www.elsevier.com/locate/clnu ORIGINAL ARTICLE Effect of nutritional support on clinical outcome in patients at nutritional risk Niels Johansen a, *, Jens Kondrup a , Lise Munk Plum a , Line Bak a , Pernille Nørregaard a , Else Bunch b , Hanne Bærnthsen b , Jens Rikardt Andersen c , Irene Højlund Larsen c , Anette Martinsen c a Clinical Nutrition Unit 5711, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark b Department of Surgery, Hobro-Terndrup Hospital, Denmark c Department of Medicine, County Hospital, Nykbing Falster, Denmark Received 3 July 2003; accepted 7 October 2003 Summary Background & Aims: Undernourished patients have an increased risk of complications and a prolonged hospital stay, compared to those who are not undernourished. The aim of this study was to evaluate the effect of nutritional intervention in a random sample of hospitalized patients at nutritional risk. Methods: A randomized, controlled trial of nutritional intervention in 212 patients. Intervention consisted of a specialized nutritional team (nurse and dietician) who attended patients and staff for motivation, detailed a nutritional plan, assured delivery of prescribed food and gave advice on enteral or parenteral nutrition when appropriate. The control group received the standard regime used in the department. The primary endpoint was the part of the length of stay (LOS) that was considered to be sensitive to nutritional support, designated LOS NDI . The nutritional discharge index (NDI) consists of three objective criteria: (1) the patient is able to manage toilet visits without assistance, reflecting mobilization; (2) the patient is without fever (tpo381C), reflecting absence of infection; and (3) the patient has no intravenous access, reflecting absence of complications in general. On the day when all three criteria were fulfilled, hospital stay was no longer considered to be sensitive to nutritional support. Actual LOS is also reported. Incidence and severity of complications were recorded to explain LOS NDI findings. As a secondary endpoint, quality of life was evaluated by the Short Form 36 (SF-36) questionnaire. Results: Intervention led to an intake of X75% of requirements in 62% of the intervention patients, as compared to 36% of the control patients. Rates of complications, mean LOS NDI and LOS were not significantly different between the two study groups. However, among patients with complications a difference in LOS NDI between intervention patients (1472 days, mean7SE) and control patients (2072 days) was statistically significant (P ¼ 0.015). In the same patients, LOS was 1772 days in the intervention group and 2272 days in the control group (P ¼ 0.028). The SF-36 questionnaire did not show a significant effect of treatment. ARTICLE IN PRESS KEYWORDS Undernutrition; Hospital; Intervention; Randomised controlled trial; Length of stay *Corresponding author. Tel.: þ 45-35-45-23-59; fax: þ 45-35-34-29-13. E-mail address: nielsjohansen@dadlnet.dk (N. Johansen). S0261-5614/$ - see front matter & 2003 Elsevier Ltd. All rights reserved. doi:10.1016/j.clnu.2003.10.008 Clinical Nutrition (2004) 23, 539–550