Dietary advice for illness-related malnutrition in adults

  • Review
  • Intervention

Authors

  • C Baldwin,

  • T Parsons,

  • S Logan


Ms Christine Baldwin, Research Dietitian, c/o Cochrane CF & Genetic Disorders Group, Institute of Child Health, University of Liverpool, RLCH NHS Trust, Eaton Road, Liverpool, L12 2AP, UK. c.baldwin@ic.ac.uk.

Abstract

Background

Illness-related malnutrition has been reported in 10% to 55% of ill people in hospital and the community in areas of food sufficiency. Dietary advice encouraging the use of energy- and nutrient-rich foods rather than oral nutritional supplements has been suggested for managing illness-related malnutrition.

Objectives

To examine evidence that dietary advice to improve nutritional intake in adults with illness-related malnutrition improves survival, weight and anthropometry; to estimate the size of any additional effect of nutritional supplements given in combination with dietary advice.

Search strategy

Relevant publications were identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Additional studies were sought by contacting dietitians, clinicians and the manufacturers of nutritional supplements.

Last search: October 2006

Selection criteria

Randomised controlled trials of dietary advice in people with illness-related malnutrition compared with:
(1) no advice;
(2) oral nutritional supplements; and
(3) dietary advice plus oral nutritional supplements.

Data collection and analysis

Two authors independently assessed trial eligibility, methodological quality and extracted data.

Main results

Thirty-five studies (37 comparisons) met the inclusion criteria with 2648 randomised participants. Twelve trials (comparing dietary advice plus supplements if required with no advice) identified during searching are included as a separate comparison. Follow up ranged from 18 days to 24 months. No comparison showed a significant difference in mortality. Significant improvements in weight at three months were found for groups receiving dietary advice plus nutritional supplements compared with dietary advice alone, WMD 1.68 kg (95% CI 0.14 to 3.21) or no additional advice, WMD 1.97 (95% CI 0.07 to 3.86). There were significant improvements in grip strength and mid-arm muscle circumference in the advice plus supplement groups compared with dietary advice alone. It is uncertain whether nutritional supplements and dietary advice produce the same effects. No significant differences were found between groups for clinical outcomes.

Few data were available for other outcomes.

Authors' conclusions

This review highlights the lack of evidence for the provision of dietary advice in managing illness-related malnutrition. Dietary advice plus nutritional supplements may be more effective than dietary advice alone or no advice in enhancing short-term weight gain, but whether this is sustainable, or whether survival and morbidity are improved remains uncertain. A large adequately-powered randomised controlled trial is needed comparing the efficacy of different therapies to increase dietary intake in people with illness-related malnutrition and examining the impact of this on clinical function and survival.

Plain language summary

Plain language summary

Oral nutritional supplements are more effective than dietary advice in improving body weight and energy intake in people with illness-related malnutrition

Ill people often eat less than usual. If this reduced food intake is prolonged, it can cause weight loss, malnutrition and death. Counselling may be offered to encourage good eating habits of high-protein and high-energy foods so that weight can be gained and the person's nutritional status improved. Oral nutritional supplements are also offered. The review of studies found that counselling (dietary advice) with oral nutritional supplements is more effective than counselling alone or no help with food in the short-term improvement of body weight and energy intake in people with illness-related malnutrition. There was not enough information to know whether any method of improving nutritional intake resulted in fewer deaths and patients doing better. More research is needed to work out the best ways to help ill people with weight loss to improve their nutritional intake and identify whether improvements in nutrition result in fewer deaths and in patients doing better.