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This is a combined list of Nutrition Assessment and Monitoring and Evaluation terms. Indicators that are shaded are used ONLY for nutrition assessment. The rest of the indicators are used for assessment and monitoring and evaluation. Each term has an Academy unique identifier, a five-digit number (e.g., 99999) following the alpha-numeric IDNT code. Neither should be visible in nutrition documentation. The Academy unique identifier is for data tracking purposes in electronic health records. FOOD/NUTRITION-ReLated HISTORY
Food and nutrient intake, food and nutrient administration, medication and complementary/alternative medicine use, knowledge/beliefs/attitudes, behavior, food and supply availability, physical activity and function, nutrition-related patient/ client-centered measures.
(FH)
Composition and adequacy of food and nutrient intake, meal and snack patterns, current and previous diets and/or food modifications, and eating environment. Energy Intake (1.1) Total energy intake from all sources including food, beverages, breastmilk/formula, supplements, and via enteral and parenteral routes. Energy intake (1.1.1) q Total energy intake FH-1.1.1.1 10005
Protein intake (1.5.2) q Total protein q High biological value protein q Casein q Whey q Amino acids q Essential amino acids Carbohydrate intake (1.5.3) q Total carbohydrate q Sugar q Starch q Glycemic index q Glycemic load q Source of carbohydrate q Insulin-to-carbohydrate ratio Fiber intake (1.5.4) q Total fiber q Soluble fiber q Insoluble fiber
Fat and cholesterol intake (1.5.1), contd q Polyunsaturated fat q Monounsaturated fat q Omega-3 fatty acids q Dietary cholesterol q Essential fatty acids
FH-1.5.1.4 FH-1.5.1.5 FH-1.5.1.6 FH-1.5.1.7 FH-1.5.1.8 FH-1.5.2.1 FH-1.5.2.2 FH-1.5.2.3 FH-1.5.2.4 FH-1.5.2.5 FH-1.5.2.6 FH-1.5.3.1 FH-1.5.3.2 FH-1.5.3.3 FH-1.5.3.4 FH-1.5.3.5 FH-1.5.3.6 FH-1.5.3.7 FH-1.5.4.1 FH-1.5.4.2 FH-1.5.4.3
10047 10048 10049 10050 10051 10053 10054 10055 10056 10057 10058 10060 10061 10062 10063 10064 10065 10066 10068 10069 10070
Food and Beverage Intake (1.2) Type, amount, and pattern of intake of foods and food groups, indices of diet quality, intake of fluids, breastmilk and infant formula Fluid/beverage intake (1.2.1) q Oral fluids q Food-derived fluids q Liquid meal replacement or supplement Food intake (1.2.2) q Amount of food q Types of food/meals q Meal/snack pattern q Diet quality index q Food variety FH-1.2.1.1 FH-1.2.1.2 FH-1.2.1.3 FH-1.2.2.1 FH-1.2.2.2 FH-1.2.2.3 FH-1.2.2.4 FH-1.2.2.5 FH-1.2.3.1 FH-1.2.3.2 10008 10009 10010 10012 10013 10014 10015 10016 10018 10019
Micronutrient Intake (1.6) Vitamin and mineral intake from all sources, e.g., food, beverages, supplements, and via enteral and parenteral routes. Vitamin intake (1.6.1) q A (1) q C (2) q D (3) q E (4) q K (5) q Thiamin (6) q Riboflavin (7) 10073 10074 10075 10076 10077 10078 10079 q Niacin (8) q Folate (9) q B6 (10) q B12 (11) q Pantothenic acid (12) q Biotin (13) q Multivitamin (14) q Copper (11) q Iodine (12) q Selenium (13) q Manganese (14) q Chromium (15) q Molybdenum (16) q Boron (17) q Cobalt (18) q Multi-mineral (19) q Multi-trace element (20) 10080 10081 10082 10083 10084 10085 10086 10099 10100 10101 10102 10103 10104 10105 10106 10107 10108
