Nutritional supplements after hip fracture: poor compliance limits effectiveness. A comparison between oral and nasogastric nutritional supplements in malnourished patients. Effects of protein-rich supplementation and nandrolone in lean elderly women with femoral neck fractures. Randomized clinical trial of nutritional supplementation shows little effect on functional status among free-living frail elderly. The effects of exercise and protein-energy supplements on body composition and muscle function in frail elderly individuals: a long-term controlled randomised study. Effect of nutritional supplements on wound healing in home-nursed elderly: a randomized trial. Dietary supplementation in elderly patients with fractured neck of the femur Impact of nutritional support on functional status during an acute exacerbation of chronic obstructive pulmonary disease. Physiologic effects of nutritional support and anabolic steroids in patients with chronic obstructive pulmonary disease. A placebo-controlled randomized trial. Should the food intake of patients admitted to acute hospital services be routinely supplemented? A randomized placebo controlled trial. Prognostic significance of monthly weight fluctuations among older nursing home residents. Prevention of malnutrition in older people during and after hospitalisation: results from a randomised controlled clinical trial. The effect of a liquid nutrition supplement on body composition and physical functioning in elderly people. Protein-energy undernutrition and life-threatening complications among the hospitalized elderly Nutritional support in patients with chronic obstructive pulmonary disease during hospitalization for an acute exacerbation; a randomized controlled feasibility trial. Protein-energy oral supplementation in malnourished nursing-home residents. A controlled trial. Benefits of nutritional supplementation in free-living, frail, undernourished elderly people: a prospective randomized community trial. Effect of dietary supplement on nutritional status and clinical outcome in 501 geriatric patients--a randomised study. Study of the effect of a liquid nutrition supplement on the nutritional status of psycho-geriatric nursing home patients A prospective randomised controlled trial of nutritional supplementation in malnourished elderly in the community: clinical and health economic outcomes. Nutritional Supplementation of Very Old People at Hospital Discharge Increases Muscle Strength: A Randomised Controlled Trial Nutritional supplementation for diabetic foot ulcers: the first RCT. Does low lactose milk powder improve the nutritional intake and nutritional status of frail older Chinese people living in nursing homes? Incidence and recognition of malnutrition in hospital Body composition in elderly men: effect of dietary modification during strength training. A multi-center trial of the effects of oral nutritional supplementation in critically ill older inpatients. GAGE Group. Groupe Aquitain Geriatrique d'Evaluation. The effect of a supplement which is nutrient dense compared to standard concentration on the total nutritional intake of anorectic patients. Subjectively healthy elderly consuming a liquid nutrition supplement maintained body mass index and improved some nutritional parameters and perceived well-being. Effects of increased consumption of fluid milk on energy and nutrient intake, body weight, and cardiovascular risk factors in healthy older adults. Improvement of weight and fat-free mass with oral nutritional supplementation in patients with Alzheimer's disease at risk of malnutrition: a prospective randomized study. Nutritional status of elderly patients during recovery from chest infection and the role of nutritional supplementation assessed by a prospective randomized single-blind trial. Nutritional support and functional status in undernourished geriatric patients during hospitalization and 6-month follow-up Protein energy supplements in unwell elderly patients--a randomized controlled trial. Beta blockade during and after myocardial infarction: an overview of the randomized trials. Exercise training and nutritional supplementation for physical frailty in very elderly people. Dietary supplementation and respiratory muscle performance in patients with COPD. Dietary supplementation at home improves the regain of lean body mass after surgery. A randomized, controlled, a single-blind trial of nutritional supplementation after acute stroke.
BACKGROUND Undernutrition and weight loss are important determinants of clinical outcome in older patients after hip fracture but the effectiveness of nutritional support programs in routine clinical practice remains controversial . AIMS OF THE PROJECT : To determine if oral nutritional supplements given daily for 28 days after hip fracture surgery could prevent weight loss and /or lead to improved clinical outcomes ( mortality rates , discharge destination , activities of daily living or length of hospital stay ) in non-malnourished community-dwelling older women with hip fracture . METHODS One hundred and nine women with BMI range 20 - 30 kg/m(2 ) were allocated to either nutritional supplements ( 352 kcal/day ) or usual hospital nutrition using a quasi-r and omisation technique . Body weight changes were monitored at 4 and 8 weeks and clinical outcomes were recorded at discharge and at 6 months . RESULTS No significant differences in weight change or clinical outcomes were seen between the two groups . Compliance with consuming the nutritional supplements was quite variable and there was a significant negative correlation between the amount of supplement consumed and subsequent weight change ( r=-0.36 , P=0.019 ) . CONCLUSIONS Poor compliance with oral nutritional supplements is an important determinant of the effectiveness of oral nutritional interventions in preventing weight loss after hip fracture . Whilst this may explain the lack of clinical improvements seen , our data do not support the routine use of oral nutritional supplements in non-malnourished hip fracture patients There is a common perception that malnutrition is an inevitable manifestation of illness , that oral nutritional supplements are not taken or reduce the consumption of oral diet , and that nasogastric feeding is poorly tolerated . This study assessed the efficacy of supplemental enteral feeding on the nutritional status of malnourished patients , to compare oral supplements ( OS ) with overnight supplemental nasogastric feeding ( NG ) on nutritional status and to determine the effect of nutritional supplements on oral diet . Malnourished hospital patients were r and omized to one of three groups : control ( C ) , OS , or NG . All patients had access to hospital diet .  Supplements were prescribed to meet estimated nutritional needs . Nutritional status was recorded at the start and the end of the feeding period . The total nutritional intake was recorded . Weight gain occurred in 64 % of the supplemented patients , whereas 73 % of the controls lost weight with mean weight changes of + 2.9 % OS . + 3.3 % NG , and -2.5 % C. There was no difference in the mean energy intake from food in the three groups . There were no documented complications of OS and three minor complications of NG . Both methods of supplementation allow weight gain without significantly affecting spontaneous oral intake AIM To evaluate the effects of a protein-rich liquid supplementation , alone or in combination with the anabolic steroid n and rolone decanoate , on body composition , activities of daily living ( ADL ) status and the health-related quality of life ( HRQoL ) after a femoral neck fracture . METHODS Sixty women , aged 83 + /- 5 years ( mean + /- SD ) , BMI < 24 kg/m2 ( 20.4 + /- 2 kg/m2 ) and capable of co-operating , with a femoral neck fracture treated with internal fixation , were r and omised to open treatment during 6 months with a protein-rich liquid formula alone ( PR , Fortimel , 200 ml/day , 20 g protein/day ) or in combination with n and rolone decanoate ( PR/N , Deca-Durabol 25 mg i.m./3 weeks ) or to a control group ( C ) . The patients were re-examined after 6 and 12 months regarding body weight ( BW ) , lean body mass ( LBM , DXA ) , ADL status according to Katz , HRQoL according to EQ 5-D and fracture healing . RESULTS LBM decreased in the C ( -1.2 + /- 2 kg ) and PR groups ( -1.2 + /- 1 kg ) but remained the same in the PR/N group ( 0.3 + /- 1 kg ) ( P < 0.05 between groups ) . ADL remained at a high level in the two intervention groups but declined significantly in the C group ( P < 0.005 between groups ) . The decline in HRQoL was least pronounced in the PR/N group at 6 months ( P < 0.05 between groups ) . Patients with fracture healing complications lost more BW ( P < 0.05 ) and LBM ( P < 0.01 ) than patients with uneventful fracture healing . CONCLUSION Protein-rich liquid supplementation in combination with n and rolone given for 6 months