针对有营养不良风险的心力衰竭患者，7份与21份家庭配送的医学定制餐的营养影响：一项随机顺序交叉喂养试验（MEDIMEALS）。
The nutritional impact of 7 versus 21 home-delivered medically tailored meals in patients with heart failure and malnutrition risk: a random order crossover feeding trial (MEDIMEALS).
作者信息
Compher Charlene, Henstenburg Jule Anne, Aloupis Marianne, Sun Amy, Quinn Ryan, Emery Elizabeth, Thomas Jovina, Crafford Adrian Glass, Schwartz Daniel R
机构信息
School of Nursing, University of Pennsylvania, Philadelphia, PA, 19104, USA.
Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA.
出版信息
BMC Nutr. 2025 Mar 18;11(1):56. doi: 10.1186/s40795-025-01036-y.
BACKGROUND
Heart failure (HF) is frequently associated with malnutrition or malnutrition risk. The delivery of medically tailored meals (MTM) to the homes of patients with HF and malnutrition risk or malnutrition after hospital discharge holds promise for improving outcomes. However, the number of MTM needed to provide benefit is not established.
METHODS
A random order crossover study was designed to compare the delivery of 7 versus 21 MTM for four weeks each to patients discharged from the hospital with HF and malnutrition risk. Telephone surveys were conducted at baseline, 30, and 60 days post-discharge to evaluate change in malnutrition risk, American Heart Association (AHA) diet goals, sarcopenia risk, and 30-day readmissions.
RESULTS
Forty-six patients were enrolled. Patients had reduced odds of having malnutrition risk relative to the baseline score at one and two months (OR 0.18, 95% CI 0.04-0.74 and OR 0.21, 95% CI 0.05-0.99, respectively). The AHA diet score improved over time from baseline by 0.73 ± 0.22 units at one month (p = 0.0014), and by 0.48 ± 0.23 units at two months (p = 0.0430), regardless of the number of MTM provided. Sarcopenia risk improved over time (p = 0.01), decreasing by 0.43 ± 0.2 units by one (p = 0.03) and 0.59 ± 0.21 units by two months (p = 0.007) regardless of the number of MTM provided. Readmissions by 30 days were not significantly different based on the number of MTM provided (9% for 21 MTM vs 12.5% for 7 MTM), but well below national data at 23%.
CONCLUSION
The provision of at least seven MTM per week in the early window after hospital discharge to patients with HF and malnutrition or malnutrition risk is a promising strategy to improve malnutrition and sarcopenia risk and diet adherence, while keeping readmissions below national averages.
TRIAL REGISTRATION
Clinicaltrials.gov NCT06142903, registered 11/23/2023.
背景
心力衰竭（HF）常与营养不良或营养不良风险相关。出院后为有HF和营养不良风险或营养不良的患者提供医学定制餐（MTM）有望改善治疗效果。然而，提供有益效果所需的MTM数量尚未确定。
方法
设计一项随机顺序交叉研究，比较为出院的有HF和营养不良风险的患者每周提供7份与21份MTM，各为期四周。在出院后基线、30天和60天进行电话调查，以评估营养不良风险、美国心脏协会（AHA）饮食目标、肌肉减少症风险和30天再入院率的变化。
结果
46名患者入组。与基线评分相比，患者在1个月和2个月时出现营养不良风险的几率降低（分别为OR 0.18，95%CI 0.04 - 0.74和OR 0.21，95%CI 0.05 - 0.99）。无论提供的MTM数量如何，AHA饮食评分从基线开始随时间推移在1个月时提高了0.73±0.22分（p = 0.0014），在2个月时提高了0.48±0.23分（p = 0.0430）。肌肉减少症风险随时间改善（p = 0.01），无论提供的MTM数量如何，在1个月时降低了0.43±0.2分（p = 0.03），在2个月时降低了0.59±0.21分（p = 0.007）。基于提供的MTM数量，30天内的再入院率无显著差异（21份MTM为9%，7份MTM为12.5%），但远低于全国23%的数据。
结论
出院后的早期阶段，每周为有HF和营养不良或营养不良风险的患者提供至少7份MTM，是改善营养不良和肌肉减少症风险以及饮食依从性的一种有前景的策略，同时使再入院率低于全国平均水平。
试验注册
Clinicaltrials.gov NCT06142903，于2023年11月23日注册。
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