Abstract：
BACKGROUND: Nutrition support is associated with improved survival and nonelective hospital readmission rates among malnourished medical inpatients; however, limited evidence supporting dietary counseling is available. We intend to determine the effect of dietary counseling with or without oral nutrition supplementation (ONS), compared with standard care, on hospitalized adults who are malnourished or at risk of malnutrition.
METHODS: We searched MEDLINE/PubMed, CINAHL, Embase, Scopus, The Cochrane Library, and Google Scholar for studies listed from January 1, 2011, to August 31, 2021. Meta-analysis was performed to obtain pooled risk ratios (RRs) and 95% CIs to estimate the effect. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the certainty of the evidence.
RESULTS: Sixteen studies were identified. Compared with standard care, dietary counseling with or without ONS probably does not reduce inpatient rates of 30-day mortality (RR = 1.24; 0.60-2.55; I2 = 45%; P = 0.56; moderate certainty), slightly reduces 6-month mortality (RR = 0.83; 0.69-1.00; I2 = 16%; P = 0.06; high certainty), reduces complications (RR = 0.85; 0.73-0.98; I2 = 0%; P = 0.03; high certainty), and may slightly reduce readmission (RR = 0.83; 0.66-1.03; I2 = 55%; P = 0.10; low certainty) but may not reduce length of stay (mean difference: -0.75 days; -1.66-0.17; I2 = 70%; P = 0.11; low certainty). Intervention may result in slight improvements in nutrition status/intake and weight/body mass index (low certainty).
CONCLUSIONS: There is an increase in the certainty of evidence regarding the positive impact of dietary counseling on outcomes. Future studies should standardize and provide details/frequencies of counseling methods and ONS adherence to determine dietary counseling effectiveness.
METHODS: We searched MEDLINE/PubMed, CINAHL, Embase, Scopus, The Cochrane Library, and Google Scholar for studies listed from January 1, 2011, to August 31, 2021. Meta-analysis was performed to obtain pooled risk ratios (RRs) and 95% CIs to estimate the effect. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the certainty of the evidence.
RESULTS: Sixteen studies were identified. Compared with standard care, dietary counseling with or without ONS probably does not reduce inpatient rates of 30-day mortality (RR = 1.24; 0.60-2.55; I2 = 45%; P = 0.56; moderate certainty), slightly reduces 6-month mortality (RR = 0.83; 0.69-1.00; I2 = 16%; P = 0.06; high certainty), reduces complications (RR = 0.85; 0.73-0.98; I2 = 0%; P = 0.03; high certainty), and may slightly reduce readmission (RR = 0.83; 0.66-1.03; I2 = 55%; P = 0.10; low certainty) but may not reduce length of stay (mean difference: -0.75 days; -1.66-0.17; I2 = 70%; P = 0.11; low certainty). Intervention may result in slight improvements in nutrition status/intake and weight/body mass index (low certainty).
CONCLUSIONS: There is an increase in the certainty of evidence regarding the positive impact of dietary counseling on outcomes. Future studies should standardize and provide details/frequencies of counseling methods and ONS adherence to determine dietary counseling effectiveness.
摘要：
背景：营养支持与营养不良住院患者的生存率和非选择性住院再入院率相关；然而，支持饮食咨询的证据有限.我们打算确定有或没有口服营养补充剂（ONS）的饮食咨询的效果，与标准护理相比，营养不良或有营养不良风险的住院成年人。
方法：我们搜索了MEDLINE/PubMed，CINAHL,Embase,Scopus,科克伦图书馆,和谷歌学者的研究从2011年1月1日至2021年8月31日列出。进行荟萃分析以获得合并风险比（RR）和95％CIs来估计效果。建议评估的分级，发展,采用评估(GRADE)系统对证据的确定性进行评估。
结果：确定了16项研究。与标准护理相比，有或没有ONS的饮食咨询可能不会降低住院患者30天死亡率(RR=1.24;0.60-2.55;I2=45%;P=0.56;中等确定性)，6个月死亡率略有降低(RR=0.83;0.69-1.00;I2=16%;P=0.06;高确定性)，减少并发症（RR=0.85;0.73-0.98;I2=0%;P=0.03;高确定性），可能会略微降低再入院率(RR=0.83;0.66-1.03;I2=55%;P=0.10;低确定性),但可能不会降低住院时间(平均差:-0.75天;-1.66-0.17;I2=70%;P=0.11;低确定性)。干预可能会导致营养状况/摄入量和体重/体重指数略有改善（确定性较低）。
结论：关于饮食咨询对结果的积极影响的证据的确定性增加。未来的研究应标准化并提供咨询方法和ONS依从性的详细信息/频率，以确定饮食咨询的有效性。
方法：我们搜索了MEDLINE/PubMed，CINAHL,Embase,Scopus,科克伦图书馆,和谷歌学者的研究从2011年1月1日至2021年8月31日列出。进行荟萃分析以获得合并风险比（RR）和95％CIs来估计效果。建议评估的分级，发展,采用评估(GRADE)系统对证据的确定性进行评估。
结果：确定了16项研究。与标准护理相比，有或没有ONS的饮食咨询可能不会降低住院患者30天死亡率(RR=1.24;0.60-2.55;I2=45%;P=0.56;中等确定性)，6个月死亡率略有降低(RR=0.83;0.69-1.00;I2=16%;P=0.06;高确定性)，减少并发症（RR=0.85;0.73-0.98;I2=0%;P=0.03;高确定性），可能会略微降低再入院率(RR=0.83;0.66-1.03;I2=55%;P=0.10;低确定性),但可能不会降低住院时间(平均差:-0.75天;-1.66-0.17;I2=70%;P=0.11;低确定性)。干预可能会导致营养状况/摄入量和体重/体重指数略有改善（确定性较低）。
结论：关于饮食咨询对结果的积极影响的证据的确定性增加。未来的研究应标准化并提供咨询方法和ONS依从性的详细信息/频率，以确定饮食咨询的有效性。
