MON-P021: Effect of a three month Post-Hospital Nutritional Intervention on Functional Performance in Frail and Malnourished Older Adults - A Randomized Controlled Study

Otten, L.; Kiselev, Jörn; Franz, K.; Steinhagen‐Thiessen, Elisabeth; Müller‐Werdan, Ursula; Eckardt, Rahel; Spira, Dominik; Norman, K.

doi:10.1016/s0261-5614(16)30655-0

Cited by 4 publications

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“…With the exception of one study 57 that was a cluster randomized clinical trial, all remaining studies were individually randomized controlled trials. The main characteristics of the 19 included publications are summarized in Table 2 57,[59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75] and details concerning their results can be found in Supplementary Table S2.…”

Section: Selection Process and Study Characteristicsmentioning

confidence: 99%

“…Most studies 57,[59][60][61][62][63][64][65][66][67][68] included only frail individuals, two studies 69,70 included only pre-frail individuals and six studies 14,71-75 included participants with both frailty and pre-frailty. The criteria used by each study to diagnose frailty and pre-frailty are described in detail in Suplementary Table S3.…”

Section: Selection Process and Study Characteristicsmentioning

confidence: 99%

“…We present details regarding the comorbidities included/allowed and excluded in each original study in Supplementary Table S4. Eight studies 14,68,69,[71][72][73][74][75] used the CHS frailty criteria to define physical frailty based on the following five criteria: unintentional weight loss, self-reported exhaustion, weakness, slow walking speed, low physical activity. 28 One study 59,60,63 defined frailty based on the Chin A Paw criteria.…”

Section: Selection Process and Study Characteristicsmentioning

confidence: 99%

“…Only one of the included studies was restricted to older people with frailty and obesity (BMI ≥ 30 kg/m²). 65 Regarding the setting of the included studies, 14 studies recruited participants living in the community, 14,59,60,[63][64][65][66][69][70][71][72][73][74][75] three, 57,61,67 studies recruited participants from long-term care facilities, one study included both participants living in long-term care facilities and the community, 62 and another study 68 did not provide a clear description about whether its participants were living in the community or in long-term care facilities (Table 2 57,[59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75] ). The proportion of women in the included studies ranged from 36% to 100%, and the mean age of participants ranged from 68 to 84 years.…”

Section: Selection Process and Study Characteristicsmentioning

confidence: 99%

“…In 15 of 17 studies the nutritional intervention consisted of nutritional supplements 14,57,61,62,[64][65][66][67][68][69][71][72][73][74][75] and in the two remaining studies 59,60,63,70 the intervention was nutritional education.…”

Section: Selection Process and Study Characteristicsmentioning

confidence: 99%

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Nutritional interventions for the management of frailty in older adults: systematic review and meta-analysis of randomized clinical trials

et al. 2020

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Context Although nutrition is considered an important intervention for the management of frailty, the actual effectiveness of interventions addressing nutrition in frail older people remains unclear. Objective The aim for this systematic review was to appraise the evidence regarding the effectiveness of nutritional interventions for the management of frailty in older adults. Data Extraction We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Web of Science, and Latin American and Caribbean Health Sciences Literature databases were searched from January 2001 to November 2019. Two independent reviewers extracted relevant data. From 2370 initial records, 19 publications presenting data from 17 studies (1564 individuals; follow-up: 7–96 weeks) were included. Data Analysis None of the Bayesian random-effects meta-analyses comparing nutritional supplements with placebo regarding mortality, body mass index, weight, frailty status, muscle strength, gait speed, body composition, and cognitive function showed statistically significant differences. The same applies to a single meta-analysis comparing nutritional education with general health advice regarding muscle strength. Conclusion Our results suggest, mostly with low to very low degrees of certainty, that nutritional supplements or nutritional education delivered in isolation may not be effective for the management of frailty in older people. Review registration number CRD42018111510 (PROSPERO).

