Results from a new clinical trial show that the use of a specialised oral nutritional supplement was associated with a 50% lower death rate in older malnourished patients with a heart or lung disease 90 days following hospitalisation. The study, published online today in Clinical Nutrition and supported by Abbott, estimated that within this population one life could be saved for every 21 patients who received the specialised nutritional supplement, demonstrating it as a highly effective therapy.
The NOURISH (Nutrition effect On Unplanned ReadmIssions and Survival in Hospitalized patients) study – one of the largest nutrition clinical studies of its kind – was a prospective, randomised, double-blind, placebo-controlled trial. The study was designed to build upon the body of evidence demonstrating that oral nutritional supplements may reduce complications, mortality, and hospital readmissions in malnourished patients. Participants in the NOURISH study included 652 malnourished adults, aged 65 or older, who were admitted to the hospital and suffered from heart or lung disease. Researchers compared the effects of a specialised nutritional supplement with high protein (20 grams), HMB and Vitamin D to a placebo supplement on rates of readmissions or death 90-days after leaving the hospital.
Results showed no significant differences between the two groups for the primary composite (ie. combined) endpoint of hospital readmissions or death. However, the study individual components and additional analyses showed:
- A significantly lower (50%) death rate for those patients who received the specialised nutritional supplement. This lower incidence of death began at 30 days and continued for 90 days after participants left the hospital.
- Similar rates of hospital readmissions between the two groups.
- Improvements in other health outcomes including body weight, nutritional status and Vitamin D levels at 30 and 60 days after leaving the hospital, and continued body weight and nutritional status improvements at 90 days for the group taking the specialised nutritional supplement.
"The NOURISH study clearly reinforces the power of nutrition in impacting health outcomes. For the people in this study who were ill and malnourished, nutrition was critical to survival because it helps keep your body, especially your muscles, functioning properly," said Nicolaas E. Deutz, MD, PhD, Center for Translational Research in Aging & Longevity, Department of Health and Kinesiology, Texas A&M University, and lead study author. "This is more proof that we need to change the standard and include nutrition as an integral part of care, much like flu shots or aspirin, to help older adults who already have or are at risk for malnutrition and chronic illness."
Up to 1 in 2 older adults are malnourished when they are admitted to the hospital. Many adults may not even realise they are malnourished – they can be of normal weight, or overweight, but have low levels of muscle or lean body mass. The loss of muscle, strength and energy can intensify in malnourished patients and those with a health issue like heart failure or pneumonia. Other studies have shown that malnutrition can worsen their health outcomes including higher chances of complications, readmissions and even death.
"Surprisingly, malnutrition in older adults is very common – and it’s a condition that is having a rippling effect on our health and health system," said Alfonso Cruz-Jentoft, MD, PhD, Head of the Geriatrics Department, Hospital Ramón y Cajal, Spain, and past president of the European Union Geriatric Medicine Society. He was not involved in the study. "People underestimate how critical strength and muscle health are to recovery from hospitalisation and illness. Proper nourishment is a key component and cannot be left out of the conversation."
The NOURISH study builds upon existing research that shows the role specialised nutrition plays in a patient’s health, ranging from rebuilding muscle mass to helping with recovery from disease and time in the hospital. The nutrients in the specialised nutritional supplement used in the study – protein, HMB and Vitamin D – are all important components in repairing and rebuilding muscle while recovering from hospitalisation and illness.
The commercially available versions of the specialised nutritional supplement evaluated in the study are Ensure® Plus Advance in Europe, and it will be available this year as Ensure® Enlive® in the United States. The specialised nutritional supplement is also expected to be available in other countries around the world in the next couple of years.
Kelly Grainger, Head of Dietetics and Therapies, Leaders in Oncology Care, London: “The findings from the NOURISH trial add to the growing evidence base to support nutrition screening on admission to hospital and the provision of appropriate nutrition support to malnourished older adults. This is the first study to show that the use of oral nutritional supplements after discharge significantly reduced mortality rates in the treatment group, as well as improving overall nutritional status as assessed using Subjective Global Assessment”.