Adaptation of nutritional risk screening tools may better predict response to nutritional treatment. A secondary analysis of the randomized controlled trial EFFORT.

clinical outcome disease-related malnutrition mortality nutritional risk screening nutritional support personalized nutrition polymorbid medical inpatient treatment response

Journal

The American journal of clinical nutrition
ISSN: 1938-3207
Titre abrégé: Am J Clin Nutr
Pays: United States
ID NLM: 0376027

Informations de publication

Date de publication:
28 Jan 2024
Historique:
received: 15 11 2023
revised: 18 01 2024
accepted: 22 01 2024
medline: 31 1 2024
pubmed: 31 1 2024
entrez: 30 1 2024
Statut: aheadofprint

Résumé

Nutritional screening tools have proven valuable for predicting clinical outcomes but have failed to determine which patients would be most likely to benefit from nourishment interventions. The Nutritional Risk Screening 2002 (NRS) and the Mini Nutritional Assessment (MNA) are two of these tools, which are based on both nutritional parameters and parameters reflecting disease severity. We hypothesized that adaptation of nutritional risk scores, by removing parameters reflecting disease severity, would improve their predictive value regarding response to a nutritional intervention while providing similar prognostic information regarding mortality at short- and long-term. We re-analyzed data of 2,028 patients included in the Swiss-wide multicenter, randomized controlled Effect of early nutritional therapy on Frailty, Functional Outcomes, and Recovery of malnourished medical inpatients Trial (EFFORT) trial comparing individualized nutritional support with usual care nutrition in medical inpatients. The primary endpoint was 30-day all-cause mortality. While stratifying patients by high compared with low NRS score showed no difference in response to nutritional support, patients with high adapted NRS showed substantial benefit, while patients with low adapted NRS showed no survival benefit (adjusted hazard ratio (HR) 0.55 [95% CI 0.37 to 0.80], compared with 1.17 [95%CI 0.70-1.93], a finding that was significant in an interaction analysis (coefficient 0.48, [95%CI 0.25-0.94], p=0.031). A similar effect regarding treatment response was found when stratifying patients based on MNA vs. the adapted MNA. Regarding the prognostic performance, both original scores were slightly superior in predicting mortality compared to the adapted scores. Adapting the NRS and MNA by including nutritional parameters only improved their ability to predict response to a nutrition intervention, but slightly reduces their overall prognostic performance. Scores dependent on disease severity may best be considered prognostic scores, while nutritional risk scores not including parameters reflecting disease severity may indeed improve a more personalized treatment approach for nourishment interventions. Clinicaltrials.gov as NCT02517476 (registered 7 August 2015).

Sections du résumé

BACKGROUND BACKGROUND
Nutritional screening tools have proven valuable for predicting clinical outcomes but have failed to determine which patients would be most likely to benefit from nourishment interventions. The Nutritional Risk Screening 2002 (NRS) and the Mini Nutritional Assessment (MNA) are two of these tools, which are based on both nutritional parameters and parameters reflecting disease severity.
OBJECTIVE OBJECTIVE
We hypothesized that adaptation of nutritional risk scores, by removing parameters reflecting disease severity, would improve their predictive value regarding response to a nutritional intervention while providing similar prognostic information regarding mortality at short- and long-term.
METHODS METHODS
We re-analyzed data of 2,028 patients included in the Swiss-wide multicenter, randomized controlled Effect of early nutritional therapy on Frailty, Functional Outcomes, and Recovery of malnourished medical inpatients Trial (EFFORT) trial comparing individualized nutritional support with usual care nutrition in medical inpatients. The primary endpoint was 30-day all-cause mortality.
RESULTS RESULTS
While stratifying patients by high compared with low NRS score showed no difference in response to nutritional support, patients with high adapted NRS showed substantial benefit, while patients with low adapted NRS showed no survival benefit (adjusted hazard ratio (HR) 0.55 [95% CI 0.37 to 0.80], compared with 1.17 [95%CI 0.70-1.93], a finding that was significant in an interaction analysis (coefficient 0.48, [95%CI 0.25-0.94], p=0.031). A similar effect regarding treatment response was found when stratifying patients based on MNA vs. the adapted MNA. Regarding the prognostic performance, both original scores were slightly superior in predicting mortality compared to the adapted scores.
CONCLUSION CONCLUSIONS
Adapting the NRS and MNA by including nutritional parameters only improved their ability to predict response to a nutrition intervention, but slightly reduces their overall prognostic performance. Scores dependent on disease severity may best be considered prognostic scores, while nutritional risk scores not including parameters reflecting disease severity may indeed improve a more personalized treatment approach for nourishment interventions.
CLINICAL TRIAL REGISTRATION BACKGROUND
Clinicaltrials.gov as NCT02517476 (registered 7 August 2015).

Identifiants

DOI: 10.1016/j.ajcnut.2024.01.013 PMID: 38290574
pubmed: 38290574
pii: S0002-9165(24)00046-7
doi: 10.1016/j.ajcnut.2024.01.013
pii:
doi:

Banques de données

ClinicalTrials.gov
['NCT02517476']

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.

Auteurs

Carla Wunderle (C)

Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Tellstrasse 25, 5001 Aarau, Switzerland.

Jolanda Siegenthaler (J)

Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Tellstrasse 25, 5001 Aarau, Switzerland.

David Seres (D)

Institute of Human Nutrition, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032.

Michael Owen-Michaane (M)

Institute of Human Nutrition, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032.

Pascal Tribolet (P)

Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Tellstrasse 25, 5001 Aarau, Switzerland; Department of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008 Bern, Switzerland;; Faculty of Life Sciences University of Vienna, Djerassiplatz 1, 1030 Vienna, Austria.

Zeno Stanga (Z)

Division of Diabetes, Endocrinology, Nutritional Medicine, and Metabolism, Inselspital Bern, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland.

Beat Mueller (B)

Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Tellstrasse 25, 5001 Aarau, Switzerland; Medical Faculty of the University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland.

Philipp Schuetz (P)

Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Tellstrasse 25, 5001 Aarau, Switzerland; Medical Faculty of the University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland;. Electronic address: schuetzph@gmail.com.

Classifications MeSH