practice applications topics of professional interest · care process and includes a reference...

This article was written by Gabriele J.Gäbler, MSc, a dietitian and researchassociate, Section for OutcomesResearch, Center for Medical Statistics,Informatics, and Intelligent Systems,Medical University of Vienna, Vienna,Austria; Michaela Coenen, PhD, MPH,head, Research Unit for BiopsychosocialHealth, Department of MedicalInformatics, Biometry and Epidemi-ology, and chair, Public Health andHealth Services Research, Ludwig-Maximilians-University, München,Germany; Claudia Bolleurs, MSc, LD,policy advisor, Dutch Association ofDietitians, Houten, the Netherlands;Willy K. Visser, RD*, a dietitian,Department of Dietetics, Leiden Uni-versity Medical Centre, Leiden, theNetherlands; Sytske Runia, RD*, adietitian, Department of Dietetics,University Medical Centre Utrecht,Utrecht, the Netherlands; Yvonne F.Heerkens, PhD, program manager,Terminology and Technology, DutchInstitute of Allied Health Professions,and professor (lector), Occupation andHealth, Amersfoort, the Netherlands;and Tanja A. Stamm, PhD, professorand head of Section for OutcomesResearch, Center for Medical Statistics,Informatics, and Intelligent Systems,Medical University of Vienna, Vienna,Austria.

*Certified in the Netherlands.

Supplementary materials: Figure 1 and Table 2are available at www.andjrnl.org

http://dx.doi.org/10.1016/j.jand.2016.12.002

†The term e-healthhealth care practiceelectronic processes ation such as electroniwhich enables the copatient data betweencare professionals an(physical and psychoand treatments at a d

ª 2017 by the Academy of Nutrition and Dietetics. This is an open accessarticle under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

PRACTICE APPLICATIONS
Topics of Professional Interest
Toward Harmonization of the Nutrition CareProcess Terminology and the InternationalClassification of Functioning, Disability andHealth�Dietetics: Results of a Mapping Exerciseand Implications for Nutrition and DieteticsPractice and Research

QUALITY, CONTINUITY, ANDsafety are essential aspects ofall health care interventionsand are equally important in

e-health care†. In addition, e-health isincreasingly used in various settingsand new models of care in Europeancountries. The e-Health GovernanceInitiative founded by the EuropeanUnion has worked to establish a com-mon structure for e-health withinEurope to facilitate quality health carewithin countries and across borders.1,2

The Guidelines on Minimum/Non-Exhaustive Patient Summary Datasetfor Electronic Exchange in Accordancewith the Cross-Border Directive 2011/24/EU1 indicate that member stateswishing to engage in cross-bordercommunication may perform mapping,transcoding, and translation activitiesto support such activity. A major themeof this initiative is the semantic andtechnical interoperability of data,2

which is a high-priority target in nutri-tion and dietetics care as well.3 Toachieve interoperability of data, a stan-dardized nutrition and dietetics termi-nology is essential and should bemandatory for documentation in elec-tronic health records systems.4

Currently, two different nutritionand dietetics terminologies are used inEurope, namely the Nutrition CareProcess Terminology (NCPT),5 devel-oped by the Academy of Nutrition and

care refers tosupported by

nd communica-c health records,mmunication ofdifferent healthd Telemedicinelogical diagnosisistance).

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Dietetics, and the Classifications andCoding Lists for Dietetics (CCD),6

developed by the Dutch Association ofDietitians, in collaboration with theDutch Institute of Allied Health Care.The International Classification ofFunctioning, Disability and Health-�Dietetics (ICF-Dietetics)7 is the mostimportant classification of the CCD.

The NCPT is based on the NutritionCare Process and Model8-11 and isdesigned to improve the consistencyand quality of individualized or groupcare of individuals with any kind ofnutrition-related problems and di-agnoses. The NCPT defines standardterms for each step of the NutritionCare Process and includes a referencemanual providing definitions andimportant usage advice for each term.5

The development and continuousdissemination of a standardized lan-guage covering the Nutrition CareProcess began in 2003.12 The fourthedition of this terminology was pub-lished in 2013.13 Finally, the NCPT, theformer International Dietetics andNutrition Terminology, was publishedas an electronic version (eNCPT).5

During the development of NCPT, theAcademy of Nutrition and Dieteticsbegan including the terminology in theSystematized Nomenclature of Medi-cine International and in LogicalObservation Identifiers Names andCodes, and the International Classifi-cation of Diseases.5

Meanwhile, countries in Europe andworldwide, such as Sweden, Denmark,Norway, Switzerland, and Canada, havestarted to translate and implement theNCPT.5 An advantage of the NCPT for

DEMY OF NUTRITION AND DIETETICS 1

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the practicing registered dietitiannutritionist (RDN) is that it is a so-phisticated and specific nutrition anddietetics terminology covering thewhole Nutrition Care Process.The CCD is a standardized nutrition

and dietetics terminology consisting ofdifferent classifications and code lists,such as a classification to describe aperson’s functioning (ICF-Dietetics),a classification of procedures of RDNs, aclassification of assistive products forRDNs, a classification of medical termsfor RDNs, and several code lists.6 TheCCD has been developed to documentthe Dietetic Care Process,14,15 whichconsists of referral and nutrition/dietetics screening, nutrition/dieteticsassessment, dietetics diagnoses, treat-ment plan and intervention, evaluationand closing. In 1999, the first draft ofthe CCD16 was developed, followed bya first version of the CCD17 in 2003. In2012, a revision was published.6

The ICF-Dietetics, as the main clas-sification of the CCD, is based on theInternational Classification of Func-tioning, Disability and Health (ICF) andthe biopsychosocial Model of theWorld Health Organization (WHO).18,19

The ICF-Dietetics can be seen as a de-rivative of the ICF and contains most ofthe original ICF categories specified bythe ICF code, title, description and in-clusions and exclusions, and of addedspecific nutrition/dietetics categories.The advantage of the ICF is the appli-cability by different health pro-fessionals. In addition, the ICF helps toachieve a common understanding ofassessment, intervention targets, andevaluation.20 The joint use of the ICFand the International Classification ofDiseases,21 in order to complementmedical diagnosis with information onfunctioning and health-related infor-mation, is recommended by WHO andis true for the ICF-Dietetics as well.The ICF-Dietetics is currently used by

dietitians in the Netherlands andBelgium. It has been accepted by theDutch WHO Collaborating Centre forthe Family of International Classifica-tions solely. Due to its multidisciplinaryapplicability of the ICF, Austria andother European Countries (eg, Ger-many) are considering implementingthe ICF-Dietetics.The aims of this article were to

describe and discuss how interopera-bility and harmonization could influ-ence nutrition/dietetics practice and

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research on the one hand, and, on theother hand, provide information on aunidirectional mapping exercise fromthe NCPT to the ICF-Dietetics.

