LB123 - ORAL NUTRITIONAL INTERVENTIONS IN HOSPITALISED OLDER PEOPLE AT NUTRITIONAL RISK: A NETWORK META-ANALYSIS OF INDIVIDUAL PARTICIPANT DATA

LB123

ORAL NUTRITIONAL INTERVENTIONS IN HOSPITALISED OLDER PEOPLE AT NUTRITIONAL RISK: A NETWORK META-ANALYSIS OF INDIVIDUAL PARTICIPANT DATA

E. Kiesswetter^1,*, G. Schwarzer², J. Stadelmaier¹, S. Lohner³, K. Grummich⁴, P. C. Dagnelie⁵, A. M. Beck⁶, J. Beelen⁷, J. I. Botella-Carretero⁸, G. Faxén-Irving ⁹, M. Hickson¹⁰, S. Iff¹¹, A. Johansen¹², Y. Sharma¹³, J. M. Sorensen¹⁴, N. Kägi-Braun¹⁵, C. Wunderle¹⁶, B. Bongaerts¹⁷, J. J. Meerpohl^1,18, K. Norman^19,20, P. Schuetz¹⁶, G. Torbahn²¹, M. Visser²², D. Volkert²³, L. Schwingshackl¹

¹Institute for Evidence in Medicine, Faculty of Medicine and Medical Center, University of Freiburg, ²Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany, ³Cochrane Hungary, Medical School, University of Pécs, Pécs, Hungary, ⁴ZB MED - Information Centre for Life Sciences, Cologne, Germany, ⁵Departments of Epidemiology & Internal Medicine, Care and Public Health Research Institute & Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands, ⁶Dietetic and Nutritional Research Unit, EATEN, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark, ⁷Division of Human Nutrition, Wageningen University, Wageningen, Netherlands, ⁸Department of Endocrinology and Nutrition, IRyCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain, ⁹Department of Neurobiology, Care Science and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden, ¹⁰School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, United Kingdom, ¹¹Institute of Social and Preventive Medicine, University Bern, Bern, Switzerland, ¹²University Hospital of Wales and School of Medicine, Cardiff University, Cardiff, United Kingdom, ¹³Department of Acute and General Medicine, Division of Medicine, Cardiac & Critical Care, Flinders Medical Centre, Adelaide, Australia, ¹⁴Long-Term Care and Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada, ¹⁵Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden, ¹⁶Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland, ¹⁷Cochrane Evidence Synthesis Unit Germany/UK – Düsseldorf Sub-Unit, Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, ¹⁸Cochrane Germany, Cochrane Germany Foundation, Freiburg, ¹⁹Department of Geriatrics and Medical Gerontology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, ²⁰Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam Rehbrücke, Nuthetal, ²¹Department of Pediatrics, Paracelsus Medical University Nuernberg, Nürnberg, Germany, ²²Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands, ²³Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany

Rationale: This systematic review with individual participant-data network meta-analysis (IPD-NMA) compares the effects of different nutritional interventions with control and with each other on patient-relevant outcomes in older people hospitalised for different acute conditions at risk of or with established malnutrition.

Methods: We systematically searched 7 databases and 2 trial registries until July 2024 for eligible randomised controlled trials (RCTs). We performed random-effects NMAs including both results based on IPD and published data if IPD were not available. Critical outcomes were all-cause mortality, serious adverse events (SAE) and functional status (activities of daily living [ADL]) assessed at discharge or 30 days after randomisation. We rated the certainty of evidence (CoE) according to the GRADE approach.

Results: We included 21 RCTs (n=3309). Interventions comprised the provision of additional protein, energy supplements, oral nutritional supplements (ONS), individualised feeding support and comprehensive individualised nutritional care. ONS may reduce all-cause mortality (relative risk [RR] 0.46, 95%CI 0.25-0.84; absolute risk difference [RD] 57 fewer per 1000, 95%CI 79-17 fewer) and SAE (RR 0.56, 95%CI 0.32-0.95; RD 78 fewer per 1000, 95%CI 120-9 fewer) compared to control. All other comparisons of nutritional interventions with each other or with control may mainly result in little or no differences in outcomes including ADL (moderate to very-low CoE).

Conclusion: In older people in hospital at risk of or with established malnutrition evidence suggests a reduction of mortality and SAE when providing ONS compared to control at discharge or 30 days after randomisation. To improve certainty, adequately powered studies should compare not only interventions with controls but also different interventions against each other.

This abstract is based on a pre-peer review version of a Cochrane Review (doi.org/10.1002/14651858.CD015468). Upon completion and approval, the final version is expected to be published in the Cochrane Database of Systematic Reviews. Funding: German Federal Ministry of Education and Research, grant no. 01KG2102.

Disclosure of Interest: E. Kiesswetter: None declared, G. Schwarzer Consultant for: External statistical consultant of Roche Pharma AG, Grenzach-Wyhlen, Germany, J. Stadelmaier: None declared, S. Lohner: None declared, K. Grummich: None declared, P. Dagnelie Other: Author of an included study, but had no role in its evaluation., A. M. Beck Other: Author of an included study, but had no role in its evaluation., J. Beelen Other: Author of an included study, but had no role in its evaluation., J. Botella-Carretero Other: Author of an included study, but had no role in its evaluation., G. Faxén-Irving Other: Author of an included study, but had no role in its evaluation., M. Hickson Other: Author of an included study, but had no role in its evaluation., S. Iff Other: Author of an included study, but had no role in its evaluation., A. Johansen Other: Author of an included study, but had no role in its evaluation., Y. Sharma Other: Author of an included study, but had no role in its evaluation., J. Sorensen Other: Author of an included study, but had no role in its evaluation., N. Kägi-Braun Other: Author of an included study, but had no role in its evaluation., C. Wunderle Other: Author of an included study, but had no role in its evaluation., B. Bongaerts Other: Coordinating Editor of the Cochrane metabolic and endocrine disorders group, but she was excluded from the editorial processing of this review., J. Meerpohl: None declared, K. Norman: None declared, P. Schuetz Other: reports that his institution has contracts with/receives grants from Abbott Fund, bioMerieux, Nestle HealthCare Nutrition Inc., and Thermo Fisher Scientific; author of an included study, but had no role in its evaluation., G. Torbahn: None declared, M. Visser: None declared, D. Volkert: None declared, L. Schwingshackl: None declared