Abstract
Malnutrition affects a considerable proportion of patients in the hospital and is associated with adverse clinical outcomes. Recent trials found a survival benefit among patients receiving nutritional support. To investigate whether there is an association of nutritional support with in-hospital mortality in routine clinical practice. This cohort study was conducted from April 2013 to December 2018 among a population of patients from Swiss administrative claims data. From 114 264 hospitalizations of medical patients with malnutrition, 34 967 patients (30.6%) receiving nutritional support were 1:1 propensity score matched to patients with malnutrition in the hospital who were not receiving nutritional support. Patients in intensive care units were excluded. Data were analyzed from February 2020 to November 2020. Receiving nutritional support, including dietary advice, oral nutritional supplementation, or enteral and parenteral nutrition. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were 30-day all-cause hospital readmission and discharge to a postacute care facility. Poisson and logistic regressions were used to estimate incidence rate ratios (IRRs) and odds ratios (ORs) of outcomes. After matching, the study identified 69 934 hospitalizations of patients coded as having malnutrition in the cohort (mean [SD] age, 73.8 [14.5] years; 36 776 [52.6%] women). Patients receiving nutritional support, compared with those not receiving nutritional support, had a lower in-hospital mortality rate (2525 of 34 967 patients died [7.2%] vs 3072 of 34 967 patients died [8.8%]; IRR, 0.79 [95% CI, 0.75-0.84]; P < .001) and a reduced 30-day readmission rate (IRR, 0.95 [95% CI, 0.91-0.98]; P = .002). In addition, patients receiving nutritional support were less frequently discharged to a postacute care facility (13 691 patients [42.2%] vs 14 324 patients [44.9%]; OR, 0.89 [95% CI, 0.86-0.91]; P < .001). These findings suggest that nutritional support was associated with reduced mortality among patients in the medical ward with malnutrition. The results support data found by randomized clinical trials and may help to inform patients, clinicians, and authorities regarding the usefulness of nutritional support in clinical practice.
Highlights
Malnutrition is defined as a state of insufficient intake or uptake of nutrients, leading to an altered body composition.[1]
Patients receiving nutritional support, compared with those not receiving nutritional support, had a lower in-hospital mortality rate (2525 of 34 967 patients died [7.2%] vs 3072 of 34 967 patients died [8.8%]; incidence rate ratio (IRR), 0.79 [95% CI, 0.75-0.84]; P < .001) and a reduced 30-day readmission rate (IRR, 0.95 [95% CI, 0.91-0.98]; P = .002)
These findings suggest that nutritional support was associated with reduced mortality among patients in the medical ward with malnutrition
Summary
Malnutrition is defined as a state of insufficient intake or uptake of nutrients, leading to an altered body composition.[1]. In light of the high number of patients with malnutrition in the hospital, awareness of the detrimental associations of malnutrition among patients with multiple conditions has increased.[8,9] While a 2016 study[10] did not find an association between nutritional interventions and mortality or other clinical outcomes, randomized clinical trials from 201911 and 201612 found that nutritional support reduced risks for mortality and complications and improved functional outcomes and quality of care. Current practice guidelines issued by the European Society for Clinical Nutrition and Metabolism[3] and the American Society for Parenteral and Enteral Nutrition[13] suggest screening for malnutrition, nutritional assessment, and nutritional support for inpatients with malnutrition
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
