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Objective: To determine whether a 1-day calorie count can replace the labor-intensive 3-day calorie count commonly performed in hospitalized patients when estimates of caloric and protein intake are required. Design: Pilot study using prospective, non-concurrent review of medical records. Setting: Hospital. Participants: Thirty patients (mean age 67 years). Results: Mean 3-day intake (952 ± 91 calories, 41 ± 4 g protein) was about half of calculated requirements; first-day intake was similar (918 ± 116 calories, 40 ± 5 g protein). The first day had high sensitivity (calories 96%; protein 93%) and positive predictive value (calories 100%; protein 96%). Malnutrition was evident; three-fourths of patients had weights below recommended ranges, and 83% were hypoalbuminemic. Conclusions: Three-day calorie counts are frequently performed in patients suspected of eating poorly. Results of this pilot study suggest that 1-day calorie counts may be a valid alternative. However, readily available anthropometric and biochemical data may be as good an indicator of inadequate dietary intake.

Objective: To determine the effect of dietary protein on healing of pressure ulcers in malnourished patients. Design: Nutritional intervention trial with the non-randomized assignment of patients by pressure ulcer stage and bed type. Setting: Long-term care facility. Patients: Twenty-eight malnourished patients (age = 72 ± 18 years, mean ± SD) with a total of 33 truncal pressure ulcers. Nine patients had stage II ulcers, eight had stage III ulcers, and 16 had stage IV ulcers. Methods: Patients received liquid nutritional formulas as tubefeedings or meal supplements containing either 24% protein (61 g protein/L; n = 15) or 14% protein (37 g protein/L; n = 13) for 8 weeks. Results: There was a significant decrease in total truncal pressure ulcer surface area of the 15 patients in the 24% protein group (-4.2 ±7.1 cm2, P < 0.02), but not in the 13 patients in the 14% protein group (-2.1 ±11.5 cm2, P = NS). The change in total ulcer area correlated with both dietary protein intake per kg body weight (rs = −0.50, P < 0.01) and caloric intake per kg body weight (rs = −0.41, P < 0.03). The decrease in stage IV ulcer area in eight patients in the 24% protein group (-7.6 ± 5.8 cm2, P < 0.02) was significantly greater (P < 0.05) than in eight patients in the 14% protein group (-3.2 ± 16.4, P = NS). In these 16 patients, the decrease in ulcer size also correlated with dietary protein intake per kg body weight (rs = −0.63, P < 0.01). Conclusion: High protein diets may improve the healing of pressure ulcers in malnourished nursing home patients.