PRACTICE IMPLICATIONSThe use of a standardized terminologywill enhance communication, trans-parency, and measurability of the careprocess and its evaluation in termsof reimbursement and paymentsystems.22 Moreover, a standardizedterminology enables the comparisonand interpretation of health care re-sults or different studies across coun-tries and would allow the creation of anew body of knowledge on effective-ness and efficiency of nutrition anddietetic care.12,22,23

Thus, a consequent use of a stan-dardized terminology within countriesis an important step in quality nutri-tion/dietetics care. Inadequate orinconsistent documentation of thenutrition/dietetics care process withambiguous terminology or differentmeanings of terms will have a negativeimpact on quality.22,23 Furthermore,documented care data are comparableonly if the terms used to describe thecare process have the same definitionsand understanding among RDNs. Thismakes data pooling meaningful at bothnational and international levels. Theseare prerequisites for making qualityhealth care available to every person infuture. Therefore, interoperability andharmonization of the nutrition anddietetics terminologies are needed.

What Is Interoperability?The European Committee for Standardi-zationdefines interoperabilityasaprocessin which “an application can accept datafrom another and perform a specifiedtask in an appropriate and satisfactorymanner (as judged by the user of thereceiving system) without the need forextra operator intervention.”24 Further-more, semantic interoperability “meansthat data shared by systems are under-stood by these at the level of fully defineddomain concepts.” This includes that themeaning of exchanged information isunambiguously interpretable.24

Prerequisites for semantic interoper-ability and data sharing are a standard-ized terminology and a correspondingclassification. For example, in a cross-border setting, it is agreed that it is

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necessary to have structured and codeddata for identified fields.1

What Is Harmonization?In the context of this article, two defi-nitions of harmonization were consid-ered that have been proposed bythe International Organization forStandardization: concept harmoniza-tion and term harmonization.

Concept harmonization means “thereduction or elimination of minor dif-ferences between two or more closelyrelated concepts, without transferringa concept system to another lan-guage.”25 It involves the comparisonand matching of concepts and conceptsystems in one or more languages orsubject fields by describing similaritiesand differences. Term harmonization, onthe other hand, “refers to the designa-tion of a single concept (in differentlanguages) by terms that reflect similarcharacteristics or similar forms.” Termharmonization is possible if the con-cepts that the terms represent arealmost the same or very similar.25

Why Are Interoperability andHarmonization Important to theProfession of RDNs?Electronic data storage and processingand exchange of data within a countryas well as across country borders areincreasingly important topics inhealth care. These issues are primarilydriven by high quality, continuity, andquantity aspects—for example, bigdata initiatives.1 Currently, health in-surance and population-based datasets are increasingly used to enhanceclinical practice and research in orderto answer advanced clinical questionsthat can only be analyzed based onlarge data sets. RDNs should keepon track with this health informa-tion technology developments andchanges.

RDNs apply the Nutrition/Dietetic CareProcess in their clinical practice. Thisprocess was designed to improve consis-tency and quality of nutrition/dieteticscare, as well as to assess outcomes.9,13

Semantic interoperability of data isnecessary to link the Nutrition/DieteticCare Process to a valid outcome manage-ment system. To achieve semantic inter-operability, a standardized nutrition anddietetics terminology as well as a codingsystem for documentation are needed.

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Figure 2. Process of Nutrition Care Practice Terminology (NCPT)/International Classification of Functioning, Disability and Health(ICF)�Dietetics mapping exercise.


Outcomes research and cross-bordercare are reasons why harmonization ofnutrition/dietetics care data acrosscountries and different languages willbecome more important in the future.Harmonization improves effective andefficient nutrition/dietetics care anddevelopment of informed evidenceby means of benchmark and goodpractice models. In accordance withthe two definitions given here, thefollowing two different aspects of thisharmonization have to be considered:Firstly, harmonization is necessary inthe cross-cultural adoption processwhen translating a standardizednutrition and dietetics terminologyfrom the source into a target lang-uage. Ensuring equivalence involves


maintaining the same meaning of theword or concept between the sourceand target languages. Equivalence isachieved through interpretation,which goes beyond word-for-wordtranslation in order to explain themeaning of concepts using under-standable terms and the grammaticalrules of the target language.26 Sec-ondly, because there are currently twodifferent standardized nutrition anddietetics terminologies used, for inter-operability and joint use, conceptharmonization between these twoterminologies is indispensable.Inter-terminology mapping or linking

is a common method to compare termi-nologies.26-28 This method describes notonly whether there are comparable

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concepts, it also defines the gap, a po-tential different understanding of con-cepts and terms, and visualizes whichterms and concepts are needed to beharmonized. Thus, mapping can be seenas a first step in a harmonizationprocess.25

Mapping of the NCPT to theICF-DieteticsThe mapping exercise was carried outusing the online version, eNCPT 2015,5

and the ICF-Dietetics (Dutch DieteticAssociation andDutch Institute of AlliedHealth Care, ICF-Dietetics Draft-aversion, unpublished data, 2012), as itwas the only available English version.However, this version was presented to


Table 1. Nutrition Care Practice Terminology (NCPT)/International Classification of Functioning, Disability and Health(ICF)�Dietetics mapping: Definition and example of closeness-of-matched categories (granularity)

Closeness ofmatchedcategories Definitiona Example NCPT ICF-DieteticsLlinked categories

Same The term in the NCPT is nearlyidentical in wording and concept tothe ICF term

PD-1.1.5.13Epigastric pain

b28012 Pain in stomach orabdominalb

b280120 Pain in stomachc

Similar The term is comparable: or “alike insubstance”

FH-1.2.2.3Meals/snack pattern

d5701 Managing diet and fitnessb

a570100 Selecting and consumingmealsc

Broader The term is larger in scope, or lessspecific, or can be considered toencompass the term in the ICF

PD-1.1.20.3Difficulty moving tongue

b5103 Manipulation of food in themouthc

Narrower The term is smaller in scope, or morespecific, or can be considered to beencompassed by the ICF term

