This document discusses various nutrition interventions including nutrition prescriptions, oral diets, modifications to regular diets, clear and full liquid diets, increasing nutrient density, supplements, feeding assistance, medication management, education, counseling, coordination of care, and monitoring and evaluation. The interventions are based on standards of practice and aim to best meet individual nutritional needs based on diagnoses and conditions. Counseling focuses on developing collaborative and individualized plans to help patients take responsibility for behaviors.

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Nutrition Therapy and Pathophysiology | 3e
Nelms | Sucher | Lacey | Roth
Marcia Nahikian-Nelms, PhD, RD, LD
The Ohio State University
Karen Lacey MS, RD, CD
University of Wisconsin—Green Bay
Nutrition Intervention
Chapter 4

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Nutrition Prescription
• Concisely states individualized plan for
best meeting nutritional needs
• Drive nutrition intervention or frame
context within which intervention is
implemented
• Based on evidence-based dietetics
practice
• See Table 4.1

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Standards of Practice

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Food and/or Nutrient Delivery
(Oral Diets)
• First step in prevention or treatment of
malnutrition
– Adequate supply of acceptable food
composing individualized diet
– See Figure 4.2

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Factors Affecting Nutritional Intake
during Illness

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“House” or Regular Diet
• Changes to the house diet
– Caloric level
– Consistency
– Single nutrient manipulation
– Preparation
– Food restriction
– Number, size, frequency of meals
– Addition of supplements

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Modification of Meals and Snacks
• Texture & consistency modifications for
dysphagia and other conditions
• Soft diets
• Clear or full liquid diets
– Consider osmolality
– Hyperosmolar liquids may not be tolerated
• Preparation for a specific medical test

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Principles of Clear and Full Liquid
Diets

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Nutrition Interventions to Increase
Nutrient Density

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Medical Food
Supplements/Modified Foods
• Medical food supplements
– Commercial or prepared foods or beverages
intended to supplement energy, protein,
carbohydrate, fiber, and/or fat intake.
• Modified foods and beverages
– Add single nutrients via modular products

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Vitamin/Mineral/Bioactive
Supplements
• Vitamin and mineral supplements
– To meet recommendations
– To maximize absorption and utilization
• Bioactive substance supplements
– Food substances added to a food product or
taken as supplements that have a specific
intended health purpose
• Includes plant stanol or sterol esters,
pre/probiotics, fiber, soy protein, caffeine

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Nutrition Intervention: Feeding
Assistance/Environment
• Address diagnoses such as:
– Inadequate energy or oral intake
– Unintended weight loss
– Disordered eating pattern
– Self-feeding difficulty
• May include:
– Changing environment to allow food choice
– Providing adaptive equipment

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Nutrition-Related Medication
Management
• Addresses diagnoses such as:
– Altered GI function
– Impaired nutrient utilization
– Altered nutrient-related laboratory values
– Inadequate oral intake
– Food–medication interaction

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Nutrition Education
• Instruction or training in a skill or
knowledge
• Group classes, individual instruction,
written instruction, via phone or electronic
communication
• Outpatient setting more conducive to
education
– Most often provided in acute care setting

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Nutrition Counseling
• Supportive process, collaborative, goal
setting and individualized action plans
• Ultimate goal is for the patient/client to
take responsibility for behaviors

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Nutrition Counseling
• Counseling
– Supportive
– Process
– Collaborative
– Relationship
– Individualized
– Self-care

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Characteristics of Counselors that
Promote a Positive Relationship

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Effective Communication Skills

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Theoretical Framework for Nutrition
Counseling
• Theories and models provide research
based rationale for design and tailoring of
interventions
– Guides information needed at different times
in the behavior change process
– Identifies best tools and strategies to use
– Uses outcome measures to determine
effectiveness

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Theoretical Basis/Approach for
Nutrition Counseling and Education

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Strategies to Accomplish Nutrition
Interventions
• Motivational interviewing
• Self-monitoring
• Cognitive restructuring

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Coordination of Care
• RDs work with numerous other health care
professionals
– To ensure successful transition from the
health care facility to the patient’s home or
other facility
• Activities depend on specific nutrition
interventions

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Nutrition Monitoring and Evaluation
• Four domains of nutrition care outcomes
– Food-/nutrition-related history data
– Anthropometrics
– Biochemical data, medical tests, and
procedures
– Nutrition-focused physical findings

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Nutrition Diagnosis Status
• Terms
– Resolved
– Improvement shown
– Unresolved
– No longer appropriate