title: Individualised dietary counselling for nutritionally at-risk older patients following discharge from acute hospital to home: a systematic review and meta-analysis.
abstract: BACKGROUND
  Many older patients are undernourished after hospitalisation. Undernutrition impacts negatively on physical function and the ability of older patients to perform activities of daily living at home after discharge from acute hospital. The present study aimed to evaluate the evidence for an effect of individualised dietary counselling following discharge from acute hospital to home on physical function, and, second, on readmissions, mortality, nutritional status, nutritional intake and quality of life (QoL), in nutritionally at-risk older patients.
  
  
  METHODS
  A systematic review of randomised controlled trials was conducted. The overall quality of the evidence was assessed according to Grading of Recommendations Assessment, Development and Evaluation system (GRADE) criteria.
  
  
  RESULTS
  Four randomised controlled trials (n = 729) were included. Overall, the evidence was of moderate quality. Dietitians provided counselling in all studies. Meta-analyses showed a significant increase in energy intake [mean difference (MD) = 1.10 MJ day(-1), 95% confidence interval (CI) = 0.66-1.54, P < 0.001], protein intake (MD = 10.13 g day(-1), 95% CI = 5.14-15.13, P < 0.001) and body weight (BW) (MD = 1.01 kg, 95% CI = 0.08-1.95, P = 0.03). Meta-analyses revealed no significant effect on physical function assessed using hand grip strength, and similarly on mortality. Narrative summation of effects on physical function using other instruments revealed inconsistent effects. Meta-analyses were not conducted on QoL and readmissions as a result of a lack of data.
  
  
  CONCLUSIONS
  Individualised dietary counselling by dietitians following discharge from acute hospital to home improved BW, as well as energy and protein intake, in older nutritionally at-risk patients, although without clearly improving physical function. The effect of this strategy on physical function and other relevant clinical outcomes warrants further investigation.
authors: Nutritional Research Unit, EFFECT, Herlev University Hospital, Herlev, Denmark.
authors: T
authors: T
authors: Munk
authors: Mondelez Danmark, Brøndby, Denmark.
authors: U
authors: U
authors: Tolstrup
authors: Nutritional Research Unit, EFFECT, Herlev University Hospital, Herlev, Denmark.
authors: A M
authors: AM
authors: Beck
authors: Centre for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark.
authors: M
authors: M
authors: Holst
authors: Centre for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark.
authors: H H
authors: HH
authors: Rasmussen
authors: The Cochrane Anaesthesia Review Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors: K
authors: K
authors: Hovhannisyan
authors: Abdominal Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors: T
authors: T
authors: Thomsen
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001835:Body Weight; D003376:Counseling; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D018737:Hand Strength; D006801:Humans; D044342:Malnutrition / Q000517:prevention & control*; D015596:Nutrition Assessment; D009752:Nutritional Status; D064686:Nutritionists; D010351:Patient Discharge; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
chemical_list: D004044:Dietary Proteins
keywords: dietary counselling; discharge; nutritional at-risk; older patients; physical function; undernutrition