to lean elderly women after a femoral neck fracture may positively affect LBM , ADL and Nutritional deficiencies , frequently observed among the frail elderly , have been associated with increased morbidity and dependency . A r and omized clinical trial was conducted to assess the impact of nutritional supplementation on the functional status of frail elderly living at home . Subjects ( n = 50 ) over age 60 ( mean 78 y ) requiring community services and at elevated risk of undernutrition ( excessive weight loss or body mass index < 24 kg/m2 ) were r and omized to a high energy nutrient dense supplement provided by a dietitian or a control group receiving visits only . Outcome measures , including changes in h and grip strength , general well-being score , perception of health and number of falls , were measured by an investigator who was unaware of treatment assignment . After 12 wk , weight gain was greater in the supplemented group ( 2.1 + /- 2.3 vs. 0.6 + /- 1.6 kg ; P < 0.01 ) . Despite adequate statistical power , no functional measures differed except that the number of falls was lower among treated subjects vs. controls ( 0 % vs. 21 % ; P = 0.05 ) . Frail elderly can gain weight through oral supplementation , indicating the reversibility of weight loss in this group , but changes in functional status indicators may require a longer period of supplementation Fighting against inactivity and inadequate nutritional intake are of utmost importance in the elderly . To our knowledge , the few studies which have been performed were conducted for only a short period and the results do not permit formal conclusions to be drawn . We therefore tried to fill this gap in our knowledge by determining whether an intervention combining an acceptable progressive exercise programme and nutritional supplements would be feasible for a long-term period in the very frail elderly , and would bring about concomitant benefits in body composition and muscle power . Accordingly , this exercise and nutritional combination was assessed in the frail elderly in a 9-month r and omised trial with a factorial design . Fifty-seven elderly volunteers over 72 years , from sixteen retirement homes in Lyon , France participated in the study .  Dietary supplements were compared with placebo , and physical exercise was compared with memory training . Main outcome measures were fat-free mass ( FFM ) and muscle power . FFM was determined by labelled water , and muscle power was measured by a leg-extensor machine . At 9 months , the compliance was 63 % for exercise sessions , and 54 % for nutritional supplements . In patients with dietary supplements , muscle power increased by 57 % at 3 months ( P=0.03 ) , and showed only a tendency at 9 months ; although FFM increased by 2.7 % at 9 months , the difference was not significant ( P=0.10 ) . Exercise did not improve muscle power at 9 months , but improved functional tests ( five-time-chair rise , P=0.01 ) . BMI increased with supplements ( + 3.65 % ) , but decreased with placebo ( -0.5 % ) at 9 months ( P=0.007 ) . A long-term combined intervention is feasible in frail elderly individuals with a good rate of compliance . Nutritional supplements and exercise may improve muscle function . Despite no significant results on FFM , due to the limited number of volunteers , combined intervention should be suggested to counteract muscle weakness in the frail elderly OBJECTIVE The objective was to determine whether provision of oral nutritional supplements , delivered by community nurses , could improve nutritional status and wound healing in home-nursed elderly . METHODS This was a double-blind , r and omized trial in 50 elderly patients referred for wound management . Patients received 237 mL/d of 4 or 8 kJ/mL of an oral nutritional supplement for 4 wk . Nutritional status was measured with the Subjective Global Assessment and the Mini-Mental State Examination question naire to determine cognitive function and wound characteristics to assess healing . Differences between variables were examined with the Mann-Whitney or Student 's t test for comparing two groups , one-way analysis of variance when there was more than two groups , and chi-square analysis for comparing two categorical variables . Associations between variables were examined with Pearson 's correlation and regression analysis . RESULTS At baseline , 34 % subjects were moderately malnourished and 8 % were severely malnourished . In both groups , there was significantly greater improvement in Mini-Mental State Examination scores at week 4 ( 95 % confidence interval -2.0 to -0.001 , P = 0.04 ) and a greater decrease in the wound effusion score ( 95 % confidence interval -2.0 to 0.0 , P = 0.045 ) . Median length of stay did not differ between groups ( P > 0.05 ) . CONCLUSIONS Malnutrition is common in elderly patients who are nursed at home for wound management . Provision of energy- and protein-dense oral supplements by community nurses is effective in improving some indices of wound healing and cognitive function in this group . Although further study is needed to determine the effect on length of stay , the nutritional needs of this vulnerable group should not be overlooked 59 elderly patients ( mean age 82 ) with femoral neck fractures were r and omised into two groups . 27 patients received daily an oral nutrition supplement ( 250 ml , 20 g protein , 254 kcal ) for a mean of 32 days ; 32 patients acted as controls . On admission most patients had nutritional deficiencies . Despite being offered adequate quantities , nutritional requirements were not met during the hospital stay . Clinical outcome was significantly better in the supplemented group ( 56 % favourable course vs 13 % in controls ) during the stay in the convalescent hospital . The rates of complications and deaths were also significantly lower in supplemented patients ( 44 % vs 87 % ) . 6 months after the fracture the rates of complications and mortality were significantly lower in supplemented patients ( 40 % vs 74 % ) . The median duration of hospital stay was significantly shorter in the supplemented group ( 24 vs 40 days ) . Thus the clinical outcome of elderly patients with femoral neck fracture can be improved by once daily dietary oral supplementation The impact of oral nutritional supplementation during an acute exacerbation of COPD on functional status was assessed through measuring change in lung function , strength testing , and general well-being .  Subjects hospitalized for an acute exacerbation of COPD ( n = 33 ) were r and omized to extra nutritional support or the regular hospital care . They consumed an additional 10 kcal/kg/d . Outcome measures were measured at 2 wk as change scores . Forced vital capacity ( % predicted ) improved in the treatment group as compared with the control group ( + 8.7 % versus -3.5 % , p = 0.015 ) , and change in FEV1 was in the same direction but not significantly different ( p = 0.099 ) . There were no changes in h and grip strength or respiratory muscle strength , but there was a trend towards more improvement in the general well-being score ( + 11.96 versus -10.25 , p = 0.066 ) . Almost all subjects were in negative nitrogen balance , indicating muscle wasting . The degree of muscle wasting was strongly correlated with the dose of corticosteroids ( r = 0.73 , p < 0.005 ) . In conclusion , it is difficult to prevent important muscle wasting in patients with COPD treated with corticosteroids , but some small gains were observed with increased dietary intake Nutritional depletion commonly occurs in patients with COPD , causing muscle wasting and impaired physiologic function . Two hundred seventeen patients with COPD participated in a placebo-controlled , r and omized trial investigating the physiologic effects of nutritional intervention alone ( N ) for 8 wk or combined with the anabolic steroid n and rolone decanoate ( N + A ) . N and rolone decanoate or placebo ( P ) was injected intramuscularly ( women , 25 mg ; men , 50 mg ) in a double-blind fashion on Days 1 , 15 , 29 , and 43 . Nutritional intervention consisted of a daily high caloric supplement ( 420 kcal ; 200 ml ) . Also , all patients participated in an exercise program . In the depleted patients , both treatment regimens induced a similar significant body weight gain ( 2.6 kg ) but different body compositional changes . Particularly in the last 4 wk of treatment , weight gain in the N group was predominantly due to an expansion of fat mass ( p < 0.03 versus P and N + A ) , whereas the relative changes in fat-free mass ( FFM ) and other measures of muscle mass were more favorable in the N + A group ( p < 0.03 versus P ) . Maximal inspiratory mouth pressure improved within both treatment groups in the first 4 wk of treatment , but after 8 wk only N + A was significantly different from P ( p < 0.03 ) . Nutritional supplementation in combination with a short course of anabolic steroids