The DOI matches its Crossref record; 201 of the 202 references it cites were found in a registry or an index; 105 of the 263 sources its claims cite were checked for support.
ESPEN guideline on nutritional support for polymorbid medical inpatients
Open accessAbstract
BACKGROUND: 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. AIM: As there are uncertainties in applying disease-specific guidelines to patients with multiple conditions, our aim was to provide evidence-based recommendations on nutritional support for the polymorbid patient population hospitalized in medical wards. METHODS: This update adheres to the standard operating procedures for ESPEN guidelines. 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. 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. RESULTS: 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 procedure of intervention. The results of the first online voting showed a strong consensus (agreement of >90%) on 100% of the recommendations. Therefore, no final consensus conference was needed. CONCLUSIONS: Recent high-quality trials have provided increasing evidence that nutritional support can reduce morbidity and other complications associated with malnutrition in polymorbid patients. The timely screening of patients for risk of malnutrition at hospital admission followed by individualized nutritional support interventions for at-risk patients should be part of routine clinical care and multimodal treatment in hospitals worldwide. Use of this updated guideline offers an evidence-based nutritional approach to the polymorbid medical inpatients and may improve their outcomes.
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Written from the paper’s full text.
TL;DR
This ESPEN guideline update provides 32 evidence-based recommendations on nutritional support for polymorbid medical inpatients, covering screening, assessment, energy/protein requirements, intervention, monitoring, and post-discharge continuation. It concludes that timely screening and individualized nutritional support can reduce morbidity and complications in this population.
Key findings
- From 3527 screened abstracts, 60 new relevant studies were analyzed and a total of 100 studies were included; the guideline proposes 32 recommendations (7 A, 11 B, 10 O, 4 GPP), with >90% agreement on 100% of recommendations in the first online Delphi vote.
- In a meta-analysis restricted to polymorbid patients using the guideline’s definition, nutritional support significantly reduced mortality (OR 0.68; 95% CI 0.51–0.91) and hospital readmissions (OR 0.64; 95% CI 0.45–0.90).
- The EFFORT trial reported lower adverse clinical outcomes (adjusted OR 0.79, 95% CI 0.64–0.97) and lower 30-day mortality (adjusted OR 0.65, 95% CI 0.47–0.91) with individualized nutritional support targeting 1.2–1.5 g protein/kg/day, with per-patient cost savings of 199 € within 30 days.
- Continued post-discharge nutritional support lowered mortality in a meta-analysis of 2438 patients (OR 0.63, 95% CI 0.48–0.84); in NOURISH, 90-day mortality was 4.8% vs 9.7% (RR 0.49, 95% CI 0.27–0.90, p=0.018).
Methods
- Update of the 2018 ESPEN guideline following ESPEN standard operating procedures, conducted by a multidisciplinary team of 14 European specialists; it retained 12 PICO questions and addressed 3 non-PICO topics, with a new question on biomarkers predicting treatment response.
- Systematic literature search for 15 clinical questions in Medline, Embase, and the Cochrane Library, plus secondary sources, with the primary-source update performed on 12 July 2022 since April 2016; abstracts were screened, full texts reviewed, and discrepancies resolved by consensus or a third reviewer.
- Evidence was graded using SIGN, recommendations were drafted and submitted to online Delphi voting in April 2023; because of strong consensus on the first vote, no final consensus conference was held.
Limitations
- The paper states that the rigorous methodological approach led to a lower number of included trials, that many published studies did not report multiple comorbidities or use typical key terms, and that there are no MeSH terms dedicated to multiple chronic conditions; authors were contacted for 16 papers, and for 11 unreachable papers the working group made consensus decisions (7 included, 4 excluded).
- The paper states that some included studies were conducted in older populations, and that evidence for certain recommendations (e.g., recommendations 11, 22, and 23) is limited to the subgroup of polymorbid older patients; for some questions no studies were identified (e.g., comparing energy prediction equations with weight-based formulae, and multivitamin/multi-trace-element supplementation vs no supplements in exclusively orally fed polymorbid inpatients).
- Evident from the text: many recommendations are graded O or GPP (10 O, 4 GPP), and several cited studies are small, non-randomized, underpowered for clinical outcomes, or at high risk of bias; the authors repeatedly call for further large-scale and head-to-head trials.
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Claims the paper makes
116 No full text of the sources · 44 Partly supported · 36 Supported · 19 Own method · 10 Not checked yet · 7 Own interpretation · 7 No basis given · 4 Not supported · 4 Couldn’t confirm · 3 Supported so far · 3 Sources not found · 3 Own result · 1 Mixed support · accuracy not yet measured
At least one cited source doesn’t support this claim or points to a different paper, and none confirmed it — see the verdicts below.
In the paper
“In this study the authors concluded that no single prediction equation was accurate (i.e.within 90e110% of measured REE) in the majority of the population.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Disputedcites [63] Harris, 1918, A biometric study of human basal metabolism, Proc Natl Acad Sci USA sourceExperimental — accuracy not yet measured
The Abstract identifies the study population as 136 men, 103 women, and 94 newborn infants who were presumably in good health—not 395 inpatients referred for nutritional support. It presents regression equations for predicting basal metabolism but does not report the claimed 90–110% accuracy assessment or conclusion. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
- Not checked — no full text of the sourcecites [64] Ireton-Jones, 1997, Comparison of the metabolic response to burn injury in obese and nonobese patients, J Burn Care Rehabil source
- Not checked — no full text of the sourcecites [69] Mifflin, 1990, A new predictive equation for resting energy expenditure in healthy individuals, Am J Clin Nutr source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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- Disputed
At least one cited source doesn’t support this claim or points to a different paper, and none confirmed it — see the verdicts below.
In the paper
“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].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation A e
What the sources say
- Disputedcites [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
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.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
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- Disputed
At least one cited source doesn’t support this claim or points to a different paper, and none confirmed it — see the verdicts below.
In the paper
“They concluded, due to high heterogeneity and small sample size, that so far the metabolites had only little prognostic and therapeutic potential for phenotyping the risk of malnutrition and response to nutritional therapy [194] (Level of evidence 1þþ).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.32. Recommendation 32
What the sources say
- Disputedcites [194] Struja, 2021, Association of metabolomic markers and response to nutritional support: a secondary analysis of the EFFORT trial using an untargeted metabolomics approach, Clin Nutr sourceExperimental — accuracy not yet measured
Split into 2 atoms — 1 confirmed, 0 partially supported, 1 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Checked by a reasoning model — may be wrong.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Disputed
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Yet, recent large randomized controlled trials (RCT) over the last five years have provided important new evidence showing that nutritional support can reduce morbidity and other complications in polymorbid patients, which may help us to answer these question and formulate evidence-based recommendations [8,9].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 1.1. What is the definition of polymorbidity?
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 supportedcites [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
The Discussion describes NOURISH as a large randomized trial in malnourished older adults hospitalized for several conditions. The Results (§3.3; page unavailable) report lower 90-day mortality with the specialized supplement, but no significant reduction in readmissions or the primary composite outcome. The Safety results (§3.5; page unavailable) also do not show fewer adverse events, so this trial does not establish the claimed reduction in morbidity and other complications across polymorbid patients. (LLM, conf=0.88)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Similarly, improved survival in medical inpatients receiving nutritional support was reported in the meta-analysis by Gomes et al.where the analysis of 27 trials resulted in lower mortality rates in patients receiving nutritional care vs. the controls (230 of 2758 [8.3%] vs. 307 of 2787 [11.0%];OR 0.73; 95% CI, 0.56e0.97)[35].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > A
What the sources say
- Partly supportedcites [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 sourceExperimental — accuracy not yet measured
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Nutrition support was also associated with lower non-elective hospitalizations 14.7% vs. 18.0%;RR 0.76; 95% CI 0.60 to 0.96) improved energy and protein intake (mean difference of 365 kcal, 95% CI 272e458 kcal for energy and mean difference of 17.7 g, 95% CI 12.1e23.3g for protein), and improvements in nutritional and functional status (Level of evidence 1þþ).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > A
What the sources say
- Supportedcites [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
The Results, under Secondary Outcomes (page not provided), report significantly higher energy and protein intake with nutritional support. Both mean differences and 95% confidence intervals match the claim. (LLM, conf=0.95)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Nutrition support was also associated with lower non-elective hospitalizations 14.7% vs. 18.0%;RR 0.76; 95% CI 0.60 to 0.96) improved energy and protein intake (mean difference of 365 kcal, 95% CI 272e458 kcal for energy and mean difference of 17.7 g, 95% CI 12.1e23.3g for protein), and improvements in nutritional and functional status (Level of evidence 1þþ).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > A
What the sources say
- Partly supportedcites [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 sourceExperimental — accuracy not yet measured
The Results (Secondary Outcomes) report the stated rates and risk ratio for nonelective hospital readmissions. The claim calls these nonelective hospitalizations, which is broader than the readmissions measured in the source. (LLM, conf=0.85)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“The effects of this ONS were also positive in a subgroup of patients with chronic obstructive pulmonary disease (COPD) from the same study, where the IG had significant decreased mortality risk compared to the CG (1.83%, 2.75%, 2.75% vs. 6.67%,9.52% and 10.48%, p ¼ 0.0395, 0.0193, 0.0113, respectively).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > High protein ONS containing e b-Hydroxy b-Methylbutyrate
What the sources say
- Partly supportedcites [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
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“According to the NOURISH study, a multicenter RCT which included 652 malnourished inpatients, high protein bHMB ONS may not yield a difference when compared with placebo on readmission rates, but may help with the maintenance of muscle mass during hospital stay and result in a significant decrease in post-discharge mortality (90-day mortality was 4.8% in the IG vs. 9.7% in the CG; RR 0.49, 95% CI”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > High protein ONS containing e b-Hydroxy b-Methylbutyrate
What the sources say
- Partly supportedcites [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
The Introduction and Discussion say that protein and HMB may help prevent lean-body-mass loss, which supports the claim as a possibility. But the trial’s reported outcomes do not include muscle mass during hospitalization, so the NOURISH study did not establish that its supplement maintained muscle mass during the hospital stay. (LLM, conf=0.82)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“These cost benefits were mostly due to reduced infection rates and shorter lengths of stay.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Supportedcites [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
The Abstract (Results) explicitly says the cost savings were mainly due to reduced infection rates and shorter lengths of stay. The Discussion (Limitations of this modelling analysis) also identifies both as contributors to the modelled savings. (LLM, conf=0.95)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“According to the NOURISH study, a multicenter RCT which included 652 malnourished inpatients, high protein bHMB ONS may not yield a difference when compared with placebo on readmission rates, but may help with the maintenance of muscle mass during hospital stay and result in a significant decrease in post-discharge mortality (90-day mortality was 4.8% in the IG vs. 9.7% in the CG; RR 0.49, 95% CI”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > High protein ONS containing e b-Hydroxy b-Methylbutyrate
What the sources say
- Supportedcites [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
The Abstract reports significantly lower 90-day postdischarge mortality with HP-HMB than with placebo, with the same rates, relative risk, confidence interval, and p-value stated in the claim. The Discussion also reports lower mortality following initiation of HP-HMB during hospitalization and continuation after discharge. (LLM, conf=0.95)
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“According to the NOURISH study, a multicenter RCT which included 652 malnourished inpatients, high protein bHMB ONS may not yield a difference when compared with placebo on readmission rates, but may help with the maintenance of muscle mass during hospital stay and result in a significant decrease in post-discharge mortality (90-day mortality was 4.8% in the IG vs. 9.7% in the CG; RR 0.49, 95% CI”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > High protein ONS containing e b-Hydroxy b-Methylbutyrate
What the sources say
- Supportedcites [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
Section 3.3 (Composite and component efficacy endpoints) reports no significant difference between the HP-HMB and placebo groups in 90-day readmission rates. This supports the claim's cautious wording. (LLM, conf=0.94)
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Nutrition support was also associated with lower non-elective hospitalizations 14.7% vs. 18.0%;RR 0.76; 95% CI 0.60 to 0.96) improved energy and protein intake (mean difference of 365 kcal, 95% CI 272e458 kcal for energy and mean difference of 17.7 g, 95% CI 12.1e23.3g for protein), and improvements in nutritional and functional status (Level of evidence 1þþ).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > A
What the sources say
- Partly supportedcites [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 sourceExperimental — accuracy not yet measured
The Results (Secondary Outcomes) report higher energy and protein intake and a significant increase in body weight with nutritional support. They report no overall difference in functional outcome at follow-up (Barthel index mean difference, 0.32 points; 95% CI, −0.51 to 1.15). The Discussion likewise says improved functional outcomes were not observed in the overall analysis. (LLM, conf=0.92)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“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).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > A
What the sources say
- Partly supportedcites [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
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“For polymorbid medical inpatients who are malnourished or at nutritional risk, the economic analysis using modelled cost-savings calculations of several RCTs reflect reductions in infectious complications, LOS, and non-elective readmissions, as measures for the effectiveness of in-hospital nutritional support.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Partly supportedcites [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 sourceExperimental — accuracy not yet measured
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“A supportive retrospective analysis of data collected from 341 patients showed that the daily provision of wound-specific ONS resulted in a significant greater decrease in the wound area, compared to the patients who did not receive nutritional support (61.1% in the IG vs. 34.5% in the CG, p ¼ 0.01) [42].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > High protein ONS containing e b-Hydroxy b-Methylbutyrate
What the sources say
- Partly supportedcites [42] Clark, 2023, Evaluating the impact of using a wound-specific oral nutritional supplement to support wound healing in a rehabilitation setting, Int Wound J sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaindirectn = 341 ·- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“In polymorbid medical inpatients whose nutritional requirements cannot be met orally, the use of EN may be superior to PN because of a lower risk of infectious, non-infectious complications and maintenance of gut integrity.”
