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Clin Nutr. 2016 Feb;35(1):18-26. doi: 10.1016/j.clnu.2015.12.010. Epub 2016 Jan 18.

Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: A randomized clinical trial.

Author information

1
Center for Translational Research in Aging & Longevity, Department of Health & Kinesiology, Texas A&M University, 1700 Research Parkway, College Station, TX 77845, USA. Electronic address: nep.deutz@ctral.org.
2
Department of Family Medicine, Medical University of South Carolina, 5 Charleston Center Dr, Charleston, SC, USA. Electronic address: matheson@musc.edu.
3
Brody School of Medicine, East Carolina University, 600 Moye Blvd, Greenville, NC, USA. Electronic address: mataresel@ecu.edu.
4
Abbott Nutrition, Research and Development, 3300 Stelzer Rd, Columbus, OH, USA. Electronic address: Menghua.Luo@abbott.com.
5
Abbott Nutrition, Research and Development, 3300 Stelzer Rd, Columbus, OH, USA. Electronic address: geraldine.baggs@abbott.com.
6
Abbott Nutrition, Research and Development, 3300 Stelzer Rd, Columbus, OH, USA. Electronic address: jeffrey.l.nelson@abbott.com.
7
Abbott Nutrition, Research and Development, 3300 Stelzer Rd, Columbus, OH, USA. Electronic address: Refaat.Hegazi@abbott.com.
8
Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, 905 S. Goodwin Ave, Urbana, IL, USA. Electronic address: tappende@illinois.edu.
9
Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, 1648 Pierce Dr NE, Atlanta, GA, USA. Electronic address: tzieg01@emory.edu.

Abstract

BACKGROUND:

Hospitalized, malnourished older adults have a high risk of readmission and mortality.

OBJECTIVE:

Evaluation of a high-protein oral nutritional supplement (HP-HMB) containing beta-hydroxy-beta-methylbutyrate on postdischarge outcomes of nonelective readmission and mortality in malnourished, hospitalized older adults.

DESIGN:

Multicenter, randomized, placebo-controlled, double-blind trial.

SETTING:

Inpatient and posthospital discharge.

PATIENTS:

Older (≥65 years), malnourished (Subjective Global Assessment [SGA] class B or C) adults hospitalized for congestive heart failure, acute myocardial infarction, pneumonia, or chronic obstructive pulmonary disease.

INTERVENTIONS:

Standard-of-care plus HP-HMB (n = 328) or a placebo supplement (n = 324), 2 servings/day.

MEASUREMENTS:

Primary composite endpoint was 90-day postdischarge incidence of death or nonelective readmission. Other endpoints included 30- and 60-day postdischarge incidence of death or readmission, length of stay (LOS), SGA class, body weight, and activities of daily living (ADL).

RESULTS:

The primary composite endpoint was similar between HP-HMB (26.8%) and placebo (31.1%). No between-group differences were observed for 90-day readmission rate, but 90-day mortality was significantly lower with HP-HMB relative to placebo (4.8% vs. 9.7%; relative risk 0.49, 95% confidence interval [CI], 0.27 to 0.90; p = 0.018). The number-needed-to-treat to prevent 1 death was 20.3 (95% CI: 10.9, 121.4). Compared with placebo, HP-HMB resulted in improved odds of better nutritional status (SGA class, OR, 2.04, 95% CI: 1.28, 3.25, p = 0.009) at day 90, and an increase in body weight at day 30 (p = 0.035). LOS and ADL were similar between treatments.

LIMITATIONS:

Limited generalizability; patients represent a selected hospitalized population.

CONCLUSIONS:

Although no effects were observed for the primary composite endpoint, compared with placebo HP-HMB decreased mortality and improved indices of nutritional status during the 90-day observation period.

CLINICAL TRIAL REGISTRATION:

www.ClinicalTrials.govNCT01626742.

KEYWORDS:

High-protein beta-hydroxy-beta-methylbutyrate; Hospitalization; Lean body mass; Malnourished; NOURISH study; Oral nutritional supplement

PMID:
26797412
DOI:
10.1016/j.clnu.2015.12.010
[Indexed for MEDLINE]
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