![]() ![]() MNT in the hospital can be challenging in the presence of acute medical illness, poor appetite, inability to eat, increased nutrient and calorie needs due to catabolic stress, and variation in diabetes medications. Individualized MNT during hospitalization, along with intensive medical management, is generally required for patients with diabetes to achieve blood glucose targets. Individuals with diabetes should receive MNT as needed to achieve treatment goals, preferably provided by a registered dietitian familiar with the components of diabetes MNT. ![]() The goals of inpatient MNT for patients with diabetes are to help optimize glycemic control, provide adequate calories to meet metabolic demands, address individuals needs based on personal food preferences, and provide a discharge plan for follow-up care. MNT is defined as a process of a nutritional assessment and individualized meal planning in consultation with a nutrition professional. Nutritional management in the hospital is frequently complicated by hospital routines including abrupt discontinuation of meals in preparation for diagnostic studies or procedures, variability in appetite due to the underlying illness, limitations in food selections, and poor coordination between insulin administration and meal delivery that creates difficulties in predicting the efficacy of glycemic management strategies. Although there are no randomized controlled studies comparing different inpatient nutritional strategies, health care professionals should keep in mind that nutrition requirements often differ in the home versus the hospital setting. Lack of attention to MNT in the hospital contributes to unfavorable changes in blood glucose and in the coordination of appropriate insulin therapy. Inpatient hyperglycemia in patients with and without diabetes is associated with an increased risk of adverse patient outcomes. MNT is an essential component of inpatient glycemic management in patients with diabetes and hyperglycemia. Expert opinion consensus suggests that all hospitalized patients should undergo nutrition assessment on admission with subsequent implementation of physiologically sound caloric support. Current nutrition guidelines state that any patient unable to consume adequate nutrients orally (≥ 60% nutrition needs) for at least 5 days in the critically ill, or 7 to 14 days in the general population, should be a candidate for specialized nutrition support. ![]() Data from a large national database from over 1 million patients in the United States (surgical, medical, and trauma) indicated that specialized nutrition support is cost effective, and decreases infectious complications and length of hospital stay by 51% and by 9.7 days, respectively. ![]() Inpatient medical nutrition therapy (MNT) aims to optimize glycemic control and to provide adequate calories to meet metabolic demands. Improving the nutritional state can restore immunologic competence and reduce the frequency and severity of infectious complications in hospitalized patients. Malnutrition in critically ill patients is common with a prevalence of 40% in intensive care unit (ICU). Malnutrition among hospitalized patients is associated with depletion of body mass, poor wound healing, impaired immune function, impaired ventilatory drive, and weakened respiratory muscles, leading to longer hospital stay and increased infectious morbidity and mortality. ![]()
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