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Kaegi-Braun N, Kilchoer F, Dragusha S, Gressies C, Faessli M, Gomes F, Deutz NE, Stanga Z, Mueller B, Schuetz P. Nutritional support after hospital discharge improves long-term mortality in malnourished adult medical patients: Systematic review and meta-analysis. Clin Nutr 2022; 41:2431-2441. [DOI: 10.1016/j.clnu.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/08/2022] [Accepted: 09/21/2022] [Indexed: 11/25/2022]
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Kaegi-Braun N, Germann S, Faessli M, Kilchoer F, Dragusha S, Tribolet P, Gomes F, Bretscher C, Deutz NE, Stanga Z, Mueller B, Schuetz P. Effect of micronutrient supplementation in addition to nutritional therapy on clinical outcomes of medical inpatients: results of an updated systematic review and meta-analysis. Eur J Clin Nutr 2022; 76:964-972. [DOI: 10.1038/s41430-021-01061-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/22/2021] [Accepted: 12/08/2021] [Indexed: 11/09/2022]
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Kaegi-Braun N, Faessli M, Kilchoer F, Dragusha S, Tribolet P, Gomes F, Bretscher C, Germann S, Deutz NE, Stanga Z, Mueller B, Schuetz P. Nutritional trials using high protein strategies and long duration of support show strongest clinical effects on mortality.: Results of an updated systematic review and meta-analysis. Clin Nutr ESPEN 2021; 45:45-54. [PMID: 34620354 DOI: 10.1016/j.clnesp.2021.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/03/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND There is increasing evidence from randomized-controlled trials demonstrating that nutritional support improves clinical outcomes in the population of malnourished medical inpatients. We investigated associations of trial characteristics including clinical setting, duration of intervention, individualization of nutritional support and amount of energy and protein, and effects on clinical outcomes in an updated meta-analysis. METHODS We searched Cochrane Library, MEDLINE and EMBASE, from inception to December 15, 2020. Randomized-controlled trials investigating the effect of oral and enteral nutritional support interventions, when compared to usual care, on clinical outcomes of malnourished non-critically ill medical inpatients were included. Two reviewers independently extracted data and assessed risk of bias. The primary endpoint was all cause-mortality within 12-months. RESULTS We included 29 randomized-controlled trials with a total of 7,166 patients. Heterogeneity across RCTs was high, with overall moderate study quality and mostly moderate or unclear risk of bias. Overall, there was an almost 30%-reduction in mortality in patients receiving nutritional support compared to patients not receiving nutritional support (253/2960 [8.5%] vs. 336/2976 [11.3%]) with an odds ratio of 0.72 (95% CI 0.57 to 0.91, p = 0.006). The most important predictors for the effect of nutritional trials on mortality were high protein strategies (odds ratio 0.57 vs. 0.93, I2 = 86.3%, p for heterogenity = 0.007) and long-term nutritional interventions (odds ratio 0.53 vs. 0.85, I2 = 76.2%, p for heterogenity = 0.040). Nutritional support also reduced unplanned hospital readmissions and length of hospital stay. CONCLUSIONS There is increasing evidence from randomized trials showing that nutritional support significantly reduces mortality, unplanned hospital readmissions and length of stay in medical inpatients at nutritional risk, despite heterogeneity and varying methodological quality among trials. Trials with high-protein strategies and long-lasting nutritional support interventions were most effective.
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Affiliation(s)
- Nina Kaegi-Braun
- University Department of Medicine, Clinic for Endocrinology, Diabetology, and Metabolism, Kantonsspital Aarau, Switzerland and Medical Faculty of the University of Basel, Aarau, Basel, Switzerland
| | - Montserrat Faessli
- University Department of Medicine, Clinic for Endocrinology, Diabetology, and Metabolism, Kantonsspital Aarau, Switzerland and Medical Faculty of the University of Basel, Aarau, Basel, Switzerland
| | - Fiona Kilchoer
- University Department of Medicine, Clinic for Endocrinology, Diabetology, and Metabolism, Kantonsspital Aarau, Switzerland and Medical Faculty of the University of Basel, Aarau, Basel, Switzerland
| | - Saranda Dragusha
- Medical Faculty of the Università della Svizzera italiana, Switzerland
| | - Pascal Tribolet
- University Department of Medicine, Clinic for Endocrinology, Diabetology, and Metabolism, Kantonsspital Aarau, Switzerland and Medical Faculty of the University of Basel, Aarau, Basel, Switzerland
| | - Filomena Gomes
- University Department of Medicine, Clinic for Endocrinology, Diabetology, and Metabolism, Kantonsspital Aarau, Switzerland and Medical Faculty of the University of Basel, Aarau, Basel, Switzerland; Nutrition Science Program, The New York Academy of Sciences, New York, USA; NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Céline Bretscher
- University Department of Medicine, Clinic for Endocrinology, Diabetology, and Metabolism, Kantonsspital Aarau, Switzerland and Medical Faculty of the University of Basel, Aarau, Basel, Switzerland
| | - Sara Germann
- University Department of Medicine, Clinic for Endocrinology, Diabetology, and Metabolism, Kantonsspital Aarau, Switzerland and Medical Faculty of the University of Basel, Aarau, Basel, Switzerland
| | - Nicolaas E Deutz
- Center for Translational Research in Aging and Longevity, Department of Health & Kinesiology, Texas A&M University, College Station, USA
| | - Zeno Stanga
- Division of Diabetology, Endocrinology, Nutritional Medicine, & Metabolism, University Hospital Inselspital Bern, University of Bern, Bern, Switzerland
| | - Beat Mueller
- University Department of Medicine, Clinic for Endocrinology, Diabetology, and Metabolism, Kantonsspital Aarau, Switzerland and Medical Faculty of the University of Basel, Aarau, Basel, Switzerland
| | - Philipp Schuetz
- University Department of Medicine, Clinic for Endocrinology, Diabetology, and Metabolism, Kantonsspital Aarau, Switzerland and Medical Faculty of the University of Basel, Aarau, Basel, Switzerland.
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