Nutrition support in hospitalised adults at nutritional risk

• Published in: Cochrane database of systematic reviews 2017-05, Vol.5 (5), p.CD011598-CD011598
• Main Authors: Feinberg, Joshua, Nielsen, Emil Eik, Korang, Steven Kwasi, Halberg Engell, Kirstine, Nielsen, Marie Skøtt, Zhang, Kang, Didriksen, Maria, Lund, Lisbeth, Lindahl, Niklas, Hallum, Sara, Liang, Ning, Xiong, Wenjing, Yang, Xuemei, Brunsgaard, Pernille, Garioud, Alexandre, Safi, Sanam, Lindschou, Jane, Kondrup, Jens, Gluud, Christian, Jakobsen, Janus C
• Format: Article
• Language: English
• Subjects: Adult; ANY DISEASE REQUIRING NUTRITION SUPPORT; Body Weight; Cause of Death; Enteral Nutrition - adverse effects; Enteral Nutrition - statistics & numerical data; Food, Fortified - statistics & numerical data; Hospitalization; Humans; Malnutrition - mortality; Malnutrition - prevention & control; Nutritional Support - adverse effects; Nutritional Support - statistics & numerical data; Parenteral Nutrition - adverse effects; Parenteral Nutrition - statistics & numerical data; Quality of Life; Randomized Controlled Trials as Topic
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD011598.pub2

The prevalence of disease-related malnutrition in Western European hospitals is estimated to be about 30%. There is no consensus whether poor nutritional status causes poorer clinical outcome or if it is merely associated with it. The intention with all forms of nutrition support is to increase uptake of essential nutrients and improve clinical outcome. Previous reviews have shown conflicting results with regard to the effects of nutrition support. To assess the benefits and harms of nutrition support versus no intervention, treatment as usual, or placebo in hospitalised adults at nutritional risk. We searched Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE (Ovid SP), Embase (Ovid SP), LILACS (BIREME), and Science Citation Index Expanded (Web of Science). We also searched the World Health Organization International Clinical Trials Registry Platform (www.who.int/ictrp); ClinicalTrials.gov; Turning Research Into Practice (TRIP); Google Scholar; and BIOSIS, as well as relevant bibliographies of review articles and personal files. All searches are current to February 2016. We include randomised clinical trials, irrespective of publication type, publication date, and language, comparing nutrition support versus control in hospitalised adults at nutritional risk. We exclude trials assessing non-standard nutrition support. We used standard methodological procedures expected by Cochrane and the Cochrane Hepato-Biliary Group. We used trial domains to assess the risks of systematic error (bias). We conducted Trial Sequential Analyses to control for the risks of random errors. We considered a P value of 0.025 or less as statistically significant. We used GRADE methodology. Our primary outcomes were all-cause mortality, serious adverse events, and health-related quality of life. We included 244 randomised clinical trials with 28,619 participants that met our inclusion criteria. We considered all trials to be at high risk of bias. Two trials accounted for one-third of all included participants. The included participants were heterogenous with regard to disease (20 different medical specialties). The experimental interventions were parenteral nutrition (86 trials); enteral nutrition (tube-feeding) (80 trials); oral nutrition support (55 trials); mixed experimental intervention (12 trials); general nutrition support (9 trials); and fortified food (2 trials). The control interventions were treatment as usual (122 trials); no inter