Nutritional supplements after hip fracture: poor compliance limits effectiveness. Treatment with supplementary arginine, vitamin C and zinc in patients with pressure ulcers: a randomised controlled trial. A comparison between oral and nasogastric nutritional supplements in malnourished patients. Energy density of foods affects energy intake in normal-weight women. Volume of food consumed affects satiety in men. Energy density but not fat content of foods affected energy intake in lean and obese women. Randomized controlled trial of nutritional supplementation in patients with newly diagnosed tuberculosis and wasting. 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. Effect of a protein and energy dense n-3 fatty acid enriched oral supplement on loss of weight and lean tissue in cancer cachexia: a randomised double blind trial Use of oral nutritional supplements in patients with Huntington's disease. Reduced total energy expenditure and physical activity in cachectic patients with pancreatic cancer can be modulated by an energy and protein dense oral supplement enriched with n-3 fatty acids Physiologic effects of nutritional support and anabolic steroids in patients with chronic obstructive pulmonary disease. A placebo-controlled randomized trial. Effects of nutritional supplementation and resistance training on muscle strength in free living elders. Results of one year follow. Should the food intake of patients admitted to acute hospital services be routinely supplemented? A randomized placebo controlled trial. The effect of oral nutritional supplements on habitual dietary quality and quantity in frail elders. Provision of high-protein supplement for patients recovering from hip fracture. The effect of nutritional intervention in elderly subjects residing in group-living for the demented Nutrition intervention using an eicosapentaenoic acid (EPA)-containing supplement in patients with advanced colorectal cancer. Effects on nutritional and inflammatory status: a phase II trial Can prescription of sip-feed supplements increase energy intake in hospitalised older people with medical problems? Prevention of malnutrition in older people during and after hospitalisation: results from a randomised controlled clinical trial. Combined effects of functionally-oriented exercise regimens and nutritional supplementation on both the institutionalised and free-living frail elderly (double-blind, randomised clinical trial) The effect of a liquid nutrition supplement on body composition and physical functioning in elderly people. Three month intervention with protein and energy rich supplements improve muscle function and quality of life in malnourished patients with non-neoplastic gastrointestinal disease--a randomized controlled trial. A prospective randomized study of preoperative nutritional supplementation in patients awaiting elective orthotopic liver transplantation. Benefits of nutritional supplementation in free-living, frail, undernourished elderly people: a prospective randomized community trial. Compliance of orthopaedic patients with postoperative oral nutritional supplementation. Study of the effect of a liquid nutrition supplement on the nutritional status of psycho-geriatric nursing home patients A randomised, double-blind assessment of the effect of nutritional supplementation on the prevention of pressure ulcers in hip-fracture patients. Home-made oral supplement as nutritional support of old nursing home residents, who are undernourished or at risk of undernutrition based on the MNA. A pilot trial A randomized controlled trial of preoperative oral supplementation with a specialized diet in patients with gastrointestinal cancer. The effect of unselected post-operative nutritional supplementation on nutritional status and clinical outcome of orthopaedic patients. Nutritional Supplementation of Very Old People at Hospital Discharge Increases Muscle Strength: A Randomised Controlled Trial Nutritional status after short-term dietary supplementation in hospitalized malnourished geriatric patients. Nutritional supplementation and resistance training in nutritionally at risk older adults following lower limb fracture: a randomized controlled trial Does nutritional supplementation influence the voluntary dietary intake in an acute geriatric hospitalized population? Effects of peridialytic oral supplements on nutritional status and quality of life in chronic hemodialysis patients. A prospective study of the use of liquid oral dietary supplements in nursing homes. The effect of supplementation with an enriched drink on indices of immune function in frail elderly. A multi-center trial of the effects of oral nutritional supplementation in critically ill older inpatients. GAGE Group. Groupe Aquitain Geriatrique d'Evaluation. Compliance with an oral hyperproteic supplement with fibre in nursing home residents The effect of a supplement which is nutrient dense compared to standard concentration on the total nutritional intake of anorectic patients. Adherence to nutrition supplements among patients with a fall-related lower limb fracture. Short-term protein and energy supplementation activates nitrogen kinetics and accretion in poorly nourished elderly subjects. The effect of a nutrient dense drink on mental and physical function in institutionalized elderly people Effects of oral nutritional supplements in normally nourished or mildly undernourished geriatric patients after surgery for hip fracture: a randomized clinical trial. Protein energy supplements in unwell elderly patients--a randomized controlled trial. Exercise training and nutritional supplementation for physical frailty in very elderly people. Use of a renal-specific oral supplement by haemodialysis patients with low protein intake does not increase the need for phosphate binders and may prevent a decline in nutritional status and quality of life.
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 BACKGROUND & AIMS Nutrients putatively implicated in pressure ulcer healing were evaluated in a clinical setting . METHODS Sixteen in patients with a stage 2 , 3 or 4 pressure ulcer r and omised to receive daily a  st and ard hospital diet ; a st and ard diet plus two high-protein/energy supplements ; or a st and ard diet plus two high-protein/energy supplements containing additional arginine ( 9 g ) , vitamin C ( 500 mg ) and zinc ( 30 mg ) . Nutritional status measurements ( dietary , anthropometric and biochemical ) and pressure ulcer size and severity ( by PUSH tool ; Pressure Ulcer Scale for Healing ; 0=completely healed , 17=greatest severity ) were measured weekly for 3 weeks . RESULTS Patients ' age and BMI ranges were 37 - 92 years and 16.4 - 28.1 k g/m2 ) respectively . Baseline PUSH scores were similar between groups ( 8.7+/-0.5 ) . Only patients receiving additional arginine , vitamin C and zinc demonstrated a clinical ly significant improvement in pressure ulcer healing ( 9.4+/-1.2 vs. 2.6+/-0.6 ; baseline and week 3 , respectively ; P<0.01 ) . All patient groups presented with low serum albumin and zinc and elevated C-reactive protein . There were no significant changes in biochemical markers , oral dietary intake or weight in any group . CONCLUSIONS In this small set of patients , supplementary arginine , vitamin C and zinc significantly improved the rate of pressure ulcer healing . The results need to be confirmed in a larger study 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 This study examined the effect of energy density , independent of fat content and palatability , on food and energy intakes . With use of a within-subjects design , normal-weight women ( n = 18 ) were provided with meals for 2 d during each of three test sessions . During lunch , dinner , and an evening snack , subjects were given free access to a main entree varying in energy density ( low , medium , or high ) . The manipulated main entrees were similar in palatability to their counterparts across conditions . Low-energy compulsory ( consumption required ) side dishes accompanied each meal . Subjects also consumed a st and ard , compulsory breakfast . Results showed that subjects consumed a similar amount of food ( by weight ) across the three conditions of energy density . Thus , significantly more energy was consumed in the condition of high energy density ( 7532 + /- 363 kJ , or 1800 + /- 86 kcal ) than in the medium- ( 6356 + /- 281 kJ , or 1519 + /- 67 kcal ) and low- ( 5756 + /- 178 kJ , or 