入院リハ患者の低栄養に対する経口栄養介入：メタ解析

入院リハ患者の低栄養に対する経口摂取での栄養介入の予防と治療効果をみた系統的レビューとメタ解析の論文を紹介します。

http://www.ncbi.nlm.nih.gov/pubmed/24811842

10論文が系統的レビューの対象となっていますが、メタ解析は経口栄養剤によるエネルギーとたんぱく質の摂取量のみ行われました。エネルギーとたんぱく質の摂取量は、どちらも有意に増加しました。

でもエネルギーとたんぱく質の摂取量は、リハ栄養の一次アウトカムではないですよね。少なくとも低栄養改善、できればADLやQOL改善、入院期間短縮などがアウトカムでないと…。リハ栄養のエビデンスが少ないことがよくわかります。 何とかしないとですね。

Collins J1, Porter J.　The effect of interventions to prevent and treat malnutrition in patients admitted for rehabilitation: a systematic review with meta-analysis.　J Hum Nutr Diet. 2014 May 9. doi: 10.1111/jhn.12230. [Epub ahead of print]

Abstract
BACKGROUND: Malnutrition occurs frequently among patients in rehabilitation, leading to poorer outcomes. Evidence of the effects of interventions to prevent or treat malnutrition is required to guide clinical practice in this setting. This systematic review aimed to determine the effect of oral nutrition interventions implemented in rehabilitation on nutritional and functional outcomes.

METHODS: Five databases were searched to identify relevant publications; intervention trials of oral nutrition interventions (such as oral nutrition supplements, foodservice interventions, clinical care processes, enhanced eating environments) conducted with patients admitted for rehabilitation, reporting dietary intake, anthropometric, biochemical or functional outcomes. The reviewers determined study eligibility and assessed the included studies for risk of bias. Outcome data were combined narratively and by meta-analyses.

RESULTS: From 1765 publications, 10 studies trialling oral nutrition supplements, foodservice interventions and clinical care processes (of neutral or positive quality) were identified. Compared to meals alone, oral nutritional supplements significantly improved energy and protein intake, with some evidence for improvements in anthropometry and length of stay. There was little evidence that speciality supplements were beneficial compared to standard versions. Meta-analyses demonstrated significantly greater energy [weighted mean difference (WMD) = 324 kcal, 212-436 kcal 95% confidence interval (CI)] and protein (WMD = 9.1 g, 0.2-17.9 g 95% CI) intake with energy dense meals. Opposing results were reported in studies investigating enhanced clinical care processes.

CONCLUSIONS: The provision of oral nutrition supplements and energy dense meals improved energy and protein intake and therefore may comprise effective strategies for addressing malnutrition in rehabilitation. The effect of these strategies on other nutritional and functional outcomes should be explored further.