Supportive nutritional care intervention 

Broad intervention category

Examples

1. Changes to the organisation of nutritional care

• Use of dietetic or healthcare assistants

• Targeted staff training in nutritional care

• Monitoring and documentation of nutritional care

• Implementation of nutritional care pathways/protocols

• Identification of nutritionally at‐risk individuals (e.g. red trays, mandatory nutrition screening)

2. Changes to the feeding environment

• Changes to dining arrangements/style/setting

• Protected meal times

• Feeding assistance

3. Modification of meal profile or pattern

• Changes to meal pattern (e.g. 5 small meals/day)

• Manipulating energy/nutrient density of foods (e.g. food fortification

• Changes to the taste, flavour, appearance of foods, or a combination

4. Additional supplementation of meals

• Between‐meal snacks, drinks or both

• Supplementation with oral nutritional supplements (e.g. routinely provided to entire ward, not individually prescribed)

5. Congregate and home meal delivery systems

• Home meal delivery systems

• Community lunch clubs

Intervention(s) and comparator(s)

Screened/eligible
(N)

Randomised
(N)

ITT
(N)

Finishing trial
(N)

Randomised finishing trial
(%)

Follow‐up

Barton 2000^a2
(modification of meal profile or pattern)

I1: reduced portion size, fortified menu

‐

13

‐

^b

70^c

56 days

I2: cooked breakfast

(8 not randomised)

C: normal hospital diet with usual portion size

14

total:

27^a

‐

‐

Beck 2002^a1
(additional supplementation of meals)

I1: homemade oral supplement (A)

‐

‐

‐

‐

‐

2 months

I2: homemade oral supplement (B)

C: usual diet

total:

36

‐

‐

Bouillane 2013^a1
(modification of meal profile or pattern)

I: 78% protein at lunch

‐

30

‐

30

88

6 weeks

C: usual diet (protein distributed between meals)

36

23

79

total:

66

63

96

Bourdel‐Marchasson 2000^a3
(additional supplementation of meals)

I: 2 oral nutritional supplements

295

‐

‐

‐

15 days or until hospital discharge

C: usual care

377

total:

672

‐

‐

Brouillette1991^a1
(changes to the feeding environment)

I: osmotherapy + activities

‐

10

‐

9

90

4 weeks

C: activities only

10

7

70

total:

20

16

80

Castellanos 2009^a2
(modification of meal profile or pattern)

I1: fortified breakfast and lunch menu

39

^d

^e

2 days of the study

I2: fortified lunch menu

39

C: usual menu

39

total:

39^a

33

85

Chang 2005^a3
(changes to the organisation of nutritional care)

I: training in feeding skills

‐

31

‐

12

60

Quote: "Data collection was from February 2004 to May 2004"

Comment: implies 4 months of data collection, following training but not clearly stated

C: no training

36

8

50

total:

67

20^f

56

Dennis 2005^a1
(additional supplementation of meals)

I: oral nutritional supplement + normal diet

2016

‐

‐

‐

6 months

C: normal hospital diet

2007

total:

4023

‐

‐

Duncan 2006^a1
(changes to the organisation of nutritional care)

I: dietetic assistant

363

153

‐

145

95

4 months

C: usual care

165

157

95

total:

318

302

95

Essed 2007^a4
(modification of meal profile or pattern)

I1: monosodium glutamate

‐

‐

‐

19

N/A

16 weeks

I2: flavour

19

I3: monosodium glutamate + flavour

22

C: maltodextrin (placebo)

23

total:

97

83

86

Essed 2009^a2
(modification of meal profile or pattern)

I: monosodium glutamate + NaCl

‐

59

‐

53

90

4 weeks

C: usual hot meal

59

53

90

total:

59^a

53

90

Faxen‐Irving 2011^a1
(additional supplementation of meals)

I: 30 mL of fat emulsion 3 x per day

107

34

‐

24

71

Median 8 days

C: usual care

37

27

73

total:

71

51

72

Gaskill 2009^a3
(changes to the organisation of nutritional care)

I: nutrition education programme

377

‐

‐

‐

‐

6 months

C: usual care

total:

352

‐

‐

Germain 2006^a1
(modification of meal profile or pattern)

I: re‐formed foods

93

8

‐

7

88

12 weeks

C: usual diet

9

8

89

total:

17

15

88

Hankey 1993^a1
(additional supplementation of meals)

I: supplemented with nutritionally complete drink
in addition to normal hospital diet

‐

10

‐

7

70

8 weeks

C: standard hospital food

10

7

70

total:

20

14

70

Hickson 2004^a1
(changes to the organisation of nutritional care)

I: feeding assistance

1776

292

292

250

86

Duration of hospital stay

C: usual care

300

300

259

86

total:

592

592

509

86

Holyday 2012^a1
(changes to the organisation of nutritional care)

I: malnutrition care plan

‐

71

71

71

100

Duration of hospital stay

C: usual care

72

72

72

100

total:

143

143

143

100

Johansen 2004^a1
(changes to the organisation of nutritional care)

I: nutrition team

7468

‐

‐

108

N/A

Duration of hospital stay

C: usual care

104

total:

215

212

99

Kraft 2012^a1
(changes to the organisation of nutritional care)

I: oral nutritional supplement + telemedicine monitoring

87/50

13

5

1

8

6 months

C: usual care

13

9

4

31

total:

