System News

July 5, 2024

Nutrition Manual Across the Continuum of Care

The 2024 updates to the online version of the manual are now available.
Accounts with hard copy manual(s) that are on the annual auto-ship list, the 2024 manuals (contents only) have been shipped.
The sections with major changes are noted below. Refer to the 2024 Summary of Changes for more details.
The updated 2024 Nutrition Assessment Quick Reference sheet is also available on MyCompass.

Section A: Normal Nutrition

Statement of Nutritional Adequacy:

Content updated to align with 2023 release of Dietary Reference Intakes (DRIs) for energy by the National Academies of Sciences, Engineering, and Medicine. Dietary Reference Intakes for Energy. Washington, DC: National Academies Press; 2023.
Tables added to provide 2023 estimated energy requirements (EER) based on gender, age, and physical activity categories including:
Content and source updated to align with the Dietary Guidelines for Americans, 2020-2025, 9^th edition.
The Food Fortification and Dietary Supplements Section was removed as the Academy Position on this topic is retired and out of date.

Regular Diet – Adult:

Content and sources updated to align with the Dietary Guidelines for Americans, 2020-2025, 9^th edition. The updated U.S. Style Dietary Pattern for Adults (Table A.14) integrates portions of food using the U.S. Department of Agriculture (USDA) Food Guide that is currently used as the basis for planning the Morrison Healthcare menu. The Healthy Mediterranean Dietary Pattern was also incorporated as a variation of the healthy dietary pattern that can be used as the basis for menu planning (Table A.15).

Nutrition Management During Pregnancy and Lactation

Section was revised and updated to align with the Dietary Guidelines for Americans, 2020-2025, 9th edition. Section now provides the 2023 DRI equations for estimating energy requirements (EER) during the second and third trimester of pregnancy and lactation (Table A.16 and Tables A.17 to A.18), respectively. Academy Positions retired were removed from the reference list.

Section C: Modification of Carbohydrate and Fat

Medical Nutrition Therapy for Overweight and Obesity (Adults)

Section reviewed and updated based on release of Medical Nutrition Therapy Interventions Provided by Dietitians for Adult Overweight and Obesity Management: An Academy of Nutrition and Dietetics Evidence-Based Practice Guideline (2023) . The formerly released evidence-based guideline (2014) remains current for many topic areas and a key reference. The updated release focuses on interventions specific to behavior-change based nutrition interventions.

Section II Nutrition Assessment & Intervention

Estimation of Energy Expenditure

Included the most current DRI values for energy, based on National Academies of Sciences, Engineering, and Medicine. Dietary Reference Intakes for Energy. Washington, DC: National Academies Press; 2023. Discussion expanded to include discussion on estimating energy requirements using the updated DRI predication formulas and explanation of determining physical activity level categories in adults.

May 8, 2023

Nutrition Manual Across the Continuum of Care

Accounts will receive updates by May 8. The sections with major changes include:

Section B: Enteral and Parenteral Nutrition

Content reviewed and updated based on The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N) guidelines for provision of nutrition support therapy (2022) update. The 2022 update impacts only a few topic areas. Majority of guidelines published in 2016 with Society of Critical Care Medicine (SCCM) are retained as part of this review. Highlights include:

Emphasis on preventing overfeeding and optimally managing blood glucose ranges (140 mg/dL to 180 mg/dL) for patients receiving specialized nutrition support.
Use of parenteral nutrition should be reserved until at least 7 days in the ICU setting for critically ill patients that are well-nourished, for patients with malnutrition clinical judgement should dictate initiation.
Conservative provision of energy needs between 12 to 25 kcal/kg during the first 7-10 days of ICU stay is recommended irrelevant of nutrition risk to minimize metabolic complications.
Insulin guidelines for use with enteral feedings added.
Updated content related to newer versions of mixed oil and fish oil lipid injectable emulsions used in parenteral nutrition.
Updated content related to parenteral nutrition dosing and daily requirements for adult parenteral vitamins, trace elements, and electrolyte and minerals.

Section C: Medical Nutrition Therapy for Type 1 and Type 2 Diabetes Mellitus

Section updates are based on American Diabetes Association (ADA) Standards of Medical Care (2022) including relevant Position Statements in addition to updated guidelines from The Endocrine Society (2022) and American College of Gastroenterology (2022). Highlights include:

Greater focus on evidence-based dietary patterns and quality of food intake to improve diabetes management.
Clarification of definition for type 1 diabetes in adults and latent autoimmune diabetes in adults (LADA).
Emphasis of adequate carbohydrate intake (150 g) 3 days prior to oral glucose tolerance testing when screening for diabetes mellitus.
Screening criteria for diabetes mellitus is now recommended at 35 years of age for all adults. Those with known risk factors should have screening independent of age for prediabetes. For persons living with HIV screening for diabetes should occur before antiretroviral therapy or at time of switching antiretroviral therapy and rechecked at 3 to 6 months and then annually.
Blood glucose monitoring (BGM) replaces the former term self-monitoring of blood glucose (SMBG).
Management of Hyperglycemia in Hospitalized Patients discussion is expanded to include The Endocrine Society Clinical Practice Guideline of Hyperglycemia in Hospitalized Non-Critical Care Settings (2022). Guidelines include those with and without existing diabetes considering the increase prevalence of hyperglycemia observed in hospitalized noncritical care patients caused by medical treatments, injury, infection, stress response, and pharmacotherapy.
Management of Gastroparesis updated based on American College of Gastroenterology Clinical Guideline: Gastroparesis (2022) including endorsement of small particle diet including other medical and dietary strategies.

