TABLE 1.
Main characteristics and outcomes reported of identified systematic reviews of oral nutritional supplement interventions in participants who were malnourished or at nutritional risk. Reviews are sorted by clinical background of patients (mixed clinical background or single clinical conditions) and by year of publication1
| Reference (first author) and year | Review aim | Search strategy | Number of included studies of ONS (n participants) | Healthcare setting | Nutritional status of participants | Outcomes reported | Outcomes reported in meta-analyses |
|---|---|---|---|---|---|---|---|
| Reviews in patients with mixed clinical backgrounds | |||||||
| Potter 1998 (19) | To assess the effectiveness of routinely prescribed oral or enteral protein energy supplements in improving body weight, anthropometry and survival of adults | MEDLINE only + contact with colleagues and manufacturers No language restrictions | 20 RCTs (1310) | Any setting | Not specified as an inclusion criterion. | Mortality, % change in weight, and anthropometry | Mortality, weight, anthropometry |
| Potter 2001 (20) (partialupdate of Potter1998) | To summarize the evidence available for nutritional supplementation | Not described | 30 RCTs (2132) | Any setting | Not specified as an inclusion criterion | Mortality, % change in weight, and anthropometry, LOS, institutionalization | Mortality |
| Stratton 1999 (17) | To assess the effects of oral nutritional supplementation in different groups of patients living in the community | MEDLINE, BIDS, NHS Research and Development Evidence-based Medicine, NHS Centre for Reviews and Dissemination, Cochrane Library + contact with experts and reference lists of included studies Language limits not specified | 45 RCTs (1728) 39 non-RCTs (842) | Community | Not specified as an inclusion criterion | Food intake, appetite, body weight, body structure, functional outcomes | % weight change |
| Stratton 2003 (16)[partial update ofStratton 1999 (17)] | To assess the effects of ONSs in patients in hospital and living in the community | MEDLINE, BIDS, NHS Research and Development Evidence-based Medicine, NHS Centre for Reviews and Dissemination, Cochrane Library + contact with experts and reference lists of included studies Language limits not specified | Acute: 34 RCTs (2475), 24 non-RCTs (1408) Community: 44 RCTs (2194) 64 non-RCTs (1553) | Acute and community | Not specified as an inclusion criterion | Food intake, total energy intake, weight, body composition, functional outcome, clinical outcomes, costs | Mortality, weight, complications |
| NICE 2006 (18) | To investigate the clinical and nutritional effects of oral nutritional interventions | Cochrane, MEDLINE, EMBASE, CINAHL, Allied and Complimentary Medicine, British Nursing Index + searching reference lists, guidelines, and reports Papers not in English excluded | 32 RCTs of ONSs (no dietary advice in either arm; 7200 participants) | Acute, community, and hospital outpatients | Included patients were malnourished or at risk of malnutrition (judged that >50% of participants would meet the definition of malnourished) in any healthcare setting, all clinical diagnoses | Mortality, complications, LOS, weight | Mortality, complications, LOS, weight |
| Vanderkroft 2007 (22) | To identify the best available practices in hospital that reduce or minimize the risk of undernutrition, especially for the older patient | MEDLINE, PREMEDLINE, CINAHL, Australasian Medical Index, AustHEALTH, EMBASE, Science Citation Index + Dissertation abstracts. All searches from 1980 only + searching reference lists and hand-searching of abstracts Studies not in English excluded | 13 RCTs (1957) and 2 non-RCTs (64) | Acute | Not specified as an inclusion criterion | Dietary intake, anthropometry, body composition (weight, BMI, skinfolds, AMC, and MAC), biochemical markers, mortality, LOS, prevalence or incidence of malnutrition, functional outcomes (grip strength and ADL) | Weight, TSF, AMC, MAC, albumin, mortality, LOS, prevalence or incidence of malnutrition, handgrip strength |