may enhance the gain in FFM and respiratory muscle function in depleted patients with COPD without causing adverse side effects BACKGROUND Many patients admitted to acute hospital services are underweight or harbour vitamin deficiencies . OBJECTIVES To determine the effect on patient throughput of a policy of routine vitamin supplementation , and of early routine sipfeed supplementation in ' thin ' patients ( 5 - 10 % weight loss or body mass index 18 - 22 ) . DESIGN Factorial r and omized placebo controlled trial of oral multivitamins from the first day of admission , and , after nutritional screening , of a nutritionally complete sipfeed from the second day in ' thin ' patients . SETTING Acute medical , surgical and orthopaedic hospital services of a London teaching hospital . PARTICIPANTS 1561 patients admitted as emergencies were included in the vitamin study of which 549 were included in the sipfeed study . MAIN OUTCOME MEASURE Length of hospital stay ( LOS ) . RESULTS Offering multivitamins to acute admissions result ed in a mean change ( reduction ) in LOS of -0.4 days 95 % CI ( -2 - 1.2days ) . The results suggest greater reductions for those discharged after 10 days : mean change=-2.3 days 95 % CI ( -5.7 to 1.2 ) . Sipfeed supplementation was associated with an increased mean length of stay 2.8 days 95 % CI ( -0.8 - 6.3 ) . 18 % of acute admissions were classified undernourished on the basis of BMI , MUAC or percent weight loss combined . CONCLUSIONS No benefit was observed for sipfeed intervention although a small benefit of less than one day is not excluded . Vitamin supplementation may have slight but economically important benefit BACKGROUND Although weight change in older persons has proven prognostic significance , it is not known whether monthly weights obtained by the clinical staff in long-term care institutions are reliable enough to be useful in identifying at-risk residents . The objective of this study was to determine whether an association exists between mortality risk and the intraresident variation in weight in long-term care institutions . METHODS For this study , 900 nursing home residents with a recently identified nutritional problem from 96 long-term care facilities in 8 states were r and omly selected . At study entry , nutritional , health status , and demographic data were extracted from the nursing home chart or the Minimum Data Set . Weights obtained by the nursing home staff were recorded at baseline and during each of the subsequent 6 months . Cox proportional hazards regression analysis was used to assess relationships between weight parameters and mortality risk during the 7 months of observation . RESULTS During the study , 435 ( 48 % ) participants had at least 1 monthly weight that differed from the previous month 's weight by > or = 5 % ; 163 ( 18 % ) participants had this magnitude of a 1-month weight change more than once . By controlling for the linear trend ( i.e. , slope ) of each residents ' weight change between the first to the last weight , the average month-to-month residual variability in the resident 's weights was calculated . This residual variability or " average r and om fluctuation " in weight from 1 month to the next was > or = 2 % in 229 ( 25 % ) participants and > or =3 % in 82 ( 9 % ) participants . Despite the large r and om fluctuation in the residents ' weights , weight loss was an important prognostic indicator . Those who lost > or = 5 % in any month had a 10-fold increased risk for death compared with those who gained weight ( adjusted relative risk , 10.6 ; 95 % confidence interval , 3.2 to 35.5 ) . The average r and om fluctuation in weight was associated with an increased risk for death only at the upper 10th percentile for the population . CONCLUSIONS Many nutritionally compromised elderly nursing home residents experience significant bidirectional fluctuations in their weight from month to month . How much of this variability is due to measurement error is not known . However , a weight loss of > or = 5 % in any month has important prognostic implication OBJECTIVE to prevent the occurrence of weight loss during hospitalisation and following discharge by daily oral supplementation . DESIGN in a prospect i ve , r and omised , controlled study of 80 patients aged 75 or more , and at risk of undernutrition based on their initial Mini Nutritional Assessment score , patients were r and omised into a control group or one receiving oral supplementation . The intervention was a prescription of 200 ml sweet or salty sip feed twice daily ( 500 kcal , 21 g protein per day ) throughout hospitalisation and convalescence . Nutritional status was assessed at baseline and after 2 months using Mini Nutritional Assessment and body weight record . RESULTS compliance with oral supplementation was good and daily extra energy intake was 407+/-184 kcal . On day 60 , significant weight loss from upon admission was observed in the control group ( -1.23+/-2.5 kg ; P=0.01 ) , but not in the supplemented group ( 0.28+/-3.8 kg ; NS ) . At the end of the study , Mini Nutritional Assessment scores were higher in the supplemented group than in the control group ( 23.5+/-3.9 versus 20.8+/-3.6 ; P<0.01 ) . CONCLUSION use of daily oral supplementation during and after hospitalisation maintains body weight and increases Mini Nutritional Assessment score in patients at risk of undernutrition BACKGROUND & AIMS The elderly are at an increased risk of poor nutritional status which is mutually interacting with functional status . We evaluated the effects of a liquid nutrition supplement on anthropometric and functional indices in elderly people . METHODS Subjects ( n=68 ; mean age=82+/-7 years ) with body mass index < or=25 kg/m(2 ) received either a supplement or a placebo for 6 months . Anthropometric ( body weight , bioelectrical impedance , calf circumference ) , biochemical ( albumin , prealbumin ) , functional parameters ( h and grip strength , timed ' up and go ' test ) and dietary intake were measured . Activities of daily living and Nottingham Health Profile ( NHP ) were assessed . RESULTS No compensation of energy intake occurred . After 6 months , the supplement group had gained more weight ( + 1.6 kg ) than the placebo group ( + 0.3 kg ) ( P=0.03 ) . No other significant changes in anthropometric , functional or blood parameters were seen . There was a significant improvement on the section ' sleep ' of the NHP ( mean change+/-SE=-0.38+/-0.19 for supplement vs 0.24+/-0.19 for placebo , P=0.03 ) . CONCLUSION Dietary supplementation led to an increase in body weight and had a positive influence on sleep in elderly persons . Supplementation did not affect energy intake from regular meals and thus result ed in additional energy intake Abstract OBJECTIVE : To determine whether elderly patients with protein-energy undernutrition at admission are at increased risk for subsequent life-threatening events after controlling for illness severity . DESIGN : Prospect i ve cohort study . SETTING : University-affiliated Department of Veterans Affairs hospital . PATIENTS : Five hundred eighty-six nonterminal patients ( mean age 74±6 [ SD ] years , 98 % male , 86 % white ) with a length of stay of 3 days or more . MAIN OUTCOME MEASURES : Life-threatening complications . RESULTS : Subsequent to admission , 37 subjects ( 6.3 % ) experienced at least 1 life-threatening complication . All of the putative nutrition variables examined and many non-nutrition , illness severity measures were strongly correlated with the risk of a life-threatening complication by univariate analyses ( P<.05 for all analyses ) . After controlling for illness severity , admission serum albumin , prealbumin , and cholesterol were no longer significantly correlated with the outcome . In contrast , weight loss ( > 5 % within 6 months ) , body mass index , mid-arm circumference , and suprailiac skinfold thickness remained strong independent predictors . The adjusted relative risk of a life-threatening complication ranged from 2.9 ( 95 % confidence interval [ CI ] , 1.3 to 6.4 ) for a body mass index < 22 kg/m2 to 7.1(95 % CI , 2.0 to 25.7 ) for a suprailiac skinfold thickness in the lower tertile for the study population . The putative nutrition and illness severity variables were highly intercorrelated . CONCLUSIONS : There is a complex interrelationship between nutritional status , illness severity , and clinical outcomes among the hospitalized elderly .  