Dietary advice for illness-related malnutrition in adults.

Full 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.

Learn Faster Today Improve your study skills

Author information

Author/s: Baldwin, C (C); Parsons, T (T); Logan, S (S);

Affiliation: Institute of Child Health, c/o Cochrane CF & Genetic Disorders Group, University of Liverpool, RLCH NHS Trust, Eaton Road, Liverpool, UK, L12 2AP. c.baldwin(-atsign-)ic.ac.uk

Journal and publication information

Publication Type: Journal Article; Meta-Analysis; Review

Journal: Cochrane database of systematic reviews (Online) (Cochrane Database Syst Rev), published in England. (Language: eng)

Reference: 2007-; vol (issue 1) : pp CD002008

Dates: Created 2007/01/26; Completed 2007/05/08; Revised 2008/11/21;

PMID: 17253472, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

UpdateIn: Cochrane Database Syst Rev. 2008;(1):CD002008. (PMID: 18254000)

UpdateOf: Cochrane Database Syst Rev. 2001;(2):CD002008. (PMID: 11406021)

External Links for this article (including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.

MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Disease
Humans
Nutrition Disorders - diet therapy; etiology; mortality
Nutritional Physiological Phenomena
Randomized Controlled Trials as Topic

These are the highest related articles currently in the database:

Vietnam, 1978: crisis in food, nutrition, and health. 27 Feb 1979
Dietary advice for illness-related malnutrition in adults. 30 Dec 2000
A problem-based nutrition care model that is diagnostic driven and allows for monitoring and managing outcomes. 30 Mar 2002
Activating the community for nutritional improvement. 30 May 2002
Position paper update for 2004. 30 Jan 2004
Principles of nutritional therapy. 29 Apr 1979
Exocrine pancreatic insufficiency and primitive malnutrition. 30 Dec 1976
Nutritional problems of hospitalized patients. A preliminary survey. 30 Aug 1977
Cystic fibrosis: nutrition. 29 Sep 1992
[Characteristics of nutrition and metabolism in patients with post-burn esophageal strictures] 29 Apr 1991

See 100+ related articles.