MEDPass versus conventional administration of oral nutritional supplements - A randomized controlled trial comparing coverage of energy and protein requirements.

Autor: Kurmann S; Health Division, Nutrition and Dietetics, Bern University of Applied Sciences, Bern, Switzerland. Electronic address: silvia.kurmann@bfh.ch., Reber E; Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland. Electronic address: emilie.reber@insel.ch., Schönenberger KA; Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland; Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland. Electronic address: katja.uhlmann@bfh.ch., Schuetz P; Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland. Electronic address: schuetzph@gmail.com., Uhlmann K; Health Division, Nutrition and Dietetics, Bern University of Applied Sciences, Bern, Switzerland., Vasiloglou MF; University of Bern, AI in Health and Nutrition Laboratory, ARTORG Center for Biomedical Engineering Research, Bern, Switzerland. Electronic address: vasilogloumaria@gmail.com., Schoenenberger AW; Department of Geriatrics, Inselspital, Bern University Hospital and University of Bern, Bern Switzerland. Electronic address: andreas.w.schoenenberger@gmail.com., Bertschi D; Department of Geriatrics, Inselspital, Bern University Hospital and University of Bern, Bern Switzerland. Electronic address: dominic.bertschi@spitaltiefenau.ch., Sterchi AB; Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland. Electronic address: anna-barbara.sterchi@insel.ch., Stanga Z; Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland. Electronic address: zeno.stanga@insel.ch.
Jazyk: angličtina
Zdroj: Clinical nutrition (Edinburgh, Scotland) [Clin Nutr] 2023 Feb; Vol. 42 (2), pp. 108-115. Date of Electronic Publication: 2022 Dec 05.
DOI: 10.1016/j.clnu.2022.11.015
Abstrakt: Background & Aims: The use of oral nutritional supplements (ONS) in the hospital setting is important to reach individual protein and energy goals in patients at risk for malnutrition. Compliance with ONS can be challenging but may be improved by prescribing ONS in smaller portions with medication rounds (MEDPass). We compared the likelihood of meeting energy and protein requirements in patients receiving ONS with MEDPass versus conventional ONS administration.
Methods: The MEDPass Trial is a randomized, controlled, open-label superiority trial conducted on medical and geriatric wards in a University Hospital in Switzerland. The MEDPass group was allocated to receive 50 ml of ONS four times per day with the medication rounds. The control group received ONS per conventional care between the meals. The primary outcome was the percentage of energy in relation to the individual requirement. Secondary outcomes included the coverage of protein intake in relation to the individual requirement, the amount of daily consumed ONS, the course of handgrip strength (HGS), body weight appetite and nausea. Furthermore, we compared 30-day mortality and hospital length of stay (LOS) was studied in medical patients.
Results: From November 22nd, 2018 until November 30th, 2021, 204 patients were included in the trial (MEDPass group n = 100, control group n = 104). A total of 203 patients at nutritional risk were analyzed in the intention-to-treat analysis (ITT). Regarding the primary endpoint, there was no difference in the coverage of energy requirement between the MEDPass and control group (82 vs. 85% (Δ -3%, 95%CI -11 to 4%), p = 0.38). Similarly, no differences were found for the secondary outcomes including coverage of protein requirement (101 vs. 104% (Δ -3%, 95% CI -12 -7%), p = 0.57, average daily intake of ONS (170 vs 173 ml (Δ - 3 ml, 95% CI -14 to 8 ml), p = 0.58) and 30-day mortality (3 vs. 8 patients, OR 0.4 (95% CI 0.1-1.4), p = 0.15). The course of HGS, body weight, appetite and nausea did not differ between the groups (p = 0.29, p = 0.14, p = 0.65 and p = 0.94, respectively). The per protocol analysis including 178 patients showed similar results.
Conclusion: Within this controlled trial setting, we found a high compliance for ONS intake and high coverage of protein requirements but no further improvement when ONS was administered using MEDPass compared to conventional care. MEDPass administration may provide an alternative that is easy to integrate into nursing routines, which may lead to lower workload with cost benefits and reduction of food waste.
Trial Registration: ClinicalTrials.gov: NCT03761680.
Competing Interests: Conflict of Interest SK: SK has received honorariums from Abbott Nutrition and Fresenius Kabi and consulting fees from Omanda Medical Nutrition. ER, KAS, KU, MV, AWS, DB and ABS: no conflicts of interest. PS: The institution of PS has received grants unrelated to this project from Nestlé Health Science, Abbott Nutrition, Thermofisher and bioMerieux. ZS: The institution of ZS received research support from Nestlé Health Science, Abbott Nutrition, Fresenius Kabi and B. Braun.
(Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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