Issues have been identified during the promotion of US extension nutrition content. Currently a number of concepts in the US extension win the form "Inadequate intake of X" and "Excessive intake of X" are not modeled according to International editorial policy. When these concepts are revised to conform to editorial policy, they generate equivalency errors with existing International concepts of the form "Inadequate dietary intake of X" and "Excessive dietary intake of X". I have been informed that these are not equivalent concepts by the Nutrition group modeler (Lee Unangst).
The issue lies with the modeling of the International concepts using an INTERPRETS value of "X intake (observable entity)" as opposed to a more specific "X dietary intake (observable entity)". Since the international concepts do not specify dietary intake, the US extension concepts appear as equivalent concepts. The International concepts were created in 2008 and it is unclear whether the intention of these terms is intake of nutrients from any source or were intended to be restricted to only dietary sources.
We request the group to review this content and decide:
- Are the "Inadequate dietary intake" and "Inadequate intake" terms truly non-equivalent?
- Should the International "dietary" concepts be converted to primitive concepts so they classify as subtypes of the US extension concepts?
- Should the international concepts be inactivated as the intent is intake from any source?
- Should new Observable entities specifying "Dietary X intake (observable entity) be created to appropriately model the international concepts?
Resolution of this issue must be made before the content from the US extension can be promoted to the International release.
6 Comments
Jim Case
After the first call, the consensus was that dietary intake is a more specific term, needed for clinical recording. It was also determined that a general reorganization of the top level of 300893006 Nutritional finding (finding) be revised to more accurately represent the types of nutrition concepts currently used by the profession. new discussion on the revision of this hierarchy will be started as that must be cleaned up before we can add the US extension content to the International release.
Jim Case
All of the requested concepts from the US extension have been promoted to the International release for the July 2018 International release. The proposed changes to dietary intake have been made as well as some slight reorganization as a result of the movement of 41829006|Dietary finding under 300893006|Nutritional finding. Some additional cleanup of the top level hierarchies is still needed, but the project group is now in a position to begin reviewing the current structure and content for coverage and accuracy
Constantina Papoutsakis
Jim, this is really great news, and a very dynamic way to kick off the new year.
On the topic of “inadequate intake of nutrient X”:
If an inadequate intake finding is due to inadequate intake and/or inadequate absorption and/or metabolism, does this necessitate separation these as term concepts when a disorder is not evident?
I would hesitate to use the word 'assimilation' because based on interpreting the OED (Oxford dictionary) definition, this means absorption and does not include metabolism.
Also, I have added under documentation a proposed hierarchy.
Input/request on the document you posted earlier:
It is difficult to understand the implications of the suggested reorganization based on the description provided here, specifically with regards to item 5 in the initial design section. Is it possible to look at the change in a development version of SNOMED? This would help us understand and provide feedback and consent for the proposed changes.
More simply put, would you be able to walk us through the process in a development environment (in the next mtg to discuss) so we are understand what is going on?
It is not clear what is happening when we study the document.
Nathan Billing
Hey all,
I guess the issue here has to do with the context. The majority of nutrient intake within healthy individuals is oral, this is what would be regarded as normal dietary intake. However within the hospital setting the intake of nutrients can be via feeding tube (enteral), or via intravenous (parenteral) in this situation looking at the overall intake of individuals.
So to answer your questions
They are the same but different. It depends on how you define "dietary intake" if this is to mean nutrient absorbed by the gut only (oral and enteral) then they are not equivalent. If dietary intake includes intravenous intake of nutrients then they are the same. It would depend on the context in question eg fast food vs Sodium intake
There is potential for ambiguity here and it would make sense for "dietary intake" to be removed or better defined i.e is this just oral intake (food that is swallowed) / or enteral intake (i.e via feeding tube) / or intake of all nutrients (oral, enteral and intravenous).
Furthermore I think it is important to appreciate that the route of delivery of nutrient and whether this is in excess of deficit could in fact be defined qualifier values (i.e.
So I guess is there need to look at how quantifier values are Is the work being under taken to look at the post co-ordination of the terms like intake to quantify route and whether in excess or deficient
As mentioned above "dietary" needs to be better defined if this can be done then it could remain fully defined and if not then it would most definitely need to be converted to a primitive concept
Again sort of what is the alternative to define route of nutrient intake. The route of intake is as important as the quantity of intake and removing the ability to quantify it would be problematic if intake was meant to be intake from any source. I.e you would not need to worry about providing dietary advice to someone with insufficient intake if they were dyshpagic and nil by mouth and were receiving all their nutrition via a enteral feeding tube.
If we are clear on being able to define how nutrients are being consumed when taking a diet history by utilising qualifier values then this should not be a problem
We come back to what is meant by "dietary" here i.e. is this oral only or oral and enteral.
I think it is important to look at utilizing the fields that are already within the international edition and look at using these to better define these terms, rather than splitting hairs and creating more terms that will lead to confusion.
I hope that is some useful feedback and makes sense, please get back to me
All the best,
Nathan
William Swan
I was wondering if excessive intakes would be handled the same way as inadequate intakes. Nathan seems to have approached that topic above. Needs to be a part of the nutrition diagnosis discussions.
Constantina Papoutsakis
I agree w. this approach. Inadequate and excessive intake should be addressed in our work.
Please chack out the agenda for today's mtg as well.