Impact of Nutritional Support Teams and Micronutrient Supplementation on Clinical Outcomes: Assessing Compliance and Feasibility in a Cohort Study

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However, the evidence for the impact of MN supplementation remains controversial. Therefore, our study aims to assess the impact on nutritional outcomes according to exploring the implementation of MN support with multidisciplinary collaboration. Methods All 255 patients referred to a nutrition support team (NST) between July and November 2022 were included. The NST reviews the MN protocol, which includes multivitamins and trace elements, based on international nutrient guidelines. All patients who were on nothing per oral and did not meet ≥ 70% of their nutritional requirements within 1 week were recommended MN supplements. Compliance with the MN protocol was evaluated, alterations in nutritional status based on the Nutrition Risk Screening 2002 (NRS 2002) scoring system and clinical outcomes were assessed after 7 day and at discharge. Multiple logistic regression analysis was used to identify factors associated with high nutritional risk in discharged patients. In addition, a sub-analysis was performed on changes in the nutritional of patients on the ward and in the intensive care unit (ICU). Results The rate of implementation of MN supplementation was 50.2%. The findings indicated a significant decrease in the NRS 2002 score in the good-compliance group with MN supplementation. No significant differences in protocol compliance were observed in terms of mortality, hospital stay, or length of stay in the intensive care unit. However, bad compliance with MN supplementation was correlated with risk factors for malnutrition at discharge. In subgroup analysis, nutritional status in the ICU and wards improved, with a significant difference between the two groups. Conclusion MN supplementation via the protocol is helpful for inpatients’ nutritional status. Therefore, bad compliance with MN supplementation has been identified as a risk factor for malnutrition at discharge, which requires active intervention by the NST. Nutritional support team Micronutrient Malnutrition Multivitamins Trace elements Intensive care unit Clinical outcomes Figures Figure 1 Figure 2 Figure 3 Introduction Nutritional insufficiency is related to specific diseases, including anemia, obesity following bariatric surgery, chronic liver disease, kidney disease, inflammatory bowel disease, cardiomyopathies, and heart failure. Failure to meet nutritional requirements can contribute to the aggravation of diseases among inpatients [ 1 ]. Moreover, proper nutritional supplementation has shown favorable clinical outcomes, including morbidity, mortality, and readmission rates, in the intensive care unit (ICU) [ 2 – 5 ]. Most nutritional supplements tend to target patients’ total calorie and protein nutritional needs [ 3 ]. Malnutrition often correlates with deficiencies in both micronutrients and macronutrients [ 6 ]. Nutrient support guidelines recommend micronutrient (MN) supplementation, particularly in patients with long-term malnutrition [ 7 – 9 ]. Guidelines recommend trace element supplementation for malnourished patients with daily requirements for intravenous nutrition and low caloric intake [ 9 ]. A consensus on the daily recommended intake has also been established to guide the supply of MNs. Despite the positive clinical outcomes observed with nutritional supplements, MN supplementation remains controversial owing to statistically inconsistent clinical outcomes [ 10 ]. There is insufficient evidence regarding the clinical benefits of high-dose supplementation of trace elements [ 11 ]. No clinical benefit was found for additional micronutrient supplementation. However, previous studies have not included specific protocols based on guidelines for micronutrients, and further research based on consistent criteria is needed [ 6 ]. We presented a protocol for the provision of trace elements based on international guidelines in collaboration with a multidisciplinary nutrition support team (NST). The aim was to determine the feasibility of nutritional interventions by a multidisciplinary NST and to identify changes in nutritional status and clinical outcomes following MN supplementation. Materials and methods Study design and participation All patients referred to the NST between July and November 2022 were included. Among malnourished patients referred to the NST, all patients 1) who received MN-free parenteral nutrition and 2) who did not meet 70% of their nutritional requirements (energy and protein) via enteral nutrition were classified as individuals eligible for MN supplementation. Patients with incomplete information in their electronic medical records, as well as pediatric patients, were excluded. The implementation of the prescribed supplementation within 7 days of the NST recommendation was checked. Patients who successfully received the prescribed supplementation were categorized into the good compliance group, whereas those who did not receive supplementation were classified into the bad compliance group. This study is to evaluate the compliance of the multidisciplinary interventions and to identify changes in nutritional status and factors associated with nutritional risk groups after compliance with the intervention protocol. In addition, we also analyze the difference in change in nutritional status between patients in ICU and wards. Nutrient supplement protocol To develop a nutrient support protocol that includes MNs according to international guidelines (ASPEN, American Society for Parenteral and Enteral Nutrition; ESPEN, European Society for Parenteral and Enteral Nutrition) [ 8 , 9 ], a multidisciplinary protocol council comprising physicians, pharmacists, nurses, and nutritionists was established. Caloric and protein requirements were expressed as percentages to ensure adequacy. In cases where patients had a body mass index (BMI) > 25, the adjusted weight was used. Caloric intake ranged from 25 to 30 kcal per kilogram of body weight, while protein requirements were determined to be between 0.8 and 1.2 g per kilogram of body weight, considering renal function [ 7 , 12 ]. Among the various multivitamin products available in Korea, daily supplementation with products that fulfill the daily requirements of adults was recommended [ 9 ] (Table 1 S). However, for trace elements, it was challenging to identify a suitable product that could adequately meet the required dosage among the available options within a hospital setting. Consequently, a weekly supply of trace elements was adopted as a general practice [ 13 ]. Selenium was selected as the standard product for supplementation due to the lack of a combination product. Selenium, as described in Table S1 , was selected as the standard product in Korea that met the recommended daily allowance for supplementation. We recommended the parenteral route for PN, while allowing any form of MN to be administered according to clinical practice. Monitoring and verifying trace element levels after supplementation is recommended, particularly in situations anticipating significant deficiency, like continuous renal replacement therapy, burns, gastrointestinal surgery, and excessive gastrointestinal loss [ 14 ]. After 1 week, the implementation of all recommendations was assessed, and a nutritional evaluation was repeated at the end of the study in instances of discharge or mortality. Data Collection Baseline characteristics, such as age, sex, weight, and BMI, were documented. To assess the clinical condition, the Charlson Comorbidity Index (CCI), Acute Physiology and Chronic Health Evaluation III (APACHE III) score, and use of a mechanical ventilator were evaluated in patients admitted to the ICU. For nutritional status assessment, data on feeding status and laboratory findings, such as albumin and total protein levels, were collected. Nutritional status was assessed based on the Nutrition Risk Screening 2002 (NRS 2002) scoring system [ 15 ]. Study variables and analysis For descriptive statistical analysis, continuous variables were expressed as mean (standard deviation) for normally distributed variables and median (interquartile range) for non-normally distributed variables, while categorical values were presented as percentages. To compare groups, the chi-square, and Fisher’s exact tests were employed for categorical variables, while the t-test was used for continuous variables. Paired t-tests and chi-square tests were used to compare the mortality rate, NRS 2002, duration of hospitalization, and length of ICU admission. Kaplan–Meier curves were used to investigate the relationship between overall survival and the administration of MN supplements. The impact of nutritional interventions on ICU and ward patients, excluding those who had expired, was assessed using repeated measures ANOVA for the analysis of NRS. Multivariate logistic regression analyses were performed to identify the risk of malnutrition in the NRS 2002 evaluation. Variable selection was based on items with a p-value < 0.1 in the binary regression analysis. Two-sided p-values were used to determine statistical significance. All statistical analyses were conducted using IBM SPSS Statistics V21.0 software. Results During the study period, 903 malnourished patients were referred to the NST. Among these, 63 were excluded from the analysis based on the exclusion criteria (Fig. 1 ). In this study, 255 patients required MN supplementation, with 148 in the ward and 107 in the ICU. Of these, 80 patients (31.4%) receiving enteral nutrition (EN) did not meet the nutritional requirements for over 1 week, whereas 162 patients (63.5%) received MN-free parenteral nutrition (PN). The EN group had a lower rate of nutritional adequacy compared to the PN group. Sex differences were observed between the good and bad compliance groups to meet the NST recommendations, although no significant differences were noted in other variables. Further details are listed in Table 1 . Table 1 Baseline characteristics Value Total (N = 255) Good Compliance (N = 128) Bad compliance (N = 127) p-value Age, year 70.1 ± 15.5 68.5 ± 16.2 71.8 ± 14.6 0.087 Male, n (%) 150 (58.8) 67 (52.3) 83 (65.4) 0.047 Weight, kg 58.3 ± 27.8 60.2 ± 36.4 56.5 ± 14.7 0.296 BMI, kg/m 2 21.7 ± 6.5 21.9 ± 6.0 21.6 ± 7.0 0.692 Feeding status Enteral, n (%) 80 (31.4) 33 (25.8) 47 (37.0) 0.29 Non per oral, n (%) 162 (63.5) 88 (68.8) 74 (58.3) Others, n (%) 13 (5.2) 7 (5.4) 6 (4.7) Enteral achievement rate, Energy, kcal/kg 43.0 (26.0–58.0) 42.0 (29.0–51.0) 46.0 (26.0–60.5) 0.417 Protein, g/dL 44.0 (25.0–60.0) 46.0 (25.0–58.0) 44.0 (25.0–60.5) 0.926 Parenteral achievement rate Energy, kcal/kg 55.0 (40.0–73.0) 58.0 (40.5–74.0) 51.0 (40.0–71.0) 0.528 Protein, g/dL 62.5 (43.0–84.0) 62.0 (43.0–84.0) 63.0 (44.0–83.0) 0.77 CCI 5.0 (4.0–7.0) 5.0 (4.0–7.0) 5.0 (4.0–7.0) 0.971 APACHE II 19.0 (14.0–24.0) 19.0 (13.5–25.5) 19.0 (14.0–24.0) 1 NRS 2002 5.0 (4.0–5.0) 4.5 (4.0– 5.0) 5.0 (4.0–6.0) 0.111 Ventilator care, n (%) 63 (25.7) 26 (21.1) 37 (30.3) 0.279 Total Protein, g/dL 6.4 (5.7–7.0) 6.5 (5.7–7.0) 6.3 (5.8–7.0) 0.556 Albumin, g/dL 3.3 (2.6–3.8) 3.4 (2.6–3.9) 3.2 (2.6–3.8) 0.459 Values are presented as mean ± standard deviation, number (%), or median (interquartile range). APACHE II score, Acute Physiology and Chronic Health Evaluation II score; BMI, body mass index; NRS, nutritional risk screening; CCI, Charlson Comorbidity Index The NRS score at reference was no significant difference between the two groups (P = 0.605). There were no significant differences in the duration of hospitalization and ICU stay between the two groups. However, there was a difference in NRS at discharge and in the change in score depending on compliance, as shown in Table 2 . The mean difference between intake and output was significantly higher at the time of admission in good and bad compliance group, it is evaluated to have a less effect on body weight of NRS 2002 at discharge (Table 2 ). Table 2 Clinical outcomes after intervention of nutrition support team focusing on micronutrients supplements a Value Total (N = 204) Good Compliance (N = 100) Bad compliance (N = 104) p-value NRS 2002 at referral 4.5 ± 1.3 4.5 ± 1.1 4.6 ± 1.5 0.605 NRS 2002 at discharge 3.8 ± 1.2 3.5 ± 1.2 4.1 ± 1.2 0.002 NRS 2002 change -0.7 (1.5) -0.7 (1.5) -0.4 ± 1.5 0.001 Difference between input and output at referral, mL 403.2 ± 65.9 533.5 ± 105.6 272.9 ± 77.4 0.048 Difference between input and output at discharge, mL 208.1 ± 57.3 277.8 ± 86.1 284.4 ± 76.1 0.954 Length of hospital stay, day 22.0 (14.0–41.5) 23.0 (15.0–47.0) 21.0 (13.0–36.0) 0.137 Length of ICU, day 5.0 (0.0–15.0) 4.0 (0.0–15.0) 6.0 (0.0–15.0) 0.384 Mortality b , n (%) 51 (20.0) 28 (21.8) 23 (18.1) 0.552 Values are presented as mean ± standard deviation, number (%), or median (interquartile range). NRS, nutritional risk screening; NRS 2002 Change = NRS at discharge – NRS at referral, ICU, intensive care unit; a Patient group excluding death, b Good compliance group (n = 128), Bad compliance group (n = 127) Regarding mortality rates, no significant difference was observed between the good compliance and bad compliance groups. The Kaplan–Meier curves of the overall survival according to interventions are shown in Fig. 2 . No statistically significant difference in overall survival was observed between the bad compliance group and the good compliance group (P = 0.536). However, significant differences over time were observed in the influence of ICU and ward patients, as evidenced by notable distinctions in NRS assessments (Fig. 3 ). The results of identifying the nutritional factors associated with the high-risk group based on NRS 2002, as assessed during discharge, are presented in Table 3 . Both the group with bad compliance and the presence of nutritional risk on hospitalization were identified as risk factors for being classified in the high-risk group even at discharge, with respective odds ratio 1.54 (95% confidence interval [CI] 1.74–12.63, P = 0.002) and 1.55 (95% CI 1.05–2.29, P = 0.024). Table 3 Risk factors of high-risk malnutrition at discharge based on NRS 2002 a, b B S.E. OR OR 95% CI p-value Constant -2.93 2.09 .05 0.161 Bad compliance 1.54 0.50 4.68 1.74 12.63 0.002 NRS 2002 at referral 0.44 0.19 1.55 1.05 2.29 0.024 Ventilator care status 0.29 0.63 1.34 0.38 4.71 0.641 CCI 0.09 0.10 1.09 0.90 1.33 0.363 Length of ICU 0.03 0.01 1.03 0.99 1.07 0.056 Age 0.02 0.01 1.02 0.98 1.05 0.268 Length of hospital stay 0.01 0.01 1.01 0.98 1.03 0.331 BMI at referral -0.18 0.06 0.83 0.73 0.93 0.003 Wound status -0.60 0.64 0.54 0.15 1.92 0.346 CCI, Charlson Comorbidity Index; ICU, intensive care unit; BMI, body mass index; NRS, nutritional risk screening; B, regression coefficient; OR, odds ratio; SE, standard error. a Logistic regression included variables significant in the univariate analysis. b Patient group, excluding deaths (n = 204) OR: Odds Ratio; CI: confidence interval. Conversely, a higher BMI at admission was found to be a variable associated with a lower risk of being categorized in the high-risk group (odds ratio 0.83, 95% confidence interval 0.73–0.93, P = 0.003). Discussion This study shows that MN supplementation under the guidance of a multidisciplinary council was correlated with improving factors for malnutrition at discharge according to compliance. Nutritional status in the ICU and wards improved significantly found in the NRS 2002 scores change through NST in Korea. This study focused on the continuous monitoring of nutritional and clinical outcomes. The nutrition intervention protocol includes a plan for providing MN to malnourished patients. MNs play a crucial role in nutrient metabolism and function, and according to guidelines, their supplementation is recommended for hospitalized patients who are at risk of deficiency [ 7 – 9 ]. While the clinical benefits of additional supplementation or high doses of single antioxidant nutrients remain inconclusive, guidelines suggest meeting the daily requirements to prevent malnutrition without adverse effects [ 11 ]. In this study, patients receiving MN-free PN or EN, who were expected to experience long-term nutritional deficiencies, were selected as participants for investigation [ 16 , 17 ]. Multidisciplinary efforts have been made to address the nutritional needs of these patients. In addition to identifying high-risk patient groups, multi-vitamin products that fulfilled the daily requirements were carefully chosen. Concerning trace elements, products containing manganese, chromium, zinc, and copper were administered once a week to supplement the recommended dosage without anticipated toxicity while closely monitoring liver and renal function indicators [ 13 , 14 ]. Furthermore, selenium supplementation is recommended as part of the recommended supplemental regimen. Based on individual assessments, vitamin K was advised to provide the minimum required amount [ 7 ]. Achieving an optimal vitamin supply proved challenging, especially when dealing with trace elements affecting the kidneys and liver. The guideline recommended that micronutrients should be supplied in the recommended daily allowance and provided periodically, even in situations of product shortage [ 8 , 13 ]. Our protocol recommended staying within the range of daily requirements for trace elements (Table S1 ). Numerous discussions are necessary to identify suitable products for supplementation, considering factors, such as reasonable pricing and determining the most effective products for clinical application. Through multidisciplinary collaboration, we aimed to generate exemplary instances that facilitated the drawing of meaningful conclusions. Nutritional assessments were conducted using the NRS 2002 after nutritional interventions. Clinical outcomes, such as mortality, length of stay, and ICU stay, were monitored. In our study, significant differences were found in the NRS 2002 scores change. It is possible to assess a positive nutritional outcome in our study by monitoring the food intake status over the past week. Therefore, the NRS 2002 is a widely recommended tool for assessing and predicting malnutrition in hospital settings [ 19 ]. It has also been extensively examined to predict long-term clinical outcomes [ 20 ]. Within the context of this study, a significant reduction in the scores of the good compliance group was observed following the intervention, indicating a positive impact. During the intervention period, there were consistent nutritional impacts, especially among ICU patients compared to ward patients (Fig. 3 ). Furthermore, patients with a shorter hospitalization period or longer ICU admission period demonstrated a lower acceptance rate of NST and required active intervention. Previous studies have indicated a positive correlation between NST activity and clinical outcomes, with acceptance of the protocol suggested as a crucial factor in this relationship [ 3 ]. In the present study, a higher mortality rate was observed in the good compliance group than in the bad compliance group, although the difference was not statistically significant. Nevertheless, significant observations were made regarding the conduct of physicians in accepting interventions, and these findings should be acknowledged in future endeavors targeting at-risk groups where interventions have not been carried out. These findings highlight the importance of implementing diverse strategies to enhance patient acceptance and adherence to the protocol in future interventions. The nutritional status of the hospitalized patients was closely monitored by assessing their NRS 2002 scores at the time of referral to the NST and after the observation period. Among these patients, those identified as high-risk (with a score of ≥ 5) were selected for further analysis because previous studies have associated this high-risk group with adverse clinical outcomes, including mortality [ 20 – 23 ]. Despite the absence of a significant difference in the referral NRS 2002 scores between the two groups, bad compliance emerged as a risk factor for the high-risk group after accounting for the other significant variables. These findings are consistent with those of previous studies that focused on the high-risk group identified by the NRS 2002, demonstrating a propensity for reduced malnutrition risk following intervention [ 2 ]. This descriptive study examined the nutritional clinical status and clinical outcomes following interventions by a multidisciplinary team with a particular focus on trace element supplementation based on guidelines. However, this study has certain limitations. First, the NRS 2002 is usually used as an index to screen for malnutrition, assessing the overall nutritional status in the acute phase individual [ 24 , 25 ]. It compromised nutritional impairment, severity of illness, and nutritional status for one week. Although the NRS2002 has been evaluated as a predictor of clinical outcomes [ 26 , 27 ], it cannot differentiate between clinical and nutritional intervention results [ 28 ]. The results between intake and output value may have been biased by the clinical effect of the NRS. Further research is needed to determine whether this improvement is the result of the nutrition team's intervention efforts. Second, the follow-up of MN supplementation was limited to 7 d based on NRS 2002, highlighting the need for continuous monitoring in patients with long-term hospitalization. Individual monitoring of suspected deficient trace elements was not performed despite recommendations. Therefore, further research in the form of prospective intervention studies is warranted to address this. Given the retrospective observational nature of this study, further validation through randomized intervention studies is warranted to strengthen our findings. The results emphasize the crucial role of a multidisciplinary team in recognizing malnourished patients at the time of referral and enhancing the acceptance rate of NST activities. Conclusion We confirmed the feasibility of the MN supplementation protocol through multidisciplinary collaboration. Also, compliance with MN supplementation is associated with the risk factor of malnutrition at discharge. Therefore, MN supply protocol and compliance is needed to improve malnutrition in hospital patients. Abbreviations MN micronutrient NST nutrition support team NRS 2002 Nutrition Risk Screening 2002 ICU intensive care unit Declarations Ethics approval and consent to participate Each participant provided informed written consent. This study was approved by the Institutional Review Board of the Research Institute for Inha University Hospital. Data availability The datasets used to reach the findings of the study are available from the corresponding author upon reasonable request. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Funding This work was supported by the Basic Science Research Program through the National Research Foundation of Korea, funded by the National Research Foundation of Korea (NRF) under Grant (NRF-2021R1G1A1095241), and supported by 2023 academic research funds of The Korean Society of Clinical Neurophysiology. Author contributions SML, JBS, and SHP participated in the conception and design of the study; SML, SHP performed the literature search; MNK, SJJ participated in data acquisition; SML, SHP created figures; SML carried out the statistical analysis; SML, JBS, and SHP participated in interpretation of the analyses and writing the manuscript; SML, JBS, and SHP participated in critical revision and final approval of the manuscript. The final manuscript was read and approved by all authors. References Berger MM, Pantet O, Schneider A, Ben-Hamouda N. Micronutrient deficiencies in medical and surgical inpatients. J. Clin. Med. 2019;8:931. Schuetz P, Fehr R, Baechli V, Geiser M, Deiss M, Gomes F, et al. Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial. Lancet (London, England). 2019;393:2312-2321. Gomes F, Baumgartner A, Bounoure L, Bally M, Deutz NE, Greenwald JL, et al. 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Nutritional risk screening score as an independent predictor of nonventilator hospital-acquired pneumonia: a cohort study of 67,280 patients. BMC Infect Dis. 2021;21:313. Sanson G, Sadiraj M, Barbin I, Confezione C, De Matteis D, Boscutti G, et al. Prediction of early- and long-term mortality in adult patients acutely admitted to internal medicine: NRS-2002 and beyond. Clin Nutr. 2020;39:1092-1100. Sahli L, Hagenbuch N, Ballmer PE, Rühlin M, Imoberdorf R. NRS-2002 components, nutritional score and severity of disease score, and their association with hospital length of stay and mortality. Swiss Med Wkly. 2021;151:w20517. Additional Declarations No competing interests reported. Supplementary Files Supplement.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3995710","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":275703546,"identity":"621f8b93-530a-425b-920c-dfc8a85e63d5","order_by":0,"name":"Sunmin Lee","email":"","orcid":"","institution":"Sunchon National University","correspondingAuthor":false,"prefix":"","firstName":"Sunmin","middleName":"","lastName":"Lee","suffix":""},{"id":275703547,"identity":"bca178eb-049e-4c15-a8ed-b08553b57124","order_by":1,"name":"Jongbeom Shin","email":"","orcid":"","institution":"Inha University Hospital, Inha University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jongbeom","middleName":"","lastName":"Shin","suffix":""},{"id":275703548,"identity":"d18883ef-89db-4466-91cd-76f52a72bdab","order_by":2,"name":"Mina Kim","email":"","orcid":"","institution":"InHa hospital","correspondingAuthor":false,"prefix":"","firstName":"Mina","middleName":"","lastName":"Kim","suffix":""},{"id":275703549,"identity":"7daaba4c-1e92-4f89-bd94-b0ffb4c7957d","order_by":3,"name":"Suejin Jo","email":"","orcid":"","institution":"Dongduk Women's University Graduate School","correspondingAuthor":false,"prefix":"","firstName":"Suejin","middleName":"","lastName":"Jo","suffix":""},{"id":275703550,"identity":"f00a7fd6-9c19-471b-a31e-16241c317b0f","order_by":4,"name":"Soo-Hyun Park","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2UlEQVRIiWNgGAWjYDAC9gZmZhDNDyISCojRwnMAokWyAaTFgBgtEgkQLQYHwCQROuQd0h8bF1RskzM+vzrxwwMDBnl+sQP4tRgeOGOcPOPMbWOzG283SwAdZjhzdgIBLY09zId5224nbrtxdgNIS4LBbUJamtkfg7TUb55xdvMPorTIszEYJwO1JBjw924jzhYDHh5jY54ztw1n3ODdZpFgIEHYL/Lznz+W5qm4Lc/ff3bzzR8VNvL80oRsOQBjSYBVSuBXDralAcbiP4Bb1SgYBaNgFIxsAAD550WQyYiJUQAAAABJRU5ErkJggg==","orcid":"","institution":"Soon Chun Hyang University Hospital","correspondingAuthor":true,"prefix":"","firstName":"Soo-Hyun","middleName":"","lastName":"Park","suffix":""}],"badges":[],"createdAt":"2024-02-28 05:14:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3995710/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3995710/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":51973411,"identity":"abbc7798-5593-4e1d-946d-29ff433821cf","added_by":"auto","created_at":"2024-03-04 19:01:14","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":50172,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlow of micronutrient supplement plan\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNST, nutritional support team; ECMO, extracorporeal membrane oxygenation; CRRT, continuous renal replacement