A team that visited Victoria Hospital, Kirkcaldy, found one patient lost almost a fifth of body weight while in hospital, but did not see a dietician until 24 days after being admitted.
Another did not have nutritional screening until 10 days after arriving at the hospital, which should have been competed within 24 hours, while patient notes about nutrition were not always being completed accurately.
The unannounced inspection followed previous investigations, in May and December last year, when serious concerns were uncovered. After the follow-up, three of four requirements relating to nutritional care and hydration remain in place, while an additional area for improvement, around the care of patients with complex needs, was identified.
Jacqui Macrae, of Healthcare Improvement Scotland, said: "We found evidence NHS Fife was working towards addressing our recommendations. While we saw one has been met, three remain.
"We had particular concerns about nutritional care and hydration across the wards inspected. We asked NHS Fife to carry out an immediate review of all patients in one ward to provide assurance the correct care was in place."
Heather Knox, the health board's director of acute services, said: "We acknowledge that at the time of the inspection there were inconsistencies of approach in certain areas - these are being actively addressed through a number of initiatives.
"We are pleased the report highlights the improvements made to the management of patient meal times, the calm and organised manner of lunchtimes on our wards, and the positive input of our dietetic services and speech and language therapists."