Malnutrition includes both the deficiency and excess (or imbalance) of energy, protein and other nutrients. In clinical practice, undernutrition, and inadequate intake of energy, protein and nutrients, is the focus. Undernutrition affects body tissues, functional ability and overall health. In hospitalized patients, undernutrition is often complicated by acute conditions (e.g. a trauma), infections and diseases that cause inflammation. Such complications worsen undernutrition and make it more challenging to correct due to extensive physiological changes and increased nutritional needs when appetite is decreased.
Adapted from AW McKinlay: Malnutrition: the spectre at the feast. J R Coll Physicians Edinb 2008:38317–21.
The effect of the NPO diet order
This brief article, written by Dr. Jeejeebhoy, describes what happens to the body when fasting or kept “NPO” (or without food and fluids) for too long. A hospital practice that is not recommended.
Recommendations for the best nutrition care
Make standardized screening protocols mandatory in hospitals in Canada
Include an interdisciplinary team in the nutrition care process that starts with nutrition screening, then subjective global assessment and a full nutrition assessment and development of a nutrition care plan by a Registered Dietitian
- Ensure staff (nursing and food/nutrition services) provides patient-focused and protected nutrition through mealtime care that is consistent with the nutrition care plan
- Establish a national standard for menu planning to ensure quality food is provided in hospitals and requires that food services staff provide adequate nutrients to meet the needs of diverse patients, as indicated in their nutrition care plans
- Educate hospital administrators, physicians, nurses and allied health professionals on the need to integrate nutrition care as part of quality interdisciplinary practice
- Effective use of oral nutrition supplementation, enteral nutrition and parenteral nutrition to prevent and/or treat malnutrition