- Also stated in: § Commentary · hedged
“Still, when also considering high-quality evidence from critical care and in patients with pancreatitis as well as observational evidence from polymorbid medical inpatients, there are several arguments for the use of EN as a first line therapy as compared to PN due to lower risks for infectious and non-infectious complications.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.7. Recommendation 7
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
- Partly supportedcites [59] Elke, 2016, Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials, Crit Care sourceExperimental — accuracy not yet measured
The Results report fewer infectious complications with EN, and the Background describes maintenance of gut integrity as a potential benefit. But the review concerns critically ill adults, not polymorbid medical inpatients generally. It does not establish fewer non-infectious complications with EN; the Discussion notes that PN had lower rates of vomiting and diarrhea in one trial. No page numbers are available in our copy. (LLM, conf=0.88)
- Partly supportedcites [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
The Results (Pooled results) report lower infection and overall complication rates with EN than PN, and the Discussion says EN preserves the intestinal mucosal barrier. The evidence concerns patients with severe acute pancreatitis, not polymorbid medical inpatients generally; it also does not establish a separate reduction in non-infectious complications for that broader population. (LLM, conf=0.88)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Commentary · hedged
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“In these situations, use of EN or PN can help increase nutritional intake until oral intake is sufficient [51,52].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Partly supportedcites [51] Bounoure, 2016, Detection and treatment of medical inpatients with or at-risk of malnutrition: suggested procedures based on validated guidelines, Nutrition sourceExperimental — accuracy not yet measured
The Route, monitoring, and reassessment section (p. 7) recommends enteral tube feeding when medical inpatients cannot meet nutritional requirements orally and says intake should be reassessed. The retrieved passage discusses parenteral nutrition as a comparator, but does not say it should be used to increase intake until oral intake is sufficient; that part of the claim is not supported by our copy. (LLM, conf=0.82)
- Partly supportedcites [52] Schuetz, 2015, Eat your lunch!” – controversies in the nutrition of the acutely, non-critically ill medical inpatient, Swiss Med Wkly sourceExperimental — accuracy not yet measured
The 'Outlook and future direction' section supports using enteral or parenteral nutrition when other measures fail to meet nutritional targets. It recommends trying snacks, food enrichment, and oral supplements first, and does not specify continuing EN or PN until oral intake becomes sufficient. No page number is available in our copy. (LLM, conf=0.84)
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: In the acute care setting many obstacles may prevent patients from meeting their nutritional requirements orally.
- Rests on an assumption: Obstacles to meeting nutritional requirements orally include loss of appetite due to acute illness, delayed gastric emptying causing nausea and early satiety, inability to swallow, and vomiting.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“A physiological rational is also the prevention of intestinal mucosal atrophy by EN compared to PN [61].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Supportedcites [61] Shaw, 2012, Intestinal mucosal atrophy and adaptation, World J Gastroenterol source
The MUCOSAL ATROPHY section states that atrophy occurs despite adequate parenteral nutrition and that direct contact with luminal contents is needed to sustain the mucosa. The Current medical management of intestinal failure section recommends some enteral nutrition even when parenteral supplementation is required. Page numbers were not supplied in our copy. (LLM, conf=0.91)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Specifically, a recent metaanalysis of 18 RCTs studying 3347 patients did not find benefits in terms of mortality.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Supportedcites [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
The Discussion states that the meta-analysis included 18 RCTs and 3347 critically ill patients and found no difference in mortality between EN and PN. The Results clarify that 16 of those trials reported mortality data. (LLM, conf=0.95)
plainn = 3,347- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“The review included 27 RCTs from several countries comprising 6803 medical inpatients, and reported a 27% reduction in mortality and non-elective hospital readmissions [35].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Supportedcites [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
The Results report 27 studies, and the Discussion gives 3,736 patients in the original analysis plus 3,067 in the new studies, totaling 6,803. The Methods identify the population as medical inpatients, and the Results table lists trials from multiple countries. Page numbers are not available in our copy. (LLM, conf=0.91)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“A 2019 systematic review and metaanalysis on nutritional support in medical inpatients found significantly improved clinical outcomes in those receiving adequate nutritional support.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Supportedcites [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
The Discussion reports that this updated systematic review and meta-analysis found statistically significant reductions in mortality and nonelective hospital readmissions with nutritional support. The finding applies to medical inpatients who were malnourished or at nutritional risk; the paper describes nutritional support interventions rather than a separately measured threshold of ‘adequate’ support. (LLM, conf=0.90)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“The review included 27 RCTs from several countries comprising 6803 medical inpatients, and reported a 27% reduction in mortality and non-elective hospital readmissions [35].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Partly supportedcites [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 sourceExperimental — accuracy not yet measured
The Discussion describes an updated review of 27 studies comprising 6,803 patients. Results > Primary Outcome reports lower mortality with nutritional support (OR 0.73, or 27% lower odds), but Results > Secondary Outcomes reports nonelective readmissions at RR 0.76, or 24% lower risk—not 27%. (LLM, conf=0.93)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“A similar budget-impact analysis, applied to a Mexican population, reported average total healthcare costs over 30-days 3527 $ for patients with early nutrition therapy vs. 6032 $ for patients with standard nutrition therapy À a savings of 2505 $ per early nutrition-treated patient (41.5% lower).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation A e
What the sources say
- Supportedcites [111] Sulo, 2021, Hospital nutrition care informs potential cost-savings for healthcare: a budget impact analysis, Clinical Nutrition ESPEN source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“However, the degree of kidney impairment was a strong predictor for response to nutritional support and patients with eGFR of 15e29 l/min/1.73m 2 receiving 0.8 g and those with 30e59 ml/min/1.73m 2 receiving 1.2e1.5 g/kg body weight/day showed the strongest benefits on 30day mortality (OR 0.37, 95% CI 0.14 to 0.95 and 0.39, 95% CI 0.21 to 0.75, respectively) (Level of Evidence 1þþ) [89].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Partly supportedcites [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
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“In patients with chronic heart failure included in the EFFORT trial, Hersberger et al., 2021, reported that mortality over 30 days was 66% lower in the IG (OR 0.44 95% CI 0.26 to 0.75; p ¼ 0.002) [107].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation A e
What the sources say
- Partly supportedcites [107] Hersberger, 2021, Individualized nutritional support for hospitalized patients with chronic heart failure, J Am Coll Cardiol sourceExperimental — accuracy not yet measured
The Results report lower 30-day mortality in the nutritional-support group and match the cited OR, confidence interval, and p-value. The stated 66% reduction is incorrect: an OR of 0.44 represents 56% lower adjusted odds, while the observed mortality rates were 8.4% versus 14.8%. (LLM, conf=0.94)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“In younger malnourished patients (50.6 ± 16.1 years) with benign gastrointestinal or liver disease who received ONS during their hospital stay and for three months post discharge, QoL assessed by the 36-Item Short Form Health Survey questionnaire was significantly improved in the IG patients (n ¼ 60) compared to the CG patients (n ¼ 54) (mean improvement at three months was 0.128, 95% CI 0.095 to”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Partly supportedcites [123] Norman, 2011, Cost-effectiveness of a 3-month intervention with oral nutritional supplements in disease-related malnutrition: a randomised controlled pilot study, Eur J Clin Nutr sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“A secondary analysis of the threemonth RCT by Neelemaat revealed no differences in mortality at year one and four between groups”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Supportedcites [129] Neelemaat, 2017, Survival in malnourished older patients receiving post-discharge nutritional support; long-term results of a randomized controlled trial, J Nutr Health Aging source
The Methods (Study design) describe this survival study as a post-hoc analysis of an RCT with a three-month nutritional intervention. The Results report no statistically significant difference in survival between groups at any time point, including one and four years; this supports the claim about mortality, though it does not mean the observed rates were identical. (LLM, conf=0.94)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“This increase was statistically significant when adjusted for weight (p ¼ 0.03 for protein, p ¼ 0.003 for energy intake) (Level of evidence 1-).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > (Level of Evidence 1þ).