1376 + /- 43 kcal ) energy-density conditions ( P < 0.0001 ) . There were no differences in hunger or fullness before meals , after meals , or over the 2 d across conditions . The results from this study indicate that energy density affects energy intake independent of macronutrient content or palatability , suggesting that the overconsumption of high-fat foods may be due to their high energy density rather than to their fat content This study tested the hypothesis that the amount ( weight or volume ) of food consumed affects the satiating potency of a food , independent of its energy content . Normal-weight young men ( n = 20 ) were tested in a within-subjects design . Subjects were served a milk-based drink or no drink ( control ) , followed 30 min later by a self-selected lunch and > 4 h later by a self-selected dinner . Milk drinks were equal in energy content ( 2088 kJ , or 499 kcal ) and had similar proportions of fat ( 30.3 % ) , carbohydrate ( 54.7 % ) , and protein ( 15 % ) across three volumes : 300 , 450 , and 600 mL. Ratings of palatability , sensory properties , and energy content of the drinks and of hunger completed before consumption of the preloads were not significantly different among conditions . The results showed that preload volume affected energy intake at lunch ( P < or = 0.009 ) such that energy intake was less after the 600-mL preload than after the 300-mL preload . This effect was still present when energy intake at dinner was included ( P < or = 0.022 ) . At lunch , including energy from the preload , subjects overate relative to the control condition ( 4323 + /- 322 kJ ) after the 300- ( 5263 + /- 321 kJ ) and 450-mL ( 5011 + /- 300 kJ ) preloads but not after the 600-mL ( 4703 + /- 353 kJ ) preload . Thus , the best adjustment for the energy in the preloads was with the largest , least energy-dense drink . Consistent with the effects on intake , the volume of the drinks affected ratings of hunger and fullness . These results indicate that the volume consumed is an important determinant of satiety after milk drinks under these conditions BACKGROUND Studies have shown that energy intake increases when both the fat content and energy density of the entire diet increases . When the fat content and energy density vary independently of one another , however , energy density , but not fat content , influences intake . OBJECTIVE The present study examined whether energy intake in lean and obese women is affected when either the energy density or the fat content of a portion of the diet is manipulated and palatability is held constant . DESIGN In a within-subjects design , 17 lean and 17 obese women consumed meals in the laboratory for four , 4-d test periods . In 3 of these test periods the energy density ( 4.4 and 6.7 kJ/g ) or the fat content ( 16 % and 36 % of energy ) of compulsory entrees representing 50 % of each subject 's usual energy intake was manipulated . Additional self-selected foods were consumed ad libitum at meals and as snacks . RESULTS There were no systematic differences in palatability of the manipulated foods across conditions . Obese and lean participants responded similarly to the dietary manipulations . Intake of self-selected foods at meals was reduced significantly by 16 % for both lean and obese subjects in the low- compared with the high-energy-density condition . The fat content of the compulsory foods had no significant effect on energy intake . Ratings of hunger did not differ between diets . CONCLUSION These results indicate that when a portion of the diet was manipulated , the energy density , but not the fat content , of the foods affected total energy intake at meals in both lean and obese women BACKGROUND Nutritional support is often recommended as part of the treatment of tuberculosis , but it has never been properly tested . OBJECTIVE We assessed the effects of early nutritional intervention on lean mass and physical function in patients with tuberculosis and wasting . DESIGN Patients who started antituberculous therapy within the previous 2 wk were r and omly assigned to receive st and ard nutritional counseling ( control group ) or nutritional counseling to increase their intake through diet and high-energy supplements ( nutritional supplement group ) for 6 wk . Body composition was measured by dual-energy X-ray absorptiometry , and physical function was assessed by maximum grip strength . RESULTS Patients in the nutritional supplement group ( n = 19 ) had a significantly greater increase in body weight ( 2.57 + /- 1.78 compared with 0.84 + /- 0.89 kg , P = 0.001 ) , total lean mass ( 1.17 + /- 0.93 compared with 0.04 + /- 1.26 kg , P = 0.006 ) , and grip strength ( 2.79 + /- 3.11 compared with -0.65 + /- 4.48 kg , P = 0.016 ) than did the control subjects ( n = 17 ) at week 6 . During subsequent follow-up , the increase in body weight remained greater in the nutritional supplement group , but this increase was due mainly to a greater gain in fat mass in the nutritional supplement group than in the control group . CONCLUSIONS Early intervention to increase nutritional intake increases lean mass and physical function . This adjunct to tuberculosis therapy could confer socioeconomic and survival benefits that deserve investigation in large-scale trials . Nutritional intervention after the initial phase of treatment could be less beneficial because it mainly increases fat 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 Aim : N-3 fatty acids , especially eicosapentaenoic acid ( EPA ) , may possess anticachectic properties . This trial compared a protein and energy dense supplement enriched with n-3 fatty acids and antioxidants ( experimental : E ) with an isocaloric isonitrogenous control supplement ( C ) for their effects on weight , lean body mass ( LBM ) , dietary intake , and quality of life in cachectic patients with advanced pancreatic cancer . Methods : A total of 200 patients ( 95 E ; 105 C ) were r and omised to consume two cans/day of the E or C supplement ( 480 ml , 620 kcal , 32 g protein ± 2.2 g EPA ) for eight weeks in a multicentre , r and omised , double blind trial . Results : At enrolment , patients ’ mean rate of weight loss was 3.3 kg/month . Intake of the supplements ( E or C ) was below the recommended dose ( 2 cans/day ) and averaged 1.4 cans/day . Over eight weeks , patients in both groups stopped losing weight ( Δ weight E : −0.25 kg/month versus C : −0.37 kg/month ; p = 0.74 ) and LBM ( Δ LBM E : + 0.27 kg/month versus C : + 0.12 kg/month ; p = 0.88 ) to an equal degree ( change from baseline E and C , p<0.001 ) . In view of evident non-compliance in both E and C groups , correlation analyses were undertaken to examine for potential dose-response relationships . E patients demonstrated significant correlations between their supplement intake and weight gain ( r = 0.50 , p<0.001 ) and increase in LBM ( r = 0.33 , p = 0.036 ) . Such correlations were not statistically significant in C patients . The relationship of supplement intake with change in LBM was significantly different between E and C patients ( p = 0.043 ) . Increased plasma EPA levels in the E group were associated with weight and LBM gain ( r = 0.50 , p<0.001 ; r = 0.51 , p = 0.001 ) . Weight gain was associated with improved quality of life ( p<0.01 ) only in the E group . Conclusion : Intention to treat group comparisons indicated that at the mean dose taken , enrichment with n-3 fatty acids did not provide a therapeutic advantage and that both supplements were equally effective in arresting weight loss . Post hoc dose-response analysis suggests that if taken in sufficient quantity , only the n-3 fatty acid enriched energy and protein dense supplement results in net gain of weight , lean tissue , and improved quality of life . Further trials are required to examine the potential role of n-3 enriched supplements in the treatment of cancer cachexia OBJECTIVE This study assessed the effect of oral nutritional supplements on the nutritional status of patients with Huntington 's disease . METHODS This was an experimental , longitudinal , prospect i ve study of 30 patients with Huntington 's disease . We performed neurologic evaluation and dietary assessment and measured anthropometric indexes and biochemical indicators ; in addition , patients were question ed about their weight , appetite , chewing difficulty , and dysphagia . Patients consumed two cans daily of a nutritional supplement that