With the recent focus on improving patient experiences and outcomes while in the hospital, there has been a significant emphasis placed on how to improve the nutritional status of hospitalized patients.
Providing high-quality nutrition care and interventions are critical for recovery from surgery, illness, or prolonged hospitalization.
At least one-third of patients arriving at the hospital are malnourished, which can adversely impact patient outcomes.1 Of those who arrive malnourished, the nutritional status will decline during the hospital stay in 2/3 of patients.2 As practitioners, there is a lot that can be done to improve malnutrition and prevent patients from declining further during hospitalization.
Nutrient Requirements of Hospitalized Patients
Malnutrition is defined as an imbalance in nutritional needs, not necessarily undernutrition. This can mean a patient’s diet does not provide the right amount or appropriate ratio of calories, macronutrients, or micronutrients to promote adequate healing.3
But, many hospitalized patients do have elevated nutrient needs. Depending on the medical condition of the patient, nutrient requirements can be extremely high to encourage wound healing, improve nutritional status, and support recovery from illness or surgery. For example, a patient with a pressure ulcer may need up to 2.2 g/kg (1 g/pound) of protein per day.4
Micronutrients may also be a concern for hospitalized patients. A 2016 study published in Nutrients evaluated the micronutrient status of hospitalized patients in an infectious disease clinic. Patients were found to be deficient in zinc, selenium, thiamine, vitamin B6, and vitamin B12. Of the patients evaluated 32% had multiple micronutrient deficiencies.5
Meeting nutritional needs is a challenge for any patient. They frequently need to consume a higher volume of more concentrated foods. Since protein is of greatest importance, eating a large amount of protein, which is very satiating, can be difficult even for a healthy person.6 Many of the micronutrients discussed in the study above are also found in high protein foods, posing an additional challenge.
Challenges to Adequate Nutrient Intake
Hospitalized patients experience multiple barriers to properly meeting their nutrient needs. Many struggle with a loss of appetite due to medications, surgery, or chronic illness. Digestive discomfort, such as constipation or gas, may cause patients to eat less.
If the patient is older, low activity levels can slow metabolism and decrease appetite. Changes to sight, taste, and smell can impact food intake as well. Dentition, swallowing problems, and self-feeding issues can pose additional difficulties in meeting nutrient needs, a particular challenge with consuming high protein meat.
Infections, gastrointestinal illnesses, surgery, and advanced age can all lead to a reduction in nutrient absorption, even if a patient is eating adequate calories.
Depression and other mental health disorders are common in hospitalized patients, all of which can influence appetite. Many people with chronic illness lack social support, worsening depression and motivation to eat. If a patient is bed-bound, they may be required to eat in bed, which may reduce the appeal of food.
An interdisciplinary approach, requiring interventions by physicians, nurses, pharmacists, social workers, and Registered Dietitians can help address many of these barriers to improve patient nutritional status and hospital outcomes.
Tips to Help Increase Nutrient Density
Both during and even post-hospitalization patients remain at risk for poor nutrition. Here are a few tips to help ensure they meet their nutrition needs both during and after discharge:
- Begin nutrition interventions as soon as possible, preferably within 24 hours of admission.
- Provide comfort foods that are familiar to the patient.
- Encourage the patient to give in to “cravings” for specific foods.
- Utilize liquid dietary supplements in between meals to fill in nutrient gaps.
- Find ways to fortify familiar foods to maintain palatability, but increase nutrient density.
- Focus on increasing food variety to ensure adequate intake of all necessary nutrients and reduce boredom.7
- Promote small, frequent meals if patients experience early satiety.
- Provide written instructions and nutrition follow-up before discharge.
- Provide resources that make obtaining nutrient-dense foods feasible upon discharge.
Maintaining and improving a patient’s nutritional status in the hospital requires an interdisciplinary approach. When all members of the care team are focused on nutrition, this offers multiple opportunities to improve the quality of care, reduce cost, and decrease hospital readmission rates.
Ana Reisdorf, MS, RD is a Registered Dietitian Nutritionist and freelance writer with 12-years of experience in the field of nutrition and dietetics.
- Barker LA, Gout BS, Crowe TC. Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system. Int J Environ Res Public Health. 2011;8(2):514-527.
- Somanchi M, Tao X, Mullin GE. The facilitated early enteral and dietary management effectiveness trial in hospitalized patients with malnutrition. JPEN J Parenter Enteral Nutr. 2011;35(2):209-216.
- Tappenden KA, Quatrara B, Parkhurst ML, Malone AM, Fanjiang G, Ziegler TR. Critical role of nutrition in improving quality of care: an interdisciplinary call to action to address adult hospital malnutrition. JPEN J Parenter Enteral Nutr. 2013;37(4):482-497.
- Saghaleini SH, Dehghan K, Shadvar K, Sanaie S, Mahmoodpoor A, Ostadi Z. Pressure Ulcer and Nutrition. Indian J Crit Care Med. 2018;22(4):283-289.
- Dizdar OS, Baspınar O, Kocer D, et al. Nutritional Risk, Micronutrient Status and Clinical Outcomes: A Prospective Observational Study in an Infectious Disease Clinic. Nutrients. 2016;8(3):124.
- Belza A, Ritz C, 4. Sørensen MQ, Holst JJ, Rehfeld JF, Astrup A. Contribution of gastroenteropancreatic appetite hormones to protein-induced satiety. Am J Clin Nutr. 2013;97(5):980-989.
- Bernstein MA, Tucker KL, Ryan ND, et al. Higher dietary variety is associated with better nutritional status in frail elderly people. J Am Diet Assoc. 2002;102(8):1096-1104.