What the sources say
- Partly supportedcites [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
The Results section states that energy and protein intake at day 14 were significantly higher in the intervention group after adjustment for weight. The copy of Table 2 does not include the relevant data rows, so it cannot verify the attributed p-values of 0.03 and 0.003. (LLM, conf=0.82)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“The authors reported their intervention to potentially release time for nursing staff but, however, found no positive effect on dietary intake (Level of Evidence 1þ).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.28. Recommendation 28
What the sources say
- Supportedcites [163] Roberts, 2017, The impact of trained volunteer mealtime assistants on the dietary intake of older female in-patients: the southampton mealtime assistance study, J Nutr Health Aging source
The Results report no difference in dietary intake between wards or in the pre-post comparison on the intervention ward. The Discussion says additional lunchtime assistance did not increase dietary intake and that trained volunteers had the potential to free nursing time for other tasks. (LLM, conf=0.94)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“This suggests that mealtime volunteers may be successfully implemented to release nursing staff to carry out other clinical tasks [161] (Level of Evidence 1þ).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.28. Recommendation 28
What the sources say
- Could not verifycites [161] Roberts, 2019, Improving nutrition care, delivery, and intakes among hospitalised patients: a mixed methods, integrated knowledge translation study, Nutrients sourceExperimental — accuracy not yet measured
The Methods (2.4, page unavailable) describe staff training and changes to breakfast service, but not mealtime volunteers. The Results (3.3, page unavailable) discuss nursing interruptions; our copy does not say volunteers were implemented or freed nurses for other clinical tasks. Searches for mealtime volunteers and nursing workload found no passage addressing that claim. (LLM, conf=0.75)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Could not verify
Every source the paper cites for this claim was checked and supports it.
In the paper
“The number of patients achieving adequate energy and protein intake increased significantly from pre-intervention to post-interventional.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.28. Recommendation 28
What the sources say
- Supportedcites [161] Roberts, 2019, Improving nutrition care, delivery, and intakes among hospitalised patients: a mixed methods, integrated knowledge translation study, Nutrients source
The Results (sections 3.1–3.2) report 207 patients observed before and after the intervention and a significantly higher number consuming adequate energy and protein afterward. The Discussion describes the intervention as multifaceted and directed at nutrition care on an acute medical ward. (LLM, conf=0.93)
plaindirectn = 207- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Where a controlled trial found no difference in the energy or protein intake of older female patients with the implementation of mealtime volunteers, volunteers were as effective as ward nursing staff in providing appropriate feeding assistance.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.28. Recommendation 28
What the sources say
- Partly supportedcites [161] Roberts, 2019, Improving nutrition care, delivery, and intakes among hospitalised patients: a mixed methods, integrated knowledge translation study, Nutrients sourceExperimental — accuracy not yet measured
The Discussion (section 4; page unavailable) reports that most cited protected-mealtime or feeding-assistance studies found no effect on energy and protein intakes. It does not identify a controlled trial of older female patients using mealtime volunteers or compare volunteers with ward nursing staff. The Methods (section 2.4; page unavailable) describe this paper’s intervention as staff training and foodservice changes, not mealtime volunteers. (LLM, conf=0.78)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“The use of conceptual frameworks to implement changes has been successful in some studies [161,162].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.28. Recommendation 28
What the sources say
- Supportedcites [161] Roberts, 2019, Improving nutrition care, delivery, and intakes among hospitalised patients: a mixed methods, integrated knowledge translation study, Nutrients source
The Introduction reports that a hospital nutrition-care intervention developed using the PARIHS framework was effective in changing practice. The Methods say this study’s intervention was underpinned by a conceptual framework, and the Conclusions report improved nutritional intake after implementation, while noting that its success was probably multifactorial. (LLM, conf=0.90)
- Not checked — no full text of the sourcecites [162] Young, 2018, Improving nutrition care and intake for older hospital patients through system-level dietary and mealtime interventions, Clin Nutr ESPEN source
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Data were missing for 41.1% of patients on day 14.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > (Level of Evidence 1þ).
What the sources say
- Supportedcites [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 source
The Results state that the final sample was 122 patients and that day-14 data were unavailable for 51 participants (41.1%). The Study design identifies it as a non-randomised controlled pilot study. (LLM, conf=0.95)
plainn = 122- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“Where a controlled trial found no difference in the energy or protein intake of older female patients with the implementation of mealtime volunteers, volunteers were as effective as ward nursing staff in providing appropriate feeding assistance.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.28. Recommendation 28
What the sources say
- Could not verifycites [161] Roberts, 2019, Improving nutrition care, delivery, and intakes among hospitalised patients: a mixed methods, integrated knowledge translation study, Nutrients sourceExperimental — accuracy not yet measured
The Discussion (page unavailable) mentions feeding-assistance studies but does not compare mealtime volunteers with ward nursing staff. The Results (page unavailable) report this paper’s pre-post intervention, not a controlled trial of volunteers. Searches for volunteers and a volunteer-versus-nurse comparison found no passage addressing the claim. (LLM, conf=0.76)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Could not verify
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“These three studies suggest that a combination of organizational changes may be sustained over a period of time and culminate in improved dietary intake (Level of Evidence 2þ).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.28. Recommendation 28
What the sources say
- Supportedcites [161] Roberts, 2019, Improving nutrition care, delivery, and intakes among hospitalised patients: a mixed methods, integrated knowledge translation study, Nutrients source
The Methods (Section 2.4) describe a multifaceted intervention spanning individual, ward, and organisational levels. The Discussion reports improved dietary intake after implementation, and its limitations discussion describes the intervention as feasible and sustainable in practice. Together, these support the citing sentence’s hedged claim that combined changes may be sustained and improve intake. (LLM, conf=0.86)
- Not checked — no full text of the sourcecites [162] Young, 2018, Improving nutrition care and intake for older hospital patients through system-level dietary and mealtime interventions, Clin Nutr ESPEN source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“A similar association was also found for cancer patients, with a significantly extenuated response to nutrition in patients with high inflammation [167].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e Strong consensus 100% agreement.
What the sources say
- Supportedcites [167] Bargetzi, 2021, Inflammation reduces the effect of nutritional therapy on clinical outcomes in cancer patients, Ann Oncol source
The letter’s main text (section labeled “4 ∙ P. Schuetz,” pp. 1451–1452) reports a significant interaction between inflammation measured by CRP and the effect of nutritional support in 491 cancer patients. Patients with high CRP showed no mortality benefit, while those with lower CRP showed stronger reductions in mortality, supporting the claim of an attenuated response. (LLM, conf=0.94)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“In a population-based cohort study of more than 110,000 patients, effect of nutritional support remained robust in subgroup analyses which stratified for main diagnoses and comorbidities, among others [169] (Level of evidence: 2-).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e Strong consensus 92% agreement.
What the sources say
- Supportedcites [169] Kaegi-Braun, 2021, Evaluation of nutritional support and in-hospital mortality in patients with malnutrition, JAMA Netw Open source
The Discussion describes a population-based cohort of more than 110,000 hospitalized patients with malnutrition and says the potential survival benefits were mostly robust across subgroups, including reason for admission and comorbidities. The Results (Sensitivity and Subgroup Analyses) explicitly report generally robust in-hospital mortality findings after stratification by main diagnoses and comorbidities, while noting differences by frailty risk and length of stay. (LLM, conf=0.93)
plaindirectn = 110,000- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“For example, a systematic review of polypharmacy defined as !5 medicines in subjects !65 years of age was significantly associated with malnutrition [172], and polypharmacy when defined as >10 medicines was associated with an increased risk of malnutrition after three years in those >75 years [173].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Supportedcites [172] Kok, 2022, The association between polypharmacy and malnutrition(risk) in older people: a systematic review, Clin Nutr ESPEN source
The Discussion (p. 6) states that all seven included studies found a statistically significant association between malnutrition and polypharmacy defined as five or more drugs. The summary (p. 1) identifies people aged 65 or older as the review's population of interest. (LLM, conf=0.94)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“There are several studies looking at biomarkers of muscle strength and/or function with some suggesting that low muscle strength measured by HGS is a predictor for response [134] (Level of evidence 1þþ) while others found sarcopenia to be a predictor of non-response in mixed populations [165,188].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.32. Recommendation 32
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
- Could not verifycites [188] Arends, 2021, Cancer cachexia in adult patients: ESMO clinical practice guidelines, ESMO Open sourceExperimental — accuracy not yet measured
The Nutritional requirements section says that increased energy and protein intake may not prevent weight loss in all patients, while the Assessment of nutritional status section lists measures of body composition and grip strength. Neither reports that sarcopenia predicts non-response to nutritional treatment in mixed populations. Searches for sarcopenia, treatment response, and non-responders found no passage establishing that link; page numbers were unavailable in our copy. (LLM, conf=0.72)
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“For example, it has been known for long that patients with cachexia may show less response compared to patients with less severe stages or phenotypes of malnutrition [165,188].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.32. Recommendation 32
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 supportedcites [188] Arends, 2021, Cancer cachexia in adult patients: ESMO clinical practice guidelines, ESMO Open sourceExperimental — accuracy not yet measured
In 'Deciding on cachexia treatment' (Table 3; page unavailable), the guidelines list benefit from nutritional and metabolic interventions as possible with mild, slow weight loss but uncertain with rapid, severe weight loss or persistent inflammation. 'Nutritional requirements' also says increased energy and protein intake may not attenuate weight loss in all patients. These passages support reduced benefit in some more severe cases, but do not establish that patients with cachexia generally respond less than patients with less severe malnutrition phenotypes. (LLM, conf=0.83)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The cited sources support only part of this claim — read each source’s verdict below.
