PES Statements: The Complete 2026 Guide + 20 Examples -

This article has been updated by Michelle Saari, MS RD, on August 26, 2026 with the most up to date information available.

Have you ever sat down to chart, stared at the nutrition diagnosis field, and just… blanked? You know something is wrong with the resident’s intake. You have the data. But turning that into one clean, standardized sentence feels harder than it should be.

I get it and I’ve been writing PES statements almost every single day for over a decade as a long term care dietitian.

Here’s the good news: once the formula clicks, it genuinely does become second nature. This guide walks you through exactly how I approach it, with real examples pulled from the kind of cases I see most often in geriatric and long term care practice.

What Is a PES Statement?

A PES statement is how a dietitian documents a nutrition diagnosis. It’s a single, standardized sentence that captures three things: the problem, why it’s happening, and the evidence proving it’s real. It’s the “D” (Diagnosis) step of the Nutrition Care Process (NCP), and it’s what turns a pile of assessment data into a clear, actionable clinical statement.

It’s not just a documentation formality a well-written PES statement is really a snapshot of your clinical reasoning. Anyone reading your chart note should be able to see exactly what you found, why you think it’s happening, and what evidence backs it up, all in one sentence.

What Does PES Stand For?

P = Problem — The nutrition diagnosis itself, using standardized nutrition terminology. You can have more than one nutrition problem, but each one gets its own separate PES statement.
E = Etiology — The root cause or contributing factor behind the problem.
S = Signs & Symptoms — The subjective and objective evidence proving the problem and etiology are real.

The sentence always follows this exact structure:

Problem related to Etiology as evidenced by Signs and Symptoms.

That phrasing — “related to” and “as evidenced by” — isn’t optional stylistic language. It’s part of the standardized format, so keep it exactly as written.

One quick caveat for newer dietitians: not every assessment needs a PES statement. If there’s genuinely no nutrition problem present, you don’t need to force one into existence. In that case, you’ll simply write: “No nutrition diagnosis at this time.”

Where PES Statements Fit in the Nutrition Care Process

The PES statement doesn’t exist on its own, it’s one part of a four-step clinical process:

1. Nutrition Assessment This is where you gather the data — labs, intake history, weight trends, physical findings. Without a solid assessment, you can’t accurately identify the “P” in PES.

2. Nutrition Diagnosis (the PES Statement) This is where you take everything from the assessment and condense it into your standardized diagnosis sentence.

3. Nutrition Intervention Your intervention should directly target the etiology and aim to resolve or reduce the signs and symptoms you documented. If your PES statement and your intervention don’t connect logically, something’s off.

4. Nutrition Monitoring & Evaluation This is where you circle back and reassess the same signs and symptoms to see if your intervention actually worked.

If you want the full breakdown of how PES fits into ADIME charting specifically, I’ve got a dedicated article on ADIME format here.

Why Bother Getting Good at This? (The Real Benefits)

I won’t pretend PES statements are the most exciting part of the job. But getting genuinely skilled at writing them pays off in a few concrete ways:

It sharpens your clinical thinking. Having to distill a case into one precise sentence forces clarity, you can’t hide behind vague language.
It makes your interventions more targeted. When your etiology is nailed down correctly, your intervention almost writes itself.
It protects you during survey. A specific, well-evidenced PES statement is one of the best defenses you have when a surveyor or auditor reviews your chart.
It improves interdisciplinary communication. Nurses, physicians, and other team members can quickly understand your clinical reasoning without needing you to explain it.

How to Actually Write One: Step-by-Step

Step 1: Identify the Nutrition Diagnosis (the “P”)

After completing your full nutrition assessment, your clinical judgment should point you toward the primary nutrition problem. You can have multiple diagnoses for one resident, that’s completely fine but each one needs its own separate PES statement.

Every nutrition diagnosis falls into one of three categories:

Intake (e.g., inadequate energy intake, excessive fluid intake)
Clinical (e.g., altered GI function, swallowing difficulty)
Behavioral (e.g., self-feeding difficulty, food and nutrition knowledge deficit)

A practice tip from my own experience in long term care: I rarely reach for a behavioral diagnosis with older adults unless I’m truly confident that’s the driving issue. Cognitive changes that come with age absolutely affect food-related decisions and behavior, but that’s not something a nutrition intervention is going to resolve. In those cases, the clinical or intake domain is almost always the more accurate and more useful choice.

