Dietary Advice With or Without Oral Nutritional Supplements for Disease-Related Malnutrition in Adults

Cochrane Database Syst Rev. 2011 Sep 7; 2011(9):CD002008. doi: 10.1002/14651858.CD002008.pub4.
Baldwin, C., & Weekes, C. E.


Disease‐related malnutrition has been reported in 10% to 55% of people in hospital and the community. Dietary advice encouraging the use of energy‐ and nutrient‐rich foods rather than oral nutritional supplements has been suggested as the initial approach for managing disease‐related malnutrition.
To examine evidence that dietary advice in adults with disease‐related malnutrition improves survival, weight and anthropometry; to estimate the size of any additional effect of nutritional supplements combined with dietary advice and to compare the effects of dietary advice with oral nutritional supplements.
Search methods
Relevant publications were identified from comprehensive electronic database searches and handsearching.
Last search: 14 February 2010.
Selection criteria
Randomised controlled trials of dietary advice with or without oral nutritional supplements in people with disease‐related malnutrition in any health‐care setting compared with no advice, oral nutritional supplements or dietary advice given alone.
Data collection and analysis
Two authors independently assessed trial eligibility, risk of bias and extracted data.
Main results
Forty‐five studies (3186 participants) met the inclusion criteria; (dietary advice compared with: no advice (1053 participants); with oral nutritional supplements (332 participants); with dietary advice and oral nutritional supplements (731 participants); and dietary advice plus oral nutritional supplements compared with no additional intervention (1070 participants). Follow‐up ranged from 18 days to 24 months. No comparison showed a significant difference between groups for mortality or morbidity. There was a significant change in weight found between groups when comparing dietary advice to no advice for interventions lasting greater than 12 months, mean difference 3.75 kg (95% confidence interval 0.97 to 6.53), and when all studies were combined, mean difference 1.47 kg (95% confidence interval 0.32 to 2.61) although there was significant heterogeneity in the combined analysis (I2 = 90%). Similar improvements in weight were found for the comparison of dietary advice with nutritional supplements if required versus no advice, mean difference 2.20 kg (95% confidence interval 1.16 to 3.25). Dietary advice compared with no advice was also associated with significantly improved mid‐arm muscle circumference when all studies were combined, but with moderate heterogeneity, mean difference 0.81 mm (95% confidence interval 0.31 to 1.31). Dietary advice given with nutritional supplements compared with dietary advice alone resulted in improvements in: mid‐arm muscle circumference, mean difference ‐0.89 mm (95% confidence interval ‐1.35 to ‐0.43); triceps skinfold thickness, mean difference ‐1.22 mm (95% confidence interval ‐2.34 to ‐0.09); and grip strength, mean difference ‐1.67 kg (95% confidence interval ‐2.96 to ‐0.37), although the effects on triceps skinfold thickness and grip strength were heterogeneous. Dietary advice with supplements if required resulted in a significant increase in triceps skinfold thickness compared with no advice, mean difference 0.40 mm (95% confidence interval 0.10 to 0.70), although these results are from a single trial with only 29 participants.
Authors' conclusions
Evidence of variable quality suggests that dietary advice with or without oral nutritional supplements may improve weight, body composition and grip strength. We found no evidence of benefit of dietary advice or oral nutritional supplements given alone or in combination on survival. Studies addressing the impact of nutritional interventions on nutritional, functional and patient‐centred outcomes are needed.

Information NutriBib

Reference work for leading, current and selected literature in the field of clinical nutrition

Publications on clinical nutrition have grown steadily in recent years and the scientific evidence has been improved by numerous observational as well as intervention studies. Various umbrella organisations, such as the Swiss Society for Clinical Nutrition (GESKES), the German Society for Nutritional Medicine (DGEM) or the European Society for Clinical Nutrition and Metabolism (ESPEN) publish guidelines on nutrition in various clinical situations at regular intervals. Thus, a large amount of literature is available for evidence-based nutritional medicine.

The NutriBib aims to filter out authoritative publications in the various fields of nutritional medicine and thus to provide an overview of the abundance of literature. A large number of experienced nutrition experts contributed to the selection of relevant sources and allow a broadly based selection. Nevertheless, the literature selection cannot be considered exhaustive. Specific literature can be found by entering search words (using the magnifying glass at the top right) or by searching the table of contents.

Is important literature still missing? We would be very pleased to hear from you:

List of abbreviations

DGEM German Society for Nutritional Medicine (German Deutsche Gesellschaft für Ernährungsmedizin)
GESKES  Swiss Society for Clinical Nutrition (German Gesellschaft für klinische Ernährung der Schweiz) 
ESPEN European Society of Clinicl Nutrition and Metabolism