Effectiveness of dietary counseling with or without nutrition supplementation in hospitalized patients who are malnourished or at risk of malnutrition: A systematic review and meta-analysis

Background Nutrition support is associated with improved survival and nonelective hospital readmission rates among malnourished medical inpatients; however, limited evidence supporting dietary counseling is available. We intend to determine the effect of dietary counseling with or without oral nutrition supplementation (ONS), compared with standard care, on hospitalized adults who are malnourished or at risk of malnutrition. Methods We searched MEDLINE/PubMed, CINAHL, Embase, Scopus, The Cochrane Library, and Google Scholar for studies listed from January 1, 2011, to August 31, 2021. Meta-analysis was performed to obtain pooled risk ratios (RRs) and 95% CIs to estimate the effect. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the certainty of the evidence. Results Sixteen studies were identified. Compared with standard care, dietary counseling with or without ONS probably does not reduce inpatient rates of 30-day mortality (RR = 1.24; 0.60-2.55; I-2 = 45%; P = 0.56; moderate certainty), slightly reduces 6-month mortality (RR = 0.83; 0.69-1.00; I-2 = 16%; P = 0.06; high certainty), reduces complications (RR = 0.85; 0.73-0.98; I-2 = 0%; P = 0.03; high certainty), and may slightly reduce readmission (RR = 0.83; 0.66-1.03; I-2 = 55%; P = 0.10; low certainty) but may not reduce length of stay (mean difference: -0.75 days; -1.66-0.17; I-2 = 70%; P = 0.11; low certainty). Intervention may result in slight improvements in nutrition status/intake and weight/body mass index (low certainty). Conclusions There is an increase in the certainty of evidence regarding the positive impact of dietary counseling on outcomes. Future studies should standardize and provide details/frequencies of counseling methods and ONS adherence to determine dietary counseling effectiveness.