therapy\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-3995710/v1/b829a8719f8584a969a05664.png"},{"id":51973413,"identity":"f32767e7-0877-4067-928d-02078066a398","added_by":"auto","created_at":"2024-03-04 19:01:14","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":31130,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePlots of Kaplan-Meier survival between good compliance and bad compliance group (P=0.536)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-3995710/v1/f2a3fbac11e3bff495206ed8.png"},{"id":51973412,"identity":"df634e77-a018-48a7-9211-c20c3fee7952","added_by":"auto","created_at":"2024-03-04 19:01:14","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":59127,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDifferences in the effectiveness of nutritional interventions between ICU and ward\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNRS 2002, Nutrition Risk Screening 2002; ICU, the intensive care unit\u003c/p\u003e\n\u003cp\u003eICU patients (n= 71), Ward patients (n= 86)\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-3995710/v1/e6fbb6d24c92eff920f74ee8.png"},{"id":53001205,"identity":"f822982e-2964-4a93-ae2e-2bd8ddb3b923","added_by":"auto","created_at":"2024-03-19 14:22:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":461920,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3995710/v1/3489a496-f0a0-47cc-8e8e-a81c03333ef5.pdf"},{"id":51973414,"identity":"021910f7-61b6-42c9-9f7c-60a4355f12a0","added_by":"auto","created_at":"2024-03-04 19:01:14","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":17432,"visible":true,"origin":"","legend":"","description":"","filename":"Supplement.docx","url":"https://assets-eu.researchsquare.com/files/rs-3995710/v1/60fdac30537d6351c6524f84.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of Nutritional Support Teams and Micronutrient Supplementation on Clinical Outcomes: Assessing Compliance and Feasibility in a Cohort Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNutritional insufficiency is related to specific diseases, including anemia, obesity following bariatric surgery, chronic liver disease, kidney disease, inflammatory bowel disease, cardiomyopathies, and heart failure. Failure to meet nutritional requirements can contribute to the aggravation of diseases among inpatients [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Moreover, proper nutritional supplementation has shown favorable clinical outcomes, including morbidity, mortality, and readmission rates, in the intensive care unit (ICU) [\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Most nutritional supplements tend to target patients\u0026rsquo; total calorie and protein nutritional needs [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMalnutrition often correlates with deficiencies in both micronutrients and macronutrients [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Nutrient support guidelines recommend micronutrient (MN) supplementation, particularly in patients with long-term malnutrition [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Guidelines recommend trace element supplementation for malnourished patients with daily requirements for intravenous nutrition and low caloric intake [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. A consensus on the daily recommended intake has also been established to guide the supply of MNs.\u003c/p\u003e \u003cp\u003eDespite the positive clinical outcomes observed with nutritional supplements, MN supplementation remains controversial owing to statistically inconsistent clinical outcomes [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. There is insufficient evidence regarding the clinical benefits of high-dose supplementation of trace elements [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. No clinical benefit was found for additional micronutrient supplementation. However, previous studies have not included specific protocols based on guidelines for micronutrients, and further research based on consistent criteria is needed [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e We presented a protocol for the provision of trace elements based on international guidelines in collaboration with a multidisciplinary nutrition support team (NST). The aim was to determine the feasibility of nutritional interventions by a multidisciplinary NST and to identify changes in nutritional status and clinical outcomes following MN supplementation.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and participation\u003c/h2\u003e \u003cp\u003eAll patients referred to the NST between July and November 2022 were included. Among malnourished patients referred to the NST, all patients 1) who received MN-free parenteral nutrition and 2) who did not meet 70% of their nutritional requirements (energy and protein) via enteral nutrition were classified as individuals eligible for MN supplementation. Patients with incomplete information in their electronic medical records, as well as pediatric patients, were excluded. The implementation of the prescribed supplementation within 7 days of the NST recommendation was checked. Patients who successfully received the prescribed supplementation were categorized into the good compliance group, whereas those who did not receive supplementation were classified into the bad compliance group. This study is to evaluate the compliance of the multidisciplinary interventions and to identify changes in nutritional status and factors associated with nutritional risk groups after compliance with the intervention protocol. In addition, we also analyze the difference in change in nutritional status between patients in ICU and wards.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eNutrient supplement protocol\u003c/h2\u003e \u003cp\u003eTo develop a nutrient support protocol that includes MNs according to international guidelines (ASPEN, American Society for Parenteral and Enteral Nutrition; ESPEN, European Society for Parenteral and Enteral Nutrition) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], a multidisciplinary protocol council comprising physicians, pharmacists, nurses, and nutritionists was established. Caloric and protein requirements were expressed as percentages to ensure adequacy. In cases where patients had a body mass index (BMI)\u0026thinsp;\u0026gt;\u0026thinsp;25, the adjusted weight was used. Caloric intake ranged from 25 to 30 kcal per kilogram of body weight, while protein requirements were determined to be between 0.8 and 1.2 g per kilogram of body weight, considering renal function [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAmong the various multivitamin products available in Korea, daily supplementation with products that fulfill the daily requirements of adults was recommended [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003eS). However, for trace elements, it was challenging to identify a suitable product that could adequately meet the required dosage among the available options within a hospital setting. Consequently, a weekly supply of trace elements was adopted as a general practice [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Selenium was selected as the standard product for supplementation due to the lack of a combination product. Selenium, as described in Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e, was selected as the standard product in Korea that met the recommended daily allowance for supplementation.\u003c/p\u003e \u003cp\u003eWe recommended the parenteral route for PN, while allowing any form of MN to be administered according to clinical practice. Monitoring and verifying trace element levels after supplementation is recommended, particularly in situations anticipating significant deficiency, like continuous renal replacement therapy, burns, gastrointestinal surgery, and excessive gastrointestinal loss [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. After 1 week, the implementation of all recommendations was assessed, and a nutritional evaluation was repeated at the end of the study in instances of discharge or mortality.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003eBaseline characteristics, such as age, sex, weight, and BMI, were documented. To assess the clinical condition, the Charlson Comorbidity Index (CCI), Acute Physiology and Chronic Health Evaluation III (APACHE III) score, and use of a mechanical ventilator were evaluated in patients admitted to the ICU. For nutritional status assessment, data on feeding status and laboratory findings, such as albumin and total protein levels, were collected. Nutritional status was assessed based on the Nutrition Risk Screening 2002 (NRS 2002) scoring system [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStudy variables and analysis\u003c/h2\u003e \u003cp\u003eFor descriptive statistical analysis, continuous variables were expressed as mean (standard deviation) for normally distributed variables and median (interquartile range) for non-normally distributed variables, while categorical values were presented as percentages. To compare groups, the chi-square, and Fisher\u0026rsquo;s exact tests were employed for categorical variables, while the t-test was used for continuous variables. Paired t-tests and chi-square tests were used to compare the mortality rate, NRS 2002, duration of hospitalization, and length of ICU admission. Kaplan\u0026ndash;Meier curves were used to investigate the relationship between overall survival and the administration of MN supplements. The impact of nutritional interventions on ICU and ward patients, excluding those who had expired, was assessed using repeated measures ANOVA for the analysis of NRS. Multivariate logistic regression analyses were performed to identify the risk of malnutrition in the NRS 2002 evaluation. Variable selection was based on items with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.1 in the binary regression analysis. Two-sided p-values were used to determine statistical significance. All statistical analyses were conducted using IBM SPSS Statistics V21.0 software.