Abstract
Pneumonia leads to changes in body composition and weakness due to the malnourished condition. In addition, patient family caregivers always have a lack of nutritional information, and they do not know how to manage patients’ nutritional intake during hospitalization and after discharge. Most intervention studies aim to provide nutritional support for older patients. However, whether long-term nutritional intervention by dietitians and caregivers from patients’ families exert clinical effects—particularly in malnourished pneumonia—on nutritional status and readmission rate at each interventional phase, from hospitalization to postdischarge, remains unclear. To investigate the effects of an individualized nutritional intervention program (iNIP) on nutritional status and readmission rate in older adults with pneumonia during hospitalization and three and six months after discharge. Eighty-two malnourished older adults with a primary diagnosis of pneumonia participated. Patients were randomly allocated to either a nutrition intervention (NI) group or a standard care (SC) group. Participants in the NI group received an iNIP according to energy and protein intake requirements in addition to dietary advice based on face-to-face interviews with their family caregivers during hospitalization. After discharge, phone calls were adopted for prescribing iNIPs. Anthropometry (i.e., body mass index, limb circumference, and subcutaneous fat thickness), blood parameters (i.e., albumin and total lymphocyte count), hospital stay, Mini-Nutritional Assessment-Short Form (MNA-SF) score, target daily calorie intake, total calorie intake adherence rate, and three-major-nutrient intakes were assessed during hospitalization and three and six months after discharge. Both groups received regular follow-up through phone calls. Furthermore, the rate of readmission resulting from pneumonia was recorded after discharge. During hospital stay, the NI group showed significant increases in daily calorie intake, total calorie intake adherence rate, and protein intake compared with the SC group (p < 0.05); however, no significant difference was found in anthropometry, blood biochemical values, MNA-SF scores, and hospital stay. At three and six months after discharge, the NI group showed significantly higher daily calorie intake and MNA-SF scores (8.2 vs. 6.5 scores at three months; 9.3 vs. 7.6 scores at six months) than did the SC group (p < 0.05). After adjusting for sex, the readmission rate for pneumonia significantly decreased by 77% in the NI group compared with that in the SC group (p = 0.03, OR: 0.228, 95% CI: 0.06–0.87). A six-month iNIP under dietitian and patient family nutritional support for malnourished older adults with pneumonia can significantly improve their nutritional status and reduce the readmission rate.
Highlights
According to the World Health Organization, 450 million people develop pneumonia each year, and approximately four million people die from this disease, accounting for 7% of the global population [1]
Pneumonia is defined as an infection process of the lung parenchyma, which results from the invasion and overgrowth of microorganisms, breaking down defenses, and provoking intra-alveolar exudates [2]
No significant differences were observed in age, the readmission rate, and number of comorbidities between the groups, but significant differences were observed in sex (p < 0.044) (Table 1)
Summary
According to the World Health Organization, 450 million people develop pneumonia each year, and approximately four million people die from this disease, accounting for 7% of the global population [1]. In a less active lifestyle, the consequence of the patients with pneumonia leads to malnutrition and higher mortality rates [3]. Patients with pneumonia become malnourished (e.g., protein-calorie malnutrition), exhibit declining health and changes in weight loss, and seriously impair respiratory muscle contractility and endurance [4]. Malnutrition leads to the development of pneumonia and weakens the physical activity and immune system [5]. Adequate nutrition directly aids respiratory muscle function and immune defense mechanisms and provides high immunity against environmental pathogens in the lungs to reduce potential disease progression [6,7]. The major role of nutrition in alleviating pneumonia is reducing malnutrition that induces high mortality and morbidity [8,9] and maintaining impaired respiratory muscle contractility [10].
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