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. 2011 Sep 7;2011(9):CD002008.
doi: 10.1002/14651858.CD002008.pub4.

Dietary advice with or without oral nutritional supplements for disease-related malnutrition in adults

Christine Baldwin  1 , Christine Elizabeth Weekes
Affiliations

Dietary advice with or without oral nutritional supplements for disease-related malnutrition in adults

Christine Baldwin et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Disease-related malnutrition has been reported in 10% to 55% of people in hospital and the community. Dietary advice encouraging the use of energy- and nutrient-rich foods rather than oral nutritional supplements has been suggested as the initial approach for managing disease-related malnutrition.

Objectives: To examine evidence that dietary advice in adults with disease-related malnutrition improves survival, weight and anthropometry; to estimate the size of any additional effect of nutritional supplements combined with dietary advice and to compare the effects of dietary advice with oral nutritional supplements.

Search strategy: Relevant publications were identified from comprehensive electronic database searches and handsearching.Last search: 14 February 2010.

Selection criteria: Randomised controlled trials of dietary advice with or without oral nutritional supplements in people with disease-related malnutrition in any health-care setting compared with no advice, oral nutritional supplements or dietary advice given alone.

Data collection and analysis: Two authors independently assessed trial eligibility, risk of bias and extracted data.

Main results: Forty-five studies (3186 participants) met the inclusion criteria; (dietary advice compared with: no advice (1053 participants); with oral nutritional supplements (332 participants); with dietary advice and oral nutritional supplements (731 participants); and dietary advice plus oral nutritional supplements compared with no additional intervention (1070 participants). Follow-up ranged from 18 days to 24 months. No comparison showed a significant difference between groups for mortality or morbidity. There was a significant change in weight found between groups when comparing dietary advice to no advice for interventions lasting greater than 12 months, mean difference 3.75 kg (95% confidence interval 0.97 to 6.53), and when all studies were combined, mean difference 1.47 kg (95% confidence interval 0.32 to 2.61) although there was significant heterogeneity in the combined analysis (I(2) = 90%). Similar improvements in weight were found for the comparison of dietary advice with nutritional supplements if required versus no advice, mean difference 2.20 kg (95% confidence interval 1.16 to 3.25). Dietary advice compared with no advice was also associated with significantly improved mid-arm muscle circumference when all studies were combined, but with moderate heterogeneity, mean difference 0.81 mm (95% confidence interval 0.31 to 1.31). Dietary advice given with nutritional supplements compared with dietary advice alone resulted in improvements in: mid-arm muscle circumference, mean difference -0.89 mm (95% confidence interval -1.35 to -0.43); triceps skinfold thickness, mean difference -1.22 mm (95% confidence interval -2.34 to -0.09); and grip strength, mean difference -1.67 kg (95% confidence interval -2.96 to -0.37), although the effects on triceps skinfold thickness and grip strength were heterogeneous. Dietary advice with supplements if required resulted in a significant increase in triceps skinfold thickness compared with no advice, mean difference 0.40 mm (95% confidence interval 0.10 to 0.70), although these results are from a single trial with only 29 participants.

Authors' conclusions: Evidence of variable quality suggests that dietary advice with or without oral nutritional supplements may improve weight, body composition and grip strength. We found no evidence of benefit of dietary advice or oral nutritional supplements given alone or in combination on survival. Studies addressing the impact of nutritional interventions on nutritional, functional and patient-centred outcomes are needed.

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Conflict of interest statement

The first year of work on the protocol for this review was funded by the British Dietetic Association.

The authors of this review are both first authors of studies included in the review.

