Dietary advice and nutritional supplements in the management of illness-related malnutrition: systematic review.
OBJECTIVE
This review investigated whether dietary advice to improve nutritional intake in adults with illness-related malnutrition improved mortality, morbidity, weight and energy intake, and whether oral nutritional supplements gave additional benefit, when given in combination with dietary advice.


METHODS
Systematic review of randomised controlled trials comparing dietary advice with either (i) no advice, (ii) nutritional supplements or (iii) dietary advice plus nutritional supplements, in people with illness-related malnutrition.


RESULTS
Twenty-four trials (25 comparisons) met the inclusion criteria, including 2135 randomised participants. Duration of follow-up ranged from 16 days to 24 months. There was no significant difference in mortality or morbidity for each comparison. Groups receiving supplements gained significantly more weight (or lost significantly less weight) than those who received dietary advice, weighted mean difference 1.09 kg (0.29-1.90) (4 studies). There were no significant differences in weight and energy intake between groups for the other comparisons. Few data were available for other outcomes.


CONCLUSIONS
Nutritional supplements may have a greater role than dietary advice in the short-term improvement of body weight in illness-related malnutrition. There is a lack of evidence to support dietary advice in the management of illness-related malnutrition, but this is based on few, often poor quality, studies.
Baldwin
Christine
C
Department of Medicine and Therapeutics, Imperial College, University of London, Chelsea & Westminster Hospital, Fulham Road, London SW10 9NH, UK. c.baldwin@ic.ac.uk
Parsons
Tessa J
TJ
D001835:Body Weight / Q000502:physiology*; D019587:Dietary Supplements; D002149:Energy Intake; D005500:Follow-Up Studies; D006801:Humans; D009748:Nutrition Disorders / Q000178:diet therapy / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome