Malnutrition is underrecognized by physicians. However, further research is needed to determine if physician recognition and treatment of malnutrition can improve outcomes. The most important criteria for identifying malnourished patients in our cohort were weight loss and reduced energy intake.

Objectives: The aims of this study were, first, to compare the predicted (calculated) energy requirements based on standard equations with target energy requirement based on indirect calorimetry (IC) in critically ill, obese mechanically ventilated patients; and second, to compare actual energy intake to target energy requirements. Methods: We conducted a prospective cohort study of mechanically ventilated critically ill patients with body mass index ≥30.0 kg/m 2 for whom enteral feeding was planned. Clinical and demographic data were prospectively collected. Resting energy expenditure was measured by open-circuit IC. American Society of Parenteral and Enteral Nutrition (APSPEN)/Society of Critical Care Medicine (SCCM) 2016 equations were used to determine predicted (calculated) energy requirements. Target energy requirements were set at 65% to 70% of measured resting energy expenditure as recommended by ASPEN/SCCM. Nitrogen balance was determined via simultaneous measurement of 24-h urinary nitrogen concentration and protein intake. Results: Twenty-five patients (mean age: 64.5 ± 11.8 y, mean body mass index: 35.2 ± 3.6 kg/m 2 ) underwent IC. The mean predicted energy requirement was 1227 kcal/d compared with mean measured target energy requirement of 1691 kcal/d. Predicted (calculated) energy requirements derived from ASPEN/SCCM equations were less than the target energy requirements in most cases. Actual energy intake from enteral nutrition met 57% of target energy requirements. Protein intake met 25% of target protein requirement and the mean nitrogen balance was −2.3 ± 5.1 g/d. Conclusions: Predictive equations underestimated target energy needs in this population. Further, we found that feeding to goal was often delayed resulting in failure to meet both protein and energy intake goals.

Background Malnutrition remains an important yet under‐recognised problem among hospitalised adults. Although interventions exist aiming to improve nutritional status beyond hospitalisation, few studies examine how often and what type of nutrition care instructions are given at discharge. The present study sought to review nutrition‐focused discharge care provided to malnourished adults. Methods We reviewed the electronic medical record for discharge nutrition care instructions provided to adult patients identified by dietitians as malnourished over a 4‐month period. Results Seventy‐six eligible patients were identified during the study period. More than half of malnutrition cases (64.5%) were attributed to chronic illness. According to electronic medical record documentation, 6.6% received discharge instructions to consume oral nutrition supplements and 30.3% received new or changed prescriptions for vitamins/noncaloric supplements. Almost half of patients (47.4%) received general diet instructions that did not address malnutrition and 44.8% received inappropriate instructions to limit caloric intake. Conclusions A majority of malnourished adult patients receive inappropriate or inadequate nutrition care instructions at the time of discharge. Clinician education and redesign of nutrition care options in the electronic medical record may improve the provision of post‐discharge nutrition care instructions.