Individualized Nutritional Support versus Usual Care in Medical Inpatients at Risk of Malnutrition: Randomized Trial

Iff, Samuel; Jüni, Peter; Hodel, Estelle; Perrig, Martin; Leuenberger, Michèle; Sterchi, Anna-Barbara; Aubry, Emilie; Schütz, Philipp; Stanga, Zeno (2020). Individualized Nutritional Support versus Usual Care in Medical Inpatients at Risk of Malnutrition: Randomized Trial [Dataset]. 10.5281/zenodo.4098386

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Objective
To evaluate if medical inpatients at risk of malnutrition benefit from an individualized nutritional intervention in terms of clinical outcome
Design
Single-centre randomized controlled trial
Setting
All inpatients admitted to the Division of General Internal Medicine at a Swiss University Hospital
Participants
Screened patients with risk of malnutrition defined by a Nutritional Risk Screening (NRS 2002) total score of ≥3. Patients with severe organ malfunction or short life expectancy were excluded.
Interventions
Enrolled patients were randomly allocated (1:1) to receive individualized nutritional support or usual care. Both groups received standard hospital meals. In the intervention group, the target was to ensure an oral, enteral or parenteral intake above 75% of the estimated energy requirements.
Outcome measures
Length of hospital stay was the powered primary endpoint. Pre-specified secondary endpoints included quality of life, readmissions, death, and the composite of death or protocol-specified complications.
Results
A total of 2207 admitted patients were screened and 263 randomized, 121 patients to the intervention, and 142 to usual care. In the intervention group, 59% of patients reached their caloric goals, compared to 40% in the control group. There were no significant differences between groups in length of hospital stay (HR 0.94, 95% CI 0.72, 1.22), death (HR 1.07, 95% CI 0.54, 2.09), readmissions (HR 1.09, 95% CI 0.61, 1.98), the composite of death or protocol-specified complications up to 8 weeks (HR 0.88, CI 95% 0.49, 1.58) or quality of life.
Conclusions
We found no evidence for a benefit of individualized nutritional support on length of stay, quality of life, death, readmissions, or the composite of death or protocol-specified complications up to 8 weeks in medical inpatients at risk of malnutrition admitted to a university hospital.

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