26

14

5

19

Kretser 2003^a1
(congregate and home meal delivery systems)

I: modified meals on wheels

324

102

‐

‐

‐

26 weeks

C: traditional meals on wheels

101

total:

203

60

30

Larsson 1990^a1
(additional supplementation of meals)

I: oral nutritional supplement + normal hospital diet

‐

197

‐

‐

‐

26 weeks

C: normal hospital diet

238

total:

435

‐

‐

Leslie 2012^a3
(modification of meal profile or pattern)

I: energy enriched usual meals

445

22

16

73

12 weeks

C: usual care

19

16

84

total:

41

Lin 2010^a3
(changes to the organisation of nutritional care)

I1: spaced‐retrieval^g

‐

32

‐

‐

‐

8 weeks

I2: Montessori^h

29

C: usual care

24

total:

85

82

97

Lin 2011^{a2, a3}
(changes to the organisation of nutritional care)

I: Montessori

‐

‐

‐

‐

8 weeks

C: usual care

total:

29^a

29

100

Mathey 2001a^a3
(changes to the feeding environment)

I: improved meal ambiance

60

21

‐

12

57

12 months

C: usual care

17

10

59

total:

38

22

58

Mathey 2001b^a1
(changes to the feeding environment)

I: flavour enhancement

‐

‐

‐

31

N/A

16 weeks

C: usual care

36

total:

71

67

94

Munk 2014^a1
(modification of meal profile or pattern)

I: energy and protein enriched foods provided via a la carte menu in addition to hospital food

44

41

96

Duration of hospital stay

C: usual care

40

40

total:

84

Nijs 2006^a3
(changes to the feeding environment)

I: family‐style meals

282

133

‐

95

71

6 months

C: usual care

112

83

74

total:

245

178

73

Olofsson 2007^a1
(changes to the organisation of nutritional care)

I: multi‐component intervention (including nutrition)

353

102

‐

83

81

4 months

C: usual care

97

74

76

total:

199

157

79

Pivi 2011^a1
(changes to the organisation of nutritional care)

I1: nutrition education

‐

‐

‐

25

N/A

6 months

I2: oral nutritional supplements

26

C: usual care

27

total:

90

78

87

Potter 2001^a1
(additional supplementation of meals)

I: oral nutritional supplement + normal hospital diet

618

186

‐

186

100

Duration of hospital stay

C: normal hospital diet

195

195

100

total:

381

381

100

Remsburg 2001^a1
(changes to the feeding environment)

I: buffet‐style meals

62

20

‐

20

100

3 months

C: usual care

20

19

95

total:

40

39

98

Salva 2011^a3
(changes to the organisation of nutritional care)

I: teaching and training

‐

448

448

300

67

12 months

C: usual care

498

498

368

74

total:

946

946

668

71

Silver 2008^a2
(modification of meal profile or pattern)

I: fortified home‐delivered lunch

‐

‐

‐

‐

‐

7 months

C: usual home‐delivered lunch

total:

52

45

87

Simmons 2008^{a2, a3}
(additional supplementation of meals)

I: feeding assistance and/or snacks

173

30

‐

28

88

24 weeks

C: usual diet

34

32

94

total:

64^a

‐

60

94

Simmons 2010^a1
(additional supplementation of meals)

I1: snacks

280

‐

‐

25

N/A

6 weeks

I2: additional supplementation of meals

18

C: usual care

20

total:

86

63

73

Smolliner 2008^a3
(modification of meal profile or pattern)

I: fortified meals and snacks

295/92

‐

‐

22

N/A

12 weeks

C: usual diet

30

total:

65

52

80

Splett 2003^a3
(changes to the organisation of nutritional care)

I: medical nutrition therapy

394

223

‐

200

90

19‐180 days

C: usual care

171

164

96

total:

394

364

92

Taylor 2006^a2
(modification of meal profile or pattern)

I: 5‐meal menu

66

‐

‐

‐

‐

2 periods of 4 days

C: usual (3‐meal menu)

total:

31^a

31

100

Van den Berg 2015^a1
(additional supplementation of meals

I1: offered 125 mL ONS daily with medication rounds

885

88

75

85

Maximum period 30 days

I2: offered 62 mL ONS daily with medication rounds

66

51

77

C: offered 125 mL ONS twice daily in between meals

80

66

83

total:

234

Van Ort 1995^a1
(changes to the feeding environment)

I: contextual and behavioural intervention

8

‐

‐

‐

‐

1 month to 6 weeks

C: usual care

total:

8

7

88

Grand total

All interventions^j

All controls^j

All interventions and controls

10,681

Outcome measure

No. of studies
reporting outcome

No. of participants

Studies potentially with data for meta‐analysis

Energy intake

5

666

1

Health‐related quality of life

1

220

0

Patient satisfaction

2

1105

0

Complications

4

1263

3

Nutritional status: weight

10

2184

9

BMI

7

1537

6

TSF

3

536

3

MAC

3

568

3

Length of stay

5

1256

3

Hospital admission

1

143

1

Mortality

5

2182

5

Costs

2

1089

0

Outcome measure

No. of studies
reporting outcome

No. of participants
(treatment/control)

