Table 3 Certainty of Evidence for Outcomes Associated with In-Hospital Nutritional Decline.

	Certainty Assessment^a
Outcome	Number of Participants (Studies)	Risk of bias	Inconsistency	Indirectness	Imprecision	Publication bias	GRADE^e
Length of stay	1112 (3 observational prospective studies) [39, 41, 42]	Serious^b	Not serious	Not serious	Not serious	Undetected	Moderate ⨁⨁⨁◯
Readmission in 6 months	299 (1 observational prospective study) [42]	Not serious	Not serious	Not serious	Serious^c	Undetected	Moderate ⨁⨁⨁◯
Complications	404 (1 observational prospective study) [41]	Serious^d	Not serious	Not serious	Serious^c	Undetected	Low ⨁⨁◯◯
Infections	404 (1 observational prospective study) [41]	Serious^d	Not serious	Not serious	Serious^c	Undetected	Low ⨁⨁◯◯

^aCertainty of the evidence assessed using the Grading of Recommendation Assessment, Development and Evaluation (GRADE) criteria.
^bevidence downgraded due the quality of the evidence being neutral for one study (Table 3).
^cevidence downgraded due to low number of observations/events.
^devidence downgraded due the quality of the evidence being neutral for this study (Table 3).
^eGRADE Working Group grades of evidence:
⊕⊕⊕⊕High Quality: Further research is very unlikely to change our confidence in the estimate of the effect.
⊕⊕⊕○Moderate Quality: There is moderately confidence in the effect estimate: the true effect is likely to be close the estimate of the effect, but there is a possibility that is substantially different
⊕⊕○○Low Quality: The confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
⊕○○○Very Low Quality (D): We have very little confidence in the effect estimate.

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