When should nutritional support be implemented in a hospitalized patient?

Case

A 60-year-old male with a history of head & neck cancer, treated with radical neck dissection and radiation 5 years prior is admitted with community-acquired pneumonia and anasarca. Prior to admission, he was on a soft dysphagia diet and reports increased difficulty with solid foods and weight loss from 70 kg to 55 kg over 2.5 years. Should nutritional support be initiated?

Background

At the time of admission to the hospital, malnutrition is already present in over 20% of patients.¹ Hospitalized patients are particularly susceptible to developing malnutrition because of increased catabolic states in acute illness and poor intake from decreased appetite, nil per os status, and impaired mental status.

Malnutrition is associated with increased hospital mortality, decreased functional status and quality of life, infections, longer length of stay, higher hospital costs, and more frequent nonelective readmissions.^1,2