Only select a problem that your nutrition interventions can realistically address. If your diagnosis is “unintentional weight loss,” for example, your interventions should logically be things like calorie fortification or supplement additions, not something unrelated.

Step 2: Pin Down the Etiology (the “E”)

The etiology is the why, the root cause your assessment points to. This is also the piece your nutrition prescription is actually trying to resolve, so it needs to be accurate.

Sometimes, the true root cause isn’t something a dietitian can resolve directly. Common examples in long term care include:

Stroke / cerebrovascular accident (CVA)
Head, neck, or throat cancer
Dementia or other cognitive impairment
Parkinson’s disease

In those cases, you’re not going to reverse the underlying condition but you can absolutely address and minimize its downstream effects. When this happens, use the phrase “secondary to” to connect the two.

Example: Swallowing difficulty related to dysphagia secondary to CVA as evidenced by frequent coughing at meals, pocketing, and a wet-sounding voice.

Notice what’s happening there, you can’t resolve the CVA itself through nutrition, but you absolutely can target the dysphagia it caused.

Step 3: Gather Your Signs & Symptoms (the “S”)

This is your evidence, the subjective and objective data proving the problem and etiology are real. Whenever possible, lean on objective, measurable data: anthropometrics, lab values, documented intake percentages.

Common examples of strong, specific evidence include:

BMI
Percentage and amount of weight loss
Usual body weight vs. current body weight
Documented meal intake percentages
Relevant lab values (albumin, prealbumin, HbA1c, etc.)

A rule I always follow: use only data that’s actually documented in your assessment, never data you’re assuming or estimating. And don’t skimp here. My general recommendation is a minimum of two pieces of evidence, though I personally aim for at least three whenever the data supports it. The stronger your evidence, the more defensible your diagnosis is.

20+ Real PES Statement Examples

Here’s a mix of the most common PES statements I write in long term care and geriatric practice, plus several diabetes-specific examples since that’s one of the most frequent questions I get.

Inadequate Energy Intake: “Inadequate energy intake related to decreased appetite due to age-related olfactory decline, as evidenced by weight loss of 5% over the past month and reduced meal portions.”
Excessive Fluid Intake: “Excessive fluid intake related to congestive heart failure, as evidenced by lower extremity edema and documented fluid intake exceeding the physician-ordered restriction.”
Inadequate Fluid Intake: “Inadequate fluid intake related to fear of incontinence, as evidenced by concentrated urine, infrequent urination, and reported minimal fluid consumption.”
Altered GI Function: “Altered gastrointestinal function related to chronic constipation, as evidenced by less than three bowel movements per week and reported discomfort during defecation.”
Inadequate Protein Intake: “Inadequate protein intake related to difficulty chewing due to poor dental health, as evidenced by low serum albumin levels and avoidance of high-protein foods.”
Altered Nutrition-Related Lab Values (Sodium): “Altered nutrition-related laboratory values related to renal insufficiency, as evidenced by elevated serum sodium and a documented need for a sodium-restricted diet.”
Inadequate Vitamin D and Calcium Intake: “Inadequate vitamin D and calcium intake related to limited sunlight exposure and dietary restrictions, as evidenced by osteopenia and low dietary intake of dairy products.”
Inadequate Fiber Intake: “Inadequate fiber intake related to reduced intake of whole texture foods secondary to a modified diet consistency, as evidenced by chronic constipation and diet history low in fruits, vegetables, and whole grains.”
Swallowing Difficulty: “Swallowing difficulty related to post-stroke dysphagia, as evidenced by coughing during meals and a preference for pureed foods.”
Unintentional Weight Loss: “Unintentional weight loss related to altered taste perception and early satiety, as evidenced by a 7% weight loss in three months and reported lack of interest in eating.”
Malnutrition: “Inadequate nutrient intake related to decreased oral intake due to age-related anorexia, as evidenced by unintentional weight loss of 8% over six months and reduced muscle mass.”
Chronic Kidney Disease: “Altered nutrient intake related to chronic kidney disease stage 3, as evidenced by elevated serum creatinine levels and dietary intake high in potassium and phosphorus.”