BD-1.4.29Gastric emptying time

b5150 Transport of food throughstomach and intestinesc

b51500 Transport of food throughstomachc

aAdapted from Zielstorff and colleagues.36bICF-Dietetics original ICF category,cAdded, more-precise dietetics category: The ICF-Dietetics consists of original ICF categories and additional specific dietetics categories. The table depicts the original ICF categories and theadded specific dietetics categories in case a more-precise added dietetics category was available.


allmembers of the European Federationof the Associations of Dietitians and alsoto a workgroup of the InternationalConfederation of Dietetic Associations.The specific objectiveswere to explore

howmany and which terms of the NCPTare covered by the ICF-Dietetics, distin-guished between the original ICF cate-gories and the added specific dieteticscategories, furthermore, to highlightsimilarities and differences.In total, the NCPT contains 1,276

NCPT terms, namely of 816 “nutritionassessment, monitoring and evalua-tion” terms (including 52 “comparativestandards”), 160 “diagnosis” terms, and300 “intervention” terms. Because ICFis not designed to classify interventionsand comparative standards, 764“assessment, monitoring and evalua-tion” (without “comparative stan-dards”) and 160 “diagnoses” termswere selected for the mapping process(n¼924).The NCPT is organized in a hierar-

chical structure with domains, classes,sub-classes, and, in parts, sub-sub-classes. The smallest unit of the NCPTis the termwith an alpha-numeric codethat consists of the prefix of thedomain and the number of the hierar-chical structure. For example, the


diagnosis domain “Intake (NI)” isfurther classified with the class, forexample, “Nutrient (5),” further withthe sub-class “Fat and Cholesterol(5.6)” and finally the term “InadequateFat Intake (NI-5.6.1).”The ICF (as main part of the ICF-

Dietetics) was used for the mappingas standard. The ICF is a core classifi-cation of WHO, is used worldwide, andhas been used in numerous studies asstandard for mapping exercises.29-32

The ICF is structured hierarchicallywith a numeric code that begins withthe chapter number (one digit) fol-lowed by the second level (threedigits), and the third and fourth levels(one digit each). The ICF has two parts.Part one covers functioning anddisability and includes two compo-nents “Body Functions (b)”/“BodyStructures (s),” and “Activities/Partici-pation (d).” Part two covers contextualfactors that include the components“Environmental Factors (e)” and “Per-sonal Factors (pf).”19 Although PersonalFactors has not yet been classified inthe ICF.The ICF-Dietetics enlarges the ICF by

adding codes and categories addressingnutrition and dietetics�related issues.Moreprecisely, the ICF-Dietetics includes

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900 specific nutrition/dietetics cate-gories inaddition to approximately1,000of the original ICF categories. Theseenhance the granularity in this field. Anexample of the hierarchical structure ofthe ICF-Dietetics and its underlyingmodel is shown in Figure 1 (availableonline at www.andjrnl.org). In contrastto the ICF, the ICF-Dietetics proposescategories addressing biochemical data,differentiates between “Activities (a)”and “Participation (p),” and provides afirst draft of codes covering “PersonalFactors (pf).”

Method of the Mapping ExerciseThe mapping exercise was basedon well-established ICF-LinkingRules.33,34 The first author (G.G.), aclinical and research dietitian trainedin ICF linking, performed the entiremapping process of 924 NCPT terms.Each term/concept was linked to themost precise ICF-Dietetics category. Aspecific dietetic category was assignedin case a more precise dietetics cate-gory, compared to the original ICFcategories, was available. If NCPTterms comprised more than oneconcept, every single concept waslinked to the ICF-Dietetics, meaning



Figure 3. Nutrition Care Practice Terminology (NCPT)/International Classification ofFunctioning, Disability and Health (ICF)�Dietetics mapping: decision process (adaptedfrom Cieza and colleagues33) complemented with closeness-of-match categories(adapted from Zielstorff and colleagues36).


that one NCPT term could be linked tomore than one ICF-Dietetics category.For quality assurance, 15% of the NCPTterms were randomly selected andlinked by a second researcher (M.C.,psychologist) experienced in linkinghealth-related data to the ICF. Per-centage agreement with 95% CI andCohen’s k35 between the two linkerswas calculated to verify the qualityof the mapping. In addition, fourmembers of the Dutch CCD committee(C.B., W.K.V., S.R., and Y.F.H.) involvedin the development of the ICF-Dietetics, reviewed about 15% of themapping results, which were chosenbecause of mapping difficulties anddisagreements between the two raters(G.G. and M.C.). If unclear meanings


regarding the NCPT terms werebrought up, requests for clarificationwere mailed to Naomi Trostler, PhD,RD, FAND, one of the developers of theNCPT. Based on this additional infor-mation, a final consensus for themapping results was reached by thetwo researchers (G.G. and M.C.).Figure 2 illustrates the process ofmapping exercise.According the ICF-Linking Rules,34

concepts that could not be linked toan ICF category and that were clearlynot personal factors were assigned “notcovered (nc).” If the information aboutthe NCPT term was not sufficient tomake a decision about the most preciseICF-Dietetics category, the concept wasassigned “not definable (nd).” If the

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NCPT term referred to a medical diag-nosis or a health condition according tothe International Statistical Classifica-tion of Diseases and Related HealthProblems, 10th revision,21 it wasassigned “health condition (nc-hc).” Inaddition to the ICF-Linking Rules, thecloseness of the match with respect tocomparable concepts was described byusing “same,” “similar,” “broader,” and“narrower,” which is adapted fromZielstorff and colleagues.36 Table 1shows definitions and examples ofthese closeness-of-match categories.Figure 3 depicts the entire mappingdecision process.

What Are the Major Findings?A total of 960 NCPT concepts werelinked. Of these concepts 830 (86.5%)matched with a corresponding ICF-Dietetics category, namely, 259 NCPTconcepts (31.2%) with an original ICFcategory and 571 NCPT concepts(68.8%) with a more precise dieteticscategory. Figure 4 illustrates the fre-quencies of matched NCPT conceptsregarding NCPT domains and the cor-responding ICF components.

The mapping exercise demonstratesimilarities and differences, in terms of310 “same” concepts (37.3%) and 55(6.6%) concepts of “similar” granularity,whereas 433 (52.2%) of the NCPT termswere more specific (“narrower”) and32 (3.9%) less specific (“broader”) thanthe ICF-Dietetics categories. One hun-dred thirty NCPT terms (13.5%) couldnot be linked to a specific ICF-Dieteticscategory. Of these terms, 103 (79.2%)were assigned to “health condition,” 25(19.2%) to “not definable,” and two(1.5%) to “not covered” (NO-1.1: NoNutrition Diagnosis at This Time andFH-2.1.3.5: Eats Alone).

