Systematic review of non-pharmacological interventions to prevent or treat malnutrition in older people. The SENATOR (ONTOP series) and MaNuEL Knowledge Hub project

Introduction: Systematic reviews (SRs) on malnutrition suggest that energy and protein intake can be improved, but results for functional or clinical outcomes have been inconclusive. Following the ONTOP methodology, we aimed to perform a review of SRs of non-pharmacological interventions in older patients with well-defined malnutrition using relevant outcomes agreed by a broad panel of experts. Method: SPubMed, Cochrane, EMBASE, and CINHAL databases were searched for SRs. Primary studies from those SRs, in any setting, were included. Quality assessment was made using Cochrane and GRADE criteria. Results: Nineteen primary studies from seventeen SRs were included. The most frequent intervention was oral nutritional supplementation (ONS) compared with usual care (11 RCTs). Meta-analysis was only feasible for six studies assessing changes in body weight (BW) and two studies for body mass index (BMI) at follow-up. Neither showed beneficial effects of the intervention [mean difference (95% CI) BW 0.59 (- 0.08, 1.96); BMI 0.31 (- 0.17, 0.79)]. No beneficial effects of ONS treatment in MNA scores, muscle strength, activities of daily living, timed Up&Go, quality of life and mortality were found. Other intervention studies (dietary counselling and ONS, ONS combined with exercise, nutrition delivery systems) could not be pooled and results of individual studies were inconsistent. The overall quality of the evidence was very low due to risk of bias and small sample size. Conclusions: This review does not show beneficial effects of ONS or other non-pharmacological interventions versus usual care on nutritional, functional or other health outcomes in older malnourished patients. High quality research studies are urgently needed in this area