Nutrition Section¶

OID: 2.16.840.1.113883.10.20.22.2.57 Version: (No extension) Badge: Specialized Section

Overview¶

The Nutrition Section represents diet and nutrition information including special diet requirements and restrictions (such as texture-modified diet, liquids only, or enteral feeding). It also represents the overall nutritional status of the patient and nutrition assessment findings.

This section is particularly important for patients with special dietary needs, those at risk for malnutrition, and those receiving nutrition support therapy.

Template Details¶

Template ID: 2.16.840.1.113883.10.20.22.2.57
Extension: None
Conformance: MAY
Cardinality: 0..1 (Optional in documents)
LOINC Code: 61144-2 "Diet and nutrition"

Protocol Requirements¶

NutritionalStatusProtocol¶

from typing import Protocol, Optional, List
from datetime import date, datetime

class NutritionAssessment(Protocol):
    assessment_type: str  # Type of assessment (e.g., "BMI", "Weight", "Albumin Level")
    value: str           # Assessment value

class NutritionalStatusProtocol(Protocol):
    status: str                      # Nutritional status (e.g., "Well nourished", "Malnourished")
    date: Union[date, datetime]     # Date of assessment
    assessments: List[NutritionAssessment]  # List of specific nutrition assessments

Code Example¶

Basic Nutritional Status¶

from ccdakit import NutritionSection, CDAVersion
from datetime import date

# Define nutritional status observations
nutritional_statuses = [
    {
        "status": "Well nourished",
        "date": date(2025, 1, 15),
        "assessments": [
            {
                "assessment_type": "BMI",
                "value": "23.5 kg/m2"
            },
            {
                "assessment_type": "Weight",
                "value": "68 kg"
            }
        ]
    }
]

section = NutritionSection(
    nutritional_statuses=nutritional_statuses,
    version=CDAVersion.R2_1
)

xml_element = section.build()

Multiple Nutrition Assessments¶

from ccdakit import NutritionSection, CDAVersion
from datetime import date

nutritional_statuses = [
    {
        "status": "Moderate malnutrition",
        "date": date(2025, 1, 10),
        "assessments": [
            {
                "assessment_type": "BMI",
                "value": "17.8 kg/m2"
            },
            {
                "assessment_type": "Weight",
                "value": "52 kg"
            },
            {
                "assessment_type": "Albumin Level",
                "value": "2.8 g/dL"
            },
            {
                "assessment_type": "Dietary Intake",
                "value": "Poor - consuming less than 50% of meals"
            }
        ]
    }
]

section = NutritionSection(
    nutritional_statuses=nutritional_statuses,
    version=CDAVersion.R2_1
)

xml_element = section.build()

Tracking Nutritional Status Over Time¶

from ccdakit import NutritionSection, CDAVersion
from datetime import date

# Multiple status assessments showing progression
nutritional_statuses = [
    {
        "status": "Malnourished",
        "date": date(2025, 1, 1),
        "assessments": [
            {
                "assessment_type": "Weight",
                "value": "50 kg"
            },
            {
                "assessment_type": "BMI",
                "value": "17.2 kg/m2"
            }
        ]
    },
    {
        "status": "Improving nutritional status",
        "date": date(2025, 1, 15),
        "assessments": [
            {
                "assessment_type": "Weight",
                "value": "52 kg"
            },
            {
                "assessment_type": "BMI",
                "value": "17.9 kg/m2"
            }
        ]
    }
]

section = NutritionSection(
    nutritional_statuses=nutritional_statuses,
    version=CDAVersion.R2_1
)

xml_element = section.build()

Special Dietary Needs¶

from ccdakit import NutritionSection, CDAVersion
from datetime import date

nutritional_statuses = [
    {
        "status": "At nutritional risk - requires modified diet",
        "date": date(2025, 1, 20),
        "assessments": [
            {
                "assessment_type": "Diet Order",
                "value": "Mechanical soft diet"
            },
            {
                "assessment_type": "Fluid Consistency",
                "value": "Nectar thick liquids"
            },
            {
                "assessment_type": "Caloric Needs",
                "value": "2000 kcal/day"
            },
            {
                "assessment_type": "Protein Requirements",
                "value": "1.2 g/kg/day"
            }
        ]
    }
]

section = NutritionSection(
    nutritional_statuses=nutritional_statuses,
    version=CDAVersion.R2_1
)

xml_element = section.build()

Official Reference¶

HL7 C-CDA Nutrition Section Specification

Best Practices¶

Complete Assessment: Document comprehensive nutritional assessments including BMI, weight, albumin levels, and dietary intake.
Track Over Time: Document serial assessments to show trends in nutritional status, especially for at-risk patients.
Include Diet Orders: Document current diet orders and texture modifications (e.g., pureed, mechanical soft).
Specify Restrictions: Clearly document dietary restrictions (e.g., low-sodium, diabetic, renal diet).
Fluid Consistency: For patients with dysphagia, document required fluid consistency (thin, nectar, honey, pudding).
Caloric Requirements: Include calculated caloric and protein requirements when relevant.
Risk Factors: Document risk factors for malnutrition (poor intake, weight loss, medical conditions).
Supplementation: Document nutritional supplements, enteral nutrition, or parenteral nutrition if applicable.
Interdisciplinary Input: Incorporate input from registered dietitians and nutritionists when available.
Functional Impact: Note how nutritional status affects function (e.g., "weakness limiting mobility").

Common Nutritional Status Values¶

Well nourished: Patient meeting nutritional needs
At risk for malnutrition: Factors present that could lead to malnutrition
Mild malnutrition: Some nutritional deficits present
Moderate malnutrition: Significant nutritional deficits
Severe malnutrition: Critical nutritional deficits requiring intervention
Overweight/Obese: Excess body weight
Improving nutritional status: Responding to interventions

Common Assessment Types¶

BMI: Body Mass Index (kg/m2)
Weight: Current weight with trend
Albumin Level: Serum albumin (g/dL)
Prealbumin: More sensitive marker for acute changes
Dietary Intake: Percentage of meals consumed
Diet Order: Type of diet prescribed
Fluid Consistency: Required liquid thickness
Caloric Needs: Daily caloric requirements
Protein Requirements: Daily protein needs (g/kg/day)
Swallowing Assessment: Dysphagia screening results
Enteral Nutrition: Type and rate of tube feeding
Parenteral Nutrition: TPN formulation and rate