Oral protein and energy supplementation in older people: a systematic review of randomized trials.

Abstract

A report of the UK Royal College of Physicians entitled ‘Nutrition and Patients: A Doctor’s Responsibility’, published in July 2002 [1], highlighted again the importance of nutritional care for vulnerable groups such as undernourished elderly people, particularly those who are hospitalized or institutionalized. Older people have longer periods of illness and longer hospital stays [2], and data show that up to 55% of elderly hospitalized patients are undernourished on admission [3, 4]. Malnutrition is associated with poorer recovery in a broad range of patients and conditions [5, 6], and furthermore, nutritional status has been shown to decline during hospitalization [3, 7]. This has led to the hypothesis that providing nutritional support to those at risk of malnutrition will have beneficial effects on outcome. The best way to establish this is to demonstrate it in a randomized controlled trial (RCT). A systematic review of RCTs by Potter et al. [8] in 1998 examined the effects of oral and enteral protein and energy supplementation in trials involving adults of all ages with any medical or surgical condition. Supplementation seemed to improve the nutritional indices of adult patients, but there were insufficient data in trials which met strict methodological criteria to be certain if mortality was reduced. A Cochrane Review of dietary advice for illness-related malnutrition in adults of all ages was also carried out by Baldwin et al. [9]. There was insufficient evidence to establish whether dietary advice alone improves the outcomes, however the limited information available suggested that weight gain was greater in people who also received supplements, with or without advice. Lochs H, Thomas DR (eds): Home Care Enteral Feeding. Nestlé Nutrition Workshop Series Clinical & Performance Program, vol 10, pp 103–125, Nestec Ltd., Vevey/S. Karger AG, Basel, © 2005.