Malnutrition is a common occurrence in hospitalized patients. Current clinical practice guidelines recommend considering placing medical inpatients deemed to be at risk of malnutrition on additional nutritional support, but these recommendations are largely based on observational studies and physiologic rationale. In this randomized controlled trial, 2,088 hospitalized medical patients at nutritional risk with an expected hospital stay of at least 4 days were assigned to individualized nutrition (intervention group) or standard hospital food (control group). The primary outcome was any adverse clinical outcome, defined as all-cause mortality, admission to intensive care, non-elective hospital readmission, major complications, and decline in functional state at 30 days. Nutritional risk was defined as a score of 3 or more points based on the nutritional risk screening 2002 (NRS 2002) score. In the intervention group, patients received individualized nutritional support to reach protein and caloric goals according to a previously published consensus protocol that follows 2018 international guidelines. Patients in the control group received standardized hospital food based on their ability and desire to eat. Researchers found that more patients in the intervention group reached their caloric (79%) and protein (76%) goals as compared to patients in the control group (54% and 55%, respectively) during their hospital stay. At 30 days after randomization, fewer patients in the intervention group experienced an adverse clinical outcome as compared with the control group (23% vs. 27%, respectively, OR 0.79, 95% CI 0.64 to 0.97, p=0.023). Moreover, by day 30, fewer patients in the intervention group had died as compared to the control group (7% vs. 10%, respectively, OR 0.65, 95% CI 0.47 to 0.91, p=0.011). There was no difference in the proportion of patients experiencing side effects from nutritional support between the intervention and control groups (16% vs. 14% respectively, OR 1.16, 95% CI 0.90 to 1.51, p=0.26). Overall, results from this study support the implementation of individualized nutritional goals in hospitalized patients at nutritional risk.
Click to read the study in Lancet
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