What does a hospital do for malnutrition? A comprehensive approach to nutritional care

October 22, 2025 •

3 min read

According to research, the prevalence of hospital malnutrition risk is high, affecting 20-50% of inpatients, yet it often goes underdiagnosed. To combat this, a hospital uses a systematic, multidisciplinary approach to identify and treat malnutrition, employing various methods to ensure patients receive proper nutritional support tailored to their specific needs.

Quick Summary

Hospitals address malnutrition by performing early screenings and comprehensive assessments to identify at-risk patients, followed by implementing tailored nutritional support. Treatment strategies include oral supplements, enteral tube feeding for a functioning gut, or parenteral IV feeding for compromised digestive systems. Care teams manage risks like refeeding syndrome and provide follow-up planning to support long-term recovery.

Key Points

Initial Screening is Mandatory: All hospital patients are screened for malnutrition risk within 24 hours of admission to identify those requiring further assessment.
Multidisciplinary Team Approach: Nutritional care is managed by a team of dietitians, doctors, and nurses, especially for complex cases involving enteral or parenteral nutrition.
Tailored Feeding Methods: Treatment can involve oral nutritional supplements (ONS) for adequate intake, enteral tube feeding for a functioning gut, or intravenous parenteral nutrition (PN) for GI tract issues.
Careful Management of Refeeding Syndrome: Severe malnutrition requires cautious re-feeding to prevent dangerous electrolyte shifts, with intensive monitoring and supplementation.
Comprehensive Discharge Planning: Hospitals arrange for follow-up care, including dietitian consultations, home meal services, and prescriptions for nutritional support to ensure continued recovery after discharge.
Patient and Caregiver Education: Education is a key component of the discharge process, teaching patients and their families about managing dietary needs and identifying potential issues.

Identifying and Assessing Malnutrition

The process of addressing malnutrition in a hospital begins immediately upon a patient's admission. The first step is to perform a nutritional risk screening, ideally within 24 hours of arrival. This initial screening helps identify patients who may need a more in-depth assessment. Standardized tools like the Nutritional Risk Screening (NRS) or Mini Nutritional Assessment (MNA) are often used. For inpatients, screenings are typically repeated weekly.

Patients identified as at-risk are referred to a registered dietitian nutritionist (RDN) for a comprehensive nutritional assessment. This assessment includes gathering a detailed history of eating habits, weight changes, symptoms, and medical conditions, along with a physical examination to check for signs of malnutrition. This information helps the healthcare team diagnose the severity of malnutrition and create an effective care plan.

Tailored Nutritional Support Plans

Based on the patient's nutritional needs and the functionality of their gastrointestinal (GI) tract, a specialized nutritional support plan is developed. A team involving dietitians, doctors, and nurses collaborate to determine and manage the appropriate feeding method.

Oral Nutrition Support (ONS)

For patients able to eat but with reduced intake, oral nutritional support is the first course of action. Dietitians provide guidance on dietary modifications, food fortification, and high-energy snacks. Food fortification enhances the calorie and protein content of meals, while ready-made oral nutritional supplements like shakes or puddings can be consumed between meals.

Enteral Nutrition (Tube Feeding)

When a patient cannot meet their nutritional requirements orally but has a working GI tract, enteral nutrition is used. A feeding tube delivers liquid formula directly to the stomach or small intestine. Tube types vary based on the expected duration of use; nasogastric (NG) tubes are for short-term use (up to six weeks), while gastrostomy (PEG) or jejunostomy (PEJ) tubes are for longer-term support. Feeding can be continuous or in boluses.

Parenteral Nutrition (IV Feeding)

Parenteral nutrition is utilized when the patient's digestive system is not functioning correctly. This involves administering a nutrient solution directly into the bloodstream via an IV catheter. Total Parenteral Nutrition (TPN) provides complete nutritional needs through a central vein, while Peripheral Parenteral Nutrition (PPN) is for shorter periods or supplemental feeding via a peripheral vein. Due to higher risks like infection, patients on PN require close monitoring in the hospital.


Method of Nutritional Support	Description	Indication	Risks/Considerations
Oral Nutritional Support (ONS)	Enhancing regular food with fortification and specialized supplement drinks.	Patients who can swallow safely but have poor appetite or intake.	Can sometimes affect appetite for normal meals if not timed correctly. Needs patient compliance.
Enteral Nutrition (EN)	Delivery of liquid nutrients via a feeding tube inserted into the stomach or intestine.	Patients with a functioning GI tract but unable to meet needs orally.	Aspiration risk, tube issues, metabolic complications like refeeding syndrome.
Parenteral Nutrition (PN)	Intravenous feeding of a nutrient solution, bypassing the digestive system.	Patients with a non-functional GI tract or severe malabsorption issues.	Higher risk of infection, metabolic abnormalities, and requires intensive monitoring.

Managing the Risk of Refeeding Syndrome

Refeeding syndrome is a potentially life-threatening complication that can occur when severely malnourished patients are refed. It involves dangerous shifts in electrolyte levels as metabolism resumes. Hospitals prevent this by starting feeding slowly, gradually increasing caloric intake over several days. Electrolyte levels are closely monitored and supplemented, and thiamine is often given. The nutrition support team is essential during this phase.

Post-Discharge Planning and Long-Term Care

Hospital care includes planning for a patient's nutritional needs after discharge. Dietitians arrange for necessary resources, equipment, and prescriptions for patients requiring ongoing nutritional support at home. Referrals to dietitians or community services may be made for less severe cases. Educating patients and caregivers on dietary needs, managing feeding equipment, and recognizing potential issues is a crucial part of ensuring continuity of care and preventing nutritional decline.

Conclusion

Hospitals address malnutrition through a structured and comprehensive approach, starting with identification and assessment and progressing to tailored treatment plans. They utilize various feeding methods, including oral supplements, enteral tube feeding, and parenteral IV nutrition, while actively managing risks such as refeeding syndrome. Post-discharge planning and patient education are key to ensuring long-term recovery and preventing complications. For further information on nutritional care, organizations like the American Society for Parenteral and Enteral Nutrition (ASPEN) are valuable resources.

Frequently Asked Questions

The first step is a nutritional risk screening, which is conducted on all patients upon admission, usually within 24 hours.

If a patient can't eat enough solid food but has a functional gut, they may receive a liquid diet via a feeding tube (enteral nutrition). If the gut is not functional, they receive nutrients intravenously (parenteral nutrition).

Refeeding syndrome is a metabolic complication that occurs when reintroducing nutrition to a severely malnourished person. Hospitals prevent it by starting feeding at a low rate and closely monitoring and replacing electrolyte levels.

Intravenous (parenteral) nutrition is used when a patient's gastrointestinal tract is non-functional, inaccessible, or severely compromised by illness or surgery.

A dietitian is a key member of the nutrition support team. They conduct comprehensive assessments, develop personalized nutrition plans, monitor patient progress, and provide education to patients and families.

Before discharge, a dietitian coordinates a follow-up plan that includes arrangements for ongoing nutritional support, prescriptions for oral supplements or tube feeding supplies, and education for the patient and caregivers.

Oral nutritional supplements are high-energy and high-protein drinks, puddings, or powders used to supplement a patient's diet when oral intake is insufficient. They are not meant to replace full meals.