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].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Partly supportedcites [184] Hoen, 2021, Association of drug application and hydration status in elderly patients, Nutrients sourceExperimental — accuracy not yet measured
The Results (section 3.3; page unavailable) report that prescribed medications were enriched in different hydration groups. The Methods (section 2.4; page unavailable) define enrichment as a difference in prescribing frequency. The paper therefore supports an association, but not the implication that hydration status causes drug enrichment or changes drug concentrations. (LLM, conf=0.84)
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Recent high-quality trials have provided increasing evidence that nutritional support can reduce morbidity and other complications associated with malnutrition in polymorbid patients.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Abstract
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
In the paper
“Further, in the one-day cross-sectional study of Beck et al. patients at nutritional risk were more likely to be readmitted within 30 days (45% vs. 27%, p ¼ 0.024) and had a higher mortality within 30 days after discharge (23% vs. 10%., p ¼ 0.0285) [19].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e
What the sources say
- Not checked — no full text of the sourcecites [19] Beck, 2021, Poor performance in nutrition risk screening may have serious consequences for hospitalized patients, Clin Nutr ESPEN source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Schuetz el al., in the EFFORT trial, reported a lower risk of adverse clinical outcome in the IG compared to controls (adjusted OR 0.79, 95% CI 0.64 to 0.97, p ¼ 0.023) and a lower risk of mortality (adjusted OR 0.65, 95% CI 0.47 to 0.91, p ¼ 0.011), with no statistically significant difference in side effects between both groups [34] (Level of evidence 1þþ).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > A
What the sources say
- Not checked — no full text of the sourcecites [34] Schuetz, 2019, Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial, Lancet (London, England) source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“The same effect was shown by Li et al. in patients with community acquired pneumonia [21] (Level of Evidence 2-).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e
What the sources say
- Not checked — no full text of the sourcecites [21] Li, 2016, Nutritional risk screening and clinical outcome assessment among patients with community-acquired infection: a multicenter study in Beijing teaching hospitals, Nutrition source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“When comparing mortality in intervention group (IG) patients to the control group (CG) stratified by severity of malnutrition, there was overall no clear trend towards more benefit in patients with more severe malnutrition, with NRS 2002 and SGA showing the most pronounced relationship between the severity of malnutrition and reduction in mortality as a response to nutritional support [31].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e
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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“The latter also showed a significant increase in the prevalence of nutritional risk measured by the Nutritional Risk Screening 2002 (NRS 2002) within two weeks after admission (40.61% vs. 48.93%;p ¼ 0.036).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e
What the sources say
- Not checked — no full text of the sourcecites [21] Li, 2016, Nutritional risk screening and clinical outcome assessment among patients with community-acquired infection: a multicenter study in Beijing teaching hospitals, Nutrition source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“When comparing mortality in intervention group (IG) patients to the control group (CG) stratified by severity of malnutrition, there was overall no clear trend towards more benefit in patients with more severe malnutrition, with NRS 2002 and SGA showing the most pronounced relationship between the severity of malnutrition and reduction in mortality as a response to nutritional support [31].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e
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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“The overall complication rate was significantly lower in the group with nutritional therapy than in the no-support group (20.3% vs. 28.1%,p ¼ 0.009), primarily because of the lower rate of infectious complications (10.5% vs. 18.9%, p < 0.001).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Schuetz el al., in the EFFORT trial, reported a lower risk of adverse clinical outcome in the IG compared to controls (adjusted OR 0.79, 95% CI 0.64 to 0.97, p ¼ 0.023) and a lower risk of mortality (adjusted OR 0.65, 95% CI 0.47 to 0.91, p ¼ 0.011), with no statistically significant difference in side effects between both groups [34] (Level of evidence 1þþ).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > A
What the sources say
- Not checked — no full text of the sourcecites [34] Schuetz, 2019, Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial, Lancet (London, England) source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Therefore, ONS have a supplemental role in the provision of nutrition during hospitalization.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > A
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Also, in a prospective observational cohort study, Lengfelder et al. were able to show higher odds for malnourished patients having a LOS of !3 days (2.38, 95% CI, 1.45 to 3.88; p < 0.001) and for readmission within 30 days (2.28, 95% CI, 1.26 to 4.12; p < 0.006) [20].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e
What the sources say
- Not checked — no full text of the sourcecites [20] Lengfelder, 2022, Prevalence and impact of malnutrition on length of stay, readmission, and discharge destination, JPEN - J Parenter Enter Nutr source
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Also, in the same study, the effects of each medical nutrition therapy were analyzed separately, and significantly lower complication rates were found only in patients who received enteral nutrition (EN) compared to the group without nutritional support (8.2% vs. 28.1%,p < 0.001).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e
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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“without negatively affecting the hospital food consumption (72.8% in the IG vs. 71.3% in the CG, p ¼ 0.528) [33] (Level of evidence 1þþ).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > A
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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Also, in a prospective observational cohort study, Lengfelder et al. were able to show higher odds for malnourished patients having a LOS of !3 days (2.38, 95% CI, 1.45 to 3.88; p < 0.001) and for readmission within 30 days (2.28, 95% CI, 1.26 to 4.12; p < 0.006) [20].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e
What the sources say
- Not checked — no full text of the sourcecites [20] Lengfelder, 2022, Prevalence and impact of malnutrition on length of stay, readmission, and discharge destination, JPEN - J Parenter Enter Nutr source
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“In a prospective, non-randomized cohort study, Jie et al. found nutritional support was beneficial for polymorbid medical inpatients at nutritional risk as defined by the NRS 2002 [17] (Level of evidence 2þ).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
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).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e
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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“The intervention resulted in both a more pronounced weight gain (0.92 ± 0.27 kg in the IG (IG) vs. À0.76 ± 0.28 kg in the CG, p < 0.001) and a significant lower rate of nosocomial infections (23.6% vs. 36.7%,p ¼ 0.01) (Level of evidence 2þ).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“The overall complication rate was significantly lower in the group with nutritional therapy than in the no-support group (20.3% vs. 28.1%,p ¼ 0.009), primarily because of the lower rate of infectious complications (10.5% vs. 18.9%, p < 0.001).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Scoring systems for determining nutritional risk, such as NRS 2002 and the Mini Nutritional Assessment Short-Form (MNA-SF) link nutritional risk assessment to treatment by predicting that nutritional interventions will have a positive influence on variable outcomes [22e25].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e
What the sources say
- Not matchedcites [22e25]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Several prospective cohort studies showed a prevalence of approximately 40e50% in a hospitalized population of tertiary centers [16,17].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e
What the sources say
- Not checked — no full text of the sourcecites [16] Gutzwiller, 2011, Glucocorticoid treatment, immobility, and constipation are associated with nutritional risk, Eur J Nutr source
- 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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
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”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > A
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Polymorbid medical inpatients are at high risk of malnutrition.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e
What the sources say
- Not checked — no full text of the sourcecites [16] Gutzwiller, 2011, Glucocorticoid treatment, immobility, and constipation are associated with nutritional risk, Eur J Nutr source
- 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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Schuetz el al., in the EFFORT trial, reported a lower risk of adverse clinical outcome in the IG compared to controls (adjusted OR 0.79, 95% CI 0.64 to 0.97, p ¼ 0.023) and a lower risk of mortality (adjusted OR 0.65, 95% CI 0.47 to 0.91, p ¼ 0.011), with no statistically significant difference in side effects between both groups [34] (Level of evidence 1þþ).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > A
What the sources say
- Not checked — no full text of the sourcecites [34] Schuetz, 2019, Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial, Lancet (London, England) source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“The intervention resulted in both a more pronounced weight gain (0.92 ± 0.27 kg in the IG (IG) vs. À0.76 ± 0.28 kg in the CG, p < 0.001) and a significant lower rate of nosocomial infections (23.6% vs. 36.7%,p ¼ 0.01) (Level of evidence 2þ).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Further, in the one-day cross-sectional study of Beck et al. patients at nutritional risk were more likely to be readmitted within 30 days (45% vs. 27%, p ¼ 0.024) and had a higher mortality within 30 days after discharge (23% vs. 10%., p ¼ 0.0285) [19].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e
What the sources say
- Not checked — no full text of the sourcecites [19] Beck, 2021, Poor performance in nutrition risk screening may have serious consequences for hospitalized patients, Clin Nutr ESPEN source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Patients receiving specialized ONS showed in a greater extent improvement in HGS, nutritional and performance status, compared to the controls receiving the placebo ONS (49% vs. 31%, p ¼ 0.0003) [39] (Level of evidence 1þþ).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > High protein ONS containing e b-Hydroxy b-Methylbutyrate
What the sources say
- 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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“In addition, provision of ONS containing 995 kcal from macronutrients and covering 100% of the RDA for healthy older adults in vitamins and minerals led to a lower incidence of depressive symptoms (p ¼ 0.021) in older medical inpatients, with no other effect on their cognitive performance but with a significant positive effect on their self-reported QoL”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > High protein ONS containing e b-Hydroxy b-Methylbutyrate
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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“In addition, provision of ONS containing 995 kcal from macronutrients and covering 100% of the RDA for healthy older adults in vitamins and minerals led to a lower incidence of depressive symptoms (p ¼ 0.021) in older medical inpatients, with no other effect on their cognitive performance but with a significant positive effect on their self-reported QoL”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > High protein ONS containing e b-Hydroxy b-Methylbutyrate
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“The analysis showed again a significant reduction in mortality risk (OR 0.68; 95% CI 0.51e0.91)(Fig. 1) and hospital readmissions (OR 0.64; 95% CI 0.45e0.90)proofing the effectiveness of nutritional”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > A
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Moreover, COPD patients receiving the high protein bHMB ONS showed an increase in handgrip strength (HGS) from discharge to 30 days (1.56 kg vs. À0.34kg, p ¼ 0.0413) and increased body weight (0.66 kg vs. À0.01 kg, p < 0.05) [38] (Level of evidence 1þþ).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > High protein ONS containing e b-Hydroxy b-Methylbutyrate
What the sources say
- Not checked — no full text of the sourcecites [38] Deutz, 2021, Reduced mortality risk in malnourished hospitalized older adult patients with COPD treated with a specialized oral nutritional supplement: sub-group analysis of the NOURISH study, Clin Nutr source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“According to a cost-effectiveness analysis by Philipson et al., in a retrospective study from 2000 to 2010, the provision of ONS to malnourished medical inpatients resulted in a reduction in LOS of 2.3 days, 95% CI -2.42 to À2.16 that subsequently decreased annual hospital costs by 4734 $, 95% CI -4754 $ to À4714 $, and reduced the readmission rate by 6.7%, from 34.3% to 32.0% [44] (Level of”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Not checked yetcites [44] Philipson, 2003, Impact of oral nutritional supplementation on hospital outcomes, Am J Manag Care
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“According to a cost-effectiveness analysis by Philipson et al., in a retrospective study from 2000 to 2010, the provision of ONS to malnourished medical inpatients resulted in a reduction in LOS of 2.3 days, 95% CI -2.42 to À2.16 that subsequently decreased annual hospital costs by 4734 $, 95% CI -4754 $ to À4714 $, and reduced the readmission rate by 6.7%, from 34.3% to 32.0% [44] (Level of”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Not checked yetcites [44] Philipson, 2003, Impact of oral nutritional supplementation on hospital outcomes, Am J Manag Care
