Summary of findings 1. Dietary advice compared with no advice for disease‐related malnutrition in adults.
| Dietary advice compared with no advice for disease‐related malnutrition in adults | ||||||
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Patient or population: adults with disease‐related malnutrition Settings: all healthcare settings Intervention: dietary advice Comparison: no advice | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| No advice | Dietary advice | |||||
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Mortality Follow‐up: up to 3 months |
67 per 1000 | 58 per 1000 (17 to 198) |
RR 0.87 (0.26 to 2.96) | 574 (7 studies) | ⊕⊕⊝⊝ lowa,b | The results at all other time points also suggest there may be little or no difference between dietary advice and no advice. |
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Number of people admitted or readmitted to hospital Follow‐up: up to 3 months |
See comments. | NA | NA | NA | The results at 4 to 6 months and 12 months and over suggest there may be little or no difference between dietary advice and no advice. | |
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Length of hospital stay (days) Follow‐up: up to 3 months |
The mean length of hospital stay in the no dietary advice group was 13.5 days. | The mean length of hospital stay in the dietary advice group was 1.10 days lower (1.35 days lower to 0.85 days lower). | NA | 148 (1 study) | ⊕⊕⊝⊝ lowc,d | The results at 4 to 6 months and 12 months and over suggest there may be little or no difference between dietary advice and no advice. |
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Complications Follow‐up: up to 3 months |
The mean number of complications in the no dietary advice group was 1.2. | The mean difference in the number of complications in the dietary advice group was 0.00 higher (0.32 lower to 0.32 higher). | NA | 148 (1 study) | ⊕⊕⊝⊝ lowc,d | The results at 4 to 6 months suggest there may be little or no difference between dietary advice and no advice. |
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Change in weight (kg) Follow‐up: up to 3 months |
The mean change in weight in the no dietary advice group ranged from ‐2.0 kg to 1.32 kg. | The mean change in weight in the dietary advice group was 0.97 kg higher (0.06 kg higher to 1.87 kg higher). | NA | 802 (10 studies) | ⊕⊕⊕⊝ lowe,f | The results at all other time points also suggest dietary advice may improve weight gain. |
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Change in fat‐free mass (kg) Follow‐up: up to 3 months |
The mean change in fat‐free mass in the no dietary advice group was ‐0.14 kg. | The mean change in fat‐free mass in the dietary advice group was 0.29 kg higher (0.11 kg lower to 0.69 kg higher). | NA | 98 (2 studies) | ⊕⊕⊝⊝ lowd,g | The results at 4 to 6 months also suggest there may be little or no difference between dietary advice and no advice. However, results at 12 months and over suggest that dietary advice may increase fat‐free mass. |
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Change in global QoL score Follow‐up: up to 3 months |
The mean change in global QoL score in the no dietary advice group ranged from ‐19.0 to 2.9. | The mean change in global QoL score in the dietary advice group was 3.30 higher (1.47 higher to 5.13 higher). | NA | 421 (5 studies) | ⊕⊕⊝⊝ lowg,h | The results at all other time points suggest there may be little or no difference between dietary advice and no advice. |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; QoL: quality of life; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence High certainty: further research is very unlikely to change our confidence in the estimate of effect. Moderate certainty: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low certainty: 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 certainty: we are very uncertain about the estimate. | ||||||
a. Downgraded once due to imprecision caused by low event rates.
b. Downgraded once due to indirectness; the studies included in this outcome look at mortality in different disease groups. Most of the deaths occurred in one study where the disease was cancer of the gastro‐intestinal tract and the results may be not be applicable across different diseases.
c. Downgraded once due to risk of bias in the single included trial for this outcome particularly across the domains of sequence generation and allocation concealment.
d. Downgraded once due imprecision caused by small sample size which doesn't meet the optimal information size.
e. Downgraded once due to indirectness: the studies included in this outcome look at different disease groups and the results of these studies may not be generalisable to other disease groups.
f. Downgraded once due to heterogeneity: I2 value was 88%.
g. Downgraded once due to risk of bias across several domains but particularly around randomisation and allocation concealment.
h. Downgraded once due to risk of bias within the included trials from concerns around blinding. Although it is not possible to blind this kind of intervention, knowledge of allocation could affect how participants score themselves with regard to QoL.