Also reduces 30-day readmission rates

Hospitalized patients with malnutrition achieve a significant mortality benefit if they receive nutritional support, Swiss researchers found.

Their study, published in JAMA Network Open, showed that the in-hospital mortality rate was significantly lower among patients receiving nutritional support compared with those not receiving nutritional support. Researchers Nina Kaegi-Braun, MD, and colleagues, suggested that these results highlight the importance of nutritional support for patients hospitalized with malnutrition.

Malnutrition is a risk factor associated with adverse outcomes and, consequentially, is often diagnosed in the hospital — and the prevalence is quite high, with a recent Swiss study showing malnutrition rates of up to 27.8% in 2015. Furthermore, the authors pointed out that patients who are older and considered frail are likely to experience a reduction of appetite associated with disease-related malnutrition. The association between illness and malnutrition is bi-directional, with malnutrition associated with morbidity, mortality, functional decline, prolonged hospital stays, and higher health care costs.

Here, the authors conducted a population-based cohort study of Swiss patients using an administrative claims database that provided an almost complete sample of hospitalizations in the country.

Kaegi-Braun and colleagues screened all patients with malnutrition for nutritional support, including dietary advice, oral nutritional supplementation, and tube feeding or intravenous nutrition administration. The primary outcome of the trial was all-cause, in-hospital mortality.

The authors identified and propensity score matched 69,934 hospitalized patients diagnosed with malnutrition (mean age 73.8 years, 52.6% women). Of these, 5,597 patients died in the hospital, for an overall all-cause in-hospital mortality rate of 8.0%.

Among matched patients, 2,525 of 34,967 patients receiving nutritional support died, for a mortality rate of 7.2%, compared with 3,072 of 34,967 patients in the matched control group, for a mortality rate of 8.8% (IRR, 0.79 [95% CI, 0.75-0.84]).

The authors found that patients receiving nutritional support had reduced 30-day readmission rates compared with the matched reference group (5,950 of 32,442 patients [18.3%] versus 6,077 of 31,895 patients [19.1%]; IRR, 0.95 [95% CI, 0.91-0.98]). Additionally, they were less frequently admitted to post-acute care facilities compared with matched patients in the control group (13,691 patients [42.2%] versus 14,324 patients [44.9%]; OR, 0.89 [95% CI, 0.86- 0.91]).

Kaegi-Braun and colleagues also found that receiving nutritional support was associated with a greater reduction in mortality risk in patients with lower hospital frailty risk scores, as was nutritional intervention among patients with shorter hospital length of stays (<5 days).

“Whether this finding is directly associated with the nonbeneficial or even unfavorable associations of nutritional support in the critical care setting remains hypothetical,” wrote Kaegi-Braun and colleagues.

In a commentary accompanying the study William J. Evans, PhD, Department of Nutritional Sciences and Toxicology, University of California, Berkeley, noted that treating undernutrition and malnutrition in hospitalized patients presents a number of challenges.

“The potential influence of nutritional support on outcomes, particularly in patients who are very ill, is powerful,” Evans observed. And, while there is strong evidence that ignoring the nutritional status of malnourished patients results in poor outcomes, he also suggested that “evidence that nutrition support can improve these outcomes is mixed, particularly from prospective randomized trials.”

He noted that while the clinical presentation of malnutrition is weight loss, without the knowledge of components of changes in body composition accompanying that weight loss, there will be insufficient information for clinicians to enact targeted nutritional therapy.

“The inconsistent evidence from prospective studies that nutrition support results in reduced risk of mortality in hospitalized patients who are malnourished suggests that either many of these patients are not responsive to this intervention or that the type of nutrition support provided is nonspecific and not targeted to the cause of poor nutritional status,” Evans wrote.

“The results of Kaegi-Braun and colleagues1demonstrate that use of commercial enteral or total parenteral nutrition formulae may improve outcomes in some, but not all, patients who are very ill and malnourished,” Evans added. “Assessment of nutritional status and diagnosis of the cause of malnutrition are critically important in providing nutrients that treat both malnutrition and its causes.”

  1. Nutritional support for patients with malnutrition results in reduced in-hospital mortality, according to results from a Swiss population-based cohort study.

  2. Patients who received nutritional support also had reduced 30-day readmission rates and were less frequently discharged to post acute care facilities.

Michael Bassett, Contributing Writer, BreakingMED™

None of the authors cited in this article disclosed any relevant relationships.

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