How Do Hospitals Treat Malnutrition?: A Detailed Guide to Nutritional Care

November 1, 2025 •

4 min read

Up to 50% of patients admitted to the hospital are malnourished or at risk of malnutrition, which can lead to longer hospital stays and poor outcomes. In these cases, it is critical for healthcare providers to know how do hospitals treat malnutrition using specialized teams and carefully managed nutritional interventions.

Quick Summary

Hospitals manage malnutrition through a systematic process involving initial screening, comprehensive assessment, and personalized treatment plans. This often includes oral nutritional supplements, specialized tube feeding (enteral nutrition), or intravenous feeding (parenteral nutrition), along with careful refeeding strategies to mitigate risks. The approach prioritizes patient safety and successful long-term recovery.

Key Points

Team-Based Approach: Hospitals use a multidisciplinary Nutrition Support Team, including physicians, dietitians, nurses, and pharmacists, to create and manage treatment plans for malnourished patients.
Screening is Standard Practice: All patients are screened for malnutrition risk within 24-48 hours of admission using validated tools like MUST or NRS-2002 to identify those needing intervention.
Gradual Refeeding is Crucial: Malnourished patients are refed cautiously with low-calorie, high-nutrient formulas to prevent refeeding syndrome, a dangerous electrolyte imbalance.
Multiple Feeding Methods are Used: Treatment progresses from oral supplements to tube feeding (enteral) or intravenous feeding (parenteral) based on the patient’s ability to digest food.
Refeeding Syndrome Requires Vigilance: This potentially fatal condition is managed by careful monitoring of electrolytes, particularly phosphate, potassium, and magnesium, and supplementing as needed.
Discharge Planning Ensures Long-Term Success: A comprehensive discharge plan is developed to arrange continued nutritional care, follow-up appointments, and home support to prevent relapse.

Systematic Screening and Assessment

The process for treating malnutrition in a hospital begins immediately upon admission with a thorough screening. This initial step identifies patients who are already malnourished or are at high risk due to their illness, recent weight loss, or poor appetite. Common screening tools used by nurses and other healthcare professionals include the 'Malnutrition Universal Screening Tool' (MUST) or the 'Nutritional Risk Screening 2002' (NRS-2002).

If a patient screens positive, a more comprehensive nutritional assessment is conducted by a dietitian. This involves evaluating the patient's dietary history, current food intake, physical exam findings (like muscle wasting), functional status, and relevant lab results. For children, growth charts and body measurements are also used to determine the severity of malnutrition.

The Role of the Nutrition Support Team (NST)

Optimal care for malnourished patients is provided by a multidisciplinary Nutrition Support Team (NST). This specialized team typically includes:

A Clinician (often a gastroenterologist or intensivist): Oversees the overall medical management and nutritional plan.
A Dietitian: Conducts detailed nutritional assessments, calculates individual nutrient requirements, and designs the specific feeding regimen.
A Nutrition Support Nurse: Manages feeding tubes and catheters, trains staff and caregivers, and monitors for complications.
A Pharmacist: Optimizes the parenteral nutrition formula and advises on drug-nutrient interactions.
Other Specialists (e.g., Speech Therapist, Social Worker): Address specific issues like swallowing difficulties or social factors affecting nutrition post-discharge.

Nutritional Intervention Strategies

Treatment is tailored based on the patient's condition and the functionality of their digestive system. The hierarchy of support begins with oral feeding and progresses to artificial support if necessary.

Oral Nutritional Supplements (ONS)

For patients who can still eat but have a poor appetite, dietary advice and oral supplements are the first line of treatment. A dietitian may recommend food fortification (adding nutrients to regular food) or liquid nutritional drinks to increase energy and protein intake.

Enteral Nutrition (Tube Feeding)

When oral intake is insufficient or unsafe (e.g., due to swallowing problems), enteral nutrition is used. This involves delivering a liquid formula directly into the stomach or small intestine via a feeding tube. The type of tube depends on the anticipated duration of treatment.

Common Enteral Feeding Methods:

Nasogastric tube (NGT): A tube inserted through the nose into the stomach. Used for short-term feeding.
Percutaneous Endoscopic Gastrostomy (PEG) tube: A tube surgically placed through the abdomen directly into the stomach. Suitable for long-term feeding.

Parenteral Nutrition (Intravenous Feeding)

If the patient's digestive system is not working or needs to rest, parenteral nutrition is necessary. This method bypasses the gastrointestinal tract, delivering nutrients directly into the bloodstream through an intravenous (IV) catheter.

