The impact of nutritional support on malnourished inpatients with aging-related vulnerability

Objectives: Malnutrition is highly prevalent in patients with aging-related vulnerability defined by very old
age (�80 y), physical frailty or cognitive impairment, and increases the risks for morbidity and mortality. The
effects of individualized nutritional support for patients with aging-related vulnerability in the acute hospital
setting on mortality and other clinical outcomes remains understudied.
Methods: For this secondary analysis of the randomized-controlled Effect of Early Nutritional Support
on Frailty, Functional Outcomes, and Recovery of Malnourished Medical Inpatients Trial (EFFORT), we
analyzed data of patients at a nutritional risk (Nutritional Risk Screening 2002 score �3 points) with
aging-related vulnerability, randomized to receive protocol-guided individualized nutritional support
to reach specific protein and energy goals (intervention group) or routine hospital food (control group).
The primary endpoint was all-cause 30-d mortality.
Results: Of the 881 patients with aging-related vulnerability, 23.4% presented with a frailty syndrome, 81.8%
were age �80 y and 15.3% showed cognitive impairment. Patients with aging-related vulnerability receiving
individualized nutritional support compared with routine hospital food showed a >50% reduction in the risk
of 30-day mortality (60 of 442 [13.6%] versus 31 of 439 [7.1%]; odds ratio: 0.48; 95% confidence interval,
0.31�0.76; P = 0.002). Significant improvements were also found for long-term mortality at 180 days, as well
as functional outcomes and quality of life measures.