Nutritional Support and Outcomes in Malnourished Medical Inpatients: A Systematic Review and Meta-analysis
Abstract
Importance During acute illness, nutritional therapy is widely used for medical inpatients with malnutrition or at risk for malnutrition. Yet, to our knowledge, no comprehensive trial has demonstrated that this approach is effective and beneficial for patients. Objective To assess the effects of nutritional support on outcomes of medical inpatients with malnutrition or at risk for malnutrition in a systematic review of randomized clinical trials (RCTs). Data sources The Cochrane Library, MEDLINE, and EMBASE. The study dates were October 5, 1982, to April 30, 2014, in various (mostly European) countries. The dates of our analysis were March 10, 2015, to September 16, 2015. Study selection Based on a prespecified Cochrane protocol, we systematically searched RCTs investigating the effects of nutritional support (including counseling and oral and enteral feeding) in medical inpatients compared with a control group. Data extraction Two reviewers extracted data on study characteristics, methods, and outcomes. Disagreement was resolved by consensus. Main outcomes and measures The primary study outcome was mortality. Secondary outcomes included hospital-acquired infections, nonelective readmissions, functional outcome, length of hospital stay, daily caloric and protein intake, and weight change. Results We included 22 RCTs with a total of 3736 participants. Heterogeneity across RCTs was high, with overall low study quality and mostly unclear risk of bias. Intervention group patients…
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Positive effects of ONS on dietary intake and body weight, and reduced risk of complications and readmissions were reported, whereas length of hospital stay and mortality risk were not significantly reduced.
“Altogether, positive effects of ONS on dietary intake (115, 116, 119, 121) and BW (115, 116, 119, 121), and reduced risk of complications (121) and readmissions (115, 120, 121) were reported, whereas the length of hospital stay (114, 115, 121) and mortality risk (114-116, 119, 121) were not significantly reduced.”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [115]
A systematic literature search found six high-quality SLRs that have assessed the efficacy of ONS versus usual care in older persons.
“A systematic literature search found six high-quality SLRs that have assessed the efficacy of ONS versus usual care in older persons (114-121).”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [115]
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- Authors
- Bally, M. R., Blaser Yildirim, P. Z., Bounoure, L., Gloy, V. L., Mueller, B., Briel, M., & Schuetz, P.
- Affiliations
- University of Basel (CH)
- General Medicine, Dr M. Deppeler, Zollikofen, Switzerland
- University Department of Medicine, Clinic for Endocrinology/Metabolism/Clinical Nutrition, Kantonsspital Aarau, Aarau, Switzerland2Medical Faculty of the University of Basel, Basel, Switzerland
- University Hospital of Basel (CH)
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2016-01-01
- Volume
- 176
- Issue
- 1
- Pages
- 43
- ISSN
- 2168-6106 (ISSN-L)
- OpenAlex
- W2215014536
- Cited by
- 159
- References
- 63
- Citations by year
- 2026: 9 · 2025: 8 · 2024: 12 · 2023: 9 · 2022: 14 · 2021: 11 · 2020: 21 · 2019: 25 · 2018: 16 · 2017: 20 · 2016: 14
- FWCI
- 16.04
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Health Professions › Health Information Management › Dietetics, Nutrition, and Education
- Keywords
- nutritional support, malnutrition, medical inpatients, enteral nutrition, nosocomial infections, mortality, length of hospital stay, functional outcome, weight gain, energy intake, protein intake, acute illness, risk of bias, trial heterogeneity, quality of evidence, future research directions, cost-effectiveness
- MeSH terms
- Acute Disease, Energy Intake, Counseling, Cross Infection, Enteral Nutrition, Hospitalization, Humans, Length of Stay, Patient Readmission, Weight Gain, Weight Loss, Nutritional Support, Malnutrition
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