Summary of findings 2. Dietary advice compared with oral nutritional supplements for disease‐related malnutrition in adults.
| Dietary advice compared with nutritional ONS 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: nutritional ONS | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Nutritional ONS | Dietary advice | |||||
|
Mortality Follow‐up: up to 3 months |
74 per 1000 | 49 per 1000 (25 to 93) |
RR 0.66 (0.34 to 1.26) | 576 (8 studies) |
⊕⊕⊝⊝ lowa,b | The results at all other time points also suggest there may be little or no difference between dietary advice and nutritional ONS. |
|
Number of people admitted or re‐admitted to hospital Follow‐up: up to 3 months |
115 per 1000 | 41 per 1000 (5 to 373) |
RR: 0.36 (0.04 to 3.24) | 50 (1 study) |
⊕⊕⊝⊝ lowa,c | The results for 4 to 6 months suggest nutritional ONS may reduce the number of people admitted or re‐admitted to hospital. |
|
Length of hospital stay (days) |
Not reported. | NA | NA | NA | ||
|
Complications |
Not reported. | NA | NA | NA | ||
|
Change in weight (kg) Follow‐up: up to 3 months |
The mean change in weight in the nutritional ONS group ranged from 0 kg to 3.2 kg. | The mean change in weight in the dietary advice group was 0.14 kg lower (2.01 kg lower to 1.74 kg higher). | NA | 517 (9 studies) |
⊕⊕⊝⊝ lowd,f | The results for 4 to 6 months also suggest there may be little or no difference between the 2 groups. |
|
Change in fat‐free mass (kg) Follow‐up: up to 3 months |
Not reported. | NA | NA | NA | ||
|
Change in global QoL score Follow‐up: up to 3 months |
The mean change in global QoL score in the nutritional ONS group ranged from ‐0.66 to 20. | The mean change in global QoL score in the dietary advice group was 1.26 higher (0.32 lower to 2.85 higher). | NA | 283 (4 studies) |
⊕⊕⊝⊝ lowd,e | The results for 12 months and over suggest dietary advice may improve global QoL scores. The results at all other time points suggest there may be little or no difference between dietary advice and nutritional ONS. |
| *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; ONS: oral nutritional supplements; 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 or small sample size or a combination of both.
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 due to indirectness; it is not clear whether the results of this single study would be generalisable to other disease groups.
d. 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.
e. 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.
f. Downgraded once due to heterogeneity: I2 value was 94%.