Association between dietary counselling and nutrition provision during transition from ICU to post-ICU wards. Three-centre retrospective analysis.

BACKGROUND: Adequate nutrition is crucial in critical illness and remains important after discharge from the intensive care unit. The transition from enteral to oral feeding increases the risk of protein and energy deficiency. This study evaluated whether structured dietary counselling affects nutritional provision and reduces deviation from calculated nutritional goals during hospitalization and the transition from the intensive care unit to the post-intensive care unit. METHODS: This retrospective study included adult patients discharged from the intensive care unit to in-hospital wards after ≥3 days of stay (July-December 2025). Data from the last day of stay in the intensive care unit and the first day after leaving the unit were analysed, including calculated energy and protein requirements and actual oral, enteral, and parenteral intake. Patients were compared in terms of the presence of dietary counselling in the intensive care unit, counselling after leaving the intensive care unit, and adherence to ICU's discharge recommendations. RESULTS: This study included 103 patients. In the ICU dietary counselling was present in 56.3% of patients and improved energy adequacy (104% vs 88%, p = 0.02), reduced energy goal deviation (11% vs 45%, p < 0.0001), and favoured higher energy enteral formulas (1.42 kcal/mL vs 1.17 kcal/mL, p < 0.0001). Protein adequacy and goal deviations did not differ between groups. In the post-ICU wards dietary counselling was present in 41.7% of patients and improved both protein and energy adequacy (protein: 98.7% vs 69.1%, p < 0.0001; energy: 97.7% vs 69.1%, p < 0.0001), as well as reduced goal deviations (protein: 20.8% vs 41.3%, p < 0.0001; energy: 13.9% vs 37.3%, p < 0.0001). In addition to the nutritional impact of post-ICU dietary counselling, adherence to ICU discharge recommendations was associated with a higher frequency of enteral nutrition and ONS use (enteral: 69.7% vs 21.7%, p < 0.0001; ONS: 51.2% vs 26.7%, p = 0.01). DISCUSSION: This study provides audit evidence indicating opportunity for optimalization in both ICU and post-ICU nutrition. Discontinuity in prescriptions and inadequate nutrition provision were frequent in our cohort and resulted in suboptimal nutritional intake. In our study, dietary counselling, throughout hospital care was associated with lower energy and protein goal deviation and lower energy and protein inadequacy. In conclusion, ICU to post-ICU transitions remain a critical vulnerability in nutritional care. These challenges can be attenuated by the integration of clinical dietitians into the ICU and post-ICU standard of care.