The serum secretory proteins and cholesterol are correlated with other indicators of illness severity and adverse outcomes , but may not be good markers of nutritional risk . In contrast , weight loss , a low body mass index , and other indicators of lean and fat mass depletion appear to place the patient at increased risk for adverse outcomes independent of illness severity . Whether it is possible to reverse such established nutritional deficits and reduce complication risk in the acute care setting remains to be determined BACKGROUND & AIMS Previous studies reported a severely impaired energy balance in COPD patients during the first days of an acute exacerbation , mainly due to a decreased energy and protein intake . The aim of the study was to investigate the feasibility and effectiveness of energy- and protein-rich nutritional supplements during hospitalization for an acute exacerbation in nutritionally depleted COPD patients . METHODS In a r and omized double-blind , placebo-controlled two-center trial , 56 COPD patients were r and omized and 47 patients completed the study .  Nutritional intervention consisted of 3 x 125 ml ( 2.38 MJ/day ) and the placebo group received similar amounts of a non-caloric fluid . Medical therapy and dietetic consultation were st and ardized and dietary intake was measured daily . Body composition , respiratory and skeletal muscle strength , lung function and symptoms were measured on admission and on days 4 and 8 of hospitalization . RESULTS Forty-seven percent of the patients had experienced recent involuntary weight loss prior to admission . The degree of weight loss was inversely related to resting arterial oxygen tension ( r = 0.31 ; P < 0.05 ) . Nutritional intervention result ed in a significant increase in energy ( 16 % vs. placebo ) and protein intake ( 38 % vs. placebo ) . Mean duration of hospitalization was 9 + /- 2 days . Relative to usual care , no additional improvements in lung function or muscle strength were seen after nutritional intervention . CONCLUSIONS Oral nutritional supplementation during hospitalization for an acute exacerbation is feasible in nutritionally depleted COPD patients and does not interfere with normal dietary intake OBJECTIVES To vali date a nutritional intervention programme for elderly people living in nursing homes . DESIGN In a prospect i ve , r and omized , controlled study of 88 residents , we determined nutritional status at day 0 and day 60 using a record of dietary intake , anthropometry , h and -grip strength and mini-nutritional assessment . Dietary intake , grip strength and body weight were also recorded at day 30 . We divided subjects into four groups according to their mini-nutritional assessment score . Those with a score 24 received no oral supplementation .  Those at risk of malnutrition ( with a score of 17 - 23.5 ) were r and omized to oral supplementation . Those with a score < 17 received oral supplementation . We recorded the amount of oral supplements consumed daily . RESULTS Compliance with oral supplementation was good , and daily intake averaged about 400 kcal . The total energy intake on day 60 was significantly higher in both of the groups that received supplements . Following supplementation , most subjects at risk of malnutrition improved their mini-nutritional assessment score and increased their weight ( by 1.4 + /- 0.5 kg ) . Neither the mini-nutritional assessment score nor weight improved in subjects at risk of malnutrition who did not receive supplements . Supplementation in the malnourished group result ed in a mean mini-nutritional assessment score increase ( from 13.9 + /- 2.6 to 17.1 + /- 3.9 ) and a mean weight gain of 1.5 + /- 0.4 kg . CONCLUSION Oral nutritional supplements are well accepted and result in increased daily protein and energy intake , body weight and nutritional status in most malnourished patients and in those at risk of malnutrition OBJECTIVE To evaluate the impact of nutritional supplementation on nutritional status , muscle strength , perceived health , and functional status in a population of community-living , frail , undernourished elderly people . DESIGN A 16-week intervention study in which subjects were r and omized to an experimental or a control group and visited in their home on a monthly basis . Outcome variables were measured at the start and end of the study at subjects ' homes by a dietitian blinded to treatment assignment . SUBJECTS/ SETTING 83 elderly people ( experimental group : n=42 ; control group : n=41 ; mean age=80+/-7 years ) receiving community home-care services and at high risk for undernutrition . INTERVENTION Provision of a nutrient-dense protein-energy liquid supplement and encouragement to improve intake from other foods . OUTCOME MEASURES Anthropometric indexes , h and grip strength , isometric elbow flexion and leg extension strength , lower extremity function , perceived health , and functional status . STATISTICAL ANALYSES Study groups were compared on an " intention to treat " basis using analysis of variance for repeated measures and unpaired and paired t tests and their nonparametric equivalents where appropriate . RESULTS Total energy intake ( 1,772 vs 1,440 kcal ; P<.001 ) and weight gain ( 1.62 vs 0.04 kg ; P<.001 ) were higher in the supplemented group . No significant changes were observed with respect to other anthropometric indexes , muscle strength , or functional variables ; however , beneficial effects were observed in emotional role functioning ( P<0.01 ) and number of days spent in bed ( P=.04 ) . APPLICATIONS/ CONCLUSIONS Nutrition intervention is feasible in free-living , frail , undernourished elderly people and results in significant improvement of nutritional status with respect to energy and nutrient intake and weight gain . Weight loss can be stopped and in some cases reversed ; however , increased physical activity may also be required to improve health and functional status The present study was design ed to evaluate to the effect of dietary supplements on clinical outcome and nutritional status in a large group of geriatric patients ( n = 501 ) . The patients were r and omised into an experimental group which received nutritional supplementation ( 400 kcal ) as well as a st and ard hospital diet , and a control group on hospital diet alone . The nutritional state was measured on admission and after 8 and 26 weeks by anthropometry , serum protein analysis and a delayed hypersensitivity skin test . Protein energy malnutrition was defined as the presence of three or more abnormal parameters . 28.5 % of patients showed evidence of malnutrition on admission . Hospitalisation itself result ed in a gradual deterioration in nutritional status .  Nutritional supplementation generally improved nutritional state . Among those patients who were well nourished on admission , and subsequently receiving dietary supplementation , 8.3 % fulfilled malnutrition criteria after 26 weeks , while 21.1 % were considered malnourished in the control group ( p < 0.05 ) . The improvement observed in transport proteins was probably related to nutritional support and not just to the reversal of inflammation . In the initially well nourished group of more than 300 patients , the mortality rate was 8.6 % in those given nutritional support compared to 18.6 % in the control group ( p < 0.02 ) Objectives : To evaluate the acceptance of a multinutrient liquid nutrition supplement in psycho-geriatric nursing home patients and the effect on weight , plasma nutrients and activities of daily life . Design : Double-blind , placebo-controlled 12-week intervention study . Setting : Two nursing homes in Boxtel , The Netherl and s . Subjects : Forty-two ( body mass index ( BMI ) < 23 kg/m2 for men or < 25 kg/m2 for women ) psycho-geriatric nursing home patients aged 60 y or over . Interventions : Provision with a complete micronutrient-enriched liquid nutrition supplement of 125 ml and 0.6 MJ ( 135 kcal ) or placebo twice daily during daytime between main meals . Study parameters were assessed at 0 , 6 and 12 weeks . Main Outcome for Measures : Weight , Barthel index of daily activities , several plasma values ( albumin , C-reactive protein ( CRP ) , homocysteine , thiamine , thiamine diphosphate ( TDF ) , vitamin B6 , vitamin B12 , folic acid , vitamin D ) , bowel function . Results : The supplement was well accepted . Thirty-five patients completed the intervention period ( 16 control group ; 19 supplement group ) . Baseline daily nutrient intake was low . A statistically significant improvement was observed for body weight ( difference between groups 2.2 kg , P=0.03 ) , and homocysteine , vitamin B1 , TDF , vitamin B6 , vitamin B12 , folate and vitamin D in the supplement group compared to the placebo group . No significant difference was observed in the Barthel index ( mean difference −0.3±1.1 for both groups ) . No difference in occurrence of diarrhoea was observed . Conclusions : The study shows that nutritional supplementation is well accepted and can improve the nutritional status of psycho-geriatric nursing home patients .Sponsorship : Numico Research BV BACKGROUND & AIMS Malnutrition is common in sick elderly people on admission to hospital and in the community . We conducted a r and omised controlled trial to determine if nutritional supplementation after discharge from hospital improved nutritional status and functional