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Section: Selection Process and Study Characteristicsmentioning

confidence: 99%

Section: Selection Process and Study Characteristicsmentioning

confidence: 99%

Section: Selection Process and Study Characteristicsmentioning

confidence: 99%

Section: Selection Process and Study Characteristicsmentioning

confidence: 99%

Section: Selection Process and Study Characteristicsmentioning

confidence: 99%

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Nutritional interventions for the management of frailty in older adults: systematic review and meta-analysis of randomized clinical trials

et al. 2020

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Effectiveness and cost-effectiveness of oral nutritional supplements in frail older people who are malnourished or at risk of malnutrition: a systematic review and meta-analysis

Thomson

Rice

Arisa

et al. 2022

The Lancet Healthy Longevity

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Oral nutritional interventions in frail older people who are malnourished or at risk of malnutrition: a systematic review

Thomson

Rice

Arisa

et al. 2022

Health Technol Assess

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Background Malnutrition worsens the health of frail older adults. Current treatments for malnutrition may include prescribed oral nutritional supplements, which are multinutrient products containing macronutrients and micronutrients. Objective To assess the effectiveness and cost-effectiveness of oral nutritional supplements (with or without other dietary interventions) in frail older people who are malnourished or at risk of malnutrition. Data sources MEDLINE, EMBASE, Cochrane Library, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and grey literature were searched from inception to 13 September 2021. Review methods A systematic review and meta-analysis was conducted to evaluate the effectiveness and cost-effectiveness of oral nutritional supplements in frail older people (aged ≥ 65 years) who are malnourished or at risk of malnutrition (defined as undernutrition as per National Institute for Health and Care Excellence guidelines). Meta-analysis and network meta-analysis were undertaken, where feasible, along with a narrative synthesis. A cost-effectiveness review was reported narratively. A de novo model was developed using effectiveness evidence identified in the systematic review to estimate the cost-effectiveness of oral nutritional supplements. Results Eleven studies (n = 822 participants) were included in the effectiveness review, six of which were fully or partly funded by industry. Meta-analyses suggested positive effects of oral nutritional supplements compared with standard care for energy intake (kcal) (standardised mean difference 1.02, 95% confidence interval 0.15 to 1.88; very low quality evidence) and poor mobility (mean difference 0.03, p < 0.00001, 95% confidence interval 0.02 to 0.04; very low quality evidence) but no evidence of an effect for body weight (mean difference 1.31, 95% confidence interval –0.05 to 2.66; very low quality evidence) and body mass index (mean difference 0.54, 95% confidence interval –0.03 to 1.11; very low quality evidence). Pooled results for other outcomes were statistically non-significant. There was mixed narrative evidence regarding the effect of oral nutritional supplements on quality of life. Network meta-analysis could be conducted only for body weight and grip strength; there was evidence of an effect for oral nutritional supplements compared with standard care for body weight only. Study quality was mixed; the randomisation method was typically poorly reported. One economic evaluation, in a care home setting, was included. This was a well-conducted study showing that oral nutritional supplements could be cost-effective. Cost-effectiveness analysis suggested that oral nutritional supplements may only be cost-effective for people with lower body mass index (< 21 kg/m2) using cheaper oral nutritional supplements products that require minimal staff time to administer. Limitations The review scope was narrow in focus as few primary studies used frailty measures (or our proxy criteria). This resulted in only 11 included studies. The small evidence base and varied quality of evidence meant that it was not possible to determine accurate estimates of the effectiveness or cost-effectiveness of oral nutritional supplements. Furthermore, only English-language publications were considered. Conclusions Overall, the review found little evidence of oral nutritional supplements having significant effects on reducing malnutrition or its adverse outcomes in frail older adults. Future work Future research should focus on independent, high-quality, adequately powered studies to investigate oral nutritional supplements alongside other nutritional interventions, with longer-term follow-up and detailed analysis of determinants, intervention components and cost-effectiveness. Study registration This study is registered as PROSPERO CRD42020170906. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 51. See the NIHR Journals Library website for further project information.

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MON-P021: Effect of a three month Post-Hospital Nutritional Intervention on Functional Performance in Frail and Malnourished Older Adults - A Randomized Controlled Study

Cited by 4 publications

References 0 publications

Nutritional interventions for the management of frailty in older adults: systematic review and meta-analysis of randomized clinical trials

Nutritional interventions for the management of frailty in older adults: systematic review and meta-analysis of randomized clinical trials

Effectiveness and cost-effectiveness of oral nutritional supplements in frail older people who are malnourished or at risk of malnutrition: a systematic review and meta-analysis

Oral nutritional interventions in frail older people who are malnourished or at risk of malnutrition: a systematic review

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