Effectiveness of Medical Nutrition Therapy Provided by Registered Dietitian Nutritionists on Nutrition and Health Outcomes in Adults with Protein-Energy Malnutrition: A Systematic Review and Meta-Analysis.
Lisa Moloney, Violeta Chacón, Sri Lakshmi S Devarakonda, Terese Scollard, Samira Jones, Mary Rozga, Deepa Handu
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引用次数: 0
Abstract
Background: Malnutrition is associated with increased morbidities and mortality.
Objective: The aim of this systematic review and meta-analysis was to evaluate the effect of medical nutrition therapy (MNT) provided by a registered dietitian nutritionist or international equivalent compared with no MNT on nutritional status and health outcomes (eg, mortality, length of stay, readmissions, quality of life, weight, physical function, and cost-effectiveness) in adults with protein-energy malnutrition.
Methods: MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central, Food Science Sources, and SPORTDiscus databases were searched for observational and controlled trials published in English in peer-reviewed journals from 2000 to September 2024. Risk of bias was assessed using Cochrane Risk of Bias tools for randomized controlled trials (RCTs) and observational studies. Meta-analyses were conducted using the DerSimonian-Laird random-effects model. Certainty of evidence (COE) was assessed using the Grading of Recommendations, Assessment, and Evaluation method.
Results: Fifteen articles representing 11 studies (9 RCTs, 1 non-RCT, and 1 retrospective cohort) with 86 740 participants were included. Risk of bias for included studies were low (1 study), some concerns (7 studies), and high (3 studies). MNT may decrease length of stay, increase weight (inpatient), and improve quality of life (inpatient) (low COE). In adults with protein-energy malnutrition, the effect of MNT on nutritional status, calorie and protein intake, body mass index (BMI), handgrip strength, and cost-effectiveness is uncertain. The effect of MNT on mortality was uncertain in outpatient settings and conflicted in inpatient settings, with no effect in pooled RCTs (low COE) and reduced mortality in an observational study (moderate COE). Its effect on readmissions was also uncertain in an RCT but may reduce readmissions according to an observational study (moderate COE).
Conclusions: MNT may improve some outcomes (eg, length of stay, hospital readmissions, weight, and quality of life) in inpatients with protein-energy malnutrition, but evidence is uncertain for most outcomes (eg, nutritional status, mortality, weight, handgrip strength, and quality of life) in outpatient settings and requires more research.
期刊介绍：
The Journal of the Academy of Nutrition and Dietetics is the premier source for the practice and science of food, nutrition, and dietetics. The monthly, peer-reviewed journal presents original articles prepared by scholars and practitioners and is the most widely read professional publication in the field. The Journal focuses on advancing professional knowledge across the range of research and practice issues such as: nutritional science, medical nutrition therapy, public health nutrition, food science and biotechnology, foodservice systems, leadership and management, and dietetics education.
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