outcomes , or reduced health-care costs . METHODS Elderly malnourished subjects were r and omised to 8 weeks of supplementation or no supplementation post discharge , and followed up for 24 weeks . Weight , body mass index , anthropometrics , h and grip strength , quality of life and requirements for health-care professionals ' services and social services were measured throughout the study . RESULTS Nutritional status improved significantly from baseline to week 24 in the intervention group ( P<0.05 ) , but not in the control group . There was no significant difference in nutritional status between groups at week 24 . H and grip strength improved significantly in the intervention group during supplementation , and was significantly different from that of the control group at week 8 , but decreased thereafter . There was no significant difference in quality of life or health economic outcomes between groups at week 24 . CONCLUSIONS In already malnourished elderly subjects , it may be too late to expect to improve function or quality of life or to reduce health-care costs simply by providing nutritional supplements after hospitalisation . Prevention is key . All elderly patients should be nutritionally assessed as part of their routine care , and appropriate intervention initiated early Background : Undernutrition is common in older people admitted to hospital , but little is known about how nutritional state changes after discharge . Objective : This r and omised controlled trial was design ed to examine the effect of oral nutritional supplementation of undernourished very old people prepared to take supplements after hospital discharge following acute illness . Methods : Participants aged ≧75 years with a BMI ≤24 kg/m2 and triceps skin fold thickness or mid-arm muscle circumference below the 10th centile and /or weight loss ≧5 % during an acute hospital stay were allocated at r and om to either oral nutritional supplementation for 8 weeks from hospital discharge or to usual care . Primary outcome was change in weight , secondary outcomes were h and grip strength and anthropometry . Results : Of 198 patients eligible to participate , 136 patients ( mean age 85 years ) were r and omised and 76/136 ( 56 % ) completed the study . Twenty percent ( 13/66 ) of the intervention group withdrew after only 2 weeks , citing intolerance of the supplements . Using intention-to-treat analysis , body weight increased by a mean of 1.6 and 2.2 % in the control and intervention groups , respectively , but this between-group difference was not significant ( p = 0.188 ) . However , h and grip strength increased more ( p = 0.055 ) in the intervention group ( 13.9 % ) than in the control group ( 7.2 % ) . Conclusions : Oral nutritional supplementation was associated with a greater increase in h and grip strength than in non-supplemented controls and this observation merits further study OBJECTIVE To determine if oral nutritional supplementation improved wound healing in malnourished patients with diabetic foot ulcers when compared with a placebo . METHOD This prospect i ve r and omised controlled double-blind trial involved patients aged over 60 with diabetes mellitus and a Wagner grade I-II foot ulcer of over four weeks ' duration . Patients received either 400 ml ( 400 kcal ) oral nutritional supplementation ( n = 26 ) or 400 ml placebo ( n = 27 ) daily for six months . Patients were followed monthly for six months and after one and two years . RESULTS A third of the patients were classified as having protein-energy malnutrition at inclusion , with no difference between the two groups . Critical leg ischaemia was more common in the intervention group than in the placebo group ( p = 0.008 ) . Nine patients in the intervention group ( 35 % ) and four in the placebo group ( 15 % ) dropped out of the study ( not significant ) . Of those who completed the study , the wound had healed at six months in eight out of 23 patients ( 41 % ) ( placebo ) and in seven out of 17 ( 35 % ) ( intervention ) ( not significant ) . Twenty-four per cent of patients with protein-energy malnutrition at inclusion had healed at six months compared with 50 % of those without it ( not significant ) . CONCLUSION This is the first study to evaluate the possible benefits of nutritional supplementation on diabetic foot ulcers . A third of patients were malnourished . We encountered several method ological problems and were unable to demonstrate an improved wound healing rate in these patients BACKGROUND Malnutrition is prevalent among nursing home residents in Hong Kong .  Nutrient dense oral supplements and yoghurt are unpopular among the Chinese older people because of their unfamiliar tastes and relatively high costs . Vitamin and mineral supplements do not address the problem of protein calorie undernutrition . Milk powder may be a suitable alternative supplement , but diarrhoea result ing from lactase deficiency is common in Chinese people . OBJECTIVE We hypothesized that a low lactose milk powder would be better tolerated in Chinese nursing home residents and result in improvement in nutritional intake without reducing habitual intake . DESIGN Forty-seven residents were r and omized to receive milk powder twice daily , or no supplement for seven weeks . Twenty-four hour food record , body weight , upper limb skinfold thicknesses and midarm circumference , grip strength , Barthel Index , and abbreviated mental test score were carried out at baseline and at seven weeks . RESULTS The overall compliance was nearly 100 % , and no subjects developed diarrhoea . Compared with controls , milk supplementation increased intake of calcium , vitamin D , vitamin A , riboflavin and potassium . There was no significant reduction in habitual dietary intake in supplemented subjects . There was a trend of weight gain in supplemented subjects , though this did not reach statistical significance . There was no change in h and grip strength , mental function and disability level . CONCLUSION The study shows that low lactose milk powder is a well-accepted nutritional supplement without reducing habitual dietary intake Abstract Objectives : To determine incidence of malnutrition among patients on admission to hospital , to monitor their changes in nutritional status during stay , and to determine awareness of nutrition in different clinical units . Design : Prospect i ve study of consecutive admissions . Setting : Acute teaching hospital . Subjects : 500 patients admitted to hospital : 100 each from general surgery , general medicine , respiratory medicine , orthopaedic surgery , and medicine for the elderly . Main outcome measures : Nutritional status of patients on admission and re assessment on discharge , review of case notes for information about nutritional status . Results : On admission , 200 of the 500 patients were undernourished ( body mass index less than 20 ) and 34 % were overweight ( body mass index > 25 ) . The 112 patients reassessed on discharge had mean weight loss of 5.4 % with greatest weight loss in those initially most undernourished . But the 10 patients referred for nutritional support showed mean weight gain of 7.9 % . Review of case notes revealed that , of the 200 undernourished patients , only 96 had any nutritional information documented . Conclusion : Malnutrition remains a largely unrecognised problem in hospital and highlights the need for education on clinical nutrition OBJECTIVE To assess how dietary change affects gain in strength and muscle mass during heavy resistance training of elderly men . DESIGN R and omized controlled trial . INTERVENTION During 12 weeks of resistance training of knee extensors and flexors , a daily supplement of 560 + /- 16 kcal/day ( 17 % energy from protein , 43 % from carbohydrate , 40 % from fat ) was r and omly assigned to six men ( S ) while five men ( U ) received no supplement .  