(P26-014-24) Effectiveness of Medical Nutrition Therapy Provided by Dietitians in Adults With Malnutrition: A Systematic Review

Objectives: To evaluate the effectiveness of medical nutrition therapy (MNT) provided by registered dietitians (dietitians) for the treatment of adults diagnosed with protein-energy malnutrition through use of a valid nutrition assessment tool or framework; compared to lesser or no MNT received on nutrition related outcomes of interest.

Methods: A systematic review was conducted using Academy of Nutrition and Dietetics Evidence Analysis Center and Cochrane methods. A systematic search was performed in MEDLINE, Cochrane Central, APA PsycINFO, and CINAHL Complete for clinical trials and observational studies published in English from January 2000 until July 2023.  Outcomes of interest included nutrition status, mortality, quality of life, hospital readmissions, length of stay, cost-effectiveness, calorie and protein intake, weight and BMI, and physical function.  Risk of bias was assessed by two independent reviewers using the ROB 2.0 for randomized controlled trials, and the Quality Criteria Checklist for nonrandomized and observational studies. Evidence was narratively synthesized and meta-analysis was performed as appropriate for each outcome. Certainty of the evidence was evaluated using the GRADE method for each outcome.

Results: There were 5,288 articles identified in the systematic search and screened; 557 full text articles were reviewed, and 15 articles representing 10 studies were included. The results of the systematic review indicate a trend toward improvement in nutrition status from MNT, however, results were uncertain (very low certainty). MNT may have no effect on mortality, yet may slightly reduce in-hospital mortality (low certainty). MNT may increase weight and BMI, and reduce readmissions (low certainty). The effect of MNT on calorie and protein intake, length of stay, quality of life, physical function (handgrip strength) and cost effectiveness is uncertain (very low certainty evidence). Certainty of evidence was primarily marked down for risk of bias and imprecision.

Conclusions: MNT may improve nutrition related outcomes in adults with malnutrition however evidence is limited. Additional research on the effectiveness of MNT for the treatment of malnutrition (diagnosed with a valid nutrition assessment tool or framework) is warranted.

Funding Sources: Academy of Nutrition and Dietetics
Academy of Nutrition and Dietetics Foundation