The actual mapping results of Nutri-tion Diagnostic Terminology have beenprovided as Table 2 (available online atwww.andjrnl.org).

Accuracy of Mapping ProcessThe two researchers agreed on 83.3%(95% CI 76.3 to 89.7) of the linkedconcepts at component level. Thecalculated k coefficients ranged be-tween 0.76 at the component and 0.61at the fourth level of the ICF-Dieteticsclassification. These results can, there-fore, be regarded as substantialagreement.37



Figure 4. Nutrition Care Practice Terminology (NCPT)/International Classification of Functioning, Disability and Health (ICF)�Di-etetics mapping results: Frequencies of 830 mapped concepts regarding NCPT domains and ICF components. The ovals representNCPT domains and rectangles represent ICF components. Dark black arrows show to which ICF component the NCPT concepts ofeach domain were mainly linked. The additional dotted arrows indicate frequencies <20%.


What Were the Challenges andLimitations of the MappingProcess?

Although the mapping process isexplained in the literature and could,thus, be well planned and structured,we still faced some challenges. The ICF-Dietetics describes the actual situationof individuals at one point in time, notthe future or past, and no causal re-lationships between domains of func-tioning. Thus, we linked, for example,NI-1.4: Predicted Inadequate EnergyIntake to the ICF-Dietetics categorya570103: Managing Intake of Energy,and PD-1.1.10.8: Hair Changes Due toMalnutrition to b850: Functions ofHair. In practical use of the ICF-Dietetics, notes should be added todocument the time point(s) of theassessment or causal relationships.Furthermore, the ICF-Dietetics is

about functioning and contextual fac-tors of the individual. Assistive prod-ucts, like tests or questionnaires fornutrition diagnostics, are described inthe Classification Assistive Products forDietetics, and interventions aredescribed in the Classification In-terventions for Dietetics.17 The NCPT,however, also includes tests and med-ical interventions. For our mappingexercise, we applied the followingquestions when linking these tests orinterventions: What is the aim of this


intervention? What is assessed/testedwith this test? This was done inagreement with the published ICF-Linking Rules.33

In addition, there were NCPT termsthat can be linked to different ICF-Dietetics categories, for example, NI-4.3: Excessive Alcohol Intake waslinked to a57022: Avoiding Risks ofDrug or Alcohol Addiction and to theICF-Dietetics component Personal Fac-tors, having in mind personal habitswith regard to the use of alcohol. Inthese cases, we documented bothpossible linking opportunities.Limitations of this study were that

we have mapped NCPT terms to theICF-Dietetics and not the other wayaround, and not to other classificationsof the CCD. This means that this studydoes not give detailed insight in termsof the ICF-Dietetics, which are notcovered in the NCPT, and not whichterms of the NCPT are covered by otherclassifications of the CCD. However, ourstudy provides the first contentcomparison of the NCPT and theICF-Dietetics. It is a first step toharmonize the currently used nutritionand dietetics terminologies.

What Can We Learn from ThisStudy?The mapping of the NCPT to the ICF-Dietetics shows that although both

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terminologies have different purposesand are based on different models, thegreat majority of the NCPT terms(86.5%) could be linked to correspond-ing ICF-Dietetics categories. That in-dicates that two standardizedterminologies that illustrate the sameprocess came largely to similar results.

The original ICF categories of the ICF-Dietetics cover the NCPT terms in avery nonspecific manner, while themore-specific added dietetic categoriesprovide more specialization in the areaof nutrition and nutrition-related as-pects; for example, managing nutritionand diet and digestive functions. It isimportant to emphasize that the ICFhas been established as a commonlanguage for describing health andhealth-related states in order toimprove communication betweendifferent users.19 It is a framework andreference system that describes func-tioning and contextual factors of peo-ple with all kinds of health conditionsor health-related problems. Therefore,the ICF-Dietetics does not cover thewhole nutrition/dietetics care process,as the NCPT does.

However, the NCPT has a mainlybiomedical approach; about two-thirdsof the NCPT terms were linked to theICF-Dietetics components “Body Func-tions,” “Body Structures,” and “HealthConditions.” ICF-Dietetics provide aframework and classification based



on the biopsychosocial perspective,covering additional “Activities andParticipation” and “EnvironmentalFactors” categories.In addition, the mapping exercise

indicates that NCPT terms were likelyto be more granular than categoriesfrom the ICF-Dietetics (eg, FH.1.5.3.5:Gluten Intake was linked to the ICF-Dietetics proposed category a5701021:Managing Intake of Protein and FH-1.5.1.2: Saturated Fat Intake toa5701020: Managing Intake of Fat). TheNCPT terms describe precisely thewhole care process. This is an advan-tage for the practicing RDN comparedto the sole use of the ICF-Dietetics.However, the ICF-Dietetics in theNetherlands is used in combinationwith other classifications, such as theClassifications of Assistive Products.17

This makes it possible to define thespecific type of protein and fat.Finally, the NCPT provides specific,

validated, nutrition diagnosis termi-nology.38,39 Nutrition diagnosis isdefined by the Academy of Nutritionand Dietetics as “existing nutritionproblems that the food and nutri-tion professional is responsible fortreating.”10 In the Netherlands, thediagnosis of the dietitian is formulatedas the “professional specific judgmentabout the health profile of theclient.”14,15,40 The ICF-Dietetics can beemployed to describe and code (prob-lems in) functioning and the negativeand positive influence of contextualfactors (environmental and personal)using qualifiers. Qualifiers are addi-tional digits that can be used to indi-cate the severity of problems, in termsof impairments in body functions orstructures, limitations in activities,and restrictions in participation.19,40

Despite these differences, nearly allNCPT diagnosis terms were linked toICF-Dietetics categories, just in theirneutral form. In this study, no use wasmade of the possibility to add quali-fiers. For example, NB-2.4: ImpairedAbility to Prepare Foods/Meals wasmapped to the ICF category a630: Pre-paring Meals. Further information andthe actual mapping results of thesediagnosis terms are provided in Table 2(available online at www.andjrnl.org).

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22. Hakel-Smith N, Lewis NM. A standardizednutrition care process and language areessential components of a conceptualmodel to guide and document nutritioncare and patient outcomes. J Am DietAssoc. 2004;104(12):1878-1884.

23. Hakel-Smith N, Lewis NM, Eskridge KM.Orientation to nutrition care processstandards improves nutrition care docu-mentation by nutrition practitioners. J AmDiet Assoc. 2005;105(10):1582-1589.