Food intake , strength , whole body composition , and midthigh composition by CT scan were assessed before training and at 6 and 12 weeks . SETTING The men were out patients but lived in a Metabolic Research Unit during the three assessment s. PARTICIPANTS Eleven healthy men aged 61 to 72 years . RESULTS Densitometry showed no change over time in fat or fat-free mass . However , the S men increased ( P less than 0.05 ) weight , skinfold thickness at six sites , subcutaneous midthigh fat , and creatinine excretion ; in all men , changes in these values and in midthigh muscle were proportional to changes in reported energy intake ( P less than 0.05 ) . There was midthigh muscle hypertrophy in both groups , but it was greater in S than U ( P less than 0.01 ) . Both groups gained strength ( P less than 0.001 ) with no effect of diet . CONCLUSIONS During physical rehabilitation of the elderly , dietary intake may influence the increase in lean as well as adipose tissue without altering strength gain . These preliminary findings should be confirmed by a larger study with sedentary controls The purpose of this study was to assess the effect of nutritional supplementation on dietary intake and on pressure ulcer development in critically ill older patients . The multi-center trial involved 19 wards stratified according to specialty and recruitment for critically ill older patients ; 9 wards were r and omly selected for nutritional intervention ( nutritional intervention group ) , consisting of the daily distribution of two oral supplements , with each supplement containg 200 kcal , for 15 d. Pressure ulcer incidence was prospect ively recorded for grade s I ( erythema ) , II ( superficial broken skin ) , and III ( subcutaneous lesion ) for 15 d. Nutritional intake was monitored by using estimates in units of quarters vali date d by comparison with weight measurement . There were 672 subjects older than 65 y , and 295 were in the nutritional intervention group versus 377 in the control group . The patients were similar for age , sex ratio , and C-reactive protein . In comparison with the control group , the nutritional intervention group included more patients with stroke , heart failure , and dyspnea and fewer with antecedent falls , delirium , lower limb fractures , and digestive disease . The nutritional intervention group had a lower risk of pressure ulcers according to the Norton score but was less dependent ( Kuntzman score ) and had a lower serum albumin level . During the trial , energy and protein intakes were higher in the nutritional intervention group ( day 2 : 1081 + /- 595 kcal versus 957 + /- 530 kcal , P = 0.006 ; 45.9 + /- 27.8 g protein versus 38.3 + /- 23.8 g protein in the control group , P < 0.001 ) . At 15 d , the cumulative incidence of pressure ulcers was 40.6 % in the nutritional intervention group versus 47.2 % in the control group . The proportion of grade I cases relative to the total number of cases was 90 % . Multivariate analysis , taking into account all diagnoses , potential risk factors , and the intra-ward correlation , indicated that the independent risk factors of developing a pressure ulcer during this period were : serum albumin level at baseline , for 1 g/L decrease : 1.05 ( 95 % confidence interval : 1.02 to 1.07 , P < 0.001 ) ; Kuntzmann score at baseline , for 1-point increase : 1.22 ( 0.32 to 4.58 , P = 0.003 ) ; lower limb fracture : 2.68 ( 1.75 to 4.11 , P < 0.001 ) ; Norton score < 10 versus > 14 : 1.28 ( 1.01 to 1.62 , P = 0.04 ) ; and belonging to the control group : 1.57 ( 1.03 to 2.38 , P = 0.04 ) . In conclusion , it was possible to increase the dietary intake of critically ill elderly subjects by systematic use of oral supplements . This intervention was associated with a decreased risk of pressure ulcer incidence A r and omised , double-blind trial was conducted to compare the intake of a st and ard ( 4.2kJ/ml ) and a nutrient dense ( 6.3kJ/ml ) commericial liquid supplement , and to assess their effect on total nutrient intake . Both products were offered as a supplement to the regular hospital diet to 34 elderly in- patients with poor appetite and intake . Only 24 of these patients completed the entire supplementation period of 10 days . Median ( interquartile range ) volumes of intake were 300 ( 200 - 400 ) ml of the st and ard product and 400 ( 250 - 500 ) ml of the nutrient dense product ( NS ) . Neither product decreased energy intake from the hospital diet . In fact , patients on the st and ard product increased slightly their intake from the hospital diet . This was enough to outweigh the increased contribution to total energy intake provided by the nutrient dense product . Both products received high palatability ratings , but high ratings did not imply high volume intake or good compliance OBJECTIVE To evaluate regular use of a liquid nutrition supplement by subjectively healthy elderly persons in terms of body mass index , nutrient intake , selected biochemical parameters , and perceived quality -of-life changes , and to identify advantages and limitations of use . DESIGN A 16-week intervention study in which subjects were assigned r and omly to either a supplemented group or a control group and compared in terms of intergroup and intragroup differences in weight , food intake , blood values , and quality -of-life indexes . Adherence to protocol was monitored by monthly visits with an interviewer and food intake records . SUBJECTS/ SETTING Seventy-one independent living , older Canadian adults ( mean age = 70 + /- 7 years ) consuming on average less than 4 servings of fruit and vegetables daily and a supplement-free diet before the study . Subjects were without functional limitations and did not require therapeutic diets or medical treatments that affect nutritional status . Data were collected in home interviews . Blood for analysis was obtained from a sub sample of 36 subjects . INTERVENTION Inclusion of six 235-mL cans of liquid nutrition supplement weekly into the self-selected dietary patterns of the supplemented group . STATISTICAL ANALYSIS Results were analyzed by Student t tests or Wilcoxon rank sum test , analysis of variance , and multiple stepwise regression . RESULTS Body mass index , energy intake , and consumption of fruit and vegetables did not change throughout the study . In the supplemented group , statistically significant increases occurred from baseline to termination of the study in these nutrients : protein , calcium , iron , magnesium , and folate . Serum albumin , folate , ferritin , hemoglobin , and zinc values were within the normal range for the supplemented and control groups . Scores for the Medical Outcomes Study 36-Item Short-Form Health Status scales increased for the supplemented group from baseline to termination for vitality and general health perception . Values for the General Well-Being Question naire improved for anxiety and general well-being . Of the dietary predictors , folate intake explained the most variance for vitality and for general well-being , 8.6 % and 14.2 % , respectively . APPLICATIONS A liquid nutrition supplement could be recommended to the elderly when energy maintenance and increases in nutrient intake are necessary and convenience is an important consideration . Dietetics professionals should address the issues of affordability of the supplement , the role of food in achieving nutritional adequacy , and overall quality of life of clients . Folate intake as a predictor of perceived general well-being and vitality requires further investigation OBJECTIVE To assess the impact of increased consumption of milk , without other dietary advice , on older adults '  energy and nutrient intakes , weight , cardiovascular risk factors ( blood pressure , plasma lipid levels ) , and quality of life . SUBJECTS/ SETTING Two hundred four healthy men and women , aged 55 to 85 years , who consumed fewer than 1.5 dairy servings per day were chosen from six US academic health centers . DESIGN R and omized , controlled open trial . INTERVENTION Advice to increase skim or 1 % milk intake by 3 cups per day ( n = 101 ) or to maintain usual diet ( n = 103 ) for 12 weeks after a 4-week baseline period . MAIN OUTCOME MEASURES Changes in energy and nutrient intake assessed from 3-day food records , body weight , blood pressure , and plasma lipid levels . STATISTICAL ANALYSES PERFORMED Group-by-time analysis of variance with repeated- measures , chi 2 test . RESULTS Compliance with the intervention was good . Compared with controls , participants in the milk-supplemented group significantly increased energy , protein , cholesterol , vitamins A , D , and B-12 , riboflavin , pantothenate , calcium , phosphorus , magnesium , zinc , and potassium intakes . Prevalence of nutrient inadequacy , assessed for nutrients with Estimated Average Requirements , decreased among women in the milk group for magnesium ( 40 % at baseline vs 13 % at 12 weeks , P < .001 ) and vitamin B-12 ( 6 % vs 0 % , P < .05 ) and tended to decrease ( P < .10 ) for protein and thiamin ( women ) and magnesium and vitamin B-6 ( men ) . The milk group gained 0.6 kg more than control group ( P < .01 ) ; however , weight gain was less than predicted , which suggests some compensation for the added energy from milk . Blood pressure decreased similarly over time in both groups . Total and low-density lipoprotein cholesterol levels , and the ratio of total cholesterol to high-density lipoprotein cholesterol , were unchanged . Triglyceride levels increased within the normal range in the milk group ( P = .002 ) . Quality of life scores were high at baseline and remained high throughout . APPLICATIONS/ CONCLUSIONS Older adults can successfully increase milk intake , thereby meaningfully improving their nutrient intakes . Dietitians can play a key role in disseminating this advice OBJECTIVES To study the effects of oral nutritional supplements ( OS ) on body weight , body composition , nutritional status , and cognition