Timing of Nutrition Assessment Does Not Improve Compliance With Nutritional Goals in the ICU

Introduction: The mNUTRIC score is a validated tool that identifies the most nutritionally at risk critically ill patients. A score greater than 5 is associated with having the greatest benefit of meeting nutritional goals. Per SCCM/ASPEN guidelines, these patients should meet >80% of their caloric goal by hospital day seven (HD7). Poor compliance with meeting daily goals in intensive care units (ICU) due to frequent nutrition interruptions is common. We hypothesized that an early nutrition assessment would improve compliance with meeting nutritional goals in the most at risk population at HD7.


Methods: A retrospective chart review from January 1st, 2023 to May 6th, 2025 was performed. Adult patients admitted to surgical ICU and mechanically ventilated for at least 72 hours with a calculated mNUTRIC score greater than 5 were included. Exclusion criteria were age < 18, hospital length of stay < 7 days and transition to comfort care. If a patient had more than one ICU stay, only the index admission was observed. Time to dietary consult and nutritional assessment, nutritional daily goals, and daily nutrition received were collected.


Results: After exclusion criteria, 56 patients had a mNUTRIC score > 6. On HD7, 10 additional patients were excluded for transferring prior to the endpoint. Of the remaining 46 patients, 29 (63%) received >80% of their nutritional goal and 17 (37%) received < 80%. The median time to assessment in the group that met their nutritional goal was 3.6 (2.1-4.4) days versus 3.9 (3.0-4.7) days for the group that did not (p=0.3371). Time to assessment was not independently associated with meeting nutritional goals (OR 0.78, 0.52-1.18). No difference was observed between groups in regards to ventilator days (p=0.3735), ICU LOS (p=0.3735), ICU mortality (p=0.5012), and hospital mortality (p=0.1949). Of the 17 who did not meet their goal, 9 (53%) were due to incomplete charting, 4 (24%) were due to NPO status and 4 (24%) were due to intentional hypocaloric prescribing.


Conclusions: In critically ill surgical patients admitted to SICU >72 hours with mNUTRIC score > 6, earlier nutrition assessment did not increase likelihood of meeting nutrition goals. The most common cause for failure to meet nutritional goals was inconsistent charting.