You may have heard the nutrition diagnosis: increased nutrients needs, but you have no idea when to use it. The term is used interchangeably with Hypermetabolism when using the standardized nutrition terminology, and it seems it is a very misunderstood nutrition diagnosis.
Increased nutrient needs requires a patient to have a higher resting metabolic rate in order to address the increased calories that they require. This can be from a condition, disease, or acute issue that requires serious nutrition interventions.
Here you will find exactly when to use the increased nutrient needs nutrition diagnosis in order to better meet a patient’s nutrient needs!
When Does a Person Have Increased Nutrient Needs?
The definition from the Academy of Nutrition and Dietetics lists hypermetabolism as,
“Resting metabolic rate (RMR) above predicted requirements due to stress, trauma, injury, sepsis, or disease. RMR is the sum of metabolic processes of active cell mass related to the maintenance of normal body functions and regulatory balance during rest.”
On a nutrition assessment form, there should be an area to check off if a patient has increased nutrient needs. If there isn’t, you can find a nutrition assessment form here.
In order to check this off they should have one of the below conditions:
- Pressure Injury (Stage 3,4 )
- Trauma (Acute)
- Chronic Obstructive Pulmonary Disease
- Cancer (specify the type)
- Post surgey
- Hip/Long bone fracture
- Hyperthyroidism (untreated or pre-)
- Medications associated with increased resting metabolic rate
Outside of these parameteres, I would caution you to only use this when there is a specific disease or cause of increased nutrient needs. Ensure you use your best clinical judgement to determine.
When to Not Use Increased Nutrient Needs
This nutrition diagnosis is not when someone simply needs to gain weight or has inadequate food and fluid intake. If a person has malnutrition, underweight, inadequate intake, unintentional weight loss, you should not be selecting the increased nutrient needs diagnosis.
The nutrition diagnosis in those cases would be:
- Unintentional weight loss
- Inadequate energy intake
Increased Nutrient Needs PES Statement
Let’s walk through an example for how to use increased nutrients needs PES statement.
Increased Nutrient Needs (Hypermetabolism) (N-1.1).
If you need more help figuring out how to choose a nutrition diagnosis, I have a great piece on that here:
PES Statement Examples:
Increased nutrient needs related to stage 3 pressure injury as evidenced by high protein and calorie needs of 1.2 g/kg and 35 kcal/kg.
Increased nutrient needs related to increased demand for nutrients as evidenced by current cancer treatments of the neck.
Increased nutrient needs related to recent hip fracture as evidenced by estimated caloric needs of 2,500 daily, and 75 grams of protein.
If we use the first PES statement to follow through with this example, here are some nutrition goals that could be used:
- Promote good skin integrity to heal stage 3 pressure injury.
- Ensure patient meets their protein and energy needs daily.
- Provide patient with 1.2-1.5 grams/kilogram body weight of protein daily to meet daily protein needs.
- Provide oral nutrition supplement drink 3 times daily at 60 mL given during Medpass.
Nutrition Monitoring and Evaluation Plan
- Will follow up with patient and wound care Nurse on Mondays, Wednesdays, and Fridays for wound update.
- Will review Medpass records for amount of ONS taken by patient.
Issues with Increased Nutrient Needs Selection
An issue I see frequently come up with the increased nutrient needs PES statement is that the etiology is rarely able to be ‘cured’ by the nutrition interventions. In most cases this is true, particularly if you look at the criteria for diagnosing it.
This is typically the goal with most nutrition interventions. But in some scenarios this is not possible. Instead the nutrition interventions shift to focusing on reducing the nutrition side effects.
For example, a patient going through cancer treatments will not be cured by any nutrition interventions. But the nutrition interventions can reduce the side effects such as weight loss, inadequate intake, nutrient deficiencies and similar effects.
Dietitian Takeaway Points
- Increased nutrient needs and Hypermetabolism can be use interchangeably as a nutrition diagnosis
- Increased nutrient needs as a nutrition diagnosis only when there is an increased resting metabolic rate.
- Increased nutrient needs will have an etiology that will not typically be able to be ‘cured’ by nutrition interventions.
- The nutrition goal will be to reduce the side effects of the etiology.
If you enjoyed this article and want more help with your PES statement development or nutrition care process examples, be sure to check out the articles below!
Michelle Saari is a Registered Dietitian based in Canada. She has a Master's Degree in Human Nutritional Sciences and is a passionate advocate for spreading easy to understand, reliable, and trustworthy nutrition information. She is currently a full time online entrepreneur with two nutrition focused websites.