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“The analysis showed again a significant reduction in mortality risk (OR 0.68; 95% CI 0.51e0.91)(Fig. 1) and hospital readmissions (OR 0.64; 95% CI 0.45e0.90)proofing the effectiveness of nutritional”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > A
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Moreover, COPD patients receiving the high protein bHMB ONS showed an increase in handgrip strength (HGS) from discharge to 30 days (1.56 kg vs. À0.34kg, p ¼ 0.0413) and increased body weight (0.66 kg vs. À0.01 kg, p < 0.05) [38] (Level of evidence 1þþ).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > High protein ONS containing e b-Hydroxy b-Methylbutyrate
What the sources say
- Not checked — no full text of the sourcecites [38] Deutz, 2021, Reduced mortality risk in malnourished hospitalized older adult patients with COPD treated with a specialized oral nutritional supplement: sub-group analysis of the NOURISH study, Clin Nutr source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“According to a cost-effectiveness analysis by Philipson et al., in a retrospective study from 2000 to 2010, the provision of ONS to malnourished medical inpatients resulted in a reduction in LOS of 2.3 days, 95% CI -2.42 to À2.16 that subsequently decreased annual hospital costs by 4734 $, 95% CI -4754 $ to À4714 $, and reduced the readmission rate by 6.7%, from 34.3% to 32.0% [44] (Level of”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Not checked yetcites [44] Philipson, 2003, Impact of oral nutritional supplementation on hospital outcomes, Am J Manag Care
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Improved functionality measured by HGS was also observed in other subgroup analyses from the NOURISH study, including patients with cardiovascular and pulmonary disease.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > High protein ONS containing e b-Hydroxy b-Methylbutyrate
What the sources say
- 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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Again, no significant difference in the complication rate was found between PN patients and control patients.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“When the nutritional support group was further divided into those receiving PN and those receiving EN, the overall complication rate and the rates of infectious complications and non-infectious complications were significantly lower in those patients receiving EN than in those patients with no nutritional support (p ¼ 0.001).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“However, no difference in the complication rates was found between patients with PN and patients with no nutritional support (p ¼ 0.29).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“In summary, several trials found that the addition of either EN or PN to oral nutrition improves outcomes, but high-quality randomized studies comparing EN and PN head-to-head in the polymorbid medical inpatient setting are scarce.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“No studies were identified that reported the supplementation of multivitamins (with or without trace elements) compared to no supplements in polymorbid medical inpatients exclusively fed orally.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation GPP e
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“At discharge (after 12e13 days of supplementation in both groups), there was a nonsignificant increase in lean body mass index and skeletal muscle mass index in the EPA group compared with the CG (lean body mass index: þ0.35 vs. þ0.19kg/m 2 , p ¼ 0.60, and skeletal muscle mass index: þ0.2 vs. À0.3kg/m 2 , p ¼ 0.17, respectively).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.18. Recommendation 18
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
plainn = 50- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Also, the IG showed a better NIHSS score than that of the CG after 21 days (12.04 ± 2.55) vs. 10.78 ± 2.69); p ¼ 0.008).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation A e
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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“The infection rate in the IG was significantly lower than that in the CG (33.3% vs. 52.1%,p ¼ 0.022).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation A e
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“A RCT from Singapore that included 26 polymorbid patients hospitalized for more than two weeks [100] showed a marginal albeit significant effect of an arginine/glutamine/bHMB mixture on the healing of pressure ulcers (greatest improvement of viable tissues at two weeks in the IG, by 43% vs. 26%, p ¼ 0.02) (level of evidence 1þ).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.16. Recommendation 16
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
plaindirectn = 26 ·- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“The amount of lean body mass in CG patients decreased during their hospital stay but did not change in the IG.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation A e
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“These effects did not differ comparing patients with hypoalbuminemia and with normalbuminemia”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Not checked — no full text of the sourcecites [128] Ramiro-Ortega, 2018, Nutritional intervention in acute heart failure patients with undernutrition and normalbuminemia: a subgroup analysis of PICNIC study, Clin Nutr source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“a recently published systematic review and meta-analysis [115] including a total of 2438 patients concluded that mortality was significantly lowered in patients with nutritional support which was continued after hospital discharge (OR 0.63, 95% CI 0.48 to 0.84, p ¼ 0.001, I 2 ¼ 1%; 13 trials).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
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
plaindirectn = 2,438- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“a significant improvement in self-reported functional limitations (mean difference À0.72, 95% CI -1.15 to À0.28)”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Not checked — no full text of the sourcecites [121] Neelemaat, 2012, Post-discharge nutritional support in malnourished elderly individuals improves functional limitations, J Am Med Dir Assoc source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“3month nutritional intervention (with energy and protein rich diets, ONS and calcium þ vitamin D supplements, providing 600 kcal/day and 24 g protein/day as well as 400 IU vitamin D3 and 500 mg calcium) resulted in a reduction in the number of falls (10% vs. 24%, p ¼ 0.02)”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Not checked — no full text of the sourcecites [120] Neelemaat, 2012, Short-term oral nutritional intervention with protein and vitamin D decreases falls in malnourished older adults, J Am Geriatr Soc source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“On the other hand, Casals et al. reported significantly improved QoL scores (assessed by SF-12, with a difference between IG and CG of 13.72, p < 0.001) after six months of individualized nutritional support”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“However, the calculated Q-5D-3L scores which reflect the overall multidimensional aspect of QoL did not differ between groups”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Not checked — no full text of the sourcecites [125] Munk, 2021, A multimodal nutritional intervention after discharge improves quality of life and physical function in older patients - a randomized controlled trial, Clin Nutr source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“and was neutral in financial cost”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Not checked — no full text of the sourcecites [122] Neelemaat, 2012, Oral nutritional support in malnourished elderly decreases functional limitations with no extra costs, Clin Nutr source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“showed that continued nutritional support in malnourished patients aged !65 years resulted in a significantly higher change in mean MNA score, compared to the combined group 2 and 3 (3.01 ± 2.65 in the IG vs. 1.81 ± 2.97 in the CG, p ¼ 0.004)”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.20. Recommendation 20
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A longer duration of nutritional support might explain differences in clinical outcome.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“In the study by Feldblum et al., the IG patients (>65 years) who received individualized nutritional support from a dietitian during hospitalization and for six month after discharge (three home visits after discharge) exhibited a significantly lower mortality rate (3.8%) than the CG (vs.11.6%, p ¼ 0.03) at month 6”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Although the scope of this guideline is the general group of polymorbid patients, the available evidence for recommendation 22 is limited to the subgroup of polymorbid older patients.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“A recent metaanalysis also demonstrated that caloric intake but also protein intake was significantly higher in patients receiving nutritional support after hospital discharge”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.20. Recommendation 20
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
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Thirty-nine % of the IG had died compared to 59% of the CG (HR 0.53, 95% CI 0.31 to 0.89; p ¼ 0.017)”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“HGS was also significantly improved in the IG of malnourished patients after three months of 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)) in the NOURISH study”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- 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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“A study which used multimodal nutritional approach (dietary counselling with a nutrition plan, telephone follow ups and free samples) in older malnourished patients showed a significant improvement in the 30 s chair rise test in the IG (7.2 ± 4.3 vs. 5.3 ± 4.1), p ¼ 0.010).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“On the other hand, increase in QoL did not differ between IG and CG receiving standard care”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Not checked — no full text of the sourcecites [122] Neelemaat, 2012, Oral nutritional support in malnourished elderly decreases functional limitations with no extra costs, Clin Nutr source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Another meta-analysis by the same author group including 29 studies on nutritional support in hospital as well as continued nutritional support after hospital discharge (n ¼ 7) also showed a 30% reduction in mortality in patients from the IGs (OR 0.72 95% CI 0.57 to 0.91, p ¼ 0.006)”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“At twelve months, the primary composite endpoint (all-cause mortality and readmission due to deterioration of heart failure) occurred in 27.1% of the IG compared to 60.7% of CG patients (HR 0.45, 95% CI 0.19e0.62,p ¼ 0.0004).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Mudge et al. identified diagnosis of infection or cancer to be associated with inadequate energy intake in patients aged 65 years or older [170] (Level of evidence: 2þþ).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e Strong consensus 92% agreement.
What the sources say
- Not checked — no full text of the sourcecites [170] Mudge, 2011, Helping understand nutritional gaps in the elderly (HUNGER): a prospective study of patient factors associated with inadequate nutritional intake in older medical inpatients, Clin Nutr source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Results showed a significant difference in energy intake between cohorts (cohort 1: 1212 kcal/ day (SD 442), cohort 2: 1291 kcal/day (SD 538), cohort 3: 1431 kcal/ day (SD 625), p ¼ 0.04).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.28. Recommendation 28
What the sources say
- Not checked — no full text of the sourcecites [162] Young, 2018, Improving nutrition care and intake for older hospital patients through system-level dietary and mealtime interventions, Clin Nutr ESPEN source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“A single-blinded RCT [148] demonstrated how the use of a protein fortified menu was effective in increasing the protein intake of patients.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
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
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Interestingly, recent data also suggest that inflammation modulates the response to nutritional treatment.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e Strong consensus 100% agreement.
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“A significant weight gain (mean þ 0.9 kg) was observed in the IG, whereas a weight loss (mean À0.8 kg) was observed in the CG, during admission.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > (Level of Evidence 1þ).
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Despite these interesting studies in non-polymorbid patients, a systematic review of non-randomized studies showed that improvements are not consistently demonstrated [158].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Not checked — no full text of the sourcecites [158] Kimber, 2015, Supportive interventions for enhancing dietary intake in malnourished or nutritionally at-risk adults: a systematic review of nonrandomised studies, J Hum Nutr Diet source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“There is strong evidence from large RCTs that polymorbid patients at risk for malnutrition benefit from nutritional support [36].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e Strong consensus 92% agreement.
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
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“A recent meta-analysis also showed that interventions which lasted >60 days had a stronger effect on mortality (OR 0.53 95% CI 0.38 to 0.75) than trials with shorter durations of the intervention (OR 0.85 95% CI 0.64 to 1.13, p for subgroup difference: 0.04.)”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Protein intake increased significantly in each successive cohort (þ48 g/day (SD 19), þ50 g/day (SD 21) andþ57 g/day (SD 26) respectively, p ¼ 0.02).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.28. Recommendation 28
What the sources say
- Not checked — no full text of the sourcecites [162] Young, 2018, Improving nutrition care and intake for older hospital patients through system-level dietary and mealtime interventions, Clin Nutr ESPEN source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, among medical patients, the effect of nutritional support may also depend on underlying disease.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e Strong consensus 92% agreement.
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“In addition, the IG developed fewer hospital acquired infections (33/140 compared to 58/158, p ¼ 0.01).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > (Level of Evidence 1þ).