contributed an extra 473 kcal to their diet for a 90-d period . At the study 's end , the supplement was suspended and the same variables were reassessed . RESULTS After 90 d , 68.7 % of patients had increased body weight , 68.7 % had ideal body weight percentages and body mass indexes , 53.3 % had increased midarm circumferences , and 60.0 % had increased arm muscle circumferences and body fat percentages ; these changes were statistically significant ( P < 0.05 ) . The neurologic evaluation subscales and the biochemical indicators did not change significantly . With regard to subjective variables , patients who reported losing weight during the 3 mo before the study did not lose more weight and patients who reported having an increased appetite before the study remained stable during the study . CONCLUSIONS The nutritional intervention stabilized or slightly improved the anthropometric variables assessed ; however , no significant change in body mass index occurred in 87 % of patients . For the purpose of maintaining an acceptable nutritional status in patients who have Huntington 's disease and normal nutritional status , we suggest oral nutritional supplements that contribute an average of 473 kcal/d in addition to a normal diet The aim of the study was to assess the total energy expenditure ( TEE ) , resting energy expenditure ( REE ) and physical activity level ( PAL ) in home-living cachectic patients with advanced pancreatic cancer . The influence of an energy and protein dense oral supplement either enriched with or without the n-3 fatty acid eicosapentaenoic acid ( EPA ) and administered over an 8-week period was also determined . In total , 24 patients were studied at baseline . The total energy expenditure was measured using doubly labelled water and REE determined by indirect calorimetry . Patients were studied at baseline and then r and omised to either oral nutritional supplement . Measurements were repeated at 8 weeks . At baseline , REE was increased compared with predicted values for healthy individuals ( 1387(42 ) vs 1268(32 ) kcal day−1 , P=0.001 ) , but TEE ( 1732(82 ) vs 1903(48 ) kcal day−1 , P=0.023 ) and PAL ( 1.24(0.04 ) vs 1.50 ) were reduced . After 8 weeks , the REE , TEE and PAL of patients who received the control supplement did not change significantly . In contrast , although REE did not change , TEE and PAL increased significantly in those who received the n-3 ( EPA ) enriched supplement . In summary , patients with advanced pancreatic cancer  were hypermetabolic . However , TEE was reduced and this was secondary to a reduction in physical activity . The control energy and protein dense oral supplement did not influence the physical activity component of TEE . In contrast , administration of the supplement enriched with EPA was associated with an increase in physical activity , which may reflect improved quality of life 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 PURPOSE To assess the effects of a one year nutritional supplementation and resistance training program on muscle strength and walking capacity in the elderly . MATERIAL AND METHODS Elderly subjects from two outpatient clinics received a nutritional supplement , that provided 400 Kcal , 15 g/protein and 50 % of vitamin DRVs per day . Half the subjects receiving and not receiving the supplement were r and omly assigned to a resistance exercise training program with two sessions per week . Every six months , body composition using DEXA , limb muscle strength , maximal inspiratory and expiratory pressures and walking capacity were assessed . RESULTS One hundred forty nine subjects were considered eligible and 101 ( 31 supplemented and trained , 28 supplemented , 16 trained and 26 without supplementation nor training ) completed the year of follow up . Overall compliance with the supplement was 48 22 % and trained subjects attended 56 21 % of programmed sessions . No changes in fat free mass were observed in any of the groups , but fat mass increased from 22.5 7.3 to 23.2 7.3 kg in all groups ( p < 0.001 ) . Upper and lower limb strength and walking capacity increased significantly in trained subjects whether supplemented or not . Maximal inspiratory pressure and right h and grip strength increased only in the supplemented and trained group . CONCLUSIONS Resistance training improved muscle strength and walking capacity 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 Frail institutionalized elders have a high prevalence of nutritional risk factors , undernutrition , weight loss , and nutrition-related morbidity and excess mortality . Little information is available on effective means to intervene in this setting . HYPOTHESES We tested the hypothesis that addition of multinutrient oral supplements to the diet of frail elders would improve their overall nutritional status and functional level . METHODS Fifty nursing home residents aged 88+/-1 yr . were followed for 10 weeks in the course of a r and omized controlled trial of supplementation with a multinutrient liquid supplement vs. a non-nutritive placebo drink . Three-day food weighing was used to analyze their habitual dietary intake before and during the final week of the intervention . Nutritional status was further assessed with nutritional biochemistries , anthropometric measurements , and body composition analysis as well as physical and functional performance tests . RESULTS The nutritional supplement was consumed with high compliance , but did not significantly augment total caloric intake . Supplementation was associated with significant reductions in total energy , protein , fat , water , fiber , and many vitamins and minerals in the habitual diet of these nursing home residents . Nutritional status improved in terms of folate levels in serum , but no other measured vitamin or mineral indices . Body composition analysis revealed a small gain in weight , increases in fat stores , but no improvement in lean tissue mass associated with supplemention . No physical performance or functional gains were associated with supplementation . CONCLUSION Short-term nutritional supplementation in elders at nutritional risk is offset by simultaneous reduction in voluntary food intake . It seems likely that changing other components of energy expenditure such as physical activity levels or basal metabolism may be required to produce overall improvements in nutritional intake in this setting OBJECTIVE We compared clinical outcomes with a st and ard ( Ensure ) or a high-protein ( Boost HP ) liquid nutritional supplement for older adults recovering from hip fracture surgery in a rehabilitation hospital . METHODS This r and omized , double-blind , parallel-group study compared the clinical effectiveness of a st and ard ( Ensure ) with a high-protein ( Boost HP ) liquid nutritional supplement among patients ( n = 46 ) 60 y or older who recently underwent surgical repair of a hip fracture . Patients were encouraged to drink at least two 8-oz cans ( 17.8 g/d protein for Ensure versus 30 g/d protein for Boost HP ) per day for 28 d. Study measurements included change in Functional Independence Measure between rehabilitation admission and discharge , length of rehabilitation stay , laboratory measures ( i.e. , serum albumin , prealbumin , and C-reactive protein ) , physical activity energy expenditure by 7-d triaxial accelerometry , and dietary intake by three r and om , telephonic , 24-h dietary recalls . RESULTS There were no significant group differences with respect to age , sex , acute hospital days , hip fracture assessment parameters , or surgical treatment . Consumption of supplement ( 260 oz/28 d of Ensure versus 239 oz/28 d of Boost HP ) was comparable . There were no differences in complication or adverse event rates during the study . The Boost HP group consumed more protein than the Ensure group ( 63 versus 50 g , P < 0.048 ) and had a greater improvement in serum albumin over the 28-d supplementation period ( + 0.7 versus + 0.2 g/dL , P < 0.019 ) . The Boost HP group also consumed more fiber ( 12 versus 8 g ) , calcium ( 821 versus 639 mg ) , vitamin K ( 66 versus 45 microg ) , and phosphorus ( 1035 versus 833 mg ) than did the Ensure group . Rehabilitation length of stay was shorter in the Boost HP than in the Ensure group , although this trend did not reach statistical significance ( 23 versus 28 d , P = 0.27 ) . Outcome differences were not detected in the Functional Independence Measure . CONCLUSIONS Supplementation was well tolerated in this population and contributed significantly to total dietary intake . Consumption of a high-protein liquid nutritional supplement may offer some benefits by improving visceral protein status Objectives : We studied the nutritional status and the effects of nutritional intervention on body weight , cognition and activities of daily life (ADL)-function in demented individuals . Design : Controlled non-r and omised study . Setting : Group-living for demented elderly ( GLD ) , ie community assisted housing . Subjects and interventions : Twenty-two residents living in one of two units ( GLD-I ) , received oral liquid supplements ( 1720 kJ/410 kcal/day ) and the personnel of the GLD-I were given nutritional education .  