What diet recommendations are suitable for someone with malnutrition?

Diet Recommendations for Malnutrition

For individuals with malnutrition, a comprehensive nutritional approach should provide at least 30 kcal/kg body weight per day and 1.2-1.5 g/kg body weight per day of protein, with oral nutritional supplements (ONS) providing at least 400 kcal/day including 30g or more of protein when dietary intake alone is insufficient.

Nutritional Requirements

• Energy requirements for malnourished individuals should be approximately 30 kcal/kg body weight per day 1, 2
• Protein intake should be increased to 1.2-1.5 g/kg body weight per day to promote muscle protein anabolism and prevent further loss of fat-free mass 2, 3
• Restrictive diets that may limit dietary intake should be avoided as they are potentially harmful and can worsen malnutrition 1

Dietary Interventions (Stepwise Approach)

First-Line Interventions

• Begin with dietary counseling and food fortification to increase energy and protein intake through regular foods 1
• Offer texture-modified, enriched foods for individuals with chewing or swallowing difficulties 1
• Implement food fortification techniques (adding energy-dense ingredients to regular meals) to increase caloric density without increasing volume 1

Second-Line Interventions

• When dietary counseling and food fortification are insufficient to reach nutritional goals, oral nutritional supplements (ONS) should be offered 1
• ONS should provide at least 400 kcal/day including 30g or more of protein/day 1, 2
• ONS should be continued for at least one month with monthly assessment of efficacy 1
• Type, flavor, texture, and timing of ONS consumption should be adapted to the patient's preferences and eating capabilities to improve compliance 1

Special Considerations

• For older persons with diabetes and malnutrition, follow the same guidelines as for non-diabetic older adults, as prevention and treatment of malnutrition is more important than possible long-term complications of hyperglycemia 1
• In patients with insulin resistance, increase the ratio of energy from fat to energy from carbohydrates to increase energy density and reduce glycemic load 1
• For malnourished patients with pressure ulcers, supplementation with formulas enriched with arginine, zinc, and antioxidants may improve healing 1

Meal Pattern and Eating Environment

• Offer small, frequent meals and additional snacks between main meals to increase total daily intake 1
• Provide mealtime assistance for individuals with eating dependency to support adequate dietary intake 1
• Create a pleasant meal ambience and encourage eating with others to address social isolation and improve intake 1

Refeeding Syndrome Prevention

• In severely malnourished individuals, nutritional support should start early but increase gradually during the first three days to prevent refeeding syndrome 1
• Monitor blood levels of phosphate, magnesium, potassium, and thiamine during the first three days of nutritional therapy and supplement even in case of mild deficiency 1

Multimodal Approach

• Combine nutritional interventions with physical activity and exercise to maintain or improve muscle mass and function 1
• Screen for and address nutrition impact symptoms (nausea, pain, early satiety) that may impair food intake 1
• Regular assessment of nutritional status and adjustment of interventions based on response is essential 1

Common Pitfalls and Caveats

• Avoid using hypoalbuminemia as the sole marker for protein malnutrition, as it is affected by inflammation and other non-nutritional factors 2
• Do not restrict energy intake in patients with malnutrition, even in those with obesity, as this can worsen nutritional status 1
• Recognize that malnutrition can occur in individuals with obesity due to micronutrient deficiencies despite excessive energy consumption 4
• Do not delay nutritional intervention until severe malnutrition develops; early intervention is more effective 1

By following these evidence-based recommendations, malnutrition can be effectively addressed, leading to improved clinical outcomes, reduced complications, and enhanced quality of life.