University Department of Medicine, Clinic for Endocrinology/Metabolism/Clinical Nutrition, Kantonsspital Aarau, Aarau, Switzerland2Medical Faculty of the University of Basel, Basel, Switzerland.
General Medicine, Dr M. Deppeler, Zollikofen, Switzerland.
JAMA Intern Med. 2016 Jan;176(1):43-53. doi: 10.1001/jamainternmed.2015.6587.
During acute illness, nutritional therapy is widely used for medical inpatients with malnutrition or at risk for malnutrition. Yet, to our knowledge, no comprehensive trial has demonstrated that this approach is effective and beneficial for patients.
To assess the effects of nutritional support on outcomes of medical inpatients with malnutrition or at risk for malnutrition in a systematic review of randomized clinical trials (RCTs).
The Cochrane Library, MEDLINE, and EMBASE. The study dates were October 5, 1982, to April 30, 2014, in various (mostly European) countries. The dates of our analysis were March 10, 2015, to September 16, 2015.
Based on a prespecified Cochrane protocol, we systematically searched RCTs investigating the effects of nutritional support (including counseling and oral and enteral feeding) in medical inpatients compared with a control group.
Two reviewers extracted data on study characteristics, methods, and outcomes. Disagreement was resolved by consensus.
The primary study outcome was mortality. Secondary outcomes included hospital-acquired infections, nonelective readmissions, functional outcome, length of hospital stay, daily caloric and protein intake, and weight change.
We included 22 RCTs with a total of 3736 participants. Heterogeneity across RCTs was high, with overall low study quality and mostly unclear risk of bias. Intervention group patients significantly increased their weight (mean difference, 0.72 kg; 95% CI, 0.23-1.21 kg), caloric intake (mean difference, 397 kcal; 95% CI, 279-515 kcal), and protein intake (mean difference, 20.0 g/d; 95% CI, 12.5-27.1 g/d) compared with control group patients. No differences between intervention group patients and control group patients were found with respect to mortality (9.8% vs 10.3%; odds ratio [OR], 0.96; 95% CI, 0.72-1.27), hospital-acquired infections (overall, 6.0% vs 7.6%; OR, 0.75; 95% CI, 0.50-1.11), functional outcome (mean Barthel index difference, 0.33 point; 95% CI, -0.88 to 1.55 points), or length of hospital stay (mean difference, -0.42 days; 95% CI, -1.09 to 0.24 days). Nonelective readmissions were significantly decreased by the intervention (20.5% vs 29.6%; risk ratio, 0.71; 95% CI, 0.57-0.87).
In medical inpatients, nutritional support increases caloric and protein intake and body weight. However, there is little effect on clinical outcomes overall except for nonelective readmissions. High-quality RCTs are needed to fill this gap.
在急性疾病期间，营养疗法被广泛用于患有营养不良或有营养不良风险的住院患者。然而，据我们所知，尚无全面的试验证明这种方法对患者有效和有益。
通过系统评价随机临床试验（RCT）来评估营养支持对患有营养不良或有营养不良风险的住院患者结局的影响。
Cochrane 图书馆、MEDLINE 和 EMBASE。研究日期为 1982 年 10 月 5 日至 2014 年 4 月 30 日，地点在不同的（主要是欧洲）国家。我们的分析日期为 2015 年 3 月 10 日至 2015 年 9 月 16 日。
根据预先制定的 Cochrane 方案，我们系统地搜索了 RCT，这些 RCT 调查了营养支持（包括咨询和口服及肠内喂养）与对照组相比对住院患者的影响。
两位评审员提取了研究特征、方法和结局的数据。意见分歧通过共识解决。
主要研究结局为死亡率。次要结局包括医院获得性感染、非选择性再入院、功能结局、住院时间、每日热量和蛋白质摄入量以及体重变化。
我们纳入了 22 项 RCT，共有 3736 名参与者。RCT 之间的异质性很高，总体研究质量较低，且大部分存在偏倚风险不明确。与对照组患者相比，干预组患者的体重（平均差异，0.72kg；95%置信区间，0.23-1.21kg）、热量摄入（平均差异，397kcal；95%置信区间，279-515kcal）和蛋白质摄入（平均差异，20.0g/d；95%置信区间，12.5-27.1g/d）均显著增加。干预组患者与对照组患者在死亡率（9.8%比 10.3%；比值比[OR]，0.96；95%置信区间，0.72-1.27）、医院获得性感染（总体，6.0%比 7.6%；OR，0.75；95%置信区间，0.50-1.11）、功能结局（平均巴氏指数差异，0.33 分；95%置信区间，-0.88 至 1.55 分）或住院时间（平均差异，-0.42 天；95%置信区间，-1.09 至 0.24 天）方面无差异。干预组患者的非选择性再入院率显著降低（20.5%比 29.6%；风险比，0.71；95%置信区间，0.57-0.87）。
在住院患者中，营养支持增加了热量和蛋白质的摄入和体重。然而，除了非选择性再入院外，总体上对临床结局几乎没有影响。需要高质量的 RCT 来填补这一空白。
