Hospital malnutrition.
Up to half of inpatients are malnourished and most are never diagnosed. Screen within 24h, diagnose with GLIM, and feed to target — one of the few inpatient interventions with a survival signal.
Reviewed June 2026 · verify against current guidelines
Common, costly, invisible.
The scale
Up to half of hospital inpatients are malnourished, and about a third who arrive well-nourished decline during the stay.
Why it gets missed
- No weight, no intake record, no muscle exam.
- Blamed on the disease instead of flagged as its own problem.
- A normal albumin falsely reassures; it tracks inflammation, not nutrition.
- Undocumented means uncoded, and uncoded means untreated.
Screen everyone, fast.
Within 24 hours
The Joint Commission requires nutrition screening within 24 h of admission. Use a validated tool, not a clinical hunch.
Validated screens
| MST | Recent weight loss plus reduced intake. Two questions. |
|---|---|
| NRS-2002 | Nutrition status plus disease severity plus age. Inpatient standard. |
| MUST | BMI plus weight loss plus acute disease effect. |
GLIM in one slide.
The rule
Diagnose malnutrition with at least one phenotypic criterion plus at least one etiologic criterion.
Phenotypic (need ≥1)
| Weight loss | >5% in 6 months, or >10% beyond 6 months |
|---|---|
| Low BMI | <20 if age <70; <22 if age ≥70 |
| Low muscle mass | By exam or body composition (BIA, DXA) |
Etiologic (need ≥1)
| Reduced intake | ≤50% of needs >1 wk, any drop >2 wk, or malabsorption |
|---|---|
| Inflammation | Acute illness or injury, or chronic disease |
Severity (moderate vs severe) is graded on the phenotypic criteria. Asia uses lower BMI cutoffs.
Feed to a target.
Set the targets
| Energy | 25-30 kcal/kg/day |
|---|---|
| Protein | 1.2-2.0 g/kg/day. The RDA's 0.8 is for the healthy. |
The intervention
- Refer to a dietitian; start oral nutrition supplements.
- Reassess intake daily; escalate if targets are missed.
- Document and code the diagnosis so it gets treated.
Test, replete, refeed safely.
Test and replete
| Thiamine (B1) | Empirically: alcohol use, bariatric, prolonged poor intake. |
|---|---|
| B12, folate | Macrocytic anemia or neuro symptoms. |
| Vit D, iron, zinc | Common deficits; read iron and zinc against inflammation. |
Refeeding (NICE)
| Electrolytes | Phosphate, K, Mg fall as feeding starts. Monitor and replete. |
|---|---|
| High risk | Start ≤10 kcal/kg/day; build to full over 4-7 days. |
Sources
Verify against current guidelines and local protocol before acting.
- Cederholm T, Jensen GL, Correia MITD, et al. GLIM criteria for the diagnosis of malnutrition: a consensus report. Clin Nutr 2019;38:1-9 (also JPEN 2019;43:32-40).
- Jensen GL, Cederholm T, et al. GLIM consensus approach to diagnosis of malnutrition: a 5-year update. JPEN / Clin Nutr 2025.
- Schuetz P, Fehr R, Baechli V, et al. Individualised nutritional support in medical inpatients at nutritional risk (EFFORT). Lancet 2019;393:2312-2321.
- ESPEN guideline on nutritional support for polymorbid medical inpatients. Clin Nutr 2023.
- Evans DC, et al. Use of visceral proteins as nutrition markers: ASPEN position paper. Nutr Clin Pract 2021 (albumin/prealbumin reflect inflammation, not nutrition).
- NICE CG32. Nutrition support for adults: refeeding risk (high-risk start ≤10 kcal/kg/day; thiamine plus electrolytes).
- The Joint Commission: nutrition screening required within 24 h of admission.
Downloads
Every card for this topic — carousels and tables, print-ready for the wards or for sharing.
