Disease-associated malnutrition is common across all healthcare settings. Nevertheless, it remains inadequately treated, resulting in many significant, adverse effects to the patient and the healthcare system.
Malnutrition not only delays recovery from an illness, but it also exacerbates complications, hospital readmissions and the duration of hospitalization. Cawood and colleagues (2012) have conducted a first-of-its-kind systematic review involving 36 randomized, controlled trials with 3790 subjects (mean age 74 years; 83% of trials in patients >65 years) and a series of meta-analyses of high protein oral nutritional supplementation (ONS). In these studies, ONS was administered in the hospital or community setting or both. The patients were mostly elderly and included those with hip fractures, pressure ulcers, chronic obstructive pulmonary disease (COPD), cancer, gastrointestinal disease, and a range of critical and acute illnesses. The prescribed daily energy and protein intake from the high protein ONS ranged from 149 to 995 calories (mean 440 calories) and 10-60 grams of proteins (mean 29 grams). The results showed significant clinical, nutritional, and functional benefits, including a 19% reduction in associated complications, 10% decrease in the duration of hospitalization and a marked 30% decline in hospital readmissions. The findings also demonstrated an improvement in handgrip strength, increase in body weight and muscle mass, as well as an elevation in protein and energy intake.
The intervention ranged from short to long term (mean period of 3 months) across a range of patients (elderly patients 33% of trials; hip fracture 33% of trials), with varying nutritional status, and different care settings (hospital and community). In malnutrition patients whose inadequate dietary intake is due to poor appetite, the main purpose of prescribing high protein ONS is to increase protein intake. The analysis noted that the high protein ONS increased protein intake from a mean of 55 grams to 74 gram, a marked increase compared to the control group. Importantly, the studies showed that use of high protein ONS affected normal food intake only minimally. Improved nutritional intake is considered to be a key component of the causal pathway leading to clinical benefits. This improved intake may explain the significant increase in body weight and muscle mass, which can also explain the significant improvement in grip strength. A major finding of this systematic review was a significant overall reduction (19%) in a range of complications including healing of surgical wounds, pressure ulcers and infection rates.
This article is intended for medical professionals.
Prepared by:
Dr Reshma Ramracheya
Diabetes UK RD Lawrence Research Fellow
Senior Research Fellow at Wolfson College
University of Oxford, UK
Reshma.ramracheya@ocdem.ox.ac.uk
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