Metabolic diseases, including obesity, Type 2 Diabetes Mellitus (T2DM), chronic kidney disease (CKD), Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), and dyslipidemia, represent a significant global health challenge, particularly for Hispanic populations, where the rates of these disorders are disproportionately high. In Mexico, the 2022 National Health and Nutrition Survey (ENSANUT) indicates that 75.2% of Mexican adults are classified as overweight or obese (1). In 2021, this alarming rate was linked to 118,000 deaths attributable to elevated body mass index (BMI), with elevated BMI accounting for 55% of T2DM-related deaths and 41.1% of deaths from CKD (2). Dyslipidemia also significantly affects the adult population, with approximately 50% presenting some form of lipid disorder (3). Moreover, MASLD (previously known as NAFLD and later as MAFLD), represents a significant and growing public health challenge in Mexico with a prevalence of 17–41.3%, this condition is intricately linked to the country’s rising rates of obesity, T2DM, and metabolic syndrome (4). Despite its impact, accurate diagnosis of MASLD remains limited due to diagnostic challenges (5). In 2021, the prevalence of CKD was reported at 9,184.9 cases per 100,000 inhabitants, largely driven by T2DM, the leading cause of CKD. T2DM contributed to 69,052 deaths (95% CI = 60,412–77,991) across all age groups in Mexico (6). Furthermore, the prevalence of T2DM was estimated at 18.3% among adults aged 20 years and older, equating to around 14.6 million individuals (7).

Unhealthy dietary habits, particularly the consumption of sugary drinks, processed meats, saturated fats, and general caloric imbalance, are the most significant modifiable factors associated with metabolic diseases, contributing to 27.3% of Disability-Adjusted Life Years (DALY) lost (8). Effective management of these diseases requires addressing dietary risk factors. Nutritional Medical Treatment (NMT) is a crucial component emphasized in various consensus statements for its integration into multidisciplinary teams managing metabolic conditions. Guidelines recommend implementing NMT through comprehensive nutritional education programs aimed at promoting self-care. This approach should be consistently reinforced across different life contexts to achieve metabolic control, reduce complications, and improve quality of life (3, 9). International guidelines advocate for nutrition professionals to utilize evidence-based NMT to address nutritional issues at both individual and population levels.

The Nutrition Care Process (NCP), introduced by the Academy of Nutrition and Dietetics in 2003, provides a valuable framework for implementing NMT across various clinical settings (10–13). Despite its potential, the NCP is underutilized in nutrition service centers, primarily due to barriers such as inefficient staffing, limited time for documentation, and the lack of necessary infrastructure, including supportive electronic health record systems (14–17). While the NCP has been shown to enhance nutritional care quality in chronic metabolic diseases (18–20). most studies focus on non-Latin American settings. This gap indicates different health systems, food cultures, accessibilities, and metabolic disease rates, such as those in Mexico. Research supports the effectiveness of culturally adapted programs to improve lifestyle intervention adherence among Latinos in the US (21), underscoring the need for tools that simplify the NCP’s implementation in environments reflecting the unique characteristics of the Mexican population, especially concerning prevalent metabolic disorders, particularities of the health system and food culture. In this study, we aimed to describe the adaptation of the NCP for managing five metabolic diseases— Individuals with Obesity at Risk of Type 2 Diabetes (ORT2D), T2DM, CKD, MASLD, and dyslipidemia—in Mexican individuals. The objectives of the adaptation involved prioritizing specific evaluation items and nutritional diagnoses for each disease, creating educational materials, summarizing clinical guidelines for nutritional management, and recommending tailored monitoring tables for each pathology.

Our literature review encompassed 370 articles, including 25 clinical practice guidelines. Two of these guidelines specifically focused on exercise and physical activity [Guides 1 (22) and 24 (23), as detailed in Table 1] for managing obesity and dyslipidemia. The majority of the guidelines supported the implementation of the NCP across various settings, primarily in primary care for metabolically stable patients. They provided a framework for outpatient management, with limited recommendations for inpatient care [Guides 8 (24) and 15 (25) in Table 1].

We adapted the NCP to address five prevalent metabolic diseases in the Mexican population. The material provides a standardized framework for the various NCP steps—diagnosis, evaluation, nutritional intervention, and monitoring—to ensure consistent care across different settings and providers. Each step of the NCP was meticulously customized to these conditions, including the development of targeted educational materials designed to (1) increasing individuals’ disease risk awareness, (2) broaden their knowledge of nutritional management, and (3) provide tailored strategies for developing personalized action plans. This tailored approach was successfully implemented in both research and clinical environments. The educational materials created are documented in an online book publication, serving as a valuable resource for health professionals.

