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MSUD Nutrition Management Guidelines
First Edition
February 2013, v.1.50
Current version: v.1.58
Updated: August 2016
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Nutrition Problem Identification
Overview

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.

Common Nutrition Diagnoses

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

Nutrition Diagnosis

(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

Excessive protein intake

Insufficient protein intake

Intake of types of protein or amino acids inconsistent with needs (specify)

Predicted excessive energy intake

Predicted suboptimal energy intake

Excessive fat intake

Inadequate fat intake

Excessive enteral nutrition infusion

Inadequate enteral nutrition infusion

Enteral nutrition composition inconsistent with needs

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

Consumption Factors

Lack of medical food consumption

Suboptimal medical food consumption

Excessive intake of (specify food or beverage)

Provider Factors

Nutrition prescription no longer meets protein needs

Nutrition prescription no longer meets energy needs

Underlying Disease Factors

New diagnosis of MSUD

LEU, VAL, and ILE restriction necessary for MSUD 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 dietary therapy recommendations

Presentation to clinic for initial nutrition education

Off diet

Access Factors

Lack of financial resources for medical food and low-protein foods

Lack of medical insurance

Inadequate third-party or denial of coverage for medical foods or low protein foods

Lack of access to resources or care

From Biochemical Tests

Laboratory value compared to norm or goal (specify) (e.g. plasma LEU of 300 µmol/L)

Abnormal plasma amino acids (specify)

Presence of ketones in urine

Positive DNPH test

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 MSUD

EFA 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)

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

Table 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 MSUD 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.

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