| Milne 2009 (23) | To assess the effects and acceptability of oral dietary supplements in elderly people (>65 y) | Cochrane, MEDLINE, EMBASE, Healthstar, CINAHL, BIOSIS, CAB, current controlled trials + contact with experts, hand-searching and reference lists of included studies Language limits not specified | 62 RCTs (10,187) | Any setting | Not specified as an inclusion criterion | Nutritional status, dietary intake, mortality, morbidity, complications, LOS, functional status, QoL, cost | Mortality, weight, complications, AMC, LOS, and grip strength |
| Cawood 2012 (21) | To examine whether high-protein ONSs have beneficial effects in clinical practice and the extent to which these are associated with high protein intake | PubMed, Cochrane, Clinical Evidence Database, National Electronics Library for Health guidelines finder, TRIP, CINAHL National Service Frameworks + contact with experts, searching reference lists Papers not in English excluded | 36 RCTs (3790) | Any setting | Malnourished and well nourished | Mortality, LOS, complications, readmissions, strength, QoL, ADL, dyspnea, mobility, intake, weight, appetite, body composition | Mortality, LOS, complications, readmissions, strength, weight, MAMC, energy and protein intake |
| Beck 2013 (24) | To estimate the effectiveness of oral nutritional support compared with placebo or usual care in improving readmissions, survival, nutritional status, functional status, quality of life and morbidity of older (≥65 y) medical and surgical patients after discharge from hospital | MEDLINE, Embase, Web of Science hand-searching of 3 relevant systematic reviews, searching of reference lists and related citations + publication status of any previously ongoing studies checked Papers not in English excluded | 6 RCTs (716) | On discharge from hospital | Malnourished or at nutritional risk | Primary: readmissions and death Secondary: energy and protein intake, nutritional status, functional status, quality of life and morbidity, compliance, and adverse events | Mortality and hospital readmissions |
| Stratton 2013 (37) | To critically review and synthesize the literature to assess the impact of ONSs used in the community setting across all patient groups on hospital admissions and readmissions | MEDLINE, EMBASE, Cochrane Library, DARE, NHSEED, Clinicaltrials.gov, ISRCTN, trial TROVE, hand-searching of reference lists, related systematic reviews and conference proceedings. No language limits specified | 9 RCTs (1316) | Patients living in the community | Any nutritional status | LOS, handgrip strength, overall healthcare use and expenditure, mortality, overall disability | Hospital readmissions |
| Feinberg 2017 (25) | To assess the benefits and harms of nutrition support vs. no intervention, treatment as usual, or placebo in hospitalized adults at nutritional risk | CENTRAL, MEDLINE, Embase, LILACS, BIOSIS, Web of Science, Clinitrials, TRIP, and Google scholar. Hand-searching of bibliographies of reviews and identified trials + conference proceedings and contact with companies making ONSs. No limits to search on publication type, status, or language | 55 RCTs (not reported) | Acute (hospitalized at the start of the intervention) | At nutritional risk according to specific criteria or characterized by trialists | Primary: all-cause mortality, serious adverse events, QoL Secondary: time to death, morbidity (defined by trialists), BMI, weight, hand-grip strength, 6-min walking distance | All-cause mortality, serious adverse events, BMI, weight |
| Reviews in patients with specific clinical backgrounds | |||||||
| Patients with cancer | |||||||
| Elia 2006 (35) | To determine the extent to which nutritional support vs. routine care improves the outcome of cancer patients receiving treatment or palliative care | PubMed, Cochrane, TRIP, Clinical Evidence, NELH, National Service Frameworks, checking of reference lists and contact with experts Full papers only included, abstracts excluded. No language limits | Not clearly reported. Results appear to be based on 7 RCTs (329) | Acute and community | Malnourished and well nourished | Energy and protein intake, weight, mortality, response to treatment | Mortality, energy intake |
| Patients with COPD | |||||||