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eDuring the study period, 903 malnourished patients were referred to the NST. Among these, 63 were excluded from the analysis based on the exclusion criteria (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). In this study, 255 patients required MN supplementation, with 148 in the ward and 107 in the ICU. Of these, 80 patients (31.4%) receiving enteral nutrition (EN) did not meet the nutritional requirements for over 1 week, whereas 162 patients (63.5%) received MN-free parenteral nutrition (PN). The EN group had a lower rate of nutritional adequacy compared to the PN group. Sex differences were observed between the good and bad compliance groups to meet the NST recommendations, although no significant differences were noted in other variables. Further details are listed in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eBaseline characteristics\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eValue\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;255)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGood Compliance\u003c/p\u003e\n\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;128)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eBad compliance\u003c/p\u003e\n\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;127)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep-value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge, year\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e70.1\u0026thinsp;\u0026plusmn;\u0026thinsp;15.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e68.5\u0026thinsp;\u0026plusmn;\u0026thinsp;16.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e71.8\u0026thinsp;\u0026plusmn;\u0026thinsp;14.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.087\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale, n (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e150 (58.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e67 (52.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e83 (65.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.047\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWeight, kg\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e58.3\u0026thinsp;\u0026plusmn;\u0026thinsp;27.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e60.2\u0026thinsp;\u0026plusmn;\u0026thinsp;36.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e56.5\u0026thinsp;\u0026plusmn;\u0026thinsp;14.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.296\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBMI, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21.7\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.692\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFeeding status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEnteral, n (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e80 (31.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33 (25.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e47 (37.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.29\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNon per oral, n (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e162 (63.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e88 (68.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e74 (58.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOthers, n (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13 (5.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7 (5.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6 (4.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\" align=\"left\"\u003e\n\u003cp\u003eEnteral achievement rate,\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEnergy, kcal/kg\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e43.0 (26.0\u0026ndash;58.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42.0 (29.0\u0026ndash;51.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e46.0 (26.0\u0026ndash;60.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.417\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eProtein, g/dL\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44.0 (25.0\u0026ndash;60.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e46.0 (25.0\u0026ndash;58.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44.0 (25.0\u0026ndash;60.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.926\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\" align=\"left\"\u003e\n\u003cp\u003eParenteral achievement rate\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEnergy, kcal/kg\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e55.0 (40.0\u0026ndash;73.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e58.0 (40.5\u0026ndash;74.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e51.0 (40.0\u0026ndash;71.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.528\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eProtein, g/dL\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e62.5 (43.0\u0026ndash;84.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e62.0 (43.0\u0026ndash;84.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e63.0 (44.0\u0026ndash;83.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.77\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCCI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.0 (4.0\u0026ndash;7.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.0 (4.0\u0026ndash;7.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.0 (4.0\u0026ndash;7.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.971\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAPACHE II\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19.0 (14.0\u0026ndash;24.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19.0 (13.5\u0026ndash;25.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19.0 (14.0\u0026ndash;24.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNRS 2002\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.0 (4.0\u0026ndash;5.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.5 (4.0\u0026ndash; 5.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.0 (4.0\u0026ndash;6.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.111\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVentilator care, n (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e63 (25.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26 (21.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37 (30.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.279\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTotal Protein, g/dL\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.4 (5.7\u0026ndash;7.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.5 (5.7\u0026ndash;7.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.3 (5.8\u0026ndash;7.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.556\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAlbumin, g/dL\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.3 (2.6\u0026ndash;3.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.4 (2.6\u0026ndash;3.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.2 (2.6\u0026ndash;3.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.459\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003eValues are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, number (%), or median (interquartile range).