ESPEN guideline on nutritional support for polymorbid medical inpatients

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [8] Schuetz, 2019, Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial, Lancet source
• Disputed

  Split into 2 atoms — 0 confirmed, 1 partially supported, 1 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Checked by a reasoning model — may be wrong.

  cites [37] Kaegi-Braun, 2021, Six-month outcomes after individualized nutritional support during the hospital stay in medical patients at nutritional risk: secondary analysis of a prospective randomized trial, Clin Nutr sourceExperimental — accuracy not yet measured
• Partly supported

  Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

  cites [46] Schuetz, 2020, Economic evaluation of individualized nutritional support in medical inpatients: secondary analysis of the EFFORT trial, Clin Nutr sourceExperimental — accuracy not yet measured

In the paper

“it was significantly reduced after six months of nutritional intervention in several trials (level of evidence: 1-) [116] (level of evidence: 1þ) [130] (level of evidence: 1þþ) [126] but not all (level of evidence: 1þ) [125].”

What the sources say

• ?Not checked — no full text of the sourcecites [116] Feldblum, 2011, Individualized nutritional intervention during and after hospitalization: the nutrition intervention study clinical trial, J Am Geriatr Soc source
• Disputed

  The citation to this paper is attached to “but not all,” implying that its trial did not find a significant reduction. In Results §3.6, the paper instead reports a significantly lower six-month pneumonia readmission rate in the nutritional-intervention group than in the standard-care group after adjustment for sex (p = 0.03). (LLM, conf=0.90)

  Checked by a reasoning model — may be wrong.

  cites [130] Yang, 2019, Effect of nutritional intervention programs on nutritional status and readmission rate in malnourished older adults with pneumonia: a randomized control trial, Int J Environ Res Publ Health sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [126] Bonilla-Palomas, 2016, Nutritional intervention in malnourished hospitalized patients with heart failure, Arch Med Res source

In the paper

“Whilst the prevalence increases with age, more than half of all people affected with this problem are younger than 65 years [11].”

What the sources say

• Supported

  The Discussion explicitly states that, although multimorbidity is more prevalent in older people, more than half of people with multimorbidity were younger than 65. The Results corroborate this with 210,500 people younger than 65 versus 194,966 aged 65 or older. (LLM, conf=0.95)

  cites [11] Barnett, 2012, Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study, Lancet source

In the paper

“Fried et al. showed that clinicians struggle with the uncertainties of applying disease-specific guidelines to their patients with multiple conditions, and would therefore benefit from a number of tools to assist them in decision making for this population [12].”

What the sources say

• Supported

  The Discussion states that clinicians struggled with uncertainty about applying disease-specific guidelines to their older patients with multiple conditions. It also says they would benefit from tools to assist treatment decision making for this population. (LLM, conf=0.94)

  cites [12] Fried, 2011, Primary care clinicians' experiences with treatment decision making for older persons with multiple conditions, Arch Intern Med source

In the paper

“In this context, the current single-disease healthcare approach has been challenged, as clinical guidelines are largely created for individual diseases and rarely account for polymorbidity [11].”

What the sources say

• Supported

  The Discussion states that clinical evidence and guidelines are largely created for individual diseases and that guidelines rarely account for multimorbidity. The paper also says its findings challenge the single-disease framework of health care. (LLM, conf=0.95)

  cites [11] Barnett, 2012, Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study, Lancet source

In the paper

“Polymorbidity is highly prevalent, affecting more than 70% of the hospitalized adult population, and is associated with higher mortality and healthcare burden [10].”

What the sources say

• Supported

  The Abstract Results state that a higher number of multiple chronic conditions was associated with higher mortality, service use, and average cost. The Summary likewise reports substantial differences in mortality and hospital costs, while noting that the analysis does not establish causation. (LLM, conf=0.93)

  cites [10] Steiner, 2013, Hospital utilization, costs, and mortality for adults with multiple chronic conditions, Nationwide Inpatient Sample, 2009, Prev Chronic Dis source

In the paper

“The Charlson comorbidity index is the most extensively studied comorbidity index and is considered a valid and reliable method to measure comorbidity that can be used in clinical research [6,14].”

What the sources say

• Partly supported

  The Conclusions state that the CCI is a reliable and valid index for assessing comorbidity in clinical research and practice. The Methods note extensive literature on the CCI, including more than 36,925 citations of its original version, but do not establish that it is the most extensively studied comorbidity index. (LLM, conf=0.85)

  cites [6] Charlson, 2022, Charlson comorbidity index: a critical review of clinimetric properties, Psychother Psychosom sourceExperimental — accuracy not yet measured
• Supported

  The Results section calls the Charlson Index “the most extensively studied comorbidity index” and reports evidence for its validity and reliability. The Discussion concludes that it is a valid and reliable method for measuring comorbidity in clinical research, while noting that its evidence is most extensive when mortality is the outcome of interest. (LLM, conf=0.94)

  cites [14] de Groot, 2003, How to measure comorbidity: a critical review of available methods, J Clin Epidemiol source

In the paper

“Whilst the prevalence increases with age, more than half of all people affected with this problem are younger than 65 years [11].”

What the sources say

• Supported

  The Results (page not provided) state that the proportion of people with multimorbidity increased substantially with age. They also report that more people with multimorbidity were younger than 65 than were 65 or older, supporting both parts of the citing sentence. (LLM, conf=0.95)

  cites [11] Barnett, 2012, Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study, Lancet source

In the paper

“Additionally polymorbidity is associated with increased health service utilization and poorer health outcomes [6,7], demonstrating the relevance of proper treatment for polymorbid patients.”

What the sources say

• Partly supported

  The Sensitivity section reports that mortality increased stepwise with increasing comorbidity, supporting the poorer-outcomes part of the claim. The Discussion says the review did not focus on multimorbidity or outcomes such as readmissions, length of stay, and cost. A References entry mentions health service use, but the paper's text does not establish the claimed increase in utilization. (LLM, conf=0.86)

  cites [6] Charlson, 2022, Charlson comorbidity index: a critical review of clinimetric properties, Psychother Psychosom sourceExperimental — accuracy not yet measured
• Supported

  The introductory passage (section labeled “T”; page not provided) explicitly states that multimorbidity is associated with increased health service utilization and poorer health outcomes. The claim uses “polymorbidity” for the same concept of multiple coexisting conditions. (LLM, conf=0.95)

  cites [7] Huntley, 2012, Measures of multimorbidity and morbidity burden for use in primary care and community settings: a systematic review and guide, Ann Fam Med source

In the paper

“Polymorbidity is highly prevalent, affecting more than 70% of the hospitalized adult population, and is associated with higher mortality and healthcare burden [10].”

What the sources say

• Partly supported

  The Abstract Results report that 39% of adult discharges had 2–3 chronic conditions and 33% had 4 or more—72% combined—but exclude pregnancy- and maternity-related discharges. The Summary says nearly 66% of all adult discharges had two or more chronic conditions. Thus, the claim's unqualified figure of more than 70% for the hospitalized adult population overstates the paper's broader estimate; the paper also measures discharges rather than unique people. (LLM, conf=0.88)

  cites [10] Steiner, 2013, Hospital utilization, costs, and mortality for adults with multiple chronic conditions, Nationwide Inpatient Sample, 2009, Prev Chronic Dis sourceExperimental — accuracy not yet measured

In the paper

“Both of these tools are rapid, easily undertaken and show a high degree of content validity and reliability, thereby making them suitable in polymorbid medical inpatients including those patients with cognitive dysfunction [26,27].”

What the sources say

• Partly supported

  The Discussion (page not provided) says MNA-SF takes under five minutes and preserves diagnostic accuracy. It does not establish high content validity or reliability for MNA-SF, and its conclusion about suitability for patients with cognitive dysfunction concerns the different m-MNA. The paper does not address NRS 2002. (LLM, conf=0.88)

  cites [26] Hengstermann, 2008, Which are the most efficient items of mini nutritional assessment in multimorbid patients?, J Nutr Health Aging sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [27] Kondrup, 2003, ESPEN guidelines for nutrition screening 2002, Clin Nutr source

In the paper

“Overall costs of care within 30 days of admission averaged 27,240 V per-patient in the IG versus 27,439 V in the CG resulting in per-patient cost savings of 199 V.”

