Malnutrition for Hospitalized Adults: A Systematic Review

Project Summary Title and Description

Malnutrition for Hospitalized Adults: A Systematic Review
Objectives. To review the association between malnutrition and clinical outcomes among hospitalized patients, evaluate effectiveness of measurement tools for malnutrition on clinical outcomes, and assess effectiveness of hospital-initiated interventions for patients diagnosed with malnutrition. Data sources. We searched electronic databases (EMBASE, MEDLINE, PubMed, and the Cochrane Library) from January 1, 2000 to June 3, 2021. We hand-searched reference lists of relevant studies and searched for unpublished studies in Review methods. Using predefined criteria and dual review, we selected 1) existing systematic reviews (SRs) to assess the association between malnutrition and clinical outcomes, 2) randomized and non-randomized studies to evaluate the effectiveness of malnutrition measurement tools on clinical outcomes, and 3) randomized controlled trials (RCTs) to assess effectiveness of hospital-initiated treatments for malnutrition. Clinical outcomes of interest included mortality, length of stay, 30-day readmission, quality of life, functional status, activities of daily living, hospital acquired conditions, wound healing, and discharge disposition. When appropriate, we conducted meta-analysis to quantitatively summarize study findings; otherwise, data were narratively synthesized. When available, we used pooled estimates from existing SRs to determine the association between malnutrition with clinical outcomes and assessed the strength of evidence. Results. Six existing SRs (including 43 unique studies) provided evidence on the association between malnutrition and clinical outcomes. Low to moderate strength of evidence (SOE) showed an association between malnutrition and increased hospital mortality and prolonged hospital length of stay. This association was observed across patients hospitalized for an acute medical event requiring ICU care, heart failure, and cirrhosis. Literature searches found no studies that met inclusion criteria and assessed effectiveness of measurement tools. The primary reason studies did not meet inclusion criteria is because they lacked an appropriate control group. Moderate SOE from 11 RCTs found that hospital-initiated malnutrition interventions likely reduce mortality compared with usual care among hospitalized patients diagnosed with malnutrition. Low SOE indicated that hospital-initiated malnutrition interventions may also improve quality of life compared to usual care. Conclusions. Evidence shows an association between malnutrition and increased mortality and prolonged length of hospital stay among hospitalized patients identified as malnourished. However, the strength of this association varied depending on patient population and tool used to identify malnutrition. Evidence indicates malnutrition-focused hospital-initiated interventions likely reduce mortality and may improve quality of life compared to usual care among patients diagnosed with malnutrition. Research is needed to assess the clinical utility of measurement tools for malnutrition.
ECRI-Penn Medicine Evidence Based Practice Center
Authors of Report
Stacey Uhl, MS Shazia Mehmood Siddique, MD, MPH Liam McKeever, PhD, RDN Aaron Bloschichak, MPH Kristen D’Anci, PhD Brian Leas, MS, MA Nikhil K. Mull, MD Amy Y. Tsou, MD, MSc
Methodology description
Systematic Review
Data were entered into SRDR+ retrospectively from data extraction forms created using Word and Excel. Internet Citation: Systematic Review: Malnutrition in Hospitalized Adults. Content last reviewed October 2021. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD.
Funding Source
Agency for Healthcare Research and Quality

Key Questions

1. KQ1. What is the association between malnutrition and clinical outcomes among hospitalized adults?
2. KQ2. What is the effectiveness of screening or diagnostic assessment for malnutrition among hospitalized adults?
3. KQ3. Among patients diagnosed with malnutrition, what is the effectiveness of hospital-initiated interventions used to treat malnutrition on clinical outcomes?

Associated Extraction Forms


Associated Studies (each link opens a new tab)

