Evaluation of Nutritional Support and In-Hospital Mortality in Patients With Malnutrition
Open accessAbstract
Importance: Malnutrition affects a considerable proportion of patients in the hospital and is associated with adverse clinical outcomes. Recent trials found a survival benefit among patients receiving nutritional support. Objective: To investigate whether there is an association of nutritional support with in-hospital mortality in routine clinical practice. Design, Setting, and Participants: This cohort study was conducted from April 2013 to December 2018 among a population of patients from Swiss administrative claims data. From 114 264 hospitalizations of medical patients with malnutrition, 34 967 patients (30.6%) receiving nutritional support were 1:1 propensity score matched to patients with malnutrition in the hospital who were not receiving nutritional support. Patients in intensive care units were excluded. Data were analyzed from February 2020 to November 2020. Exposures: Receiving nutritional support, including dietary advice, oral nutritional supplementation, or enteral and parenteral nutrition. Main Outcomes and Measures: The primary outcome was all-cause in-hospital mortality. Secondary outcomes were 30-day all-cause hospital readmission and discharge to a postacute care facility. Poisson and logistic regressions were used to estimate incidence rate ratios (IRRs) and odds ratios (ORs) of outcomes. Results: After matching, the study identified 69 934 hospitalizations of patients coded as having malnutrition in the cohort (mean [SD] age, 73.8 [14.5] years; 36 776 [52.6%] women). Patients receiving nutritional support, compared with those not receiving nutritional support, had a lower in-hospital mortality rate (2525 of 34 967 patients died [7.2%] vs 3072 of 34 967 patients died [8.8%]; IRR, 0.79 [95% CI, 0.75-0.84]; P < .001) and a reduced 30-day readmission rate (IRR, 0.95 [95% CI, 0.91-0.98]; P = .002). In addition, patients receiving nutritional support were less frequently discharged to a postacute care facility (13 691 patients [42.2%] vs 14 324 patients [44.9%]; OR, 0.89 [95% CI, 0.86-0.91]; P < .001). Conclusions and Relevance: These findings suggest that nutritional support was associated with reduced mortality among patients in the medical ward with malnutrition. The results support data found by randomized clinical trials and may help to inform patients, clinicians, and authorities regarding the usefulness of nutritional support in clinical practice.
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In a population-based cohort study of more than 110,000 patients, the effect of nutritional support remained robust in subgroup analyses stratified for main diagnoses and comorbidities.
“In a population-based cohort study of more than 110,000 patients, effect of nutritional support remained robust in subgroup analyses which stratified for main diagnoses and comorbidities, among others [169] (Level of evidence: 2-).”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [169]
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ESPEN guideline on nutritional support for polymorbid medical inpatients
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- Authors
- Kaegi-Braun, N., Mueller, M., Schuetz, P., Mueller, B., & Kutz, A.
- Affiliations
- Kantonsspital Aarau (CH)
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Corresponding author
- Kutz, Alexander
- Venue
- JAMA Network Open
- Publisher
- American Medical Association (AMA)
- Published
- 2021-01-20
- Volume
- 4
- Issue
- 1
- Pages
- e2033433
- ISSN
- 2574-3805 (ISSN-L)
- PMC
- PMC7818145
- OpenAlex
- W3123976730
- Cited by
- 126
- References
- 6
- Citations by year
- 2026: 16 · 2025: 30 · 2024: 30 · 2023: 21 · 2022: 18 · 2021: 11
- FWCI
- 12.75
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JAMA Network Open (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- National Science Foundation
- Universität Basel
- Nestlé Health Science
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (3071410.000.086, 167376)
- 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
- malnutrition, nutritional support, in-hospital mortality, hospital readmission, enteral nutrition, parenteral nutrition, oral nutritional supplementation, dietary recommendations, medical inpatients, routine clinical practice, propensity score matching, hospital costs, length of hospital stay, hospital readmission costs
- MeSH terms
- Aged, Female, Hospitalization, Humans, Male, Patient Readmission, Switzerland, Hospital Mortality, Nutritional Support, Subacute Care, Malnutrition, Propensity Score
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