Nutritional support

Abstract

Malnutrition also has other important consequences. A number of studies have shown that 40% of patients have some degree of malnutrition on admission, and in half of these it is severe.51 This goes largely unrecognized because of failure of doctors and nurses to understand the importance of nutrition.52 The nutritional state of patients also tends to deteriorate while in hospital through lack of adequate nutritional care.51 Catering in many hospitals is ill-adapted to the needs of the sick, resulting in food wastage rates in excess of 40% and food intakes of less than 80% of requirements.53"55 A recent review56 has shown a direct relation between the degree of undernutrition and the length of hospital stay, as well as a reduced length of stay with early and adequate intervention. The delayed recovery from illness associated with inadequately treated malnutrition has therefore economic as well as clinical consequences. The nutrition-related problems faced by the surgical or critically ill patient are summarized in Table 65.1 with their causes, consequences, and treatment.