Individualized Nutritional Intervention During and After Hospitalization: The Nutrition Intervention Study Clinical Trial

OBJECTIVES To test the hypothesis that individualized nutritional treatment during and after discharge from acute hospitalization will reduce mortality and improve nutritional outcomes. DESIGN Randomized, controlled trial. SETTING Internal medicine departments. PARTICIPANTS Two hundred fifty-nine hospitalized adults aged 65 and older at nutritional risk were recruited and randomized according to hospitalization ward into one intervention and two control groups during hospitalization. INTERVENTION Group 1 (intervention group) received individualized nutritional treatment from a dietitian in the hospital and three home visits after discharge. Group 2 received one meeting with a dietitian in the hospital. Group 3 received standard care. Groups 2 and 3 were combined into a single group that served as the control group in the analysis. MEASUREMENTS Mortality, health status, nutritional outcomes, blood tests, cognition, emotional, and functional parameters were assessed at baseline and after 6 months. All participants were contacted monthly. RESULTS The overall dropout rate was 25.8%. After 6 months, rise in Mini Nutritional Assessment score, adjusted for education and hospitalization ward, was significantly higher in the intervention group than in the control groups (3.01 +/- 2.65 vs 1.81 +/- 2.97, P=.004) mainly on the subjective assessment part (0.34 +/- 0.86 vs. -0.04 +/- 0.87, P=.004). The only laboratory parameter for which a difference was observed between the groups was albumin; 9.7% of the intervention group had serum albumin levels of less than 3.5 g/dL, versus 22.9% of the control group (P=.03). Mortality was significantly lower in the intervention group (3.8%) than in the control group (11.6%, P=.046). CONCLUSION Lower mortality and moderate improvement in nutritional status were found in patients receiving individualized nutritional treatment during and after acute hospitalization.