Enteral and Parenteral Nutrition Intake (1.3) Specialized nutrition support intake from all sources, e.g., enteral and parenteral routes. Enteral nutrition intake (1.3.1) q Formula/solution q Feeding tube flush FH-1.3.1.1 FH-1.3.1.2 FH-1.3.2.1 FH-1.3.2.2 10022 10023 10025 10026
Bioactive Substance Intake (1.4) Alcohol, plant stanol and sterol esters, soy protein, psyllium and b-glucan, and caffeine intake from all sources, e.g., food, beverages, supplements, and via enteral and parenteral routes. Alcohol intake (1.4.1) q Drink size/volume q Frequency q Pattern of alcohol consumption FH-1.4.1.1 FH-1.4.1.2 FH-1.4.1.3 FH-1.4.2.1 FH-1.4.2.2 FH-1.4.2.3 FH-1.4.2.4 FH-1.4.2.5 FH-1.4.2.6 FH-1.4.2.7 FH-1.4.3.1 10029 10030 10031 10034 10807 10035 10827 10037 10038 10039 10041
Mineral/element intake (1.6.2) q Calcium (1) 10089 q Chloride (2) 10090 q Iron (3) 10091 q Magnesium (4) 10092 q Potassium (5) 10093 q Phosphorus (6) 10094 q Sodium (7) 10095 q Zinc (8) 10096 q Sulfate (9) 10097 q Fluoride (10) 10098
Macronutrient Intake (1.5) Fat and cholesterol, protein, carbohydrate, and fiber intake from all sources including food, beverages, supplements, and via enteral and parenteral routes. Fat and cholesterol intake (1.5.1) q Total fat q Saturated fat q Trans fatty acids FH-1.5.1.1 FH-1.5.1.2 FH-1.5.1.3
Bioactive substance intake (1.4.2) q Plant stanol esters q Plant sterol esters q Soy protein q Psyllium q b-glucan q Food additives (specify) q Other (specify)
Current and previous diets and/or food modifications, eating environment, and enteral and parenteral nutrition administration. Diet History (2.1) Description of food and drink regularly provided or consumed, past diets followed or prescribed and counseling received, and the eating environment. Diet order (2.1.1) q General, healthful diet q Modified diet q Enteral nutrition order q Parenteral nutrition order FH-2.1.1.1 FH-2.1.1.2 FH-2.1.1.3 FH-2.1.1.4 FH-2.1.2.1 FH-2.1.2.2 FH-2.1.2.3 FH-2.1.2.4 FH-2.1.2.5 FH-2.1.2.6 10113 10114 10115 10116 10118 10119 10120 10121 10805 10806
Diet experience (2.1.2) q Previously prescribed diets q Previous diet/nutrition education/counseling q Self-selected diet/s followed q Dieting attempts q Food allergies q Food intolerance
Reprinted with permission from International Dietetics & Nutrition Terminology (IDNT) Reference Manual, Fourth Edition. Copyright 2013 Academy of Nutrition and Dietetics.
Enteral and parenteral nutrition administration (2.1.4) q Enteral access FH-2.1.4.1 q Parenteral access FH-2.1.4.2 q Body position, EN FH-2.1.4.3
Factors that affect intake and availability of a sufficient quantity of safe, healthful food as well as food/nutrition-related supplies. FH-6.1.1 FH-6.1.2 FH-6.1.3 FH-6.1.4 FH-6.2.1 FH-6.2.2 FH-6.2.3 FH-6.2.4 FH-6.2.5 FH-6.2.6 FH-6.3.1 FH-6.3.2 10187 10188 10189 10190 10192 10800 10194 10195 10196 10801 10198 10199 10201 10202 10203
Prescription and over-the-counter medications, including herbal preparations and complementary/alternative medicine products used. FH-3.1.1 FH-3.1.2 FH-3.1.3 FH-3.2.1 10820 10134 10135 10137
Knowledge/Beliefs/Attitudes (4)
Understanding of nutrition-related concepts and conviction of the truth and feelings/ emotions toward some nutrition-related statement or phenomenon, along with readiness to change nutrition-related behaviors. Food and nutrition knowledge/skill (4.1) q Area(s) and level of knowledge/skill q Diagnosis specific or global nutrition-related knowledge score FH-4.1.1 FH-4.1.2 10848 10143
