The effect of unselected post-operative nutritional supplementation on nutritional status and clinical outcome of orthopaedic patients

Lawson, R. M.; Doshi, M.K.; Barton, J R; Cobden, I

doi:10.1054/clnu.2002.0588

Cited by 70 publications

(56 citation statements)

References 15 publications

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“…Analysis of the 3-day food logs revealed that energy intake was low at baseline, averaging 1,396 and 1,546 calories consumed per day in the placebo and EAA groups, respectively. While low, others have reported similar values in older healthy (33) adults and older patient populations (34,35). However, while not significantly different between the groups 2 weeks postoperation, relative to baseline, the placebo group demonstrated greater decreases in calorie and protein intake.…”

Section: Discussionmentioning

confidence: 76%

Essential amino acid supplementation in patients following total knee arthroplasty

Dreyer¹,

Strycker²,

Senesac³

et al. 2013

J. Clin. Invest.

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Background. By the year 2030, 3.48 million older U.S. adults are projected to undergo total knee arthroplasty (TKA). Following this surgery, considerable muscle atrophy occurs, resulting in decreased strength and impaired functional mobility. Essential amino acids (EAAs) have been shown to attenuate muscle loss during periods of reduced activity and may be beneficial for TKA patients.Methods. We used a double-blind, placebo-controlled, randomized clinical trial with 28 older adults undergoing TKA. Patients were randomized to ingest either 20 g of EAAs (n = 16) or placebo (n = 12) twice daily between meals for 1 week before and 2 weeks after TKA. At baseline, 2 weeks, and 6 weeks after TKA, an MRI was performed to determine mid-thigh muscle and adipose tissue volume. Muscle strength and functional mobility were also measured at these times.Results. TKA patients receiving placebo exhibited greater quadriceps muscle atrophy, with a -14.3 ± 3.6% change from baseline to 2 weeks after surgery compared with -3.4 ± 3.1% for the EAA group (F = 5.16, P = 0.036) and a -18.4 ± 2.3% change from baseline to 6 weeks after surgery for placebo versus -6.2 ± 2.2% for the EAA group (F = 14.14, P = 0.001). EAAs also attenuated atrophy in the nonoperated quadriceps and in the hamstring and adductor muscles of both extremities. The EAA group performed better at 2 and 6 weeks after surgery on functional mobility tests (all P < 0.05). Change in quadriceps muscle atrophy was significantly associated with change in functional mobility (F = 5.78, P = 0.021).Conclusion. EAA treatment attenuated muscle atrophy and accelerated the return of functional mobility in older adults following TKA.Trial registration. Clinicaltrials.gov NCT00760383.

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Section: Discussionmentioning

confidence: 76%

Essential amino acid supplementation in patients following total knee arthroplasty

Dreyer¹,

Strycker²,

Senesac³

et al. 2013

J. Clin. Invest.

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“…[29][30][31][32][33][34][35][36][37][38] Although relatively more studies were identified in this category, the studies were very diverse in terms of setting, interventions, and outcomes measured, making any direct comparisons across studies very difficult. In terms of study design, a range of designs were employed including randomised designs, [29][30][31]35 a number of non or quasi-randomised designs 32,33,36,37 and modelled studies. 34,38 Although sample size varied from less than 100 to over 2000, half of the studies included between 100 and 300 participants.…”

Section: Results Of Studies Where Participants Were Defined As Malnoumentioning

confidence: 99%

“…29 This study assessed a multidisciplinary intervention including exercise and smoking cessation counselling in addition to ONS in community dwelling adults with chronic obstructive pulmonary disease and was found to be near the cost effectiveness threshold at AUD$39,438 per QALY gained ( patients with COPD discharged to the community, 29 community dwelling older adults, 30 and a large number focusing on patients from various hospital wards. [32][33][34][35][36]38 Follow up period was similarly varied across the studies ranging from the duration of hospital stay to a two year period, with the greatest proportion of studies (five out of nine) centred on the period of hospitalisation. In addition, the costs included in the analysis varied from the incremental costs of providing the intervention only, [30][31][32] compared to wider viewpoints including the costs of providing the intervention and medical treatment over the follow up time period.…”

Section: Results Of Studies Where Participants Were Defined As Malnoumentioning

confidence: 99%

Economic evaluation for protein and energy supplementation in adults: opportunities to strengthen the evidence

et al. 2013

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Malnutrition is a costly problem for health care systems internationally. Malnourished individuals require longer hospital stays and more intensive nursing care than adequately nourished individuals and have been estimated to cost an additional £7.3 billion in health care expenditures in the United Kingdom alone. However, treatments for malnutrition have rarely been considered from an economic perspective. The aim of this systematic review was to identify the cost effectiveness of using protein and energy supplementation, as a widely used intervention to treat adults with and at risk of malnutrition. Papers were identified that included economic evaluations of protein or energy supplementation for the treatment or prevention of malnutrition in adults. While the variety of outcome measures reported for cost effectiveness studies made synthesis of results challenging, cost benefit studies indicated that the savings for the health system could be substantial due to reduced lengths of hospital stay and less intensive use of health services after discharge. In summary the available economic evidence indicates that protein and energy supplementation in treatment or prevention of malnutrition provides an opportunity to improve patient wellbeing and lower health system costs.

