Meal composition and nutrient intake in hospitalized adults: the role of relative energy and protein content

Inadequate oral intake among hospitalized adults contributes to malnutrition and adverse outcomes. While guidelines advocate meals with higher energy and protein content, how meal composition relates to intake under routine conditions is unclear.

In this cross-sectional study, 392 lunch and dinner meals were recorded across six departments at a tertiary hospital. Intake was measured by weighing food before and after consumption, and nutrient content was derived from standardized recipes and food composition tables. Meals were stratified by relative energy and protein content (per 100 g food), categorized as above or below the median. Associations between meal composition and intake outcomes were analyzed using non-parametric tests (Mann-Whitney U and Kruskal-Wallis).

Median consumption was 205 g [IQR: 119-286], providing 250 kcal [137-385] and 10.0 g [5.8-15.6] of protein per meal. Meals above the median for relative energy content were associated with higher energy (+117 kcal; p < 0.001) and protein intake (+3.6 g; p < 0.001) compared with meals below the median, with no difference in food weight. Meals above the median for relative protein content provided +4.9 g more protein (p < 0.001) despite a 23 g reduction in weight (p = 0.007).

Hospitalized patients consume modest energy and protein. Higher relative energy and protein content of foods was associated with greater intake despite similar or smaller portions. These findings support targeted meal-composition strategies focusing on energy and protein enrichment.