Beliefs and attitudes (4.2) q Conflict with personal/family value system q Distorted body image q End-of-life decisions q Motivation q Preoccupation with food/nutrients q Preoccupation with weight q Readiness to change nutrition-related behaviors q Self-efficacy q Self-talk/cognitions q Unrealistic nutrition-related goals q Unscientific beliefs/attitudes q Food preferences q Emotions
Food and nutrition-related supplies availability (6.4) q Access to food and nutrition-related supplies FH-6.4.1 q Access to assistive eating devices FH-6.4.2 q Access to assistive food preparation devices FH 6.4.3
Safe water availability (6.3) q Availability of potable water q Appropriate water decontamination
Safe food/meal availability (6.2) q Availability of shopping facilities q Procurement of safe food q Appropriate meal preparation facilities q Availability of safe food storage q Appropriate storage technique q Identification of safe food
FH-4.2.1 FH-4.2.2 FH-4.2.3 FH-4.2.4 FH-4.2.5 FH-4.2.6 FH-4.2.7 FH-4.2.8 FH-4.2.9 FH-4.2.10 FH-4.2.11 FH-4.2.12 FH-4.2.13
10145 10146 10147 10148 10149 10150 10151 10152 10153 10154 10155 10156 10157
Physical activity, cognitive and physical ability to engage in specific tasks, e.g., breastfeeding, self-feeding. FH-7.1.1 FH-7.1.2 FH-7.1.3 FH-7.1.4 FH-7.2.1 FH-7.2.2 FH-7.2.3 FH 7.2.4 FH 7.2.5 FH-7.2.6 FH-7.2.7 FH-7.2.8 FH-7.2.9 FH-7.2.10 FH-7.2.11 10206 10207 10208 10209 10211 10212 10213 10214 10215 10216 10139 10218 10219 10220 10221
Behavior (5)
Patient/client activities and actions, which influence achievement of nutrition-related goals. Adherence (5.1) q Self-reported adherence score q Nutrition visit attendance q Ability to recall nutrition goals q Self-monitoring at agreed upon rate q Self-management as agreed upon FH-5.1.1 FH-5.1.2 FH-5.1.3 FH-5.1.4 FH-5.1.5 FH-5.2.1 FH-5.2.2 FH-5.2.3 FH-5.3.1 FH-5.3.2 FH-5.4.1 FH-5.4.2 FH-5.4.3 FH-5.4.4 FH-5.4.5 FH-5.4.6 FH-5.4.7 10160 10161 10162 10163 10164 10166 10167 10168 10170 10171 10173 10174 10175 10176 10177 10178 10179
Mealtime behavior (5.4) q Meal duration q Percent of meal time spent eating q Preference to drink rather than eat q Refusal to eat/chew q Spitting food out q Rumination q Patient/client/caregiver fatigue during feeding process resulting in inadequate intake
Bingeing and purging behavior (5.3) q Binge eating behavior q Purging behavior
Physical activity (7.3) q Physical activity history q Consistency q Frequency q Duration q Intensity q Type of physical activity q Strength q TV/screen time q Other sedentary activity time q Involuntary physical movement q NEAT
Nutrition-related ADLs and IADLs (7.2) q Physical ability to complete tasks for meal preparation q Physical ability to self-feed q Ability to position self in relation to plate q Receives assistance with intake q Ability to use adaptive eating devices q Cognitive ability to complete tasks for meal preparation q Remembers to eat q Recalls eating q Mini Mental State Examination Score q Nutrition-related activities of daily living (ADL) score q Nutrition-related instrumental activities of daily living (IADL) score
FH-7.3.1 FH-7.3.2 FH-7.3.3 FH-7.3.4 FH-7.3.5 FH-7.3.6 FH-7.3.7 FH-7.3.8 FH-7.3.9 FH-7.3.10 FH-7.3.11
10223 10224 10225 10226 10227 10228 10229 10230 10231 10232 10233
Reprinted with permission from International Dietetics & Nutrition Terminology (IDNT) Reference Manual, Fourth Edition. Copyright 2013 Academy of Nutrition and Dietetics.
