New Delhi: In India’s hospitals where ventilators hum and clinicians move briskly from bed to bed, one quiet determinant of recovery continues to be overlooked: nutrition. At the second edition of the ETHealthworld NutriWell Conclave, an expert panel came together to confront this long-ignored gap and make a compelling case: clinical nutrition is not supportive care; it is clinical care.
The session, held under the theme “From Awareness to Action: Advancing Evidence-Based Clinical Nutrition in Patient Care,” where experts underscored the stark paradox where nutrition is the bedrock of recovery, yet remains one of the least prioritised aspects of patient care.
The expert panel brought together leaders from across the continuum of hospital nutrition and quality systems —Sandhya Pandey, GM and Chief Clinical Nutritionist at Medanta–The Medicity; Dr. Shabana Parveen, Head of Dietetics at Artemis Hospital; and Dr. B. K. Rana, CEO, Quality & Accreditation Institute (QAI)—each examining the same challenge from a distinct vantage point. The session was moderated by Rashmi Mabiyan Kaur, Principal Correspondent, ETHealthworld.
The Hidden Crisis: Malnutrition Inside Hospitals
For Sandhya Pandey, the issue is both glaring and under-discussed. She calls it “the skeleton in the closet.” “People assume patients in hospitals are well cared for nutritionally. But admission is often when metabolic demands are highest and food intake is lowest,” she explained. Critically ill and post-surgical patients enter a catabolic state—breaking down muscle rapidly, often without the nutritional support needed to counter it.
Her team screens every admitted patient using validated tools such as SGA, NRS-2002, and GLIM criteria. Nursing staff initiate a quick screening, followed by a detailed dietitian-led assessment to diagnose malnutrition risk and establish individualized nutrition goals. This structured, protocol-driven approach, she stressed, must become non-negotiable in every Indian hospital.
Pandey highlighted three crucial data-backed reasons why early nutrition intervention is both a clinical and economic necessity, first it reduces complications like surgical-site infections and delayed wound healing, second it shortens hospital and ICU stays and third it lowers re-hospitalisation rates by supporting better recovery at home.
“These outcomes are published globally, but we need more Indian evidence,” she added.
The Execution Challenge
Even when nutrition assessments are completed, ensuring prescriptions are followed remains a major hurdle, said Dr. Shabana Parveen. She emphasized that nutrition processes must begin the moment a patient enters the hospital. A detailed assessment—covering diagnosis, weight trends, intake history, and biochemical markers—helps determine risk, after which dietitians revisit patients daily or at defined intervals.
Compliance, she noted, hinges on three factors, first is to daily face-to-face coordination among dietitians, doctors, nurses, physiotherapists, and pharmacists. Second is real-time digital documentation enabled by mobile apps integrated with hospital systems, and third is continuous nursing education, since nurses ultimately execute feeding plans, and cultural and dietary diversity add another layer of complexity.
“We follow ESPEN guidelines, but Indian patients need Indian diets,” Dr. Parveen said. “You cannot ignore vegetarian preferences, home food habits, or cultural norms. Family education is as important as patient education because long-term recovery happens at home.”
Why Accreditation Must Enforce Nutrition Standards
While clinicians work at the patient level, systemic change requires enforceable standards, emphasized Dr. B. K. Rana. QAI’s accreditation programs—from clinics to hospitals to home care—embed nutrition as a mandatory element.
“Every patient—OPD or IPD—must undergo a nutritional assessment. Not selectively, not optionally—every patient,” he said.
But standards matter only if implemented effectively. Dr. Rana stressed the need for clear guidelines, uniform execution across departments, meaningful communication with patients and caregivers, and a broader shift from treating disease to delivering holistic, individualized care.
“It’s no longer about patient care alone; it’s about involving the family and community. Nutrition must be part of this continuum,” he added.
No One-Size-Fits-All
In complex cases—gastrointestinal surgeries, inflammatory conditions, or gut failure—aggressive feeding can backfire. Pandey explained the critical need for close collaboration between dietitians, surgeons, and intensivists to balance risks and benefits.
A severely malnourished patient, for instance, cannot simply be put on full caloric feeding due to the risk of refeeding syndrome. Nutrition must be titrated gradually with daily biochemical monitoring.
“With gut-compromised patients, there is no fixed formula,” she explained. “You re-evaluate every single day and make course corrections. Monitoring is the key.”
Growing evidence also supports incorporating probiotics and prebiotics into perioperative care—yet another area where dietitians must stay updated with evolving science.
The Road Ahead: Nutrition Is Not Optional—It Is Foundational
As the panel concluded, the message was unmistakable: early nutrition intervention is not optional. It is both a clinical and economic imperative.
From accreditation standards to cultural sensitivity, from documentation to system-wide implementation, the panel reinforced that nutrition forms the foundation of recovery, outcomes, and quality of life.
If India is to improve patient outcomes and reduce healthcare burdens, evidence-based nutrition must move from the margins to the mainstream of clinical practice.
Experts informed that evident, nutrition is not just nourishment; it is treatment. And it may well be the most powerful, yet underused, medicine in India’s healthcare system.
