TY - JOUR
T1 - Quality of the Evidence Supporting the Role of Oral Nutritional Supplements in the Management of Malnutrition
T2 - An Overview of Systematic Reviews and Meta-Analyses
AU - Baldwin, Christine
AU - Smith, Rosemary
AU - Gibbs, Michelle
AU - Weekes, C Elizabeth
AU - Emery, Peter
PY - 2020/8/9
Y1 - 2020/8/9
N2 - There is considerable heterogeneity across the findings of systematic reviews of oral nutritional supplement (ONS) interventions, presentingdifficulties for healthcare decision-makers and patients alike. It is not known whether heterogeneity arises from differences in patient populationsor relates to methodological rigor. This overview aimed to collate and compare findings from systematic reviews of ONSs compared with routinecare in adult patients who were malnourished or at risk of malnutrition with any clinical condition and to examine their methodological quality.Three electronic databases were searched to July 2019, supplemented with hand-searching. Data on all outcomes were extracted and reviewmethodological quality assessed using A MeaSurement Tool for Assessment of systematic Reviews (AMSTAR). Twenty-two reviews were included,11 in groups from mixed clinical backgrounds and 11 in specific clinical conditions. Ninety-one meta-analyses were identified for 12 differentoutcomes but there was discordance between results. Significant benefits of ONSs were reported in 4 of 4 analyses of energy intake, 7 of 11analyses of body weight, 7 of 22 analyses of mortality, 10 of 17 analyses of complications (total and infectious), 1 of 3 analyses of muscle strength,4 of 9 analyses of body composition/nutritional status, 2 of 14 analyses of length of stay, and 2 of 5 analyses of hospital readmissions. Ten reviewswere high quality (AMSTAR scores 8–11), 9 moderate (AMSTAR scores 3–8), and 3 poor (AMSTAR scores 0–3). Methodological deficiencies werelimitations to searches, poor reporting of heterogeneity, and failure to incorporate quality of evidence into any recommendations. Discordancebetween reviews was not markedly reduced when only high-quality reviews were considered. Evidence for the effects of ONS in malnourishedpatients or those who are at risk of malnutrition is uncertain, and discordance in results can arise from differences in clinical background of patientsor the etiological basis of malnutrition.
AB - There is considerable heterogeneity across the findings of systematic reviews of oral nutritional supplement (ONS) interventions, presentingdifficulties for healthcare decision-makers and patients alike. It is not known whether heterogeneity arises from differences in patient populationsor relates to methodological rigor. This overview aimed to collate and compare findings from systematic reviews of ONSs compared with routinecare in adult patients who were malnourished or at risk of malnutrition with any clinical condition and to examine their methodological quality.Three electronic databases were searched to July 2019, supplemented with hand-searching. Data on all outcomes were extracted and reviewmethodological quality assessed using A MeaSurement Tool for Assessment of systematic Reviews (AMSTAR). Twenty-two reviews were included,11 in groups from mixed clinical backgrounds and 11 in specific clinical conditions. Ninety-one meta-analyses were identified for 12 differentoutcomes but there was discordance between results. Significant benefits of ONSs were reported in 4 of 4 analyses of energy intake, 7 of 11analyses of body weight, 7 of 22 analyses of mortality, 10 of 17 analyses of complications (total and infectious), 1 of 3 analyses of muscle strength,4 of 9 analyses of body composition/nutritional status, 2 of 14 analyses of length of stay, and 2 of 5 analyses of hospital readmissions. Ten reviewswere high quality (AMSTAR scores 8–11), 9 moderate (AMSTAR scores 3–8), and 3 poor (AMSTAR scores 0–3). Methodological deficiencies werelimitations to searches, poor reporting of heterogeneity, and failure to incorporate quality of evidence into any recommendations. Discordancebetween reviews was not markedly reduced when only high-quality reviews were considered. Evidence for the effects of ONS in malnourishedpatients or those who are at risk of malnutrition is uncertain, and discordance in results can arise from differences in clinical background of patientsor the etiological basis of malnutrition.
M3 - Article
SN - 2161-8313
JO - Advances in Nutrition
JF - Advances in Nutrition
ER -
