Keep calm and protect mealtimes: But what is the evidence? Findings of a systematic review and meta-analyses

Dr Catherine E. Huggins1, Dr Judi Porter1,2, Ms Ella Ottrey1,2

1Monash University , Notting Hill, Australia, 2Eastern Health, Box Hill, Australia

Aim: Protected Mealtimes is an intervention designed to address insufficient food intake during hospitalisation, a contributing factor towards the development of malnutrition.  This systematic review aimed to synthesise the literature to evaluate the effect of Protected Mealtimes on nutritional intake of hospital patients.

Methods: This review followed the PRISMA guidelines and was registered prospectively with PROSPERO (CRD42015023423).  Inclusion criteria were original research in the hospital setting; the intervention of interest was Protected Mealtimes compared to usual care.  Nutritional intake (including at least energy intake) was the primary outcome measure.  Meta-analyses were undertaken in RevMan when there were at least three studies reporting the same outcome.

Results: Seven pre-post observational studies met the inclusion criteria.  No studies reported a significant effect on energy intake.  One study reported a favourable and another study a negative change in protein intake whilst no changes were observed in the other studies. Meta-analyses of the results of four studies found no statistically significant difference in favour of usual care or the intervention for energy (mean difference -16.5kJ per day; p=0.59) or protein intake (mean difference -1.3g per day; p=0.18). Quality was rated as neutral in the research papers, whilst the brief reports were negatively rated.

Significance of the findings to allied health: Given the small number of observational studies undertaken and their quality of evidence, there appears insufficient evidence to advocate for widespread Protected Mealtimes implementation.  Other approaches to prevent and malnutrition warrant consideration.