title: Effectiveness and efficacy of nutritional therapy: A systematic review following Cochrane methodology.
abstract: Disease-related malnutrition has deleterious consequences on patients' outcome and healthcare costs. The demonstration of improved outcome by appropriate nutritional management is on occasion difficult. The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed the Nutrition Education Study Group (ESPEN-NESG) to increase recognition of nutritional knowledge and support in health services.
  
  
  
  To obtain the best available evidence on the potential effects of malnutrition on morbidity, mortality and hospital stay; cost of malnutrition; effect of nutritional treatment on outcome parameters and pharmaco-economics of nutritional therapy, a systematic review of the literature was performed following Cochrane methodology, to answer the following key questions: Q1) Is malnutrition an independent predictive factor for readmission within 30 days from hospital discharge? Q2) Does nutritional therapy reduce the risk of readmission within 30 days from hospital discharge? Q3) Is nutritional therapy cost-effective/does it reduce costs in hospitalized patients? and Q4) Is nutritional therapy cost effective/does it reduce costs in outpatients?
  
  
  
  For Q1 six of 15 identified observational studies indicated that malnutrition was predictive of re-admissions, whereas the remainder did not. For Q2 nine randomized controlled trials and two meta-analyses gave non-conclusive results whether re-admissions could be reduced by nutritional therapy. Economic benefit and cost-effectiveness of nutritional therapy was consistently reported in 16 identified studies for hospitalized patients (Q3), whereas the heterogeneous and limited corresponding data on out-patients (Q4) indicated cost-benefits in some selected sub-groups.
  
  
  
  This result of this review supports the use of nutritional therapy to reduce healthcare costs, most evident from large, homogeneous studies. In general, reports are too heterogeneous and overall of limited quality for conclusions on impact of malnutrition and its treatment on readmissions.
authors.affiliation: Department of Clinical Medicine, Sapienza- University of Rome, Viale dell'Università, 37, 00185 Roma, Italy. Electronic address: maurizio.muscaritoli@uniroma1.it.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Muscaritoli
authors.affiliation: Department of Gastroenterology and Centre for Clinical Nutrition, Clinical Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia.
authors.forename: Zeljko
authors.initials: Z
authors.lastname: Krznarić
authors.affiliation: General Intensive Care Department and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
authors.forename: Pierre
authors.initials: P
authors.lastname: Singer
authors.affiliation: Department of Medical, Surgical and Health Sciences, University of Trieste, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Barazzoni
authors.affiliation: Departments of Geriatric Medicine, Uppsala University Hospital and Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
authors.forename: Tommy
authors.initials: T
authors.lastname: Cederholm
authors.affiliation: Service of Therapeutic Education for Chronic Diseases, Geneva University Hospitals, Villa Soleillane, Chemin Venel 7, 1206 Geneva, Switzerland.
authors.forename: Alain
authors.initials: A
authors.lastname: Golay
authors.affiliation: Department of Gastroenterology, Clinic of Intestinal Diseases and Nutritional Support, Hopital Erasme, Free University of Brussels, Brussels, Belgium.
authors.forename: André
authors.initials: A
authors.lastname: Van Gossum
authors.affiliation: Department of Clinical Medicine, Trinity Centre for Health Sciences, Dublin, Ireland.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Kennedy
authors.affiliation: Baxter Health Care SA Europe, CH 8010 Zurich, Switzerland.
authors.forename: Georg
authors.initials: G
authors.lastname: Kreymann
authors.affiliation: Department of Clinical Medicine, Sapienza- University of Rome, Viale dell'Università, 37, 00185 Roma, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Laviano
authors.affiliation: Department of Gastroenterology and Hepatology, Clinical Hospital Center "Sisters of Mercy", Zagreb, Croatia.
authors.forename: Tajana
authors.initials: T
authors.lastname: Pavić
authors.affiliation: Cochrane Croatia, University of Split School of Medicine, Soltanska 2, Split, Croatia.
authors.forename: Livia
authors.initials: L
authors.lastname: Puljak
authors.affiliation: Department of Nursing, Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, Ilica 242, Zagreb, Croatia.
authors.forename: Dario
authors.initials: D
authors.lastname: Sambunjak
authors.affiliation: Cochrane Croatia, University of Split School of Medicine, Soltanska 2, Split, Croatia.
authors.forename: Ana
authors.initials: A
authors.lastname: Utrobičić
authors.affiliation: Department of Gastroenterology and Clinical Nutrition, University Hospital and University of Nice Sophia-Antipolis, Nice, France.
authors.forename: Stéphane M
authors.initials: SM
authors.lastname: Schneider
mesh_terms: D000328:Adult; D000818:Animals; D015897:Comorbidity; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D000072001:Diet, Healthy / Q000191:economics; D019317:Evidence-Based Medicine; D014943:Global Health; D017721:Hospital Costs; D006801:Humans; D044342:Malnutrition / Q000178:diet therapy / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D018529:Nutritional Support / Q000191:economics; D010044:Outpatient Clinics, Hospital / Q000191:economics; D010359:Patient Readmission / Q000191:economics
keywords: Cochrane; Effectiveness; Efficacy; Nutritional therapy