What the sources say

• Supported

  The summary reports 30-day overall costs of €27,240 per patient in the intervention group and €27,439 in the control group, with €199 in savings. Section 3.2 repeats those figures and specifies that the €199 saving is the base-case estimate accounting for nutritional intervention costs only. (LLM, conf=0.95)

  cites [46] Schuetz, 2020, Economic evaluation of individualized nutritional support in medical inpatients: secondary analysis of the EFFORT trial, Clin Nutr source

In the paper

“The cost analysis of the multicenter, randomized clinical EFFORT trial showed that nutritional support for polymorbid medical inpatients is a highly cost-effective intervention to reduce risks for ICU admissions and hospital-associated complications, while improving patient survival.”

What the sources say

• Supported

  Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [46] Schuetz, 2020, Economic evaluation of individualized nutritional support in medical inpatients: secondary analysis of the EFFORT trial, Clin Nutr source

In the paper

“Early detection and intervention against DRM has been shown to improve nutritional status and reduce complications during hospital stay and non-elective readmissions [9,43] (Level of Evidence 1þþ for both).”

What the sources say

• Partly supported

  Section 3.4 (page unavailable) reports better nutritional status at day 90 with the supplement. But section 3.3 found no significant reduction in nonelective readmissions, and the paper does not show that early detection reduced complications during the hospital stay. The claim therefore extends beyond this trial’s findings. (LLM, conf=0.90)

  cites [9] Deutz, 2016, Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: a randomized clinical trial, Clin Nutr sourceExperimental — accuracy not yet measured
• Partly supported

  The Abstract reports improved nutritional status and fewer non-elective readmissions after supplementation in hospitalized patients aged 65–92. The Clinical Outcomes section reports no clinically important difference in infections or length of hospital stay, so this trial does not support the claimed reduction in complications during the hospital stay. It studied supplementation, not early detection of malnutrition. (LLM, conf=0.91)

  cites [43] Gariballa, 2006, A randomized, double-blind, placebo-controlled trial of nutritional supplementation during acute illness, Am J Med sourceExperimental — accuracy not yet measured

In the paper

“In the metaanalysis of Schuetz et al. the overall costs of care within the model timeframe of 6 months averaged 63,227 $ per patient in the IG vs. 66,045 $ in the CG, which correlate to per patient cost savings of 2818 $.”

What the sources say

• Supported

  Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [47] Schuetz, 2021, Cost savings associated with nutritional support in medical inpatients: an economic model based on data from a systematic review of randomised trials, BMJ Open source

In the paper

“The economic benefits calculated to prevent adverse outcomes were 256 V for one severe complication, 2490 V for one day in ICU, and 7423 V for one death [46] (Level of Evidence 2þ).”

What the sources say

• Partly supported

  Section 3.2 reports exactly €256 per severe complication prevented, €2,490 per ICU day prevented, and €7,423 per death prevented. It describes these figures as costs to prevent adverse outcomes, however, not economic benefits or savings from preventing them. (LLM, conf=0.84)

  cites [46] Schuetz, 2020, Economic evaluation of individualized nutritional support in medical inpatients: secondary analysis of the EFFORT trial, Clin Nutr sourceExperimental — accuracy not yet measured

In the paper

“No single, validated method for estimating requirements exists, and the evidence-base for all prediction methods currently in use is poor [65].”

What the sources say

• Supported

  The Conclusion (page not supplied) says that estimation tools continue to be used despite a lack of supporting evidence and advises caution in the absence of direct measurements or other accurate methods. It also calls for guidelines to identify the most appropriate estimation methods, supporting the claim that no single validated prediction method is established for clinical use. (LLM, conf=0.88)

  cites [65] Reeves, 2003, Predicting energy requirements in the clinical setting: are current methods evidence based?, Nutr Rev source

In the paper

“Similarly for pancreatitis, a metaanalysis including eleven trials and 562 patients found that compared with PN, EN was associated with decreased mortality (relative risk 0.43, 95% CI 0.23 to 0.78, p ¼ 0.006), a lower risk of infection and complications (RR 0.53, 95% CI 0.39 to 0.71, p ¼ 0.000) and a reduction in mean LOS (mean difference ¼ À2.93, 95% CI -4.52 to À1.34, p ¼ 0.000) [60].”

What the sources say

• Partly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [60] Wu, 2018, Efficacy comparisons of enteral nutrition and parenteral nutrition in patients with severe acute pancreatitis: a meta-analysis from randomized controlled trials, Biosci Rep sourceExperimental — accuracy not yet measured

In the paper

“The review also found significantly higher energy and protein intake, as well as beneficial effects on weight when comparing nutritional support (including counseling and oral and enteral feeding) to CG patients.”

What the sources say

• Supported

  Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [35] Gomes, 2019, Association of nutritional support with clinical outcomes among medical inpatients who are malnourished or at nutritional risk: an updated systematic review and meta-analysis, JAMA Netw Open source

In the paper

“According to this analysis the provision of high protein bHMB ONS had an incremental cost-effectiveness ratio (ICER) of 524 $/life years, concluding that this intervention was cost effective and positive in terms of survival for the patients [49] (Level of Evidence 1þþ).”

What the sources say

• Supported

  Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [49] Zhong, 2017, The cost-effectiveness of oral nutrition supplementation for malnourished older hospital patients, Appl Health Econ Health Pol source

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [8] Schuetz, 2019, Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial, Lancet source
• Partly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [37] Kaegi-Braun, 2021, Six-month outcomes after individualized nutritional support during the hospital stay in medical patients at nutritional risk: secondary analysis of a prospective randomized trial, Clin Nutr sourceExperimental — accuracy not yet measured
• Partly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [46] Schuetz, 2020, Economic evaluation of individualized nutritional support in medical inpatients: secondary analysis of the EFFORT trial, Clin Nutr sourceExperimental — accuracy not yet measured

In the paper

“Energy requirements in polymorbid medical inpatients can be estimated using indirect calorimetry (IC), a published prediction equation or a weight-based formula, although the accuracy of prediction equations in this population is low.”

What the sources say

• ?Not checked — no full text of the sourcecites [62] Branson, 2004, The measurement of energy expenditure, Nutr Clin Pract source
• Partly supported

  The Introduction describes indirect calorimetry and prediction equations, General Estimates describes weight-based formulas, and Implication for Current Practice says current prediction methods do not determine energy requirements accurately. The review discusses clinical and hospitalized patients, but does not establish the accuracy of prediction equations specifically in polymorbid medical inpatients. Page numbers were not supplied in our copy. (LLM, conf=0.86)

  cites [65] Reeves, 2003, Predicting energy requirements in the clinical setting: are current methods evidence based?, Nutr Rev sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [66] Boullata, 2007, Accurate determination of energy needs in hospitalized patients, J Am Diet Assoc source

In the paper

“Albeit outside the scope of these guidelines, studies from critical care demonstrated that EN compared to PN results in similar mortality but lower complication risk.”

What the sources say

• Supported

  The Results report no difference in overall mortality between EN and PN and a lower incidence of infectious complications with EN. The Conclusions describe the same overall finding, while cautioning that caloric-intake differences and publication bias weaken the inference about infectious complications. (LLM, conf=0.88)

  cites [59] Elke, 2016, Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials, Crit Care source

In the paper

“According to their analysis the intervention proved to be cost effective, improved survival and marginally reduced cost of treatment [50] (Level of evidence 1þ).”

What the sources say

• Partly supported

  Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [50] Ballesteros-Pomar, 2018, Cost-effectiveness of a specialized oral nutritional supplementation for malnourished older adult patients in Spain, Nutrients sourceExperimental — accuracy not yet measured

In the paper

“The authors also calculated 820 $ to prevent a hospital-acquired infection and 733 $ to avoid a nonelective readmission [47].”

