The impact of nutritional support on malnourished inpatients with aging-related vulnerability

Baumgartner, Annic; Pachnis, Daphne; Parra, Lucie; Hersberger, Lara; Bargetzi, Annika; Bargetzi, Laura; Kaegi-Braun, Nina; Tribolet, Pascal; Gomes, Filomena; Hoess, Claus; Pavlicek, Vojtech; Bilz, Stefan; Sigrist, Sarah; Braendle, Michael; Henzen, Christoph; Thomann, Robert; Rutishauser, Jonas; Aujesky, Drahomir; Rodondi, Nicolas; Donzé, Jacques; ... (2021). The impact of nutritional support on malnourished inpatients with aging-related vulnerability. Nutrition, 89, p. 111279. Elsevier 10.1016/j.nut.2021.111279

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Introduction

Malnutrition is highly prevalent in patients with aging-related vulnerability, defined by very old age (≥80 years), physical frailty or cognitive impairment, and increases risks for morbidity and mortality. The effects of individualized nutritional support in the acute hospital setting on mortality and other clinical outcomes remains understudied.

Methods

For this secondary analysis of the randomized-controlled EFFORT trial, we analyzed data of patients at nutritional risk (Nutritional Risk Screening 2002 [NRS] score ≥3 points) with aging-related vulnerability randomized to receive protocol-guided individualized nutritional support to reach specific protein and energy goals (intervention group), or to standard usual hospital food (control group). The primary endpoint was all-cause 30-day mortality.

Results

Of 881 patients with aging-related vulnerability, 23.4% presented with a frailty syndrome, 81.8% were ≥80 years of age and 15.3% showed cognitive impairment. Patients with aging-related vulnerability receiving individualized nutritional support compared to usual hospital food showed a more than 50% reduction in the risk of 30-day mortality (60/442 [13.6%] vs. 31/439 [7.1%], odds ratio 0.48 (95%CI 0.31 to 0.76), p=0.002). Significant improvements were also found for long-term mortality at 180 days, as well as functional improvements and quality of life measures.

Conclusion

Malnourished patients with aging-related vulnerability show a significant and clinically relevant reduction in the risk of mortality and other adverse clinical outcomes following individualized in-hospital nutritional support. These data support the early screening of patients with aging-related vulnerability for nutritional risk, followed by a nutritional assessment and implementation of individualized nutritional interventions.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Endocrinology, Diabetology and Clinical Nutrition
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

UniBE Contributor:

Aujesky, Drahomir; Rodondi, Nicolas; Donzé, Jacques and Stanga, Zeno

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0899-9007

Publisher:

Elsevier

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

28 Apr 2021 19:49

Last Modified:

16 Jun 2021 16:52

Publisher DOI:

10.1016/j.nut.2021.111279

PubMed ID:

34090212

BORIS DOI:

10.48350/156120

URI:

https://boris.unibe.ch/id/eprint/156120

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