Which ‘nutritional models-of-care’ improve energy and protein intake, clinical outcomes and malnutrition in hospitalised patients?

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Abstract

Aim:

This systematic review examined studies for improvement in energy and protein intake, nutritional status, and clinical outcomes when specific nutritional models-of-care (protected mealtimes, feeding assistance, communal dining and the red tray initiative) were implemented in hospitalised acute and rehabilitation patients.

Methods:

An electronic database search was conducted on MEDLINE, Embase and CINAHL. Reference lists were also hand searched, and a key author search was completed. Two reviewers independently applied selection criteria and assessed trial quality.

Results:

A total of 172 articles were identified from the search strategy, and after application of inclusion and exclusion criteria, seven articles were included for final review. Most studies found a mean improvement in energy and protein intake from the implementation of the feeding assistance and communal dining models, although the overall quality of the evidence is low. No studies found a significant difference in weight, and the two trials measuring key clinical outcomes found no differences in length of stay and most markers of nutritional status; results for mortality were mixed. Protected mealtimes had a negative effect on energy and protein intake, although only one study was included for review; and no studies were found looking at the red tray initiative.

Conclusions:

While some of the evidence appears positive, this review highlights that there is a scarcity of high-quality evidence to support the use of specific nutritional models-of-care to improve energy and protein intake in hospitalised patients. Large-scale multicentre trials focusing more on primary outcomes of clinical relevance are still required.

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