Malnutrition in surgical patients is associated with higher rates of morbidity and mortality. Nutrition support for perioperative and critically ill patients is still considered as a challenge and remains a controversial topic. In the high-risk populations of obese, diabetic and geriatric patients these concerns are even more emphasized. To adapt to their special needs, the management of nutrition support must carefully integrate data from current trials and guidelines. Clinical expertise not only in nutrition support but also in the illness or injury treated and the patient's profile is paramount. This review article discusses current strategies of perioperative nutrition support with special regard to obese, diabetic and geriatric patients.