Diabetes-Specific PES Statement Examples

Diabetes related PES statements come up constantly in geriatric practice, so here are several dedicated examples, each framed around age-related and physiological factors rather than lifestyle or dietary choices. (For an even deeper dive, I’ve also written a full article specifically on PES statements for diabetes.)

Inconsistent Carbohydrate Intake: “Inconsistent carbohydrate intake related to fluctuating appetite associated with advancing dementia, as evidenced by diet recall showing an erratic meal pattern and elevated HbA1c of 8.9%.”
Altered Nutrition-Related Lab Values: “Altered nutrition-related laboratory values related to diabetes mellitus with declining pancreatic function, as evidenced by fasting blood glucose consistently above 180 mg/dL and HbA1c of 9.1%.”
Impaired Nutrient Utilization: “Impaired nutrient utilization related to long-standing type 1 diabetes with variable insulin absorption, as evidenced by fluctuating blood glucose readings despite a consistent meal pattern.”
Inadequate Carbohydrate Intake: “Inadequate carbohydrate intake related to reduced oral intake secondary to dysphagia, as evidenced by recurrent hypoglycemic episodes and meal intake averaging 40% for the past week.”
Self-Monitoring Deficit: “Self-monitoring deficit related to declining cognitive function affecting diabetes self-management, as evidenced by family report of missed blood glucose checks and inconsistent meal timing.”

More Long-Term Care Examples

Increased Nutrient Needs: “Increased nutrient needs (protein) related to a stage 3 pressure injury, as evidenced by a wound measuring 4cm x 3cm and albumin level of 2.8 g/dL.”
Self-Feeding Difficulty: “Self-feeding difficulty related to upper extremity weakness secondary to CVA, as evidenced by observed inability to bring utensils to mouth without assistance.”
Underweight: “Underweight related to inadequate oral intake, as evidenced by BMI of 17.2 and documented meal intake averaging 25% for the past two weeks.”

Looking for even more? I’ve also put together a dedicated list of the top malnutrition-specific PES statements here.

Frequently Asked Questions

What if there’s no nutrition diagnosis?

This one trips up a lot of newer RDs. Sometimes your resident really is nutritionally stable — and that’s okay to document as-is. I know it can feel uncomfortable not to “find” a problem, especially with residents who carry malnutrition risk. But if intake has been stable, weight has stayed within +/- 1-2 kg, there’s no new swallowing difficulty, and medical status is unchanged, it’s completely appropriate to write: “No nutrition diagnosis at this time.”Don’t manufacture a diagnosis just to have something to write.

Are dietitians allowed to diagnose?

Yes, but it’s important to understand the distinction. A nutrition diagnosis is different from a medical diagnosis, which only a physician can make. Nutrition diagnoses come from the standardized nutrition terminology list, and they’re squarely within a dietitian’s scope. That said, some facilities require physician sign-off on a malnutrition diagnosis specifically, often tied to reimbursement policy so it’s worth checking your facility’s specific requirements.

How many signs and symptoms do I need?

There’s no hard rule, but I recommend a minimum of two pieces of subjective or objective evidence, and I personally aim for at least three whenever the data supports it. More specific, measurable evidence makes your diagnosis stronger and more defensible.

Can I use more than one PES statement per resident?

Yes, and it’s common. If a resident has multiple active nutrition problems, each one gets documented as its own separate, complete PES statement don’t try to combine them into one sentence.

What’s the difference between PES statements and the Nutrition Care Process?

The Nutrition Care Process (NCP) is the full four-step clinical framework; assessment, diagnosis, intervention, and monitoring/evaluation. The PES statement is specifically the output of step two, the diagnosis phase. ADIME, meanwhile, is how you chart the NCP and the PES statement lands in the “D” section of an ADIME note. If you want the full comparison, I’ve written more on that in my ADIME format guide.

Still Want More Practice?

The honest truth is that PES statements get easier with repetition, not memorization. The more real cases you write through, the more natural the format becomes.

If you want to keep building your skills, check out my Top Malnutrition PES Statement Examples, or grab the free downloadable guide below for even more sample statements you can reference on the job.

Michelle Saari MSc, RD

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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.

PES Statements: The Complete 2026 Guide + 20 Examples