24. Joint Initiative for Global StandardsHarmonization Health Informatics Docu-ment Registry and Glossary Stan-dards Knowledge Management Tool.http://www.skmtglossary.org/default.aspx.Accessed July, 2016.

25. ISO TC 37/SC 1. ISO 860:2007 TerminologyWork—Harmonization of Concepts andTerms.3rd ed. London, UK: International Organi-zation for Standardization (ISO); 2007.

26. Kim TY, Coenen A. Toward harmonisingWHO international classifications: Anursing perspective. Inform Health SocCare. 2011;36(1):35-49.

27. Kim TY, Hardiker N, Coenen A. Inter-ter-minology mapping of nursing problems.J Biomed Inform. 2014;49:213-220.

28. Wieteck P. Furthering the development ofstandardized nursing terminologythrough an ENP�-ICNP� cross-mapping.Int Nurs Rev. 2008;55(3):296-304.

29. Stamm TA, Cieza A, Machold KP, Smolen JS,StuckiG.Content comparisonofoccupation-based instruments in adult rheumatologyandmusculoskeletal rehabilitation based onthe International Classification of Func-tioning, Disability and Health. ArthritisRheum. 2004;51(6):917-924.

30. Stamm TA, Mattsson M, Mihai C, et al. Con-cepts of functioning andhealth important topeoplewith systemic sclerosis: A qualitativestudy in four European countries. AnnRheum Dis. 2011;70(6):1074-1079.

31. Coenen M, Kus S, Rudolf K-D, et al. Dopatient-reported outcome measurescapture functioning aspects and environ-mental factors important to individuals



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with injuries or disorders of the hand?J Hand Ther. 2013;26(4):332-342; quiz 342.

32. Stucki A, Borchers M, Stucki G, Cieza A,Amann E, Ruof J. Content comparison ofhealth status measures for obesity basedon the international classification offunctioning, disability and health. Int JObes. 2006;30(12):1791-1799.

33. CiezaA, FayedN, Bickenbach J, Prodinger B.Refinements of the ICF Linking Rules tostrengthen their potential for establishingcomparability of health information [pub-lished online ahead of print March 17,2016]. Disabil Rehabil. 2016:1-10. http://dx.doi.org/10.3109/09638288.2016.1145258.


34. Cieza A, Geyh S, Chatterji S, Kostanjsek N,Üstün B, Stucki G. ICF linking rules: Anupdate based on lessons learned. J RehabilMed. 2005;37(4):212-218.

35. Cohen J. A coefficient of agreement fornominal scales. Educ Psychol Meas.1960;20:37-46.

36. Zielstorff RD, Tronni C, Basque J,Griffin LR, Welebob EM. Mapping nursingdiagnosis nomenclatures for coordinatedcare. Image J Nurs Sch. 1998;30(4):369-373.

37. Landis JR, Koch GG. The measurement ofobserver agreement for categorial data.Biometrics. 1977;33:159-174.

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38. Ritter-Gooder P, Lewis NM. Content val-idity of nutrition diagnostic term invol-untary weight loss. J Am Diet Assoc.2009;109(9):A22.

39. Ritter-Gooder PK, Lewis NM,Eskridge KM. Content validation of astandardized language diagnosis bycertified specialists in gerontologicalnutrition. J Am Diet Assoc. 2011;111(4):561-566.

40. Runia S, Tiebie J, Visser W. Dietischediagnose onmisbaar bij effectievebehandeling: volg de logica: Probleem-doel-advies. Nederlands tijdschrift voorvoeding en dietetiek; 2010:20-22.

DISCLOSURESSTATEMENT OF POTENTIAL CONFLICT OF INTERESTNo potential conflict of interest was reported by the authors.

FUNDING/SUPPORTThere is no funding to disclose.

ACKNOWLEDGEMENTSThe authors thank both developers of the NCPT, Naomi Trostler, PhD, RD, FAND, and Esther Myers, PhD, RDN, FAND, for their contributions tothis study.










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Figure 1. Nutrition Care Practice Terminology (NCPT)5/International Classification of Functioning, Disability and Health (ICF)�Dietetics (Dutch Dietetic Association and Dutch Institute of Allied Health Care, ICF-Dietetics Draft-a version, unpublished data, 2012)mapping. The ICF-Dietetics is based on the Biopsychosocial Model of Functioning and Disability and on the hierarchical structure ofthe ICF.19 The figure depicts the interactions between components of the ICF (Body Functions/Body Structures, Activities, Partic-ipation, Environmental Factors, Personal Factors) and an example of the hierarchical structure of original ICF categories and addedmore precise dietetics categories (highlighted in red). The ICF describes human functioning from different perspectives (BodyFunctions/Body Structures and Activities/Participation) that is influenced on the one hand by health conditions (classified with theInternational Statistical Classification of Diseases and Related Health Problems, 10th revision21) and, on the other hand, bycontextual factors (Environmental and Personal factors). Each ICF component is organized in a hierarchical structure. TheICF-Dietetics enlarges the original ICF by adding categories and codes (highlighted in red) addressing nutrition anddietetics�related issues to enhance the granularity in this field. Throughout the whole ICF-Dietetics, the hierarchical structure of theICF is maintained and further lower (more detailed) levels are added. Adapted and reprinted from: International Classification ofFunctioning, Disability and Health: ICF. Geneva, Switzerland: World Health Organization; page 18, Copyright 2001.19


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Table 2. Nutrition Care Practice Terminology (NCPT)5/International Classification of Functioning, Disability and Health (ICF)�Dietetics (Dutch Dietetic Association and DutchInstitute of Allied Health Care, ICF-Dietetics Draft-a version, unpublished data, 2012) mapping result of 160 Nutrition Care Practice Terminology nutrition diagnostic termsa

NCPT termDomain/class

NCPTterm no.