in elderly patients with Alzheimer 's disease ( AD ) . DESIGN Prospect i ve , r and omized , controlled study . SETTING Geriatric wards and day care centers in the Toulouse area , France . PARTICIPANTS Ninety-one subjects with AD aged 65 and older at risk of undernutrition as evaluated using the Mini Nutritional Assessment . INTERVENTION After r and omization , 46 patients ( intervention group ) received 3-month OS . The other 45 patients ( control group ) received usual care . MEASUREMENTS Weight , body composition ( evaluated using dual-energy x-ray absorptiometry ) , cognitive function , activities of daily living , eating behavior , and dietary intakes were evaluated at the beginning of the study and at 3 months and 6 months . Supplement compliance was recorded each day . RESULTS Between baseline and 3 months , energy and protein intakes significantly improved in the intervention group , result ing in a significant increase in weight and fat-free mass , but no significant changes were found for dependence , cognitive function , or biological markers . The nutritional benefit was maintained in the intervention group after discontinuation of OS at 3 months . CONCLUSION Three-month daily OS significantly improves body weight . It is practicable and effective , and the patients accepted it well . The improvement that was observed even in the control group showed that caregiver education is an important factor in maintaining the nutritional status of patients with AD . Moreover , regular courses of OS may help to maintain the increase in fat-free mass and improve the nutritional status of these patients We examined changes in the nutritional status of elderly patients with chest infection for a period of 3 months after discharge from hospital , including the effects of nutritional supplementation on well-being and functional status as well as on nutritional indices . Eighty-one subjects admitted to an acute medical ward aged 65 years and over with chest infection were recruited consecutively , and r and omized to receive supplement ( 500 ml of Ensure liquid daily ) for 1 month , or no supplement , on discharge . Assessment at baseline , 1 , 2 and 3 months included a question naire to determine health , mental and functional status , and anthropometric measurements . Biochemical nutritional status was assessed at baseline , 1 and 3 months , and  dietary intake  ( 24 h recall method ) at 1 and 3 months . During recovery , both supplement and non-supplement groups showed improvement in various measures of well-being and biochemical status . In addition , the former group showed improvement in more anthropometric measurements , in thiamine and pyridoxine status , while the non-supplement group showed a lower level of functional ability after 3 months . Various measures of well-being and biochemical status of the water-soluble vitamins were better in the supplement groups . We conclude that nutritional supplementation may have a role in helping elderly patients to recover from chest infections The objective of this study , design ed as a r and omized controlled prospect i ve intervention study , was to evaluate the effect of nutritional supplementation on functional status and need of care in undernourished geriatric patients during hospitalization , and up to 6 months after discharge . Participants consisted of 46 undernourished geriatric patients from a geriatric acute care hospital aged 75 years or older without malignant disease , or need for tube feeding or parenteral nutrition . Patients in the supplement group ( SG , N=20 ) were offered 400 mL ( 2100 kJ ) daily of a liquid supplement during hospital stay and 200 mL ( 1050 kJ ) per day for the following 6 months at home . Patients in the control group ( CG , N=26 ) had usual care without supplements . The main outcome measure was functional status based on the Barthel Activities of Daily Living score ( ADL ) at hospital admission , discharge and after 6 months , with higher scores indicating greater independence and a maximum score of 100 points . In supplemented patients with good acceptance ( SG+ , N=11 ) , a median improvement of 20 points was observed between admission and discharge , and a further improvement of 5 points at home . Median changes were 0 and −10 points in supplemented patients with poor acceptance ( SG- , N=9 ) and 5 and 2.5 points in CG , respectively . In SG+ , the proportion of independent patients ( > 65 points ) increased continuously from 36 % at admission to 63 % at discharge , to 72 % after 6 months , and was significantly higher compared to CG at discharge ( 63 % vs 19 % , pš 0.05 ) and after 6 months ( 72 % vs 39 % , p<0.05 ) . 64 % of the patients in SG+ improved during hospitalization , compared to 23 % in CG ( p<0.05 ) . In the six months at home , 18 % of SG+ improved ; none of SG+ deteriorated in hospital or at home . In contrast , deterioration of the ADL score occurred in considerable proportions of SG− ( 22 % in hospital , 22 % at home ) and CG ( 4 % at hospital , 12 % at home ) patients . The proportion of patients who improved was smaller in SG− ( 44 % at hospital , 22 % at home ) as well as in CG ( 23 % at hospital , 35 % at home ) , compared to SG+ . In conclusion , a positive functional course was evident in supplemented patients with good acceptance during hospitalization , and further improvement was observed during the following 6 months at home . Nutritional support may contribute to reconvalescence and recovery of undernourished geriatric patients BACKGROUND To determine whether oral protein energy supplements , prescribed during hospitalization to elderly medical admissions , affect nutritional status and if baseline nutritional state influences this status . We also considered the effects on mortality , length of hospital stay , functional recovery , and institutionalization . METHODS A prospect i ve r and omized controlled trial with no placebo .  Consenting patients were stratified in 3 nutritional categories , and patients from each stratum were r and omized into treatment or control . Observers were blinded to r and omization . The participants were emergency admissions from home to a Medicine for the Elderly Unit in a Scottish hospital . The inclusion criteria were as follows : no known malignancy , the ability to swallow , and nonobesity ( BMI < 75th percentile ) . The intervention was a prescription of 120 mL sip feed , 3 times daily ( 540 kcal , 22.5 g protein per day ) throughout hospitalization , using the medicine prescription chart . The trial was powered to detect change in mean percentage weight . The following outcomes were also considered : anthropometry ; mortality , length of hospital stay , functional recovery , and rates of institutionalization . RESULTS Included in the trial were 381 patients .  Nutritional supplementation was associated with significantly better energy intake ( p = .001 ) and weight gain ( p = .003 ) pooled across all nutritional categories . In the most poorly nourished patients , the intervention was associated with reduced mortality ( 5/34 versus 14/40 , p < .05 ) and more patients improved functionally ( 17/25 versus 11/28 , p < .04 ) . Overall mortality results were 21/186 versus 33/195 , odds ratio ( OR ) 0.62 , 95 % confidence interval ( CI ) 0.35 , 1.13 . CONCLUSIONS Prescribing sip feed supplements in the medicine prescription chart during hospital stay reduces weight loss . Our data also support other evidence for a reduction in mortality noted in elderly patients on nutritional supplementation . There were suggestions of other clinical benefits Long-term beta blockade for perhaps a year or so following discharge after an MI is now of proven value , and for many such patients mortality reductions of about 25 % can be achieved . No important differences are clearly apparent among the benefits of different beta blockers , although some are more convenient than others ( or have slightly fewer side effects ) , and it appears that those with appreciable intrinsic sympathomimetic activity may confer less benefit . If monitored , the side effects of long-term therapy are not a major problem , as when they occur they are easily reversible by changing the beta blocker or by discontinuation of treatment . By contrast , although very early IV short-term beta blockade can definitely limit infa rct size , more reliable information about the effects of such treatment on mortality will not be available until a large trial ( ISIS ) reports later this year , with data on some thous and s of patients entered within less than 4 hours of the onset of pain . Our aim has been not only to review the 65-odd r and omized beta blocker trials but also to demonstrate that when many r and omized trials have all applied one general approach to treatment , it is often not appropriate to base inference on individual trial results . Although there will usually be important differences from one trial to