Effectiveness of mealtime interventions to improved nutritional intake of adult patients in the acute care setting: a systematic review

Background Malnutrition affects 20-50% of patients in acute care hospitals. It is a problem that often goes unrecognized and untreated despite being associated with a number of adverse health consequences including delayed wound healing, increased infection rates, functional decline, increased length of stay in hospital and increased mortality. Lack of mealtime assistance has been suggested as a possible barrier to adequate nutritional intake in patients. Mealtime intervention strategies focusing on either the mealtime environment or on the provision of support have been promoted by various organisations and advocacy groups as a means to improve nutritional intake. Objectives The objective of this systematic review was to identify, assess and synthesize the available evidence on the effectiveness of mealtime interventions to improve nutritional intake of adult patients in the acute care setting. Inclusion criteria Types of participants Adults and/or elderly, aged 18 years and over, from any ethnic background, who were inpatients in acute care hospital with any diagnosis. Patients in intensive care or high dependency units, those obtaining their nutrition exclusively by enteral or parenteral means, those receiving palliative care or considered to be at end of life were excluded. Types of intervention(s)/phenomena of interest Any supportive mealtime practices that promote optimal eating and feeding for adult patients in the acute care setting that are not solely related to the actual food or fluid offered or ordered, for or by the patient. Types of studies Randomized controlled trials and quasi-experimental studies. Types of outcomes The primary outcome measures of interest were measures of nutritional intake namely energy and protein and/or nutritional status, length of stay in hospital and all-cause mortality. Search strategy A three step search strategy was used to find published and unpublished studies reported in English language. Methodological quality Studies that met the review inclusion criteria were critically appraised by two reviewers for methodological validity using the Joanna Briggs Institute Meta Analysis Statistics Assessment and Review Instrument (JBI-MAStARI). Data collection Data was extracted from the included studies by the primary reviewer using JBI-MAStARI data extraction tool. The tool included specific details about the interventions, population, study methods and outcome measures of relevance to the systematic review question. Data synthesis Heterogeneity in study designs, interventions, outcomes and reporting meant meta-analysis was not possible. The findings were therefore presented as a narrative summary. Results Six included studies involving 1071 patients evaluated the effectiveness of employed assistants, trained volunteers and eating at a table or in a dining room rather than by the bedside or in bed. Patient energy intake increased when employed assistants provided mealtime assistance, however this was only statistically significant for one of the two studies that investigated this mealtime intervention. Similarly, energy intake increased when trained volunteers supported patients at mealtimes; however this was only statistically significant in one of two relevant studies. Protein intake significantly increased in two studies where trained volunteers provided assistance at mealtimes. One study reported that energy intake significantly increased when patients ate at a table and another when patients ate in a dining room as compared with eating beside or in their beds. Conclusions Mealtime interventions including the use of assistants, trained volunteers and eating at a table or in a dining room increased the energy intake of patients in acute care hospitals. Mealtime assistance provided by trained volunteers also increased protein intake in this patient group. Few studies were TRUNCATED AT 600 WORDSGail Whitelock, Edoardo Aromatari