In 2012, physician and healthcare groups defined malnutrition as the presence of two or more of the following characteristics: "insufficient energy intake, weight loss, loss of muscle mass, loss of subcutaneous fat, localized or generalized fluid accumulation, or decreased functional status."
"Processes must be put into place to ensure that appropriate nutrition intervention is provided and patients' nutrition status is routinely monitored," the alliance's report notes. "Without question, nutrition care must be made a high priority and systematized in United States' hospitals."
The alliance is highly critical of nutritional care in hospitals, noting that too often physicians aren't as involved in monitoring nutrition care as they should be. Clinicians and hospital administrators "often fail to prioritize nutrition and fail to recognize" potential impacts.
In addition, hospital oversight of nutrition programs is lagging because of a lack of nutrition education and training, and a dearth of coordination among staff. At many institutions, dietitians are solely responsible for nutrition, but hospitals lack staff or simply don't bother to coordinate the work of dietitians with physicians and nurses.
While nurses oversee patients 24/7, they are often not included in nutrition care because physician "sign-off" is required to implement a nutrition care plan... But physicians may neglect dietitian recommendations because they are focusing on other medical concerns. Doctors also may be uncertain about "specific micronutrient therapy options" in their hospitals.