Summary of findings 3. Dietary advice compared with dietary advice plus oral nutritional supplements for disease‐related malnutrition in adults.
| Dietary advice compared with dietary advice plus 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 plus nutritional ONS Comparison: dietary 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 | |||||
| Dietary advice | Dietary advice plus nutritional ONS | |||||
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Mortality Follow‐up: up to 3 months |
74 per 1000 | 68 per 1000 (35 to 133) |
RR 0.92 (0.47 to 1.80) | 777 (10 studies) |
⊕⊕⊝⊝ lowa,b | The results for all other time points also suggest there may be little or no difference between the 2 groups. |
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Number of people admitted or re‐admitted to hospital Follow‐up: up to 3 months |
283 per 1000 | 481 per 1000 (294 to 784) |
RR 1.70 (1.04 to 2.77) | 114 (1 study) |
⊕⊕⊝⊝ lowc,d | The results for 4 to 6 months suggest there is probably no difference between dietary advice with or without nutritional ONS. |
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Length of hospital stay (days) Follow‐up: up to 3 months |
The mean length of hospital stay in the dietary advice group was 17.5 days. | The mean length of hospital stay in the dietary advice plus nutritional ONS group was 1.07 days lower (4.10 days lower to 1.97 days higher). | NA | 202 (2 studies) |
⊕⊕⊝⊝ lowc,d | |
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Complications Follow‐up: up to 3 months |
417 per 1000 | 313 per 1000 (234 to 413) |
RR 0.75 (0.56 to 0.99) | 317 (3 studies) |
⊕⊕⊝⊝ lowd,e | The results for 4 to 6 months suggest there may be little or no difference between the 2 groups. |
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Change in weight (kg) Follow‐up: up to 3 months |
The mean change in weight in the dietary advice group ranged from ‐5.86 kg to 2.2 kg. | The mean change in weight in the dietary advice plus nutritional ONS group was 1.15 kg higher (0.42 kg higher to 1.87 kg higher). | NA | 931 (14 studies) |
⊕⊕⊝⊝ lowa,d | The results for all other time points suggest there may be little or no difference between the 2 groups. |
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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 dietary advice group ranged from ‐0.1 kg to 0.9 kg. | The mean change in fat‐free mass in the dietary advice plus nutritional ONS group was 0.10 higher (0.18 lower to 0.39 higher). | NA | 187 (3 studies) |
⊕⊕⊝⊝ lowc,d | |
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Change in global QoL score Follow‐up: up to 3 months |
The mean change in global QoL score in the dietary advice group ranged from ‐9.55 to 2.0. | The mean change in global QoL score in the dietary advice plus nutritional ONS group was 0.33 higher (0.09 higher to 0.57 higher). | NA | 321 (4 studies) |
⊕⊕⊝⊝ lowd,f | The results for 4 to 6 months suggest there may be little or no difference between the two groups. |
| *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 risk of bias within the included trials; in 4 out of the 10 trials there were concerns around the randomisation process or allocation concealment, or both. All studies had concerns around blinding of outcome assessment.
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 imprecision caused by small sample size which does not reach the optimum information size.
d. Downgraded once due to indirectness as it is unclear whether the results are generalisable to other disease groups.
e. Downgraded once due to inconsistency; there is some heterogeneity in both the magnitude and direction of effect (I² = 58%).
f. 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.