Nina Kaegi-Braun1,2, Sara Germann1,2, Montserrat Faessli1,2, Fiona Kilchoer1,2, Saranda Dragusha3, Pascal Tribolet1,2, Filomena Gomes1,2,4,5, Céline Bretscher1,2, Nicolaas E Deutz6, Zeno Stanga7, Beat Mueller1,2, Philipp Schuetz8,9. 1. University Department of Medicine, Clinic for Endocrinology, Diabetology, and Metabolism, Kantonsspital Aarau, Aarau, Switzerland. 2. Medical Faculty of the University of Basel, Basel, Switzerland. 3. Medical Faculty of the Università della Svizzera italiana, Lugano, Switzerland. 4. Nutrition Science Program, The New York Academy of Sciences, New York, NY, USA. 5. NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal. 6. Center for Translational Research in Aging and Longevity, Department of Health & Kinesiology, Texas A&M University, College Station, TX, USA. 7. Division of Diabetology, Endocrinology, Nutritional Medicine, & Metabolism, University Hospital Inselspital Bern, University of Bern, Bern, Switzerland. 8. University Department of Medicine, Clinic for Endocrinology, Diabetology, and Metabolism, Kantonsspital Aarau, Aarau, Switzerland. Philipp.schuetz@ksa.ch. 9. Medical Faculty of the University of Basel, Basel, Switzerland. Philipp.schuetz@ksa.ch.
Abstract
BACKGROUND: There is increasing evidence from randomized controlled trials showing that different types of nutritional support interventions improve clinical outcomes in malnourished medical inpatients. Whether trials using micronutrient supplementation in addition to nutritional therapy are superior to trials without micronutrient supplementation remains unclear. METHODS: This is a secondary analysis of a systematic search and meta-analysis. We searched Cochrane Library, MEDLINE, and EMBASE electronic database from inception to December 15, 2020, for randomized controlled trials comparing the nutritional support interventions vs. usual care on all-cause mortality (primary endpoint) of medical inpatients with nutritional risk. We stratified trials based on whether or not micronutrient supplementation was used as part of the nutritional strategy. RESULTS: We included 23 randomized controlled trials (5 trials with and 18 trials without micronutrient supplementation) with a total of 6745 patients. Overall, mortality was significantly lower in patients receiving nutritional support compared to control group patients with an odds ratio of 0.74 (95% CI 0.59-0.94, p = 0.01). There was no difference between trials with and without micronutrient supplementation on mortality (odds ratio 0.70 (95% CI 0.46-1.08) vs. 0.77 (95% CI 0.57-1.04), I2 = 0%, p for subgroup difference = 0.73). Similarly, no differences in effect were found regarding non-elective readmissions and length of hospital stay. CONCLUSIONS: While nutritional support reduces mortality and improves other clinical outcomes, we did not find evidence that trials using micronutrient supplementation in addition to nutritional therapy were superior to trials with no supplementation. The role of micronutrient supplementation in addition to nutritional support needs further research.
BACKGROUND: There is increasing evidence from randomized controlled trials showing that different types of nutritional support interventions improve clinical outcomes in malnourished medical inpatients. Whether trials using micronutrient supplementation in addition to nutritional therapy are superior to trials without micronutrient supplementation remains unclear. METHODS: This is a secondary analysis of a systematic search and meta-analysis. We searched Cochrane Library, MEDLINE, and EMBASE electronic database from inception to December 15, 2020, for randomized controlled trials comparing the nutritional support interventions vs. usual care on all-cause mortality (primary endpoint) of medical inpatients with nutritional risk. We stratified trials based on whether or not micronutrient supplementation was used as part of the nutritional strategy. RESULTS: We included 23 randomized controlled trials (5 trials with and 18 trials without micronutrient supplementation) with a total of 6745 patients. Overall, mortality was significantly lower in patients receiving nutritional support compared to control group patients with an odds ratio of 0.74 (95% CI 0.59-0.94, p = 0.01). There was no difference between trials with and without micronutrient supplementation on mortality (odds ratio 0.70 (95% CI 0.46-1.08) vs. 0.77 (95% CI 0.57-1.04), I2 = 0%, p for subgroup difference = 0.73). Similarly, no differences in effect were found regarding non-elective readmissions and length of hospital stay. CONCLUSIONS: While nutritional support reduces mortality and improves other clinical outcomes, we did not find evidence that trials using micronutrient supplementation in addition to nutritional therapy were superior to trials with no supplementation. The role of micronutrient supplementation in addition to nutritional support needs further research.
Authors: Filomena Gomes; Philipp Schuetz; Lisa Bounoure; Peter Austin; María Ballesteros-Pomar; Tommy Cederholm; Jane Fletcher; Alessandro Laviano; Kristina Norman; Kalliopi-Anna Poulia; Paula Ravasco; Stephane M Schneider; Zeno Stanga; C Elizabeth Weekes; Stephan C Bischoff Journal: Clin Nutr Date: 2017-07-24 Impact factor: 7.324
Authors: Philipp Schuetz; Rebecca Fehr; Valerie Baechli; Martina Geiser; Manuela Deiss; Filomena Gomes; Alexander Kutz; Pascal Tribolet; Thomas Bregenzer; Nina Braun; Claus Hoess; Vojtech Pavlicek; Sarah Schmid; Stefan Bilz; Sarah Sigrist; Michael Brändle; Carmen Benz; Christoph Henzen; Silvia Mattmann; Robert Thomann; Claudia Brand; Jonas Rutishauser; Drahomir Aujesky; Nicolas Rodondi; Jacques Donzé; Zeno Stanga; Beat Mueller Journal: Lancet Date: 2019-04-25 Impact factor: 79.321
Authors: Martina R Bally; Prisca Z Blaser Yildirim; Lisa Bounoure; Viktoria L Gloy; Beat Mueller; Matthias Briel; Philipp Schuetz Journal: JAMA Intern Med Date: 2016-01 Impact factor: 21.873
Authors: Nicolaas E Deutz; Eric M Matheson; Laura E Matarese; Menghua Luo; Geraldine E Baggs; Jeffrey L Nelson; Refaat A Hegazi; Kelly A Tappenden; Thomas R Ziegler Journal: Clin Nutr Date: 2016-01-18 Impact factor: 7.324
Authors: Filomena Gomes; Annic Baumgartner; Lisa Bounoure; Martina Bally; Nicolaas E Deutz; Jeffrey L Greenwald; Zeno Stanga; Beat Mueller; Philipp Schuetz Journal: JAMA Netw Open Date: 2019-11-01