¹DocMode Health Technologies Ltd, Mumbai, India
²SL Raheja Hospital, Mumbai, India

*Corresponding author:Prachi Velhal, Dietician and Research Consultant, DocMode Health Technologies, Mumbai, India, E-mail Id: prachi@docmode.com

Article Information:Submission: 17/12/2024; Accepted: 15/01/2025; Published: 20/01/2025

Copyright: © 2025 Lewis H, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Malnutrition in hospitalized patients remains a significant challenge, with studies indicating up to 30% of hospitalized patients and 50% of ICU patients experiencing nutritional deficiencies. This paper presents iNutrimon, a comprehensive digital nutrition management system currently implemented in 15 of India’s leading hospitals, including all five Gleneagles (IHH group) hospitals, AIG Hospital, and SL Raheja Hospital. The system integrates evidence based nutritional screening tools, automated calculations, and standardized care protocols based on ASPEN and ESPEN guidelines. Through systematic implementation and validation over five years, iNutrimon has demonstrated significant improvements in nutritional care delivery, resource utilization, and patient outcomes.

Malnutrition in hospitalized patients remains a persistent challenge in healthcare delivery worldwide. Studies have consistently demonstrated that approximately 30% of patients are malnourished upon hospital admission, with rates escalating to nearly 50% in intensive care settings. This compromised nutritional status significantly impacts patient outcomes, leading to increased length of stay, higher infection rates, and elevated mortality risks.

This secondary research article synthesizes findings from four key primary studies conducted using the iNutrimon platform:
1. “Nutrition Management Practices in Critical Care in Tertiary Hospitals - A Survey from India” (2017)
o Survey of 20 tertiary care ICUs across Mumbai
o Revealed only 50% utilization of scientific formula feeds
o Identified significant variations in nutritional assessment methodologies

o Demonstrated gaps in dietitian consultation timing
2. “Cost of Enteral Formulae Feed in Critically Ill Patients in a Tertiary Care Centre: An Observational Study from India” (2019)
o Analysis of 2,748 patients over 3 years
o Documented average formula feed costs of INR 749 (USD 8.83) per day
o Established correlation between length of stay and feeding costs
3. “Making Nutrition Management Scientific, Objective and Simple with the Help of Technology” (2017)
o Validated iNutrimon’s technological framework
o Demonstrated reduction in calculation errors

o Documented improved efficiency in nutrition delivery
4. “Comparison of Nutric Score, Nutritional Risk Screening (NRS) 2002 and Subjective Global Assessment (SGA) in the ICU: a Cohort Study” (2019)
o Evaluated 348 consecutive patients
o Compared effectiveness of different screening tools
o Established correlations with clinical outcomes
These foundational studies identified several critical challenges in hospital nutrition management:
1. Delayed screening and dietician consultation
2. Inconsistent nutritional assessment methodologies
3. Complexity in calculating and delivering precise nutritional requirements
4. Difficulties in monitoring and adjusting nutritional delivery
5. Food service management inefficiencies
6. Lack of standardization across institutions

The presence of multiple caregivers in the ICU setting - including physicians, dietitians, nutritionists, and nurses - often leads to communication gaps and delayed implementation of nutritional interventions. Furthermore, the studies highlighted significant variation in practices across institutions, from basic screening procedures to the implementation of evidence-based feeding protocols.

Through comprehensive analysis of these primary research findings, this paper presents a unified framework for understanding the evolution of scientific nutrition management in Indian healthcare settings. It examines how systematic digitalization and standardization of nutrition care processes can address the identified challenges while improving both clinical outcomes and operational efficiency.