What the sources say

• Supported

  The Results section, under “Costs and cost-benefits of nutritional intervention,” explicitly reports US$820 for one prevented hospital-acquired infection and US$733 for one prevented non-elective readmission. The Abstract’s Results section repeats both figures. (LLM, conf=0.95)

  cites [47] Schuetz, 2021, Cost savings associated with nutritional support in medical inpatients: an economic model based on data from a systematic review of randomised trials, BMJ Open source

In the paper

“In that meta-analysis, EN compared to PN was associated with a significant reduction in infectious complications (RR 0.64, 95% CI 0.48 to 0.87, p ¼ 0.004) and with a significant reduction in ICU LOS (weighted mean difference [WMD] À0.80, 95% CI -1.23 to À0.37, p ¼ 0.0003, I 2 ¼ 0%), while no significant differences in hospital LOS and mechanical ventilation were observed.”

What the sources say

• Supported

  Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [59] Elke, 2016, Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials, Crit Care source

In the paper

“An economic evaluation of EFFORT indicates that the high-protein nutritional support was highly cost-effective with per-patients savings of 199 V of overall costs of care within 30 days of admission; and 18 V in full cost analysis (Level of Evidence 1þþ) [46].”

What the sources say

• Partly supported

  Section 3.2 reports savings of €199 per patient in the 30-day base-case analysis and €18.21 when dietitian costs were included; the summary calls the intervention highly cost-effective. But Section 2.3 describes individualized support aimed at both protein and energy goals, not a specifically high-protein intervention. (LLM, conf=0.87)

  cites [46] Schuetz, 2020, Economic evaluation of individualized nutritional support in medical inpatients: secondary analysis of the EFFORT trial, Clin Nutr sourceExperimental — accuracy not yet measured

In the paper

“Cost differences between the groups were 2336 $ vs. 3065 $ for hospital-associated costs (23.8% lower), 262 $ vs. 780 $ for 30-day readmissions (66.4% lower) and 1348 $ for malnutrition-associated infections”

What the sources say

• Supported

  The Abstract reports all three figures and both percentage differences exactly as claimed. It identifies them as modeled cost differences between early individualized nutrition therapy and standard delayed therapy in a Mexican budget-impact analysis. (LLM, conf=0.95)

  cites [111] Sulo, 2021, Hospital nutrition care informs potential cost-savings for healthcare: a budget impact analysis, Clinical Nutrition ESPEN source

In the paper

“For polymorbid medical inpatients at nutritional risk with impaired kidney function (eGFR <30 ml/min/1.73m 2 ) who are not on kidney replacement therapy, a low amount of protein of 0.8 g protein/kg body weight/day should be targeted.”

What the sources say

• Partly supported

  The Accepted Manuscript (p. 32) reports that renal-patient guidelines recommend 0.8–1 g/kg/day for at-risk or malnourished inpatients with renal failure who are not receiving renal replacement therapy. It does not specify an eGFR threshold or a fixed 0.8 g/kg/day target; it explicitly says a protein-intake recommendation cannot be made for polymorbid inpatients with a renal condition. (LLM, conf=0.88)

  cites [1] Gomes, 2018, ESPEN guidelines on nutritional support for polymorbid internal medicine patients, Clin Nutr sourceExperimental — accuracy not yet measured
• Partly supported

  Recommendation 18 supports 0.8 g/kg body weight/day as the upper end of a 0.6–0.8 g/kg/day range for hospitalized patients with CKD without acute or critical illness. It does not set 0.8 g/kg/day as a target for all polymorbid inpatients at nutritional risk with eGFR <30 who are not on kidney replacement therapy; it recommends higher intakes for patients with acute or critical illness. (LLM, conf=0.87)

  cites [88] Fiaccadori, 2021, ESPEN guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease, Clin Nutr (Edinb) sourceExperimental — accuracy not yet measured
• Partly supported

  The Study intervention section sets a target of 0.8 g/kg body weight for patients with eGFR <30, supporting the stated amount and threshold. But the Patient population section says patients on dialysis were included in the eGFR <15 group, so the paper does not limit that target to patients not receiving kidney replacement therapy. The Discussion also says the trial did not validate whether 0.8 g/kg was the optimal target. (LLM, conf=0.88)

  cites [89] Bargetzi, 2021, Admission kidney function is a strong predictor for the response to nutritional support in patients at nutritional risk, Clin Nutr sourceExperimental — accuracy not yet measured

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [8] Schuetz, 2019, Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial, Lancet source
• Partly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [106] Baumgartner, 2020, Effect of nutritional support in patients with lower respiratory tract infection: secondary analysis of a randomized clinical trial, Clin Nutr sourceExperimental — accuracy not yet measured
• Partly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [107] Hersberger, 2021, Individualized nutritional support for hospitalized patients with chronic heart failure, J Am Coll Cardiol sourceExperimental — accuracy not yet measured

In the paper

“In polymorbid medical inpatients with pressure ulcers, specific amino-acids (arginine and glutamine) and bHMB can be added to oral/enteral feeds to accelerate the healing of pressure ulcers.”

What the sources say

• ?Not checked — no full text of the sourcecites [100] Wong, 2014, The use of a specialised amino acid mixture for pressure ulcers: a placebo-controlled trial, J Wound Care source
• ?Could not verify

  The indexed copy shows the article title, which identifies an oral arginine, glutamine and HMB mixture for treating high-grade pressure ulcers, but it does not expose the study text or results. Searches for accelerated healing, oral or enteral feeds, and the inpatient population returned only webpage material, so the claimed effect and setting cannot be checked against our copy. (LLM, conf=0.73)

  cites [101] Miu, 2021, The use of an oral mixture of arginine, glutamine and β-Hydroxy-β-Methylbutyrate (hmb) for the treatment of high grade pressure ulcers: a randomized study, Aging Medicine and Healthcare sourceExperimental — accuracy not yet measured

In the paper

“This target of 30 kcal/kg actual body weight in severely underweight patients should be cautiously and slowly achieved, as this is a population at high risk of refeeding syndrome.”

What the sources say

• Partly supported

  Section 3.2.6 (Refeeding syndrome; page unavailable) identifies severe chronic undernutrition as a high-risk condition and says refeeding syndrome can occur when feeding begins too aggressively. It does not specify a target of 30 kcal/kg actual body weight or say how slowly that target should be reached. (LLM, conf=0.88)

  cites [74] Cederholm, 2017, ESPEN guidelines on definitions and terminology of clinical nutrition, Clin Nutr sourceExperimental — accuracy not yet measured

In the paper

“In polymorbid medical inpatients exclusively fed orally, an adequate intake of micronutrients (vitamins and trace elements) to meet daily estimated requirements should be ensured.”

What the sources say

• Partly supported

  The Results, under “Nutritional support” (page unavailable), describe a protocol recommending multivitamin, multimineral, and trace-element supplements for hospitalized COVID-19 patients who may not meet nutritional needs through a normal diet. The passage does not specify polymorbid medical inpatients fed exclusively orally or say that supplementation should meet daily estimated micronutrient requirements. (LLM, conf=0.84)

  cites [91] James, 2021, The role of nutrition in COVID-19 susceptibility and severity of disease: a systematic review, J Nutr sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [92] Kaegi-Braun, 2022, Effect of micronutrient supplementation in addition to nutritional therapy on clinical outcomes of medical inpatients: results of an updated systematic review and meta-analysis, Eur J Clin Nutr source
• Partly supported

  Recommendation 1 (p. 8) calls for adequate trace elements and vitamins for patients receiving medical nutrition, and Recommendation 2 (p. 8) allows oral supplementation. But the guideline says it focuses primarily on enteral and parenteral nutrition (section 2.4, p. 8); these passages do not specifically establish daily estimated requirements for polymorbid inpatients fed exclusively orally. (LLM, conf=0.86)

  cites [93] Berger, 2022, ESPEN micronutrient guideline, Clin Nutr sourceExperimental — accuracy not yet measured

In the paper

“Poor nutritional status is acknowledged to contribute to the recently described post hospital syndrome that represents a 30-day “generalized transient vulnerability following hospital discharge” leading to higher morbidity and an increased rate of unplanned readmissions”

