Schuetz P, et al. - In the Effect of early nutritional support on Frailty, Functional Outcomes, and Recovery of malnourished medical inpatients Trial (EFFORT), researchers determined whether protocol-guided, individualized nutritional support to reach protein and caloric goals lessens the risk of adverse clinical outcomes in medical inpatients at nutritional risk. They found that, in these at-risk patients, the use of individualized nutritional support during hospital stay improved clinical results, including survival, compared with standard hospital food. These outcomes strongly support the concept of systematically screening hospital admission of medical patients with regard to nutritional risk, regardless of their medical condition, followed by a nutritional assessment and the introduction of individualized nutritional support in patients at risk.

Methods

• Medical patients at nutritional risk (nutritional risk screening 2002 score of ≥ 3 points) who had an expected length of hospital stay of > 4 days were recruited from eight Swiss hospitals.
• These patients were randomized to receive either protocol-guided, individualized nutritional support to reach protein and caloric goals (intervention group) or standard hospital food (control group).
• Randomization was performed using an interactive web-response system with variable block sizes and stratification according to the study site and severity of malnutrition.
• Individualized nutritional support goals were defined by specialist dietitians, and nutritional support was initiated no later than 48 hours after admission in the intervention group.
• No dietary consultation was received by patients in the control group.
• The primary composite endpoint was any adverse clinical outcome defined as all-cause mortality, intensive care admission, non-elective hospital readmission, major complications, and 30-day decrease in functional status, and was measured in all randomized patients who completed the trial.

Results

• A total of 2,088 participants were recruited and monitored (intervention group, n=1,050; control group, n=1,038).
• During the course of the trial, 35 in the intervention group and 25 in the control group withdrew consent.
• Of the patients in the intervention group, caloric goals were achieved by 79%, and protein goals by 76% during the hospital stay.
• By 30 days, 23% patients in the intervention group had an adverse clinical outcome vs 27% in the control group.
• By day 30, 73 patients had died in the intervention group vs 100 patients in the control group.
• No difference was found in the proportion of patients who experienced side effects from nutritional support between the intervention and the control group.