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“A doubleblind randomized trial of nutritional supplementation published [166] by Gariballa et al., in 2006, including 445 polymorbid patients, concluded that the acute-phase response was strongly associated with poor nutritional status and worse clinical outcomes, particularly in older patients (Level of evidence: 1þþ).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e Strong consensus 100% agreement.
What the sources say
- Not checked — no full text of the sourcecites [166] Gariballa, 2006, Effects of acute-phase response on nutritional status and clinical outcome of hospitalized patients, Nutrition source
boostedcorrelationaln = 445- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Additionally, 55 episodes of PN (41% of referrals) were avoided by appropriate NST assessment and rapid instigation of enteral feeding (Level of Evidence 2þ).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.28. Recommendation 28
What the sources say
- Not checked — no full text of the sourcecites [164] Kennedy, 2005, Cost savings of an adult hospital nutrition support team, Nutrition source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“After a structured training program for nurses led by the NST, catheter-related sepsis rates decreased in PN patients from 71% pre-NST to 29% in their first year (p ¼ 0.05).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.28. Recommendation 28
What the sources say
- Not checked — no full text of the sourcecites [164] Kennedy, 2005, Cost savings of an adult hospital nutrition support team, Nutrition source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“There are several other factors and conditions which may predict whether or not a patient benefits from nutritional therapy including illness-specific factors (comorbidities, inflammation, acute vs. chronic course) or patient-specific factors (age, gender and genetic vulnerability).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.32. Recommendation 32
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“For example, a systematic review of polypharmacy defined as !5 medicines in subjects !65 years of age was significantly associated with malnutrition [172], and polypharmacy when defined as >10 medicines was associated with an increased risk of malnutrition after three years in those >75 years [173].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Not checked — no full text of the sourcecites [173] Jyrkkä, 2011, Association of polypharmacy with nutritional status, functional ability and cognitive capacity over a three-year period in an elderly population, Pharmacoepidemiol Drug Saf source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Whilst the use of multiple medicines is often essential, it can present a number of risks that include potential 'drugedrug' and/or 'drug-nutrient' interactions.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: Polymorbid medical inpatients often require multiple medicines to manage their comorbidities.
- Rests on an assumption: The use of multiple medicines is often essential.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Currently, no specific blood biomarkers of treatment response are used in routine clinical care apart from physiological nutritional markers such as weight and weight-loss, appetite among others although data from large RCTs suggest that their use might be advantageous.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.32. Recommendation 32
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Polypharmacy has been associated with sarcopenia [174], which could result in insufficiency of some electrolytes or micronutrients [175].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Not checked — no full text of the sourcecites [174] Pana, 2022, Sarcopenia and polypharmacy among older adults: a scoping review of the literature, Arch Gerontol Geriatr source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“There are several studies looking at biomarkers of muscle strength and/or function with some suggesting that low muscle strength measured by HGS is a predictor for response [134] (Level of evidence 1þþ) while others found sarcopenia to be a predictor of non-response in mixed populations [165,188].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.32. Recommendation 32
What the sources say
- Not checked — no full text of the sourcecites [134] Kaegi-Braun, 2021, Value of handgrip strength to predict clinical outcomes and therapeutic response in malnourished medical inpatients: secondary analysis of a randomized controlled trial, Am J Clin Nutr source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Several studies and secondary analyses of trials within the polymorbid medical inpatient population have found that markers of inflammation, muscle strength, kidney function among others may help to further individualize treatment [165].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.32. Recommendation 32
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
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Recent high-quality RCTS have provided increasing evidence that nutritional support can reduce morbidity and other complications, which is reflected by several A and B recommendations.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 4. Conclusions
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- It may state two separate claims as one. 99
- Probably not a substantial claim. 43
- The quote only partly states this claim. 4
Some cited sources support this claim and some don’t — read each source’s verdict below.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation A e
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
- Disputedcites [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
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.
- Partly supportedcites [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
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
plaincorrelationaln = 2,028- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
At least one cited source doesn’t support this claim or points to a different paper, and none confirmed it — see the verdicts below.
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].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
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
- Disputedcites [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
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.
- 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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
Every source the paper cites for this claim was checked and supports it.
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].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 1.1. What is the definition of polymorbidity?
What the sources say
- Supportedcites [11] Barnett, 2012, Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study, Lancet source
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)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Supported
Every source the paper cites for this claim was checked and supports it.
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].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 1.1. What is the definition of polymorbidity?
What the sources say
- Supportedcites [12] Fried, 2011, Primary care clinicians' experiences with treatment decision making for older persons with multiple conditions, Arch Intern Med source
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)
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
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].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 1.1. What is the definition of polymorbidity?
What the sources say
- Supportedcites [11] Barnett, 2012, Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study, Lancet source
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)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
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].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 1.1. What is the definition of polymorbidity?
What the sources say
- Supportedcites [10] Steiner, 2013, Hospital utilization, costs, and mortality for adults with multiple chronic conditions, Nationwide Inpatient Sample, 2009, Prev Chronic Dis source
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)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
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].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 2.1. Pragmatic definition of polymorbidity for the current project
What the sources say
- Partly supportedcites [6] Charlson, 2022, Charlson comorbidity index: a critical review of clinimetric properties, Psychother Psychosom sourceExperimental — accuracy not yet measured
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)
- Supportedcites [14] de Groot, 2003, How to measure comorbidity: a critical review of available methods, J Clin Epidemiol source
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)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
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].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 1.1. What is the definition of polymorbidity?
What the sources say
- Supportedcites [11] Barnett, 2012, Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study, Lancet source
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)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 1.1. What is the definition of polymorbidity?
What the sources say
- Partly supportedcites [6] Charlson, 2022, Charlson comorbidity index: a critical review of clinimetric properties, Psychother Psychosom sourceExperimental — accuracy not yet measured
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)
- Supportedcites [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
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)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
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].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 1.1. What is the definition of polymorbidity?
What the sources say
- Partly supportedcites [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
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)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
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].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e
What the sources say
- Partly supportedcites [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
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)
- Not checked — no full text of the sourcecites [27] Kondrup, 2003, ESPEN guidelines for nutrition screening 2002, Clin Nutr source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Supportedcites [46] Schuetz, 2020, Economic evaluation of individualized nutritional support in medical inpatients: secondary analysis of the EFFORT trial, Clin Nutr source
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)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Supportedcites [46] Schuetz, 2020, Economic evaluation of individualized nutritional support in medical inpatients: secondary analysis of the EFFORT trial, Clin Nutr source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
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).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Partly supportedcites [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
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)
- Partly supportedcites [43] Gariballa, 2006, A randomized, double-blind, placebo-controlled trial of nutritional supplementation during acute illness, Am J Med sourceExperimental — accuracy not yet measured
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)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
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 $.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Supportedcites [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
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
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).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Partly supportedcites [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
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)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one. The quote only partly states this claim.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
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].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Supportedcites [65] Reeves, 2003, Predicting energy requirements in the clinical setting: are current methods evidence based?, Nutr Rev source
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)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
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].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Partly supportedcites [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
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaincorrelationaln = 562 ·- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Supportedcites [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
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
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).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Supportedcites [49] Zhong, 2017, The cost-effectiveness of oral nutrition supplementation for malnourished older hospital patients, Appl Health Econ Health Pol source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.12. Recommendation 12
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 supportedcites [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
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
- Partly supportedcites [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
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.8. Recommendation 8
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 supportedcites [65] Reeves, 2003, Predicting energy requirements in the clinical setting: are current methods evidence based?, Nutr Rev sourceExperimental — accuracy not yet measured
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)
- Not checked — no full text of the sourcecites [66] Boullata, 2007, Accurate determination of energy needs in hospitalized patients, J Am Diet Assoc source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
Every source the paper cites for this claim was checked and supports it.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Supportedcites [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
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)
boosteddirectn = 3,347- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
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).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Partly supportedcites [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
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“The authors also calculated 820 $ to prevent a hospital-acquired infection and 733 $ to avoid a nonelective readmission [47].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Supportedcites [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
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)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Supportedcites [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
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaincorrelationaln = 3,347 ·- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
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].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation A e
What the sources say
- Partly supportedcites [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
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)
hedgeddirectn = 2,028- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
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”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation A e
What the sources say
- Supportedcites [111] Sulo, 2021, Hospital nutrition care informs potential cost-savings for healthcare: a budget impact analysis, Clinical Nutrition ESPEN source
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)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.13. Recommendation 13
What the sources say
- Partly supportedcites [1] Gomes, 2018, ESPEN guidelines on nutritional support for polymorbid internal medicine patients, Clin Nutr sourceExperimental — accuracy not yet measured
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)
- Partly supportedcites [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
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)
- Partly supportedcites [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
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)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.19. Recommendation 19
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 supportedcites [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
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
- Partly supportedcites [107] Hersberger, 2021, Individualized nutritional support for hospitalized patients with chronic heart failure, J Am Coll Cardiol sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
- Rests on an assumption: Polymorbid medical inpatients are at high risk of developing disease-related malnutrition (DRM).
The cited sources that could be checked couldn’t confirm or dispute this claim.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.16. Recommendation 16
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 verifycites [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
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)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Rests on an assumption: Pressure ulcers are responsible for protein loss, hypermetabolism and hypercatabolism, and are often associated with malnutrition, including nutrient deficiencies that are critical to the different phases of wound healing.
The cited sources support only part of this claim — read each source’s verdict below.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.11. Recommendation 11
What the sources say
- Partly supportedcites [74] Cederholm, 2017, ESPEN guidelines on definitions and terminology of clinical nutrition, Clin Nutr sourceExperimental — accuracy not yet measured
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)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Rests on an assumption: Severely underweight patients are at high risk of refeeding syndrome.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.14. Recommendation 14
What the sources say
- Partly supportedcites [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
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)
- 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 supportedcites [93] Berger, 2022, ESPEN micronutrient guideline, Clin Nutr sourceExperimental — accuracy not yet measured
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)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Rests on an assumption: Polymorbid medical inpatients may be at risk of micronutrient deficiency as a result of decreased intake or greater micronutrient utilization.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
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”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.20. Recommendation 20
What the sources say
- Supportedcites [112] Krumholz, 2013, Post-hospital syndrome — an acquired, transient condition of generalized risk, N Engl J Med source
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)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
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”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.20. Recommendation 20
What the sources say
- Partly supportedcites [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
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaindirectn = 80- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“A sub-analysis of the NOURISH study showed an increase in nutrient intake in IG patients without decrease in dietary intake”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.20. Recommendation 20
What the sources say
- Supportedcites [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
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)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
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],”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Partly supportedcites [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
Split into 2 atoms — 1 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
- Not matchedcites [120e124]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- 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
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
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]”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Supportedcites [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
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)
- 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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
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”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Supportedcites [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
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)
plaindirectn = 652 ·- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The quote only partly states this claim.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
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].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e Strong consensus 100% agreement.
