DOI: 10.4103/jascp.jascp_11_26 ISSN: 2772-364X

Impact of Nutrition Support Team Implementation on Handgrip Strength and Nutritional Outcomes in Critically Ill Adults: A Pre–post Observational Study from a Tertiary Care Hospital in India

Sanjith Saseedharan, Rajeswari Shetty, Hemant Ingole
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Background:

Malnutrition and muscle wasting are common in critically ill patients and contribute to functional decline. Multidisciplinary nutrition support teams (NSTs) are recommended to improve nutritional delivery; however, data from Indian intensive care units (ICUs) using functional endpoints are limited.

Objectives:

To evaluate the effect of NST implementation on handgrip strength (HGS) (primary endpoint) and nutritional outcomes in critically ill adults.

Materials and Methods:

Single-center pre–post observational study including 100 adult ICU patients (>18 years; ICU stay >48 h). Phase 1 ( n = 50) received standard nutrition care and Phase 2 ( n = 50) received structured NST-led care (intensivist, dietitian, nurse, pharmacist, and respiratory therapist). Nutrition targets were prescribed based on body mass index and measured resting energy expenditure (indirect calorimetry). Dominant HGS and weight were recorded on day 1, at discharge, and at day 28 postdischarge.

Results:

Baseline age, sex distribution, and acute physiology and chronic health evaluation II (APACHE II) were similar between groups; Nutrition risk in critically ill (NUTRIC) score was higher in Phase 1. Calorie and protein delivery improved in Phase 2 with lower deficits (all P < 0.01). The primary endpoint change in dominant HGS from Day 1 to Day 28 was − 1.02 ± 1.48 kg in Phase 1 versus + 1.99 ± 2.88 kg in Phase 2 (mean difference 3.01 kg; 95% confidence interval [CI] 2.11 to 3.91; P < 0.001). Effect size was large (Cohen’s d = 1.31). In an adjusted linear model (age, sex, APACHE II, and NUTRIC), NST remained independently associated with improved grip change (adjusted mean difference 3.01 kg; 95% CI 2.02 to 3.99; P < 0.001).

Conclusion:

Implementation of a multidisciplinary NST improved nutritional adequacy and was associated with clinically meaningful improvement in muscle strength recovery. Structured team-based nutritional care may improve the functional outcomes in critically ill patients in Indian tertiary care settings.

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