Effectiveness of nutritional interventions in older adults at risk of malnutrition across different health care settings: Pooled analyses of individual participant data from nine randomized controlled trials

Reinders, Ilse; Volkert, Dorothee; Groot, Lisette C. P. G. M. de; Beck, Anne Marie; Feldblum, Ilana; Jobse, Inken; Neelemaat, F.; Schueren, Marian A.E. de van der; Shahar, Danit R.; Smeets, E.; Tieland, Michael; Twisk, Jos W. R.; Wijnhoven, Hanneke A. H.; Visser, Marjolein

doi:10.1016/j.clnu.2018.07.023

Cited by 53 publications

(49 citation statements)

References 38 publications

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“…The purpose was to provide simple instruction on modifying food intake (e.g., food fortification, meal plan adaptation) to improve nutritional intake, which could be replicated in primary care, outside of a clinical trial setting. This is not the same as intensive, individualised dietary counselling by a dietitian, which combined with ONS may be the optimal strategy [43]. This approach can however be restricted by limited resources of the dietetic profession, especially in the primary care setting, as such DA was chosen for this study as it represents a pragmatic and viable nutritional first line intervention in this setting.…”

Section: Discussionmentioning

confidence: 99%

Ready-Made Oral Nutritional Supplements Improve Nutritional Outcomes and Reduce Health Care Use—A Randomised Trial in Older Malnourished People in Primary Care

et al. 2020

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Large trials assessing oral nutritional supplements (ONS) and dietary advice (DA) in primary care are lacking. This study examined effects of ONS + DA versus DA on intake, weight, QoL, healthcare use and satisfaction in malnourished free-living older people. Three hundred and eight people (71.5 ± 10.7y) were randomised to receive ONS + DA (n154) or DA (n154) for 12 weeks. At baseline, 4, 8, 12 weeks, intake, weight, QoL, healthcare use and satisfaction were measured. ONS + DA group (mean daily intake ONS 480 kcal; 21 g protein; 80% compliance) had significantly greater total energy and protein intakes (+401 kcal/d, p < 0.001; +15 g/d, p < 0.001) and weight gain (+0.8 kg; p < 0.001) compared to DA. QoL improved in both groups over time with a significant improvement in index with ONS + DA (p = 0.009). Significantly more participants found ONS + DA made a difference for them (p = 0.011), but no differences were found between groups using Euroqol. Compared to DA, healthcare use reduced with ONS + DA, (HCP visits by 34%, emergency admissions 50%, LOS 62%). Acceptability of both interventions was high (ONS 96%, DA 95%), with significantly more participants satisfied with ONS (89%) than DA (73%) (p = 0.009). This trial in primary care indicates that ONS are acceptable, make a difference to patients, significantly improve intake and weight, and reduce health care use with potential savings.

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Section: Discussionmentioning

confidence: 99%

Ready-Made Oral Nutritional Supplements Improve Nutritional Outcomes and Reduce Health Care Use—A Randomised Trial in Older Malnourished People in Primary Care

et al. 2020

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“…After stratifying by the type of intervention, the intervention effect was significant only for an increase in energy intake when dietary counseling was given in combination with ONS (OR 2.28; CI 1.90, 2.73). Therefore, for older adults at risk of PEM, they identified nutritional interventions had a positive effect on energy intake and body weight, and dietary counseling combined with ONS was the most effective intervention [48].…”

Section: Pemmentioning

confidence: 99%

Screening Community-Living Older Adults for Protein Energy Malnutrition and Frailty: Update and Next Steps

et al. 2019

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Protein-energy malnutrition (PEM)/undernutrition and frailty are prevalent, overlapping conditions impacting on functional and health outcomes of older adults, but are frequently unidentified and untreated in community settings in the United States. Using the World Health Organization criteria for effective screening programs, we reviewed validity, reliability, and feasibility of data-driven screening tools for identifying PEM and frailty risk among community-dwelling older adults. The SCREEN II is recommended for PEM screening and the FRAIL scale is recommended as the most promising frailty screening tool, based on test characteristics, cost, and ease of use, but more research on both tools is needed, particularly on predictive validity of favorable outcomes after nutritional/physical activity interventions. The Malnutrition Screening Tool (MST) has been recommended by one expert group as a screening tool for all adults, regardless of age/care setting. However, it has not been tested in US community settings, likely yields large numbers of false positives (particularly in community settings), and its predictive validity of favorable outcomes after nutritional interventions is unknown. Community subgroups at highest priority for screening are those at increased risk due to prior illness, certain demographics and/or domiciliary characteristics, and those with BMI < 20 kg/m 2 or < 22 if > 70 years or recent unintentional weight loss > 10% (who are likely already malnourished). Community-based health professionals can better support healthy aging by increasing their awareness/use of PEM and frailty screening tools, prioritizing high-risk populations for systematic screening, following screening with more definitive diagnoses and appropriate interventions, and re-evaluating and revising screening protocols and measures as more data become available.

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“…This support significantly lowered the risk of experiencing adverse clinical outcomes after 30 days, reduced all-cause mortality, and improved the patients’ functional status and quality of life [ 18 ]. Another systematic review found that nutritional interventions, such as prescribing oral nutritional supplements (ONS), were most effective if they were combined with dietary counselling by a dietitian [ 19 ]. Another study showed that tube-fed patients received 10% more energy and about 8% more protein from enteral formula prescribed by dietitians than formula prescribed by physicians.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Dietitian Referrals in Hospitals

Eglseer

Bauer

2020

Nutrients

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Dietitian involvement has considerable benefits for hospitalized patients, resulting in better health outcomes and improved quality of life. However, dietitian referral routines are often inappropriate in hospitals. The aim of this study was to identify predictors for dietitian referrals in hospitalized patients. This study was performed on data collected in an annually conducted cross-sectional study (in the years 2017, 2018, 2019). A standardized questionnaire was used to collect data, and logistic regression and a generalized estimating equation (GEE) model were used to calculate the associations between the patient characteristics and dietitian referrals. In the final GEE model, the following predictors for dietitian referrals remained significant: diabetes diagnosis (OR 1.80), cancer diagnosis (OR 1.76), digestive disease diagnosis (OR 2.03), presence of a pressure injury (OR 1.58), risk of malnutrition based on body mass index (BMI) and weight loss (OR 1.72), risk of malnutrition based on the malnutrition universal screening tool (MUST) (2.55), and the application of any malnutrition screening at admission to hospital (2.20). Total dietitian referral rate was 16.8%. The highest rate of dietitian referrals was found in patients with a risk of malnutrition (37%). This study included a large sample of hospitalized adult patients and revealed a low dietitian referral rate among these patients. These results indicate that dietitian involvement in hospitalized patients with nutrition-related conditions urgently needs to be improved.

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Effectiveness of nutritional interventions in older adults at risk of malnutrition across different health care settings: Pooled analyses of individual participant data from nine randomized controlled trials

Abstract: Based on pooled data of older adults (at risk of malnutrition), nutritional interventions have a positive effect on energy intake and body weight. Dietary counseling combined with ONS is the most effective intervention.

Cited by 53 publications

References 38 publications

Ready-Made Oral Nutritional Supplements Improve Nutritional Outcomes and Reduce Health Care Use—A Randomised Trial in Older Malnourished People in Primary Care

Ready-Made Oral Nutritional Supplements Improve Nutritional Outcomes and Reduce Health Care Use—A Randomised Trial in Older Malnourished People in Primary Care

Screening Community-Living Older Adults for Protein Energy Malnutrition and Frailty: Update and Next Steps

Predictors of Dietitian Referrals in Hospitals

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