Studies with data for meta‐analysis

Energy intake

3

216

3

Health‐related quality of life

2

200

0

Nutritional status: weight

3

239

3

MAC

1

178

1

Clinical function

3

1664

2

Mortality

3

236

3

Outcome measure

No. of studies
reporting outcome

No. of participants

Studies potentially with data for meta‐analysis

Energy intake

11

506

7

Health‐related quality of life

1

52

0

Complications

1

66

1

Nutritional status:  weight

7

387

7

BMI

3

98

3

MAC

1

32

1

Clinical function

3

200

3

Length of stay

1

81

1

Mortality

4

243

4

Outcome measure

No. of studies
reporting outcome

No. of participants

Studies potentially with data for meta‐analysis

Energy intake

8

1469

7

Health‐related quality of life

1

4023

0

Complications

2

4695

1

Nutritional status: weight

7

605

4

BMI

2

102

1

TSF

2

0

MAC

3

1

Clinical function

2

618

0

Length of stay

4

4689

1

Mortality

5

5745

5

Costs

1

63

0

Outcome measure

No. of studies
reporting outcome

No. of participants
(treatment/control)

Studies included in the meta‐analysis

Energy intake

27

2857

0

Health‐related quality of life

5

4495

0

Patient satisfaction

2

1105

0

Complications

7

6024

5

Nutritional status: weight

28

3618

24

BMI

12

1737

0

TSF

5

‐

0

MAC

8

‐

0

Clinical function

9

2746

0

Length of hospital stay

10

6026

5

Hospital admissions

2

389

0

Mortality

18

8690

17

Economic costs

3

1152

0

Outcome

Reason the data were not usable

Contact with author

Outcome of contact with author

Action taken

1. Organisational change

Chang 2005

Energy intake

Data reported as amount eaten in ¼, ½, ¾

Yes

No response

Data reported in structured narrative summary

Duncan 2006

Complications

Reported as a median and IQR

Yes

Data provided

Data used

Length of stay

Reported as median and IQR

Yes

Confirmed data skewed

Data reported in structured narrative summary

Gaskill 2009

Measured prevalence of malnutrition with SGA

Not an outcome of interest for this review

Yes, to request weight data (a component of SGA)

Unable to provide data

Data not reported

Hickson 2004

Energy intake

Not measured at baseline, only at follow‐up

Yes, to confirm interpretation of data

Data not measured at baseline

Data reported in structured narrative summary

Complications (antibiotic prescription)

Reported as median and IQR

Yes, to request complications according to group allocation

No. complications according to group allocation was provided

Data reported in structured narrative summary

Hospital admission

States in protocol these are collected, but not reported

Yes, to request data

Author unable to recall what happened with data

Data not reported

Holyday 2012

Costs

An estimate based on local prices, not a complete cost analysis

No, judged unlikely to be available

N/A

Data not reported

Hospital admission

Presented as a frequency

Yes, to request total number of readmissions

Data provided

Data reported in structured narrative summary

Johansen 2004

Energy intake

Reported as kJ/kg/day

Yes, for mean change

No response

Data not reported

Kraft 2012

BMI

Presented as mean and SD at baseline and follow‐up, but no mean change

Yes

No response

Data not reported

Lin 2010

Energy intake

'Amount of each meal consumed' was reported as % eaten

Yes

No response

Data reported in structured narrative summary

Weight

Reported as mean and SD pre and post intervention/control

Yes, to request mean change

No response

Calculated mean change, and imputed the SD of change from Salva 2011

BMI

Reported as mean and SD pre and post intervention/control

Yes, to request mean change

No response

Calculated mean change, and imputed the SD of change from Salva 2011

Olofsson 2007

Weight

Reported as mean and SD pre and post intervention/control

Yes, to request mean change and SD

Data provided

Data reported in structured narrative summary

BMI

Reported as mean and SD pre and post intervention/control

Yes, to request mean change and SD

Data provided

Data reported in structured narrative summary

Complications

Reported as no. falls in men and women

Yes, to request total complications per group

Data provided

Data reported in structured narrative summary

Pivi 2011

Weight

Reported as mean and SD pre and post intervention/control

Yes, to request mean change

No response

Calculated mean change, and imputed the SD of change using the P value

BMI

Reported as mean and SD pre and post intervention/control

Yes, to request mean change

No response

Calculated mean change, and imputed the SD of change from Salva 2011

TSF

Reported as mean and SD pre and post intervention/control

Yes, to request mean change

No response

Calculated mean change, and imputed the SD of change from Salva 2011

MAC

Reported as mean and SD pre and post intervention/control

Yes, to request mean change

No response

Calculated mean change, and imputed the SD of change

Salva 2011

MAC

Methodology reported this was an outcome measured, but not reported in results

Yes

No response

Data not used

Costs

Described as data to be collected, but reported that analysis was not undertaken

No

Not reported

Splett 2003

Intake

Food intake is documented as a nutrition assessment activity

Yes, to request mean energy intake per group

Unable to provide data

Not reported

Weight

Methodology reports this was an outcome measured, but reported in a format not usable

Yes

Unable to provide data

Not reported

2. Feeding environment

Brouilette 1991

Energy

Reported pre and post intervention data, but no SD of change

No, as no author contact details and study published in 1991

N/A

Imputed the SD from Nijs 2006

Van Ort 1995

Weight change

No figures reported

Yes, to request data on mean and SD of change for each group

Waiting response

Not used

Intervention group clarification

Were the behavioural and contextual intervention received at the same time

Yes, to request this detail

Waiting response

Assumed the two interventions were given at the same time

3. Meal modification

Bouillanne 2013

Weight

Did not report weight, but assumed they had the data as Full Body Composition was used

