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

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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.


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.


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.


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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