Types of Parenteral Nutrition:

Peripheral Parenteral Nutrition (PPN): Provides partial nutrition via a peripheral vein for a short period.
Total Parenteral Nutrition (TPN): Provides all essential nutrients via a central vein for complete nutritional support over a longer duration.

Managing Refeeding Syndrome

Refeeding syndrome is a critical and potentially fatal complication that can occur when severely malnourished patients are refed too quickly. During starvation, the body’s metabolism slows down, and intracellular electrolytes become depleted. Reintroducing carbohydrates rapidly triggers a surge in insulin, causing these electrolytes (especially phosphate, potassium, and magnesium) to shift back into the cells, leading to dangerously low blood levels.

To prevent this, hospitals follow strict refeeding protocols, often guided by organizations like the American Society for Parenteral and Enteral Nutrition (ASPEN). These protocols involve starting with low-calorie feeds and gradually increasing them while closely monitoring electrolyte levels through regular blood tests. Thiamine and other vitamin supplements are also administered preemptively. The entire process is managed under constant medical supervision to detect and correct any metabolic shifts immediately.

Comparison of Enteral and Parenteral Nutrition


Feature	Enteral Nutrition (Tube Feeding)	Parenteral Nutrition (IV Feeding)
Delivery Route	Directly into the gastrointestinal tract (stomach or intestine).	Directly into the bloodstream via a vein.
Physiological Impact	More physiological, as it utilizes the gut, which helps maintain its function and integrity.	Bypasses the gut, which can lead to gut atrophy over time.
Cost & Simplicity	Generally simpler and less expensive to administer.	More complex, invasive, and costly due to formula preparation and sterile procedures.
Associated Risks	Risks include aspiration, diarrhea, and tube dislodgment.	Risks include infection, blood clots, and metabolic complications.
Suitability	For patients who can't eat but have a functioning GI tract.	For patients whose GI tract is not functioning or must rest.

Discharge Planning and Follow-up

Treatment for malnutrition doesn't end with hospital discharge. A coordinated transition of care is essential for long-term recovery. The discharge plan, created with the NST, outlines continued nutritional support. This may include:

Dietary recommendations, including specific meal plans or fortified foods.
Prescription for and education on oral nutrition supplements or at-home enteral feeding.
Scheduled follow-up appointments with a dietitian or outpatient nutrition clinic.
Coordination with home care providers or social services, especially for elderly patients or those with limited mobility.

Conclusion

Effectively addressing malnutrition in a hospital setting requires a coordinated, multifaceted approach. From initial screening and comprehensive assessment by a specialized Nutrition Support Team to the careful implementation of oral, enteral, or parenteral feeding, every step is critical. Managing the risks of refeeding syndrome is paramount, and safe refeeding is achieved through vigilant monitoring and gradual increases in nutrition. Ultimately, successful treatment extends beyond the hospital stay, relying on a robust discharge plan and follow-up care to ensure sustained recovery and improved long-term health outcomes for the patient.

Frequently Asked Questions

Enteral nutrition uses a feeding tube to deliver nutrients to a functioning gastrointestinal (GI) tract, while parenteral nutrition delivers nutrients directly into the bloodstream via an IV, bypassing the GI tract entirely.

Refeeding syndrome is a dangerous metabolic and electrolyte imbalance that can occur when a severely malnourished person is fed too rapidly. It causes critical shifts in electrolytes like phosphate and potassium.

Hospitals prevent refeeding syndrome by identifying at-risk patients, starting with a low-calorie diet, and slowly advancing the feeding while closely monitoring and supplementing electrolytes like phosphate, potassium, and magnesium.

A Nutrition Support Team typically includes a physician, a registered dietitian, a nutrition support nurse, a pharmacist, and other specialists such as a speech therapist or social worker.

Tube feeding is necessary for patients who cannot meet their nutritional needs by mouth, such as those with severe swallowing difficulties (dysphagia), certain cancers, or neurological conditions, but still have a working digestive system.

Discharge planning involves providing the patient and their family with a nutritional care plan, including dietary recommendations or home feeding instructions, arranging follow-up with a dietitian or home care agency, and checking for community resources.

Malnutrition is identified through systematic screening upon admission and weekly thereafter. A comprehensive assessment is then performed by a dietitian, evaluating factors like weight loss, BMI, dietary intake, and physical signs.