When should nutritional support be implemented in a hospitalized patient?

Inflammation associated with disease and injury results in metabolic alterations that affect a patient’s nutritional needs – increased energy expenditure, lean tissue catabolism, fluid shift to the extracellular compartment, acute phase protein changes, and hyperglycemia. Malnutrition can thus be classified in terms of etiology⁵:

• Starvation-related malnutrition, such as anorexia nervosa, presents with a deficiency in calories and protein without inflammation, .
• Chronic disease–related malnutrition, such as that caused chronic obstructive pulmonary disease, cancer, and obesity, presents with mild to moderate inflammation.
• Acute disease or injury–related malnutrition, such as that caused by sepsis, burns, and trauma, presents with acute and severe inflammation.

Laboratory indicators such as albumin, prealbumin, and transferrin are not recommended for the determination of nutritional status. Instead, as negative acute-phase reactants, they can be used as surrogate markers of nutritional risk and degree of inflammation.⁴

Overview of the data

What are the indications for initiating nutritional support, and what is the optimal timing for initiation?