Yes, to request data

Data provided

Data reported

Energy intake

Reported as kcal/kg/day

Yes, to request data

Data provided

Data reported

Hand grip strength

Reported data as mean/median and 95% CI of the median

Yes, to request data

Provided mean and SD of change

Data reported

ADL

Reported data as mean/median and 95% CI of the median

Yes, to request data

Data provided

Data reported

Castellanos 2009

Energy intake

Results were not analysed according to groups randomised, but regrouped subjects into small eaters and large eaters

Yes, to ask for data on mean and SD of change for each group

No response

Data reported

Germain 2006

BMI

They reported the mean BMI rather than mean change

Yes, for mean and SD of change

Data provided

Data reported

Smolliner 2008

Weight change

Reported mean and SD at baseline and end of intervention

Yes, for mean change and SD

Data provided

Data reported

BMI

Reported mean and SD at baseline and end of intervention

Yes, for mean change and SD

Data provided

Data reported

Handgrip strength

Reported mean and SD at baseline and end of intervention

Yes, for mean change and SD

Data provided

Data reported

health‐related quality of life

Reported mean and SD at baseline and end of intervention

Yes, for mean change and SD

Data provided

Data reported

4. Supplementation of meals

Beck 2002

Weight

Reported as median change with 95% CI

Yes, for mean change and SD

Response received but data not available

Data reported in structured narrative summary

Energy intake

Reported as median change with 95% CI

Yes, for mean change and SD

Response received but data not available

Data reported in structured narrative summary

Bourdel‐ Marchasson 2000

Pressure ulcers

Data given as percentage per group

Yes, for number per group

Data provided

Data reported in structured narrative summary

Weight

Data given for baseline only

Yes, for change in weight from baseline to follow‐up

Yes, author stated she did not find the analysis of discharge weight, probably due to the low quality of this data (too many missing data)

Data not reported

Dennis 2005

Complications

Data given as percentages

Yes for data on total complications per group

Data provided

Data reported in structured narrative summary

Health‐related quality of life score

Differences between means provided

Yes, to request mean and SD of changes

Unable to provide data, as EuroQol was only measured at follow‐up

Data reported in structured narrative summary

Faxen‐Irving 2011

Energy intake

Data given in a graph, no numbers available

Yes, for mean and SD of change in energy intake, between the control and intervention groups from baseline to the 2nd registration

Data provided

Data reported in structured narrative summary

Length of stay

Data provided at baseline, not follow‐up

Yes, for mean and SD

Data provided

Data reported in structured narrative summary

Infection

Data provided at baseline, not follow‐up

Yes, for mean and SD

Unable to provide data

Data not reported

BMI

Data provided at baseline, not follow‐up

Yes, for mean and SD

Data provided

Not reported in the summary because few studies measured this outcome

ADL

Data provided at baseline, not follow‐up

Yes, for mean and SD

Data provided

Not reported in the summary because few studies measured this outcome

Hankey 1993

Weight

Presented in graphs, no numbers given

Yes, for mean and SD

Unable to provide data but suggested using data from the review by Milne 2009 which included these data

Data obtained from systematic review by Milne 2009

MAC

Presented in graphs, no numbers given

Yes, for mean and SD

Unable to provide data but suggested using data from the review by Milne 2009 which included these data

Data obtained from systematic review by Milne 2009 but not reported as few studies measured this outcome

TSF

Presented in graphs, no numbers given

Yes, for mean and SD

Unable to provide data but suggested using data from the review by Milne 2009 which included these data

Not reported in the summary because few studies measured this outcome

Energy and protein intake

Presented in graphs, no numbers given

Yes, for mean and SD

Unable to provide data

Data not reported

Larsson 1990

Energy intake

Data included in Modified Norton Scale

Yes, data for change in energy intake between groups (mean and SD)

No response

Data not reported

Weight

Data provided as ‘weight index’

Yes, for change in weight between groups (mean and SD)

No response

Data not reported

TSF

Data provided as differences between men and women, and non‐PEM and PEM groups

Yes, for change between groups (mean and SD)

No response

Data not reported

MAC

Data provided as differences between men and women, and non‐PEM and PEM groups

Yes, for change between groups (mean and SD)

No response

Data not reported

Length of stay

Not given

Yes, for mean and SD between groups

No response

Data not reported

Total number of eligible participants

Unclear across all 4 duplicates of this study

Yes, for a clear number of randomised participants, no finishing study, and deaths

No response

Data not reported

Potter 2001

Length of stay

Provided as median with a range

Yes, for mean and SD between groups

No response

Data reported in structured narrative summary

ADL

Stated as an outcome measure in methodology, then not reported in results

Yes, for mean and SD between groups

No response

Not reported in the summary because few studies measured this outcome

BMI

Stated as an outcome measure in methodology, then not reported in results

Yes, for mean and SD between groups

No response

Not reported in the summary because few studies measured this outcome

TSF

Stated as an outcome measure in methodology, then not reported in results

Yes, for mean and SD between groups

No response

Not reported in the summary because few studies measured this outcome

Simmons 2008

Weight

Data presented as phase 1 and 2 cross‐over combined. The data from phase 1 was needed for this review

Yes, for the phase 1 data

Yes, responded but unable to provide data

Data reported in structured narrative summary

BMI

Data presented as phase 1 and 2 cross‐over combined. The data from phase 1 was needed for this review

