A PES statement is a nutrition diagnosis used in a clinical setting. It consists of the problem (P), the etiology (E) and the signs or symptoms (S).

For many newly credentialed dietitians — and even the more clinically adept dietitians — writing the perfect PES statement can be a challenge.

This article gives you the tools you need to confidently write the perfect PES statement — every time.

The Nutrition Care Process

The Nutrition Care Process (NCP) is a standardized approach intended to guide registered dietitians in providing high-quality nutrition care.

Understanding the intricacies of the NCP will help you write a better PES statement.

It consists of four steps:

  1. Nutrition Assessment
  2. Nutrition Diagnosis
  3. Nutrition Intervention
  4. Nutrition Monitoring and Evaluation

The nutrition assessment entails obtaining information regarding the patient’s food and nutrient intake, anthropometric measurements, biochemical data, medical tests and procedures, nutrition-focused physical findings and history.

This information helps the dietitian form the nutrition diagnosis, which is communicated as a PES statement.

Then the dietitian works to resolve or improve the nutrition diagnosis with nutrition interventions.

Lastly, these interventions are monitored to assess progress and whether the expected goals are being met.

If your PES statement is weak or doesn’t address the most urgent problem, then the interventions won’t be effective and the goals will not be met.

PES Statement Components

The PES statement describes the nutrition problem, its root cause and evidence for the diagnosis.

The format of the PES statement is: Problem (the nutrition diagnosis) related to Etiology (factors contributing to the nutrition diagnosis) as evidenced by Signs and Symptoms (findings from the nutrition assessment that determine the nutrition diagnosis).

The Problem

The problem, or nutrition diagnosis, is based on the most urgent issue, with verbiage taken directly from the Nutrition Diagnostic Terminology Sheet (1).

Frequently used nutrition diagnoses include:

  • Inadequate energy intake
  • Inadequate oral intake
  • Swallowing difficulty
  • Altered nutrition-related laboratory values
  • Altered GI function
  • Malnutrition (specify mild, moderate or severe and context)
  • Food/nutrition-related knowledge deficit

Depending on which nutrition diagnosis you use, you must be able to resolve or improve it.

The Etiology

The etiology is the cause or contributing risk factors of the nutrition diagnosis. It connects to the nutrition diagnosis by the words related to.

It tells you what type of intervention you need to either treat the nutrition diagnosis or lessen the signs and symptoms.

The Signs and Symptoms

The signs and symptoms are the evidence that supports your nutrition diagnosis. It connects the etiology by the words as evidenced by.

Commonly used signs and symptoms may include lab values, intake history, nutrition knowledge, anthropometric data or findings from the nutrition focused physical exam.

You should be able to monitor the signs and symptoms and document if they are resolved or improved.

PES Statement Examples

Here are a few PES statement examples using the frequently used nutrition diagnoses.

Example 1: 

  • P: Inadequate energy intake related to…
  • E: Decreased appetite secondary to chronic COPD as evidenced by…
  • S: Consuming less than 75% of estimated energy needs for 1 month and unintentional weight loss of 6% in 1 month.

Example 2: 

  • P: Inadequate oral intake related to
  • E: Swallowing difficulty and pain associated with swallowing secondary to esophageal adenocarcinoma as evidenced by
  • S: Refusal of meals and supplements while admitted and unintentional weight loss of 3% in 1 week.

Example 3: 

  • P: Swallowing difficulty related to
  • E: Cerebrovascular accident as evidenced by
  • S: Repetitive swallowing, throat clearing and hoarse voice associated with eating per SNF.

Example 4: 

  • P: Altered nutrition-related laboratory values related to
  • E: Uncontrolled type 2 diabetes mellitus as evidenced by
  • S: HgbA1c of 10.2% and noncompliance with oral medications per spouse.

Example 5: 

  • P: Altered GI function related to
  • E: Decreased functional intestine length as evidenced by
  • S: Recent small bowel resection, reports of diarrhea, abdominal pain and bloating associated with PO food intake for 10 days.

Example 6: 

  • P: Severe malnutrition in the context of chronic illness related to
  • E: Decreased appetite, early satiety, and taste changes secondary to current chemotherapy treatments as evidenced by
  • S: Consuming < 75% of estimated energy needs > 1 month (~63% x 1 month), severe loss of subcutaneous fat (orbital, triceps, fat overlying the ribs) and severe muscle mass loss (wasting of temporalis, deltoids, interosseous, trapezious and quadriceps).

Example 7: 

  • P: Food/nutrition-related knowledge deficit related to
  • E: No prior renal nutrition related education as evidenced by
  • S: Questions raised regarding protein serving size and unaware of need to take phosphate binders within 5 to 10 minutes before or after a meal.

The Takeaway

The PES statement is part of the Nutrition Care Process (NCP), a systematic approach to providing high-quality nutrition care.

The PES statement describes the (P) nutrition problem or nutrition diagnosis, (E) the etiology or root cause, (S) and the signs and symptoms of the nutrition problem.

Take every detail of your nutrition assessment into consideration when you choose your nutrition diagnosis. Also make sure that you can treat the nutrition diagnosis or improve the signs and symptoms.

No regulatory agencies require a PES statement, but it’s considered the gold-standard for communicating and documenting nutrition diagnoses.

There is no right or wrong PES statement, but some are better than others.