Effect of micronutrient supplementation in addition to nutritional therapy on clinical outcomes of medical inpatients: results of an updated systematic review and meta-analysis
Abstract
Background There is increasing evidence from randomized controlled trials showing that different types of nutritional support interventions improve clinical outcomes in malnourished medical inpatients. Whether trials using micronutrient supplementation in addition to nutritional therapy are superior to trials without micronutrient supplementation remains unclear. Methods This is a secondary analysis of a systematic search and meta-analysis. We searched Cochrane Library, MEDLINE, and EMBASE electronic database from inception to December 15, 2020, for randomized controlled trials comparing the nutritional support interventions vs. usual care on all-cause mortality (primary endpoint) of medical inpatients with nutritional risk. We stratified trials based on whether or not micronutrient supplementation was used as part of the nutritional strategy. Results We included 23 randomized controlled trials (5 trials with and 18 trials without micronutrient supplementation) with a total of 6745 patients. Overall, mortality was significantly lower in patients receiving nutritional support compared to control group patients with an odds ratio of 0.74 (95% CI 0.59-0.94, p = 0.01). There was no difference between trials with and without micronutrient supplementation on mortality (odds ratio 0.70 (95% CI 0.46-1.08) vs. 0.77 (95% CI 0.57-1.04), I 2 = 0%, p for subgroup difference = 0.73). Similarly, no differences in effect were found regarding non-elective readmissions and length of hospital s…
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In polymorbid medical inpatients exclusively fed orally, an adequate intake of micronutrients (vitamins and trace elements) to meet daily estimated requirements should be ensured.
“In polymorbid medical inpatients exclusively fed orally, an adequate intake of micronutrients (vitamins and trace elements) to meet daily estimated requirements should be ensured.”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [92]
A meta-analysis of mixed study populations found that additional micronutrient supplementation to a therapeutic diet already supplemented in micronutrients did not reduce mortality and may have increased length of stay by approximately one day (borderline statistical significance).
“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].”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [92]
Cites
Schuetz, P., Fehr, R., Baechli, V., Geiser, M., Deiss, M., Gomes, F., Kutz, A., Tribolet, P., Bregenzer, T., Braun, N., et al. (2019) · The Lancet · doi:10.1016/s0140-6736(18)32776-4 · Cited by 910 · cited 2× · see citing works
“A total of 12 trials used a multifactorial, dietician-based intervention [6, 17–19, 22, 28, 30, 32, 39, 40], of which 3 trials had additional micronutrient supplementation [6, 18, 39].”
BackgroundSelf-citationDeutz, N. E., Matheson, E. M., Matarese, L. E., Luo, M., Baggs, G. E., Nelson, J. L., Hegazi, R. A., Tappenden, K. A., & Ziegler, T. R. (2016) · Clinical Nutrition · doi:10.1016/j.clnu.2015.12.010 · Cited by 472 · see citing works
Self-citationESPEN guidelines on nutritional support for polymorbid internal medicine patients
Gomes, F., Schuetz, P., Bounoure, L., Austin, P., Ballesteros-Pomar, M., Cederholm, T., Fletcher, J., Laviano, A., Norman, K., Poulia, K.-A., et al. (2018) · Clinical Nutrition · doi:10.1016/j.clnu.2017.06.025 · Cited by 363 · see citing works
Self-citationFeldblum, I., German, L., Castel, H., Harman‐Boehm, I., & Shahar, D. R. (2011) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2010.03174.x · Cited by 127 · see citing works
Neelemaat, F., Lips, P., Bosmans, J. E., Thijs, A., Seidell, J. C., & van Bokhorst‐de van der Schueren, M. A. E. (2012) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2011.03888.x · Cited by 119 · see citing works
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ESPEN guideline on nutritional support for polymorbid medical inpatients
Wunderle, C., Gomes, F., Schuetz, P., Stumpf, F., Austin, P., Ballesteros-Pomar, M. D., Cederholm, T., Fletcher, J., Laviano, A., Norman, K., et al. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.06.023 · Cited by 105 · see citing works
“…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 signi fi cance) [92].”
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- Authors
- Kaegi-Braun, N., Germann, S., Faessli, M., Kilchoer, F., Dragusha, S., Tribolet, P., Gomes, F., Bretscher, C., Deutz, N. E., Stanga, Z., Mueller, B., & Schuetz, P.
- Affiliations
- University of Basel (CH)
- Università della Svizzera italiana (CH)
- New York Academy of Sciences (US)
- Texas A&M University (US)
- University of Bern (CH)
- ORCID
- Venue
- European Journal of Clinical Nutrition
- Published
- 2022-01-20
- Volume
- 76
- Issue
- 7
- Pages
- 964-972
- ISSN
- 0954-3007 (ISSN-L)
- 1476-5640
- OpenAlex
- W4206439988
- Cited by
- 10
- References
- 5
- Citations by year
- 2025: 3 · 2024: 3 · 2023: 4
- FWCI
- 0.34
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- ARBOR - Bern University of Applied Sciences Repository (submittedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion)
- Funders
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (PP00P3_150531)
- Research Council of the Kantonsspital Aarau
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Health Professions › Health Information Management › Dietetics, Nutrition, and Education
- Keywords
- micronutrient supplementation, nutritional therapy, nutritional support, malnutrition, medical inpatients, all-cause mortality, length of hospital stay, nutritional risk
- MeSH terms
- Humans, Inpatients, Length of Stay, Nutritional Support, Malnutrition, Nutrition Therapy
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