Yes, for the phase 1 data

Yes, responded but unable to provide data

Not reported in the summary because few studies measured this outcome

Energy intake

Presented as pre‐ and post intervention

Yes, for mean and SD of change

Yes, responded but unable to provide data

Imputed SD from Nijs 2006

Simmons 2010

Energy

Reported as mean difference without the SD

Yes, requested SD for mean change

Yes, responded but unable to provide data

Imputed SD from Nijs 2006

5. Home meal delivery systems

Kretser 2003

Weight

Reported separately for participants at risk of malnutrition, and those malnourished

No, failed to find contact information for the author

N/A

Combined the mean change data using the formulae for combining groups

Setting

No. participants
[N/N (%)]

No. studies

Hospital

7591/10,681 (71.1)

15

Residential care home

1731/10,681 (16.2)

21

Free‐living/outpatient setting

1305/10,681 (12.2)

5

Outcome

(N)

Results

P Value

Intervention

Control

Dietetic assistants (Hospital)

Duncan 2006

Mean (SD) energy intake (kcal/day)

275 (total N = 302)

1105 (361)

756 (399)

< 0.001

Hickson 2004

Between‐group difference (kcal)

37 (total N = 592)

89

0.538

Specialist training (residential care settings)

Chang 2005

% (SD) meals consumed

67

Pre: 90 % (22)

Post: 85 (25)

Pre: 78 % (34)

Post: 94 % (18)

0.49

Lin 2010

% (SD) meals consumed

85

Spaced retrieval (SR)

Pre: 85 % (11)

Post: 91 % (9)

Montessori (MON)

Pre: 75 % (23)

Post 78 % (10)

Pre: 79 % (19)

Post: 88 % (18)

SR vs control

= NS

MON vs control

< 0.05

Multi‐disciplinary team (hospital)

Johansen 2004

kcal/kg body weight per day (SE)

202 (total N = 212)

30 (SE 1)

25 (SE 1)

< 0.005

Outcome

(N)

Results

P Value

Intervention

Control

Patient satisfaction

Dietetic assistants (hospital)

Duncan 2006

Median score (IQR)

159

6.5 (2)

3.0 (4)

0.0001

Health‐related quality of life

Multi‐disciplinary team (hospital)

Johansen 2004

Change in physical score (SF‐36)

110

2.4 (1.3)

0.2 (1.5)

NS

Change in mental score (SF‐36)

110

2.2 (2.5)

3.3 (2)

NS

Number of complications

Dietetic assistants (hospital)

Duncan 2006

Total number of participants with complications

302

84/125 (67%)

79/130 (61%)

0.29

Hickson 2004

Number of participants receiving oral antibiotics

592

142/292 (49%)

150/300 (50%)

0.67

Multi‐disciplinary team (hospital)

Johansen 2004

Total number of participants with complications

212

34/108 (31%)

23/104 22%)

NS

Olofsson 2007

Total number of participants with complications

157

81/83 (98%)

74/74 (100%)

Outcome

(N)

Results

P Value

Intervention

Control

Dietetic assistants (hospital)

Duncan 2006

Mean change (SD)

Weight (kg)

MAC (cm)

TSF (mm)

(total N = 302)

170

230

205

‐0.36 (3.3)

‐0.9 (2.2)

‐0.88 (2.6)

‐1.0 (2.8)

‐1.3 (1.5)

‐1.23 (3.2)

0.16

0.002

0.087

Hickson 2004

Mean change (SD)

Weight (kg)

MAC (cm)

TSF (mm)

Median (IQR)

MAMC

BMI (kg/m²)

(total N = 592)

191

286

279

429

254

‐0.92 (2.71)

‐0.3 (1)

‐0.4 (1.8)

‐0.1 (‐0.8‐0.4)

‐0.04 (1.1)

‐0.9 (3)

‐0.3 (1)

‐0.4 (1.7)

‐0.1 (‐0.5‐0.3)

‐0.25 (1.18)

0.23

0.65

0.86

0.84

0.68

Specialist training (residential care settings)

Lin 2010

Mean change (SD)

Weight (kg)

BMI (kg/m²)

85

Spaced retrieval

‐0.07 (0.57)

Montessori

‐0.15 (0.57)

Spaced retrieval

0.1 (1.0)

Montessori

‐0.06 (1.0)

‐0.09 (0.57)

‐0.03 (1)

NS

NS

Lin 2011

BMI

29

‐0.26 (0.73)

‐0.09 (0.85)

0.245

Specialist training (free‐living individuals)

Pivi 2011

Mean change (SD)

Weight (kg)

MAC (cm)

TSF (mm)

BMI (kg/m²)

52

1.19 (imputed SD: 3.3)

1.87 (2)

2.3 (5.4)

1.19 (1)

‐2.2 (imputed SD: 3.3)

‐0.4 (0.46)

2.2 (5.3)

‐2.21 (1)

Reported as between‐group differences for 4 groups

Salva 2011

Mean change (SD)

Weight (kg)

BMI (kg/m²)

946

0.26 (0.7)

‐0.01 (2.2)

0.09 (0.5)

‐0.06 (3.2)

0.598

0.843

Multi‐disciplinary team (hospital)

Johansen 2004

Mean change (SD)

Weight (kg)

(total N = 212)

95

‐0.22 (3.9)

0.1 (2)

NS

Olofsson 2007

Mean change (SD)

Weight (kg)

BMI (kg/m²)

(total N = 199)

157

157

‐1.1 (3.6)

‐0.45 (1.3)

‐0.7 (3.8)

‐0.3 (1.5)

0.05

0.05

Protocol‐driven pathway (hospital)

Holyday 2012

Mean change (SD)

Weight (kg)

(total N = 143)

69

‐0.9 (3.6)

‐0.9 (2.3)

0.98

Protocol‐driven pathway (residential care settings)

Splett 2003

Weight

364

No wt loss at baseline: 95% maintained wt.