What the sources say

• Supported

  In “Post-Hospital Syndrome – A Condition of Generalized Risk,” poor nourishment is identified as a possible contributor to impaired health during recovery. The section also describes adverse effects of malnutrition, identifies nutritional decline as a predictor of 30-day readmission, and characterizes the post-discharge period as one of heightened risk. (LLM, conf=0.88)

  cites [112] Krumholz, 2013, Post-hospital syndrome — an acquired, transient condition of generalized risk, N Engl J Med source

In the paper

“Similarly, in a prospective RCT of 80 patients aged 75 years or more admitted for acute disease and at risk for malnutrition, a 60-day intervention with ONS which started in hospital and was continued at home or in the nursing home resulted in maintained body weight and improved MNA scores (3.01 ± 2.65 vs. 1.81 ± 2.97), p ¼ 0.004), whereas CG patients continued to lose weight”

What the sources say

• Partly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [117] Gazzotti, 2003, Prevention of malnutrition in older people during and after hospitalisation: results from a randomised controlled clinical trial, Age Ageing sourceExperimental — accuracy not yet measured

In the paper

“A sub-analysis of the NOURISH study showed an increase in nutrient intake in IG patients without decrease in dietary intake”

What the sources say

• Supported

  The Methods (Study Design) identify this as an analysis of 30 patients from the NOURISH cohort. The Discussion concludes that the supplement increased oral nutrient intake without decreasing nutrient intake from food, matching the claim about the intervention group. (LLM, conf=0.94)

  cites [98] Loman, 2019, Specialized high-protein oral nutrition supplement improves home nutrient intake of malnourished older adults without decreasing usual food intake, JPEN - J Parenter Enter Nutr source

In the paper

“However, in most RCTs on intervention with ONS, the sip feeds were given for at least three months [9,120e124], whereas individualized nutritional support (which might include ONS where necessary) was usually carried out for longer periods (e.g.four months in the study by Persson et al. [119], or six months in the studies of Feldblum et al. [116], Casals et al. [118], Bonilla-Palomas et al. [126],”

What the sources say

• Partly supported

  Split into 2 atoms — 1 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

  cites [9] Deutz, 2016, Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: a randomized clinical trial, Clin Nutr sourceExperimental — accuracy not yet measured
• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [120e124]
• ?Not checked — no full text of the sourcecites [119] Persson, 2007, Nutritional supplementation and dietary advice in geriatric patients at risk of malnutrition, Clin Nutr source

In the paper

“While readmission rates as an indicator of clinical course e.g. were not reduced after three months in one of the largest trials to date (level of evidence: 1þþ) [9] in geriatric patients (level of evidence: 1þ) [131] or in older patients (level of evidence: 1-) [132]”

What the sources say

• Supported

  Section 3.3 reports no significant difference between groups in the 90-day readmission rate. Section 3.1 reports 652 enrolled patients. This source supports the claim attached to [9]; the separate claims attached to [131] and [132] are not being judged here. (LLM, conf=0.92)

  cites [9] Deutz, 2016, Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: a randomized clinical trial, Clin Nutr source
• ?Not checked — no full text of the sourcecites [131] Terp, 2018, A nutritional intervention program improves the nutritional status of geriatric patients at nutritional risk-a randomized controlled trial, Clin Rehabil source
• ?Not checked — no full text of the sourcecites [132] Sharma, 2017, Investigation of the benefits of early malnutrition screening with telehealth follow up in elderly acute medical admissions, QJM source

In the paper

“One of the largest RCTs to date (NOURISH study; n ¼ 652 patients aged 65 years or more with medical conditions) on in-and post hospital (¼continued) nutritional support reported lower 90-day mortality in the IG receiving ONS twice a day (one drink providing 350 kcal, 20 g protein, 1.5 g calcium-bHMB), 160 IU vitamin D and other essential micronutrients) for three months compared to the CG patients”

What the sources say

• Supported

  Section 3.3 reports 90-day mortality of 4.8% with HP-HMB versus 9.7% with placebo (p = 0.018). Sections 2.3 and 3.1 confirm twice-daily supplementation during hospitalization and for 90 days after discharge, and 652 enrolled patients. The mortality percentages are based on the 622 patients who received an intervention and entered the intention-to-treat analysis. (LLM, conf=0.94)

  cites [9] Deutz, 2016, Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: a randomized clinical trial, Clin Nutr source

In the paper

“These findings may also explain differences in results of nutritional trials, depending on the clinical setting with several nutritional studies in the ICU setting or in patients with advanced cancer not showing significant benefits form nutrition in regard to clinical outcomes [165,168].”

What the sources say

• ?Not checked — no full text of the sourcecites [165] Schuetz, 2021, Management of disease-related malnutrition for patients being treated in hospital, Lancet source
• Partly supported

  Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [168] Casaer, 2014, Nutrition in the acute phase of critical illness, N Engl J Med sourceExperimental — accuracy not yet measured

In the paper

“Other conditions which may increase the effects of nutritional support are cancer [171], COPD [39] among others.”

What the sources say

• Partly supported

  The Discussion (page unavailable) reports a strong benefit of nutritional support in hospitalized patients with cancer, including lower 30-day mortality. It does not establish that cancer increases the effect relative to patients without cancer. The COPD portion is attributed to a different citation and is not assessed here. (LLM, conf=0.78)

  cites [171] Bargetzi, 2021, Nutritional support during the hospital stay reduces mortality in patients with different types of cancers: secondary analysis of a prospective randomized trial, Ann Oncol sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [39] Matheson, 2021, Specialized oral nutritional supplement (ONS) improves handgrip strength in hospitalized, malnourished older patients with cardiovascular and pulmonary disease: a randomized clinical trial, Clin Nutr source

In the paper

“A recent study by Bargetzi et al. found that kidney disease predicted response to nutritional treatment with lower estimated glomerular filtration rates [eGFR] showing stronger clinical benefit [89] (Level of evidence: 1þþ).”

What the sources say

• Supported

  The Abstract and the Results section, “Association of kidney function and effect of nutritional support on mortality” (page not provided), report that admission eGFR predicted the benefit of nutritional support in hospitalized medical patients at nutritional risk. Patients with lower eGFR had a stronger 30-day mortality benefit than those with less severe kidney impairment. (LLM, conf=0.93)

  cites [89] Bargetzi, 2021, Admission kidney function is a strong predictor for the response to nutritional support in patients at nutritional risk, Clin Nutr source

In the paper

“However, energy (1725 kcal/day vs. 1863 kcal/day, p ¼ 0.21) and protein (76 g/ day vs. 80 g/day, p ¼ 0.59) intake were higher in the IG.”

What the sources say

• Partly supported

  The Results section reports higher energy and protein intake in the intervention group at day 14, with a significant difference after adjustment for weight. The available Table 2 text contains only its header, so our copy does not verify the quoted intake values or p-values; the Results passage does not give them. (LLM, conf=0.85)

  cites [159] Collins, 2017, A foodservice approach to enhance energy intake of elderly subacute patients: a pilot study to assess impact on patient outcomes and cost, Age Ageing sourceExperimental — accuracy not yet measured

In the paper

“Similar results were also found within the NOURISH study with a significant survival benefit associated with nutritional support [9] (Level of evidence: 1þþ).”

What the sources say

• ?Not checked — no full text of the sourcecites [126] Bonilla-Palomas, 2016, Nutritional intervention in malnourished hospitalized patients with heart failure, Arch Med Res source
• Partly supported

  The Results report significantly lower 30-day mortality with nutritional support in hospitalized patients with chronic heart failure, supporting the survival-benefit claim. However, the Methods identify the trial as EFFORT, not the NOURISH study named in the citing sentence. (LLM, conf=0.88)

  cites [107] Hersberger, 2021, Individualized nutritional support for hospitalized patients with chronic heart failure, J Am Coll Cardiol sourceExperimental — accuracy not yet measured
• Supported

  The Results (§3.3; page not provided) report significantly lower 90-day mortality with the nutritional supplement than with placebo, supporting the citing sentence’s claim of a survival benefit in NOURISH. The trial enrolled malnourished older adults hospitalized for several conditions, including congestive heart failure; this result is not specific to heart-failure patients. (LLM, conf=0.94)

  cites [9] Deutz, 2016, Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: a randomized clinical trial, Clin Nutr source

In the paper

“A secondary analysis of the multicentre randomized-controlled EFFORT trial suggested that patients with CRP levels of !100 mg/l no longer responded to nutritional therapy, while patients with lower levels had a significant mortality benefit from nutritional support [147] (Level of evidence: 1þþ).”

