Malnutrition in German Hospitals and the Enriched Full-Diet Guideline, Digi Mart USA News (Germany): Up to 60 percent of patients are considered malnourished when they are admitted to hospital, with serious consequences for their recovery. An updated guideline now introduces, for the first time, a dedicated diet form intended to change that.
Malnutrition is a frequently overlooked problem in German hospitals. Between 20 and 60 percent of patients are already affected on admission, depending on the study and patient group.
Older people and those with chronic or serious illnesses are particularly at risk.
Malnourished patients stay in hospital on average about twice as long as adequately nourished patients, according to Diana Rubin, a board member of the German Society for Nutritional Medicine (DGEM), speaking at a DGEM press conference during Malnutrition Awareness Week 2026. The risk of complications also rises significantly, Rubin said.
She is also chief physician and head of the Center for Nutritional Medicine at the Vivantes Klinikum Spandau and Humboldt Klinikum in Berlin.
Malnutrition does not necessarily mean that someone eats too little or is underweight. The term covers several forms of poor nutrition, including a lack of certain nutrients such as protein.
Around 80 percent of patients lose weight during their hospital stay, a condition that Rubin said considerably impairs healing.
Based on information from Malnutrition Awareness Week, the additional annual costs to Germany’s inpatient healthcare system caused by malnutrition are estimated at 5 to 8.6 billion euros.
The updated “Guideline for Nutritional Therapy in Clinic and Practice”, known as LEKuP 2026, establishes the “enriched full diet” as a standalone basic diet form for patients at risk of malnutrition. The change does not mean preparing food fundamentally differently; rather, a specially adapted meal offering is now systematically provided for in the guideline and given a fixed place in regular hospital catering.
Patients who can eat only small amounts need small portions that still contain sufficient energy and protein.
In the enriched full diet, ordinary dishes are deliberately enhanced with high-quality vegetable oils, dairy products or other protein-rich ingredients, so that even a small amount of food delivers considerably more nutrients. “Treating malnutrition requires not only the expertise of hospital professionals but also the right food offering,” Rubin emphasized.
LEKuP 2026 is intended to create a basis for hospitals to put this into practice.
For the diet to be effective, it must reach the right patients. The guideline therefore provides for malnutrition screening upon hospital admission.
Nursing staff, who usually carry out the screening, should be able to assign the appropriate diet form immediately, without additional coordination with physicians or nutrition specialists. Rubin noted that with an average length of stay of five to ten days, valuable time is often lost before adapted nutrition reaches the patient, and that the right diet form should be available “from day one.”
Rubin also addressed a frequently raised objection: the enriched full diet does not have to be more expensive than current hospital catering. “That can be done cost-neutrally,” she said.
What matters is that hospitals train the necessary staff, carry out the screening and add the new diet form to their catalog.
The initiative also has political support. On March 6, 2026, the German Bundestag, as part of the Hospital Reform Adjustment Act, commissioned the Federal Joint Committee to develop a directive by the end of 2027 on the identification and treatment of malnutrition in hospitals.
Participants in Malnutrition Awareness Week described this as a “milestone in the history of nutritional medicine in Germany.”
Current meta-analyses support the urgency of such measures, showing that systematic nutritional management can significantly reduce both hospital mortality and readmission rates. Malnutrition nevertheless continues to be frequently overlooked, partly due to limited knowledge among medical professionals and inadequate reimbursement for nutritional medicine services.
The DGEM therefore calls for strengthening outpatient structures for treating disease-related malnutrition alongside inpatient care.