Fourteen residents in the other unit ( GLD-C ) served as controls . After 6 months 21 ( 83 ( 4 ) y , 81 % women ) and 12 ( 85 ( 4 ) y , 100 % women ) of the participants , respectively , were re-examined according to body mass index ( BMI , kg/m2 ) , cognitive function ( Mini Mental State Examination ( MMSE , 0–30 p ) and Clinical Dementia Rating Scale ( CDR ) and the Katz ' ADL index . Results : Body mass index ( BMI ) ≤20 was found in 19 % of the participants and 44 % had BMI ≤23 . BMI correlated with MMSE ( r=0.43 , P<0.01 ) . The weight of the residents in the intervention group increased by 3.4 ( 3 ) kg ( P=0.001 ) at follow-up , whereas the weight remained unchanged in the control group . The cognitive function was low at the start in both groups , ie MMSE∼9 and no apparent positive effect of the nutritional intervention was seen . In addition , the ADL functions appeared to deteriorate in both groups . Conclusions : Being underweight was common among demented elderly in group-living and was related to low cognitive capacity . Five months of oral supplementation , along with education of personnel , was followed by a weight gain . In this study the nutritional treatment did not affect the rate of decline in cognitive function or Katz ' ADL index . Sponsorship : Supported by grants from the Swedish National Board of Health and Social Welfare . Semper Foods AB provided the liquid supplements Goals The aim of the study was to assess the impact of an eicosapentanoic acid-containing protein and energy dense oral nutritional supplement ( EPA-ONS ) on nutritional and inflammatory status , quality of life ( QOL ) , plasma phospholipids ( PPL ) and cytokine profile , tolerance of irinotecan-containing chemotherapy and EPA-ONS in patients with advanced colorectal cancer ( CRC ) receiving chemotherapy . Material s and methods Patients with advanced CRC having one prior chemotherapy regimen received 480 ml of EPA-ONS daily for 3 weeks before commencing chemotherapy with folinic acid , 5-fluorouracil , irinotecan ( FOLFIRI ) , and continued for 3 cycles of treatment ( 9 weeks ) . All assessment s including weight , body composition , C-reactive protein ( CRP ) , QOL , dietary intake , PPL and cytokine analyses were performed at baseline , 3 and 9 weeks . Results Twenty-three patients were enrolled , 20 completed 3 weeks , and 15 completed 9 weeks . The mean EPA-ONS intake was 1.7 tetrapaks ( 408 ml ) daily . There was a significant increase in mean weight ( 2.5 kg ) at 3 weeks ( p = 0.03 ) . Lean body mass ( LBM ) was maintained . Protein and energy intake significantly decreased after the commencement of chemotherapy ( protein p = 0.003 , energy p = 0.02 ) . There was a significant increase in energy levels ( p = 0.03 ) , whilst all other QOL measures were maintained . PPL EPA levels increased significantly over the first 3 weeks . Mean CRP increased by 14.9 mg/L over the first 3 weeks ( p = 0.004 ) , but decreased to baseline levels by the end of the trial . There was a significant correlation between plasma IL-6 and IL-10 concentrations and survival , and between IL-12 and toxicity . Conclusion Dietary counseling and the provision of EPA-ONS may result in maintenance of nutritional status and QOL , however r and omized trials are required to evaluate the impact of EPA on toxicity from chemotherapy A blinded r and omised controlled trial of prescribed oral sip-feed supplements compared with routine hospital practice was undertaken in acute admissions to a geriatric medicine department . Patients were eligible for inclusion if they were admitted from home , were not obese ( BMI > 75th percentile ) , had no swallowing difficulties and were not deemed to be in the terminal stage of illness . On admission they were stratified by nutritional status ( BMI < 5th , > 5th to < 25th , > 25th to < 75th percentile ) and r and omised . The intervention group received 120 ml oral sip-feed supplement prescribed three times per d in the medicine prescription chart ( 22.5 g protein , 2260 kJ ( 540 kcal ) energy/d ) distributed at medication rounds for the duration of hospital stay . The control group received routine hospital care . Outcomes were patient compliance with supplement , total energy intake and nursing staff views of the method . Patients were r and omised to receive supplements ( n 186 of total n 381 ) . Half had full compliance and three-quarters at least moderate compliance . Total energy intake was significantly increased , on average , in the intervention group ( P=0.001 ) . The proportion of patients meeting estimated minimum energy requirements was significantly increased ( P=0.023 ) , but was still < 50 % for the sample of patients in the intervention group . The present study suggests this method is acceptable to patients and staff and improves total energy intake . However , the amount prescribed did not ensure minimum energy requirements were met in all cases 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 Consistently swelling proportion of the frail elderly within a modern society challenges the overstrained public health sector to provide both adequate medical care and comprehensive assistance in their multiple functional deficits of daily living . Easy-to-apply and task-specific ways of addressing this issue are being sought out , with a view to proposing systemic solutions for nationwide application . Methods The present r and omised , double-blind , placebo-controlled , 7-week clinical trial aim ed to determine whether specifically structured , intensive exercise regimens , combined with nutritional supplementation , might improve and help sustain individual muscle strength and mobility , and possibly enhance individual functional capabilities in an on-going quest for active prevention of care-dependency . Ninety-one frail elderly ( F 71 M 20 ; mean age 79 years ) were recruited from both nursing home residents and community dwellers and r and omly split into four groups : Group I – progressive resistance exercises ( PRE ) + functionally-oriented exercises ( FOE ) + nutritional supplementation ( NS ) , Group II – PRE + FOE + placebo , Group III – st and ard exercises ( SE ) + FOE + NS , Group IV – SE + FOE + placebo . Each group pursued a 45 min . exercise session 5 times weekly . The subjects ' strength with regard to four muscle groups , i.e. hip and knee extensors and flexons , was assessed at 80 % ( 1 RM ) weekly , whereas their balance and mobility at baseline and at the end of the study . Results The study was completed by 80 subjects . Despite its relatively short duration significant differences in muscle strength were noted both in Group I and Group II ( p = 0.01 ; p = 0.04 ; respectively ) , although this did not translate directly into perceptible improvement in individual mobility . Notable improvements in individual mobility were reported in Group III and Group IV ( p = 0.002 ) , although without positive impact on individual muscle strength . Conclusion Comprehensively structured , high-intensity regimen made up of diverse exercise types , i.e. functionally-oriented , progressive resistance and st and ard ones , preferably if combined with nutritional supplementation in adequate volume , demonstrates clear potential for appreciably improving overall functional status in the frail elderly in terms of individual walking capacity and muscle strength . Trial registration Central Register of Clinical Trials , Pol and – CEBK180/2000 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 BACKGROUND Malnutrition is a common problem in patients with digestive disease and is associated with impaired outcome . OBJECTIVE We investigated the effect of a three-month