March 28, 2022

Nutrition Manual Across the Continuum of Care

Accounts will receive their updates by mid-April. The sections with major changes include:

Medical Nutrition Therapy for Disorders of Lipid Metabolism: updates include recommendations from the American Heart Association (AHA) and American College of Cardiologists.

Diet pattern name changed to AHA Heart Healthy vs previous Therapeutic Lifestyle Changes Diet. Emphasis is placed on lifestyle changes and plant-based diets such as the DASH Diet, Mediterranean Diet, and vegetarian diet patterns.
Steps to Your Heart Education piece (available from Metrographics) updated to reflect the AHA Guidelines.

Medical Nutrition Therapy for Liver Disease and Hepatic Encephalopathy: Current trends support not limiting protein intake. Emphasis is placed on higher protein intake to prevent malnutrition, using plant-based and dairy protein sources. Nutrition guidelines are provided based upon type of liver disease and associated complications.

Nephrotic Syndrome: Updated recommendations for energy, protein and sodium based upon guidance by Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practical Guideline on Glomerular Disease (Oct 2021).

COPD: Revised to include the Academcy's COPD Evidence Based Guideline (2019). Energy prescription guidance includes macronutrient composition based on current evidence, i.e., aging adults and guidelines to maintain a stable adult or treat a malnourished adult.

Nutrition Manual Across the Continuum of Care

We have combined our Manual of Clinical Nutrition Management and Long Term Care Diet Manual into one manual, titled Nutrition Manual Across the Continuum of Care. It will live on this site April 14, 2021. All accounts that subscribe to our online manual will receive a hard copy of the manual over the next few weeks.

Updates are noted in the Summary of Charges document that comes with your manual. The sections with major changes include:

- Medical Nutrition Therapy for Diabetes Mellitus, Type 1 and 2 Diabetes Mellitus during Pregnancy and Gestational Diabetes Mellitus

- Medical Nutrition Therapy in Overweight and Obesity (Adults)

- Medical Nutrition Therapy for Chronic Kidney Disease (CKD) (including the 2020 KDOQI practice guidelines for patient with CKD)

- Medical Nutrition Therapy in HIV/AIDS (Adults)

- Nutrition Management of Pressure Injuries

June 5, 2020 Updated corrections to online manual

Acute care and LTC Manual:

Nutrition Management of Fluid & Hydration

Under adults: Older adults (>65 years of age): 30 to 35 mL/kg/day (corrected from 30 to 35 kcal/kg/day)

Nutrition and the Older Adult

Under Table A.4 (acute care) and Table A.6 (LTC) Suggested Energy, Protein, and Nutrient Requirements for Older Adults, the Potassium level for Males was corrected to 3400 mg (from 2600 mg)
For LTC, Table A.3: Dietary Reference Intakes was unbolded for Potassium levels as they are recommendations for Adequate Intake, not RDAs. Males are 3400 mg and Females are 2600 mg.

II. Nutrition Assessment: Body Weight Evaluation and Indicators of Nutrition-Related Problems

The BMI levels for adults for older adults is corrected to be less than 23 kg/m² (not 22 kg/m².)

The online 2020 Manual of Clinical Nutrition Management and Long Term Care Diet Manual (NEW!) is now available. Hard copy updates will be sent to accounts and should be received by the end March. Updated Patient Education materials are also available with this update.

For questions and feedback, email MyNutritionResources@IAmMorrison.com

The following summarizes updates in both Manuals.

Dietary Reference Intakes (DRI): Recommended Dietary Allowances and Adequate Intakes, Elements

Updated DRI values for potassium and sodium

Pregnancy and Lactation (acute care manual only)

Highlights emerging research providing evidence that protein requirements are significantly higher than the DRIs fo women during pregnancy, espeically during the late stage of gestation.
Includes recent evidence of Vitamin D during pregnancy and supplementation of Vitamin D, Vitamin A and Vitamin B12 during lactation
Includes recent guidance from FDA and EPA (2019) on fish consumption during pregnancy and lactation

Nutrition and Older Adult

Section completely revised based on updates to the Academy Position Papers: Position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior: Food and Nutrition Programs for Community-Residing Older Adults (2019) and Position of the Academy of Nutrition and Dietetics: Individualized Nutrition Approaches for Older Adults: Long-Term Care, Post-Acute Care, and Other Settings (2018).

Nutrition Management of Fluid Intake and Hydration

Includes latest guidelines by ESPEN (2019) and recommendations for the assessment and determination of hydration status and low-intake dehydration in the older adult population.
Section reviewed and updated to include the most current guidelines and formulas used to determine fluid needs in pediatrics, adults, and older adults.

Nutrition Management of Dysphagia

Added tables for foods allowed with IDDSI diet

Body Weight Evaluation and Indicators for Nutrition-Related Problems

Updated body mass as an indicator of lower than recommended weight levels for older adults (<65 years) from <22 to < 23.

Oncology (acute care manual only)

Content reviewed based on Oncology Evidence-Based Nutrition Practice Guideline for Adults (2017) including updates to the Oncology EAL (2015).
Tables for Nutrition Interventions expanded to provided more current and evidence-based recommendations and best practices.

Choose Your Foods: Food Lists for Diabetes

Updated Exchange Tables per AND Choose Your Foods: Food Lists for Diabetes