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

Introduction

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

Methods

For this secondary analysis of the randomized-controlled EFFORT trial, we analyzed data of patients at nutritional risk (Nutritional Risk Screening 2002 [NRS] 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 to standard usual hospital food (control group). The primary endpoint was all-cause 30-day mortality.

Results

Of 881 patients with aging-related vulnerability, 23.4% presented with a frailty syndrome, 81.8% were ≥80 years of age and 15.3% showed cognitive impairment. Patients with aging-related vulnerability receiving individualized nutritional support compared to usual hospital food showed a more than 50% reduction in the risk of 30-day mortality (60/442 [13.6%] vs. 31/439 [7.1%], odds ratio 0.48 (95%CI 0.31 to 0.76), p=0.002). Significant improvements were also found for long-term mortality at 180 days, as well as functional improvements and quality of life measures.

Conclusion

Malnourished patients with aging-related vulnerability show a significant and clinically relevant reduction in the risk of mortality and other adverse clinical outcomes following individualized in-hospital nutritional support. 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.