ICF type ofcategory ICF-Dietetics category

ICF-Dieteticscode

Closenesscategoryb

Not-matchedcategoryc

Nutrition diagnostic terminology

Intake NI

Energy balance 1

Increased energy expenditure NI-1.1 Added ICF-Dietetics Increased need for energy b5404.x2 Same

Inadequate energy intake NI-1.2 Added ICF-Dietetics Managing intake of energy accordingto RGVd

a570103 Same

Excessive energy intake NI-1.3 Added ICF-Dietetics Managing intake of energy accordingto RGV

a570103 Same

Predicted inadequate energyintake

NI-1.4 Added ICF-Dietetics Managing intake of energy accordingto RGV

a570103 Same

Predicted excessive energyintake

NI-1.5 Added ICF-Dietetics Managing intake of energy accordingto RGV

a570103 Same

Oral or nutrition support intake 2

Inadequate oral intake NI-2.1 Added ICF-Dietetics Managing nutrition according to RGV a57010 Narrower

Excessive oral intake NI-2.2 Added ICF-Dietetics Managing nutrition according to RGV a57010 Narrower

Inadequate enteral nutritioninfusion

NI-2.3 Added ICF-Dietetics Managing use of diet products, dietpreparations and nutritionalsupplements

a570111 Narrower

Excessive enteral nutritioninfusion


a570111 Narrower

Enteral nutrition compositioninconsistent with needs


a570111 Narrower

Enteral nutrition administrationinconsistent with needs


a570111 Narrower

Inadequate parenteral nutritioninfusion


a570111 Narrower

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Excessive parenteral nutritioninfusion


a570111 Narrower

Parenteral nutrition compositioninconsistent with needs


a570111 Narrower

Parenteral nutritionadministration inconsistentwith needs


a570111 Narrower

Limited food acceptance NI-2.11 Added ICF-Dietetics Motivation to eat b13010 Narrower

Fluid intake 3

Inadequate fluid intake NI-3.1 Added ICF-Dietetics Managing intake of fluids according toRGV

a5701023 Same

Excessive fluid intake NI-3.2 Added ICF-Dietetics Managing intake of fluids according toRGV

a5701023 Same

Bioactive substances 4

Inadequate bioactive substanceintake

NI-4.1 Added ICF-Dietetics Managing intake of nutrientsaccording to RGV otherspecifiede: bioactive substance

a5701028 Same

Inadequate plant stanol esterintake

NI-4.1.1 Added ICF-Dietetics Managing intake of nutrientsaccording to RGV other specified:plant stanol ester

a5701028 Same

Inadequate plant sterol esterintake

NI-4.1.2 Added ICF-Dietetics Managing intake of nutrientsaccording to RGV other specified:plant sterol ester

a5701028 Same

Inadequate soy protein intake NI-4.1.3 Added ICF-Dietetics Managing intake of nutrientsaccording to RGV other specified:soy protein

a5701028 Same

Inadequate psyllium intake NI-4.1.4 Added ICF-Dietetics Managing intake of nutrientsaccording to RGV, other specified:Inadequate psyllium

a5701028 Same


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ICF-Dieteticscode

Closenesscategoryb


Inadequate b-glucan intake NI-4.1.5 Added ICF-Dietetics Managing intake of nutrientsaccording to RGV, other specified:b-glucan

a5701028 Same

Excessive bioactive substanceintake

NI-4.2 Added ICF-Dietetics Managing intake of nutrientsaccording to RGV, other specified:bioactive substance

a5701028 Same

Excessive plant stanol esterintake

NI-4.2.1 Added ICF-Dietetics Managing intake of nutrientsaccording to RGV, other specified:plant stanol ester

a5701028 Same

Excessive plant sterol ester intake NI-4.2.2 Added ICF-Dietetics Managing intake of nutrientsaccording to RGV, other specified:plant sterol ester

a5701028 Same

Excessive soy protein intake NI-4.2.3 Added ICF-Dietetics Managing intake of nutrientsaccording to RGV, other specifiedsoy protein

a5701028 Same

Excessive psyllium intake NI-4.2.4 Added ICF-Dietetics Managing intake of nutrientsaccording to RGV, other specified:psyllium

a5701028 Same

Excessive b-glucan intake NI-4.2.5 Added ICF-Dietetics Managing intake of nutrientsaccording to RGV, other specified:b-glucan

a5701028 Same

Excessive food additive intake NI-4.2.6 Added ICF-Dietetics Managing intake of nutrientsaccording to RGV, other specified:food additive

a5701028 Same

Excessive caffeine intake NI-4.2.7 Added ICF-Dietetics Managing intake of nutrientsaccording to RGV, other specified:caffeine

a5701028 Same

Excessive alcohol intake NI-4.3 Added ICF-Dietetics Excessive use of alcohol at thismoment

pf615.x2 Same

Added ICF-Dietetics Avoiding risks of drug or alcoholaddiction

a57022 Same


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Nutrient 5

Increased nutrient needs NI-5.1 Added ICF-Dietetics Need for nutrients b5405 Same

Inadequate protein-energy intake NI-5.2 Added ICF-Dietetics Managing intake of protein accordingto RGV

b5405 Similar

Decreased nutrient needs NI-5.3 Added ICF-Dietetics Need for nutrients b5405 Same

Imbalance of nutrients NI-5.4 Added ICF-Dietetics Managing intake of nutrientsaccording to RGV

a570102 Same

Fat and cholesterol 5.5

Inadequate fat intake NI-5.5.1 Added ICF-Dietetics Managing intake of fat according toRGV

a5701020 Same

Excessive fat intake NI-5.5.2 Added ICF-Dietetics Managing intake of fat according toRGV

a5701020 Same

Intake of types of fatsinconsistent with needs

NI-5.5.3 Added ICF-Dietetics Managing intake of fat according toRGV

a5701020 Narrower

Protein 5.6

Inadequate protein intake NI-5.6.1 Added ICF-Dietetics Managing intake of protein accordingto RGV

a5701021 Same

Excessive protein intake NI-5.6.2 Added ICF-Dietetics Managing intake of protein accordingto RGV

a5701021 Same

Intake of types of proteinsinconsistent with needs

NI-5.6.3 Added ICF-Dietetics Managing intake of protein accordingto RGV

a5701021 Narrower

Amino acid 5.7

Intake of types of amino acidsinconsistent with needs

NI-5.7.1 Added ICF-Dietetics Managing intake of protein accordingto RGV

a5701021 Narrower

Carbohydrate and fiber 5.8

Inadequate carbohydrate intake NI-5.8.1 Added ICF-Dietetics Managing intake of carbohydratesaccording to RGV

a5701022 Same

Excessive carbohydrate intake NI-5.8.2 Added ICF-Dietetics Managing intake of carbohydratesaccording to RGV

a5701022 Same


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ICF-Dieteticscode

Closenesscategoryb


Intake of types of carbohydrateinconsistent with needs

NI-5.8.3 Added ICF-Dietetics Managing intake of carbohydratesaccording to RGV

a5701022 Narrower

Inconsistent carbohydrate intake NI-5.8.4 Added ICF-Dietetics Managing intake of carbohydratesaccording to RGV

a5701022 Narrower

Inadequate fiber intake NI-5.8.5 Added ICF-Dietetics Managing intake of carbohydratesaccording to RGV

