Table 29Oral vs. oral -- menu modification/counselling vs. oral supplements

Bibliographic referenceStudy TypeEvidence levelNo. of patientsPatients characteristicsInterventionComparisonLength of follow upOutcome measuresEffect sizeComments (including source of funding)
Baldwin et al 200117Systematic Review (RCTs & quasi RCTs)1+173 patients4 trials

Patient groups:
1 elderly at home
1 elderly in long-term care
1 HIV
1 cystic fibrosis
Dietary counsellingOral Supplement3 months for all studies
6 months for one study
Mortality (at 3 months for all studies and 6 months for one study. No deaths in the 6 month study)Mortality at 3 months (4 trials, n=173)
RR 0.33, 95% CI 0.04 to 2.99 [Not significant]
Hospital admission/re- admission & length of stayHospital admission (1 trial, n=50)
RR 0.36, 95% CI 0.04 to 3.24 [Not significant]
Measures of nutritional status (WMD = weighted mean difference)Weight change at 3 months (4 trials, 173)
WMD −1.15kg, 95% CI −1.93 to −0.36
Oral supplement group significantly greater weight gain than dietary counselling group

Weight change at 6 months (1 trial, only 5 people)
WMD −0.32kg 95% CI −3.87 to 3.23 [Not significant]

BMI (1 trial, n=68)
WMD 0.0 kg/m2, 95%
CI −0.56 to 0.56 [Not significant]
Nutritional intake before and after interventionChange in energy intake (4 trials, n=173)
WMD 91 kcals, 95% CI 1.59 to 23
Oral supplement group significantly greater energy intake than dietary counselling group
Measures of clinical functionGrip strength (1 trial, n=50)
WMD 0.16kg/m2, 95% CI −1.54 to 1.86 [Not significant]

Mid-arm muscle circumference (1 trial, n=50)
WMD -0.80cm, 95% CI −5.29 to 3.69 [Not significant]

Tricep skinfold (1 trial, n=50)
WMD −0.30mm 95% CI −1.69 to 1.09 [Not significant]
Ravasco et al 2005285RCT111 stratified by staging

Malnourished: 42 determined by PG-SGA 12 as determined by BMI <20Kg/m2

Dietary counselling (regular foods) n=37
Malnourished:
15 – PG-SGA
5 – BMI <20Kg/m2

High protein oral supplement

n=37
Malnourished:
14 – PG-SGA
4 – BMI
<20Kg/m2

Ad libitum intake n=37
Malnourished:
13 – PG-SGA
3 – BMI <20Kg/m2
Colorectal cancer patients undergoing radiotherapyDietary counsellingOral supplement

2 cans per day of 200ml high protein (20g per can), energy dense liquid polymeric formulations (200 Kcal per can)
3 months after end of radiotherapyWeight change in malnourished patients at 3 month follow-up (malnourished determined by Patient Generated Subjective Global Assessment (PG- SGA))Counselling 4 (2 to 7) kg (9 out of 15)
Supplement weight gain (0 out of 14) (weight change value not reported)
Ad libitum weight gain (0 out of 13) (weight change value not reported) ([p value not reported]
See Oral v Standard Care for supplements vs. ad libitum intake

see dietary counselling v standard care for counselling vs. ad libitum intake

Patient Generated Subjective Global Assessment (PG- SGA)
“Additional nutritional deterioration” at end of radiotherapy and at 3 month follow-up (malnourished determined in 2 ways by PatientSupplement and standard care group more nutritional deterioration than in counselling group. [p<0.001]
Generated Subjective Global Assessment (PG- SGA) and by BMI)Nutritional deterioration significantly more severe in ad libitum diet compared to supplement and counselling groups [p<0.008]
MortalityAll patients appear to be alive 3 months after the end of radiotherapy

From: Appendix Four, Evidence Tables

Cover of Nutrition Support for Adults
Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition.
NICE Clinical Guidelines, No. 32.
National Collaborating Centre for Acute Care (UK).
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