Nutritional trials using high protein strategies and long duration of support show strongest clinical effects on mortality.
Open accessAbstract
Background There is increasing evidence from randomized-controlled trials demonstrating that nutritional support improves clinical outcomes in the population of malnourished medical inpatients. We investigated associations of trial characteristics including clinical setting, duration of intervention, individualization of nutritional support and amount of energy and protein, and effects on clinical outcomes in an updated meta-analysis. Methods We searched Cochrane Library, MEDLINE and EMBASE, from inception to December 15, 2020. Randomized-controlled trials investigating the effect of oral and enteral nutritional support interventions, when compared to usual care, on clinical outcomes of malnourished non-critically ill medical inpatients were included. Two reviewers independently extracted data and assessed risk of bias. The primary endpoint was all cause-mortality within 12-months. Results We included 29 randomized-controlled trials with a total of 7,166 patients. Heterogeneity across RCTs was high, with overall moderate study quality and mostly moderate or unclear risk of bias. Overall, there was an almost 30%-reduction in mortality in patients receiving nutritional support compared to patients not receiving nutritional support (253/2960 [8.5%] vs. 336/2976 [11.3%]) with an odds ratio of 0.72 (95% CI 0.57 to 0.91, p = 0.006). The most important predictors for the effect of nutritional trials on mortality were high protein strategies (odds ratio 0.57 vs. 0.93, I 2 = 86.3%, p…
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A 2021 meta-analysis demonstrated that high protein intake was one of the strongest predictors for beneficial mortality effects of nutritional interventions: trials using high-protein strategies in medical inpatients at nutritional risk had significantly stronger effects on mortality compared to trials with low-protein interventions (OR 0.57, 95% CI 0.44 to 0.74 vs. 0.93, 95% CI 0.73 to 1.19).
“The results of a recent meta-analysis from 2021 demonstrated that high protein intake was one of the strongest predictors for beneficial mortality effects of nutritional interventions: trials using high-protein strategies in medical inpatients at nutritional risk, had significantly stronger effects on mortality compared to trials with low-protein interventions (OR 0.57, 95% CI 0.44 to 0.74 vs. 0.9”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [78]
Another meta-analysis including 29 studies on nutritional support in hospital as well as continued nutritional support after hospital discharge (n=7) showed a 30% reduction in mortality in intervention groups (OR 0.72, 95% CI 0.57 to 0.91, p=0.006).
“Another meta-analysis by the same author group including 29 studies on nutritional support in hospital as well as continued nutritional support after hospital discharge (n ¼ 7) also showed a 30% reduction in mortality in patients from the IGs (OR 0.72 95% CI 0.57 to 0.91, p ¼ 0.006)”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [78]
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Self-citationESPEN guidelines on nutritional support for polymorbid internal medicine patients
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Inflammation and nutrition: friend or foe?
Stumpf, F., Keller, B., Gressies, C., & Schuetz, P. (2023) · Nutrients · doi:10.3390/nu15051159 · Cited by 213 · see citing works
ESPEN guideline on nutritional support for polymorbid medical inpatients
Wunderle, C., Gomes, F., Schuetz, P., Stumpf, F., Austin, P., Ballesteros-Pomar, M. D., Cederholm, T., Fletcher, J., Laviano, A., Norman, K., et al. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.06.023 · Cited by 105 · see citing works
“High-protein interventions were considered when ONS with more than 20% protein were used or individual protein goals above 1 g of protein per kilogram body weight was de fi ned [78].”
InfluentialSelf-citationGressies, C., Kaegi-Braun, N., Gomes, F., & Schuetz, P. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2022.11.007 · Cited by 5 · see citing works
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- Authors
- Kaegi-Braun, N., Faessli, M., Kilchoer, F., Dragusha, S., Tribolet, P., Gomes, F., Bretscher, C., Germann, S., Deutz, N. E., Stanga, Z., Mueller, B., & Schuetz, P.
- Affiliations
- University of Basel (CH)
- Università della Svizzera italiana (CH)
- New York Academy of Sciences (US)
- Texas A&M University (US)
- University of Bern (CH)
- ORCID
- Venue
- Clinical Nutrition ESPEN
- Publisher
- Elsevier BV
- Published
- 2021-10
- Volume
- 45
- Pages
- 45-54
- ISSN
- 2405-4577 (ISSN-L)
- OpenAlex
- W3194053846
- Cited by
- 37
- References
- 6
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 7 · 2023: 11 · 2022: 11
- FWCI
- 0.97
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Clinical Nutrition ESPEN (publishedVersion)
- PubMed (publishedVersion)
- ARBOR - Bern University of Applied Sciences Repository (submittedVersion)
- BFH: ARBOR
- Funders
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (PP00P3_150531/1)
- National Institutes of Health
- Abbott Nutrition
- U.S. Department of Defense
- 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, enteral nutrition, oral nutritional supplementation, malnutrition, medical inpatients, all-cause mortality, high-protein diet, individualized nutritional support, hospital readmission, length of hospital stay
- MeSH terms
- Humans, Inpatients, Length of Stay, Time Factors, Nutritional Support, Malnutrition
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