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  1. Malnutrition is associated with increased mortality and remains an underdiagnosed condition affecting critically ill patients. Timely and adequate screening is important to identify patients who are at risk.

  2. Early enteral nutrition has been proven to be beneficial in ICU patients. Every effort should be made to initiate enteral nutrition within 48 hours of ICU admission unless clinically contraindicated.

  3. Developing feeding protocols has been shown to increase nutrient administration and utilization of enteral nutrition in critically ill patients. Identifying procedures that focus on the use of promotility agents and avoiding unnecessary feeding interruptions is essential.

  4. Inappropriate parenteral nutrition use has been associated with increased risk of infectious and metabolic complications. Delaying initiation of parenteral nutrition for at least 7 days may be prudent.


An estimated 40% to 50% of patients admitted to the ICU are undernourished or at risk for malnutrition.1 Malnutrition is known to impair tissue function, delay wound healing, prolong ventilator dependence, and increase length of hospital stay.2,3 During critical illness, metabolic changes can lead to hyperglycemia, increased energy expenditure, and protein catabolism. This cytokine-driven and hormone-mediated response to stress is not only vital in stabilizing organ function and preserving immune competency, but it may also contribute to the loss of body mass and development of malnutrition. Therefore, adequate nutrition should aim to reduce severity and duration of the catabolic phase and optimize nutritional status for recovery.


Adult malnutrition is poorly defined and frequently unrecognized, hence the incidence and prevalence are difficult to determine. Clinical terms, such as marasmus, kwashiorkor, and protein-calorie malnutrition have previously been used to identify malnutrition; however, the use of some of these terms is confusing and antiquated. They were originally meant to distinguish the different clinical features of acute malnutrition in children (Table 29–1).

Table 29–1Malnutrition definitions.

While numerous tools for identifying and ...

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