Nutritional Recovery in Severely Malnourished Hospitalized Patients

Assessment and Diagnosis of Malnutrition

Every hospitalized patient staying more than 48 hours should be considered at risk for malnutrition, with particular attention to those with visible weight loss, reduced lean body mass, or multiple comorbidities 2
Diagnosis of malnutrition requires at least one phenotypic criterion (non-volitional weight loss, low BMI, reduced muscle mass) and one etiological criterion (reduced food intake or disease burden/inflammation) according to the Global Leadership Initiative on Malnutrition (GLIM) criteria 3
Muscle function can be assessed using tools such as handgrip dynamometry, which serves as a good prognostic factor for recovery 2

For patients who can safely feed orally but cannot meet nutritional requirements with regular diet, oral nutritional supplements (ONS) should be offered first, as recommended by the Clinical Nutrition society 1
ONS with higher energy and protein content can add 10-12 kcal/kg and 0.3-0.5 g protein/kg daily over spontaneous intake when provided twice daily 1
ONS combined with physiotherapy has been shown to increase energy and protein intake while preserving lean body mass during recovery 1
If oral intake is insufficient to meet at least 70% of daily requirements, enteral nutrition should be implemented, as suggested by the Clinical Nutrition society 5
Enteral nutrition represents the most physiologic route of feeding compared to parenteral nutrition and has been linked to lower infection rates and shorter hospital stays 6, 7

Protein requirements are typically higher in malnourished patients to support muscle protein synthesis and recovery of lean body mass, according to the Clinical Nutrition society 8, 9
Nutritional support should be combined with physical rehabilitation to maximize recovery of muscle strength and function, as recommended by the Clinical Nutrition society 8

Severely compromised patients should receive perioperative nutritional therapy of longer duration, and when acute intervention is required, surgery should be limited, as suggested by the Clinical Nutrition society 9
In severely malnourished patients, longer periods of nutritional conditioning are necessary and should be combined with resistance exercise, according to the Clinical Nutrition society 9
Monitoring of response to nutritional therapy should include regular assessment of weight, muscle mass, and functional capacity, as recommended by the Clinical Nutrition society 2

Relying solely on BMI for nutritional assessment may underestimate malnutrition, especially in overhydrated patients, as noted by the Clinical Nutrition society 1
Neglecting the importance of physical rehabilitation alongside nutritional support will limit recovery of muscle strength and function, according to the Clinical Nutrition society 8