Effect of Nutritional Intervention Programs on Nutritional Status and Readmission Rate in Malnourished Older Adults with Pneumonia: A Randomized Control Trial

Abstract

Pneumonia leads to changes in body composition and weakness due to the malnourished condition. In addition, patient family caregivers always have a lack of nutritional information, and they do not know how to manage patients' nutritional intake during hospitalization and after discharge. Most intervention studies aim to provide nutritional support for older patients. However, whether long-term nutritional intervention by dietitians and caregivers from patients' families exert clinical effects-particularly in malnourished pneumonia-on nutritional status and readmission rate at each interventional phase, from hospitalization to postdischarge, remains unclear. To investigate the effects of an individualized nutritional intervention program (iNIP) on nutritional status and readmission rate in older adults with pneumonia during hospitalization and three and six months after discharge. Eighty-two malnourished older adults with a primary diagnosis of pneumonia participated. Patients were randomly allocated to either a nutrition intervention (NI) group or a standard care (SC) group. Participants in the NI group received an iNIP according to energy and protein intake requirements in addition to dietary advice based on face-to-face interviews with their family caregivers during hospitalization. After discharge, phone calls were adopted for prescribing iNIPs. Anthropometry (i.e., body mass index, limb circumference, and subcutaneous fat thickness), blood parameters (i.e., albumin and total lymphocyte count), hospital stay, Mini-Nutritional Assessment-Short Form (MNA-SF) score, target daily calorie intake, total calorie intake adherence rate, and three-major-nutrient intakes were assessed during hospitalization and three and six months after discharge. Both groups received regular follow-up through phone calls. Furthermore, the rate of readmission resulting from pneumonia was recorded after discharge. During hospital stay, the NI group showed significant increases in daily calorie intake, total calorie intake adherence rate, and protein intake compared with the SC group (p < 0.05); however, no significant difference was found in anthropometry, blood biochemical values, MNA-SF scores, and hospital stay. At three and six months after discharge, the NI group showed significantly higher daily calorie intake and MNA-SF scores (8.2 vs. 6.5 scores at three months; 9.3 vs. 7.6 scores at six months) than did the SC group (p < 0.05). After adjusting for sex, the readmission rate for pneumonia significantly decreased by 77% in the NI group compared with that in the SC group (p = 0.03, OR: 0.228, 95% CI: 0.06-0.87). A six-month iNIP under dietitian and patient family nutritional support for malnourished older adults with pneumonia can significantly improve their nutritional status and reduce the readmission rate.

Keywords: caregiver; family care; hospital stay; malnutrition; nutritional intervention; respiratory disease.

Figure 1

CONSORT flow diagram.

Figure 2

Mini-Nutritional Assessment-Short Form (MNA-SF) scores of the nutritional intervention group and the standard care group; * p < 0.05 indicates a significant difference between the groups. # p < 0.05 indicates a significant difference compared to T0. T0 = during hospitalization; T1 = before discharge; T3 = 3 months after discharge; T6 = 6 months after discharge. n = 39 for NI, 43 for SC at T0; n = 39 for NI, 43 for SC at T1; n = 31 for NI, 33 for SC at T3; n = 29 for both NI and SC at T6, respectively.

Figure 3

Daily intake and calorie intake adherence rate in the NI and SC groups. * p < 0.05 indicates a significant difference between the groups. # p < 0.05 indicates a significant difference compared to T0. n = 39 for NI, 43 for SC at T0; n = 39 for NI, 43 for SC at T1; n = 31 for NI, 33 for SC at T3; n = 29 for both NI and SC at T6, respectively.