Background Fragility hip fracture patients are often malnourished. Nutrition supplementation may help, but it is unclear if supplementation is impactful when considering outcomes. A systematic review of literature examining perioperative nutrition status for older adults experiencing a hip fracture was performed. Methods We searched Medline, CAB Abstracts and Embase (Ovid); Cochrane Library (Wiley); PubMed; Scopus; Global Index Medicus; Web of Science Core Collection; SPORTDiscus (EBSCO); and clinical trial registries ClinicalTrials.gov and WHO ICTRP from inception to April 2021, incorporating terminology related to nutritional interventions, fragility fractures, and postoperative outcomes. Two investigators reviewed citations for inclusion, extracted nutrition intervention criteria, and categorized hip fragility outcomes. Results Of 1792 citations, 90 articles underwent full-text screening, and 14 articles were included in the final sample. We identified nutritional interventions and 4 outcomes of interest. 8 studies (n = 649) demonstrated a mean difference of .78 days (CI .34-1.21) in length of stay (LOS) between the nutritional intervention and control groups. Rehabilitation ward stays were discussed in 2 studies demonstrating a non-statistically significant difference. 7 studies (n = 341) reported mortality rates; when pooled there was no statistically significant difference. 5 studies showed data for postoperative infections and 4 studies reported on postoperative urinary tract infections. Pooling of data found a statistically significant result (Relative Risk: .49 [.32, .75], P = .001) with low heterogeneity (I2 = 27%). 4 studies reported urinary tract infections (n = 140) in the intervention group and (n = 121) in the control group with a non-statistically significant result. Grip strength was only reported in two studies but pooling of the data was non-statistically significant. Conclusions This systematic review highlighted the lack of consensus regarding the type of nutrition interventions available and impact on outcomes of interest including mortality, length of stay, infections, and grip strength for fragility hip fractures in older adults.
HISTORY:A 27 year old male reported polydipsia and polyuria for >3 weeks with concurrent weight loss despite caloric surplus of 500 kcal/day (weighed food logs and Fitbit Charge 2 HR (Fitbit Inc, San Francisco, CA, USA)). He reported 24-hour urinary output of 4 L. In prior 4 years, oral glucose tolerance and mixed meal tests revealed peak glucose over 200 mg/dl (204 -247 mg/dL) and elevated fasting glucose (FG) (101 -154 mg/dL) with normal HbA1c (4.9 -5.4%). (Figure 1A) His sibling was diagnosed with type 1 diabetes (T1DM) at 9 years old leading to subjects participation in diabetes prevention trial at 7 years old which utilized oral insulin. He suspected some form of diabetes and requested further testing PHYSICAL EXAMINATION: Self-reports high levels of physical activity (weight lifting and running 6-7x per week) and follows plant-based diet with 3250 kcal / day (20% protein, 50% CHO, 30% fat). Weight, fat mass, and lean body mass were measured at home using an Aria 2 (Fitbit Inc, San Francisco, CA, USA) bioelectrical impedance scale. (Figure 1B) DIFFERENTIAL DIAGNOSIS: 1. T1DM 2. T2DM TEST AND RESULTS: Lab work revealed FG of 268 mg/dL and HbA1c of 9.8%. GAD antibody was elevated (9 IU/mL). Other measures were normal: ADH (2.2 pg/mL), BUN (17 mg/dL), creatinine ( 0.94 mg/dL), GFR (111 ml/min/BSA), urine osmolality (1,198 mOsm/kg) FINAL WORKING DIAGNOSIS: T1DM TREATMENT AND OUTCOMES: 1. Subject started insulin therapy with 20:1 carb to insulin ratio and began gaining weight concurrent with caloric surplus. 2. Weight 76.4 kg with a BMI of 22.7 kg/m 2 after 11 weeks of initiating insulin. 3. From September 10 th to 25 th , honeymoon phase occurred and insulin needs dropped to 0 units/day. Several instances of hypoglycemia occurred with blood glucose values as low as 41 mg/dL 4. After honeymoon phase, daily insulin needs stabilized to 15 units basal and 20 units bolus suggesting partial endogenous insulin production 771Too Weak To Breathe
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