Effect of nutritional support in patients with lower respiratory tract infection: Secondary analysis of a randomized clinical trial
Open accessAbstract
BACKGROUND: In polymorbid patients with bronchopulmonary infection, malnutrition is an independent risk factor for mortality. There is a lack of interventional data investigating whether providing nutritional support during the hospital stay in patients at risk for malnutrition presenting with lower respiratory tract infection lowers mortality. METHODS: For this secondary analysis of a randomized clinical trial (EFFORT), we analyzed data of a subgroup of patients with confirmed lower respiratory tract infection from an initial cohort of 2028 patients. Patients at nutritional risk (Nutritional Risk Screening [NRS] score ≥3 points) were randomized to receive protocol-guided individualized nutritional support to reach protein and energy goals (intervention group) or standard hospital food (control group). The primary endpoint of this analysis was all-cause 30-day mortality. RESULTS: We included 378 of 2028 EFFORT patients (mean age 74.4 years, 24% with COPD) into this analysis. Compared to usual care hospital nutrition, individualized nutritional support to reach caloric and protein goals showed a similar beneficial effect of on the risk of mortality in the subgroup of respiratory tract infection patients as compared to the main EFFORT trial (odds ratio 0.47 [95%CI 0.17 to 1.27, p = 0.136] vs 0.65 [95%CI 0.47 to 0.91, p = 0.011]) with no evidence of a subgroup effect (p for interaction 0.859). Effects were also similar among different subgroups based on etiology and type of respiratory tract infection and for other secondary endpoints. CONCLUSION: This subgroup analysis from a large nutrition support trial suggests that patients at nutritional risk as assessed by NRS 2002 presenting with bronchopulmonary infection to the hospital likely have a mortality benefit from individualized inhospital nutritional support. The small sample size and limited statistical power calls for larger nutritional studies focusing on this highly vulnerable patient population. CLINICAL TRIAL REGISTRATION: Registered under ClinicalTrials.gov Identifier no. NCT02517476.
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In a subgroup analysis of EFFORT, patients with aging-related vulnerability receiving individualized early nutritional support compared with routine hospital food showed a >50% reduction in the risk of 30-day mortality (OR 0.48, 95% CI 0.31 to 0.76; p=0.002).
“In a subgroup analysis of EFFORT, patients with aging-related vulnerability receiving individualized early nutritional support compared with routine hospital food showed a >50% reduction in the risk of 30-day mortality (OR 0.48 95% CI 0.31 to 0.76; p ¼ 0.002) [106].”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [106]
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Experimental — accuracy not yet measuredEarly nutritional support (provided in less than 48 h post hospital admission) compared to later nutritional support shall be performed in polymorbid medical inpatients, as mortality and adverse events are lower and lean body mass loss could be decreased and self-sufficiency could be improved.
“Early nutritional support (i.e.provided in less than 48 h post hospital admission) compared to later nutritional support shall be performed in polymorbid medical inpatients, as mortality and adverse events are lower and lean body mass loss could be decreased and self-sufficiency could be improved.”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [106]
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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
“In a subgroup analysis of EFFORT, patients with aging-related vulnerability receiving individualized early nutritional support compared with routine hospital food showed a > 50% reduction in the risk of 30-day mortality (OR 0.48 95% CI 0.31 to 0.76; p ¼ 0.002) [106].”
InfluentialSelf-citation
- Authors
- Baumgartner, A., Hasenboehler, F., Cantone, J., Hersberger, L., Bargetzi, A., Bargetzi, L., Kaegi-Braun, N., Tribolet, P., Gomes, F., Hoess, C., Pavlicek, V., Bilz, S., Sigrist, S., Brändle, M., Henzen, C., Thomann, R., Rutishauser, J., Aujesky, D., Rodondi, N., Donzé, J., Stanga, Z., Mueller, B., & Schuetz, P.
- Affiliations
- University of Basel (CH)
- Kantonsspital Aarau (CH)
- Bern University of Applied Sciences (CH)
- New York Academy of Sciences (US)
- Kantonsspital Münsterlingen (CH)
- Kantonsspital St. Gallen (CH)
- Luzerner Kantonsspital (CH)
- Kantonsspital Baselland (CH)
- University of Bern (CH)
- ORCID
- Baumgartner, Annic
- Hersberger, Lara
- Bargetzi, Annika
- Bargetzi, Laura
- Kaegi-Braun, Nina
- Tribolet, Pascal
- Gomes, Filomena
- Hoess, Claus
- Pavlicek, Vojtech
- Bilz, Stefan
- Sigrist, Sarah
- Brändle, Michael
- Henzen, Christoph
- Thomann, Robert
- Rutishauser, Jonas
- Aujesky, Drahomir
- Rodondi, Nicolas
- Donzé, Jacques
- Stanga, Zeno
- Mueller, Beat
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2021-04
- Volume
- 40
- Issue
- 4
- Pages
- 1843-1850
- ISSN
- 0261-5614 (ISSN-L)
- PMC
- PMC7547398
- OpenAlex
- W3092586142
- Cited by
- 34
- References
- 14
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 7 · 2023: 3 · 2022: 13 · 2021: 6
- FWCI
- 3.48
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Clinical Nutrition (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- ARBOR - Bern University of Applied Sciences Repository (submittedVersion, other-oa)
- BORIS (University Library Bern) (submittedVersion, cc-by-nc-nd)
- Funders
- Swiss National Science Foundation
- Forschungsrat of the Kantonsspital Aarau (1410.000.058, 1410.000.044)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Keywords
- nutritional support, lower respiratory tract infection, malnutrition, 30-day mortality, NRS-2002, individualized nutritional support, hospital food, multimorbidity, chronic obstructive pulmonary disease, elderly patients
- MeSH terms
- Aged, Female, Hospitalization, Humans, Male, Middle Aged, Respiratory Tract Infections, Switzerland, Cohort Studies, Comorbidity, Nutritional Support, Malnutrition
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