Neutral quality study relates to the strength of the study design and not the results of the study. Therefore the results actually show that 19/21 studies found that malnutrition had an impact on various patient outcomes, and only 2 studies showed no association. Recommendation statement will therefore not change as the overall volume of evidence supports this. Additional wording added to the summary to make this clearer. A definition of positive, neutral and negative quality will also be added into the methodology section.
Agree that C reactive protein and albumin and weight loss alone should not be used as key measures of nutritional status, however this was what was used in the studies, and this is why many of the studies could not be rated as positive quality for study design due to inappropriate use of outcome measures. Q4 provides further information on using validated nutritional assessment tools.
Teresa Brown, on behalf of the authors.