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PriorityTopicNCPT DomainJIRA TicketSummary
Status
Notes
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365921005 |Weight change finding (finding)|NA/NDhttps://jira.ihtsdotools.org/browse/NUTRITION-67A CRS request was received highlighting potential ambiguity/duplication in this hierarchy in relation to weight loss and weight gain.

"89362005 |Weight loss (finding)|, 262285001 |Weight decreased (finding)|, 161832001 |Weight decreasing (finding)| and 426977000 |Recent weight loss (finding)| have overlapping meaning. Weight loss is either recent or ongoing or it is a history of weight loss in the past (e.g. now stabilized or gained back) but no longer ongoing. There are too many concepts that seem to be intended to represent the notion of "losing weight".
The suggestion for which to retire is just one option to start to address this. |Weight decreased (finding)| and 161832001 |Weight decreasing (finding)| could be retired as duplicates for 89362005 |Weight loss (finding)|. Similar problems exist with 8943002 |Weight gain (finding)|, 427572007 |Recent weight gain (finding)|, 262286000 |Weight increased (finding)| and161831008 |Weight increasing (finding)|."

The requester provisionally discussed with the Academy of Nutrition and Dietetics Classification subcommittee with the recommendation to forward ticket the Nutrition CRG for review of the hierarchy starting with 365921005 |Weight change finding (finding)| which accounts for 23 concepts. This should be transitioned to a project and be prioritized accordingly.		Completed
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Review subhierarchy - 384760004 |Feeding and dietary regime (regime/therapy)| hierarchyNutrition interventionhttps://jira.ihtsdotools.org/browse/NUTRITION-66   Identified issues in this hiearchy during movement of nutrition counseling concepts from procedure to regime/therapy. Redundancy, in particular, in Feeding vs Dietary regime/therapyCompleted
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162864005 Body mass index 30+ - obesity (finding)NA/NDhttps://jira.ihtsdotools.org/browse/IHTSDO-264
https://jira.ihtsdotools.org/browse/NUTRITION-68		Added 6/19/2024. From the initial tracker: There is well documented variability on the accuracy of the ranges of BMI in some ethnic groups and certain types of athletes may have increased muscle bulk, as opposed to fat, so it is questionable whether "Obese" is a suitable parent in an international terminology.
95 concepts descend from High body weight (finding) grandparent; the project below is part of this subhierarchy		In ProgressPotential resources:
1) Lancet Diabetes & Endocrinology Commission on the Definition and Diagnosis of Clinical Obesity: https://pubmed.ncbi.nlm.nih.gov/36878238/
2) Exploring the Science on Measures of Body Composition, Body Fat Distribution, and Obesity: Proceedings of a Workshop Series (2024) http://nap.nationalacademies.org/27461
3) The European Association for the Study of Obesity (EASO) Endorses the Milan Charter on Urban Obesity https://pubmed.ncbi.nlm.nih.gov/33498054/
4) National-level and state-level prevalence of overweight and obesity among children, adolescents, and adults in the USA, 1990–2021, and forecasts up to 2050 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01548-4/fulltext
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Review Central obesity (disorder)Nutrition diagnosisN/APart of project above.
From CPG Pilot Test: 248311001 |Central obesity (disorder)|has parent 414920002 |Obesity by fat distribution pattern (disorder)|, which is a concern since some are not obese, but overweight with increased waist size. Perhaps revise to 366431000 |Finding of distribution of body fat (finding)| as a parent. Referral to Nutrition CRG		CompletedChanges published in May 2026
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Review subhierarchy - 373783004|Dietary product (product)Impacts nutrition assessment and nutrition intervention concept modelinghttps://jira.ihtsdotools.org/browse/DRUGS-131 and https://jira.ihtsdotools.org/browse/NUTRITION-59Reassigned to Nutrition 9/22/2020. The following areas need to be addressed in an analysis of the subhierarchy. As far as timing, there is no rush and progression depends on availability of resources.
224 concepts.
1. Identify the experts needed for the project and use cases for the subhierarchy. For example, what concepts would be modeled using products from this subhierarchy?
2. Identify the boundaries for the subhierarchy. What content should be included and what content should be excluded?
3. Create editorial guidelines for the subhierarchy. Will it be a primitive hierarchy? Will there be attributes to model the content? Which authoritative sources will be used as references? How should the content be organized?
4. Identify missing gaps in the content. Is there a large volume of content missing or just a few concepts? Are high level grouper concepts missing? What concepts would be impacted in country extensions (UK has 379 concepts in their extension, a large number are branded products; Australia has 400 concepts in their extension and may offer a categorization approach)
5. Clean up existing content. The three major subhierarchies under 373783004 |Dietary product (product)| need review. Some content seems to be misplaced. For example, is 328285005 |Cystic fibrosis food (product)| referring to a regime/therapy instead of a specific product? 		PendingUK has 379 concepts in their extension, a large number are branded products; Australia has 400 concepts in their extension; review both and any other extensions for a categorization approach//Also, briefing note pending
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UK NRC (National Release Center) queryN/A since this is substance onlyReceived 20250110Concerns about 327998007 |Gluten-free food product (product)| hierarchy.
78 concepts descend from 327998007 |Gluten-free food product (product)| part of the subhierarchy above
We’ve spotted a few problems in this hierarchy. For example, concepts such as 353355004 |Gluten-free cookies (product)| are ambiguous as ‘cookies’ do not mean the same food product across the world:
cookie (plural cookies)
1. (Canada, US) A small, flat, baked good which is either crisp or soft but firm. synonyms ▲
Synonyms: biscuit, (UK, Australia) bickie
2. (UK, Commonwealth) A sweet baked good (as in the previous sense) usually having chocolate chips, fruit, nuts etc. baked into it.
3. (Scotland) A bun.
In the UK a ‘cookie’ is always sweet and usually with other sweet things baked into it, not the same as the US definition.