• Also stated in: § 3.32. Recommendation 32 · plain

  “In a secondary analysis of EFFORT, unlike patients with lower CRP concentrations ( 100 mg/L), patients with high inflammation (defined as CRP level >100 mg/L) did not respond to nutritional support [147] (Level of evidence 1þþ).”

What the sources say

• Partly supported

  The Results section (Effect of Nutritional Support on 30-Day Mortality According to Inflammation Groups; page unavailable) reports a significant 30-day mortality benefit in the low- and moderate-CRP groups, but no significant benefit in the high-CRP group. The claim broadens that outcome-specific finding to patients ‘no longer responding’ to nutritional therapy; the paper also defines the high group as CRP >100 mg/L, not ≥100 mg/L. (LLM, conf=0.84)

  cites [147] Merker, 2020, Association of baseline inflammation with effectiveness of nutritional support among patients with disease-related malnutrition: a secondary analysis of a randomized clinical trial, JAMA Netw Open sourceExperimental — accuracy not yet measured

In the paper

“In those with complete data, there was no difference in patients' weight, HGS, functional independence measure or LOS.”

What the sources say

• Partly supported

  The Results report no between-group difference in change in weight or handgrip strength from admission to day 14, and similar change in FIM score and length of stay. However, the Results specify that FIM and length-of-stay analyses included all participants, not only those with complete day-14 data. (LLM, conf=0.87)

  cites [159] Collins, 2017, A foodservice approach to enhance energy intake of elderly subacute patients: a pilot study to assess impact on patient outcomes and cost, Age Ageing sourceExperimental — accuracy not yet measured

In the paper

“Markers of inflammation (i.e.C-reactive protein [CRP]) have been shown to correlate with disease-related anorexia, reduced food intake and muscle catabolism, and at the same predict lack of response to nutritional treatment [147,190,191].”

What the sources say

• Partly supported

  The Introduction describes inflammation as a proposed driver of disease-related anorexia, reduced food intake, and muscle catabolism. The Discussion says patients with initially very high CRP may not respond to nutritional support. The paper does not establish that CRP itself correlates with all three conditions or that it reliably predicts lack of response; its Strengths and Limitations section calls the secondary-analysis findings hypothesis-generating. (LLM, conf=0.85)

  cites [147] Merker, 2020, Association of baseline inflammation with effectiveness of nutritional support among patients with disease-related malnutrition: a secondary analysis of a randomized clinical trial, JAMA Netw Open sourceExperimental — accuracy not yet measured
• Partly supported

  The Chronic renal failure section and Table 4 associate elevated CRP in cachexia with increased protein catabolism and resistance to nutrition support. They do not show that CRP itself predicts treatment response, and Table 4 describes food intake in cachexia as low or normal, not consistently reduced. The section links cytokine excess—not specifically CRP—to anorexia. (LLM, conf=0.85)

  cites [190] Morley, 2006, Cachexia: pathophysiology and clinical relevance, Am J Clin Nutr sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [191] Braun, 2017, Obesity paradox in patients with community-acquired pneumonia: is inflammation the missing link?, Nutrition source

In the paper

“Albumin and prealbumin levels also have a strong prognostic value, but little correlation with nutritional response [192,193] (both Level of evidence 1þþ).”

What the sources say

• Partly supported

  The Discussion reports that admission albumin was a strong prognostic indicator and that response to nutritional support was independent of albumin concentration. It does not establish the same findings for prealbumin; the Discussion instead proposes studying prealbumin in future research. (LLM, conf=0.90)

  cites [192] Bretschera, 2022, Admission serum albumin concentrations and response to nutritional therapy in hospitalised patients at malnutrition risk: secondary analysis of a randomised clinical trial, EClinicalMedicine sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [193] Bretscher, 2023, Association between prealbumin, all-cause mortality, and response to nutrition treatment in patients at nutrition risk. Secondary analysis of a randomized controlled trial, JPEN - J Parenter Enter Nutr source

In the paper

“A recent metaanalysis from 2023, which included 29 studies, demonstrated that sarcopenia is associated with a higher prevalence of polypharmacy (OR: 1.65 [1.23, 2.20], p < 0.01) and higher number of medications (mean difference: 1.39, 95% CI 0.59 to 2.19, I 2 ¼ 95%, p < 0.01) compared with individuals without sarcopenia [176].”

What the sources say

• Supported

  The Abstract reports 29 included studies and gives the same odds ratio, mean difference, confidence intervals, heterogeneity, and P values. The Results section also confirms the polypharmacy estimate. No page numbers are provided in our copy. (LLM, conf=0.95)

  cites [176] Prokopidis, 2023, Sarcopenia is associated with a greater risk of polypharmacy and number of medications: a systematic review and meta-analysis, J Cachexia Sarcopenia Muscle source

In the paper

“However, the rigorous methodical approach used came up with some limitations regarding selecting trials and has led to a lower number of included trials.Thus it guarantees that our findings are valid for the population of polymorbid medical inpatients.”

In the paper

“In cases of uncertainty about the way that comorbidities were reported, the study authors were contacted in order to obtain additional information.In the event that they could not be reached, a blinded consensus decision within the guideline WG was taken about whether or not to include the study.”

In the paper

“We conducted the update of the guideline with a multidisciplinary team of 14 European specialist in nutritional support from which twelve have already been authors of the original paper from 2018 following the SOP for the development of ESPEN guidelines [2].”

What the sources say

• ?Not checked — no full text of the sourcecites [2] Bischoff, 2015, Standard operating procedures for ESPEN guidelines and consensus papers, Clin Nutr source

In the paper

“Other consequences of polymorbidity include disability, functional decline, poor quality of life (QoL) and higher healthcare costs [5].”

What the sources say

• ?Not checked — no full text of the sourcecites [5] Marengoni, 2011, Aging with multimorbidity: a systematic review of the literature, Ageing Res Rev source

In the paper

“From a total of 3527 retrieved abstracts, 60 new relevant studies were analyzed and used to generate a guideline draft that proposed 32 recommendations (7x A, 11x B, 10x O and 4x GPP), which encompass different aspects of nutritional support including indication, route of feeding, energy and protein requirements, micronutrient requirements, disease-specific nutrients, timing, monitoring and”

In the paper

“Disease-related malnutrition in polymorbid medical inpatients is a highly prevalent syndrome associated with significantly increased morbidity, disability, short-and long-term mortality, impaired recovery from illness, and cost of care.”

In the paper

“Retrieved abstracts were screened to identify relevant studies that were used to develop recommendations (incl.SIGN grading), which was followed by submission to Delphi voting.”

In the paper

“The results of the first online voting showed a strong consensus (agreement of >90%) on 100% of the recommendations.”

In the paper

“We did a systematic literature search for 15 clinical questions in three different databases (Medline, Embase and the Cochrane Library), as well as in secondary sources (e.g.published guidelines), until July 12th.”

In the paper

“This update adheres to the standard operating procedures for ESPEN guidelines.”

• Also stated in: § 1. Introduction · plain

  “The present guideline represents an update of the original guideline on polymorbid patients from 2018 [1] and follows the Standard Operating Procedures (SOP) from European Society for Clinical Nutrition and Metabolism (ESPEN) [2].”

What the sources say

• ?Not checked — no full text of the sourcecites [2] Bischoff, 2015, Standard operating procedures for ESPEN guidelines and consensus papers, Clin Nutr source

In the paper

“The classification of the literature into levels of evidence and grades of recommendation were performed according to the SIGN grading system [15], as exemplified in Tables 2 and 3.”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [15] 2014

In the paper

“On the 12th of July the primary source search update was conducted by the same author in three databases (Medline, Embase and the Cochrane Library) since April 2016.”

In the paper

“The search update in July 2022 identified 4234 additional possible eligible abstracts; after removing the duplicates, a number of 3527 abstracts were screened.”

