Nina Kaegi-Braun,

Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
University of Basel

Dr. Nina Kaegi-Braun was born in Switzerland and studied Medicine at the University of Basel, Switzerland. She is currently a resident in the Department of Endocrinology, Diabetes and Clinical Nutrition at the Kantonsspital Aarau in Switzerland. She has a special interest in clinical nutrition and is part of the research team of Prof. Dr. Philipp Schuetz, who was the principal investigator of the EFFORT trial. This is the largest-yet randomized-controlled trial looking at clinical effects of nutritional support in malnourished medical ward patients and has just been published in the Lancet recently.

Nutritional support of medical inpatients at nutritional risk: Is it worth the EFFORT?

Historically, in the field of malnutrition, there had been a lack of strong evidence from large and high-quality trials resulting in often weak guideline recommendations and therefore insufficient implementation in clinical practice. Among others, the recently published EFFORT trial investigated the influence of protocol-guided individualized nutritional therapy on clinical outcomes. It was a pragmatic, investigator-initiated, open-label trial, where nutritional risk was assessed with the validated Nutritional Risk Screening score [NRS 2002] and nutritional intervention was performed following a predefined treatment algorithm. The combined primary outcome was adverse clinical outcome 30 days post-randomization including all-cause mortality, intensive care admission, non-elective hospital readmission, major complications and decline in functional status. Overall, the trial found a significant reduction in the risk for severe complications (23% vs 27%) with a number needed to treat to prevent one severe complication of 25. Also, 30-day mortality was significantly reduced in the intervention group (7.2% vs 9.9%). These findings together with evidence from other studies had highlighted the meaningful clinical improvement associated with individualized nutritional support. We should now aim to further practice “evidence-based nutrition” with high quality trials investigating the remaining questions to optimize the management of hospitalized malnourished patients.