There is a similar problem with biscuit, 328662000 |Gluten-free biscuits (product)|:
biscuit (countable and uncountable, plural biscuits)
1. (UK, Australia, Ireland, New Zealand, sometimes Canada, rare in the US and the Philippines) A small, flat, baked good which is either hard and crisp or else soft but firm; a cookie. quotations ▼
2. (chiefly Canada, US, rare in Scotland and Guernsey) A small, usually soft and flaky bread, generally made with baking soda, which is similar in texture to a scone but which is usually not sweet.
Which have very different meanings in what you get.

Beyond this, the definition of ‘gluten-free’ is not an international definition but is subject to national law and guidance. For example, in the USA the FDA states: https://www.federalregister.gov/documents/2013/08/05/2013-18813/food-labeling-gluten-free-labeling-of-foods and for the EU: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32014R0828

There’s likely a similar problem with ‘low-protein’.

In summary, the UK’s position is that the Glute-free food products hierarchy cannot be safely defined internationally so should be made Inactive. Possibly leaving the 327998007 |Gluten-free food product (product)| concept so that NRCs can add national content as required.		PendingHelpdesk - https://ihtsdo.freshdesk.com/a/tickets/49834
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Remodel observables/procedures with products where appropriateNutrition assessment and nutrition intervention https://jira.ihtsdotools.org/browse/NUTRITION-47Use product concept in a process acts on for observable contentPending
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Review subhierarchy - 238107002 |Deficiency of macronutrients (disorder)|Nutrition diagnosishttps://jira.ihtsdotools.org/browse/IHTSDO-1176A high level review of the hierarchy of 238107002 |Deficiency of macronutrients (disorder)| which has 20 descendants indicates that the content is out of date and contains a number of inappropriately allocated synonyms and is predominantly primitive. Conferred with the Nutrition Care Process Terminology Clinical Project Group who agreed that this section needs review and updating. The intention is to develop a Nutrition CRG who will progress this.
Part of 2492009 |Nutritional disorder (disorder)| hiearchy which has a total of 266 descendants.
PendingThis content and all content under 70241007 |Nutritional deficiency disorder (disorder)| will be subject to modelling updates when there has been agreement on the modelling of deficiency of X.
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“Dietary finding” [41829006] from “Finding” to “Regime/therapy”.Nutrition interventionhttps://jira.ihtsdotools.org/browse/IHTSDO-137Currently, nearly all diet types in SNOMED CT are represented as findings. This has limited use in the practice of diet management as nutritionists view diets as sets of continuous processes that are followed by a patient over time. Diets go through process life cycles (start, stop, change, etc.). The characteristics of importance in diets fit well with the current attributes associated with the procedure content model.
Majority of content are under 226077000 |Therapeutic diet (finding)| = 249
There is a distinction in the hierachy between therapeutic diet and non-therapeutic diet - latter has 20 descendants.		PendingAnalysis document from John Snyder:
https://docs.google.com/spreadsheets/d/1pPQnwX7H8CK8v197tfuXsY7L9t4kR6Fk/edit?gid=311667578#gid=311667578

Link to Forums post: https://forums.snomed.org/t/diet-findings-crg-project/280
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Goal settingDiscussed with J. Millar that these are common among a lot of professions so a cross-CRG group is recommended.Pending
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Monitor:
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Monitor substanceshttps://jira.ihtsdotools.org/browse/SUBST-358Subsumption incorrect for minerals, fatty acidsOn HOLD per SNOMED but needs monitoring since minerals are not a part of Nutrients (substance) a clear oversite that has been raised.
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