Health experts have raised fresh concerns over worsening cases of malnutrition in hospitals, warning that delayed nutritional care continues to put patients at risk of complications and death.
The experts, who spoke at a global webinar hosted by the West African Society for Parenteral and Enteral Nutrition (WASPEN) in collaboration with its Indian counterpart, Indian Society for Parenteral and Enteral Nutrition, said the failure to prioritise early nutrition screening is fuelling a “silent but deadly crisis.”
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The webinar themed “Strengthening Clinical Nutrition Care Through Effective Nutrition Assessment,” called for an urgent overhaul of clinical nutrition protocols, urging hospitals to adopt a “golden hour” approach to nutritional screening.
Missed diagnoses
Delivering the keynote address, Chief Clinical Dietitian at Apollo Hospitals, Daphnee Lovesley, said the crisis often begins at the point of admission, where cases of malnutrition go undetected.
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Ms Lovesley revealed that at least 11 hospitalised patients go undiagnosed with malnutrition every 60 seconds.
She added that up to two-thirds of patients are already malnourished upon admission, with the figure rising to 85 per cent in parts of Africa.
She warned that delays in initiating nutritional care, particularly beyond the first 24 hours, significantly increase the risk of complications and mortality.
“If we delay our nutrition prescription for more than 24 hours, the patient is at extreme risk,” she cautioned.
Wide gaps in detection and care
Recent research findings show that hospital malnutrition remains widespread, with significant variations in how it is detected and managed across regions.
A 2024 scoping review found that malnutrition prevalence among hospitalised adults in Africa ranges from eight per cent to as high as 85 per cent, while the risk of malnutrition falls between 23 and 74 per cent, depending on the screening tools used.
The study, which analysed 28 research papers across the continent, noted that inconsistent assessment methods and poor referral practices continue to limit accurate diagnosis, warning that “routine nutritional screening should be implemented as a matter of urgency in African hospitals.”
Similarly, global studies indicate that malnutrition affects up to 50 per cent of hospitalised patients, although detection rates remain uneven due to differences in clinical practice and screening systems.
Large-scale data involving over 190,000 patients also show that nutritional risk tends to be higher among older adults and patients in intensive care or specialised units such as oncology and neurology.
Other studies have also linked hospital malnutrition to poorer clinical outcomes, including longer hospital stays and reduced survival rates, particularly among elderly patients and those with underlying conditions.
Push for ‘golden hour’ screening
To address the gap, Ms Lovesley called for the adoption of a mandatory “golden hour” approach, recommending that all patients undergo nutritional screening within six hours of admission.
She explained that early detection is key to preventing complications such as sarcopenia – the accelerated loss of muscle mass and function – which contributes to frailty, increased fracture risk and poor recovery outcomes.
The approach, she explained, aligns with the Global Leadership Initiative on Malnutrition (GLIM) framework, which helps clinicians identify high-risk patients using indicators such as weight loss, reduced dietary intake and disease severity.
Implementation challenges in Nigeria
Also speaking, WASPEN President, Teresa Pounds, said Nigeria must move beyond policy discussions to fully implement structured clinical nutrition systems across hospitals.
Ms Pounds urged the Nigerian government to adopt a top-down approach to ensure full operationalisation of the Nutritional Steering Committee (NSC) across hospitals nationwide, stressing that effective coordination is essential to tackling hospital-related malnutrition.
“When we work together, we achieve more. Nigeria is making meaningful progress toward establishing a Nutritional Steering Committee, but it is imperative that global best practices are domesticated. Accreditation bodies must integrate these standards into the healthcare system,” she said.
She also called on hospital administrators across secondary and tertiary institutions including private hospitals to prioritise routine nutritional assessments and establish multidisciplinary teams to ensure screening within 24 hours of admission.
She emphasised that nutrition care must be recognised as a core component of successful treatment outcomes, noting that greater institutional commitment is required to address the challenge effectively.
Wider impact on healthcare
Ms Lovesley noted that untreated malnutrition can prolong hospital stays by two to three days, while increasing vulnerability to infections, delayed wound healing and premature death.
The experts warned that it not only affects patient recovery but also places additional strain on healthcare systems.
They stressed the importance of a multidisciplinary approach involving physicians, nurses, and dietitians.
Key recommendations included practical measures such as protected mealtimes to allow patients to eat without interruption and a “food-first” approach that prioritises natural diets before supplements.
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Call for sustained action
In her closing remarks, Ms Pounds described clinical nutrition as a critical pillar of public health and patient care, calling for sustained commitment from all stakeholders.
She also urged healthcare professionals to participate in the upcoming WASPEN conference scheduled for 22-25 June, noting that it is a key platform for advancing clinical nutrition practice across the region.
“Nutritional assessment remains the most effective tool for preventing morbidity and early mortality among patients,” she said.
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