23 Dec Does Nutritional Support Benefit Hospitalized Patients?
MedicalResearch.com Interview with:
Philipp Schuetz, MD, MPH
University Department of Medicine
Clinic for Endocrinology/Metabolism/Clinical Nutrition,
Kantonsspital Aarau, Aarau, Switzerland
Medical Faculty of the University of Basel
Medical Research: What is the background for this study? What are the main findings?
Dr. Schuetz: Malnutrition is common in hospitalised patients and associated with detrimental metabolic consequences. The current clinical approach is to provide at risk patients nutritional support as a strategy to tackle malnutrition and its associated adverse outcomes. Yet, whether this strategy is effective and improves clinical outcomes in the medical inpatient population is unclear. In addition, recent trials from critical care have shown adverse outcomes when nutritional therapy was used too aggressively.
Herein, our metaanalysis is the first to systematically investigate effects of nutritional support in medical inpatients. Our analysis shows that nutritional support is highly effective in increasing energy and protein intake and helps to stabilize weight loss. Also, risk for unplanned readmission after discharge from the hospital was reduced and length of stay was shorter in the patient population with established malnutrition.
Yet, for other important clinical outcomes such as mortality and functional outcomes effects of nutritional support remained uncertain. Also, the quality of evidence was found to be moderate to low.
Medical Research: What should clinicians and patients take away from your report?
Dr. Schuetz: Most guidelines from the American Society for Parenteral and Enteral Nutrition (ASPEN) and the European Society for Clinical Nutrition and Metabolism (ESPEN) focus on specific medical disciplines (e.g., cancer patients, geriatric patients, sepsis) and/or organs (e.g., renal failure, wound healing) but give little guidance on polymorbid patients. Also, current recommendations are mostly based on pathophysiological considerations and evidence from smaller trials. As a consequence, general internists caring for polymorbid inpatients may have insufficient evidence for informed decision making in individual patients in regard to optimal use of nutritional therapy. Out study found that nutritional support is highly effective to increase energy and protein intake and also for stopping weight loss. The study also proofs some benefit on clinical outcomes and no evidence for harm. Still – further evidence is needed to better understand how nutritional therapy should be used to optimally impact on patients recovery – particularly for polymorbid medical inpatients.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Schuetz: Nutritional support using either oral nutrition – mainly via oral nutritional supplements (ONS) – or enteral feeding is one of the most common interventions in medicine. Still, there is a lack of comprehensive trial data demonstrating its beneficial effects on outcomes in the general medical inpatient population. This might explain why no standard nutritional algorithm for the use in polymorbid medical inpatients with malnutrition or risk for malnutrition exists today. Given the complex nature of nutritional therapy in regard to type of nutrition (e.g., amount and type of protein, total amount of calories), method of delivery (oral vs. enteral), timing and adherence, a comprehensive effectiveness research trial including a large and diverse patient population is needed to answer the question which patients show most benefits from nutritional therapy. In light of the results of our subgroup analysis, patients with established malnutrition and higher acuity patients may be more likely to have positive results.
In a second step, trials looking at specific nutritional aspects are needed to disentangle which nutritional components have positive influences on specific medical conditions (e.g., immuno-nutrition).
Philipp Schuetz, MD, MPH (2015). Does Nutritional Support Benefit Hospitalized Patients?