Nutrition in acute care

Malnutrition is common in hospitalised patients but is underrecognised and undertreated. It increases mortality and complications, and delays recovery from illness during and after hospital stay. The doctor therefore has the responsibility of ensuring that malnutrition is recognised and treated appropriately. Since hospital stays are often short, there is a need to ensure continuity of care so that treatment that begins in hospital is continued in the community. Hospital physicians have the opportunity to diagnose obesity related problems, which may go unrecognised. The most obvious example is type 2 diabetes but sleep apnoea,1 which is linked to loud snoring and disrupted sleep, can present as tiredness, headaches, depression, loss of energy and even loss of memory. It commonly occurs in overweight individuals, especially those with large neck size (neck adipose tissue deposition) and responds to weight loss, although in severe cases continuous positive airway pressure may be needed. The management of obesity takes place predominantly in the community; hence the discussion that follows focuses mainly on the problem of malnutrition.