Early dietitian‐led nutrition intervention and unplanned intensive care unit transfer in hospitalized adults with nutritional risk: A retrospective cohort study

BACKGROUND: Malnutrition and nutritional risk are common among inpatients and are associated with adverse outcomes. Although dietitian-led individualized nutrition intervention is recommended, evidence from routine practice among non-critically ill inpatients remains limited. We aimed to evaluate the association between early dietitian-led nutrition intervention and deterioration-related outcomes among adults at nutritional risk. METHODS: We conducted a retrospective cohort study using electronic medical records from a Chinese tertiary hospital (2016-2023). Adults aged 18-90 years with Nutritional Risk Screening 2002 scores ≥3 were included; patients directly admitted to intensive care unit were excluded. Patients receiving early dietitian-led nutrition intervention within 72 h after hospital admission were propensity score matched 1:1 to comparators. Outcomes were unplanned intensive care unit transfer, major gastrointestinal events after admission, and predefined clinically meaningful changes in laboratory indicators. Associations were estimated using logistic regression and reported as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: Among 96,532 eligible patients, 16,661 (17.3%) received early dietitian-led nutrition intervention. After matching, 16,419 pairs were analyzed. Early dietitian-led nutrition intervention was associated with lower odds of intensive care unit transfer (3.0% vs. 3.4%; OR 0.88, 95% CI 0.77-0.99), major gastrointestinal events (4.0% vs. 4.4%; OR 0.89, 95% CI 0.80-0.99), and higher odds of clinically meaningful reduction in C-reactive protein (12.6% vs. 10.9%; OR 1.18, 95% CI 1.11-1.27). CONCLUSION: Early dietitian-led nutrition intervention was associated with lower odds of deterioration-related outcomes among hospitalized adults at nutritional risk. Limited early dietitian involvement despite routine nutritional risk screening suggests an implementation gap and warrants further prospective evaluation.