coverage to pay for low-protein foods Other	BMI (or weight-for-height) >97th percentile BMI (or weight-for-height) >85th percentile BMI (or weight-for-height) < 3rd percentile (specify weight change) weight gain/loss over the past (specify time frame) EFA deficiency Dietary recall Altered lab values (specify) Elevated amino acids (specify) Reports of higher than recommended amino acid intake (specify) Abnormal newborn screen Lack of appreciation for the importance of making nutrition-related changes Presentation to clinic for initial nutrition education Denial by insurance company to provide payment Other