post-hospital nutritional intervention with high protein and energy supplements on body composition , muscle function and quality of life ( QoL ) in malnourished GI patients . PATIENTS AND INTERVENTION Eighty malnourished patients with benign digestive disease were r and omized to receive either oral nutritional supplements ( ONS ) for three months in addition to dietary counselling ( DC ) ( ONS patients ) or only dietary counselling ( DC patients ) . METHODS Nutritional status was determined with the subjective global assessment , body composition by bioelectrical impedance and anthropometry , muscle function with h and -grip strength and peak flow . QoL was assessed by the 36-item short-form question naire . RESULTS Age , body cell mass ( BCM ) , muscle function , gender distribution and QoL did not differ between ONS patients ( n=38 ) and DC patients ( n=42 ) at baseline . Body weight and BCM improved significantly in both groups after three months . However , h and -grip strength ( 26.1+/-11.3 - 31.5+/-10.1 kg , p<0.0001 ) and peak flow ( 329.2+/-124.0 - 388.9+/-108.4 l /min , p=0.004 ) improved only in the ONS patients and remained unchanged in the DC patients . Similarly , all eight scales of the QoL improved in the ONS patients compared with merely three in the DC patients . DC patients experienced significantly more readmissions ( n=20 ) than ONS patients ( n=10 ) during the study period ( p=0.041 ) . CONCLUSION A three month intervention with high protein oral supplements improves outcome in malnourished patients with digestive disease in terms of functional status , QoL and rehospitalization BACKGROUND Poor nutritional status is common among patients awaiting orthotopic liver transplantation and is associated with poor outcome . METHODS This prospect i ve r and omized controlled trial examined the effect of pretransplant nutritional supplementation on the outcome of patients undergoing liver transplantation . Of 82 consecutive patients with mid-arm muscle circumference < 25th percentile , 42 received enteral supplementation , and the remainder acted as the control group .  The supplemented group received a calorie-dense enteral feed taken daily ( in addition to diet ) until transplantation . Nutritional status was monitored by upper arm anthropometric measurements and h and grip strength . Dietary intake was calculated from 5-day food diaries . RESULTS Supplementation improved mid-arm circumference , mid-arm muscle circumference , and grip strength . Pretransplant nutritional status was not associated with posttransplant sepsis or major complications . Preoperative grip strength of < 85 % of normal values was predictive of increased incidence of posttransplant major complications . Supplementation did not affect outcome , although there were more deaths in the control group ( seven deaths before and two deaths after transplant ) than there were in the supplemented group ( two deaths before and three deaths after transplant ) . There was no difference in overall survival ( P = 0.075 ) . CONCLUSIONS Enteral supplementation improved some parameters of nutritional status pretransplant . Dietary intake of patients in the two groups was similar at transplant . Nutritional supplementation has not increased nutritional intake , although this may reflect the importance of regular dietetic input and support , rather than suggesting that nutritional supplementation is ineffective . Supplementation had no effect on outcome of liver transplantation 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 BACKGROUND Studies have shown clinical benefits of nutritional supplementation in orthopaedic and elderly patients in both under and well nourished groups . However , patient compliance with the supplementation has not been reported . AIM To assess level of patient compliance with nutritional supplementation when prescribed postoperatively to unselected orthopaedic patients as part of a large controlled trial research ing the clinical benefits of non-targeted nutritional supplementation . METHODS Patients in the intervention group were prescribed two oral supplements each day of their hospital stay , in addition to usual meals . Information describing the supplements was given by the dietitian . Supplements were issued on drug rounds and the proportion of each drink consumed was recorded and collated . Patients could choose to change the type of drink or to discontinue the supplements completely at any time . Twenty-four hour food intake was analysed for a r and om sub- sample of 48 patients . RESULTS Eighty-four patients ( 27 men , 57 women ; mean age , 72 years ) were prescribed supplements . Median length of stay was 14.4 days . Supplements were taken for a mean of 6.7 days . Median compliance was 14.9 % . Despite this , median energy intake in the study group was 1523 kcal/day and 1289 kcal/day in the control ( P= 0 . 0214 ) . CONCLUSION Compliance with non-targeted , postoperative nutritional supplementation is poor in unselected orthopaedic patients but even low levels of supplementation significantly increase energy intake 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 a risk factor for development of pressure ulcers ( PU ) .  Nutritional supplementation may thus reduce the incidence of PU . We investigated the effect of nutritional supplementation on incidence of PU in hip-fracture patients at risk of developing PU . METHODS Hip-fracture patients ( n=103 ) were included in this double-blind , r and omised , placebo-controlled trial . They received 400 ml daily of a supplement enriched with protein , arginine , zinc and antioxidants ( n=51 ) or a non-caloric , water-based placebo supplement ( n=52 ) . Presence and stage of PU were assessed daily for 28 days or until discharge ( median : 10 days during supplementation ) . RESULTS Incidence of PU was not different between supplement ( 55 % ) and placebo ( 59 % ) , but incidence of PU stage II showed a 9 % difference ( difference : 0.091 ; 95 % CI : 0.07 - 0.25 ) between supplement ( 18 % ) and placebo ( 28 % ) . Of patients developing PU 57 % developed it by the second day . Time of onset ( days ) showed a trend ( P=0.090 ) towards later onset of PU with supplement ( 3.6+/-0.9 ) than placebo ( 1.6+/-0.9 ) . CONCLUSIONS Hip-fracture patients develop PU at an early stage . Nutritional supplementation may not prevent PU at this stage , but contributes possibly to a delayed onset and progression of PU .  Nutritional supplementation may be more effective if initiated earlier Aims : The aim of this pilot study was to examine the effect of a home-made oral supplement on body weight and energy intake of old people residing in a nursing home . Methods : Sixty-six old ( 65 + years ) nursing home residents were included and divided into three classes according to their Mini Nutritional Assessment ( MNA ) scores . Participants who scored 17–23.5 MNA points ( at risk of undernutrition ) and had a BMI < 24 kg/m2 were r and omly allocated ( block r and omization ) to two groups : B and C. Participants with < 17 MNA-points ( undernourished ) were allocated to group A. The participants allocated to groups A and B received a home-made oral supplement every evening for two consecutive months . Results : The results after two months showed that compliance with the supplement was good and daily intake from the supplement averaged 1.6 MJ . The total energy intake in group A significantly increased ( p<0.001 ) , without suppressing the intake of energy from normal food . Group B experienced a decrease in the intake of normal food and hence no overall change in food intake . Body weight was unchanged in all groups . Conclusions : Our limited data suggest that a home-made oral supplement can improve the total energy intake of nursing home residents who are undernourished according to the MNA BACKGROUND & AIMS Perioperative nutrition with specialized enteral diets improves outcome when compared with st and ard formulas . A post-hoc analysis suggested preoperative administration as the most important period . Thus , we design ed a study to underst and prospect ively whether preoperative supplementation could be as efficacious as the perioperative approach and superior to a conventional treatment ( no artificial nutrition ) in reducing postoperative infections and length of hospital stay . METHODS A total of 305 patients with preoperative weight loss < 10 % and cancer of the gastrointestinal tract were r and omized to