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High Protein Nutrition Support Shows Strongest Effects

Published in Clinical Nutrition ESPEN, October 2021

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Evidence continues to emerge of the value of nutritional support in the management of malnutrition. Over many years, different authors from across the world have amalgamated the findings of randomised controlled trials of nutritional interventions into systematic reviews and meta-analyses. This is a new review that focuses on the evidence in hospital patients for nutritional support and is well worth a read.

This comprehensive systematic review concludes that:

  • there is an ever-increasing amount of evidence from randomised controlled trials showing that nutritional support significantly reduces mortality in medical inpatients at risk of malnutrition and has a variety of other benefits on intake, weight, readmissions and length of stay
  • high-protein nutritional support strategies and a longer duration (> 60 days) of intervention show the strongest effects. 

In light of these findings, the authors conclude that the evidence supports the importance of systematically screening medical inpatients on admission to hospital for malnutrition risk, followed by nutritional assessment and individualized nutritional support for those patients at risk.

More details on methodology:

  • Systematic review searches were undertaken up until December 15th 2020 of randomised controlled trials investigating oral and enteral nutritional support interventions, compared to usual care. They included 29 randomised controlled trials, (7,166 patients), heterogeneity was high, study quality was moderate and risk of bias was mostly moderate or unclear.
  • The primary endpoint was all cause-mortality within 12-months but they also looked at other outcomes in malnourished non-critically ill medical inpatients (intake, weight, readmissions, length of hospital stay). 
  • Interventions were multifactorial dietician-based interventions and oral nutritional supplements (ONS). 

More on results:

  • Overall, an almost 30%-reduction in mortality in patients receiving nutritional support compared to patients not receiving nutritional support (8.5% vs. 11.3%) with an odds ratio of 0.72 (95% CI 0.57 to 0.91, p = 0.006). 
  • Significant improvements in energy intakes  (357.67 kcal (95%CI 268.36 to 446.99) kcal) 
  • Significant improvements in protein intakes (17.08 g (95%CI 11.98 to 22.18)) 
  • Significant difference in weight change (0.72 kg (95%CI 0.32 to 1.12)). 
  • Significant reduction in the risk of non-elective readmissions (OR 0.79 (95%CI0.65 to 0.96)). 
  • Significant reduction in hospital length of stay (from 12.0 to 11.4 days, mean difference of 0.61 days (95%CI -1.15 to 0.06 days)

The most important predictors for the effect of nutritional intervention on mortality were high protein strategies and long-term nutritional interventions.

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