| Ferreira 2012 (32) | To assess the impact of nutritional support on anthropometric measures, pulmonary function, respiratory and peripheral muscle strength, endurance, functional exercise capacity, and HRQoL in COPD | Cochrane, MEDLINE, Embase, CINAHL, AMED, psychINFO, hand-searching of previously published reviews, respiratory journals and abstracts, and contact with authors. No language limits | 17 RCTs (632) | Any setting | Not specified as an inclusion criterion | Weight, FFM, sum of skinfold measures, functional exercise capacity, pulmonary function, respiratory muscle strength, peripheral muscle strength, HRQoL | Weight, FFM, fat mass index, MAMC, skinfold measures and skinfolds + TSF combined, functional exercise capacity (12-min walk), pulmonary function (FEV1), respiratory muscle strength (MIP, MEP), peripheral muscle strength, HRQoL |
| Patients with hip fracture | |||||||
| Avenell 2016 (33) | To review the effects (benefits and harms) of nutritional interventions in older people recovering from hip fracture | Cochrane group specialized register, CENTRAL, MEDLINE, MEDLINE-in process, Embase, CAB Abstracts, CINAHL. Trial registers (ISRCTN, Clinicaltrials.gov, and UK Clinical Research), reference lists of articles and books, contact with colleagues and investigators. Results limited to 2008 because this is an update of a previous review No language restriction | 18 RCTs (1190) | Any setting | Both malnourished and well-nourished. Subgroup analysis specified "malnourished targeted vs. malnourished not targeted." | Primary: all-cause mortality, morbidity (postop complications); unfavorable outcome (number of participants who died + number of survivors with complications) Secondary: LOS, postop function, level of care required, QoL, fracture healing, putative side effects of treatment Other: patient tolerance/compliance, carer burden, economic | Mortality and number of people with complications |
| Patients with liver disease | |||||||
| Koretz 2012 (26) | To assess whether the nutritional interventions (ONS, enteral, parenteral) favorably impacted on the morbidity or mortality of patients with liver disease other than those that have undergone transplantation | Cochrane, MEDLINE, Embase, Science Citation Index expanded, clinicaltrials.gov, hand-searching, contact with experts and manufacturers. No language limits | 14 RCTs (987) | Any setting | Not specified as an inclusion criterion | Mortality, hepatic morbidity (appearance or failure of resolution of ascites or hepatic encephalopathy, GI bleed), QoL, adverse events, serum bilirubin, infection, postop complications, LOS, costs, nutritional status | Mortality, appearance of ascites, resolution of ascites, GI bleeding, encephalopathy (appearance and resolution), infections, serum bilirubin, albumin |
| Langer 2012 (27) | To assess the effect of enteral and parenteral nutrition as well as mono- and multinutrient supplements on morbidity and mortality of patients | Cochrane, MEDLINE, Embase, Science Citation Index, and Social Sciences citations index, contact with experts and manufacturers, checking reference | 2 RCTs (144) | Any setting | Not specified as an inclusion criterion | Acute rejections, new onset of diabetes, readmissions, occurrence of infections, changes in grade of hepatic encephalopathy, encephalopathy- | Rehospitalization, infections, acute rejections, new-onset diabetes, encephalopathy-related hospitalization, |
| before and after liver transplantation. For transplanted patients also to assess the effects of food on morbidity and mortality, which is commonly known for food–drug interactions | lists and hand-searching. No language limits | related admissions, mortality, time on waiting list | changes in grade of hepatic encephalopathy | ||||
| Ney 2013 (28) | To provide an up-to-date systematic review and meta-analysis of RCTs of oral or enteral nutritional supplementation on nutritional and clinical outcomes in adult patients with liver cirrhosis | MEDLINE, SCOPUS, Embase, and PubMed and searches of bibliographies of review articles Studies in English only | 4 RCTs (259) | Any setting | Not specified as an inclusion criterion | For ONS only mortality and weight. | Mortality and weight |
| Patients with pressure ulcers | |||||||
| Stratton 2005 (30) | To determine the effect of enteral nutritional support on pressure ulcer incidence, pressure ulcer healing, quality of life, complications, mortality, nutritional status (dietary intake, body weight), and any other clinically relevant outcome measures | PubMed, Cochrane, TRIP, Clinical Evidence, NELH, NSF, checking reference lists, and contact with experts. No language limits | 5 RCTs (1345) | Any setting | Malnourished and well nourished | Prevention of pressure ulcers, healing of pressure ulcers, complications, QoL, mortality, dietary intake, nutritional status | Prevention of pressure ulcers |
