Department of Dietetic and Food Services, Changi General Hospital, Singapore, Singapore.
School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, Queensland, Australia.
JPEN J Parenter Enteral Nutr. 2022 Sep;46(7):1502-1521. doi: 10.1002/jpen.2395. Epub 2022 May 26.
Nutrition support is associated with improved survival and nonelective hospital readmission rates among malnourished medical inpatients; however, limited evidence supporting dietary counseling is available. We intend to determine the effect of dietary counseling with or without oral nutrition supplementation (ONS), compared with standard care, on hospitalized adults who are malnourished or at risk of malnutrition.
We searched MEDLINE/PubMed, CINAHL, Embase, Scopus, The Cochrane Library, and Google Scholar for studies listed from January 1, 2011, to August 31, 2021. Meta-analysis was performed to obtain pooled risk ratios (RRs) and 95% CIs to estimate the effect. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the certainty of the evidence.
Sixteen studies were identified. Compared with standard care, dietary counseling with or without ONS probably does not reduce inpatient rates of 30-day mortality (RR = 1.24; 0.60-2.55; I = 45%; P = 0.56; moderate certainty), slightly reduces 6-month mortality (RR = 0.83; 0.69-1.00; I = 16%; P = 0.06; high certainty), reduces complications (RR = 0.85; 0.73-0.98; I = 0%; P = 0.03; high certainty), and may slightly reduce readmission (RR = 0.83; 0.66-1.03; I = 55%; P = 0.10; low certainty) but may not reduce length of stay (mean difference: -0.75 days; -1.66-0.17; I = 70%; P = 0.11; low certainty). Intervention may result in slight improvements in nutrition status/intake and weight/body mass index (low certainty).
There is an increase in the certainty of evidence regarding the positive impact of dietary counseling on outcomes. Future studies should standardize and provide details/frequencies of counseling methods and ONS adherence to determine dietary counseling effectiveness.
营养支持与改善营养不良的住院患者的生存率和非选择性住院再入院率相关；然而，支持饮食咨询的证据有限。我们旨在确定饮食咨询加或不加口服营养补充（ONS）与标准护理相比，对营养不良或有营养不良风险的住院成人的影响。
我们检索了 MEDLINE/PubMed、CINAHL、Embase、Scopus、The Cochrane Library 和 Google Scholar，检索时间为 2011 年 1 月 1 日至 2021 年 8 月 31 日。采用荟萃分析获得汇总风险比（RR）和 95%置信区间（CI）来估计效果。采用推荐评估、制定与评价（GRADE）系统评估证据的确定性。
确定了 16 项研究。与标准护理相比，饮食咨询加或不加 ONS 可能不会降低 30 天住院死亡率（RR=1.24；0.60-2.55；I²=45%；P=0.56；中等确定性），略微降低 6 个月死亡率（RR=0.83；0.69-1.00；I²=16%；P=0.06；高确定性），减少并发症（RR=0.85；0.73-0.98；I²=0%；P=0.03；高确定性），可能略微降低再入院率（RR=0.83；0.66-1.03；I²=55%；P=0.10；低确定性），但不会减少住院时间（平均差值：-0.75 天；-1.66-0.17；I²=70%；P=0.11；低确定性）。干预可能会导致营养状况/摄入量和体重/体重指数略有改善（低确定性）。
关于饮食咨询对结局的积极影响，证据的确定性有所增加。未来的研究应标准化并提供饮食咨询方法和 ONS 依从性的详细信息/频率，以确定饮食咨询的效果。
