Effect of Early Nutritional Support on Frailty, Functional Outcomes, and Recovery of Malnourished Medical Inpatients - EFFORT

Jun 28, 2019
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Author/Summarized by Author:
Anthony A. Bavry, MD,MPH,FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, FACC, MBA
Trial Sponsor:
Swiss National Science Foundation and Research Council of the Kantonsspital, Aarau, Switzerland
Date Published:
06/08/2019
Date Updated:
06/28/2019
Original Posted Date:
06/28/2019
References

Contribution To Literature:

The EFFORT trial showed that individualized caloric/protein support was effective at reducing major adverse events, including mortality.

Description:

The goal of the trial was to evaluate individualized nutritional support compared with standard hospital food among inpatients hospitalized for a noncritical illness.

Study Design

  • Randomized
  • Parallel
  • Stratification

Noncritically ill patients at risk of malnutrition were randomized to protocol-guided individualized nutritional support (n = 1,050) versus standard hospital food (n = 1,038). The national risk screening score was used to screen for malnutrition.

  • Total number of enrollees: 2,088
  • Duration of follow-up: 30 days
  • Mean patient age: 72 years
  • Percentage female: 48%
  • Percentage with diabetes: 21%

Inclusion criteria:

  • Patients ≥18 years of age with anticipated hospital stay for ≥4 days and nutritional risk score of ≥3

Exclusion criteria:

  • Admitted to the medical or surgical intensive care unit
  • Unable to ingest oral nutrition
  • Receiving nutritional support on admission
  • Terminal condition
  • Admitted to hospital because of anorexia nervosa, acute pancreatitis, acute liver failure, cystic fibrosis, or stem-cell transplantation
  • After gastric bypass surgery
  • Contraindications for nutritional support

Other salient features/characteristics:

  • Caloric goals were reached in 79% and protein goals in 76% of the intervention group versus 54% and 55% of the control group.

Principal Findings:

The primary outcome, all-cause mortality, admission to intensive care, nonelective hospital readmission, major complications, and decline in functional status at 30 days, occurred in 23% of the intervention group compared with 27% of the control group (p = 0.023).

Secondary outcomes:

  • Mortality: 7% in the intervention group vs. 10% in the control group (p = 0.011)
  • Decline in functional status: 4% in the intervention group vs. 6% in the control group (p = 0.034)

Interpretation:

Among inpatients with a noncritical illness, guideline-directed individualized caloric/protein support was effective at reducing adverse events, including mortality. Evidence had been lacking regarding recommendations for nutritional support for hospitalized patients and even some evidence of possible negative effect. This trial supports screening hospitalized patients for malnutrition and starting individualized caloric/protein support.


References:

Schuetz P, Fehr R, Baechli V, et al. Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial. Lancet 2019;393:2312-21.

Keywords: Diet, Frail Elderly, Geriatrics, Hospitalization, Inpatients, Intensive Care, Length of Stay, Malnutrition, Nutritional Support, Primary Prevention, Risk Assessment


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