Nutritional support associated with improved outcomes in malnourished, at-risk inpatients

Findings of an updated systematic review and meta-analysis suggest that all hospitalized patients should be screened with a validated nutrition-screening tool, and those at risk should receive individualized nutrition support, an accompanying editorial said.

Nutritional support for medical inpatients who are malnourished or at nutritional risk was associated with improved nutritional and clinical outcomes in an updated systematic review and meta-analysis.

Researchers looked at 27 trials published between 1982 and 2019, including five trials (n=3,067 patients) published between 2015 and 2019, that compared oral and enteral nutritional support interventions with usual care in non-critically ill medical inpatients who were malnourished. Most patients in the trials received oral nutritional supplements. The primary outcome was mortality, and secondary outcomes included nonelective hospital readmissions, length of stay, infections, functional outcome, daily caloric and protein intake, and weight change. Results were published on Nov. 20 by JAMA Network Open.

A total of 6,803 patients were included in the trials. Compared with patients in the control group, those who received nutritional support had significantly lower mortality rates (230 of 2,758 [8.3%] vs. 307 of 2,787 [11.0%]; odds ratio [OR], 0.73 [95% CI, 0.56 to 0.97]). A sensitivity analysis suggested a more pronounced reduction in the risk of mortality in trials published in 2015 or later (OR, 0.47; 95% CI, 0.28 to 0.79) compared to older studies (OR, 0.94; 95% CI, 0.72 to 1.22), in patients with established malnutrition (OR, 0.52; 95% CI, 0.34 to 0.80) compared to patients at nutritional risk (OR, 0.85; 95% CI, 0.62 to 1.18), and in trials with high protocol adherence (OR, 0.67; 95% CI, 0.54 to 0.84) compared to trials with low protocol adherence (OR, 0.88; 95% CI, 0.44 to 1.76).

Nutritional support was also associated with fewer nonelective hospital readmissions (14.7% vs. 18.0%; risk ratio, 0.76 [95% CI, 0.60 to 0.96]), higher caloric intake (mean difference, 365 kcal; 95% CI, 272 to 458 kcal) and protein intake (mean difference, 17.7 g; 95% CI, 12.1 to 23.3 g), and weight increase (0.73 kg; 95% CI, 0.32 to 1.13 kg). There were no significant differences in rates of infections (OR, 0.86; 95% CI, 0.64 to 1.16), functional outcome (mean difference, 0.32; 95% CI, −0.51 to 1.15), and length of stay (mean difference, −0.24; 95% CI, −0.58 to 0.09).

The study authors noted that they observed heterogeneity with regard to the types of interventions and the control groups. In addition, several of the included studies had a high or unknown risk of bias, small sample sizes, and short study duration (i.e., limited to the hospital stay), the authors noted. However, compared to trials published before April 2014 and included in a previous systematic review and meta-analysis, the five new trials were of higher quality and had lower bias, they noted.

The findings “suggest that all hospital inpatients should undergo screening using a validated nutrition-screening tool,” an accompanying editorial said. Patients at nutritional risk should receive individualized nutritional support that includes the provision of a high-quality oral nutritional supplement, the editorialist said.