receive the following : ( 1 ) oral supplementation for 5 days before surgery with 1 L/day of a formula enriched with arginine , omega-3 fatty acids , and RNA , with no nutritional support given after surgery ( preoperative group , n = 102 ) ; ( 2 ) the same preoperative treatment plus postoperative jejunal infusion with the same enriched formula ( perioperative group , n = 101 ) ; and ( 3 ) no artificial nutrition before and after surgery ( conventional group ; n = 102 ) . RESULTS The 3 groups were comparable for all baseline and surgical characteristics . Intention-to-treat analysis showed a 13.7 % incidence of postoperative infections in the preoperative group , 15.8 % in the perioperative group , and 30.4 % in the conventional group ( P = 0.006 vs. preoperative ; P = 0.02 vs. perioperative ) . Length of hospital stay was 11.6 + /- 4.7 days in the preoperative group , 12.2 + /- 4.1 days in the perioperative group , and 14.0 + /- 7.7 days in the conventional group ( P = 0.008 vs. preoperative and P = 0.03 vs. perioperative ) . CONCLUSIONS Preoperative supplementation is as effective as perioperative administration in improving outcome . Both strategies seem superior to the conventional approach BACKGROUND AND AIMS Nutritional supplements are widely administered in hospitals and can benefit clinical outcome . The aim here was to determine the effect of routine post-operative nutritional supplementation on the nutritional status and clinical outcome of adult orthopaedic patients . METHODS A prospect i ve controlled study was conducted on two adult orthopaedic wards . Patients in the study group were prescribed two nutritional supplements/day post-operatively . Nutritional and biochemical indices and incidence of clinical complications were observed . RESULTS Of 181 patients studied , 14 in the supplemented group and 34 in the control ( P=0.005 ) developed major complications . There were 22 occurrences of major complications in the supplemented group and 55 in the control ( P=0.0002 ) . There was no significant difference in the number of minor complications between the two groups ( P=0.2 ) . There was no statistical difference in changes in nutritional parameters or in albumin or CRP between the two groups . There were significantly greater reductions in transferrin ( P=0.002 ) and in haemoglobin ( P=0.002 ) in the control group at week 1 . The median costs of hospital stay were 2068 UK pounds in the supplemented group and 2199 UK pounds in the control . The median cost of additional treatments was 30.16 UK pounds in the supplemented group and 46.23 UK pounds in the control . CONCLUSION A significant reduction in major complications and in number and costs of additional treatments was seen in the supplemented group 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 AIM To examine the evolution of different parameters of the nutritional status after short-term oral protein-energy supplementation in moderately malnourished geriatric patients . METHODS Seventeen hospitalized malnourished elderly patients and 12 healthy adults received dietary supplements for 10 days . A group of six malnourished elderly subjects served as controls . Spontaneous oral intakes , biological and biophysical markers of the nutritional status were measured . Fat-free mass ( FFM ) was assessed using Dual energy X-ray absorptiometry ( DXA ) , bio-impedance analysis ( BIA ) and anthropometry . RESULTS In elderly subjects , the supplementation significantly increased both dietary intake ( energy + 32 % , protein + 65 % ) and FFM ( + 1.3 kg , P<0.001 ) as assessed using DXA . BIA and anthropometric data correlated with DXA measurements in the elderly ( BIA : r=0.68 - -0.80 , anthropometry : r=0.80 - -0.89 ) , but failed to reflect accurately the changes measured in FFM . Supplementation had no notable effect on biological markers in any of the groups . IGF-I and h and -grip strength were not significantly influenced by the supplementation despite trends towards an improvement . CONCLUSIONS Monitoring short-term changes in nutritional status in malnourished elderly individuals is a problem in routine clinical management . Our data put in the limelight the changes in IGF-I values related to dietary supplementation , and , chiefly , suggest a prime role for the assessment of dietary intake and FFM , as assessed by DXA , as indicators of short-term efficacy of refeeding . Nevertheless larger studies are necessary to confirm the clinical and prognostic significance of the changes Objective : To describe the independent and combined effects of oral nutrition supplementation and resistance training on health outcomes in nutritionally at risk older adults following lower limb fracture . Design : R and omized controlled trial with 12-week masked outcome assessment . Setting : Teaching hospital . Participants : One hundred nutritionally at risk older adults hospitalized following a fall-related lower limb fracture . Intervention : Commenced seven days after injury . Consisted of daily multinutrient energy-dense oral supplement ( 6.3 kJ/mL ) individually prescribed for six weeks ( n = 25 ) , tri-weekly resistance training for 12 weeks ( n = 25 ) , combined treatment ( n = 24 ) or attention control plus usual care and general nutrition and exercise advice ( n = 26 ) . Measurements : Weight change , quadriceps strength , gait speed , quality of life and health care utilization at completion of the 12-week intervention . Results : At 12 weeks , all groups lost weight :  nutrition -6.2 % ( -8.4 , -4.0 ) ; resistance training -6.3 % ( -8.3 , -4.3 ) ; nutrition and resistance training -4.7 % ( -7.4 , -2.0 ) ; attention control -5.2 % ( -9.0 , -1.5 ) . Those receiving resistance training alone lost more weight than those receiving the combined treatment ( P = 0.029 ) . Significant weight loss was prevented if supplement was consumed for at least 35 days . Groups were no different at 12 weeks for any other outcome . Conclusion : Frail , undernourished older adults with a fall-related lower limb fracture experience clinical ly significant weight loss that is unable to be reversed with oral nutritional supplements . Those receiving a programme of resistance training without concurrent nutrition support are at increased risk of weight loss compared with those who receive a combined nutrition and resistance training intervention . In this high-risk patient group it is possible to prevent further decline in nutritional status using oral nutritional supplements if strategies are implemented to ensure prescription is adequate to meet energy requirements and levels of adherence are high Undernutrition is a significant problem in hospitalized elderly patients , and is associated with a higher morbidity and mortality . The aim of this study is to assess the effect of an oral nutritional supplementation on the total daily caloric intake in an acute geriatric hospitalized population . A dietary assessment and a total food intake were collected on admission and every other day ( day 0 , 2 , 4 , 6 … ) during hospitalization ( mean duration , 12.8 days±6 ) in 50 r and omly chosen elderly patients ( mean age 82.5±5.5 years , 18 men and 32 women ) .  The mean daily caloric intake was calculated from 108 dietary assessment s after receiving oral supplementation ( Nutridrink-Nutricia , 300 kcal/200 mL ) , and 154 when a voluntary diet without supplementation was consumed . The mean voluntary energy intake ( including parenteral fluid ) was similar on days a nutritional supplementation was given or not ( 1546 kcal/d vs 1475 kcal/d , respectively , p=0.27 ) , but the total caloric intake was significantly higher on days a nutritional supplementation was consumed ( 1825 kcal/d vs 1475 kcal/d , p=0.0006 ) . This beneficial effect of a nutritional supplementation  on the total caloric intake existed when patients were divided into well nourished ( N=15 ) and those at risk or malnourished ( N=35 ) , according to the Mini-Nutritional Assessment . In conclusion , short-term nutritional supplementation has a beneficial effect on the total daily caloric intake in elderly hospitalized patients with and without malnutrition , but the wastage remains high OBJECTIVE Our objective was to determine the effects of peridialytic oral supplements on nutritional markers and quality of life ( QOL ) in patients receiving maintenance hemodialysis . DESIGN This trial was open , prospect i ve , nonr and omized , and comparative . SETTING