| Langer 2014 (29) | To evaluate the effect of enteral and parenteral nutrition on the prevention and treatment of pressure ulcers | Cochrane (CENTRAL + group specialist register), DARE, HTA, Cochrane methodology register, NHS Economic Evaluation Database, MEDLINE, Embase, CINAHL + 15 clinical trials registries (international) | 9 RCTs (6169) | Any setting | Not specified as an inclusion criterion | Development of new pressure ulcers (prevention), time to healing (treatment), acceptability, side effects, costs, rate of healing, rate of change in size of ulcer, QoL | Proportion of participants developing new pressure ulcers |
| Patients presurgery | |||||||
| Burden 2012 (31) | To evaluate if nutritional support intervention by any route prior to surgery improves clinical outcomes for elective GI surgical patients and to determine if nutritional support interventions provide any benefit to nutritional intake or nutritional status prior to elective GI surgery | EBM reviews, MEDLINE, Embase, AMED, British Nursing Index Archive, and reference lists of articles + author contact for abstracts. No limits to search specified | 3 RCTs (404) | Community/OPD prior to surgery | Not specified as an inclusion criterion | Total complications, infectious complications, LOS | Total complications, infectious complications, LOS |
| Patients poststroke | |||||||
| Geeganage 2012 (34) | To determine 1) if swallowing therapy improves clinical outcome, 2) the optimal administration of feeding and fluid administration, 3) if food supplementation improves clinical outcome. Nutritional supplementation with ONSs only considered for this overview | Cochrane, MEDLINE, Embase, CINAHL, conference proceedings citation index and Current Controlled Trials register, checking reference lists and review articles, contact with researchers. No language limits | 8 RCTs (4391) | Any settings | Malnourished or undernourished | Pressure sores, energy intake, protein intake, case fatality (end of trial), institutionalization, death/dependency at end of trial, LOS, albumin | Pressure sores, energy and protein intake, mortality (end of trial), institutionalization, LOS, albumin |
| Mixed conditions, reported according to individual clinical conditions | |||||||
| Koretz 2007 (36) | To evaluate the clinical efficacy (in different disease states) of medical interventions that deliver nutrients to the gut (ONS and EN). Includes: relevant data on perioperative period, nonsurgical cancer treatment, liver | 54 RCTs (not reported) | Any setting | Not specified as an inclusion criterion | Mortality, complications, LOS, costs, interventional complications, and disease-specific outcomes | Varied according to disease: Perioperative: mortality, total and infectious complications, LOS, nonsurgical cancer mortality Chronic liver disease: mortality, infectious | |
| disease, geriatrics, hip fracture | complications, encephalopathy Geriatrics: mortality, total and infectious complications Hip fracture: mortality, total and infectious complications | ||||||
1ADL, activities of daily living; AMC, arm muscle circumference; AMED, Allied and Complementary Medicine Database; BIDS, Bath Information & Data Services; CAB, Commonwealth Agricultural Bureau; COPD, chronic obstructive pulmonary disease; DARE, Database of Abstracts of Reviews of Effects; EBM, Evidence-based Medicine; EN, enteral nutrition; FEV1, forced expiratory volume; FFM, fat-free mass; GI, gastrointestinal; HRQoL, health-related quality of life; HTA, Health Technology Assessment; ISRCTN, International Standard Registered Clinical/soCial sTudy Number; LILACS, Latin American and Caribbean Health Sciences Literature; LOS, length of stay; MAC, mid-arm circumference; MAMC, mid-arm muscle circumference; MEP, maximal expiratory pressure; MIP, maximal inspiratory pressure; NELH, National Electronic Library for Health; NHS, National Health Service; NHSEED, NHS Economic Evaluation Database; NSF, National Science Foundatation; ONS: oral nutritional supplement; OPD: outpatient department; postop, postoperative; QoL, quality of life; RCT, randomized controlled trial; TRIP, Turning Research into Practice; TSF, triceps skinfold.