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    1 Comment for this article
    Sometimes we need papers to tell what everyone knows
    Carlo Pedrolli, MD | S. Chiara Hospital, Clinical Nutrition Unit, Trento, Italy
    Everyone, as me, who works in hospital as clinical nutritionist knows that we have to screen for malnutrition everyone who gets in hospital and if we find people at nutritional risk or malnourished we have to support them from a nutritional point of view; than we can guess how to to the nutritional support : oral nutritional support (ONS), enteral nutrition, parenteral nutrition or a mixture of them.
    At the end a paper confirmed, at least in non ICU patients both what every nutritionist knows and every nutritionist does to fight malnutrition or the risk of it in hospital.
    from now on let's us drop all philosophical issues and start to fight malnutrition in hospital and the risk of it!
    Original Investigation
    Nutrition, Obesity, and Exercise
    November 20, 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

    Author Affiliations
    • 1University Department of Medicine, Clinic for Endocrinology, Diabetology, and Metabolism, Kantonsspital Aarau, Aarau, Switzerland and Medical Faculty of the University of Basel, Basel, Switzerland
    • 2Nutrition Science Group, The New York Academy of Sciences, New York
    • 3Center for Translational Research in Aging and Longevity, Department of Health & Kinesiology, Texas A&M University, College Station
    • 4Core Educator Faculty, Department of Medicine, Massachusetts General Hospital, Boston
    • 5Division of Diabetology, Endocrinology, Nutritional Medicine, & Metabolism, University Hospital Inselspital Bern, University of Bern, Bern, Switzerland
    JAMA Netw Open. 2019;2(11):e1915138. doi:10.1001/jamanetworkopen.2019.15138
    Key Points español 中文 (chinese)

    Question  What is the association of nutritional support with clinical outcomes in medical inpatients who are malnourished or at nutritional risk?

    Findings  In this updated systematic review and meta-analysis of 27 trials including 6803 patients, nutritional support provided during hospitalization was associated with significantly lower rates of mortality and nonelective hospital readmissions, as well as higher energy and protein intake and weight increase.

    Meaning  This study’s findings suggest that nutritional support in hospitalized patients who are malnourished or at nutritional risk is associated with improved nutritional and clinical outcomes and should be considered when treating this population.


    Importance  Malnutrition affects a considerable proportion of the medical inpatient population. There is uncertainty regarding whether use of nutritional support during hospitalization in these patients positively alters their clinical outcomes.

    Objective  To assess the association of nutritional support with clinical outcomes in medical inpatients who are malnourished or at nutritional risk.

    Data Sources  For this updated systematic review and meta-analysis, a search of the Cochrane Library, MEDLINE, and Embase was conducted from January 1, 2015, to April 30, 2019; the included studies were published between 1982 and 2019.

    Study Selection  A prespecified Cochrane protocol was followed to identify trials comparing oral and enteral nutritional support interventions with usual care and the association of these treatments with clinical outcomes in non–critically ill medical inpatients who were malnourished.

    Data Extraction and Synthesis  Two reviewers independently extracted data and assessed risk of bias; data were pooled using a random-effects model.

    Main Outcomes and Measures  The primary outcome was mortality. The secondary outcomes included nonelective hospital readmissions, length of hospital stay, infections, functional outcome, daily caloric and protein intake, and weight change.

    Results  A total of 27 trials (n = 6803 patients) were included, of which 5 (n = 3067 patients) were published between 2015 and 2019. Patients receiving nutritional support compared with patients in the control group had significantly lower rates of mortality (230 of 2758 [8.3%] vs 307 of 2787 [11.0%]; odds ratio [OR], 0.73; 95% CI, 0.56-0.97). A sensitivity analysis suggested a more pronounced reduction in the risk of mortality in recent trials (2015 or later) (OR, 0.47; 95% CI, 0.28-0.79) compared with that in older studies (OR, 0.94; 95% CI, 0.72-1.22), in patients with established malnutrition (OR, 0.52; 95% CI, 0.34-0.80) compared with that in patients at nutritional risk (OR, 0.85; 95% CI, 0.62-1.18), and in trials with high protocol adherence (OR, 0.67; 95% CI, 0.54-0.84) compared with that in trials with low protocol adherence (OR, 0.88; 95% CI, 0.44-1.76). Nutritional support was also associated with a reduction in nonelective hospital readmissions (14.7% vs 18.0%; risk ratio, 0.76; 95% CI, 0.60-0.96), higher energy intake (mean difference, 365 kcal; 95% CI, 272-458 kcal) and protein intake (mean difference, 17.7 g; 95% CI, 12.1-23.3 g), and weight increase (0.73 kg; 95% CI, 0.32-1.13 kg). No significant differences were observed in rates of infections (OR, 0.86; 95% CI, 0.64-1.16), functional outcome (mean difference, 0.32; 95% CI, −0.51 to 1.15), and length of hospital stay (mean difference, −0.24; 95% CI, −0.58 to 0.09).

    Conclusions and Relevance  This study’s findings suggest that despite heterogeneity and varying methodological quality among trials, nutritional support was associated with improved survival and nonelective hospital readmission rates among medical inpatients who were malnourished and should therefore be considered when treating this population.