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

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.

Should we implement mealtime assistance in the hospital setting? A systematic literature review with meta‐analyses

“…Alternative settings‐based strategies to mealtime assistance in a hospital setting also warrant further exploration. As indicated in Wade and Flett's () systematic review, communal dining room patients had a statistically significant greater energy intake than patients who received usual care at their bedside, yet this did not lead to a significant increase in weight. Additionally, only one protected mealtime study was identified by Wade and Flett (), indicating that more trials in hospitals are needed to determine the efficacy of non‐nutritive malnutrition prevention strategies.…”

“…) published subsequent to Wade and Flett's () systematic review on ‘nutritional models‐of‐care’. Unlike research by Wade and Flett (), the current review includes anthropometric data as an objective measure of nutrition status, and focuses on particularly at‐risk hospitalised patients (as indicated by malnutrition prevalence rates in hospitalised older patients) (Adams et al . , Kaiser et al .…”

Assistance at mealtimes in hospital settings and rehabilitation units for older adults from the perspective of patients, families and healthcare professionals: a mixed methods systematic review protocol

“…Mealtime assistance has the potential to enhance nutritional intake, clinical outcomes, [26][27][28][29] and patient experience. 26,30 Four reviews [26][27][28][29] and one scoping review 31 have previously been conducted in this area.…”

“…26,30 Four reviews [26][27][28][29] and one scoping review 31 have previously been conducted in this area. All of the reviews included adult patients over 18 years of age.…”

“…The review was limited to quantitative study designs (randomized controlled trials, controlled trials and observational studies and audits). A systematic review by Wade et al 29 investigated nutritional models of care (feeding assistance, protected mealtimes, red tray initiative and communal dining) for hospitalized and rehabilitation inpatients. This review focused on data from trials only and only three databases were searched.…”