Positive effect of protein‐supplemented hospital food on protein intake in patients at nutritional risk: a randomised controlled trial
Abstract
Background New evidence indicates that increased dietary protein ingestion promotes health and recovery from illness, and also maintains functionality in older adults. The present study aimed to investigate whether a novel food service concept with protein-supplementation would increase protein and energy intake in hospitalised patients at nutritional risk. Methods A single-blinded randomised controlled trial was conducted. Eighty-four participants at nutritional risk, recruited from the departments of Oncology, Orthopaedics and Urology, were included. The intervention group (IG) received the protein-supplemented food service concept. The control group (CG) received the standard hospital menu. Primary outcome comprised the number of patients achieving ≥75% of energy and protein requirements. Secondary outcomes comprised mean energy and protein intake, body weight, handgrip strength and length of hospital stay. Results In IG, 76% versus 70% CG patients reached ≥75% of their energy requirements (P = 0.57); 66% IG versus 30% CG patients reached ≥75% of their protein requirements (P = 0.001). The risk ratio for achieving ≥75% of protein requirements: 2.2 (95% confidence interval = 1.3-3.7); number needed to treat = 3 (95% confidence interval = 2-6). IG had a higher mean intake of energy and protein when adjusted for body weight (CG: 82 kJ kg(-1) versus IG: 103 kJ kg(-1) , P = 0.013; CG: 0.7 g protein kg(-1) versus 0.9 g protein kg(-1) , P = 0.003). Body weight, handgrip strength…
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In that single-blinded RCT, there was no significant difference between the protein-fortified menu group and control in energy intake, length of stay, or handgrip strength.
“There was no significant difference in energy intake, LOS or HGS between groups.”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [148]
In that single-blinded RCT, mean protein intake was significantly increased in the intervention group, with 27/41 versus 12/40 in the control group meeting ≥75% protein requirements (p=0.001).
“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).”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [148]
In a single-blinded RCT, a protein-fortified menu was effective in increasing protein intake in patients.
“A single-blinded RCT [148] demonstrated how the use of a protein fortified menu was effective in increasing the protein intake of patients.”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [148]
Eight studies investigate the effect of dietary enrichment.
“Eight studies investigate the effect of dietary enrichment [25-32].”
From ESPEN guideline on hospital nutrition (2021) · cites this paper as [27]
In hospitalized patients at nutritional risk, dietary enrichment showed an effect on overall protein intake and weight-adjusted energy.
“the effect on overall protein intake and weight-adjusted energy was shown in 441 hospitalized patients at nutritional risk.”
From ESPEN guideline on hospital nutrition (2021) · cites this paper as [27]
In the study by Munk, the range is extended to 2.0 g/kg BW during illness.
“In the study by Munk, the range is extended to 2.0 g/kg BW during 515 illness [27].”
From ESPEN guideline on hospital nutrition (2021) · cites this paper as [27]
Cites
Protein and energy supplementation in elderly people at risk from malnutrition
Milne, A. C., Potter, J., Vivanti, A., & Avenell, A. (2009) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003288.pub3 · Cited by 849 · see citing works
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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 · 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
ESPEN guideline on hospital nutrition
Thibault, R., Abbasoglu, O., Ioannou, E., Meija, L., Ottens-Oussoren, K., Pichard, C., Rothenberg, E., Rubin, D., Siljamäki-Ojansuu, U., Vaillant, M.-F., et al. (2021) · Clinical Nutrition · doi:10.1016/j.clnu.2021.09.039 · Cited by 259 · see citing works
Van Ancum, J. M., Scheerman, K., Jonkman, N. H., Smeenk, H. E., Kruizinga, R. C., Meskers, C. G. M., & Maier, A. B. (2017) · Experimental Gerontology · doi:10.1016/j.exger.2017.03.006 · Cited by 118 · see citing works
ESPEN guideline on nutritional support for polymorbid medical inpatients
Wunderle, C., Gomes, F., Schuetz, P., Stumpf, F., Austin, P., Ballesteros-Pomar, M. D., Cederholm, T., Fletcher, J., Laviano, A., Norman, K., et al. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.06.023 · Cited by 105 · see citing works
“A single-blinded RCT [148] demonstrated how the use of a protein forti fi ed menu was effective in increasing the protein intake of patients.”
Trabal, J., & Farran-Codina, A. (2015) · Nutrition Reviews · doi:10.1093/nutrit/nuv023 · Cited by 55 · see citing works
Lindhardt, T., & Nielsen, M. H. (2017) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2016.10.017 · Cited by 40 · see citing works
Self-citationGressies, C., Kaegi-Braun, N., Gomes, F., & Schuetz, P. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2022.11.007 · Cited by 5 · see citing works
- Authors
- Munk, T., Beck, A. M., Holst, M., Rosenbom, E., Rasmussen, H. H., Nielsen, M. A., & Thomsen, T.
- Affiliations
- Herlev Hospital (DK)
- Aalborg University Hospital (DK)
- Lund University (SE)
- Corresponding author
- Munk, T.
- Venue
- Journal of Human Nutrition and Dietetics
- Publisher
- Wiley
- Published
- 2014-01-31
- Volume
- 27
- Issue
- 2
- Pages
- 122-132
- ISSN
- 0952-3871 (ISSN-L)
- 1365-277X
- OpenAlex
- W2130360054
- Cited by
- 77
- References
- 1
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 5 · 2023: 8 · 2022: 8 · 2021: 10 · 2020: 5 · 2019: 4 · 2018: 6 · 2017: 12 · 2016: 9 · 2015: 4
- FWCI
- 7.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Human Nutrition and Dietetics (publishedVersion)
- PubMed (publishedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Funders
- Herlev University Hospital Research Unit
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Muscle metabolism and nutrition
- Keywords
- protein supplementation, hospital food service, protein intake, energy intake, nutritional risk, hospitalized patients, malnutrition, energy requirements, grip strength, length of hospital stay, body weight
- MeSH terms
- Aged, Aged, 80 and over, Body Weight, Energy Intake, Diet, Dietary Proteins, Female, Food Service, Hospital, Hospitalization, Hospitals, Humans, Length of Stay, Male, Nutritional Requirements, Nutritional Status, Protein-Energy Malnutrition, Single-Blind Method, Hand Strength, Dietary Supplements
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