Outcome from nutritional support using hospital food

From the results in the 733 patients without initial edema, we can make predictions for the nutritional requirements of the average hospital patient: BMR by Harris-Benedict 5.9 MJ/d (1 410 kcal/d); average activity factor 1.15, average stress factor 1.02, giving a basic requirement of 1.17 x BMR. However, the shortfall between expected weight gain and observed weight gain, which gives an average empiric disease factor of 1.1, suggests that a figure of 1.3 x BMR is a more appropriate target. If, in addition, weight gain is desired, then using a weight gain factor of 1.3, the goal should be 1.5 to 1.7 x BMR. Using this approach, less than 10% of our patients lost more than 5% of their body weight during their hospital admission, and the majority of these either maintained or gained weight. These figures contrast sharply with the report by McWhirter and Pennington, who assessed weight change during hospital stay among patients assessed as malnourished on admission. The majority of their patients lost weight with an average weight loss of 7%. Our results show that this is preventable, largely by the use of appropriately designed and targeted hospital menus using normal or fortified food.