Impact of nutritional support on clinical outcome in patients at nutritional risk: A multicenter, prospective cohort study in Baltimore and Beijing teaching hospitals

Objective: To evaluate the impact of nutritional support on clinical outcomes in patients at nutritional risk defined by the Nutritional Risk Screening 2002. Methods: In this prospective cohort study, hospitalized patients from three departments in Johns Hopkins Hospital in Baltimore and two teaching hospitals in Beijing were recruited from March 2007 to May 2008. Data were collected on the nutritional risk screening, application of parenteral nutrition and enteral nutrition, surgery, complications, and length of stay. Results: There were 1831 patients recruited, with 45.2% of them at nutritional risk. Of the "at-risk" patients, the complication rate was significantly lower in the nutritional-support group than in the no-support group (20.3% versus 28.1%, P = 0.009), mainly because of the lower rate of infectious complications (10.5% versus 18.9%, P < 0.001). Subgroup analysis showed the complication rate was significantly lower in the enteral nutrition group (P < 0.001) but not in the parenteral nutrition group (P = 0.29) when compared with the no-support group. Of the patients without nutritional risk, the complication rate was not different between the nutritional-support group and the no-support group (P = 0.10). Multivariate analysis showed nutritional support was a protective factor for complications in at-risk patients when adjusted for confounders (odds ratio 0.54, P < 0.001). No difference in length of stay was found. Conclusion: The findings suggested that nutritional support was beneficial to the patients at nutritional risk according to Nutritional Risk Screening 2002 by a lower complication rate.