Patient/clients perception of his or her nutrition intervention and its impact on life. 10236
Anthropometric Measurements
Body composition/growth/weight history (1.1) q Height/length q Weight q Frame size q Weight change q Body mass index q Growth pattern indices/percentile ranks q Body compartment estimates
Height, weight, body mass index (BMI), growth pattern indices/percentile ranks, and weight history. AD-1.1.1 AD-1.1.2 AD-1.1.3 AD-1.1.4 AD-1.1.5 AD-1.1.6 AD-1.1.7 10239 10240 10241 10242 10243 10244 10245
(AD)
Glucose/endocrine profile (1.5) q Glucose, fasting q Glucose, casual q HgbA1c q Preprandial capillary plasma glucose q Peak postprandial capillary plasma glucose q Glucose tolerance test q Cortisol level q IGF-binding protein q Thyroid function tests (TSH, T4, T3) q Pituitary hormone tests (GH, ACTH, LH, FSH) Inflammatory profile (1.6) q C-reactive protein
Laboratory data, (e.g., electrolytes, glucose, and lipid panel) and tests (e.g., gastric emptying time, resting metabolic rate). Acid-base balance (1.1) q Arterial pH q Arterial bicarbonate q Partial pressure of carbon dioxide in arterial blood, PaCO2 q Partial pressure of oxygen in arterial blood, PaO2 q Venous pH q Venous bicarbonate BD-1.1.1 BD-1.1.2 BD-1.1.3 BD-1.1.4 BD-1.1.5 BD-1.1.6 BD-1.2.1 BD-1.2.2 BD-1.2.3 BD-1.2.4 BD-1.2.5 BD-1.2.6 BD-1.2.7 BD-1.2.8 BD-1.2.9 BD-1.2.10 BD-1.2.11 BD-1.2.12 BD-1.2.13 BD-1.3.1 BD-1.4.1 BD-1.4.2 BD-1.4.3 BD-1.4.4 BD-1.4.5 BD-1.4.6 BD-1.4.7 BD-1.4.8 BD-1.4.9 BD-1.4.10 BD-1.4.11 BD-1.4.12 BD-1.4.13 BD-1.4.14 BD-1.4.15 BD-1.4.16 BD-1.4.17 BD-1.4.18 BD-1.4.19 10248 10249 10250 10251 10252 10253 10255 10256 10257 10258 10259 10260 10261 10262 10263 10264 10265 10266 10267 10269 10271 10272 10273 10274 10275 10276 10277 10278 10279 10280 10281 10282 10283 10284 10285 10286 10287 10288 10289
(BD)
Lipid profile (1.7) q Cholesterol, serum q Cholesterol, HDL q Cholesterol, LDL q Cholesterol, non-HDL q Total cholesterol:HDL cholesterol q LDL:HDL q Triglycerides, serum Metabolic rate profile (1.8) q Resting metabolic rate, measured q Respiratory quotient, measured
Gastrointestinal profile (1.4) q Alkaline phosphatase q Alanine aminotransferase, ALT q Aspartate aminotransferase, AST q Gamma glutamyl transferase, GGT q Gastric residual volume q Bilirubin, total q Ammonia, serum q Toxicology report, including alcohol q Prothrombin time, PT q Partial thromboplastin time, PTT q INR (ratio) q Fecal fat q Amylase q Lipase q Other digestive enzymes (specify) q D-xylose q Hydrogen breath test q Intestinal biopsy q Stool culture
Electrolyte and renal profile (1.2) q BUN q Creatinine q BUN:creatinine ratio q Glomerular filtration rate q Sodium q Chloride q Potassium q Magnesium q Calcium, serum q Calcium, ionized q Phosphorus q Serum osmolality q Parathyroid hormone
Mineral profile (1.9) q Copper, serum or plasma q Iodine, urinary excretion q Zinc, serum or plasma q Boron, serum or plasma q Chromium, serum or urinary q Fluoride, plasma q Manganese, urinary, blood, plasma q Molybdenum, serum q Selenium, serum or urinary Nutritional anemia profile (1.10) q Hemoglobin q Hematocrit q Mean corpuscular volume q Red blood cell folate q Red cell distribution width q B12, serum q Methylmalonic acid, serum q Folate, serum q Homocysteine, serum q Ferritin, serum q Iron, serum q Total iron-binding capacity q Transferrin saturation
Protein profile (1.11) q Albumin q Prealbumin q Transferrin q Phenylalanine, plasma q Tyrosine, plasma q Amino acid, other, specify q Antibody level, specify q Carbohydrate-deficient transferrin Urine profile (1.12) q Urine color q Urine osmolality q Urine specific gravity q Urine test, specify q Urine volume
Reprinted with permission from International Dietetics & Nutrition Terminology (IDNT) Reference Manual, Fourth Edition. Copyright 2013 Academy of Nutrition and Dietetics.