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 supportedcites [168] Casaer, 2014, Nutrition in the acute phase of critical illness, N Engl J Med sourceExperimental — accuracy not yet measured
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Other conditions which may increase the effects of nutritional support are cancer [171], COPD [39] among others.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e Strong consensus 92% agreement.
What the sources say
- Partly supportedcites [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
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)
- 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
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
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).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e Strong consensus 92% agreement.
What the sources say
- Supportedcites [89] Bargetzi, 2021, Admission kidney function is a strong predictor for the response to nutritional support in patients at nutritional risk, Clin Nutr source
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)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > (Level of Evidence 1þ).
What the sources say
- Partly supportedcites [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
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)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
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).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e Strong consensus 92% agreement.
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 supportedcites [107] Hersberger, 2021, Individualized nutritional support for hospitalized patients with chronic heart failure, J Am Coll Cardiol sourceExperimental — accuracy not yet measured
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)
- Supportedcites [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
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)
boostedcorrelationaln = 645- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
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).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e Strong consensus 100% agreement.
What the sources say
- Partly supportedcites [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
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)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Also stated in: § 3.32. Recommendation 32 · plain
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“In those with complete data, there was no difference in patients' weight, HGS, functional independence measure or LOS.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > (Level of Evidence 1þ).
What the sources say
- Partly supportedcites [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
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)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
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].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.32. Recommendation 32
What the sources say
- Partly supportedcites [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
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)
- Partly supportedcites [190] Morley, 2006, Cachexia: pathophysiology and clinical relevance, Am J Clin Nutr sourceExperimental — accuracy not yet measured
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)
- 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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
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).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.32. Recommendation 32
What the sources say
- Partly supportedcites [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
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)
- 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
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
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].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Supportedcites [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
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)
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 2.1. Pragmatic definition of polymorbidity for the current project
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 2.1. Pragmatic definition of polymorbidity for the current project
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
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].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 2.2. Guideline development
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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Other consequences of polymorbidity include disability, functional decline, poor quality of life (QoL) and higher healthcare costs [5].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 1.1. What is the definition of polymorbidity?
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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
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”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Abstract
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Abstract
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The results of the first online voting showed a strong consensus (agreement of >90%) on 100% of the recommendations.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
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].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Abstract
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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Also stated in: § 1. Introduction · plain
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Criteria Inclusion Exclusion
What the sources say
- Not matchedcites [15] 2014
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 2.2. Guideline development
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Criteria Inclusion Exclusion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
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”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 2.2. Guideline development
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Criteria Inclusion Exclusion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Criteria Inclusion Exclusion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Criteria Inclusion Exclusion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 2.2. Guideline development
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
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”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > A
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Criteria Inclusion Exclusion
plainn = 11- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The same search strategies used in the original guidelines were used in the literature searches in 2022.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 2.2. Guideline development
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“These effects were robust after multivariate adjustment.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e
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
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The quote only partly states this claim.
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].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e
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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 2.2. Guideline development
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Criteria Inclusion Exclusion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e
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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > A
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“This stresses the importance of providing nutritional support to those most in need [45] (Level of Evidence 1þþ).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
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).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > High protein ONS containing e b-Hydroxy b-Methylbutyrate
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > A
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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.9. Recommendation 9
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
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
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].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
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
plainn = 2,450- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Not matchedcites [72] Higgins, 2011
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plainn = 248- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one. The quote only partly states this claim.
- Not matched
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
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
plaindirectn = 14- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“In the absence of IC, REE for severely underweight patients can be estimated at 30 kcal/kg actual body weight.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.10. Recommendation 10
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
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
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].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“In this study mean REE by IC was 1300 ± 160 kcal/day equating to 31.4 kcal/kg body weight.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
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
plainn = 14- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation A e
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.17. Recommendation 17
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.17. Recommendation 17
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
plainconditionaln = 145 ·- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Rests on an assumption: Diarrhea and constipation are the most frequent complications of EN in hospitalized patients.
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”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation A e
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
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“We cannot recommend the use of other disease-specific nutritional supplementation in polymorbid medical inpatients.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.18. Recommendation 18
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
plainn = 50- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
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”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.17. Recommendation 17
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
plaindirectn = 145 ·- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation A e
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation A e
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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“In polymorbid medical inpatients exclusively fed orally, documented or suspected micronutrient deficiencies should be repleted.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.15. Recommendation 15
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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Rests on an assumption: Polymorbid medical inpatients may be at risk of micronutrient deficiency as a result of decreased intake or greater micronutrient utilization.
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].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation GPP e
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
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation A e
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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation A e
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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation A e
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
plaincorrelationaln = 432,620- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation A e
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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)”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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)”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“However, trial quality was deemed moderate, highlighting the need for further large-scale studies”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
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
plainn = 2,438- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.20. Recommendation 20
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.20. Recommendation 20
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
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].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.20. Recommendation 20
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e Strong consensus 100% agreement.
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
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e Strong consensus 100% agreement.
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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation B e Strong consensus 100% agreement.
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
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
plaindirectn = 40- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“There was no statistically significant difference in the development of pressure ulcers or LOS (Level of Evidence 2þ).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > (Level of Evidence 1þ).
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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.28. Recommendation 28
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“There was no significant difference in energy intake, LOS or HGS between groups.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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).”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > 3.32. Recommendation 32
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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Not checked — no full text of the sourcecites [181] Neuvonen, 1976, Interactions with the absorption of tetracyclines, Drugs source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
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].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
What the sources say
- Not checked — no full text of the sourcecites [186] Dreier, 2004, Statin-associated rhabdomyolysis triggered by grapefruit consumption, Neurology source
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
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.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: Polymorbid medical inpatients often require multiple medicines to manage their comorbidities.
- Rests on an assumption: The use of multiple medicines is often essential.
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].”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
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
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Such adverse effects from medicines on body systems could affect the status of specific types of nutrients.”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper relies on this without support.
The health and nutrition implications of suffering from more than one disease at the same time differ from the corresponding interactions between disease and aging.
“The health and nutrition implications of suffering from more than one disease at the same time differ from the corresponding interactions between disease and aging.”
The paper relies on this without support.
We did not know if the screening, assessment and treatment of disease-related malnutrition in polymorbid medical inpatients should differ from the approach used in patients with a single disease.
“In fact, we did not know if the screening, assessment and treatment of disease-related malnutrition (DRM) in polymorbid medical inpatients should differ from the approach used in patients with a single disease.”
The paper relies on this without support.
To date, it is unknown whether there is a synergistic negative effect of several diseases on nutritional status, or on clinical outcome.
“To date, it is unknown whether there is a synergistic negative effect of several diseases on nutritional status, or on clinical outcome.”
The paper relies on this without support.
The greater the number of medications, the higher the risk of weight loss and manifest malnutrition, which suggests that polypharmacy has a potentially negative effect on nutritional status.
“Additionally, it has been shown that the greater the number of medications, the higher the risk of weight loss and manifest malnutrition, which suggests that polypharmacy has a potentially negative effect on nutritional status.”
The paper relies on this without support.
Reaching energy goals in medical inpatients is important to prevent weight loss and the loss of muscle mass that may lead to poorer functional outcomes.
“Reaching energy goals in medical inpatients is important to prevent weight loss and the loss of muscle mass that may lead to poorer functional outcomes.”
The paper relies on this without support.
In the acute care setting many obstacles may prevent patients from meeting their nutritional requirements orally.
“However, in the acute care setting many obstacles may prevent patients from meeting their nutritional requirements orally.”
The paper relies on this without support.
Obstacles to meeting nutritional requirements orally include loss of appetite due to acute illness, delayed gastric emptying causing nausea and early satiety, inability to swallow, and vomiting.
“These obstacles include loss of appetite due to acute illness, delayed gastric emptying causing both nausea and early satiety, inability to swallow, and vomiting, among others.”
The paper relies on this without support.
Limited, if any, accounting for polymorbidity applies to current nutritional guidelines that focus on single diseases or on patient groups.
“Limited, if any, accounting for polymorbidity applies to current nutritional guidelines that focus on single diseases (e.g.nutritional support in renal failure) or on patient groups (e.g.older adults).”
The paper relies on this without support.
Severely underweight patients are at high risk of refeeding syndrome.
“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.”
“The target of approximately 30 kcal/kg body weight in severely underweight patients may need to be achieved with caution, as this is a population at high risk of refeeding syndrome.”
The paper relies on this without support.
Polymorbid medical inpatients are at high risk of developing disease-related malnutrition (DRM).
“Polymorbid medical inpatients are at high risk of developing DRM, so it is possible that this population could benefit from early nutritional support during hospital admission to avoid worsening of DRM with subsequent negative outcomes.”
The paper relies on this without support.
Diarrhea and constipation are the most frequent complications of EN in hospitalized patients.
“Diarrhea and constipation are the most frequent complications of EN in hospitalized patients.”
The paper relies on this without support.
Pressure ulcers are responsible for protein loss, hypermetabolism and hypercatabolism, and are often associated with malnutrition, including nutrient deficiencies that are critical to the different phases of wound healing.
“Pressure ulcers are responsible for protein loss, hypermetabolism and hypercatabolism, and are often associated with malnutrition, including nutrient deficiencies that are critical to the different phases of wound healing (conditionally essential amino acids and antioxidant micronutrients).”
The paper relies on this without support.
Polymorbid medical inpatients may be at risk of micronutrient deficiency as a result of decreased intake or greater micronutrient utilization.
“Polymorbid medical inpatients may be at risk of micronutrient deficiency as a result of decreased intake or greater micronutrient utilization, which can compromise health as well as recovery from illness or disease.”
The paper relies on this without support.
Polymorbid medical inpatients are commonly malnourished and their nutritional status frequently does not improve but instead deteriorates during hospital stay.
“Polymorbid medical inpatients are commonly malnourished and frequently nutritional status does not improve but instead deteriorates during their hospital stay.”
The paper relies on this without support.
Many patients leave the hospital malnourished, or more malnourished, which increases the risk for functional decline, loss of independence and greater morbidity.
“As a result, many patients leave the hospital malnourished, or more malnourished, which increases the risk for functional decline, loss of independence and greater morbidity.”
The paper relies on this without support.
Very few studies have directly compared nutritional intervention in and after hospital discharge versus nutritional support in hospital alone.
“Very few studies have, however, directly compared nutritional intervention in and after hospital discharge vs. nutritional support in hospital alone.”
The paper relies on this without support.
The effect of nutritional intervention with ONS on mortality has not been frequently studied in sufficiently sized patient cohorts.
“The effect of nutritional intervention with ONS on mortality has not been frequently studied in sufficiently sized patient cohorts.”
The paper relies on this without support.