This study was performed at an outpatient hemodialysis unit in a teaching hospital . PATIENTS This study included 88 adults with chronic kidney disease at stage 5 . INTERVENTION This study involved directly observed nutrition therapy with > or=1 can of enteral nutrition ( Nepro ) with each hemodialysis session thrice weekly for 3 months , or st and ard care . MAIN OUTCOME MEASURE Changes in biochemical markers of nutritional status and QOL , as measured by the Kidney Disease Quality of Life-Short Form , were determined . RESULTS Peridialytic oral nutrition result ed in a significant difference between the nutrition and comparison groups in serum albumin change over time ( P = .03 ; repeated- measures analysis of variance with covariates ) . Mean ( + /-SD ) serum albumin concentration did not differ between baseline and month 3 in the nutrition group ( 3.68 + /- 0.33 g/dL vs. 3.75 + /- 0.40 g/dL ; P = .12 ) , but in the comparison group , serum albumin levels declined significantly ( 3.93 + /- 0.34 g/dL at baseline versus 3.81 + /- 0.37 g/dL at month 3 ; P = .04 ) . The " role-physical " domain score of the Kidney Disease Quality of Life-Short Form significantly changed over time in the nutrition group versus the comparison group ( P = .02 ; repeated- measures analysis of variance with covariates ) . Nepro was well-tolerated , and greater than 80 % of the prescribed therapy was consumed . CONCLUSION Oral nutrition , as part of structured , directly observed peridialytic therapy in chronic hemodialysis patients , was well-accepted , and result ed in the maintenance of serum albumin levels and QOL with respect to impact of physical health on daily activities . These findings need to be confirmed in a r and omized , controlled trial OBJECTIVE To investigate the use of liquid oral dietary supplements among nursing home residents who were eating poorly and losing weight . DESIGN A prospect i ve , descriptive , anthropological study . SETTING Two proprietary nursing homes with 105 and 138 beds . PARTICIPANTS Purposive sampling was used to select 40 residents from among the 100 residents who were not eating well .  Dietary data  were collected on this sub- sample of 40 residents . MEASUREMENTS  Participant observation , in-depth interviews , event analysis , bedside dysphagia screenings , oral health examinations , body weight , body mass index ( BMI ) , and chart review  were used to collect data . Dietary data were collected over a 3-day period , and data were gathered on how supplements were ordered , served , and consumed . RESULTS Supplements had been ordered for 29 of the sub sample of 40 residents . Only nine of 29 residents were served the correct number and type of supplements as ordered by their physicians , and only two residents consumed the full amount of supplement as ordered . The overall mean percentage of supplement consumed compared with that ordered was 55.1 % . Although supplements were ordered primarily to prevent weight loss and to facilitate weight gain , nearly half ( n = 14 ) of the residents continued to lose weight . Supplements were ordered without investigating the underlying factors contributing to weight loss , such as inadequate staffing and lack of supervision at mealtime , undiagnosed dysphagia , and poor oral health . Without evaluation of these factors , it is unknown which residents might benefit from oral supplements . CONCLUSION Findings indicate that supplements were used nonspecifically as an intervention for weight loss in nursing home residents without regard to dose , diagnosis and management of underlying problem(s ) , amount of supplement consumed , and outcome . Further research is needed to establish when supplements should be ordered , how to ensure that they will be taken , and whether they are effective Ageing induces a change in immune responses . Besides this , impaired nutritional status is considered to have a critical influence on immune function , which may be reversed by nutritional supplementation . We evaluated the effect of an enriched drink on immune function in the elderly . 33 frail elderly subjects ( aged > or = 65 years and body mass index < or = 25 ) received two 125 ml packages of either an enriched drink ( n=20 ) or placebo ( n=13 ) daily for 6 months . The enriched drink contained macro- and micronutrients . At baseline and after 6 months blood sample s were drawn and P BMC 's were isolated . ConA stimulated proliferation and IL-2 production of P BMC 's were measured . There was a significant difference between groups in proliferation over the study period . The supplement group remained stable whereas the placebo group showed a reduction in proliferation over the 6-month period . There was no significant difference in IL-2 production between groups . Our study adds to the evidence that nutritional supplementation can affect immune function in the elderly 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 Background : Undernutrition is a common problem in older individuals that may be related to a low protein dietary intake . Oral supplements may improve the health status in this population , but their use may be limited by compliance and side effects . Objectives To evaluate effects of an oral supplement of protein and fibre on compliance , on nutritional status , and on intestinal habits in nursing home residents . Method : A prospect i ve observational study was carried out in 66 Spanish nursing homes . 358 subjects undernourished or at risk of undernutrition requiring nutritional supplements . After informed consent was given , subjects received 2 daily cartons ( 400 ml ) of a liquid oral supplement rich in protein and fibre along 3 months . Supplement intake compliance was measured at baseline and after 6 and 12 weeks . Nutritional status was assessed using the Mini-Nutritional Assessment ( MNA ) , weight , and Body Mass Index ( BMI ) . Changes in intestinal habits and digestive symptoms were also recorded , as well as subject ’s supplement acceptance . Results : Compliance with the supplement intake was 97.46 % at 6 weeks and 96 % at 12 weeks of follow-up . Significant changes ( p<0.0001 ) were found in nutritional status : mean value of MNA improved from baseline ( MNA=14.0±3.9 ) after 12 weeks ( MNA=17.0±4.0 ) , as well as weight ( + 2.1 kg , a 4.1 % increase ) . The BMI did not change significantly ( BMI = 21.43 at baseline ; BMI = 21.78 at 12 weeks ) . Undernutrition prevalence ( MNA<17 ) decreased from 76.4 to 46.6 % ( p<0.0001 ) . Intestinal habits showed a significant improvement in defecation frequency ( from 4.7 to 6.1 stools per week , p<0.0001 ) and faeces consistency ( from 53.2 % to 74.5 % reporting formed soft stools , p<0.0001 ) . 48.9 % of the subjects considered to have better intestinal habits after 6 weeks and 50.5 % after 3 months of supplementary food intake , the rest reporting no change . Vomits and flatulence were also significantly reduced ( p<0.0001 ) . Conclusion : The administration of an oral hyperproteic supplement with fibre in aged subjects who are undernourished or at risk of malnutrition can be done in nursing homes with a high level of compliance . Supplements improve their nutritional status and their intestinal habits 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 BACKGROUND The purpose of this study was to provide a detailed evaluation of adherence to nutrition supplements by patients with a lower limb fracture . METHODS These descriptive data are from 49 nutritionally " at-risk " patients aged 70 + years admitted to the hospital after a fall-related lower limb fracture and allocated to receive supplementation as part of a r and omized , controlled trial . Supplementation commenced on day 7 and continued for 42 days . Prescribed volumes aim ed to meet 45 % of individually estimated theoretical energy requirements to meet the shortfall between literature estimates of energy intake and requirements . The supplement was administered by nursing staff on medication rounds in the acute or residential care setting s and supervised through thrice-weekly home visits postdischarge . RESULTS Median daily percent of the prescribed volume of nutrition supplement  consumed averaged over the 42 days was 67 % ( interquartile range [ IQR ] , 31 - 89 , n = 49 ) . There was no difference in adherence for gender , accommodation , cognition , or whether the supplement was self-administered or supervised . Twenty-three participants took some supplement