Research in context
Evidence before this study
Current clinical practice guidelines recommend to consider initiating nutritional support during the hospital stay of medical inpatients at risk of malnutrition. However, these recommendations are largely based on physiological rationales and observational studies, rather than interventional research. A systematic review and meta-analysis published in 2016 that focused on randomised trials investigating the effects of nutritional interventions on clinical outcomes in medical inpatients, found only 22 trials with a total of 3736 participants. Trials were mostly small and heterogeneous with overall low study quality. The pooled analysis showed that nutritional interventions increased caloric and protein intake, as well as patient weight, but there was no effect on mortality, functional outcomes, or length of hospital stay. Thus, based on current clinical trials, it is still unclear whether systematic screening for malnutrition in medical patients on their admission to hospital and introduction of nutritional support in patients at risk has positive effects on clinical outcomes.
Added value of this study
This pragmatic, large-scale, multicentre trial showed that early use of individualised nutritional support to reach protein and caloric goals in medical inpatients at nutritional risk is effective in increasing caloric and protein intakes and in lowering the risk of adverse outcomes and mortality within 30 days. Patients receiving nutritional support also had improvements in functional outcomes and quality of life. The beneficial effects of nutritional support were robust and comparable in subgroups according to patient age, sex, severity of nutritional risk, and underlying disease.
Implications of all the available evidence
Malnutrition is a highly prevalent condition in medical inpatients that negatively impacts clinical outcomes. In conjunction with results of earlier smaller trials and observational research, findings of EFFORT strongly support the concept of systematically screening medical inpatients on their admission to hospital regarding nutritional risk, independent of medical condition, followed by a nutritional assessment and introduction of individualised nutritional support in patients at risk.