Six-month outcomes after individualized nutritional support during the hospital stay in medical patients at nutritional risk: Secondary analysis of a prospective randomized trial
Open accessAbstract
BACKGROUND: Among medical inpatients at risk of malnutrition, the use of individualized nutritional support during the hospital stay was found to reduce complications and improve mortality at short-term. We evaluated clinical outcomes at 6-months follow-up. METHODS: We randomly assigned 2028 patients to receive protocol-guided individualized nutritional support to reach protein and energy goals (intervention group) or hospital food as usual (control group) during the hospital stay. The intervention was discontinued at hospital discharge and further nutritional support was based on the discretion of the treating team. We had complete follow-up information of 1995 patients (98%), which were included in the final analysis. The primary endpoint was all-cause mortality at 6-months. Prespecified secondary end points included non-elective hospital readmissions, functional outcome and quality of life. RESULTS: At 6-month, 231 of 994 (23.2%) intervention group patients had died compared to 246 of 999 (24.6%) control group patients, resulting in a hazard ratio for death of 0.90 (95%CI 0.76 to 1.08, p = 0.277). Compared to control patients, intervention group patients had similar rates of hospital readmission (27.3% vs. 27.6%, HR 1.00 (95%CI 0.84 to 1.18), p = 0.974), falls (11.2% vs. 10.9%, HR 0.96 (95%CI 0.72 to 1.27), p = 0.773) and similar quality of life and activities of daily living scores. INTERPRETATION: While individualized nutritional support during the hospital stay significantly reduced short-term mortality, there was no legacy effect on longer term outcomes. Future trials should investigate whether continuation of nutritional support after hospital discharge reduces the high malnutrition-associated mortality rates in this vulnerable patient population. TRIAL REGISTRATION: ClinicalTrials.gov number, NCT02517476.
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Compared to usual care, individualized nutrition with protein targets of 1.2-1.5 g/kg/day in polymorbid patients was associated with significantly lower odds for adverse outcomes (OR 0.79, 95% CI 0.64 to 0.97) and 30-day mortality (OR 0.65, 95% CI 0.47 to 0.91), while functional status via BI and QoL significantly increased.
“Compared to the usual care CG, odds for adverse outcomes and 30-day mortality were significantly lower in patients receiving individualized nutrition with these protein targets (OR 0.79, 95% CI 0.64 to 0.97 and OR 0.65, 95% CI 0.47 to 0.91 respectively), while functional status via BI, and QoL significantly increased.”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [37]
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Experimental — accuracy not yet measuredAccording to a secondary analysis of the EFFORT trial by Kaegi-Braun et al., the positive effects of individualized nutritional support provided during hospitalization observed at 30 days were not sustained at six months after discharge when nutrition was not continued.
“According to a secondary analysis of the EFFORT trial by Kaegi-Braun et al., the positive effects of individualized nutritional support provided during hospitalization which were observed at 30 days, were not sustained at six months after discharge when nutrition was not continued [37] (Level of evidence 1þþ).”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [37]
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Experimental — accuracy not yet measuredPolymorbid medical inpatients requiring nutritional support shall receive 1.2-1.5 g protein/kg body weight per day as a cost-effective and highly efficient measure to prevent body weight loss, reduce complications, improve functional outcome and QoL.
“Polymorbid medical inpatients requiring nutritional support shall receive 1.2e1.5 g protein/kg of body weight per day as a costeffective and highly efficient measure to prevent body weight loss, to reduce complications, to improve functional outcome and QoL.”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [37]
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Cites
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Cited by
Sorted by citations
Individualized Nutritional Support for Hospitalized Patients With Chronic Heart Failure
Hersberger, L., Dietz, A., Bürgler, H., Bargetzi, A., Bargetzi, L., Kägi-Braun, N., Tribolet, P., Gomes, F., Hoess, C., Pavlicek, V., et al. (2021) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2021.03.232 · Cited by 168 · see citing works
Self-citationESPEN 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
“…secondary analysis of the EFFORT trial by Kaegi-Braun et al., the positive effects of individualized nutritional support provided during hospitalization which were observed at 30 days, were not sustained at six months after discharge when nutrition was not continued [37] (Level of evidence 1 þþ ).”
InfluentialSelf-citation
- Authors
- Kaegi-Braun, N., Tribolet, P., Gomes, F., Fehr, R., Baechli, V., Geiser, M., Deiss, M., Kutz, A., Bregenzer, T., Hoess, C., Pavlicek, V., Schmid, S., Bilz, S., Sigrist, S., Brändle, M., Benz, C., Henzen, C., Mattmann, S., Thomann, R., Rutishauser, J., Aujesky, D., Rodondi, N., Donzé, J., Stanga, Z., Mueller, B., & Schuetz, P.
- Affiliations
- Kantonsspital Aarau (CH)
- Bern University of Applied Sciences (CH)
- New York Academy of Sciences (US)
- Spital Lachen (CH)
- Kantonsspital Münsterlingen (CH)
- Kantonsspital St. Gallen (CH)
- Luzerner Kantonsspital (CH)
- Kantonsspital Baselland (CH)
- University of Bern (CH)
- University of Basel (CH)
- Corresponding author
- Schuetz, Philipp
- ORCID
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2021-03
- Volume
- 40
- Issue
- 3
- Pages
- 812-819
- ISSN
- 0261-5614 (ISSN-L)
- OpenAlex
- W3083651780
- Cited by
- 55
- References
- 7
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 12 · 2023: 7 · 2022: 11 · 2021: 8 · 2020: 2
- FWCI
- 4.43
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Clinical Nutrition (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- ARBOR - Bern University of Applied Sciences Repository (submittedVersion, other-oa)
- BORIS (University Library Bern) (submittedVersion, cc-by-nc-nd)
- Funders
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung
- 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
- individualized nutritional support, malnutrition, nutritional risk, medical inpatients, all-cause mortality, hospital readmission, falls, quality of life, activities of daily living, long-term outcomes, legacy effects
- MeSH terms
- Accidental Falls, Activities of Daily Living, Aged, Energy Intake, Dietary Proteins, Female, Hospitalization, Humans, Male, Mortality, Nutritional Status, Patient Readmission, Quality of Life, Risk Factors, Nutritional Support, Malnutrition
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