Effectiveness of dietary counseling with or without nutrition supplementation in hospitalized patients who are malnourished or at risk of malnutrition: A systematic review and meta‐analysis

Abstract

Background Nutrition support is associated with improved survival and nonelective hospital readmission rates among malnourished medical inpatients; however, limited evidence supporting dietary counseling is available. We intend to determine the effect of dietary counseling with or without oral nutrition supplementation (ONS), compared with standard care, on hospitalized adults who are malnourished or at risk of malnutrition. Methods We searched MEDLINE/PubMed, CINAHL, Embase, Scopus, The Cochrane Library, and Google Scholar for studies listed from January 1, 2011, to August 31, 2021. Meta‐analysis was performed to obtain pooled risk ratios (RRs) and 95% CIs to estimate the effect. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the certainty of the evidence. Results Sixteen studies were identified. Compared with standard care, dietary counseling with or without ONS probably does not reduce inpatient rates of 30‐day mortality (RR = 1.24; 0.60–2.55; I2 = 45%; P = 0.56; moderate certainty), slightly reduces 6‐month mortality (RR = 0.83; 0.69–1.00; I2 = 16%; P = 0.06; high certainty), reduces complications (RR = 0.85; 0.73–0.98; I2 = 0%; P = 0.03; high certainty), and may slightly reduce readmission (RR = 0.83; 0.66–1.03; I2 = 55%; P = 0.10; low certainty) but may not reduce length of stay (mean difference: −0.75 days; −1.66‐0.17; I2 = 70%; P = 0.11; low certainty). Intervention may result in slight improvements in nutrition status/intake and weight/body mass index (low certainty). Conclusions There is an increase in the certainty of evidence regarding the positive impact of dietary counseling on outcomes. Future studies should standardize and provide details/frequencies of counseling methods and ONS adherence to determine dietary counseling effectiveness.

Individualised Nutritional Care for Disease-Related Malnutrition: Improving Outcomes by Focusing on What Matters to Patients

“…To address some of these limitations, a systematic review and meta-analysis were undertaken to investigate the effectiveness of dietary counselling (1 to ≥3 sessions, mostly dietitian-led) with or without ONS in at-risk or malnourished hospitalised patients (16 RCT) compared to standard care [38]. For the intervention, the review presented high certainty of evidence for reduced complications and a slight reduction in mortality of up to 6 months, but no reduction in 30-day mortality (moderate certainty evidence) and low certainty of evidence relating to slight improvements in nutritional intake or status and weight or BMI, but no reduction in length of stay.…”

“…For the intervention, the review presented high certainty of evidence for reduced complications and a slight reduction in mortality of up to 6 months, but no reduction in 30-day mortality (moderate certainty evidence) and low certainty of evidence relating to slight improvements in nutritional intake or status and weight or BMI, but no reduction in length of stay. The authors of the review call for standardised and more detailed reporting of dietary counselling methods, including frequency of input and ONS adherence [38].…”

A Conceptual Study on Characterizing the Complexity of Nutritional Interventions for Malnourished Older Adults in Hospital Settings: An Umbrella Review Approach

“…In clinical practice and research, nutrition intervention may involve a single-component strategy such as direct provision of nutrients via the use of medical and non-medical food. More frequently, interventions involve multiple strategies, such as targeting various aspects of biochemical and biologic pathways (e.g., anti-inflammatory, appetite, and muscle stimulation) [4][5][6][7][8], nutritional knowledge (e.g., dietary counseling of patients and caregivers, and improving nutritional knowledge of healthcare professionals) [9][10][11], and service provision/quality (modifying the hospital environment, food services, and optimizing nursing and post-discharge care) [12][13][14][15][16][17][18][19].…”

“…Transitioning from the broad perspectives provided by SRMAs to a more focused approach, the Medical Research Council framework [24] offers a structured methodology for evaluating the complexity of nutritional interventions. While SRMAs often describe and present the methodologies of nutritional interventions, important features such as the individualization of intervention strategies, complexity of interventions, qualifications of the educator, delivery method of education (e.g., face-to-face, telephone, or internet), and utilization of healthcare resources (human and financial resources, e.g., time spent in intervention by clinicians) are frequently absent, as shown in a recent review [11]. Despite the acknowledged diversity of nutritional interventions for malnutrition in hospitalized adults and elderly populations, a systematic approach to categorize these interventions based on their complexity remains unexplored.…”

Challenges and considerations in delivering nutritional therapy in the ICU during COVID-19 pandemic

“…Dietary counselling with or without oral nutritional supplements (ONS) has been found to reduce complications and 6-month mortality for patients who are malnourished or at risk of malnutrition. 11 However, unsupervised provision of ONS without targeted education neither benefits the at-risk population 11 nor remains cost-effective as critically ill patients with COVID-19 tend to have extended hospitalisation.…”