Many patients in large hospitals require nutritional support to avoid the increased morbidity and mortality associated with malnutrition. Parenteral nutrition has been used for more than fifteen years but is expensive and can be hazardous. Most hospital patients requiring nutritional support can be fed through the gastrointestinal tract. Enteral nutrition can be delivered safely and cheaply orally or by tubes temporarily implanted. We outline a simple step approach from oral nutrition using a palatable, inexpensive, chemically defined, complete diet to jejunal nutrition using an implanted feeding tube and an 'elemental' dietary supplement: oral first, enteral next, parenteral when necessary.