Nutrition in the hospitalized patient

Abstract

Almost 50% of patients are malnourished on admission; many others develop malnutrition during admission. Malnutrition contributes to hospital morbidity, mortality, costs, and readmissions. The Joint Commission requires malnutrition risk screening on admission. If screening identifies malnutrition risk, a nutrition assessment is required to create a nutrition care plan. The plan should be initiated early in the hospital course, as even patients with normal nutrition become malnourished quickly when acutely ill. While the Harris‐Benedict equation is the most commonly used method to estimate calories, its accuracy may not be optimal in all patients. Calculating the caloric needs of acutely ill obese patients is particularly problematic. In general, a patient's caloric intake should be slightly less than calculated needs to avoid the metabolic risks of overfeeding. However, most patients do not receive their goal calories or receive parenteral nutrition due to erroneous practices of awaiting return of bowel sounds or holding feeding for gastric residual volumes. Patients with inadequate intake over time may develop potentially fatal refeeding syndrome. The hospitalist must be able to recognize the risk factors for malnutrition, patients at risk of refeeding syndrome, and the optimal route for nutrition support. Finally, education of patients and their caregivers about nutrition support must begin before discharge, and include coordination of care with outpatient facilities. As with all other aspects of discharge, it is the hospitalist's role to assure smooth transition of the nutrition care plan to an outpatient setting. Journal of Hospital Medicine 2013. © 2012 Society of Hospital Medicine

Malnutrition at Hospital Admission—Contributors and Effect on Length of Stay

“…Hospital malnutrition is also associated with detrimental outcomes 25 ‐ 33 and increased healthcare costs, 28 , 32 independent of underlying disease, presence of comorbidities, patient's age, and/or socioeconomic factors. However, how the presence of malnutrition at the time of admission and the presence of various components of hospital nutrition care, such as dietitian visits, food intake, and nutrition support, affect LOS remains unclear.…”

Frequency and Appropriateness of Fasting Orders in the Hospital

“…8,9 The frequent and prolonged fasting from NPO orders may not only lead to patient dissatisfaction [10][11][12] but may also cause malnutrition and adversely affect patient outcomes. 13,14 Especially given the heightened risk for malnutrition in hospitalized patients, 15 NPO orders should be used only when necessary and for minimum duration.…”

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