\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003eAPACHE II score, Acute Physiology and Chronic Health Evaluation II score; BMI, body mass index; NRS, nutritional risk screening; CCI, Charlson Comorbidity Index\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe NRS score at reference was no significant difference between the two groups (P\u0026thinsp;=\u0026thinsp;0.605). There were no significant differences in the duration of hospitalization and ICU stay between the two groups. However, there was a difference in NRS at discharge and in the change in score depending on compliance, as shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. The mean difference between intake and output was significantly higher at the time of admission in good and bad compliance group, it is evaluated to have a less effect on body weight of NRS 2002 at discharge (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eClinical outcomes after intervention of nutrition support team focusing on micronutrients supplements \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eValue\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;204)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGood Compliance\u003c/p\u003e\n\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eBad compliance\u003c/p\u003e\n\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;104)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep-value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNRS 2002 at referral\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.605\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNRS 2002 at discharge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.002\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNRS 2002 change\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.7 (1.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.7 (1.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDifference between input and output at referral, mL\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e403.2\u0026thinsp;\u0026plusmn;\u0026thinsp;65.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e533.5\u0026thinsp;\u0026plusmn;\u0026thinsp;105.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e272.9\u0026thinsp;\u0026plusmn;\u0026thinsp;77.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.048\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDifference between input and output at discharge, mL\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e208.1\u0026thinsp;\u0026plusmn;\u0026thinsp;57.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e277.8\u0026thinsp;\u0026plusmn;\u0026thinsp;86.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e284.4\u0026thinsp;\u0026plusmn;\u0026thinsp;76.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.954\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLength of hospital stay, day\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22.0 (14.0\u0026ndash;41.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23.0 (15.0\u0026ndash;47.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21.0 (13.0\u0026ndash;36.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.137\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLength of ICU, day\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.0 (0.0\u0026ndash;15.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.0 (0.0\u0026ndash;15.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.0 (0.0\u0026ndash;15.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.384\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMortality\u003csup\u003eb\u003c/sup\u003e, n (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e51 (20.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28 (21.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23 (18.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.552\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003eValues are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, number (%), or median (interquartile range).\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003eNRS, nutritional risk screening; NRS 2002 Change\u0026thinsp;=\u0026thinsp;NRS at discharge \u0026ndash; NRS at referral, ICU, intensive care unit; \u003csup\u003ea\u003c/sup\u003e Patient group excluding death, \u003csup\u003eb\u003c/sup\u003eGood compliance group (n\u0026thinsp;=\u0026thinsp;128), Bad compliance group (n\u0026thinsp;=\u0026thinsp;127)\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eRegarding mortality rates, no significant difference was observed between the good compliance and bad compliance groups. The Kaplan\u0026ndash;Meier curves of the overall survival according to interventions are shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. No statistically significant difference in overall survival was observed between the bad compliance group and the good compliance group (P\u0026thinsp;=\u0026thinsp;0.536). However, significant differences over time were observed in the influence of ICU and ward patients, as evidenced by notable distinctions in NRS assessments (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe results of identifying the nutritional factors associated with the high-risk group based on NRS 2002, as assessed during discharge, are presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e. Both the group with bad compliance and the presence of nutritional risk on hospitalization were identified as risk factors for being classified in the high-risk group even at discharge, with respective odds ratio 1.54 (95% confidence interval [CI] 1.74\u0026ndash;12.63, P\u0026thinsp;=\u0026thinsp;0.002) and 1.55 (95% CI 1.05\u0026ndash;2.29, P\u0026thinsp;=\u0026thinsp;0.024).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eRisk factors of high-risk malnutrition at discharge based on NRS 2002\u003csup\u003ea, b\u003c/sup\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eS.E.\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOR\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eOR 95% CI\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep-value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eConstant\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-2.93\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.09\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.161\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBad compliance\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e12.63\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.002\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNRS 2002 at referral\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.024\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVentilator care status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.63\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4.71\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.641\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCCI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.09\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.09\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.90\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.363\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLength of ICU\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.99\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.07\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.056\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.98\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.268\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLength of hospital stay\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.98\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.331\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBMI at referral\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.83\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.73\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.93\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.003\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWound status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.64\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.92\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.346\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\"\u003eCCI, Charlson Comorbidity Index; ICU, intensive care unit; BMI, body mass index; NRS, nutritional risk screening; B, regression coefficient; OR, odds ratio; SE, standard error. \u003csup\u003ea\u003c/sup\u003eLogistic regression included variables significant in the univariate analysis. \u003csup\u003eb\u003c/sup\u003ePatient group, excluding deaths (n\u0026thinsp;=\u0026thinsp;204)\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\"\u003eOR: Odds Ratio; CI: confidence interval.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eConversely, a higher BMI at admission was found to be a variable associated with a lower risk of being categorized in the high-risk group (odds ratio 0.83, 95% confidence interval 0.73\u0026ndash;0.93, P\u0026thinsp;=\u0026thinsp;0.003).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study shows that MN supplementation under the guidance of a multidisciplinary council was correlated with improving factors for malnutrition at discharge according to compliance. Nutritional status in the ICU and wards improved significantly found in the NRS 2002 scores change through NST in Korea. This study focused on the continuous monitoring of nutritional and clinical outcomes.