Malnutrition played a part in the death of a young chef who spent months in hospital, a coroner's court has been told.
Sean Paul Carnahan, from Beechmount Grove, west Belfast, died in July 2013 - five months after he was admitted to Belfast City Hospital with a severe brain injury.
His death is shrouded in controversy amid allegations the 22-year-old starved to death.
A nutritional expert told a resumed inquest in Belfast that, while it was not a direct cause of death, the lack of food was among the underlying reasons he died.
Dr Jon Shaffer said: "I do think that malnutrition was a contributory factor."
Mr Carnahan was taken into hospital in March 2013 after a failed suicide attempt.
He spent a month in the intensive care unit (ICU) before being transferred to a respiratory ward.
The inquest opened in September but was adjourned after just one day when coroner Joe McCrisken requested more information from a nutritional expert.
Dr Shaffer, who provided a report, said the case was among the most complex he had ever seen.
When asked if he had encountered patients with similar needs, Dr Shaffer said: "Not as complicated as this, to be honest."
The nature of Mr Carnahan's brain injury meant he could not swallow and was, at times, extremely agitated, thrashing about wildly. Hence, tube feeding was extremely difficult.
Alternative feeding options were not fully explored and neurological specialists should have been contacted earlier, the court was told.
Dr Shaffer added: "I have no problem with the things they were doing but there were other things they could have done."
It was also claimed a specialist rehabilitation unit would have been better equipped to deal with Mr Carnahan's needs.
"In an ideal world, if he could have been transferred to the rehab ward it would have given him the best chance," Dr Shaffer said.
However, the expert conceded it was impossible to know if the outcome would have been any different.
Meanwhile, a barrister representing the Belfast Health and Social Care Trust, questioned whether Dr Shaffer had consulted all the medical notes in the case before compiling his report
Mark Robinson QC suggested he had made "sweeping generalisations" without the detail.
Dr Shaffer said he had not been asked to provide a "blow by blow" account of everything that happened during Mr Carnahan's hospital stay.
According to medical documents presented during the opening day of the inquest, Mr Carnahan's weight dropped from 74kg on admission to just 32kg at the time of the post-mortem examination.
Throughout the hearing his mother, Tracey, who has fronted a campaign for justice for her son, sat in the body of the court supported by close friends and family members.
A number of others sat in the public gallery wearing T-shirts bearing the slogan Justice for Sean Paul.
In a statement ahead of the resumption of the inquest, Carnahan family solicitor Aiden Carlin said: "Our client's grief and sense of loss is very raw. She engaged with the hospital, police, politicians and the media at the material time and continues to campaign for justice for her son."