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.
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。