Improving albumin levels among hemodialysis patients: a community-based randomized controlled trial. A cluster randomised feasibility trial evaluating nutritional interventions in the treatment of malnutrition in care home adult residents A factorial-design cluster randomised controlled trial investigating the cost-effectiveness of a nutrition supplement and an exercise programme on pneumonia incidence, walking capacity and body mass index in older people living in Santiago, Chile: the CENEX study protocol Malnutrition in hip fracture patients: an intervention study. A prospective study of nutrition education and oral nutritional supplementation in patients with Alzheimer's disease The impact of outcome reporting bias in randomised controlled trials on a cohort of systematic reviews High-intensity functional exercise program and protein-enriched energy supplement for older persons dependent in activities of daily living: a randomised controlled trial. Effect of a nutrient-enriched drink on dietary intake and nutritional status in institutionalised elderly Relationship of nutritional status to length of stay, hospital costs, and discharge status of patients hospitalized in the medicine service. Randomized clinical trial of the effects of preoperative and postoperative oral nutritional supplements on clinical course and cost of care A recipe for improving food intakes in elderly hospitalized patients. Impact of protein pulse feeding on lean mass in malnourished and at-risk hospitalized elderly patients: a randomized controlled trial. Long-term nutritional support as an adjunct to chemotherapy for breast cancer. Oral nutritional supplements in a randomised trial are more effective than dietary advice at improving quality of life in malnourished care home residents. Functional biochemical and nutrient indices in frail elderly people are partly affected by dietary supplements but not by exercise. The impact of nutritional supplementation and resistance training on the health functioning of free-living Chilean elders: results of 18 months of follow-up. Energy supplementation and the nutritional status of hemodialysis patients. Effect of providing fortified meals and between-meal snacks on energy and protein intake of hospital patients. 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 Calcium β-Hydroxy-β-Methylbutyrate (CaHMB), Vitamin D, and Protein Supplementation on Postoperative Immobilization in Malnourished Older Adult Patients With Hip Fracture: A Randomized Controlled Study. Three-week Nutritional Supplementation Effect on Long-term Nutritional Status of Patients With Mild Alzheimer Disease Energy dense oleic acid rich formula to newly admitted geriatric patients--feasibility and effects on energy intake. Effect of nutritional supplements on wound healing in home-nursed elderly: a randomized trial. Dietary supplementation in elderly patients with fractured neck of the femur Oral nutritional supplementation increases caloric and protein intake in peritoneal dialysis patients. A randomised controlled trial evaluating the use of enteral nutritional supplements postoperatively in malnourished surgical patients Compliance of nursing home residents with a nutrient- and energy-dense oral nutritional supplement determines effects on nutritional status Malnutrition screening and early nutrition intervention in hospitalised patients in acute aged care: A randomised controlled trial Effect of family style mealtimes on quality of life, physical performance, and body weight of nursing home residents: cluster randomised controlled trial Impact of nutritional support on functional status during an acute exacerbation of chronic obstructive pulmonary disease. Oral nutritional supplement use in elderly nursing home patients. Effects of nutritional supplementation and resistance training on muscle strength in free living elders. Results of one year follow. Long-lasting improved amino acid bioavailability associated with protein pulse feeding in hospitalized elderly patients: a randomized controlled trial. Effect of a complete nutritional supplement on antibody response to influenza vaccine in elderly people. Nutritional enhancement of exercise performance in chronic obstructive pulmonary disease: a randomised controlled trial The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Should the food intake of patients admitted to acute hospital services be routinely supplemented? A randomized placebo controlled trial. A randomized, crossover trial of high-carbohydrate foods in nursing home residents with Alzheimer's disease: associations among intervention response, body mass index, and behavioral and cognitive function. Effects of two models of nutritional intervention on homebound older adults at nutritional risk. A Theoretically Based Behavioral Nutrition Intervention for Community Elders at High Risk: The B-NICE Randomized Controlled Clinical Trial The effect of oral nutritional supplements on habitual dietary quality and quantity in frail elders. Improving the dietary intake of under nourished older people in residential care homes using an energy-enriching food approach: a cluster randomised controlled study. Preventive versus "on-demand" nutritional support during antiviral treatment for hepatitis C: a randomized controlled trial. The effects of the administration of oral nutritional supplementation with medication rounds on the achievement of nutritional goals: a randomized controlled trial. Physiological effects beyond the significant gain in muscle mass in sarcopenic elderly men: evidence from a randomized clinical trial using a protein-rich food Development of a telemedical monitoring concept for the care of malnourished geriatric home-dwelling patients: a pilot study. Effects of dietary supplements on depressive symptoms in older patients: a randomised double-blind placebo-controlled trial. Can a nutrition intervention improve albumin levels among hemodialysis patients? A pilot study. Apparent low frequency of undernutrition in Dublin hospital in-patients: should we review the anthropometric thresholds for clinical practice? Cost-effectiveness of an interdisciplinary intervention in geriatric inpatients to prevent malnutrition. Can prescription of sip-feed supplements increase energy intake in hospitalised older people with medical problems? Compliance with nutrition prescription improves outcomes in patients with unresectable pancreatic cancer. Southampton mealtime assistance study: design and methods The Cost-Effectiveness of Oral Nutrition Supplementation for Malnourished Older Hospital Patients Using dietetic assistants to improve the outcome of hip fracture: a randomised controlled trial of nutritional support in an acute