\u003c/p\u003e \u003cp\u003eThe nutrition intervention protocol includes a plan for providing MN to malnourished patients. MNs play a crucial role in nutrient metabolism and function, and according to guidelines, their supplementation is recommended for hospitalized patients who are at risk of deficiency [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. While the clinical benefits of additional supplementation or high doses of single antioxidant nutrients remain inconclusive, guidelines suggest meeting the daily requirements to prevent malnutrition without adverse effects [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In this study, patients receiving MN-free PN or EN, who were expected to experience long-term nutritional deficiencies, were selected as participants for investigation [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMultidisciplinary efforts have been made to address the nutritional needs of these patients. In addition to identifying high-risk patient groups, multi-vitamin products that fulfilled the daily requirements were carefully chosen. Concerning trace elements, products containing manganese, chromium, zinc, and copper were administered once a week to supplement the recommended dosage without anticipated toxicity while closely monitoring liver and renal function indicators [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Furthermore, selenium supplementation is recommended as part of the recommended supplemental regimen. Based on individual assessments, vitamin K was advised to provide the minimum required amount [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Achieving an optimal vitamin supply proved challenging, especially when dealing with trace elements affecting the kidneys and liver.\u003c/p\u003e \u003cp\u003eThe guideline recommended that micronutrients should be supplied in the recommended daily allowance and provided periodically, even in situations of product shortage [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Our protocol recommended staying within the range of daily requirements for trace elements (Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e). Numerous discussions are necessary to identify suitable products for supplementation, considering factors, such as reasonable pricing and determining the most effective products for clinical application. Through multidisciplinary collaboration, we aimed to generate exemplary instances that facilitated the drawing of meaningful conclusions.\u003c/p\u003e \u003cp\u003eNutritional assessments were conducted using the NRS 2002 after nutritional interventions. Clinical outcomes, such as mortality, length of stay, and ICU stay, were monitored. In our study, significant differences were found in the NRS 2002 scores change. It is possible to assess a positive nutritional outcome in our study by monitoring the food intake status over the past week. Therefore, the NRS 2002 is a widely recommended tool for assessing and predicting malnutrition in hospital settings [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. It has also been extensively examined to predict long-term clinical outcomes [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Within the context of this study, a significant reduction in the scores of the good compliance group was observed following the intervention, indicating a positive impact. During the intervention period, there were consistent nutritional impacts, especially among ICU patients compared to ward patients (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Furthermore, patients with a shorter hospitalization period or longer ICU admission period demonstrated a lower acceptance rate of NST and required active intervention.\u003c/p\u003e \u003cp\u003ePrevious studies have indicated a positive correlation between NST activity and clinical outcomes, with acceptance of the protocol suggested as a crucial factor in this relationship [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In the present study, a higher mortality rate was observed in the good compliance group than in the bad compliance group, although the difference was not statistically significant. Nevertheless, significant observations were made regarding the conduct of physicians in accepting interventions, and these findings should be acknowledged in future endeavors targeting at-risk groups where interventions have not been carried out. These findings highlight the importance of implementing diverse strategies to enhance patient acceptance and adherence to the protocol in future interventions.\u003c/p\u003e \u003cp\u003eThe nutritional status of the hospitalized patients was closely monitored by assessing their NRS 2002 scores at the time of referral to the NST and after the observation period. Among these patients, those identified as high-risk (with a score of \u0026ge;\u0026thinsp;5) were selected for further analysis because previous studies have associated this high-risk group with adverse clinical outcomes, including mortality [\u003cspan additionalcitationids=\"CR21 CR22\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Despite the absence of a significant difference in the referral NRS 2002 scores between the two groups, bad compliance emerged as a risk factor for the high-risk group after accounting for the other significant variables. These findings are consistent with those of previous studies that focused on the high-risk group identified by the NRS 2002, demonstrating a propensity for reduced malnutrition risk following intervention [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e This descriptive study examined the nutritional clinical status and clinical outcomes following interventions by a multidisciplinary team with a particular focus on trace element supplementation based on guidelines. However, this study has certain limitations. First, the NRS 2002 is usually used as an index to screen for malnutrition, assessing the overall nutritional status in the acute phase individual [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. It compromised nutritional impairment, severity of illness, and nutritional status for one week. Although the NRS2002 has been evaluated as a predictor of clinical outcomes [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], it cannot differentiate between clinical and nutritional intervention results [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The results between intake and output value may have been biased by the clinical effect of the NRS. Further research is needed to determine whether this improvement is the result of the nutrition team's intervention efforts. Second, the follow-up of MN supplementation was limited to 7 d based on NRS 2002, highlighting the need for continuous monitoring in patients with long-term hospitalization. Individual monitoring of suspected deficient trace elements was not performed despite recommendations. Therefore, further research in the form of prospective intervention studies is warranted to address this. Given the retrospective observational nature of this study, further validation through randomized intervention studies is warranted to strengthen our findings. The results emphasize the crucial role of a multidisciplinary team in recognizing malnourished patients at the time of referral and enhancing the acceptance rate of NST activities.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWe confirmed the feasibility of the MN supplementation protocol through multidisciplinary collaboration. Also, compliance with MN supplementation is associated with the risk factor of malnutrition at discharge. Therefore, MN supply protocol and compliance is needed to improve malnutrition in hospital patients.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eMN micronutrient\u003c/p\u003e\n\u003cp\u003eNST nutrition support team\u003c/p\u003e\n\u003cp\u003eNRS 2002 Nutrition Risk Screening 2002\u003c/p\u003e\n\u003cp\u003eICU intensive care unit\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEach participant provided informed written consent. This study was approved by the Institutional Review Board of the Research Institute for Inha University Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used to reach the findings of the study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Basic Science Research Program through the National Research Foundation of Korea, funded by the National Research Foundation of Korea (NRF) under Grant (NRF-2021R1G1A1095241), and supported by 2023 academic research funds of The Korean Society of Clinical Neurophysiology.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSML, JBS, and SHP participated in the conception and design of the study; SML, SHP performed the literature search; MNK, SJJ participated in data acquisition; SML, SHP created figures; SML carried out the statistical analysis; SML, JBS, and SHP participated in interpretation of the analyses and writing the manuscript; SML, JBS, and SHP participated in critical revision and final approval of the manuscript. The final manuscript was read and approved by all authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBerger MM, Pantet O, Schneider A, Ben-Hamouda N. Micronutrient deficiencies in medical and surgical inpatients. J. Clin. Med. 2019;8:931.\u003c/li\u003e\n\u003cli\u003eSchuetz P, Fehr R, Baechli V, Geiser M, Deiss M, Gomes F, et al. Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial. Lancet (London, England). 2019;393:2312-2321.