Intensified dietetic care during and up to three months after hospital admission in older patients at risk of malnutrition, a randomised controlled trial

IF 2.9 Q3 NUTRITION & DIETETICS
Carliene van Dronkelaar , Hinke Kruizenga , Moritz Eggelbusch , Peter J.M. Weijs , Michael Tieland
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引用次数: 0

Abstract

Background

Inadequate protein intake is associated with poor physical functioning and suboptimal recovery in hospitalised older adults. Despite standard dietetic care, dietary protein intakes falls well below the recommended levels. To address this problem, we developed an intensified trans-sectorial dietetic intervention that targets hospitalised older adults. This study aims to evaluate its impact on physical functioning and dietary protein intake during and post hospitalisation.

Methods

This multicentre individually randomised controlled trial was conducted in five hospitals from January 2021 until December 2022. Hospitalised older adults, aged ≥55 years and at risk of malnutrition were randomised to receive regular care (CON) or intensive dietetic intervention (INT). The intervention consisted of personalized, intensive care, including trans-sectorial guidance by trained dietitians, increased consultations, and supportive materials focused on protein intake. Additionally, the intervention emphasized engagement in dietary behaviour and physical activity during hospitalisation and continued for three months post-discharge. The primary outcome was change in physical functioning measured by the Short Physical Performance Battery (SPPB) from admission to three months post-discharge, analysed with linear mixed models for repeated measures. Secondary outcomes included protein intake, body composition, muscle strength, physical activity, activities of daily living, fear of falling, pain, fatigue, appetite and quality of life.

Results

A total of 76 hospitalised older adults were included in the study of which 38 were in CON and 38 received INT. The overall drop-out was 30 % (CON 26 %; INT 34 %). The participants had a median age 73 y (Inter Quartile Range: 62-78 y) with 50 % females. Overall, Physical functioning improved from 6 points (IQR: 1–9 points) at baseline to 9 points (IQR: 7–11) at three months post-discharge (p < 0.0001). Likewise, protein intake increased from 0.8 g/kg bodyweight (IQR: 0.6–1.0) to 1.0 g/kg bodyweight (IQR: 0.8–1.2) (p < 0.0001). There were no significant differences between intervention and control group. All secondary outcomes improved over time, except for fear of falling, leg extension strength, and body composition, with no significant differences between intervention and control group.

Conclusions

Hospitalised older patients improved their physical functioning and protein intake after three months post-discharge, although the majority not to recommended levels. No effects of the intensive dietetic treatment could be detected due to low intervention adherence and a small sample size. Future research should be conducted with an intervention consisting of a strong combination of nutritional support and exercise with a successful implementation and a flexible study design catered to the needs of the older patient.

Trial registration

Landelijk Trial Register (NL8041; NL72069.029.19) www.onderzoekmetmensen.nl; registered 2019-09-23; covering all WHO Trial Registration Data Set items.
对有营养不良风险的老年患者在入院期间和入院后三个月内加强饮食护理,随机对照试验。
背景:蛋白质摄入不足与住院老年人身体功能差和恢复欠佳有关。尽管有标准的饮食护理,膳食蛋白质摄入量仍远低于推荐水平。为了解决这个问题,我们开发了一种针对住院老年人的强化跨部门饮食干预。本研究旨在评估其对住院期间和住院后身体功能和膳食蛋白质摄入的影响。方法:该多中心随机对照试验于2021年1月至2022年12月在五家医院进行。年龄≥55岁且有营养不良风险的住院老年人被随机分配接受常规护理(CON)或强化饮食干预(INT)。干预措施包括个性化的重症监护,包括由训练有素的营养师提供跨部门指导,增加咨询,以及关注蛋白质摄入的支持性材料。此外,干预强调住院期间饮食行为和身体活动的参与,并在出院后持续三个月。主要终点是入院至出院后3个月期间身体机能的变化,通过短物理性能电池(SPPB)测量,并使用重复测量的线性混合模型进行分析。次要结果包括蛋白质摄入量、身体成分、肌肉力量、体力活动、日常生活活动、跌倒恐惧、疼痛、疲劳、食欲和生活质量。结果:共有76名住院老年人被纳入研究,其中38人接受CON治疗,38人接受INT治疗。总退出率为30%(对照组26%;INT 34%)。参与者的中位年龄为73岁(四分位数间距:62-78岁),其中50%为女性。总体而言,身体功能从基线时的6分(IQR: 1-9分)改善到出院后3个月时的9分(IQR: 7-11分)。结论:住院的老年患者在出院后3个月后身体功能和蛋白质摄入量有所改善,尽管大多数未达到推荐水平。由于干预依从性低和样本量小,没有发现强化饮食治疗的效果。未来的研究应结合营养支持和锻炼的干预措施,并成功实施灵活的研究设计,以满足老年患者的需求。试验注册:Landelijk Trial Register (NL8041;NL72069.029.19) www.onderzoekmetmensen.nl;注册2019-09-23;涵盖所有世卫组织试验注册数据集项目。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Clinical nutrition ESPEN
Clinical nutrition ESPEN NUTRITION & DIETETICS-
CiteScore
4.90
自引率
3.30%
发文量
512
期刊介绍: Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.
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