A key differentiator of iNutrimon is its unique ability to manage both clinical nutrition and food service operations within healthcare facilities. This end-to-end integration has been validated through five years of rigorous testing and implementation across major healthcare institutions. The system has received endorsement from the Indian Society for Parenteral and Enteral Nutrition (ISPEN), validating its alignment with international best practices and guidelines.

iNutrimon extends beyond clinical nutrition management to provide comprehensive food service operation controls:
1. Menu Planning and Standardization
• Digital menu cycle management
• Recipe standardization
• Nutritional analysis of kitchen preparations
• Cost optimization algorithms

2. Food Waste Reduction
• AI-powered demand forecasting
• Portion optimization
• Real-time inventory management
• Waste tracking and analytics
3. Quality Control
• HACCP compliance monitoring
• Temperature tracking
• Food safety documentation
• Vendor management
4. Cost Management
• Raw material cost optimization
• Labor cost tracking
• Portion cost analysis
• Budget forecasting

A comprehensive analysis was conducted across multiple tertiary care hospitals implementing the iNutrimon system between 2019- 2024. The study included data from:
• 2,748 consecutive ICU patients (2015-2018 cohort)
• 348 patients assessed using multiple nutritional screening tools (2016 validation study)
• Cost analysis of enteral formula feeding in critical care (2019 study)

The system incorporates three validated screening tools:
1. Nutric Score
2. Nutritional Risk Screening (NRS) 2002
3. Subjective Global Assessment (SGA)
A comparative analysis showed that NRS 2002 and SGA demonstrated statistically significant correlation (p=0.001) for length of ICU stay prediction.

The system utilizes sophisticated algorithms to:
• Calculate precise nutritional requirements based on anthropometric data
• Suggest optimal feeding formulas based on patient needs • Monitor delivery and deficits in real-time
• Adjust for fluid restrictions and other clinical parameters

Data from implementation studies showed that formula feed costs averaged Indian Rupees (INR) 749 (USD 8.83) per day with variations based on length of stay:
• ≤5 days: INR 826 (USD 9.73) per day
• 5 days: INR 325 (USD 3.83) per day

• Manages multiple feeding modalities:
o Enteral nutrition
o Parenteral nutrition
o Kitchen feeds
o Nutritional supplements
• Monitors real-time delivery and deficits
• Tracks cumulative nutritional intake
• Facilitates feeding schedule adjustments

Critical Care Settings
In ICU environments, iNutrimon has demonstrated particular utility in:
• Calculating precise nutritional requirements for critically ill patients
• Managing continuous feeding schedules
• Monitoring feeding interruptions and deficits
• Adjusting nutritional plans based on patient condition changes

For general ward patients, the system supports:
• Transition from enteral to oral feeding
• Kitchen feed management
• Supplement integration
• Progress tracking and documentation

In specialized units such as burn units or post-surgical care, iNutrimon enables:
• Customized nutritional protocols
• Specific requirement calculations based on condition
• Integration of multiple feeding modalities
• Detailed progress monitoring

The next phase of iNutrimon development includes AI integration through:
• Large Language Models (LLMs)
• Semantic search capabilities
• Evidence-based clinical decision support
• Integration with existing hospital information systems The AIDE component aims to provide evidence-based insights with 100% accuracy, relying on validated medical literature and documentation.

Analysis of implementation data across participating hospitals revealed significant improvements in nutritional care delivery:

Comparison of screening tools showed varying identification rates of high-risk patients:
• NRS 2002: 64.94%
• SGA: 40.81%
• Nutric score: 10.63%

Integration of kitchen management and formula feed systems demonstrated:
• Reduction in food wastage from 15% to 8%
• Standardization of recipe nutritional content
• Improved cost efficiency in formula feed utilization
• Enhanced compliance with JCI/NABH standards

Based on implementation data from current hospital deployments, iNutrimon has demonstrated:
• Reduced calculation time for nutritional requirements
• Improved accuracy in feeding formula selection
• Better tracking of nutritional delivery
• Enhanced compliance with feeding schedules
• Improved documentation of nutritional care

iNutrimon addresses several critical challenges in clinical nutrition management:
1. Standardization of nutritional screening and assessment
2. Automation of complex calculations
3. Real-time monitoring of nutritional delivery
4. Integration of evidence-based guidelines
5. Comprehensive documentation and tracking
The system’s success in multiple hospital settings demonstrates its potential to improve nutritional care delivery and patient outcomes.

iNutrimon represents a significant advancement in clinical nutrition management, offering a comprehensive solution that combines screening, assessment, planning, and monitoring capabilities. Its implementation in multiple hospitals has demonstrated improved efficiency and accuracy in nutritional care delivery. As AI capabilities are integrated, the system is expected to provide even more sophisticated support for clinical decision-making in nutritional management.