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“…In addition poor appetite and oral dietary intake are likely to be significant contributing factors, with studies consistently reporting dietary energy intakes below estimated requirements (Older et al, 1980;Stableforth, 1986;Brown and Seabrook, 1992;Lumbers et al, 2001). A wide range in daily energy intakes have been reported, 2630 kJ (Duncan et al, 2001) 7560 kJ (Bastow et al, 1983) and daily protein intakes, 26 kJ (Duncan et al, 2001) 53 g (Lawson et al, 2003). However, many of these studies date back at least 15 years (Hessov, 1977;Older et al, 1980;Bastow et al, 1983;Dickerson et al, 1984;Stableforth, 1986), use questionable dietary intake methodology for assessment of current intake (e.g.…”

Section: Introductionmentioning

confidence: 99%

“…In many intake studies cognitive impairment is an exclusion criteria (Bastow et al, 1983;Jallut et al, 1990;Brown and Seabrook, 1992;Patterson et al, 1992;Sullivan et al, 1998;Murphy et al, 2000;Lawson et al, 2003;Eneroth et al, 2005) or has not been reported (Hessov, 1977;Older et al, 1980;Dickerson et al, 1984;Stableforth, 1986;MollerMadsen et al, 1988;Delmi et al, 1990;Hartgrink et al, 1998). Those studies that have included patients with cognitive impairment have not reported intake data according to cognitive status (Volkert et al, 1996;Duncan et al, 2001;Lumbers et al, 2001), despite evidence that eating behaviours associated with decreased dietary intake (e.g.…”

Section: Introductionmentioning

confidence: 99%

Lower limb fracture, cognitive impairment and risk of subsequent malnutrition: a prospective evaluation of dietary energy and protein intake on an orthopaedic ward

Miller¹,

Bannerman

Daniels

et al. 2006

Eur J Clin Nutr

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Objective: To report the dietary energy and protein intake of undernourished older adults (with and without cognitive impairment) admitted to hospital following a lower limb fracture and to determine whether dietary intakes met estimated requirements. Design: An observational study of a sequential sample. Setting: The orthopaedic ward of a South Australian metropolitan teaching hospital. Subjects: Sixty-eight patients aged X70 years screened as undernourished and admitted to hospital following lower limb fracture (50% cognitively impaired) provided 3 to 5 days of dietary data. Major outcome methods: Dietary energy and protein intake. Methods: Dietary assessment using plate waste methodology and snack record charts commenced within 6 days postinjury and continued for up to five consecutive days or until discharge. Estimated resting energy requirements were calculated and adjusted for activity equivalent to bed rest and physiological stress. Protein requirements were calculated as 1 g/kg/day. Cognition was assessed using the Short Portable Mental Status Questionnaire. Results: Cognitively impaired participants and those without cognitive impairment consumed, mean (95% CI) respectively, 3661 kJ/day (3201, 4121) versus 4208 kJ/day (3798, 4619) and 38 g (33, 44) versus 47 g (41, 52) protein/day. Cognitively impaired participants consumed mean (95% CI) 48% (43, 53) of estimated total energy expenditure and 78% (69, 87) of estimated protein requirements. Conclusions: Orthopaedic fracture patients at greatest nutritional risk, including those with cognitive impairment, do not achieve estimated energy or protein requirements from diet alone. Effective methods of achieving requirements in this vulnerable group are needed before improvements in outcomes will be observed.

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The effect of unselected post-operative nutritional supplementation on nutritional status and clinical outcome of orthopaedic patients

Cited by 70 publications

References 15 publications

Essential amino acid supplementation in patients following total knee arthroplasty

Essential amino acid supplementation in patients following total knee arthroplasty

Economic evaluation for protein and energy supplementation in adults: opportunities to strengthen the evidence

Lower limb fracture, cognitive impairment and risk of subsequent malnutrition: a prospective evaluation of dietary energy and protein intake on an orthopaedic ward

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