Perioperative oral nutritional supplements in normally or mildly undernourished geriatric patients submitted to surgery for hip fracture: A randomized clinical trial

Botella-Carretero, José I.; Iglesias, Borja; Balsa, José Antonio; Arrieta, Francisco; Zamarrón, Isabel; Vázquez, Clotilde

doi:10.1016/j.clnu.2010.01.012

Cited by 94 publications

(114 citation statements)

References 28 publications

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“…The higher rates of malnutrition and poorer intakes than those reported in other studies may be the result of selection bias associated with their highly explanatory nature (Zwarenstein et al 2008;Treweek and Zwarenstein 2009;Avenell and Handoll 2010). The need for informed consent and the acutely unwell, multi-morbid patient demographic has led to studies often excluding more than half of the initial patient population (Eneroth et al 2005;Fiatarone Singh et al 2009;Botella-Carretero et al 2010). Those excluded are considered more likely to be at risk of malnutrition and inadequate intake and may explain the higher malnutrition prevalence and incidence data identified in this study.…”

Section: Discussionmentioning

confidence: 90%

Barriers to nutritional intake in patients with acute hip fracture: time to treat malnutrition as a disease and food as a medicine?

Bell

Bauer

Capra

et al. 2013

Can. J. Physiol. Pharmacol.

131

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Inadequate energy and protein intake leads to malnutrition; a clinical disease not without consequence post acute hip fracture. Data detailing malnutrition prevalence, incidence, and intake adequacy varies widely in this patient population. The limited success of reported interventional strategies may result from poorly defined diagnostic criteria, failure to address root causes of inadequate intake, or errors associated with selection bias. This pragmatic study used a sequential, explanatory mixed methods design to identify malnutrition aetiology, prevalence, incidence, intake adequacy, and barriers to intake in a representative sample of 44 acute hip fracture patients (73% female; mean age, 81.7 ± 10.8 years). On admission, malnutrition prevalence was 52.2%. Energy and protein requirements were only met twice in 58 weighed 24 h food records. Mean daily patient energy intake was 2957 kJ (50.9 ± 36.1 kJ·kg(-1)) and mean protein intake was 22.8 g (0.6 ± 0.46 g·kg(-1)). This contributed to a further in-patient malnutrition incidence of 11%. Barriers to intake included patient perceptions that malnutrition and (or) inadequate intake were not a problem, as well as patient and clinician perceptions that treatment for malnutrition was not a priority. Malnutrition needs to be treated as a disease not without consequence, and food should be considered as a medicine after acute hip fracture.

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Section: Discussionmentioning

confidence: 90%

Barriers to nutritional intake in patients with acute hip fracture: time to treat malnutrition as a disease and food as a medicine?

Bell

Bauer

Capra

et al. 2013

Can. J. Physiol. Pharmacol.

131

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show abstract

“…An increase in the nutritional intake during hip fracture care and reduction in complications and improvement in the quality of life have been shown (31,32). However, it was concluded in the latest Cochrane Review on nutritional supplementation for hip fracture aftercare in older people conducted in 2016 that only weak evidence for the effectiveness of protein and energy feeds on mortality and complications exists (33).…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Mini-Nutritional Assessment short and long form and serum albumin as prognostic indicators of hip fracture outcomes

Helminen

Luukkaala

Saarnio

et al. 2017

Injury

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Introduction: Malnutrition is common among older hip fracture patients and associated with adverse outcomes. We examined Mini Nutritional Assessment short (MNA-SF) and long form (MNA-LF) and serum albumin as prognostic indicators of mobility, living arrangements and mortality after hip fracture.Methods: Population-based prospective data were collected on 594 hip fracture patients aged 65 and over. MNA-SF, MNA-LF and serum albumin were assessed on admission. Outcomes were poorer mobility; transfer to more assisted living accommodation and mortality one month, four months and one year post fracture. Logistic regression analyses for mobility and living arrangements with odds ratios (OR) and Cox proportional hazards model for mortality with hazard ratios (HR) and 95% confidence intervals (CI) were used, adjusted for age, gender, ASA grade and fracture type.Results: All measures predicted mortality at all time-points. Risk of malnutrition and malnutrition measured by MNA-LF predicted mobility and living arrangements within four months of hip fracture. At one year, risk of malnutrition predicted mobility and malnutrition predicted living arrangements, when measured by MNA-LF. Malnutrition, but not risk thereof, measured by MNA-SF predicted living arrangements at all time-points. None of the measures predicted one-month mobility.Conclusions: All measures were strong indicators of short-and long-term mortality after hip fracture. MNA-LF was superior in predicting mobility and living arrangements, particularly at four months. All measures were relatively poor in predicting short-term outcomes of mobility and living arrangements.

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“…Several authors have studied the effect of perioperative nutritional supplements. The results suggest that these supplements may be effective in improving nutrition [81][82][83][84], decrease complications [81,82,85], increase muscular strength [86], shorten rehabilitation [87], and decrease bedsores [88]. One study showed a limited effect of supplementation and suggested that its use be restricted to subgroups of patients at high risk [89].…”

Section: Nutritionmentioning

confidence: 99%

“…In conclusion, nutritional supplements seem to be effective [81][82][83][84][85][86][87][88] in the hip fracture population and are recommended in the perioperative period. One approach to the patient with a hip fracture is to obtain an albumin level during the admission laboratory studies.…”

Section: Nutritionmentioning

confidence: 99%

How to optimize patients for geriatric fracture surgery

et al. 2010

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Low-energy fragility fractures account for >80% of fractures in elderly patients, and with aging populations, geriatric fracture surgery makes up a substantial proportion of the orthopedic workload. Elderly patients have markedly less physiologic reserve than do younger patients, and comorbidity is common. Even with optimal care, the risk of mortality and morbidity remains high. Multidisciplinary care, including early orthogeriatric input, is recommended to anticipate and treat complications. This article explores modern treatment strategies for this challenging group of patients and provides guidance for systematically preparing and optimizing elderly patients before surgery, based on best available current evidence and recommendations by relevant health organizations.

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Perioperative oral nutritional supplements in normally or mildly undernourished geriatric patients submitted to surgery for hip fracture: A randomized clinical trial

Cited by 94 publications

References 28 publications

Barriers to nutritional intake in patients with acute hip fracture: time to treat malnutrition as a disease and food as a medicine?

Barriers to nutritional intake in patients with acute hip fracture: time to treat malnutrition as a disease and food as a medicine?

Comparison of the Mini-Nutritional Assessment short and long form and serum albumin as prognostic indicators of hip fracture outcomes

How to optimize patients for geriatric fracture surgery

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