Summary of findings for the main comparison. Supportive interventions for enhancing dietary intake versus comparators in malnourished or nutritionally at‐risk adults.
| Supportive interventions compared with usual care for malnourished or nutritionally at‐risk adults | ||||||
| Population: malnourished or nutritionally at‐risk adults Settings: residential care (21 trials), hospital (15 trials), outpatients (5 trials) Intervention: supportive interventions for enhancing dietary intake (changes to the organisation of nutritional care, changes to the feeding environment, modification of meal profile or pattern, additional supplementation of meals, congregate and home meal delivery systems) Comparison: usual care | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (trials) | Quality of the evidence (GRADE) | Comments | |
| Usual care | Supportive interventions | |||||
| All‐cause mortality Follow‐up: duration of hospital stay to 12 months | 133 per 1000 | 107 per 1000 (92 to 124) | RR 0.78 (0.66 to 0.92) | 6683 (12) | ⊕⊕⊕⊝ moderatea | ‐ |
|
Morbidity/complications (number of participants with any medical complication) Follow‐up: duration of hospital stay to 6 months |
See comment | See comment | See comment | 4015 (5) | ⊕⊝⊝⊝ very lowb | No summary effect size calculated because of high inconsistency; RR ranged from 0.59 in favour of supportive interventions to 1.42 in favour of usual care |
|
Health‐related quality of life and patient satisfaction Follow‐up: duration of hospital stay to 12 months |
See comment | See comment | See comment | 4451 (5) | ⊕⊕⊝⊝ lowc | 5/41 trials investigated health‐related quality of life using different instruments in participants from a wide range of different clinical backgrounds; overall we noted no substantial differences between intervention and comparator groups 2/41 trials investigated patient satisfaction by means of an unvalidated questionnaire |
| Hospitalisation and institutionalisation (days) Follow‐up: 8 days to 4 months | The mean hospitalisation ranged across control groups from 10 days to 40 days | The mean hospitalisation in the intervention groups was 0.5 days shorter (2.6 days shorter to 1.6 days longer) | ‐ | 667 (5) | ⊕⊝⊝⊝ very lowd | 3/5 trials with data on hospitalisation were in the group of trials of 'Changes to the organisation of nutritional care' |
|
Adverse events Follow‐up: 8 days to 6 months |
See comment | See comment | See comment | 4108 (3) | ⊕⊝⊝⊝ very lowe | Only 3/41 trials reported on adverse events (all evaluating the impact of supplementation of meals with oral nutritional supplements); 1 trial reported intolerance to the supplement (diarrhoea, vomiting) in 3/34 (15%) of participants. In another large trial 565/2017 (28%) of stroke patients stopped taking the oral nutritional supplements because of refusal or dislike of taste |
| Nutritional status (weight change in kg) Follow‐up: 8 days to 12 months | The mean weight change ranged across control groups from ‐3.0 kg to +0.3 kg | The mean weight change in the intervention groups was +0.6 kg higher (0.2 kg to 1.0 kg higher) | ‐ | 2024 (17) | ⊕⊕⊕⊝ moderatef | ‐ |
|
Economic costs Follow‐up: duration of hospital stay to 12 months |
See comment | See comment | See comment | 1152 (3) | ⊕⊝⊝⊝ very lowg | 3/41 trials evaluated and 2/41 trials reported some data on economic costs; none of the trials used accepted health economic methods and the reported data on both costs and effectiveness were generally poor |
| *The basis for the assumed risk (e.g. the median control group risk across trials) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
*aAssumed risk was derived from the event rates in the comparator groups (usual care)
aDowngraded by one level because of risk of bias in several risk of bias domains bDowngraded by three levels because of risk of bias in several risk of bias domains, serious inconsistency and imprecision cDowngraded by two levels because of risk of bias in several risk of bias domains, indirectness and few trials investigating health‐related quality of life in substantially diverse trial populations dDowngraded by three levels because of risk of performance bias and serious imprecision eDowngraded by three levels because of risk of bias in several risk of bias domains, imprecision and general substandard reporting of adverse events in included trials fDowngraded by one level because of imprecision gDowngraded by three levels because of risk of bias in several risk of bias domains, imprecision and few trials investigating economic costs with poor reporting, not using accepted health economic methods