Nutrition Intervention with High-Protein and β-Hydroxy-β-Methylbutyrate (HMB) Is Associated with Readmission Reduction and Cost Savings Among Patients with Malnutrition Risk

<b>Background/Objectives:</b> Malnutrition in hospitalized older adults is associated with increased healthcare utilization, prolonged hospitalizations, and higher readmission rates. Specialized oral nutritional supplements enriched with β-hydroxy-β-methylbutyrate (HMB-ONS) have shown benefits in preserving muscle mass, improving functional outcomes, and reducing readmission rates, yet real-world data on their effectiveness remain limited. This study evaluated the association between HMB-ONS use and hospital readmission rates, as well as healthcare costs, in patients with malnutrition or at risk of malnutrition. <b>Methods:</b> This retrospective study analyzed electronic medical records (2015-2021) of hospitalized patients at risk of malnutrition at two tertiary care hospitals in Israel. Patients receiving HMB-ONS during hospitalization were compared with those receiving standard ONS (S-ONS). Propensity score matching (PSM) was employed to reduce potential confounding due to differences in observable characteristics. Primary outcomes were readmission rates at 1-, 3-, and 6-month post-discharge. A cost analysis estimated per-patient hospitalization costs and financial savings from reduced readmissions. <b>Results:</b> Of 391,838 hospitalizations, 16,751 patients met the inclusion criteria. Patients with malnutrition or at risk of malnutrition who received HMB-ONS during hospitalization were PSM-matched to those who received S-ONS (n = 1440, 53.5% female, average age of 78.25 (±15.62) years). Patients who received HMB-ONS had significantly lower odds of readmission compared with those receiving S-ONS at 1 month (OR = 0.698; 95% CI: 0.548-0.888; <i>p</i> = 0.0034), 3 months (OR = 0.772; 95% CI: 0.623-0.958; <i>p</i> = 0.0187), and 6 months (OR = 0.780; 95% CI: 0.633-0.961; <i>p</i> = 0.0195). Based on these differences, the economic analysis estimated net cost savings of EUR 387.61 (USD 403.29) per patient for HMB-ONS versus S-ONS. <b>Conclusions:</b> HMB-ONS was associated with significantly lower readmission rates and healthcare costs compared to S-ONS in patients with malnutrition or at risk of malnutrition. These findings may support the use of specialized nutritional interventions to improve clinical outcomes and optimize hospital resource utilization in patients with malnutrition or at risk of malnutrition.