Dietary Supplements Do Not Increase Survival in Malnourished Adults
There is much uncertainty about the value of dietary advice and dietary supplements. If these interventions do anything at all, then surely this would show in malnourished patients. And if any effect can be demonstrated, then surely with a hard endpoint, such as survival. This study tested the hypothesis; it investigated the effect on survival after 6 months of treatment involving individual dietary advice and oral nutritional supplements in older malnourished adults after discharge from hospital.
This multicentre randomised controlled trial was supported by grants from Region Västmanland, Uppsala-Örebro Regional Research Foundation (RFR), and the Swedish National Board of Health and Welfare. It included 671 patients aged 65 years who were malnourished or at risk of malnutrition when admitted to hospital between 2010 and 2014, and followed up after 8.2 years (median 4.1 years). Patients were randomised to receive:
The intervention started at discharge from the hospital and continued for 6 months, with survival being the main outcome measure.
During the follow-up period 398 (59.3%) participants died. At follow-up, the survival rates were
After stratifying the participants according to nutritional status, survival still did not differ significantly between the treatment arms (log-rank test p = 0.480 and p = 0.298 for the 506 participants at risk of malnutrition and the 165 malnourished participants, respectively).
The authors concluded that oral nutritional supplements with or without dietary advice, or dietary advice alone, do not improve the survival of malnourished older adults. These results do not support the routine use of supplements in older malnourished adults, provided that survival is the aim of the treatment.
The findings of this trial seem perhaps counter-intuitive and they contradict the current Cochrane review on the subject. I nevertheless feel that this is an interesting, rigorous and important study. It deserves to be publicised widely – perhaps more widely than the ‘Upsala Journal of Medical Science’ would afford.
This content was originally published here.