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The effectiveness of nutritional interventions to reduce the risk of healthcare‐associated infection in the undernourished elderly: a systematic review

Review question/objective 
Are nutritional interventions effective in reducing the risk of acquiring healthcare-associated infection (HCAI) in the undernourished elderly? 
The objective of this review is to identify and synthesise the best available evidence relating to how effective various nutritional interventions are in reducing the incidence and prevalence of HCAI in this high-risk group. 
More specifically, the objectives are to identify: 
• Whether undernourishment and old age are risk factors for HCAI (scoping phase), and 
• How effective nutritional interventions are in reducing the risk of HCAI in this population. 
Inclusion criteria 
 
Types of participants 
 
This review will consider studies that include undernourished (including those 'at risk' of under-nutrition) participants aged 60 years old or over in acute and tertiary healthcare settings. 
 
As there is no gold standard for the measurement of under-nutrition, participants will be considered as undernourished if any of the following definitions apply: 
BMI ≤ 20 or ≤ the 15th percentile for age 
 
· Serum albumin ≤ 3.5gm/dl; albuminaemia, mean albumin or plasma albumin level ≤ 35 g/l; prealbumin ≤ 150 mg/l ; thyroxin-binding prealbumin (TBPA) ≤ 0.10 
 
· Serum transthyretin concentration ≤ 150 mg/l 
 
· Insulin-like growth factor 1 (S-IGF-1) ≤ 69 ug/l 
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