In the paper

“Many studies required the assessment of the full paper to ascertain whether it met all of the inclusion criteria, and for a proportion of the papers (n ¼ 16), the authors were contacted and requested to provide more information, which was usually to clarify whether their study population suffered from multiple”

In the paper

“Each WG member was allocated with one or two clinical questions and was responsible for: validation of the literature, quality assessment and assignment of level of evidence for each paper relevant for the recommendations (e.g. using SIGN checklists), generation of first draft of recommendations, including the supporting text and grade of recommendation.”

In the paper

“The results of this online voting were a strong consensus (agreement of >90%) in 100% of recommendations, which is so far unique in ESPEN guideline development.”

In the paper

“The WG generated a guideline draft with a total of 32 recommendations (approved by the WG and the ESPEN Guidelines Editorial Board office, which was followed by the start of the consensus procedure, by sending that draft to the members of the ESPEN guideline project, ESPEN members and other experts in clinical nutrition for online voting (Delphi method) in April 2023.”

In the paper

“The abstracts were screened by either one of two WG members in a standardized and systematic way e potential studies (full texts) were then reviewed by both members.Discrepancies were resolved through consensus or recourse to a third review author.”

In the paper

“This supplementation resulted in significant preservation of muscle mass (lean body mass difference between admission and three months after discharge was À3.5 kg in CG patients, and þ1.3 in the IG) and independence (the difference in the Barthel Index (BI) values between admission and three months showed a statistically significant decline in the CG (p < 0.01) vs. a non-significant decline in the”

What the sources say

• ?Not checked — no full text of the sourcecites [33] Hegerová, 2015, Early nutritional support and physiotherapy improved long-term self-sufficiency in acutely ill older patients, Nutrition source

In the paper

“For those studies whose authors could not be reached (n ¼ 11), seven were included and four excluded, according to the WG consensus decision.”

In the paper

“The same search strategies used in the original guidelines were used in the literature searches in 2022.”

In the paper

“These effects were robust after multivariate adjustment.”

What the sources say

• ?Not checked — no full text of the sourcecites [17] Jie, 2010, Impact of nutritional support on clinical outcome in patients at nutritional risk: a multicenter, prospective cohort study in Baltimore and Beijing teaching hospitals, Nutrition source

In the paper

“Observational studies have shown the frequency of complications in untreated at-risk patients to be three times higher than in patients not at-risk, and furthermore length of hospital stay (LOS) is 50% longer, which has a negative influence on clinical outcomes [18].”

What the sources say

• ?Not checked — no full text of the sourcecites [18] Sorensen, 2008, EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome, Clin Nutr source

In the paper

“Similar to the original guideline, a systematic literature search was conducted, first in secondary sources by searching published guidelines and systematic reviews potentially relevant for each question, followed by a search in primary sources.”

In the paper

“As a result of the update and the conversion of the statements to recommendations, a total of 100 studies are now included.”

In the paper

“In a controlled trial, Rypkema et al. demonstrated that a standardized, early nutritional intervention in older polymorbid medical inpatients at nutritional risk, determined by the MNA-SF, is effective and does not significantly increase hospital costs.”

In the paper

“While high nutritional risk was associated with higher mortality in all tools, SGA and MNA-SF showed the strongest association with adjusted odds ratios of 3.17 (95% CI, 2.18 to 4.61, p < 0.001) and 3.45 (95% CI, 2.28 to 5.22, p < 0.001).”

What the sources say

• ?Not checked — no full text of the sourcecites [31] Stalder, 2022, Prospective validation of five malnutrition screening and assessment instruments among medical inpatients: secondary analysis of a randomized clinical trial, Clin Nutr source

In the paper

“Hegerov a el al. conducted a prospective RCT in 200 inpatients from an internal medicine department and found that the provision of ONS (combined with physiotherapy) increased the overall nutritional intake, mainly energy (1954 ± 429 kcal in the IG vs. 1401 ± 364 kcal, p < 0.001) and protein (76.3 in the IG ±16.1 vs. 55.5 in the CG ±13.7, p < 0.001), without negatively affecting the hospital food”

What the sources say

• ?Not checked — no full text of the sourcecites [33] Hegerová, 2015, Early nutritional support and physiotherapy improved long-term self-sufficiency in acutely ill older patients, Nutrition source

In the paper

“This stresses the importance of providing nutritional support to those most in need [45] (Level of Evidence 1þþ).”

What the sources say

• ?Not checked — no full text of the sourcecites [45] 2005, Routine oral nutritional supplementation for stroke patients in hospital (FOOD): a multicentre randomised controlled trial, Lancet source

In the paper

“with a significant positive effect on their self-reported QoL (i.e. the treatment effect in QoL scores using the SF-36 form at 6 months was 7.0, 95% CI 0.5 to 13.6, p ¼ 0.04 for physical function, 10.2, 95% CI 0.1 to 20.2, p ¼ 0.047 for role physical, and 7.8, 95% CI 0.0 to 15.5, p ¼ 0.05 for social function domains, compared to placebo) [40,41] (Level of evidence 1þþ for both).”

What the sources say

• ?Not checked — no full text of the sourcecites [40] Gariballa, 2007, Dietary supplementation and quality of life of older patients: a randomized, double-blind, placebo-controlled trial, J Am Geriatr Soc source
• ?Not checked — no full text of the sourcecites [41] Gariballa, 2007, Effects of dietary supplements on depressive symptoms in older patients: a randomised double-blind placebo-controlled trial, Clin Nutr source

In the paper

“A meta-analysis by Gressies et al. conducted in 2022 that was an update and re-analysis of Gomes et al. included trials exclusively conducted within the population of polymorbid patients using the exact same definition as used in this guideline.”

What the sources say

• ?Not checked — no full text of the sourcecites [36] Gressies, 2022, Letter to the Editor: is nutritional support effective in malnourished polymorbid medical inpatients?, Clin Nutr source

In the paper

“In the absence of IC, TEE for polymorbid older patients (aged !65 years) can be estimated at approximately 27 kcal/kg actual body weight/day.REE can be estimated at 18e20 kcal/kg actual body weight/day with the addition of activity or stress factors to estimate TEE.”

What the sources say

• ?Not checked — no full text of the sourcecites [71] Gaillard, 2007, Energy requirements in frail elderly people: a review of the literature, Clin Nutr source

In the paper

“While both published prediction equations and weight-based formulae provide valid estimates of energy requirements for groups of patients, both methods are subject to significant bias and imprecision when applied to individuals [66,67].”

What the sources say

• ?Not checked — no full text of the sourcecites [66] Boullata, 2007, Accurate determination of energy needs in hospitalized patients, J Am Diet Assoc source
• ?Not checked — no full text of the sourcecites [67] Miles, 2006, Energy expenditure in hospitalized patients: implications for nutritional support, Mayo Clin Proc source

In the paper

“The weighted mean for the whole group was 20.4 kcal/kg actual body weight whereas the weighted mean for the polymorbid hospitalized older group was lower at 18.5 kcal/kg body weight.”

What the sources say

• ?Not checked — no full text of the sourcecites [71] Gaillard, 2007, Energy requirements in frail elderly people: a review of the literature, Clin Nutr source

In the paper

“The results of this review should be interpreted with caution since relatively few data were available in the sick older individuals (n ¼ 248) compared with the healthy older individuals (n ¼ 1970).Furthermore the methods described in the paper failed to comply fully with guidelines for the conduct of systematic reviews [72].”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [72] Higgins, 2011

In the paper

“The mean TEE in sick older individuals was 27 ± 1.8 kcal/kg body weight and the weighted physical activity level in these patients was 1.36 ± 0.03 reflecting the relative physical inactivity of this population.”

What the sources say

• ?Not checked — no full text of the sourcecites [71] Gaillard, 2007, Energy requirements in frail elderly people: a review of the literature, Clin Nutr source

In the paper

“These results should be interpreted with caution since the sample size was very small.Furthermore, patients received continuous EN or PN during IC and thus measured energy expenditure included not only REE but also diet-induced thermogenesis.”

What the sources say

• ?Not checked — no full text of the sourcecites [73] Ahmad, 1999, An evaluation of resting energy expenditure in hospitalized, severely underweight patients, Nutrition source

In the paper

“In the absence of IC, REE for severely underweight patients can be estimated at 30 kcal/kg actual body weight.”

