Key words: organization of dietary nutrition; nomenclature of diets; nutritional recommendations; energy and nutrients intake. Summary. New system and nomenclature of diets for Estonian health care institutions have been developed in the university hospital based on theoretical and practical experience obtained over several years of cooperation with medical scientists from different fields of specialization. The nomenclature of diets includes ordinary food and eight groups of diet food with subgroups.The normative values of the basic nutrients are in accordance with the Estonian and Nordic nutritional recommendations. The whole system includes the menus and recipes of nutritional food portions. The system of treatment diets helps to optimize proper nutrition in different departments and organize better patient care.

The association between poor nutritional status and treatment outcomes as well as increased healthcare costs have been shown in different clinical settings. Rational health care organization including a nutrition therapy is a theme that is in the centre of attention for physicians, health promoters and social workers. The paper demonstrates the organisation of a nutrition therapy at the Tartu University Hospital where counselling of patients and the medical team have gained much attention recently. In connection with the formation of the food service at the Tartu University Hospital on 1 May 1999 new important issues of management and organisation beside specific dietology issues have gained importance in feeding patients. By today the activities of the Tartu University Hospital in the field of nutrition have been reorganised in connection with the introduction of the electronic case history in the years 2008–2009.

Patients of health care and welfare institutions have several accompanying diseases; therefore, the nutritional counsellors’ or dietary nurses’ competence is often insufficient for administering a special diet, but the help of clinical dietologists and physicians of different specialities is necessary. In elaboration of clinical nutrition therapy strategies, their consistent development and coordination, an interdisciplinary clinical nutrition team can be helpful. Raising the nutritional awareness of the staff of structural units of medical and welfare institutions in helps them make rational choices in different disease cases, guaranteeing the patient’s wellbeing and a health care service with maximum benefit and minimum risk for the patient’s health. Physicians and other specialists of Tartu University Hospital (nurses, speech therapists, pharmacists, nutrition counsellors, diabetes nurses) have contributed comprehensively to chronic patients’ individual counselling during hospital treatment and supporting of outpatients’ nutritional treatment. In 2018, an initiative group of physicians of the hospital presented to the hospital’s Executive Board the need for establishing a broad-based expert group of clinical nutrition. With the Executive Board’s decision, a clinical nutrition committee was founded for rendering the nutrition treatment service.

Background: Dietology treatment is the one of the foundation stones in the complex treatment of the chronic kidney disease (CKD) patients together with all other treatments. The dietary intervention plays an important role to determine the effects to a decrease of metabolic abnormalities. Aim: The aim of the long-term study was to monitor nutritional parameters in the post-transplant period. Subjects and methods: We studied 28 clinically stable consecutive nondiabetic kidney transplant patients: 12 males at the age of 42.8 ± 16.1 years, and 16 females at the age of 47.0 ± 14.9 years. Intensive nutritional counselling and dietary consultation by a dietitian were carried out for all the studied patients during one and a half years after the kidney transplantation. Initial data were compared with the results obtained at the end of the study. During the 3-days dietary records analysis and counselling of CKD patients, giving answers to their questions about their food and portion sizes, the dietitian used the standards portion book with many photographs. Results: The consumption of vegetables and fruit was modest compared to Estonian food and nutrition recommendations. The food frequency questionnaire revealed that the patients consumed different foodstuffs at different frequencies, but there was a tendency to excessive consumption of foodstuffs rich in proteins and carbohydrates. To consumption of fat-rich foodstuffs a tendency of decrease was found.

Along with everyday clinical work, many nurses and physicians are dealing with clinical nutrition – counselling of patients, nutrition research and cooperation with specialists. It is essential to organise the clinical nutrition of inpatients, outpatients and home-care patients. Patients with chronic diseases and their carers expect increasingly profound information and guidelines about their nutrition from their attending physicians or department nurses and later at home – for this, specific guidelines are needed. An initiative group of physicians at Tartu University Hospital founded the Estonian Physicians’ Nutritional and Dietetics Society. The aims of the Estonian Physicians’ Nutritional and Dietetics Society are development of cooperation and information exchange with specialists in different areas, development and conducting of continuing education programmes in dietetics in cooperation with the Centre for Continuing Medical Education at the University of Tartu. The terminology of dietetics needs unification and updating. Disease-specific clinical nutrition guidelines have to be compiled and published.