Nutritional status and energy expenditure in elderly patients with recent hip fracture during a 2-month follow-up

Abstract

A 2-month follow-up of nutritional status was performed in forty elderly patients with recent hip fracture. Patients were nutritionally assessed on admission to our rehabilitation unit (day 0), then monthly (day 30, day 60) by measurement of resting energy expenditure (REE), anthropometric, impedance and biological variables. Patients were defined as undernourished (n 13) or normally nourished (n 27) on the basis of mid-arm circumference (MAC) and triceps skinfold thickness (TST) measurements. Seven patients recovered a walking autonomy and were discharged from the hospital before day 30 (group I) whereas thirteen patients were discharged after day 30 (group II); twenty patients remained in the study at day 60 (group III). MAC and TST decreased in normally nourished patients from group III throughout the study whereas they did not change in group II or in undernourished patients from group III. REE values in relation to fat-free mass were increased compared with normal values and were similar in the three groups on day 0; they did not change during the study. Daily energy intake in relation to body weight was higher in group I and increased in group II and in undernourished patients from group III throughout the study. In contrast, it was below the recommended value at day 0 and it did not significantly improve in normally nourished patients from group III. Serum albumin, transthyretin and transferrin levels on day 0 were below reference intervals in the three groups. Albumin levels increased in group III throughout the study. Inflammatory proteins decreased in groups II and III, with C-reactive protein levels returning to normal values in group II by day 30 and in group III at day 60, while orosomucoid levels did not become completely normal over this period. Our findings indicate no improvement in nutritional status in undernourished patients after surgery for recent hip fracture, despite an adequate energy intake. An insufficient spontaneous energy intake for normally nourished patients was associated with a delayed favourable outcome resulting in a prolonged duration of hospitalization. A hypermetabolic state persisted during the 3 months after surgery.

Comparing the adequacy of the MNA-SF, NRS-2002 and MUST nutritional tools in assessing malnutrition in hip fracture operated elderly patients

“…Hip fracture in the elderly has generated a substantial concern to public health services and society [1,2]. The rate of hip fractures has been increasing by 1e3% annually and will most probably affect 6.3 million people by the year 2050 [3].…”

“…Malnutrition was often found associated with impaired muscle function, anemia, immune dysfunction, reduced cognitive status, an increased risk of falling, prolonged hospitalization, morbidity and mortality [11]. Malnutrition appears to be an important determinant for both incidence and complications of hip fracture patients [2]. A close relationship between malnutrition and increased morbidity, mortality and longer recovery time, has been demonstrated in hip fracture patients [7].…”

Identifying effective and feasible interventions to accelerate functional recovery from hospitalization in older adults: A randomized controlled pilot trial

“…Results from these investigations suggest that nutritional supplementation after hospitalization can lower the incidence of falls [64], reduce inflammation (during concomitant rehabilitation) [66], and increase handgrip strength [63, 65]. However, these previous studies have not observed benefits of protein supplementation on measures of physical function or muscle size.…”

The Role of Nutrition in Injured Military Personnel at Role 4: Current Practice

“…It also decreases complication rates, commonly quoted as being important in the early introduction of enteral feeding [27,28]. [18,19] 30-50% [18,19] 10% [20] 30-50% [21] 1% increase in stress factor for every 1% full thickness burn [17,22] 5 % for uncomplicated surgery through to 25% for an extensive and complicated surgery [23,24] Traditionally there has been a tendency to attribute large stress factors to ongoing illness when calculating energy requirements based on recommendations from 1979 that hospital patients had higher requirements than their healthy counterparts and increased energy expenditure and hypermetabolism increased depending on severity of illness and degree of stress the body was under [29]. However, as more research has become available, it has been recognised that these stress factors have generally tended to overfeed patients.…”