Individualized nutritional intervention during and after hospitalization: The nutrition intervention study clinical trial

• Published in: Journal of the American Geriatrics Society (JAGS) 2011, Vol.59 (1), p.10-17
• Main Authors: Feldblum, Ilana, German, Larisa, Castel, Hana, Harman-Boehm, Ilana, Shahar, Danit R
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; acutely hospitalized; Aftercare; Aged; Biological and medical sciences; Clinical trials; cognitive ability; Education; Elderly; Female; Food Service, Hospital; General aspects; Hospitalization; Hospitals; Humans; Intervention; Israel; Male; Malnutrition - diet therapy; Medical sciences; Metabolic diseases; Miscellaneous; Mortality; Nutrition; Nutritional Status; Older people; Public health. Hygiene; Public health. Hygiene-occupational medicine; Survival Analysis; treatment
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/j.1532-5415.2010.03174.x

OBJECTIVES: To test the hypothesis that individualized nutritional treatment during and after discharge from acute hospitalization will reduce mortality and improve nutritional outcomes. DESIGN: Randomized, controlled trial. SETTING: Internal medicine departments. PARTICIPANTS: Two hundred fifty‐nine hospitalized adults aged 65 and older at nutritional risk were recruited and randomized according to hospitalization ward into one intervention and two control groups during hospitalization. INTERVENTION: Group 1 (intervention group) received individualized nutritional treatment from a dietitian in the hospital and three home visits after discharge. Group 2 received one meeting with a dietitian in the hospital. Group 3 received standard care. Groups 2 and 3 were combined into a single group that served as the control group in the analysis. MEASUREMENTS: Mortality, health status, nutritional outcomes, blood tests, cognition, emotional, and functional parameters were assessed at baseline and after 6 months. All participants were contacted monthly. RESULTS: The overall dropout rate was 25.8%. After 6 months, rise in Mini Nutritional Assessment score, adjusted for education and hospitalization ward, was significantly higher in the intervention group than in the control groups (3.01 ± 2.65 vs 1.81 ± 2.97, P=.004) mainly on the subjective assessment part (0.34 ± 0.86 vs. −0.04 ± 0.87, P=.004). The only laboratory parameter for which a difference was observed between the groups was albumin; 9.7% of the intervention group had serum albumin levels of less than 3.5 g/dL, versus 22.9% of the control group (P=.03). Mortality was significantly lower in the intervention group (3.8%) than in the control group (11.6%, P=.046). CONCLUSION: Lower mortality and moderate improvement in nutritional status were found in patients receiving individualized nutritional treatment during and after acute hospitalization.