"At Least the Second Plate": rethinking nutritional care in the geriatric unit

Adequate nutritional care is important to reduce adverse outcomes in hospitalized older adults. However, achieving adequate nutritional intake in geriatric units is challenging due to appetite-related disorders, chronic diseases, anabolic resistance, and limitations associated with oral nutritional supplementation. In this context, healthcare professionals often encourage patients to consume "at least the second plate," which is usually centered on protein-rich foods, as an attempt to preserve muscle mass and support recovery. However, it remains unclear whether this strategy alone is sufficient to meet the nutritional needs of hospitalized older adults. In this manuscript, we discuss the limitations of focusing predominantly on protein-rich meals and emphasize the importance of adequate energy intake for muscle preservation and overall recovery in geriatric inpatients.