Wt loss at baseline: 48% maintained or gained wt.

No wt loss at baseline: 58% maintained wt.

Wt loss at baseline: 57% maintained or gained wt.

Telemedicine (free‐living individuals)

Kraft 2012

Mean change (SD)

Weight (kg)

BMI (kg/m²)

26

14

‐4.5 (7.9)

Baseline 24.5 (5.1)

Follow‐up 23.0 (4.2)

‐3 (6.2)

Baseline 23.9 (4.4)

Follow‐up 22.8 (4.3)

NS

NS

Outcome

(N)

Results

P Value

Intervention

Control

Handgrip strength

Dietetic assistants (Hospital)

Duncan 2006

Mean change (SD)

126 (total N = 302)

2.2 (10.7)

0.16 (11.8)

0.32

Hickson 2004

Median change (IQR) (kg)

(total N = 592)

0.8 (‐1.4 to 2.5)

0.7 (‐1.5 to 3)

0.85

Outcome

(N)

Results

P Value

Intervention

Control

Mortality

Dietetic assistants (Hospital)

Duncan 2006

4‐month mortality

(total N = 302)

19/145 (13%)

36/157 (23%)

0.036

Hickson 2004

In‐hospital mortality

(total N = 592)

31/292 (11%)

35/300 (12%)

0.69

Specialist training (free‐living individuals)

Salva 2011

12‐month mortality

946

43/448 (10%)

29/498 (6%)

NR

Multi‐disciplinary team (hospital)

Olofsson 2007

4‐month mortality

199

9/102 (9%)

13/97 (13%)

NR

Protocol‐driven pathway (hospital)

Holyday 2012

Not reported

143

1/72 (1%)

4/71 (6%)

0.21

Length of stay in hospital

Dietetic assistants (hospital)

Duncan 2006

Median (IQR) (days)

167

34 (48)

32 (49)

0.81

Hickson 2004

Median (IQR) (days)

592

21(13‐36)

23(14‐39)

0.41

Multi‐disciplinary team (hospital)

Johansen 2004

Mean (SD)

LOS to 28 days

197

11.6 (8)

11.5( 8)

NS

Olofsson 2007

Mean (SD) (days)

157

27.4 (15.9)

39.8 (41.9)

< 0.05

Protocol‐driven pathway (hospital)

Holyday 2012

Mean (SD) (days)

143

13.7 (11.8)

13.5 (11)

0.85

Hospital readmissions

Protocol‐driven pathway (hospital)

Holyday 2012

Number of readmissions at 6 months

30/71

37/72

NR

Outcome

(N)

Results

P Value

Intervention

Control

Changes to the dining room environment

Mathey 2001

Mean change (SD) energy intake (kcal)

22

199 (406)

185( 247)

NR

Nijs 2006

Mean change (SD) energy intake (kcal)

178

116 (456)

‐100 (357)

Mean difference (95% CI)

178

235 (83‐268)

Described as significantly different

but no P value reported

Remsburg 2001

NR

Sensory stimulation

Brouillette 1991

Mean change (SD) in intake of lunch

meal (kcal)

16

‐1.6 (450)

11.14 (360)

0.49

Outcome

(N)

Results

P Value

Intervention

Control

Changes to the dining room environment

Mathey 2001a

Sickness Impact Profile, mean change (SD) in score

16/2

‐2 (11)

‐13 (12)

NR

Nijs 2006

Overall QOL mean change (95% CI) in score

178

0.4 (‐1.8 to 2.5)

‐5 (‐9.4 to ‐0.6)

NR

Mean difference (95% CI)

178

6.1 (2.1 to 10.3)

Described as significantly different

but no P value reported

Physical performance, mean change (95% CI) in score

178

0.2 (‐2.3 to 2.7)

‐2.2 (‐4.1 to ‐0.4)

NR

Mean difference (95% CI)

178

3.2 0.9 to 5.5)

Described as significantly different

but no P value reported

Outcome

(N)

Results

P Value

Intervention

Control

Weight

Changes to the dining room environment

Mathey 2001a

Mean change (SD) (kg)

22

3.3 (5)

‐0.4 (4)

I: < 0.05; C: 0.78

Nijs 2006

Mean change (SD) (kg)

178

0.5 (3.9)

‐1.1 (3.7)

NR

Mean difference (95% CI)

178

1.5 (0.6 to 2.4)

Described as significantly different

but no P value reported

Remsburg 2001

Mean change (SD) (kg)

39

‐0.11 (3.1)

0.32 (2.2)

0.638

Outcome

(N)

Results

P Value

Intervention

Control

Changes to the dining room environment

Mathey 2001a

Mortality

38

7/21 (33%)

5/17 (29%)

NR

Nijs 2006

Mortality

178

18/112 (16%)

16/133 (12%)

