Individualized nutritional intervention during and after hospitalization: the nutrition intervention study clinical trial

Abstract

Objectives: To test the hypothesis that individualized nutritional treatment during and after discharge from acute hospitalization will reduce mortality and improve nutritional outcomes.

Design: Randomized, controlled trial.

Setting: Internal medicine departments.

Participants: Two hundred fifty-nine hospitalized adults aged 65 and older at nutritional risk were recruited and randomized according to hospitalization ward into one intervention and two control groups during hospitalization.

Intervention: Group 1 (intervention group) received individualized nutritional treatment from a dietitian in the hospital and three home visits after discharge. Group 2 received one meeting with a dietitian in the hospital. Group 3 received standard care. Groups 2 and 3 were combined into a single group that served as the control group in the analysis.

Measurements: Mortality, health status, nutritional outcomes, blood tests, cognition, emotional, and functional parameters were assessed at baseline and after 6 months. All participants were contacted monthly.

Results: The overall dropout rate was 25.8%. After 6 months, rise in Mini Nutritional Assessment score, adjusted for education and hospitalization ward, was significantly higher in the intervention group than in the control groups (3.01 ± 2.65 vs 1.81 ± 2.97, P =.004) mainly on the subjective assessment part (0.34 ± 0.86 vs. -0.04 ± 0.87, P=.004). The only laboratory parameter for which a difference was observed between the groups was albumin; 9.7% of the intervention group had serum albumin levels of less than 3.5 g/dL, versus 22.9% of the control group (P =.03). Mortality was significantly lower in the intervention group (3.8%) than in the control group (11.6%, P =.046).

Conclusion: Lower mortality and moderate improvement in nutritional status were found in patients receiving individualized nutritional treatment during and after acute hospitalization.