Title Authors Year
Association Between Malnutrition and Clinical Outcomes in the Intensive Care Unit: A Systematic Review [Formula: see text]. Lew Charles Chin Han, Yandell Rosalie, Fraser Robert J L, Chua Ai Ping, Chong Mary Foong Fong, Miller Michelle 2017
Review of nutritional screening and assessment tools and clinical outcomes in heart failure. Lin Hong, Zhang Haifeng, Lin Zheng, Li Xinli, Kong Xiangqin, Sun Gouzhen 2016
Role of nutritional status in predicting the length of stay in cancer: a systematic review of the epidemiological literature. Gupta Digant, Vashi Pankaj G, Lammersfeld Carolyn A, Braun Donald P 2011
Effectiveness and efficacy of nutritional therapy: A systematic review following Cochrane methodology. Muscaritoli Maurizio, Krznarić Zeljko, Singer Pierre, Barazzoni Rocco, Cederholm Tommy, Golay Alain, Van Gossum André, Kennedy Nicholas, Kreymann Georg, Laviano Alessandro, Pavić Tajana, Puljak Livia, Sambunjak Dario, Utrobičić Ana, Schneider Stéphane M 2017
Systematic review with meta-analysis: Nutritional screening and assessment tools in cirrhosis. Ney Michael, Li Suqing, Vandermeer Ben, Gramlich Leah, Ismond Kathleen P, Raman Maitreyi, Tandon Puneeta 2020
Effect of nutritional support on clinical outcome in patients at nutritional risk. Johansen Niels, Kondrup Jens, Plum Lise Munk, Bak Line, Nørregaard Pernille, Bunch Else, Baernthsen Hanne, Andersen Jens Rikardt, Larsen Irene Højlund, Martinsen Anette 2004
Short-term individual nutritional care as part of routine clinical setting improves outcome and quality of life in malnourished medical patients. Starke Juliane, Schneider Heinz, Alteheld Birgit, Stehle Peter, Meier Rémy 2011
Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial. Schuetz Philipp, Fehr Rebecca, Baechli Valerie, Geiser Martina, Deiss Manuela, Gomes Filomena, Kutz Alexander, Tribolet Pascal, Bregenzer Thomas, Braun Nina, Hoess Claus, Pavlicek Vojtech, Schmid Sarah, Bilz Stefan, Sigrist Sarah, Brändle Michael, Benz Carmen, Henzen Christoph, Mattmann Silvia, Thomann Robert, Brand Claudia, Rutishauser Jonas, Aujesky Drahomir, Rodondi Nicolas, Donzé Jacques, Stanga Zeno, Mueller Beat 2019
Investigation of the benefits of early malnutrition screening with telehealth follow up in elderly acute medical admissions. Sharma Y, Thompson C H, Kaambwa B, Shahi R, Hakendorf P, Miller M 2017
Malnutrition and its effects in severely injured trauma patients. Dijkink Suzan, Meier Karien, Krijnen Pieta, Yeh D Dante, Velmahos George C, Schipper Inger B 2020
Nutritional Intervention in Malnourished Hospitalized Patients with Heart Failure. Bonilla-Palomas Juan L, Gámez-López Antonio L, Castillo-Domínguez Juan C, Moreno-Conde Mirian, López Ibáñez María C, Alhambra Expósito Rosa, Ramiro Ortega Esmeralda, Anguita-Sánchez Manuel P, Villar-Ráez Antonia 2016
Positive effect of protein-supplemented hospital food on protein intake in patients at nutritional risk: a randomised controlled trial. Munk T, Beck A M, Holst M, Rosenbom E, Rasmussen H H, Nielsen M A, Thomsen T 2014
Malnutrition screening and early nutrition intervention in hospitalised patients in acute aged care: a randomised controlled trial. Holyday M, Daniells S, Bare M, Caplan G A, Petocz P, Bolin T 2012
Prevention of malnutrition in older people during and after hospitalisation: results from a randomised controlled clinical trial. Gazzotti Claire, Arnaud-Battandier Franck, Parello Maria, Farine Sylvie, Seidel Laurence, Albert Adelin, Petermans Jean 2003
Individual, nutritional support prevents undernutrition, increases muscle strength and improves QoL among elderly at nutritional risk hospitalized for acute stroke: a randomized, controlled trial. Ha Lisa, Hauge Truls, Spenning Anne Bente, Iversen Per Ole 2010
Nutritional counseling improves quality of life and nutrient intake in hospitalized undernourished patients. Rüfenacht Ursula, Rühlin Maya, Wegmann Marlene, Imoberdorf Reinhard, Ballmer Peter E 2010
Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: A randomized clinical trial. Deutz Nicolaas E, Matheson Eric M, Matarese Laura E, Luo Menghua, Baggs Geraldine E, Nelson Jeffrey L, Hegazi Refaat A, Tappenden Kelly A, Ziegler Thomas R, NOURISH Study Group 2016

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