NR

Sensory stimulation

Brouillette 1991

Mortality

20

1/10 (10%)

0/10 (0%)

NR

Outcome

(N)

Results

P Value

Intervention

Control

Fortification of food (studies in hospital)

Barton 2000

Total energy intake (kcal/d)

36

1711 (195)

1425 (136)

< 0.001

Munk 2014

Mean (SD) intake (kj/d)

81

5843 (1660)

5149 (1832)

Mean (95% CI) difference between groups

693 (‐80 to 1466)

0.08

Fortification of food (studies in residential care homes)

Leslie 2012

mean (SEM) change in energy intake (baseline to week

12) (kcal/d)

16

133 (89)

‐36 (84)

0.154

Food fortification (studies in free‐living individuals)

Silver 2008

Total energy intake (kcal/d)

45

1876 (543)

1423 (422)

< 0.001

Modifications to meal composition (studies in intermediate care)

Bouillane 2013

Change in energy intake (kcal)

63

50.9 (458)

39.2 (401)

NR

Modifications to meal delivery (studies in residential care homes)

Germain 2006

Change in energy intake (kcal)

15

611 (408)

81 (169)

0.03

Taylor 2006

Total energy intake (kcal/d)

31

1342 (177)

1325 (207)

0.565

Modifications to flavour (studies in residential care homes)

Essed 2007

Change in energy intake (kcal)

83

Flavour: ‐17 (445)

Flavour + MSG: 78 (352)

MSG: ‐32 (28)

102 (452)

NR

Essed 2009

Energy intake from modified meal (kcal)

53

420 (211)

424 (216)

0.896

Mathey 2001b

Change in energy intake (kcal)

67

‐50 (267)

‐115 (298)

Baseline to end of intervention I: NR, C: < 0.05

Outcome

(N)

Results

P Value

Intervention

Control

Weight and BMI (mean change (SD))

Fortification of food (studies in hospital)

Munk 2014

Mean (SD) within‐group change in

weight (kg)

66

0.4 (2.6)

‐0.4 (1.8)

0.17

Mean (95% CI) between‐group difference in

weight (kg)

‐0.8 (‐1.9 to 0.3)

Fortification of food (studies in residential care homes)

Leslie 2012

Mean (SD) within‐group weight change (kg)

31

1.3 (0.53)*

‐0.2 (1.5)**

*0.03

**0.536

Mean (SD) within‐group change in BMI (kg/m²)

31

0.5 (0.25)*

‐0.1 (0.4)**

*0.042

**0.517

Mean (SD) within‐group change in MUAC (mm)

32

0.4 (0.16)*

‐0.1 (0.3)**

*0.019

**0.691

Smolliner 2008

Mean (SD) change weight (kg)

52

2 (2.1)

1.6 (2)

NS

BMI change (kg/m²)

52

0.77 (1.5)

0.45 (1.1)

Between‐group

difference NS

Modifications to meal composition (studies in intermediate care)

Bouillanne 2013

Mean (SD) change weight (kg)

63

0.4 (2.3)

‐0.7 (3.1)

NR

Modifications to meal delivery (studies in residential care homes)

Germain 2006

Mean (SD) change weight (kg)

15

3.9 (2.3)

‐0.8 (4.2)

0.02

BMI change (kg/m²)

15

1.51 (1.16)

0.27 (1.46)

Data provided by

study author P value NR

Modifications to flavour (studies in residential care homes)

Essed 2007

Mean (SD) change weight (kg)

83

Flavour: 0.1 (2.4)

Flavour + MSG: ‐ 0.8 (3.3)

MSG: ‐ 0.7 (3.6)

0.1 (3.8)

NR

Mathey 2001b

Mean (SD) change weight (kg)

67

1.1 (1.3)

‐0.3 (1.6)

< 0.05

Outcome

(N)

Results

P Value

Intervention

Control

Mortality

Fortification of food (studies in hospital)

Munk 2014

Mortality

81

1/44

1/40

NR

Fortification of food (studies in residential care homes)

Leslie 2012

Mortality

32

2/19

5/22

NR

Smolliner 2008

Mortality

65

2/31

1/34

NR

Modifications to meal composition (studies in intermediate care)

Bouillane 2013

Mortality

66

1/30 (3%)

1/36 (3%)

NR

Length of hospital stay

Fortification of food (studies in hospital)

Munk 2014

Days from study inclusion to discharge

81

10 (8)

10 (8)

0.73

Handgrip strength

Fortification of food (studies in hospital)

Munk 2014

Mean change (SD) baseline to day 3 (kg)

76

‐0.1 (2.9)

‐0.4 (4.3)

0.76

Mean difference (95% CI) between I & C

‐0.3 (‐1.9 to ‐1.4)

0.95

Fortification of food (studies in residential care homes)

Smolliner 2008

Mean change (SD) (kg)

61

‐0.81 (3.12)

‐1.29 (3)

NR

Modifications to meal composition (studies in intermediate care)

Bouillane 2013

Mean change (SD) (N)

63

‐0.5 (41.7)

14 (45.1)

0.411 (ANCOVA 0.271)

Bouillane 2013

Change in ADL score (mean (SD)

63

‐0.02 (1.6)

0.54 (1.7)

0.125 (ANCOVA 0.118)

Outcome

(N)

Results

P Value

Intervention

Control

Supplementation with food (residential care homes)