a5701022 Narrower

Excessive fiber intake NI-5.8.6 Added ICF-Dietetics Managing intake of carbohydratesaccording to RGV

a5701022 Narrower

Vitamin 5.9

Inadequate vitamin intake NI-5.9.1 Added ICF-Dietetics Managing intake of vitaminsaccording to RGV

a5701024 Same

A NI-5.9.1.1 Added ICF-Dietetics Managing intake of vitaminsaccording to RGV

a5701024 Narrower

C NI-5.9.1.2 Added ICF-Dietetics Managing intake of vitaminsaccording to RGV

a5701024 Narrower

D NI-5.9.1.3 Added ICF-Dietetics Managing intake of vitaminsaccording to RGV

a5701024 Narrower

E NI-5.9.1.4 Added ICF-Dietetics Managing intake of vitaminsaccording to RGV

a5701024 Narrower

K NI-5.9.1.5 Added ICF-Dietetics Managing intake of vitaminsaccording to RGV

a5701024 Narrower

Thiamin NI-5.9.1.6 Added ICF-Dietetics Managing intake of vitaminsaccording to RGV

a5701024 Narrower

Riboflavin NI-5.9.1.7 Added ICF-Dietetics Managing intake of vitaminsaccording to RGV

a5701024 Narrower

Niacin NI-5.9.1.8 Added ICF-Dietetics Managing intake of vitaminsaccording to RGV

a5701024 Narrower

Folate NI-5.9.1.9 Added ICF-Dietetics Managing intake of vitaminsaccording to RGV

a5701024 Narrower

B-6 NI-5.9.1.10 Added ICF-Dietetics Managing intake of vitaminsaccording to RGV

a5701024 Narrower


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a5701024 Narrower

Pantothenic acid NI-5.9.1.12 Added ICF-Dietetics Managing intake of vitaminsaccording to RGV

a5701024 Narrower

Biotin NI-5.9.1.13 Added ICF-Dietetics Managing intake of vitaminsaccording to RGV

a5701024 Narrower

Excessive vitamin intake NI-5.9.2 Added ICF-Dietetics Managing intake of vitaminsaccording to RGV

a5701024 Same

A NI-5.9.2.1 Added ICF-Dietetics Managing intake of vitaminsaccording to RGV

a5701024 Narrower

C NI-5.9.2.2 Added ICF-Dietetics Managing intake of vitaminsaccording to RGV

a5701024 Narrower

D NI-5.9.2.3 Added ICF-Dietetics Managing intake of vitaminsaccording to RGV

a5701024 Narrower

E NI-5.9.2.4 Added ICF-Dietetics Managing intake of vitaminsaccording to RGV

a5701024 Narrower

K NI-5.9.2.5 Added ICF-Dietetics Managing intake of vitaminsaccording to RGV

a5701024 Narrower

Thiamin NI-5.9.2.6 Added ICF-Dietetics Managing intake of vitaminsaccording to RGV

a5701024 Narrower

Riboflavin NI-5.9.2.7 Added ICF-Dietetics Managing intake of vitaminsaccording to RGV

a5701024 Narrower

Niacin NI-5.9.2.8 Added ICF-Dietetics Managing intake of vitaminsaccording to RGV

a5701024 Narrower

Folate NI-5.9.2.9 Added ICF-Dietetics Managing intake of vitaminsaccording to RGV

a5701024 Narrower


a5701024 Narrower


a5701024 Narrower


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ICF-Dieteticscode

Closenesscategoryb


Pantothenic acid NI-5.9.2.12 Added ICF-Dietetics Managing intake of vitaminsaccording to RGV

a5701024 Narrower

Biotin NI-5.9.2.13 Added ICF-Dietetics Managing intake of vitaminsaccording to RGV

a5701024 Narrower

Mineral 5.10

Inadequate mineral intake NI-5.10.1 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Same

Calcium NI-5.10.1.1 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Chloride NI-5.10.1.2 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Iron NI-5.10.1.3 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Magnesium NI-5.10.1.4 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Potassium NI-5.10.1.5 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Phosphorus NI-5.10.1.6 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Sodium NI-5.10.1.7 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Zinc NI-5.10.1.8 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Sulfate NI-5.10.1.9 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Fluoride NI-5.10.1.10 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Copper NI-5.10.1.11 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Iodine NI-5.10.1.12 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower


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Selenium NI-5.10.1.13 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Manganese NI-5.10.1.14 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Chromium NI-5.10.1.15 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Molybdenum NI-5.10.1.16 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Boron NI-5.10.1.17 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Cobalt NI-5.10.1.18 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Excessive mineral intake NI-5.10.2 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Same

Calcium NI-5.10.2.1 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Chloride NI-5.10.2.2 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Iron NI-5.10.2.3 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Magnesium NI-5.10.2.4 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Potassium NI-5.10.2.5 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Phosphorus NI-5.10.2.6 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Sodium NI-5.10.2.7 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Zinc NI-5.10.2.8 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower


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Sulfate NI-5.10.2.9 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Fluoride NI-5.10.2.10 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Copper NI-5.10.2.11 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Iodine NI-5.10.2.12 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Selenium NI-5.10.2.13 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Manganese NI-5.10.2.14 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Chromium NI-5.10.2.15 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Molybdenum NI-5.10.2.16 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Boron NI-5.10.2.17 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Cobalt NI-5.10.2.18 Added ICF-Dietetics Managing intake of mineralsaccording to RGV

a5701025 Narrower

Multinutrient 5.11

Predicted inadequate nutrientintake

NI-5.11.1 Added ICF-Dietetics Managing intake of nutrientsaccording to RGV

a570102 Same

Predicted excessive nutrientintake

NI-5.11.2 Added ICF-Dietetics Managing intake of nutrientsaccording to RGV

a570102 Same

Clinical NC

Functional 1

Swallowing difficulty NC-1.1 Original ICF Swallowing b5105 Same

Biting/chewing (masticatory)difficulty

NC-1.2 Original ICF Biting b5101 Same

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Breastfeeding difficulty NC-1.3 Original ICF Carrying out breastfeeding a5601 Same

Altered gastrointestinal function NC-1.4 Original ICF Gastric functions b5332 Broader

Original ICF Intestinal function b5335 Broader

Predicted breastfeeding difficulty NC-1.5 Original ICF Carrying out breastfeeding a5601 Same

Biochemical 2

Impaired nutrient utilization NC-2.1 Original ICF Assimilation functions b520 Similar