Only one study has studied the impact of nutritional support on long-term mortality (> one year).
“Only one study studied the impact of nutritional support on long-term mortality (> one year).”
The paper relies on this without support.
Most trials assessing the impact of nutritional support in polymorbid inpatients used nutritional and functional status as outcome rather than as monitoring tools of the efficacy of nutrition intervention in improving other outcomes.
“Most trials assessing the impact of nutritional support in polymorbid inpatient used nutritional and functional status as outcome rather than as monitoring tools of the efficacy of nutrition intervention in improving other outcomes.”
The paper relies on this without support.
Reduced food intake has several commonly occurring determinants, including anorexia, dysphagia and oral and dental problems.
“Reduced food intake has several commonly occurring determinants, including anorexia, dysphagia and oral and dental problems.”
The paper relies on this without support.
Numerous studies indicate that reduced food intake is associated with increased mortality and with complications like infections in medical patients.
“There are numerous studies indicating that reduced food intake is associated with increased mortality and with complications like infections in medical patients.”
The paper relies on this without support.
Provision of nutritional support via ONS is often discontinued or not well tolerated by hospitalized patients.
“Another important aspect is that provision of nutritional support via ONS is often discontinued or not well tolerated by hospitalized patients.”
The paper relies on this without support.
Polymorbid medical inpatients often require multiple medicines to manage their comorbidities.
“Polymorbid medical inpatients will often require the prescription of multiple medicines in order to manage their comorbidities.”
The paper relies on this without support.
The use of multiple medicines is often essential.
“Whilst the use of multiple medicines is often essential, it can present a number of risks that include potential 'drugedrug' and/or 'drug-nutrient' interactions.”
The paper relies on this without support.
Many published studies did not report data on the presence of multiple comorbidities or did not use typical key terms for this purpose.
“many of the published studies did not report data on the presence of multiple comorbidities or did not use typical key terms for this purpose.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated major: it would touch a result — a value a result rests on, reported and recomputed p-values on opposite sides of the significance level, two passages that conflict with no sign which is right, or a cited work retracted before this paper was published.
In the paper
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation 0 e Strong consensus 100% agreement.
“This intervention significantly improved the energy and protein intakes”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
“There was no significant difference in energy intake, LOS or HGS between groups.”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > A
“lean body mass difference between admission and three months after discharge was À3.5 kg in CG patients, and þ1.3 in the IG”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Grade of recommendation A e
“Three months postdischarge, lean body mass was 3.5 kg lower in the CG but only 0.4 kg lower in the treated group.”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > Commentary
“in a retrospective study from 2000 to 2010”
§ ESPEN guideline on nutritional support for polymorbid medical inpatients > References
“44. Philipson T, Snider J, Lakdawalla D, Stryckman B, Goldman D. Impact of oral nutritional supplementation on hospital outcomes. Am J Manag Care 2003;19:121e8.”
Citations
Cites
Barnett, K., Mercer, S. W., Norbury, M., Watt, G., Wyke, S., & Guthrie, B. (2012) · The Lancet · doi:10.1016/s0140-6736(12)60240-2 · Cited by 6,972 · cited 2×
“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].”
BackgroundCochrane Handbook for Systematic Reviews of Interventions
Tarsilla, M. (2010) · Journal of MultiDisciplinary Evaluation · doi:10.56645/jmde.v6i14.284 · Cited by 5,232
What is subjective global assessment of nutritional status?
Detsky, A., McLaughlin, Baker, J., Johnston, N., Whittaker, S., Mendelson, R., & Jeejeebhoy, K. (1987) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/014860718701100108 · Cited by 3,252 · cited 1×
“…the ability of fi ve different nutrition screening and partly also assessment instruments (NRS 2002 [22], Subjective Global Assessment (SGA) [28], Short Nutritional Assessment Questionnaire (SNAQ) [29], MNA-SF [24] and Malnutrition Universal Screening Tool (MUST) [30]) to predict 1-year…”
ESPEN Guidelines for Nutrition Screening 2002
Kondrup, J. (2003) · Clinical Nutrition · doi:10.1016/s0261-5614(03)00098-0 · Cited by 3,159 · cited 1×
“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].”
Aging with multimorbidity: A systematic review of the literature
Marengoni, A., Angleman, S., Melis, R., Mangialasche, F., Karp, A., Garmen, A., Meinow, B., & Fratiglioni, L. (2011) · Ageing Research Reviews · doi:10.1016/j.arr.2011.03.003 · Cited by 3,092 · cited 2×
“Other consequences of poly-morbidity include disability, functional decline, poor quality of life (QoL) and higher healthcare costs [5].”
KONDRUP, J. (2003) · Clinical Nutrition · doi:10.1016/s0261-5614(02)00214-5 · Cited by 3,063 · cited 2×
“…EFFORT trial [8], Stalder et al. investigated the ability of fi ve different nutrition screening and partly also assessment instruments (NRS 2002 [22], Subjective Global Assessment (SGA) [28], Short Nutritional Assessment Questionnaire (SNAQ) [29], MNA-SF [24] and Malnutrition Universal…”
Cederholm, T., Jensen, G. L., Correia, M. I. T. D., Gonzalez, M. C., Fukushima, R., Higashiguchi, T., Baptista, G., Barazzoni, R., Blaauw, R., Coats, A., et al. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2018.08.002 · Cited by 3,022
Self-citationRubenstein, L. Z., Harker, J. O., Salva, A., Guigoz, Y., & Vellas, B. (2001) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/56.6.m366 · Cited by 2,751 · cited 1×
“…screening and partly also assessment instruments (NRS 2002 [22], Subjective Global Assessment (SGA) [28], Short Nutritional Assessment Questionnaire (SNAQ) [29], MNA-SF [24] and Malnutrition Universal Screening Tool (MUST) [30]) to predict 1-year mortality and response to nutritional treatment.”
ESPEN guidelines on definitions and terminology of clinical nutrition
Cederholm, T., Barazzoni, R., Austin, P., Ballmer, P., Biolo, G., Bischoff, S. C., Compher, C., Correia, I., Higashiguchi, T., Holst, M., et al. (2017) · Clinical Nutrition · doi:10.1016/j.clnu.2016.09.004 · Cited by 2,560 · cited 2×
“The diagnostic criteria and the factors proposed for screening of refeeding syndrome have been proposed elsewhere [74].”
Self-citationBauer, J., Biolo, G., Cederholm, T., Cesari, M., Cruz-Jentoft, A. J., Morley, J. E., Phillips, S., Sieber, C., Stehle, P., Teta, D., et al. (2013) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2013.05.021 · Cited by 2,553 · cited 1×
“…fi nding, the recommendations from guideline on nutritional therapy by the American College of Gastroenterology [56] and other expert groups [51,79,80] for older patients and general inpatients are advocating daily protein targets of at least 1.2 g/kg body weight and even higher intake for…”
InfluentialSelf-citation
Research works printed but not linked: 2
- Schuetz, 2019, Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial, Lancet (London, England), 393, 2312, 10.1016/s0140-6736(18)32776-4 · DOI · Paper page
- Crespi-Lofton, 2016, Managing clinically significant drug interactions in patients with HIV and comorbid conditions, Pharm Today, 64
Cited by
Sorted by citations
Cederholm, T., & Bosaeus, I. (2024) · New England Journal of Medicine · doi:10.1056/nejmra2212159 · Cited by 131
Self-citationESPEN practical guideline: Nutritional support for polymorbid medical inpatients
Wunderle, C., Gomes, F., Schüetz, P., Stumpf, F., Austin, P. D., Ballesteros-Pomar, M. D., Cederholm, T., Fletcher, J. M., Laviano, A., Norman, K., et al. (2024) · Clinical Nutrition · doi:10.1016/j.clnu.2024.01.008 · Cited by 51
“The search strategies used are presented the original guideline [9].”
MethodSelf-citationHaenggi, E., Kaegi-Braun, N., Wunderle, C., Tribolet, P., Müeller, B., Stanga, Z. G., & Schüetz, P. (2024) · Clinical Nutrition · doi:10.1016/j.clnu.2024.01.001 · Cited by 45
Self-citationEnteral nutrition in hospitalized adults
Gramlich, L., & Guenter, P. (2025) · New England Journal of Medicine · doi:10.1056/nejmra2406954 · Cited by 30
Шестопалов, А. Е., Yakovleva, A. V., Yadgarov, M. Y., Sergeev, I. V., & Kuzovlev, A. N. (2024) · Nutrients · doi:10.3390/nu16152396 · Cited by 34
Metadata
- Authors
- Wunderle, C., Gomes, F., Schuetz, P., Stumpf, F., Austin, P., Ballesteros-Pomar, M. D., Cederholm, T., Fletcher, J., Laviano, A., Norman, K., Poulia, K.-A., Schneider, S. M., Stanga, Z., & Bischoff, S. C.
- Affiliations
- University of Basel (CH)
- University of Hohenheim (DE)
- University of Oxford (GB)
- Complejo Asistencial Universitario de León (ES)
- Uppsala University (SE)
- Queen Elizabeth Hospital Birmingham (GB)
- Sapienza University of Rome (IT)
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin (DE)
- Agricultural University of Athens (GR)
- Université Côte d'Azur (FR)
- University of Bern (CH)
- ORCID
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2023-09
- Volume
- 42
- Issue
- 9
- Pages
- 1545-1568
- ISSN
- 0261-5614 (ISSN-L)
- OpenAlex
- W4383646138
- Semantic Scholar
- d9cd21518d53a2153b8c52078abdecf840e6035c
- Cited by
- 105
- References
- 190
- Citations by year
- 2026: 34 · 2025: 37 · 2024: 32 · 2023: 2
- FWCI
- 15.06
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Clinical Nutrition (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Uppsala University Publications (Uppsala University) (submittedVersion, cc-by-nc-nd)
- New University of Lisbon's Repository (New University of Lisbon) (submittedVersion)
- BORIS (University Library Bern) (submittedVersion, cc-by-nc-nd)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Open Access CRIS of the University of Bern
- Funders
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (PP00 P3_150531/1)
- European Society for Clinical Nutrition and Metabolism
- Forschungsrat des Kantonsspitals Aarau (1410.000.044)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Physiology (medical) › Nutrition and Health in Aging
- Health Sciences › Nursing › Nutrition and Dietetics › Dietetics, Nutrition, and Education
- Keywords
- nutritional support, disease-related malnutrition, multimorbidity, medical inpatients, energy and protein requirements, micronutrient requirements, enteral nutrition, parenteral nutrition, nutritional monitoring, Delphi consensus
- MeSH terms
- Hospitalization, Hospitals, Humans, Inpatients, Practice Guidelines as Topic, Nutritional Support, Malnutrition
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-23, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-23 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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