Nutrition after critical illness: Exploring barriers, consequences, and nutrition interventions beyond hospital discharge

Survivors of critical illness frequently do not achieve recommended nutrition targets because of multiple barriers. Consequently, malnutrition is prevalent during hospitalization, yet posthospital discharge nutrition interventions are often missing, leaving a gap during a crucial recovery phase. This scoping review aims to explore barriers to nutrition adequacy, consequences of inadequate nutrition, and interventions for adult survivors of critical illness following hospital discharge. Using Joanna Briggs Institute methodology in conjunction with the PRISMA-ScR checklist, searches were conducted in MEDLINE, Embase, CINAHL, Web of Science, and Cochrane databases (2010-2024) for studies on adult intensive care unit (ICU) survivors posthospital discharge, reporting nutrition barriers, consequences, and/or nutrition interventions. Factors identified from the data are analyzed and presented using a conceptual framework derived from the Biopsychosocial model and the Social Ecological Model. Forty-three studies (mostly observational) were included encompassing 32,165 participants. Commonly reported barriers included (% of studies) appetite loss (40%), dysphagia (26%), and psychological distress (40%), contributing to inadequate dietary intake (19%), malnutrition (42%), and weight loss (56%) persisting up to 12 months. Body composition changes, observed in 21% of studies, demonstrated increased fat mass, whereas lean mass was maintained or lost. Despite high nutrition risk, only 37% reported nutrition input. Nutrition interventions improved nutrition, physical, and psychological outcomes. This review emphasizes the complexity of nutrition recovery faced by ICU survivors, highlighting significant gaps in nutrition care following hospital discharge. Understanding nutrition challenges from survivors' perspective is essential before evaluating specific nutrition interventions addressing the diverse nutrition needs of individuals recovering from critical illness.