Nutritional support amongst medical inpatients offers limited clinical benefit

1. In this systematic review and meta-analysis of randomized controlled trials (RCTs) addressing nutritional support, which included counseling, oral supplementation, or enteral nutrition, among medical inpatients, there was no difference in short-term mortality amongst those offered nutritional support.

2. However, the rate of non-elective readmissions amongst the patients who received nutritional support was significantly lower. There were no differences identified in the length of stay, hospital-acquired infections, or functional status.

3. The results suggest that, while increasing nutritional support does increase caloric and protein intake, and weight, it offers limited clinical benefits, except for reduced rates of readmissions.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Malnutrition is a major problem amongst the inpatient population. This generally leads to muscle wasting, and is thought to contribute to poorer outcomes, such as mortality, infection risk, length of stay, amongst others. However, recent studies in the critical care setting have shown that aggressive nutritional support may not have any meaningful clinical benefits. This study, which is a systematic review and meta-analysis of RCTs evaluating nutritional support amongst medical inpatients, was conducted to determine if there are clinical benefits with nutritional support. The results of the study suggested that nutritional support, including counseling, oral supplementation, or enteral nutrition, amongst medical inpatients did not have any effects on short-term (6-month) mortality. However, the rate of non-elective readmissions amongst the patients who received nutritional support was significantly lower. There were no differences identified in the length of stay, hospital-acquired infections, and functional status. There was a relative increase in calories, protein, and weight amongst patients who received nutritional support.

A major strength of this study was that only RCTs were included in the meta-analysis. However, there was significant heterogeneity amongst the different trials, and they were generally of low quality, which decreased the validity of the study. Also, most of the studies were done in European countries, so they may not be generalizable to the US population.

Click to read the study, published in JAMA Internal Medicine

Relevant Reading: Nutrition in the acute phase of critical illness.

In-Depth [systematic review and meta-analysis]: This study included RCTs that evaluated non-critically ill medical inpatients and randomized them into nutritional support or a control group. Pancreatitis patients were excluded given their unique nutritional and feeding goals. Parenteral nutrition was also excluded. Nutritional support included any of the following: nutritional advice, food fortification, supplemental nutrition, or enteral nutrition. No restrictions were applied to control group treatments. The primary outcome evaluated was all-cause mortality about 4-6 months after randomization. Secondary endpoints included hospital-acquired infections, non-elective readmissions, functional status, and length of stay.

In the final analysis, 22 RCTs were included (mostly performed in European countries). Fourteen of the 22 RCTs included the primary endpoint, which occurred in 9.8% in the intervention group compared to 10.3% in the control group (OR, 0.96; 95%CI 0.72 – 1.27). Among the secondary endpoints, only the readmission rate was significantly lower in the intervention group (20.5% vs 29.6%; RR 0.71, 95%CI 0.57 – 0.87). The intervention group did have significantly increased weight, calories, and protein intake.

Image: PD

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