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Cited by 61Nutrition and Health in AgingClinical Nutrition and GastroenterologyDysphagia Assessment and Management

Effect of Nutritional Intervention Programs on Nutritional Status and Readmission Rate in Malnourished Older Adults with Pneumonia: A Randomized Control Trial

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Yang, Pei-Hsin, Lin, Meng-Chih, Liu, Yi-Ying, Lee, Chia-Lun, Chang, Nai-Jen·2019·International Journal of Environmental Research and Public Health
DOI 10.3390/ijerph16234758PMC PMC6926802
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Abstract

Pneumonia leads to changes in body composition and weakness due to the malnourished condition. In addition, patient family caregivers always have a lack of nutritional information, and they do not know how to manage patients’ nutritional intake during hospitalization and after discharge. Most intervention studies aim to provide nutritional support for older patients. However, whether long-term nutritional intervention by dietitians and caregivers from patients’ families exert clinical effects—particularly in malnourished pneumonia—on nutritional status and readmission rate at each interventional phase, from hospitalization to postdischarge, remains unclear. To investigate the effects of an individualized nutritional intervention program (iNIP) on nutritional status and readmission rate in older adults with pneumonia during hospitalization and three and six months after discharge. Eighty-two malnourished older adults with a primary diagnosis of pneumonia participated. Patients were randomly allocated to either a nutrition intervention (NI) group or a standard care (SC) group. Participants in the NI group received an iNIP according to energy and protein intake requirements in addition to dietary advice based on face-to-face interviews with their family caregivers during hospitalization. After discharge, phone calls were adopted for prescribing iNIPs. Anthropometry (i.e., body mass index, limb circumference, and subcutaneous fat thickness), blood parameters (i.e., albumin and total lymphocyte count), hospital stay, Mini-Nutritional Assessment-Short Form (MNA-SF) score, target daily calorie intake, total calorie intake adherence rate, and three-major-nutrient intakes were assessed during hospitalization and three and six months after discharge. Both groups received regular follow-up through phone calls. Furthermore, the rate of readmission resulting from pneumonia was recorded after discharge. During hospital stay, the NI group showed significant increases in daily calorie intake, total calorie intake adherence rate, and protein intake compared with the SC group (p < 0.05); however, no significant difference was found in anthropometry, blood biochemical values, MNA-SF scores, and hospital stay. At three and six months after discharge, the NI group showed significantly higher daily calorie intake and MNA-SF scores (8.2 vs. 6.5 scores at three months; 9.3 vs. 7.6 scores at six months) than did the SC group (p < 0.05). After adjusting for sex, the readmission rate for pneumonia significantly decreased by 77% in the NI group compared with that in the SC group (p = 0.03, OR: 0.228, 95% CI: 0.06–0.87). A six-month iNIP under dietitian and patient family nutritional support for malnourished older adults with pneumonia can significantly improve their nutritional status and reduce the readmission rate.

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  • Readmission rates were significantly reduced after six months of nutritional intervention in several trials but not all.

    “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].”

    From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [130]

    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)

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Authors
Yang, P.-H., Lin, M.-C., Liu, Y.-Y., Lee, C.-L., & Chang, N.-J.
Affiliations
  • Kaohsiung Medical University (TW)
  • Chang Gung University (TW)
  • Kaohsiung Chang Gung Memorial Hospital (TW)
  • National Sun Yat-sen University (TW)
Corresponding author
Chang, Nai-Jen
ORCID
Venue
International Journal of Environmental Research and Public Health
Publisher
MDPI AG
Published
2019-11-27
Volume
16
Issue
23
Pages
4758
ISSN
1660-4601 (ISSN-L)
DOI
10.3390/ijerph16234758
PMC
PMC6926802
OpenAlex
W2991298608
Cited by
61
References
0
Citations by year
2026: 10 · 2025: 7 · 2024: 5 · 2023: 6 · 2022: 12 · 2021: 16 · 2020: 4 · 2019: 1
FWCI
5.66
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
Funders
  • National Sun Yat-sen University
  • Chang Gung Medical Foundation
  • Kaohsiung Chang Gung Memorial Hospital
Topics
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Health Professions › Speech and Hearing › Dysphagia Assessment and Management
Keywords
malnutrition, pneumonia, older adults, dietary intervention, hospital readmission, family caregivers, nutrition counseling, protein intake, Mini Nutritional Assessment Short Form, post-discharge follow-up, nutritional status, body composition, albumin, lymphocyte count, length of hospital stay, telehealth follow-up, post-discharge
MeSH terms
Aged, Energy Intake, Female, Hospitalization, Humans, Length of Stay, Male, Nutritional Status, Patient Readmission, Pneumonia, Risk Factors, Nutrition Assessment, Body Mass Index, Malnutrition, Nutrition Therapy

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