Altered nutrition-relatedlaboratory values

NC-2.2 nd

Foodemedication interaction NC-2.3 nd

Predicted foodemedicationinteraction

NC-2.4 nd

Weight 3

Underweight NC-3.1 Added ICF-Dietetics Body weight too low s7052.x1 Same

Unintended weight loss NC-3.2 Added ICF-Dietetics Undesired weight loss b 5310.x2 Same

Overweight/obesity NC-3.3 Added ICF-Dietetics Body weight too high s7052.x2 Same

Overweight, adult or pediatric NC-3.3.1 Added ICF-Dietetics Overweight/BMIf 25.0-29.9 s7052.x21 Broader

Obese, pediatric NC-3.3.2 Added ICF-Dietetics Body weight too high s7052.x2 Narrower

Obese, class I NC-3.3.3 Added ICF-Dietetics Obesity I/BMI 30.0-34.9 s 7052.x22 Same

Obese, class II NC-3.3.4 Added ICF-Dietetics Obesity II/BMI 35.0-39.9 s 7052.x23 Same

Obese, class III NC-3.3.5 Added ICF-Dietetics Obesity III/BMI>40.0 s 7052.x24 Same

Unintended weight gain NC-3.4 Added ICF-Dietetics Undesired weight gain b5311.x2 Same

Growth rate below expected NC-3.5 Original ICF Growth maintenance functions b560 Same

Excessive growth rate NC-3.6 Original ICF Growth maintenance functions b560 Same

Malnutrition disorders 4

Malnutrition NC-4.1 Added ICF-Dietetics Nutritional status b532 Narrower

Starvation related malnutrition NC-4.1.1 Added ICF-Dietetics Nutritional status b532 Narrower(continued on next page)

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NCPTterm no.


ICF-Dieteticscode

Closenesscategoryb


Chronic disease� or condition-related malnutrition

NC-4.1.2 Added ICF-Dietetics Nutritional status b532 Narrower

Acute disease- or injury-relatedmalnutrition

NC-4.1.3 Added ICF-Dietetics Nutritional status b532 Narrower

Behavioral�environmental NB

Knowledge and beliefs 1

Food- and nutrition-relatedknowledge deficit

NB-1.1 Added ICF-Dietetics Knowledge about nutritionInclusion of myths about nutrition,relation to nutrition and disease

pf4652 Same

Unsupported beliefs/attitudesabout food- or nutrition-relatedtopics (use with caution)

NB-1.2 Added ICF-Dietetics Attitude on nutritional behavior pf4550 Broader

Not ready for diet/lifestylechange

NB-1.3 Added ICF-Dietetics Motivation to adjust diet b13011 Same

Self-monitoring deficit NB-1.4 Original ICF Higher-level cognitive functions b164 Narrower

Disordered eating pattern NB-1.5 Added ICF-Dietetics Managing nutrition according to RGV a57010 Similar

Limited adherence to nutrition-related recommendations

NB-1.6 Added ICF-Dietetics Keep to therapy pf450 Same

Undesirable food choices NB-1.7 Added ICF-Dietetics Managing proper choice of foodproducts

a5701012 Similar

Physical activity and function 2

Physical inactivity NB-2.1 Added ICF-Dietetics Managing adequate physical activity a57013 Same

Excessive physical activity NB-2.2 Added ICF-Dietetics Managing adequate physical activity a57013 Same

Inability to manage self-care NB-2.3 Original ICF Self-care a5 Same

Impaired ability to prepare foods/meals

NB-2.4 Original ICF Preparing meals a630 Same

Poor nutrition quality of life NB-2.5 Added ICF-Dietetics Quality of life pf480 Narrower

Self-feeding difficulty NB-2.6 Original ICF Eating a550 Same(continued on next page)

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NCPTterm no.


ICF-Dieteticscode

Closenesscategoryb


Food safety and access 3

Intake of unsafe food NB-3.1 Added ICF-Dietetics Identification of rotten, contaminated,or in any other way dangerousfood

a6304 Same

Limited access to food NB-3.2 Original ICF Food e1101 Same

Limited access to nutrition-related supplies

NB-3.3 Original ICF Food e1102 Same

Limited access to potable water NB-3.4 Added ICF-Dietetics Drinking water e112 Same

Other NO

Other 1

No nutrition diagnosis at thistime

NO-1.1 nc

aThe mapping exercise was based on well-established Linking Rules.33 The ICF-Dietetics consists of original ICF categories and additional specific dietetic categories (added ICF-Dietetics). Each NCPT term were linked to the most precise ICF-Dieteticscategory. An added ICF-Dietetics category was assigned in case a more precise specific dietetic category compared to the original ICF was available. If an NCPT term comprised more than one concept, every single concept was linked to the ICF-Dietetics, meaning that one NCPT term could be linked to more than one ICF-Dietetics category.bIn addition to the ICF-Linking Rules, 33 the closeness of the match in respect of comparable concepts was described by using “same,” “similar,” “broader” and “narrower,” adopted from Zielstorff and colleagues36: Same: The term in the NCPT is nearlyidentical in wording and underlying concept to the ICF term. Similar: The term is comparable: or “alike in substance.” Broader: The term is larger in scope, or less specific, or can be considered to encompass the term in the ICF. Narrower: The term issmaller in scope, or more specific, or can be considered to be encompassed by the ICF term.cAccording the ICF-Linking Rules, concepts that could not be linked to an ICF-Dietetics category and that were clearly not personal factors were assigned “not covered (nc).” If the information of the NCPT term was not sufficient to make a decisionabout the most precise ICF-Dietetics component, the concept was assigned “not definable (nd).” If the NCPT term referred to a medical diagnosis or a health condition according to the ICD-10, it was assigned “health condition (nc-hc).”dRGV¼Dutch Dietary Guidelines: Making sure that nutritional intake is optimum for the person, which usually means that the nutrition complies with the RGV or Dietary Reference Values established by age category.eIn contrast to the previous versions of the ICF-Linking Rules,34 it is recommend now to use “other specified” categories (ending with the digit “8”). Experience has shown that not using “8”-categories leads to lost information. Therefore, the authors ofthe ICF-Linking Rules33 suggest now, if a concept is linked to an “8”-category, the additional information not specified within the ICF should be documented along with the ICF category. Furthermore, it must be mentioned that the ICF-Dietetics isused in combination with other classifications, such as the Classifications of Assistive Products.6 This makes it possible to define the specific type of protein (such as gluten or amino acids) and fat (such as saturated fat).fBMI¼body mass index; calculated as kg/m2.

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