The impact of nutritional support on malnourished inpatients with aging-related vulnerability

Annic Baumgartner; Daphne Pachnis; Lucie Parra; Lara Hersberger; Annika Bargetzi; Laura Bargetzi; Nina Kaegi-Braun; Pascal Tribolet; Filomena Gomes; Claus Hoess; Vojtech Pavlicek; Stefan Bilz; Sarah Sigrist; Michael Braendle; Christoph Henzen; Robert Thomann; Jonas Rutishauser; Drahomir Aujesky; Nicolas Rodondi; Jacques Donzé; Zeno Stanga; Beat Mueller; Philipp Schuetz

doi:10.1016/j.nut.2021.111279

The impact of nutritional support on malnourished inpatients with aging-related vulnerability

Nutrition. 2021 Sep:89:111279. doi: 10.1016/j.nut.2021.111279. Epub 2021 Apr 22.

Authors

Annic Baumgartner¹, Daphne Pachnis¹, Lucie Parra¹, Lara Hersberger¹, Annika Bargetzi¹, Laura Bargetzi¹, Nina Kaegi-Braun², Pascal Tribolet³, Filomena Gomes⁴, Claus Hoess⁵, Vojtech Pavlicek⁵, Stefan Bilz⁶, Sarah Sigrist⁶, Michael Braendle⁷, Christoph Henzen⁸, Robert Thomann⁹, Jonas Rutishauser¹⁰, Drahomir Aujesky¹¹, Nicolas Rodondi¹², Jacques Donzé¹³, Zeno Stanga¹⁴, Beat Mueller¹, Philipp Schuetz¹⁵

Affiliations

¹ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland.
² Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.
³ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.
⁴ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; The New York Academy of Sciences, New York City, New York, USA.
⁵ Internal Medicine, Kantonsspital Muensterlingen, Switzerland.
⁶ Internal Medicine & Endocrinology/Diabetes, Kantonsspital St. Gallen, Switzerland.
⁷ Internal Medicine, Kantonsspital Luzern, Switzerland.
⁸ Department of Internal Medicine, Buergerspital Solothurn, Switzerland.
⁹ Internal Medicine, Kantonsspital Baselland, Switzerland.
¹⁰ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
¹¹ Institute of Primary Health Care, University of Bern, Switzerland.
¹² Institute of Primary Health Care, University of Bern, Switzerland; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
¹³ Institute of Primary Health Care, University of Bern, Switzerland; Department of medicine, Neuchâtel Hospital Network, Neuchâtel, Switzerland; Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Switzerland.
¹⁴ Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Switzerland.
¹⁵ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland. Electronic address: schuetzph@gmail.com.

PMID: 34090212
DOI: 10.1016/j.nut.2021.111279

Abstract

Objectives: Malnutrition is highly prevalent in patients with aging-related vulnerability defined by very old age (≥80 y), physical frailty or cognitive impairment, and increases the risks for morbidity and mortality. The effects of individualized nutritional support for patients with aging-related vulnerability in the acute hospital setting on mortality and other clinical outcomes remains understudied.

Methods: For this secondary analysis of the randomized-controlled Effect of Early Nutritional Support on Frailty, Functional Outcomes, and Recovery of Malnourished Medical Inpatients Trial (EFFORT), we analyzed data of patients at a nutritional risk (Nutritional Risk Screening 2002 score ≥3 points) with aging-related vulnerability, randomized to receive protocol-guided individualized nutritional support to reach specific protein and energy goals (intervention group) or routine hospital food (control group). The primary endpoint was all-cause 30-d mortality.

Results: Of the 881 patients with aging-related vulnerability, 23.4% presented with a frailty syndrome, 81.8% were age ≥80 y and 15.3% showed cognitive impairment. Patients with aging-related vulnerability receiving individualized nutritional support compared with routine hospital food showed a >50% reduction in the risk of 30-day mortality (60 of 442 [13.6%] versus 31 of 439 [7.1%]; odds ratio: 0.48; 95% confidence interval, 0.31-0.76; P = 0.002). Significant improvements were also found for long-term mortality at 180 days, as well as functional outcomes and quality of life measures.

Conclusions: Malnourished patients with aging-related vulnerability show a significant and clinically relevant reduction in the risk of mortality and other adverse clinical outcomes after individualized in-hospital nutritional support compared to routine hospital nutrition. These data support the early screening of patients with aging-related vulnerability for nutritional risk, followed by a nutritional assessment and implementation of individualized nutritional interventions.

Keywords: Dementia; Frailty; Geriatric; Malnutrition; Nutritional support.

Publication types

Randomized Controlled Trial

MeSH terms

Aged
Aging
Frail Elderly
Hospitalization
Humans
Inpatients*
Malnutrition* / therapy
Nutritional Status
Nutritional Support
Quality of Life