Starving in the Hospital

Nutrition and recovery are intertwined...

Posted Mar 09, 2020

Making sure a patient is receiving a nutritionally adequate diet may not seem like a high priority when the individual is experiencing a medical crisis.  Watch any television series about an emergency ward and you will never see an episode showing a patient getting a tray from the food service. And, if during the program, the patient is transferred to an intensive care unit during the fraught initial period of recovery, it is unlikely that the specialists who visit the bedside include a dietician. In fact it is probably safe to say that none of the myriad medical programs show a tray of hospital food, or the patient attempting to eat it.

And yet, nutritional concerns about the critically ill patient are extremely important, and  should be a high priority. Patients undergoing acute care (and the subsequent longer recovery period) must have adequate nutrient and calorie intake to potentiate healing. The body undergoes metabolic stress when critically ill, regardless of the cause.

One way to explain this metabolic stress is that there is an increase in the breakdown of protein in muscle and other organs in the body, and the body is less able to use glucose for energy. According to Mehta and his colleagues, these changes increase the protein and calorie requirements of the patient, and as they state, “Significance of nutrition in the critical-care setting cannot be overstated. If the patient’s food intake is not adequate in total calories and protein, the clinical condition will deteriorate.“  They assert that feeding the patient should start within 24 to 48 hours, and if the patient is unable to consume food by mouth, then nutrients should be administered intravenously.

But do the patients get the nutrients they need during this critical period?  Does the doctor or dietician not only make sure that the high protein and high carbohydrate foods are ordered from the hospital food service, but also that the food is actually eaten? A tray of food may be delivered and returned to the meal cart untouched. Or the applesauce or pudding may be eaten, but the high protein food ignored.  If the high protein and carbohydrate foods so essential for healing are not consumed, is anyone recommending a nutrient rich drink like Boost or Ensure ?

The need for adequate nutrition does not disappear when the patient passes from critical care to the next phase of recovery.  Although these days, many patients may be sent home during this period, if they are still in the hospital they usually make their own menu selections.  A dietician may restrict the possible choices if the patient is following a low sodium or diabetic diet, for example, but the patient still can choose between a low nutrient food such as lettuce, and a more nutrient dense food like spinach. Moreover, as with the patient in the critical care unit, how much the patient is eating or leaving on the tray is rarely noted. The patient may be getting enough calories, but not enough protein or nutrients. Indeed why do we even assume that the patient will : a)  choose only nutrient dense, protein rich foods and,  b) eat everything delivered by the food service ? Given the almost ubiquitous dislike of hospital food, it is more likely that the foods eaten may be only the puddings, applesauce, ice-cream and fruit cup.

It has been said that family members and/friends need to be involved in the care a patient is receiving in the hospital. Being attentive to what the patient is eating or not eating, being present while menu choices are being made, and if possible when the meals are delivered, may help the patient get the calories and nutrients needed. Hospital dieticians are available to give advice and possibly offer alternative food choices if the patient is not eating what is offered on the general menu. If allowed, bringing nutritious food to the patient from home that the patient will eat, might compensate in part for the food uneaten from the hospital tray.

It is unlikely that we will encounter hospital food that pleasures our or our family member's senses and taste buds. But we should not be vulnerable to being starved of essential nutrients because no one is paying attention to what we are eating.

References

"Practice Guidelines for Nutrition in Critically Ill Patients: A Relook for Indian Scenario." Mehta Y, Sunavala J, Zirpe K et. al.  Indian J Crit Care Med. 2018;22:263–273.   

"Metabolic response to the stress of critical illness", Preiser C, Ichai C, Orban J,  BJA: British Journal of Anaesthesia, 2014 ; 113: 945–954.