Nutritional support after hospital discharge improves long-term mortality in malnourished adult medical patients: Systematic review and meta-analysis

Kaegi-Braun, Nina; Kilchoer, Fiona; Dragusha, Saranda; Gressies, Carla; Faessli, Montserrat; Gomes, Filomena; Deutz, N.E.P.; Stanga, Zeno; Müeller, Beat; Schüetz, Philipp

doi:10.1016/j.clnu.2022.09.011

Cited by 27 publications

(14 citation statements)

References 42 publications

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“…The high prevalence of malnutrition underscores the importance of enhancing nutritional assessment and intervention in clinical practice. Providing nutrition support during hospitalization and post-discharge should be prioritized among hospitalized patients to improve both short-and long-term clinical outcomes, as demonstrated elsewhere [20].…”

Section: Discussionmentioning

confidence: 99%

Malnutrition and associated factors among hospitalized adult patients at a tertiary hospital, Northern Uganda: a cross-sectional study

Okello,

Muyambi,

Agaba

et al. 2024

Preprint

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Background: Malnutrition among hospitalized patients is associated with suboptimal recovery, unfavorable prognosis and increased mortality. However, malnutrition in hospitalized patients is often overlooked, underdiagnosed, and frequently inadequately addressed in clinical practice. We determined the prevalence and associated factors of malnutrition in hospitalized adult patients at Lira Regional Referral Hospital (LRRH), Uganda. Methods: We conducted a cross-sectional study at medical wards of LRRH during November and December 2023. The study included patients aged ≥18years through consecutive sampling method. We excluded those who were too unwell to respond to the research questions. Socio-demographic and clinical characteristics were obtained through interviewer-administered questionnaires. Malnutrition was assessed using the Malnutrition Universal Screening Tool (MUST), which utilizes body mass index (BMI) scores for classification. Individuals with BMI scores <18.5 kg/m² were categorized as undernourished, those with BMI scores <18.5 kg/m² or ≥25 kg/m² were classified as malnourished, and BMI scores of 18.5-24.9 kg/m² were considered normal. Malnutrition was further categorized based on weight loss percentages, using the Subjective Global Assessment (SGA) tool: normal (weight loss 0-<5%), mild/moderate (weight loss 5-10%), and severe (weight loss >10%). Modified Poisson regression was used to evaluate associations between undernutrition and independent variables. Results: In total, 423 patients were recruited with median age of 40 (inter-quartile range [IQR]: 24-63) years; 223 (53%) were female. Overall, 176 (42%, 95% CI: 37-46%) had malnutrition; 116 (27%) were undernourished, 73 (17%) were mild/moderately undernourished, and 43 (10%) severely undernourished. Being aged >64 years (aPR 1.19, 95% CI: 1.01- 1.39), and having adequate dietary intake (aPR 0.91, 95% CI: 0.82-0.99), were independently associated with under-nutrition. Conclusion: Approximately 4 out of every 10 patients screened at LRRH had malnutrition. Patients of advanced age were more likely to be undernourished, while those with adequate dietary intake were less likely to be undernourished. The high prevalence of malnutrition highlights the need for increased attention to nutritional assessment and intervention in clinical practice, particularly for older patients. Adequate dietary intake and post-discharge nutritional interventions could reduce the magnitude of under-nutrition and potentially enhance clinical outcomes in this setting.

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Section: Discussionmentioning

confidence: 99%

Malnutrition and associated factors among hospitalized adult patients at a tertiary hospital, Northern Uganda: a cross-sectional study

Okello,

Muyambi,

Agaba

et al. 2024

Preprint

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“…Although nutritional care often begins as a hospital-based intervention, it evolves in the community. Many nutritional therapies have been shown to be effective only if provided over a long period: for example, oral nutritional support is associated with higher long-term survival rates in medical patients if supplementation is continued after hospital discharge ( 33 ). However, it is very difficult to ensure the distribution of oral nutrition products to all cancer patients at nutritional risk due to heterogeneous reimbursement policies and the lack of an adequate number of community nutrition services.…”

Section: Reimbursement Policies For Home Nutrition Carementioning

confidence: 99%

Nutritional care for cancer patients: are we doing enough?

Da Prat,

Pedrazzoli,

Caccialanza

2024

Front. Nutr.

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Malnutrition is associated with higher rates of surgical complications, increased anticancer treatment toxicities, longer hospital stays, higher healthcare costs, poorer patient quality of life, and lower survival rates. Nutritional support has been shown to improve all of these outcomes. However, the nutritional care of cancer patients is still suboptimal and several issues remain unresolved. Although the effectiveness of nutritional support depends on the timeliness of intervention, assessment of nutritional status is often delayed and perceived as unimportant. When diagnoses of malnutrition are made, they are rarely recorded in medical records. Hospitals lack medical staff dedicated to clinical nutrition, making it difficult to integrate nutritional care into the multidisciplinary management of cancer patients. Outside the hospital, nutritional support is hampered by heterogeneous reimbursement policies and a lack of adequate community nutrition services. In addition, an increasing number of patients are turning to potentially harmful “anti-cancer” diets as trust in medicine declines. Adopting mandatory nutrition screening, monitoring quality of care metrics, providing nutrition education to care providers, and implementing telehealth systems are some of the most urgent interventions that need to be established in the future.

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“…A recent meta‐analysis and systematic review of randomized controlled trials suggested outpatient nutrition support after hospital discharge significantly increased nutrition intake and body weight and improved survival. The various forms of nutrition support included in the meta‐analysis were dietary advice, food fortification, oral nutrition supplements, snacks between meals, enteral feeding, or a combination of these interventions 33 …”

Section: The Gmcs' Potential To Advance Health Equitymentioning

confidence: 99%

“…The various forms of nutrition support included in the meta-analysis were dietary advice, food fortification, oral nutrition supplements, snacks between meals, enteral feeding, or a combination of these interventions. 33…”

Section: The Gmcs' Potential To Advance Health Equitymentioning

confidence: 99%

Interprofessional implementation of the Global Malnutrition Composite Score quality measure

et al. 2023

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Malnutrition in hospitalized patients can impact health outcomes, quality of life, and health equity. Quality improvement initiatives and quality measurement can help improve the care of those hospitalized patients with malnutrition. The new Global Malnutrition Composite Score (GMCS) was recently adopted by the Centers for Medicare & Medicaid Services (CMS) as a health equity–focused measure. Beginning in 2024, the GMCS is available for reporting through the CMS Hospital Inpatient Quality Reporting Program. The GMCS provides an opportunity to elevate the importance of patient nutrition status and evidence‐based interventions throughout the interdisciplinary hospital decision‐making process. To promote this opportunity, the American Society for Parenteral and Enteral Nutrition (ASPEN) held an “Interprofessional implementation of the Global Malnutrition Composite Score” webinar as part of its 2022 Malnutrition Awareness Week programming. This article summarizes the underlying rationale and significance of the GMCS measure and showcases clinical observations about integrating quality improvement and measurement into the acute care setting, as presented during the webinar.

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Nutritional support after hospital discharge improves long-term mortality in malnourished adult medical patients: Systematic review and meta-analysis

Cited by 27 publications

References 42 publications

Malnutrition and associated factors among hospitalized adult patients at a tertiary hospital, Northern Uganda: a cross-sectional study

Malnutrition and associated factors among hospitalized adult patients at a tertiary hospital, Northern Uganda: a cross-sectional study

Nutritional care for cancer patients: are we doing enough?

Interprofessional implementation of the Global Malnutrition Composite Score quality measure

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