another ( in eligibility , treatment , end-point assessment , and so on ) , physicians who wish to decide whether to adopt a particular treatment policy should try to make their decision in the light of an overview of all these related r and omized trials and not just a few particular trial results . Although most trials are too small to be individually reliable , this defect of size may be rectified by an overview of many trials , as long as appropriate statistical methods are used . Fortunately , robust statistical methods exist -- based on direct , unweighted summation of one O-E value from each trial -- that are simple for physicians to use and underst and yet provide full statistical sensitivity . These methods allow combination of information from different trials while avoiding the unjustified direct comparison of patients in one trial with patients in another . ( Moreover , they can be extended of such data that there is no real need for the introduction of any more complex statistical methods that might be more difficult for physicians to trust . ) Their robustness , sensitivity , and avoidance of unnecessary complexity make these particular methods an important tool in trial overviews BACKGROUND Although disuse of skeletal muscle and undernutrition are often cited as potentially reversible causes of frailty in elderly people , the efficacy of interventions targeted specifically at these deficits has not been carefully studied . METHODS We conducted a r and omized , placebo-controlled trial comparing progressive resistance exercise training , multinutrient supplementation , both interventions , and neither in 100 frail nursing home residents over a 10-week period . RESULTS The mean ( + /- SE ) age of the 63 women and 37 men enrolled in the study was 87.1 + /- 0.6 years ( range , 72 to 98 ) ; 94 percent of the subjects completed the study .  Muscle strength increased by 113 + /- 8 percent in the subjects who underwent exercise training , as compared with 3 + /- 9 percent in the nonexercising subjects ( P < 0.001 ) . Gait velocity increased by 11.8 + /- 3.8 percent in the exercisers but declined by 1.0 + /- 3.8 percent in the nonexercisers ( P = 0.02 ) . Stair-climbing power also improved in the exercisers as compared with the nonexercisers ( by 28.4 + /- 6.6 percent vs. 3.6 + /- 6.7 percent , P = 0.01 ) , as did the level of spontaneous physical activity . Cross-sectional thigh-muscle area increased by 2.7 + /- 1.8 percent in the exercisers but declined by 1.8 + /- 2.0 percent in the nonexercisers ( P = 0.11 ) . The nutritional supplement had no effect on any primary outcome measure . Total energy intake was significantly increased only in the exercising subjects who also received nutritional supplementation . CONCLUSIONS High-intensity resistance exercise training is a feasible and effective means of counteracting muscle weakness and physical frailty in very elderly people . In contrast , multi-nutrient supplementation without concomitant exercise does not reduce muscle weakness or physical frailty We studied the effects of oral nutritional supplementation on respiratory muscle ( RM ) performance in 25 ambulatory patients with severe chronic obstructive pulmonary disease ( COPD ) . There was a relationship between body weight and anthropometric parameters of nutritional status ( triceps skinfold thickness [ r = 0.67 ; p less than 0.005 ] , midarm muscle circumference ( r = 0.53 ; p less than 0.005 ) , but body weight did not correlate with daily caloric intake , serum albumin , transferrin , or blood lymphocyte count . None of these measurements of nutritional status correlated with any measure of RM strength or endurance . In a r and omized observer-blinded crossover trial , patients were allocated to one of two groups . In the first eight weeks of the study , group A received nutritional supplementation , and patients in group B were control subjects . In the second eight weeks , patients in group A were control subjects , and group B received supplement .  Mean daily caloric intake and body weight increased in both groups while receiving supplement ( both p less than 0.05 ) . Calories provided by the supplement were frequently substituted for normal dietary calories . Any increases in RM performance in the group receiving supplement were matched by increases ( due to learning ) in controls . We conclude that oral dietary supplements have no important effects on RM performance in ambulatory patients with COPD Little is known about nutritional intake after discharge though it takes months to regain preoperative weight after gastrointestinal surgery . We studied whether a 4-mo intervention with dietary advice and protein-rich supplements would increase nutritional intake and gain in lean body mass ( LBM ) in patients who had undergone gastrointestinal surgery . Patients admitted for gastrointestinal surgery were r and omized at discharge to serve as control patients ( n = 47 ) or to receive intervention ( n = 40 ) . One month after discharge , the control patients had a  nutritional intake ( 3-d diet record ) comparable with the intake of the general population that did not increase further . During the 4 m , the intervention patients had an increased intake of protein ( + 22 % ) and energy ( + 16 % ) , and an enhanced gain of LBM after 2 mo ( control 0.8 kg versus intervention 2.1 kg ; P = 0.009 ) . After the 4-mo intervention , both LBM and fat were gained ( control 1.7 kg LBM and 0.2 kg fat versus intervention 3.1 kg LBM and 1.5 kg fat ; LBM : P = 0.029 and fat : P = 0.056 ) . At discharge patients should increase protein intake to 1.5 g.kg-1.d-1 for 2 mo , e.g. , by taking protein-rich liquid supplements BACKGROUND Although stroke patients who do not have difficulty swallowing may be at risk of undernutrition and worsening nutritional status during hospitalization , optimum methods for nutrition intervention in stroke patients have not been established . AIM To examine the feasibility of enteral sip feeding as an effective nutrition intervention after acute stroke . METHODS Forty-two acute ischemic stroke in patients with impaired nutritional status who did not have difficulty swallowing within 1 week after the stroke were entered into a single-blind , r and omized , controlled , prospect i ve study of enteral sip feeding .  Twenty-one patients were r and omized to receive daily oral food supplements for 4 weeks in addition to the hospital food , and 21 patients received only the hospital food for the same period . Main outcome measures were energy and protein intakes during the intervention period , change in nutritional status , disability , infective complications , length of stay , and mortality during hospitalization and at 3 months . RESULTS Two patients , one from each group , were lost to follow-up immediately after r and omization . Twenty patients received oral nutritional supplementation . The energy intake was significantly greater in the supplemented group : 1807 + /- 318 vs 1084 + /- 343 kcal/d ( mean + /- SD ; p < .0001 ) ( estimated treatment effect , 723 kcal/d ; 95 % confidence interval [ CI ] , 498 to 947 ) , as was protein intake : 65.1 + /- 13.8 vs 44.1 + /- 12.8 g/d ( p < .001 ) ( estimated treatment effect , 21.0 g/d ; 95 % CI , 11.7 to 30.3 ) . There also were significant differences between the two groups in the changes in serum albumin and serum iron concentrations between r and omization and at follow-up . There was a trend to lower mortality at 3 months in the supplemented group with two deaths ( 10 % ) compared with seven deaths ( 35 % ) in the control group ( p = .127 , relative risk , 0.29 ; 95 % CI , 0.07 to 1.21 ) . CONCLUSIONS This study suggests that enteral sip feeding is effective in improving nutritional intake and status in stroke patients who do not have swallowing difficulties . There also may be some beneficial effects on clinical outcome , but larger studies are required to confirm this observation and define more precisely the magnitude of any favorable effects
Context Physicians sometimes recommend nutritional supplementation for sick , older persons .
The Editors Undernutrition among older people is a continuing source of concern ( 1 , 2 ) .
Older people have longer periods of illness and longer hospital stays ( 3 ) , and data show that up to 55 % of elderly hospitalized patients are undernourished at admission ( 4 , 5 ) .
Malnutrition is associated with poorer recovery in a broad range of patients and conditions ( 6 - 8 ) .
However , poor nutritional status may be a marker for severity of existing medical conditions , and whether improving nutritional status with oral protein and energy supplementation can improve acute or chronic medical conditions is not clear .
Oral nutritional supplements are widely prescribed for older people both in the hospital and in the community .
Low event rates pose particular problems for summarizing data in a systematic review .