\u003c/li\u003e\n\u003cli\u003eGomes F, Baumgartner A, Bounoure L, Bally M, Deutz NE, Greenwald JL, et al. Association of nutritional support with clinical outcomes among medical inpatients who are malnourished or at nutritional risk: an updated systematic review and meta-analysis. JAMA Netw. Open. 2019;2:e1915138-e.\u003c/li\u003e\n\u003cli\u003eDeutz NE, Matheson EM, Matarese LE, Luo M, Baggs GE, Nelson JL, et al. Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: a randomized clinical trial. Clin Nutr. 2016;35:18-26 \u003c/li\u003e\n\u003cli\u003eHuynh D, Devitt A, Paule C, Reddy B, Marathe P, Hegazi R, et al. Effects of oral nutritional supplementation in the management of malnutrition in hospital and post-hospital discharged patients in I ndia: a randomised, open-label, controlled trial. J Hum Nutr Diet. 2015;28:331-43. \u003c/li\u003e\n\u003cli\u003eSchuetz P, Seres D, Lobo DN, Gomes F, Kaegi-Braun N, Stanga Z. Management of disease- related malnutrition for patients being treated in hospital. Lancet. 2021;398:1927-1938.\u003c/li\u003e\n\u003cli\u003eKumpf V, Gervasio J, Mueller C. The ASPEN Adult Nutrition Support Core Curriculum. 2017.\u003c/li\u003e\n\u003cli\u003eBerger MM, Shenkin A, Schweinlin A, Amrein K, Augsburger M, Biesalski H-K, et al. ESPEN micronutrient guideline. Clin Nutr. 2022;41:1357-1424.\u003c/li\u003e\n\u003cli\u003eBlaauw R, Osland E, Sriram K, Ali A, Allard JP, Ball P, et al. Parenteral provision of micronutrients to adult patients: an expert consensus paper. JPEN. 2019;43:S5-S23. doi: 10.1002/jpen.1525.\u003c/li\u003e\n\u003cli\u003eKaegi-Braun N, Germann S, Faessli M, Kilchoer F, Dragusha S, Tribolet P, et al. Effect of micronutrient supplementation in addition to nutritional therapy on clinical outcomes of medical inpatients: results of an updated systematic review and meta-analysis. Eur. J. Clin Nutr. 2022;76:964-972.\u003c/li\u003e\n\u003cli\u003eGudivada KK, Kumar A, Shariff M, Sampath S, Varma MM, Sivakoti S, et al. Antioxidant micronutrient supplementation in critically ill adults: A systematic review with meta-analysis and trial sequential analysis. Clin Nutr. 2021;40:740-750. \u003c/li\u003e\n\u003cli\u003eCompher C, Bingham AL, McCall M, Patel J, Rice TW, Braunschweig C, et al. Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. JPEN. 2022;46:12-41. \u003c/li\u003e\n\u003cli\u003ePlogsted S, Adams SC, Allen K, Cober MP, Greaves J, Mogensen KM, et al. Parenteral nutrition trace element product shortage considerations. Nutrition in clinical practice: ASPEN. 2016;31:843-847.\u003c/li\u003e\n\u003cli\u003eBerger MM. Nutrition and micronutrient therapy in critical illness should be individualized. JPEN. 2020;44:1380-1387. doi: 10.1002/jpen.2002.\u003c/li\u003e\n\u003cli\u003eKondrup J, Rasmussen HH, Hamberg O, Stanga Z, Group AahEW. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22:321-336. \u003c/li\u003e\n\u003cli\u003eJin J, Mulesa L, Carrilero Rouillet M. Trace elements in parenteral nutrition: considerations for the prescribing clinician. Nutrients. 2017;9:440.\u003c/li\u003e\n\u003cli\u003eElke G, Hartl WH, Kreymann KG, Adolph M, Felbinger TW, Graf T, et al. Clinical nutrition in critical care medicine\u0026ndash;Guideline of the German Society for Nutritional Medicine (DGEM). Clin. Nutr. ESPEN. 2019;33:220-275\u003c/li\u003e\n\u003cli\u003eAyers P, Adams S, Boullata J, Gervasio J, Holcombe B, Kraft MD, et al. ASPEN parenteral nutrition safety consensus recommendations. JPEN. 2014;38:296-333.\u003c/li\u003e\n\u003cli\u003eKondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22:415-421. \u003c/li\u003e\n\u003cli\u003eHersberger L, Bargetzi L, Bargetzi A, Tribolet P, Fehr R, Baechli V, et al. Nutritional risk screening (NRS 2002) is a strong and modifiable predictor risk score for short-term and long-term clinical outcomes: secondary analysis of a prospective randomised trial. Clin Nutr. 2020;39:2720-2729.\u003c/li\u003e\n\u003cli\u003eMaciel LRMdA, Franzosi OS, Nunes DSL, Loss SH, Dos Reis AM, Rubin BdA, et al. Nutritional risk screening 2002 cut-off to identify high-risk is a good predictor of ICU mortality in critically ill patients. Nutr Clin Pract. 2019;34:137-141. \u003c/li\u003e\n\u003cli\u003evan Bokhorst-de van der Schueren MA, Guaitoli PR, Jansma EP, de Vet HC. Nutrition screening tools: does one size fit all? A systematic review of screening tools for the hospital setting. Clinical nutrition (Edinburgh, Scotland). 2014;33:39-58.\u003c/li\u003e\n\u003cli\u003eStang J, Story M. Nutrition screening, assessment and intervention. In: Story M, Stang J, eds. Guidelines for Adolescent Nutrition Service. University of Minnesota Press; 2005:35\u0026ndash;54.\u003c/li\u003e\n\u003cli\u003eLewis CA, Osland EJ, de Jersey S, Hopkins G, Seymour M, Webb L, et al. Monitoring for micronutrient deficiency after bariatric surgery-what is the risk? Eur J Clin Nutr. 2023;77:1071-83.\u003c/li\u003e\n\u003cli\u003eBellanti F, lo Buglio A, Quiete S, Vendemiale G. Malnutrition in Hospitalized Old Patients: Screening and Diagnosis, Clinical Outcomes, and Management. Nutrients. 2022;14:910.\u003c/li\u003e\n\u003cli\u003eChen Z, Wu H, Jiang J, Xu K, Gao S, Chen L, et al. Nutritional risk screening score as an independent predictor of nonventilator hospital-acquired pneumonia: a cohort study of 67,280 patients. BMC Infect Dis. 2021;21:313. \u003c/li\u003e\n\u003cli\u003eSanson G, Sadiraj M, Barbin I, Confezione C, De Matteis D, Boscutti G, et al. Prediction of early- and long-term mortality in adult patients acutely admitted to internal medicine: NRS-2002 and beyond. Clin Nutr. 2020;39:1092-1100. \u003c/li\u003e\n\u003cli\u003eSahli L, Hagenbuch N, Ballmer PE, R\u0026uuml;hlin M, Imoberdorf R. NRS-2002 components, nutritional score and severity of disease score, and their association with hospital length of stay and mortality. Swiss Med Wkly. 2021;151:w20517. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Nutritional support team, Micronutrient, Malnutrition, Multivitamins, Trace elements, Intensive care unit, Clinical outcomes","lastPublishedDoi":"10.21203/rs.3.rs-3995710/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3995710/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e \u003cp\u003eMicronutrient (MN) supplementation has a positive impact on clinical outcomes. However, the evidence for the impact of MN supplementation remains controversial. Therefore, our study aims to assess the impact on nutritional outcomes according to exploring the implementation of MN support with multidisciplinary collaboration.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eAll 255 patients referred to a nutrition support team (NST) between July and November 2022 were included. The NST reviews the MN protocol, which includes multivitamins and trace elements, based on international nutrient guidelines. All patients who were on nothing per oral and did not meet\u0026thinsp;\u0026ge;\u0026thinsp;70% of their nutritional requirements within 1 week were recommended MN supplements. Compliance with the MN protocol was evaluated, alterations in nutritional status based on the Nutrition Risk Screening 2002 (NRS 2002) scoring system and clinical outcomes were assessed after 7 day and at discharge. Multiple logistic regression analysis was used to identify factors associated with high nutritional risk in discharged patients. In addition, a sub-analysis was performed on changes in the nutritional of patients on the ward and in the intensive care unit (ICU).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe rate of implementation of MN supplementation was 50.2%. The findings indicated a significant decrease in the NRS 2002 score in the good-compliance group with MN supplementation. No significant differences in protocol compliance were observed in terms of mortality, hospital stay, or length of stay in the intensive care unit. However, bad compliance with MN supplementation was correlated with risk factors for malnutrition at discharge. In subgroup analysis, nutritional status in the ICU and wards improved, with a significant difference between the two groups.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eMN supplementation via the protocol is helpful for inpatients\u0026rsquo; nutritional status. Therefore, bad compliance with MN supplementation has been identified as a risk factor for malnutrition at discharge, which requires active intervention by the NST.\u003c/p\u003e","manuscriptTitle":"Impact of Nutritional Support Teams and Micronutrient Supplementation on Clinical Outcomes: Assessing Compliance and Feasibility in a Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-04 19:01:09","doi":"10.21203/rs.3.rs-3995710/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ef143b0d-e806-4598-8ea2-b38514c96462","owner":[],"postedDate":"March 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-03-19T14:13:59+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-04 19:01:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3995710","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3995710","identity":"rs-3995710","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}