Beck 2002

Change in energy intake (kcal/d) (median 95% CI)

16

‐24 (‐454 to 860)

24 (‐167 to 478)

NS

Simmons 2008

Change in energy intake kcal/ (mean SD)

64

302 (450)

127 (360)

Baseline to 6 months I: = 0.000; C: NS

Simmons 2010

Change in energy intake (mean SD)

43

‐65 (450)

67 (360)

NS

Supplementation with ONS (in hospital) (reported as mean (SD)

Bourdel‐Marchasson 2000

Total energy intake (kcal/d)

672

1188 (613)

1102 (503)

0.13

Faxen‐Irving 2011

Change in energy intake (kcal/d)

38

94 (350)

6.5 (358)

NR

Potter 2001

Total energy intake (kcal/d)

381

1409 (448)

1090 (417)

S

Van den Berg 2015

Mean (SD) energy intake from ONS (kcal/d)

192

I1:343 (172)*

I2: 469 (111)**

389 (162)

*0.289

**0.006

Supplementation with ONS (long‐term/residential care settings)

Hankey 1993

Total energy intake (kcal/d)

21

1747 (273)

1147 (310)

Baseline to wk 8, I: 0.01; C: NS

Simmons 2010

Change in energy intake

42

28 (450)

67 (360)

0.14

Outcome

(N)

Results

P Value

Intervention

Control

Incidence of pressure ulcers

Supplementation with ONS (in hospital)

Bourdel‐Marchasson 2000

Cumulative incidence at end of follow‐up (%)

Number of participants with pressure ulcers at day 15

672

40

101/295

48

164/37

NR

NR

Dennis 2005

Number of participants with pressure ulcers

4023

15/2016

26/2007

0.0507

Total complications

Supplementation with ONS (in hospital)

Dennis 2005

All in‐hospital complications

4023

515/2014 (26%)

448/2001 (22%)

NR

Health‐related quality of life

Supplementation with ONS (in hospital)

Dennis 2005

Utilitiy (median (IQR)) (EUROQoL)

3086

Median group difference 0.52 (0.03 to 0.74)

0.96

Outcome

(N)

Results

P Value

Intervention

Control

Supplementation with food (residential care homes)

Beck 2002

Change in weight (median 95% CI)

16

1.3 (‐1 to 3)

1.5 (‐2.3 to 9)

NS

Simmonds 2008

Mean change (SD) weight (kg)

Mean (SD) change in BMI

64

The intervention group gained 4 lbs more

The intervention group gained 0.72 kg/m² than the usual care

NR

NR

0.009

0.009

Simmonds 2010

Mean change (SD) weight (kg)

43

0.02 (1.1)

0.21 (1.7)

NS

Supplementation with ONS (in hospital)

Faxen‐Irving 2011

Mean change (SD) weight (kg)

Mean (SD) BMI at follow‐up (kg/m2)

38

38

0.13 (2.2)

20.4 (3.7)

‐0.95 (2.3)

20.4 (3.7)

21.9 (3.8)

NR

0.17

Potter 2001

Mean change in weight (kg)

Mean change (SD) MAC (cm)

381

381

0.4 (2.6)

‐0.1 (1.3)

‐0.5 (2.9)

‐0.4 (1.2)

0.003

NS

Supplementation with ONS (long‐term care settings)

Hankey 1993

Mean change (SD) weight (kg)

Mean change (SD) MAC

21

21

2.83 (10)

‐1 (10)

‐0.53 (10)

0.6 (10)

NR ‐ data from Milne 2009

NR data from Milne 2009

Simmons 2010

Mean change in weight (kg)

42

0.91 (2.3)

0.24 (1.96)

NS

Outcome

(N)

Results

P Value

Intervention

Control

Mortality

Supplementation with ONS (in hospital)

Bourdel‐Marchasson 2000

Mortality

672

25/295 (8%)

22/377 (6%)

0.18

Dennis 2005

Mortality

4023

241/2016 (12%)

253/2007 (13%)

0.7

Potter 2001

Mortality

381

21/186 (11%)

33/195 (17%)

0.117

Supplementation with ONS (long‐term care settings)

Larsson 1990

Mortality

435

29/197 (15%)

56/238 (24%)

0.13

Length of stay

Supplementation with ONS (in hospital)

Faxen‐Irving 2011

Length of hospital stay (days)

51

10.5 (SD 5.6)

10.3 (SD 4.9)

NS

Dennis 2005

Length of hospital stay (days)

Median (IQR)

4023

16 (IQR 7–44)

16 (IQR 7–41)

NS

Potter 2001

Length of hospital stay (median (range))

381

16 (3‐141)

18 (2‐76)

0.31

Van den Berg 2015

Length of hospital stay (median (range))

234

I1: 10 (3‐63)

I2: 10 (3‐27)

11 (4‐71)

NR

Hospital readmissions & discharge destination

Supplementation with ONS (in‐hospital)

Potter 2001

Discharge to home

Discharge to institution

381

381

131/186

31/186

127/195

33/195

NS

Van den Berg 2015

Hospital readmissions

246

I1: 13

I2: 24

15

NR

Outcome

(N)

Results

P Value

Intervention

Control

Weight change

Kretser 2003

Mean change in weight (kg)

163

1.86 (5.3)

‐1,04 (5.2)

0.0062

Mortality

Kretser 2003

Mortality

203

3/102 (3%)

9/101 (9%)

NR