Need a simple explanation of medical nutrition therapy and the most common disease states in clinical nutrition? Start here.
An overview of Medical Nutrition Therapy
What’s considered medical nutrition therapy?
Medical nutrition therapy is used to support people in optimizing their health and medical concerns, using food and diet as a foundation.
Who can provide medical nutrition therapy?
Many medical professionals may meet the requirements needed to practice MNT. However, registered dietitians are the only health professionals to have advanced degrees and substantial practice hours in this evidenced based practice.
What’s the goal of medical nutrition therapy?
The goal of MNT is to support people in achieving normalized lab results (like blood glucose levels), meet their personal weight goals, and improve certain overall medical conditions that are directly impacted by food and diet (like hypertension and chronic kidney disease).
Why RDs need to be excellent at MNT?
Registered dietitians are the health community’s resident experts on nutrition. There are tons of opportunities for RDs to work both within and outside of a formal clinical nutrition environment. But for those who have committed to working with people struggling with any level of medical condition, knowing the basics of MNT is a fundamental to excelling as a dietitian.
No matter what level of care a dietitian is providing, MNT is key to operating a successful clinical practice. This article will give you a clear rundown on all the basics of MNT and how they’re involved with writing therapeutic diet orders.
Fundamentals In Medical Nutrition Therapy
We’ll review the basics of each disease state that support diet therapy and the nutritional status of all patients who a dietitian sees in a clinical practice.
CLICK HERE to pick up The Basics: Therapeutic Diets bundle. You’ll get full set of patient education materials on each of the most common disease states and more.
Diabetes
Many dietitians support people with all types of diabetes including type 1 diabetes, gestational diabetes and type 2 diabetes (T2DM). As a CDCES (certified diabetes care and education specialist), the range of people looking for support can be quite great.
For those working as a clinical dietitian in an acute care setting, the MNT work is often made up of a larger proportion of people who’ve been diagnosed with type 2 diabetes. Though MNT for all of these forms of diabetes can be similar, the emphasis here will be on T2DM.
Key MNT for Type 2 Diabetes Mellitus
- Labs: A1C and blood glucose levels (fasting and finger sticks).
- Carbohydrate intake: This flexible number is based on the type of diabetes, an individual’s medication and their unique response to various carbohydrate foods.
- Balanced diet: Specifically fiber and protein.
- B12 and folate intake: For more b-vitamin information, read more here and here.
Get easy to use nutrition education handouts for diabetes HERE.
Hypertension (High Blood Pressure)
This is the MNT for people struggling with regulating their blood pressure. Those at risk for heart attacks and strokes, as well as some people with renal troubles will often benefit from the same MNT provided to cardiac patients.
Key MNT for hypertension
- Low Sodium intake: 1500 mg/day is considered low. 2000 mg/day is a moderate amount of sodium.
- Fluid intake (optimized or restricted): This is usually requested by the MD. A fluid restriction usually will not dip below 1L/day with a fair goal for most people being around 1.5L/day. Typically fluid recommendations are a 1:1 reflection of a person’s caloric goals (ex: 1900 calories/day, 1900 ml water/day). A person following a high protein diet (>1.6 g/kg) is at higher risk for dehydration and should be drinking more water, proportionate to their needs and intake.
- Increased potassium, to recommended daily intake: 4700 mg/day (assuming it’s within a normal range: 3.6-5.2 mmol/L).
Standard MNT for Cardiac patients
- Low sodium
- Low fat (specifically saturated fat)
For this standard therapeutic diet, note weight status and other diagnosed conditions before choosing a cardiac diet order.
Get easy to use nutrition education handouts for a cardiac diet HERE.
Renal dysfunction
The medical nutrition therapy for different stages of chronic kidney disease (CKD) can vary fairly significantly. The basic labs to always check are sodium, potassium, phosphorus, glomerular filtration rate (GFR), creatinine (Cr), and blood urea nitrogen (BUN). There are many others that can be used to help determine renal dysfunction, however these are the ones you’ll likely always have access to in a clinical setting.
There’s also much discussion around the appropriate amount of protein required for someone not yet at end stage renal disease (ESRD) and in need of hemodialysis (HD). A general indication of protein values are noted below.
Key MNT for CKD Stage 1-4
- Electrolyte Labs: Na, K+, Phos, checking for elevated levels.
- Renal Specific Labs: Normal ranges for Cr (0.6-1.2), BUN (8-25) and GFR (90-120).
- Protein: 0.6-0.8 g/kg recommendation, with further individualization based on how elevated Cr levels are.
- Sodium: 1500 mg/day recommendation.
- Limit potassium and phosphorus rich foods: Blood work dependent.
- Caloric Intake: Individualized, based on weight status and other medical conditions.
Key MNT for ESRD and stage 5 CKD, as well as HD
- Protein: 1.0-1.2 g/kg recommendation, with further individualization based on other medical conditions.
- Sodium: 1500 mg/day.
- Limit potassium and phosphorus rich foods: Blood work dependent.
- Caloric Intake: 30-35 kcal/kg, with further individualization based on weight status, intake and other medical conditions.
Get easy to use nutrition education handouts for kidney disease HERE.
And That’s It!
Being a dietitian isn’t about memorization. It’s about education.
When you find yourself struggling with remembering some of these basics, your best shot is to have a collection of MNT handouts that make everything easier. They’re also perfect when you need something simple to reinforce the information you’ve just given a patient.
RD life is hard enough. Make it easier with these medical nutrition therapy tips.
Want even more to help in clinical?
Check out The Nutrition Cheat Sheets Shop for all the nutrition education and clinical resources that will make your life easier.