Findings from an evaluation of body systems, muscle and subcutaneous fat wasting, oral health, suck/swallow/breathe ability, appetite, and affect. PD-1.1.1 PD-1.1.2 PD-1.1.3 PD-1.1.4 PD-1.1.5 PD-1.1.6 PD-1.1.7 PD-1.1.8 PD-1.1.9 10362 10363 10364 10365 10366 10367 10368 10369 10370
(PD)
Treatments/therapy (2.2) Documented medical or surgical treatments that may impact nutritional status of the patient q Medical treatment/therapy CH-2.2.1 10401 (specify) ___________________________________ q Surgical treatment CH-2.2.2 10402 (specify) ___________________________________ q Palliative/end-of-life care CH-2.2.3 10404 (specify) ___________________________________
Patient/client socioeconomic status, housing situation, medical care support and involvement in social groups. Social history (3.1) q Socioeconomic factors (specify) ___________________________________ q Living/housing situation (specify) ___________________________________ q Domestic issues (specify) ___________________________________ q Social and medical support (specify) ___________________________________ q Geographic location of home (specify) ___________________________________ q Occupation (specify) ___________________________________ q Religion (specify) ___________________________________ q History of recent crisis (specify) ___________________________________ q Daily stress level CH-3.1.1 CH-3.1.2 CH-3.1.3 CH-3.1.4 CH-3.1.5 CH-3.1.6 CH-3.1.7 CH-3.1.8 CH-3.1.9 10407 10408 10409 10410 10411 10412 10413 10414 10415
Current and past information related to personal, medical, family, and social history. General patient/client information such as age, gender, race/ethnicity, language, education, and role in family. CH-1.1.1 CH-1.1.2 CH-1.1.3 CH-1.1.4 CH-1.1.5 CH-1.1.6 CH-1.1.7 CH-1.1.8 CH-1.1.9 CH-1.1.10 10374 10375 10376 10377 10378 10379 10380 10381 10382 10383
(CH)
(CS)
CS-1.1.1 CS-1.1.2
10419 10420
Patient/client or family disease states, conditions, and illnesses that may have nutritional impact. Patient/client OR family nutrition-oriented medical/health history (2.1) Specify issue(s) and whether it is patient/client history (P) or family history (F) q Patient/client chief nutrition complaint CH-2.1.1 10386 (specify) __________________________________ P or F q Cardiovascular CH-2.1.2 10387 (specify) ___________________________________ P or F q Endocrine/metabolism CH-2.1.3 10388 (specify) ___________________________________ P or F q Excretory CH-2.1.4 10389 (specify) ___________________________________ P or F
Estimated protein needs (2.2) q Total protein estimated needs q Type of protein needed q Method for estimating needs
Estimated fat needs (2.1) q Total fat estimated needs q Type of fat needed q Method for estimating needs
Reprinted with permission from International Dietetics & Nutrition Terminology (IDNT) Reference Manual, Fourth Edition. Copyright 2013 Academy of Nutrition and Dietetics.
Estimated fiber needs (2.4) q Total fiber estimated needs q Type of fiber needed q Method for estimating needs
Estimated fluid needs (3.1) q Total fluid estimated needs q Method for estimating needs
CS-3.1.1 CS-3.1.2
10440 10441
Estimated vitamin needs (4.1) q A (1) 10444 q C (2) 10445 q D (3) 10446 q E (4) 10447 q K (5) 10448 q Thiamin (6) 10449 q Riboflavin (7) 10450
q Niacin (8) q Folate (9) q B6 (10) q B12 (11) q Pantothenic acid (12) q Biotin (13) q Method for estimating needs (14)
Recommended body weight/body mass Index/growth (5.1) q Ideal/reference body weight (IBW) CS-5.1.1 q Recommended body mass index (BMI) CS-5.1.2 q Desired growth pattern CS-5.1.3
Reprinted with permission from International Dietetics & Nutrition Terminology (IDNT) Reference Manual, Fourth Edition. Copyright 2013 Academy of Nutrition and Dietetics.