In-hospital personalized nutrition may improve clinical treatment, study finds

29 Apr 2019 --- Personalized nutrition can boost hospital patients’ consumption of protein and calories, as well as improve clinical treatment outcomes, according to a new study published in The Lancet. Researchers from the University of Basel and Aarau Cantonal Hospital, Switzerland, examined the benefits of such nutritional support in a randomized controlled study. The trial showed that individual meal plans resulted in fewer complications and a decreased mortality rate and suggests that assessments by trained dieticians during patient-admission may tackle the issue.

According to the largest analysis of malnutrition in the US to date, one in three hospitalized adults is at risk of malnutrition and inadequate food intake is jeopardizing patient recovery and well-being. It is estimated that nearly one in five pediatric patients and one out of three adult patients aged 60 and older are malnourished. Malnutrition is a major contributor to multiple morbidities, decreased physical and cognitive function and impaired quality of life, as well as increased hospital readmissions and overall higher healthcare costs. 

“It is first important to start screening for malnutrition in patients admitted to the hospital and for at-risk patients to do an in-depth assessment. [In this process], dieticians are very important,” study leader Professor Philipp Schütz from the University of Basel and Head of Internal and Emergency Medicine at Aarau Cantonal Hospital, tells NutritionInsight.

“If a patient is malnourished, the start of individualized nutritional support should be part of the treatment plan similar to other medical treatments,” Schütz notes.

Individual nutrition management has a positive influence on disease progression in hospitalized patients.People who struggle to eat and drink properly following an illness are at risk of consuming too little protein and energy. This phenomenon affects over a third of inpatients in the medical wards of hospitals. 

Where there is a risk of nutritional deficit, guidelines recommend individualized nutrition during a patient’s stay in hospital in order to guarantee their supply of protein and calories, the researchers note. Possible measures range from a nutritional plan to tube feeding and intravenous feeding.

The medical nutrition space, which includes oral nutritional supplements (ONS) and enteral nutrition (tube feeding via the nose or gastrointestinal tract), is enjoying increased growth. Oral nutritional supplements, in particular, are experiencing a boost as consumers and healthcare providers increasingly prioritize health and wellness, focusing more on aging well and disease prevention. Moreover, ongoing research into the benefits of nutrition in the healing process, alongside a growing demand for products that encourage patient compliance, are providing ample opportunities for ongoing R&D.

First large scale controlled trial study
Until now, the lack of large scale studies meant that it was unclear whether individual nutrition management actually had a positive impact on patients, especially considering the unwanted side effects of nutritional support.

The new study included more than 2,000 patients across eight Swiss hospitals. For the trial, medical patients at risk of malnutrition were randomized into two groups. One group received traditional meals from the hospital kitchen during their hospitalization. The patients in the second group received meals that dieticians determined, according to individual nutritional plans.

One month later, it became evident that individualized nutrition not only achieved a better supply of energy and protein but also led to a general improvement in treatment outcomes. The comparison showed that fewer serious complications occurred and the mortality rate fell. Statistically, it was possible to prevent a serious complication in one in 25 people treated and one death for every 37 people treated.

“Our results show that malnutrition is a modifiable risk factor and that the therapy has a positive influence on disease progression,” says Schütz. “This study has major implications for the treatment of hospital patients with multiple morbidities and should help to reinforce the importance of nutritional therapy in high-risk patients.”

Schütz says that the results confirmed earlier smaller studies. It was important, however, to prove in a large scale trial that the results from smaller trials were accurate. The larger number of patients included in the new study, also make the results more statistically significant.

“Personalization [in medical nutrition] currently means that we define the amount of protein and energy a patient should eat every day and also use nutrition based on an assessment by a dietician so that the patient enjoys the food,” says Schütz. “In the future, we may have a better understanding of which types of proteins are more beneficial for which patient/disease – which would be more sophisticated, but is currently not possible.”

Schütz notes that there is certainly a need for further research into the matter, as nutrition is a highly complex issue. Some of the questions that remain to be answered are: 

• What types of foods are optimal for which patients?
• Which sort of diagnosis shows the best results? 
• Does the gut microbiome play a role? 

The medical community has identified the importance of medical nutrition and experts are trying to bring attention to the space. At last year’s European Society for Clinical Nutrition and Metabolism (ESPEN) Congress in Madrid, Spain, Dr. Paul Wischmeyer noted that intensive care unit (ICU) recovery begins at ICU admission and nutrition plays a vital role in this. As such, the medical nutrition industry should be investing further in research and product development into tailored protein and micronutrient solutions for patients during and after their hospital stay. 

The industry is also seeing a growing demand for nutritional solutions that can support patients and help healthcare providers tackle the increasing range of health challenges. FrieslandCampina Ingredients has launched a range of five medical nutrition prototypes to address nutritional insufficiencies that arise from disease, condition or aging. Presented at the Fi Asia in Jakarta in October 2018, the range includes nutritionally-complete tube feed and drip feed solutions and well as three powder formats. 

By Kristiana Lalou