What the sources say

• ?Not checked — no full text of the sourcecites [73] Ahmad, 1999, An evaluation of resting energy expenditure in hospitalized, severely underweight patients, Nutrition source

In the paper

“More than 200 prediction equations have been published in the literature, with accuracy rates ranging from 36% to 75% when compared with IC and no single equation emerges as being the most accurate in polymorbid medical inpatients [66].”

What the sources say

• ?Not checked — no full text of the sourcecites [66] Boullata, 2007, Accurate determination of energy needs in hospitalized patients, J Am Diet Assoc source

In the paper

“Positive results were also reported in a meta-analysis of RCTs on hospitalized patients at high risk of developing pressure ulcers, by Tuffaha et al.Provision of nutritional support resulted in a cost saving of 425 $ per patient and a marginal improvement of quality adjusted life years of 0.005, compared to the usual care [48] (Level of evidence 1þþ).”

What the sources say

• ?Not checked — no full text of the sourcecites [48] Tuffaha, 2016, Cost-effectiveness analysis of nutritional support for the prevention of pressure ulcers in high-risk hospitalized patients, Adv Skin Wound Care source

In the paper

“In this study mean REE by IC was 1300 ± 160 kcal/day equating to 31.4 kcal/kg body weight.”

What the sources say

• ?Not checked — no full text of the sourcecites [73] Ahmad, 1999, An evaluation of resting energy expenditure in hospitalized, severely underweight patients, Nutrition source

In the paper

“The previous described large EFFORT trial [8] addressed this question as the IG got their therapy initiated within 48h.By 30 days, patients in the IG experienced 21% less adverse clinical outcomes and 35% lower mortality (adjusted OR 0.65 [0.47 to 0$91], p ¼ 0.011) (Level of evidence 1þþ).”

What the sources say

• ?Not checked — no full text of the sourcecites [8] Schuetz, 2019, Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial, Lancet source

In the paper

“Recommendation 17 was downgraded from grade of recommendation B to 0, due to the limited number of available studies in identified polymorbid medical inpatients.”

In the paper

“In polymorbid medical older inpatients requiring EN, EN formulas enriched in a mixture of soluble and insoluble fibers can be used to improve bowel function.”

What the sources say

• ?Not checked — no full text of the sourcecites [104] Vandewoude, 2004, Fibre-supplemented tube feeding in the hospitalised elderly, Age Ageing source

In the paper

“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”

What the sources say

• ?Not checked — no full text of the sourcecites [78] Kaegi-Braun, 2021, Nutritional trials using high protein strategies and long duration of support show strongest clinical effects on mortality.: results of an updated systematic review and meta-analysis, Clin Nutr ESPEN source

In the paper

“We cannot recommend the use of other disease-specific nutritional supplementation in polymorbid medical inpatients.”

What the sources say

• ?Not checked — no full text of the sourcecites [105] Ogasawara, 2018, Effect of eicosapentaenoic acid on prevention of lean body mass depletion in patients with exacerbation of chronic obstructive pulmonary disease: a prospective randomized controlled trial, Clin Nutr ESPEN source

In the paper

“A Belgian study of 145 older patients receiving enteral feeding [104] found positive effects of a formula enriched with 30 g fiber including 33% insoluble (cellulose and hemicellulose A) and 67% soluble (pectin, hemicellulose B, inulin) fiber (IG) vs. the CG, which received the same EN with no fiber (level of evidence 1þþ).The frequency of stools was lower (4.1 ± 2.6 per week versus 6.3 ± 4.7 per”

What the sources say

• ?Not checked — no full text of the sourcecites [104] Vandewoude, 2004, Fibre-supplemented tube feeding in the hospitalised elderly, Age Ageing source

In the paper

“However, patients were admitted to the stroke unit in the IG and to the regular ward in the CG, which entails a high risk of bias”

What the sources say

• ?Not checked — no full text of the sourcecites [108] Zheng, 2015, Impact of early enteral nutrition on short term prognosis after acute stroke, J Clin Neurosci source

In the paper

“Regarding self-sufficiency (measured by independency in the activities of daily living through the BI, it diminished during the course of annual monitoring in both groups of patients, but the decline was sharper in the CG”

What the sources say

• ?Not checked — no full text of the sourcecites [33] Hegerová, 2015, Early nutritional support and physiotherapy improved long-term self-sufficiency in acutely ill older patients, Nutrition source

In the paper

“In polymorbid medical inpatients exclusively fed orally, documented or suspected micronutrient deficiencies should be repleted.”

What the sources say

• ?Not checked — no full text of the sourcecites [94] Joosten, 1993, Metabolic evidence that deficiencies of vitamin B-12 (cobalamin), folate, and vitamin B-6 occur commonly in elderly people, Am J Clin Nutr source
• ?Not checked — no full text of the sourcecites [95] Kilonzo, 2007, A cost-utility analysis of multivitamin and multimineral supplements in men and women aged 65 years and over, Clin Nutr source
• ?Not checked — no full text of the sourcecites [96] Graat, 2002, Effect of daily vitamin E and multivitamin-mineral supplementation on acute respiratory tract infections in elderly persons: a randomized controlled trial, JAMA source

In the paper

“For example, a meta-analysis of mixed study populations found additional micronutrient supplementation to a therapeutic diet [74] already supplemented in micronutrients did not reduce mortality and may have increased LOS by approximately one day (albeit with borderline statistical significance) [92].”

What the sources say

• ?Not checked — no full text of the sourcecites [92] Kaegi-Braun, 2022, Effect of micronutrient supplementation in addition to nutritional therapy on clinical outcomes of medical inpatients: results of an updated systematic review and meta-analysis, Eur J Clin Nutr source

In the paper

“Lean body mass did not reach its original value even twelve months post-discharge in the CG, but it did in the IG.”

What the sources say

• ?Not checked — no full text of the sourcecites [33] Hegerová, 2015, Early nutritional support and physiotherapy improved long-term self-sufficiency in acutely ill older patients, Nutrition source

In the paper

“Three months postdischarge, lean body mass was 3.5 kg lower in the CG but only 0.4 kg lower in the treated group.”

What the sources say

• ?Not checked — no full text of the sourcecites [33] Hegerová, 2015, Early nutritional support and physiotherapy improved long-term self-sufficiency in acutely ill older patients, Nutrition source

In the paper

“Using a nationwide inpatient database with 432,620 eligible patients hospitalized for acute heart failure after propensity score matching, Kaneko et al. showed that delayed initiation of feeding (later than two days after admission) was associated with higher in-hospital mortality (OR 1.32, 95% CI1.26 to 1.39), longer LOS and higher incidence of pneumonia and sepsis when compared to earlier init”

What the sources say

• ?Not checked — no full text of the sourcecites [109] Kaneko, 2021, Early initiation of feeding and in-hospital outcomes in patients hospitalized for acute heart failure, Am J Cardiol source

In the paper

“Buitrago et al. in a secondary analysis applied to a Colombian population, found that average total costs over 60 days were 3770 $ for patients with delayed nutrition therapy vs. 2419 $ for patients with early nutrition therapy (started within 24e48 h of hospital admission) À a savings of 1351 $ (35.8% decrease) per nutrition-treated patient”

What the sources say

• ?Not checked — no full text of the sourcecites [110] Buitrago, 2020, Targeting malnutrition: nutrition programs yield cost savings for hospitalized patients, Clin Nutr source

In the paper

“Both mortality (HR 0.37, 95% CI 0.19e0.72,p ¼ 0.003) and readmission rates were lower in the IG patients (10.2 vs. 36.1%,p ¼ 0.001)”

What the sources say

• ?Not checked — no full text of the sourcecites [126] Bonilla-Palomas, 2016, Nutritional intervention in malnourished hospitalized patients with heart failure, Arch Med Res source

In the paper

“The improvements in physical function were significantly higher in the IG (D 4.2 ± 4.4 vs. D 2.2 ± 2.5), p ¼ 0.008) but clinically relevant in both groups.”