The NCP has been adapted and successfully implemented in diverse settings and geographical locations, though several barriers to its adoption have been noted. In the Philippines, authors at a level 3 hospital emphasized the need for enhanced support from institutions, professional organizations, and policymakers to facilitate implementation (46). In Saudi Arabia, although most dietitians are familiar with the NCP and confident in its application, it has not yet been adopted as a standard practice in hospitals (47). Australian dietitians, prior to implementation, reported barriers including a lack of knowledge, support, training, and resources, while those already using the NCP identified heavy workloads and work status as obstacles (48). Lövestam et al. stressed the necessity for context-specific strategies to address local challenges and improve dietetic support (16).

The primary barriers to NCP implementation have been identified as inefficient staffing, limited time for completing necessary documentation, and the lack of supportive infrastructure, such as electronic health record systems (16, 17). In Switzerland, the integration of NCP documentation into electronic patient records has helped strengthen the linkage between assessment and nutrition diagnosis, although the frequent selection of similar nutrition problems by dietitians’ points to an ongoing challenge in adopting critical thinking (49). Additionally, Chen et al. explored mobile applications as a means to enhance the efficiency of the nutrition care process, potentially freeing up more time for dietetic counseling (50), found that apps could improve the efficiency of the nutrition care process, allowing more time for dietetic counseling. While these apps show promise in complementing dietetic care, they cannot replace direct practice. In Mexico, where the demand for healthcare services related to metabolic diseases is rapidly increasing, the adoption of electronic systems and tools that streamline healthcare management and reduce commute times to hospitals presents an attractive opportunity for further exploration.

Our study represents a pioneering effort in adapting the NCP for metabolic diseases within a Latin-American context, marking the first such implementation across diverse clinical and research settings in the region. This adaptation not only addresses a significant gap in the literature but also provides a practical framework for healthcare professionals in similar settings. However, several limitations warrant mention. First, the literature review that underpinned the adaptation process was conducted several years ago. While it incorporated the most relevant and up-to-date references available at that time, some of the references may now appear outdated, potentially overlooking recent advances in the management of metabolic diseases. Despite this, we have made efforts to update critical aspects, such as the nomenclature and clinical nutrition management of the diseases, to reflect current standards and practices. Second, the scope of the literature review was primarily confined to PubMed. This decision was made due to PubMed’s comprehensive coverage of biomedical literature, which aligned well with our study’s focus on metabolic diseases. However, this approach, while thorough within its specified domain, inevitably limited the breadth of our review by excluding potentially valuable insights from broader multidisciplinary sources available in other databases such as Web of Science or ScienceDirect. This limitation may have restricted our perspective and lessened the comprehensiveness of the adaptation process.

The effective implementation of the NCP in Mexican healthcare settings demands a well-established set of skills, robust institutional support, and specific practices to ensure its adoption, sustainability, and impact. Dietitians treating metabolic diseases often encounter significant challenges, including high workloads and budget constraints, which can impede the adoption of new strategies requiring additional training or resources. Moreover, the role of dietitians is not consistently defined within institutional decision-making processes, complicating the implementation of standardized care protocols. Successful implementation relies on allocating dedicated time for practitioners to familiarize themselves with the NCP, providing ongoing training to maintain and improve skills, and securing strong support and leadership from management and department leaders. These elements represent both challenges and opportunities for institutions to advocate for programs that demonstrate the benefits of such changes, thereby supporting the sustained impact of the NCP. The adapted NCP discussed in this study marks substantial progress in creating targeted tools to enhance nutritional counseling practices in populations severely affected by metabolic diseases. A standardized NCP framework not only promotes consistent practice but also provides a solid basis for evaluating the effects of nutrition care on patient health outcomes. Achieving this, however, requires active participation and commitment from both institutions and healthcare professionals. Future research should focus on validating the effectiveness of these tools in real-world settings exploring their implementation alongside electronic systems to optimize service delivery.

We adapted the NCP for five metabolic diseases, incorporating assessment tools, dietary recommendations, and educational materials specifically tailored to the Mexican population. This comprehensive framework is designed to enhance professional nutrition practice. The adaptation is particularly significant for the Mexican population, which faces disproportionately high rates of metabolic diseases and associated treatment challenges. Who face disproportionately high rates of metabolic diseases and related treatment challenges. Future research is needed to evaluate the effectiveness of this adapted NCP in clinical settings and to explore its integration with electronic health records and mobile apps to facilitate implementation within health systems.