The effect of post-discharge oral nutritional supplements on outcomes after gastrointestinal surgery: A systematic review and meta-analysis

Rowley, Annabel; Adiamah, Alfred; Kushairi, Anisa; Lewis, Stephen J; Lobo, Dileep N.

Abstract

Background
Malnutrition is a risk-factor for adverse postoperative outcomes. This systematic review and meta-analysis evaluated the impact of post-discharge oral nutritional supplements (ONS) on outcomes in patients undergoing gastrointestinal surgery.

Methods
The Medline and Embase databases were searched for randomised clinical trials in patients undergoing gastrointestinal surgery who had received ONS for at least two weeks after discharge from hospital. The primary endpoint was weight change. Secondary endpoints included quality of life, total lymphocyte count, total serum protein, serum albumin and body composition. Analysis was performed using RevMan5.4 software.

Results
Fourteen studies with 2480 participants (1249 ONS/1231 controls) were included. Pooling of results revealed that there was reduced weight loss in patients taking ONS, when compared with control: overall weighted mean difference (WMD) -1.09 kg, 95% CI -1.78 to -0.39, P=0.002. Serum albumin concentration was increased in the ONS group: WMD=1.43 g/L, 95% CI 0.56 to 2.29, P=0.001. Total lymphocyte count was increased in the ONS group compared with control: WMD 0.17×109/L, 95% CI 0.01 to 0.34, P=0.004 and so was haemoglobin: WMD 6.53 g/L, 95% CI 2.54 to 10.52, P=0.001. Total protein did not differ between the groups. Patient compliance was relatively poor across the studies and there was variability in the composition of ONS and volume consumed.

Conclusions
There was a reduction in weight loss and an improvement in other nutritional markers in patients taking ONS after gastrointestinal surgery. However, future RCTs with more consistent methodologies are needed to investigate the efficacy of ONS after discharge from hospital.

Citation

Rowley, A., Adiamah, A., Kushairi, A., Lewis, S. J., & Lobo, D. N. (2023). The effect of post-discharge oral nutritional supplements on outcomes after gastrointestinal surgery: A systematic review and meta-analysis. Clinical Nutrition, 42(7), 1189-1201. https://doi.org/10.1016/j.clnu.2023.04.028

• Journal Article Type: Article
• Acceptance Date: Apr 29, 2023
• Online Publication Date: May 4, 2023
• Publication Date: 2023-07
• Deposit Date: May 4, 2023
• Publicly Available Date: May 31, 2023
• Journal: Clinical Nutrition
• Print ISSN: 0261-5614
• Electronic ISSN: 1532-1983
• Publisher: Elsevier BV
• Peer Reviewed: Peer Reviewed
• Volume: 42
• Issue: 7
• Pages: 1189-1201
• DOI: https://doi.org/10.1016/j.clnu.2023.04.028
• Keywords: post-discharge nutrition; oral nutritional supplements; postoperative outcomes; gastrointestinal surgery
• Public URL: https://nottingham-repository.worktribe.com/output/20283876
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S0261561423001425