In the paper

“The benefits of the nutritional intervention persisted at 24 months, as the primary endpoint occurred more frequently in of the CG patients (73.8%) compared to in 47.5% of IG patients (HR 0.45, 95% CI 0.28e0.72;p ¼ 0.001).”

What the sources say

• ?Not checked — no full text of the sourcecites [127] Bonilla-Palomas, 2018, Does nutritional intervention maintain its prognostic benefit in the long term for malnourished patients hospitalised for heart failure?, Rev Clin Esp source

In the paper

“HGS and peak expiratory flow increased after three months only in the intervention patients (grip strength improved from 26.1 ± 11.3 to 31.5 ± 10.1 kg, p < 0.0001; and peak flow from 329.2 ± 124.0 to 388.9 ± 108.4 l/ min, p ¼ 0.004)”

What the sources say

• ?Not checked — no full text of the sourcecites [124] Norman, 2008, Three month intervention with protein and energy rich supplements improve muscle function and quality of life in malnourished patients with non-neoplastic gastrointestinal disease—a randomized controlled trial, Clin Nutr source

In the paper

“Regarding QoL, the Q-5D-3L VAS-score was higher in IG at the end of the study compared to the CG (IG: 61.6 ± 16.2 vs. CG: 53.3 ± 19.3, p ¼ 0.011) with a significantly higher increase in the IG (D 14.3 ± 15.5 vs. D 5.6 ± 17.2, p ¼ 0.002).”

In the paper

“In the study by Persson et al., which included older patients at risk of malnutrition (85 ± 6 years), treatment with complete or incomplete liquid supplements (providing an average intake of 60 kcals and 11.25 g protein per day) and dietary advice for four months resulted in an improvement of Katz's activities of daily living index (p < 0.001; p ¼ 0.05 between groups), but not in QoL assessed by”

What the sources say

• ?Not checked — no full text of the sourcecites [119] Persson, 2007, Nutritional supplementation and dietary advice in geriatric patients at risk of malnutrition, Clin Nutr source

In the paper

“However, trial quality was deemed moderate, highlighting the need for further large-scale studies”

What the sources say

• ?Not checked — no full text of the sourcecites [115] Kaegi-Braun, 2022, Nutritional support after hospital discharge improves long-term mortality in malnourished adult medical patients: systematic review and meta-analysis, Clin Nutr source

In the paper

“the intervention resulted in increased body weight (4.750 ± 5.12 kg in the IG vs. À0.903± 6.12) kg in the CG, p < 0.001) and improved the MUST score (À2.457 ± 1.39 in the IG vs. À1.170± 1.67) in the CG, p < 0.001) after six months of continued nutritional counseling by case manager nurses”

What the sources say

• ?Not checked — no full text of the sourcecites [118] Casals, 2015, Randomized clinical trial of nutritional counseling for malnourished hospital patients, Rev Clin Esp source

In the paper

“in a RCT of malnourished patients (according to the MNA-SF) aged 85 ± 6 years, individualized nutritional support for four months after discharge maintained body weight in the intention-to-treat analysis (difference in mean weight from baseline to 4-month followup was 0.6 kg in the IG vs. À1.5 kg in the CG, p < 0.001), although a high dropout rate was reported”

What the sources say

• ?Not checked — no full text of the sourcecites [119] Persson, 2007, Nutritional supplementation and dietary advice in geriatric patients at risk of malnutrition, Clin Nutr source

In the paper

“Systematic reviews found evidence for improved body weight and nutritional status in older patients after discharge either with individualized nutritional support [113] or intervention with ONS [114].”

What the sources say

• ?Not checked — no full text of the sourcecites [113] Munk, 2016, Individualised dietary counselling for nutritionally at-risk older patients following discharge from acute hospital to home: a systematic review and meta-analysis, J Hum Nutr Diet source
• ?Not checked — no full text of the sourcecites [114] Beck, 2013, Oral nutritional support of older (65 years+) medical and surgical patients after discharge from hospital: systematic review and meta-analysis of randomized controlled trials, Clin Rehabil source

In the paper

“There is growing evidence that type of underlying disease, severity of disease and extend of the acute-phase reaction have an impact on the effect of nutrition therapy [165].”

What the sources say

• ?Not checked — no full text of the sourcecites [165] Schuetz, 2021, Management of disease-related malnutrition for patients being treated in hospital, Lancet source

In the paper

“Thereby, inflammation is a key factor with several important metabolic effects on a cellular level (e.g., increase in insulin resistance leading to an inhibition of nutrition entering cells) and on different organs such as the brain (e.g., causing disease-related anorexia and reduced food intake), the intestines and on muscle (e.g., causing catabolism and sarcopenia).”

What the sources say

• ?Not checked — no full text of the sourcecites [165] Schuetz, 2021, Management of disease-related malnutrition for patients being treated in hospital, Lancet source

In the paper

“There are also studies showing that patients with high inflammation do not show a positive response to nutritional interventions while patients with lower levels of inflammation did.”

In the paper

“However, mean protein intake was significantly increased in the IG; with 27/41 compared to 12/40 in the CG meeting !75% protein requirements (p ¼ 0.001).”

What the sources say

• ?Not checked — no full text of the sourcecites [148] Munk, 2014, Positive effect of protein-supplemented hospital food on protein intake in patients at nutritional risk: a randomised controlled trial, J Hum Nutr Diet source

In the paper

“There was no statistically significant difference in the development of pressure ulcers or LOS (Level of Evidence 2þ).”

What the sources say

• ?Not checked — no full text of the sourcecites [160] Rypkema, 2004, Cost-effectiveness of an interdisciplinary intervention in geriatric inpatients to prevent malnutrition, J Nutr Health Aging

In the paper

“Among the predictors for the success of nutritional support were high protein supplementation (OR 0.57 vs. 0.93, I 2 ¼ 86.3%, p for heterogeneity ¼ 0.007) and long-term nutritional interventions (OR 0.53 vs. 0.85, I 2 ¼ 76.2%, p for heterogeneity ¼ 0.040).”

In the paper

“Thus, the evidence shows that organizational changes in nutritional support provision can improve energy and protein intake and reduce the risk of adverse outcomes in polymorbid medical inpatients.”

In the paper

“There was no significant difference in energy intake, LOS or HGS between groups.”

What the sources say

• ?Not checked — no full text of the sourcecites [148] Munk, 2014, Positive effect of protein-supplemented hospital food on protein intake in patients at nutritional risk: a randomised controlled trial, J Hum Nutr Diet source

In the paper

“Similarly, markers of chronic kidney dysfunction (i.e., creatinine) are associated with renal cachexia and weight loss, but patients with reduced kidney function show a particularly stronger response to nutritional treatment [8] (Level of evidence 1þþ).”

What the sources say

• ?Not checked — no full text of the sourcecites [8] Schuetz, 2019, Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial, Lancet source

In the paper

“For example, many healthcare professionals are familiar with the physical binding of drugs such as tetracyclines to the divalent and trivalent cations found in milk or antacid preparations [181] or in many of the ONS and enteral formulas, which limits absorption from the gastrointestinal tract.”

What the sources say

• ?Not checked — no full text of the sourcecites [181] Neuvonen, 1976, Interactions with the absorption of tetracyclines, Drugs source

In the paper

“This is because whilst drugs such as simvastatin have no specific requirement to be taken with or without food it has the potential to be toxic when taken concurrently with grapefruit juice [186].”

What the sources say

• ?Not checked — no full text of the sourcecites [186] Dreier, 2004, Statin-associated rhabdomyolysis triggered by grapefruit consumption, Neurology source

In the paper

“Indeed, as the number of medicines required increases so does the risk of these interactions as well as the risk of potential effects on nutritional status.”

In the paper

“Fewer are likely to be familiar with the potential for physical binding of ceftriaxone to calcium salts when each is given intravenously [182] or that hydration status, which is for example commonly impaired in acute medical admissions [183], can affect drug enrichment [184].”

What the sources say

• ?Not checked — no full text of the sourcecites [182] Donnelly, 2017, Ceftriaxone-associated biliary and cardiopulmonary adverse events in neonates: a systematic review of the literature, Pediatr Drugs source

In the paper

“Such adverse effects from medicines on body systems could affect the status of specific types of nutrients.”