Figures

1
1
Funnel plot of comparison: 1 Dietary advice compared with no advice, outcome: 1.3 Change in weight (kg).
2
2
Funnel plot of comparison: 4 Dietary advice plus supplements if required compared with no advice, outcome: 4.3 Change in weight (kg).
1.1
1.1. Analysis
Comparison 1 Dietary advice compared with no advice, Outcome 1 Mortality.
1.2
1.2. Analysis
Comparison 1 Dietary advice compared with no advice, Outcome 2 Number of people admitted or readmitted to hospital.
1.3
1.3. Analysis
Comparison 1 Dietary advice compared with no advice, Outcome 3 Change in weight (kg).
1.4
1.4. Analysis
Comparison 1 Dietary advice compared with no advice, Outcome 4 Change in mid‐arm muscle circumference (MAMC) (cm).
1.5
1.5. Analysis
Comparison 1 Dietary advice compared with no advice, Outcome 5 Change in triceps skinfold thickness (mm).
1.6
1.6. Analysis
Comparison 1 Dietary advice compared with no advice, Outcome 6 Change in energy intake (kcal).
1.7
1.7. Analysis
Comparison 1 Dietary advice compared with no advice, Outcome 7 Change in grip strength (kg force).
2.1
2.1. Analysis
Comparison 2 Dietary advice compared with nutritional supplements, Outcome 1 Mortality.
2.2
2.2. Analysis
Comparison 2 Dietary advice compared with nutritional supplements, Outcome 2 Number of people admitted or readmitted to hospital.
2.3
2.3. Analysis
Comparison 2 Dietary advice compared with nutritional supplements, Outcome 3 Change in weight (kg).
2.4
2.4. Analysis
Comparison 2 Dietary advice compared with nutritional supplements, Outcome 4 Change in mid‐arm muscle circumference (MAMC) (cm).
2.5
2.5. Analysis
Comparison 2 Dietary advice compared with nutritional supplements, Outcome 5 Change in triceps skinfold thickness (TSF) (mm).
2.6
2.6. Analysis
Comparison 2 Dietary advice compared with nutritional supplements, Outcome 6 Change in energy intake (kcal).
2.7
2.7. Analysis
Comparison 2 Dietary advice compared with nutritional supplements, Outcome 7 Change in grip strength (kg force).
3.1
3.1. Analysis
Comparison 3 Dietary advice compared with dietary advice plus nutritional supplements, Outcome 1 Mortality.
3.2
3.2. Analysis
Comparison 3 Dietary advice compared with dietary advice plus nutritional supplements, Outcome 2 Number of people admitted or readmitted to hospital.
3.3
3.3. Analysis
Comparison 3 Dietary advice compared with dietary advice plus nutritional supplements, Outcome 3 Change in weight (kg).
3.4
3.4. Analysis
Comparison 3 Dietary advice compared with dietary advice plus nutritional supplements, Outcome 4 Change in weight (kg) without Beattie 2000 & Paton 2004.
3.5
3.5. Analysis
Comparison 3 Dietary advice compared with dietary advice plus nutritional supplements, Outcome 5 Change in mid‐arm muscle circumference (MAMC) (cm).
3.6
3.6. Analysis
Comparison 3 Dietary advice compared with dietary advice plus nutritional supplements, Outcome 6 Change in triceps skinfold thickness (TSF) (mm).
3.7
3.7. Analysis
Comparison 3 Dietary advice compared with dietary advice plus nutritional supplements, Outcome 7 Change in energy intake (Kcal).
3.8
3.8. Analysis
Comparison 3 Dietary advice compared with dietary advice plus nutritional supplements, Outcome 8 Change in grip strength (kg force).
4.1
4.1. Analysis
Comparison 4 Dietary advice plus supplements if required compared with no advice, Outcome 1 Mortality.
4.2
4.2. Analysis
Comparison 4 Dietary advice plus supplements if required compared with no advice, Outcome 2 Mortality using only Persson final time‐point.
4.3
4.3. Analysis
Comparison 4 Dietary advice plus supplements if required compared with no advice, Outcome 3 Change in weight (kg).
4.4
4.4. Analysis
Comparison 4 Dietary advice plus supplements if required compared with no advice, Outcome 4 Change in weight (kg) using only Persson final time‐point.
4.5
4.5. Analysis
Comparison 4 Dietary advice plus supplements if required compared with no advice, Outcome 5 Change in triceps skinfold thickness (TSF) (mm).
4.6
4.6. Analysis
Comparison 4 Dietary advice plus supplements if required compared with no advice, Outcome 6 Change in energy intake (Kcal).
4.7
4.7. Analysis
Comparison 4 Dietary advice plus supplements if required compared with no advice, Outcome 7 Change in grip strength (kg force).
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Jamieson 1997 {published data only}
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Rabinovitch 2006 {published data only}
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References to studies awaiting assessment

Margare 2002 {published data only}
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References to other published versions of this review

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