The provision of adequate nutritional support appears to be essential for critically ill patients and other groups of patients at high risk for having malnutrition. In this review paper we describe our recent research regarding the amount of energy to be provided, how this should be assessed, and the beneficial effects of specialized nutritional support. We have shown that repeated measurements of energy expenditure using indirect calorimetry capture the dynamic energy changes characteristic of hospitalized patients. The provision of energy according to these measurements was associated with lower hospital mortality in critically ill patients when compared to patients receiving a fixed energy intake. A similar study performed in geriatric patients revealed a significant reduction in the number of infections when energy was provided according to repeated measurements. We have also shown that a diet enriched with eicosapentaenoic acid and gamma-linolenic acid improved oxygenation and lung dynamics and decreased ventilation duration in ICU patients with acute lung injury and ARDS. A similarly enriched diet together with micronutrients resulted in significantly less progression of existing pressure ulcers in ICU patients compared to an isonitrogenous, nutrient-sufficient formula. This may be related to an increase in the percentage of positive lymphocyte and granulocyte adhesion molecules. 1. Introduction Guidelines have recommended the provision of adequate nutritional support for hospitalized patients, both for critically ill patients in the intensive care unit (ICU) and for other groups of patients at high risk for having malnutrition, either preexisting at admission or developing during their hospital stay. For ICU patients, it is recommended that nutrition should be provided early after admission to the hospital, ideally within the first 24？h, and preferably by the enteral route where this is possible [1–4]. However, some questions regarding nutrition support remain controversial, including the amount of energy to be provided, how this should be assessed, and the beneficial effects of specialized nutritional support. In this review paper, we will describe our recent research in this area, specifically the beneficial effects of optimizing energy requirements to be delivered to both ICU patients and another population at risk for undernutrition, namely, elderly patients undergoing hip replacement. In addition, we will describe the beneficial effects of specialized nutrition on pulmonary function and pressure ulcer development and progression in
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