Effect of nutritional support on clinical outcome in patients at nutritional risk

• Published in: Clinical nutrition (Edinburgh, Scotland) Vol. 23; no. 4; pp. 539 - 550
• Main Authors: Johansen, Niels, Kondrup, Jens, Plum, Lise Munk, Bak, Line, Nørregaard, Pernille, Bunch, Else, Bærnthsen, Hanne, Andersen, Jens Rikardt, Larsen, Irene Højlund, Martinsen, Anette
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.08.2004; Elsevier
• Subjects: Anti-Bacterial Agents - therapeutic use; Biological and medical sciences; Female; Hospital; Hospitalization; Humans; Intervention; Length of Stay; Male; Medical sciences; Metabolic diseases; Middle Aged; Nutrition Disorders - complications; Nutrition Disorders - therapy; Nutritional Requirements; Nutritional Status; Nutritional Support - adverse effects; Other nutritional diseases (malnutrition, nutritional and vitamin deficiencies...); Quality of Life; Randomised controlled trial; Severity of Illness Index; Surveys and Questionnaires; Treatment Outcome; Undernutrition; Intervention; Hospital; Undernutrition; Randomised controlled trial; Length of stay; Human; Prognosis; Nutrition disorder; Risk factor; Hospitalization; Malnutrition; Food supplement
• ISSN: 0261-5614; 1532-1983
• DOI: 10.1016/j.clnu.2003.10.008

Background & Aims: Undernourished patients have an increased risk of complications and a prolonged hospital stay, compared to those who are not undernourished. The aim of this study was to evaluate the effect of nutritional intervention in a random sample of hospitalized patients at nutritional risk. Methods: A randomized, controlled trial of nutritional intervention in 212 patients. Intervention consisted of a specialized nutritional team (nurse and dietician) who attended patients and staff for motivation, detailed a nutritional plan, assured delivery of prescribed food and gave advice on enteral or parenteral nutrition when appropriate. The control group received the standard regime used in the department. The primary endpoint was the part of the length of stay (LOS) that was considered to be sensitive to nutritional support, designated LOS NDI. The nutritional discharge index (NDI) consists of three objective criteria: (1) the patient is able to manage toilet visits without assistance, reflecting mobilization; (2) the patient is without fever (tp<38°C), reflecting absence of infection; and (3) the patient has no intravenous access, reflecting absence of complications in general. On the day when all three criteria were fulfilled, hospital stay was no longer considered to be sensitive to nutritional support. Actual LOS is also reported. Incidence and severity of complications were recorded to explain LOS NDI findings. As a secondary endpoint, quality of life was evaluated by the Short Form 36 (SF-36) questionnaire. Results: Intervention led to an intake of ⩾75% of requirements in 62% of the intervention patients, as compared to 36% of the control patients. Rates of complications, mean LOS NDI and LOS were not significantly different between the two study groups. However, among patients with complications a difference in LOS NDI between intervention patients (14±2 days, mean±SE) and control patients (20±2 days) was statistically significant ( P=0.015). In the same patients, LOS was 17±2 days in the intervention group and 22±2 days in the control group ( P=0.028). The SF-36 questionnaire did not show a significant effect of treatment. Conclusions: Protein and energy intake of nutritionally at-risk patients was increased which resulted in shortening of the part of the length of stay that was considered to be sensitive to nutritional support (LOS NDI) and shorter length of stay (LOS) among patients with complications.