every day , and a further 12 missed < 5 days . For these 35 " nonrefusers , " adherence was 82 % ( IQR , 65 - 93 ) , and they lost on average 0.7 % ( SD , 4.0 % ) of baseline weight over the 6 weeks of supplementation compared with a loss of 5.5 % ( SD , 5.4 % ) in the " refusers " ( n = 14 , 29 % ) , p = .003 . CONCLUSIONS We achieved better volume and energy consumption than previous studies of hip fracture patients but still failed to meet target supplement volumes prescribed to meet 45 % of theoretical energy requirements . Clinicians should consider alternative methods of feeding such as a nasogastric tube , particularly in those patients where adherence to oral nutrition supplements is poor and dietary intake alone is insufficient to meet estimated energy requirements BACKGROUND An increase in protein intake exerts a stimulating effect on protein kinetics in children , young adults , and healthy elderly persons . However , there are few data on the response to such dietary changes in malnourished elderly subjects , despite important medical implication s in this population . OBJECTIVE The objective of this study was to determine the metabolic response to short-term nutritional supplementation in moderately malnourished elderly subjects . DESIGN The influence of 10 d of supplementation ( 1.67 MJ/d and 30 g protein/d ) on body composition , resting energy expenditure , and whole-body protein kinetics was studied in 17 malnourished elderly patients and 12 healthy young adults . A control group of 6 malnourished elderly patients received no supplementation . RESULTS Supplemented elderly subjects had a significantly greater fat-free mass gain than did unsupplemented elderly subjects ( 1.3 and 0.1 kg , respectively ; age effect , P < 0.05 ; diet effect , P < 0.02 ) and a significantly greater increase in fasting rate of protein synthesis than did young supplemented subjects ( 0.6 and 0.2 g*kg FFM(-1)*11 h(-1 ) ; age effect , P < 0.05 ) . The net protein balance in the supplemented elderly subjects in the fed state was positively correlated with protein intake ( r(2 ) = 0.46 ) and in the fasted state was negatively correlated with protein intake ( r(2 ) = 0.27 ) . The sum of these regressions is a line with increasingly positive net diurnal protein balance produced by increasing protein intake . CONCLUSION These data provide evidence of a short-term anabolic response of protein metabolism to dietary supplementation in malnourished elderly patients that is likely to improve muscle strength and functional status Objectives To determine whether in the current study the supply of a nutrient dense drink has a positive effect on mental and physical function of institutionalized elderly people . Design A 24-week , r and omized , double-blind , placebo-controlled , parallel-group , intervention trial . Setting Homes for the elderly and nursing homes in the Netherl and s. Participants Institutionalized elderly people older than 60 years , with a BMI ≤ 30 kg/m2 , and a Mini-Mental State Examination score of at least 10 points . InterventionIn addition to their usual diet the participants ( n=176 ) received either a nutrient dense drink or a placebo drink twice a day during 24 weeks . Measurements The functionality measures included cognitive function , mood , physical performance and the ability to perform activities of daily living . Results In the supplement group a favorable effect of the intervention drink on body weight ( 1.6 kg difference in change ; P = .035 ) , calf circumference ( 0.9 cm difference in change ; P = .048 ) , and blood values ( e.g. Hcy decreased from 16.8 to 11.2 µmol/L in the supplement group ) was found . In the total group no significant effect was found on functionality outcomes . However , a subgroup of participants with BMI at baseline below 24.4 kg/m2 performed better on the cognitive subscale of Alzheimer ’s Disease Assessment Scale ( P = .09 ) , and its language sub score ( P = .01 ) after 24 weeks of intervention . Conclusion The results in the total group of this trial suggest that the nutritional supplement used in this study improves nutritional status . Furthermore , the results of this trial suggest that it is effective as treatment for decreasing function in a subgroup of institutionalized elderly people with low BMI BACKGROUND Oral nutritional supplements have been recommended after orthopedic surgery in geriatric patients to reduce postoperative complications . However , tolerability of supplements could be a limitation , and their universal use is not supported by the heterogeneity of previous studies , especially in patients without malnutrition . METHODS This study is a r and omized , controlled , open , parallel , 3-arm clinical trial comparing supplementation with protein powder dissolved in liquids to aim at 36 g of protein per day , energy and protein supplements to aim at 37.6 g of protein and 500 kcal per day , or no intervention in normally nourished or mildly undernourished patients . Outcomes were serum albumin , prealbumin , retinol-binding globulin , and body mass index , among others . Postoperative complications were also recorded . RESULTS Ninety patients aged 83.8 + /- 6.6 years were included . The mean ingested amount of supplements was 41.1 % + /- 20.6 % in the protein powder supplement group and 51.4 % + /- 13.2 % in the energy protein supplement group ( t = 2.278 , P = .027 ) . Postoperative supplements had no effect on the nutrition status during in-hospital follow-up , as assessed by serum albumin ( P = .251 ) , prealbumin ( P = .530 ) , retinol-binding globulin ( P = .552 ) , or body mass index ( P = .582 ) . Multivariate analysis showed that length of hospital stay with an established complication until its resolution ( beta = .230 , P = .031 ) , total hospital stay ( beta = .450 , P < .001 ) , baseline body mass index ( beta = .204 , P = .045 ) , and total daily ingested proteins per body weight ( beta = .252 , P = .018 ) were predictive variables on the change in serum albumin ( R2 = 0.409 , F = 11.246 , P < .001 ) . CONCLUSIONS Oral nutritional supplements in normally nourished or only mildly undernourished geriatric patients with hip fracture su bmi tted to surgery may be of interest for patients with postoperative complications and long hospital stays 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 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 BACKGROUND Protein-energy wasting is a frequent and debilitating condition in maintenance dialysis . We r and omly tested if an energy-dense , phosphate-restricted , renal-specific oral supplement could maintain adequate nutritional intake and prevent malnutrition in maintenance haemodialysis patients with insufficient intake . METHODS Eighty-six patients were assigned to a st and ard care ( CTRL ) group  or were prescribed two 125-ml packs of Renilon 7.5(R ) daily for 3 months ( SUPP ) .  Dietary intake , serum ( S ) albumin , prealbumin , protein nitrogen appearance ( nPNA ) , C-reactive protein , subjective global assessment ( SGA ) and quality of life ( QOL ) were recorded at baseline and after 3 months . RESULTS While intention to treat analysis ( ITT ) did not reveal strong statistically significant changes in dietary intake between groups , per protocol ( PP ) analysis showed that the SUPP group increased protein ( P < 0.01 ) and energy ( P < 0.01 ) intakes . In contrast , protein and energy intakes further deteriorated in the CTRL group ( PP ) . Although there was no difference in serum albumin and prealbumin changes between groups , in the total population serum albumin and prealbumin changes were positively associated with the increment in protein intake ( r = 0.29 , P = 0.01 and r = 0.27 , P = 0.02 , respectively ) . The SUPP group did not increase phosphate intake , phosphataemia remained unaffected , and the use of phosphate binders remained stable or decreased . The SUPP group exhibited improved SGA and QOL ( P < 0.05 ) . CONCLUSION This study shows that providing maintenance haemodialysis patients with insufficient intake with a renal-specific oral supplement may prevent deterioration in nutritional indices and QOL without increasing the need for phosphate binders
BACKGROUND & AIMS Oral nutritional supplements ( ONS ) play a key role in the management of malnutrition .
This systematic review examined patients ' compliance with ONS across healthcare setting s and the influence of patient and ONS-related factors .