trauma ward. Prevention of malnutrition in older people during and after hospitalisation: results from a randomised controlled clinical trial. A checklist designed to aid consistency and reproducibility of GRADE assessments: development and pilot validation Nursing intervention to promote functional feeding. The deliverability, acceptability, and perceived effect of the Macmillan approach to weight loss and eating difficulties: a phase II, cluster-randomized, exploratory trial of a psychosocial intervention for weight- and eating-related distress in people with advanced cancer. Health and nutrition promotion program for patients with dementia (NutriAlz): Cluster randomized trial Cost-effectiveness of nutrition interventions in nursing home residents: A pilot intervention Energy-containing nutritional supplements can affect usual energy intake postsupplementation in institutionalized seniors with probable Alzheimer's disease. An innovative solid oral nutritional supplement to fight weight loss and anorexia: open, randomised controlled trial of efficacy in institutionalised, malnourished older adults. Protein-energy oral supplementation in malnourished nursing-home residents. A controlled trial. Cost-Effectiveness of Nutrition Intervention in Long-Term Care. Short-term individual nutritional care as part of routine clinical setting improves outcome and quality of life in malnourished medical patients. Effect of dietary supplement on nutritional status and clinical outcome in 501 geriatric patients--a randomised study. Consumption of vitamin D-and calcium-fortified soft white cheese lowers the biochemical marker of bone resorption TRAP 5b in postmenopausal women at moderate risk of osteoporosis fracture. Compliance of orthopaedic patients with postoperative oral nutritional supplementation. Intensive dietary intervention by a dietitian as a case manager among community dwelling older adults: The edit study Nutritional support in hospitalized patients with alcoholic liver disease. Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: A randomized clinical trial. Routine oral nutritional supplementation for stroke patients in hospital (FOOD): a multicentre randomised controlled trial. Benefits of oral protein supplementation in elderly patients with fracture of the proximal femur. Malnutrition in community-dwelling adults with dementia (Nutrialz Trial) Protein-enriched 'regular products' and their effect on protein intake in acute hospitalized older adults; a randomized controlled trial. Effectiveness of two training methods to improve the quality of foodservice in small facilities for adult care. A randomized controlled trial of dietetic interventions to prevent cognitive decline in old age hostel residents Nutritional supplementation of elderly hip fracture patients. A randomized, double-blind, placebo-controlled trial. Geriatric-based versus general wards for older acute medical patients: a randomized comparison of outcomes and use of resources. Effects of high-intensity exercise and protein supplement on muscle mass in ADL dependent older people with and without malnutrition—A randomized controlled trial Lack of compliance of staff in an intervention study with focus on nutrition, exercise and oral care among old (65+ yrs) Danish nursing home residents Perioperative oral nutritional supplements in normally or mildly undernourished geriatric patients submitted to surgery for hip fracture: a randomized clinical trial. Determining knowledge and behaviour change after nutrition screening among older adults. Effect of family-style meals on energy intake and risk of malnutrition in dutch nursing home residents: a randomized controlled trial. 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 prospective randomised controlled trial of nutritional supplementation in malnourished elderly in the community: clinical and health economic outcomes. Using spaced retrieval and Montessori-based activities in improving eating ability for residents with dementia. Energy-enriched hospital food to improve energy intake in elderly patients. Effects of oral functional training for nutritional improvement in Japanese older people requiring long-term care. Weight increase in patients with dementia, and alteration in meal routines and meal environment after integrity promoting care. Does additional feeding support provided by health care assistants improve nutritional status and outcome in acutely ill older in-patients?--a randomised control trial. [Identification and early nutritional support in hospitalized malnourished patients]. Nutritional Supplementation of Very Old People at Hospital Discharge Increases Muscle Strength: A Randomised Controlled Trial Nutritional supplementation for diabetic foot ulcers: the first RCT. Can health visitors prevent fractures in elderly people? Nutritional status after short-term dietary supplementation in hospitalized malnourished geriatric patients. Simple nutritional intervention in patients with advanced cancers of the gastrointestinal tract, non-small cell lung cancers or mesothelioma and weight loss receiving chemotherapy: a randomised controlled trial. Does low lactose milk powder improve the nutritional intake and nutritional status of frail older Chinese people living in nursing homes? Incidence and recognition of malnutrition in hospital Dietary supplements and physical exercise affecting bone and body composition in frail elderly persons. Increased fluid intake does not augment capacity to lay down new collagen in nursing home residents at risk for pressure ulcers: a randomized, controlled clinical trial. Behavioural intervention for dysphagia in acute stroke: a randomised controlled trial Positive effect of protein-supplemented hospital food on protein intake in patients at nutritional risk: a randomised controlled trial. Nutritional approach for inhibiting bone resorption in institutionalized elderly women with vitamin D insufficiency and high prevalence of fracture Providing nutrition supplements to institutionalized seniors with probable Alzheimer's disease is least beneficial to those with low body weight status. The development and healing of pressure sores related to the nutritional state. Energy balance in depleted ambulatory patients with chronic obstructive pulmonary disease: the effect of physical activity and oral nutritional supplementation. Randomised controlled trial of food supplements in patients with newly diagnosed tuberculosis and wasting. Impact of serving method on the consumption of nutritional supplement drinks: randomized trial in older adults with cognitive impairment. A controlled trial of sip-feed supplements in elderly orthopaedic patients. Nutritional repletion in malnourished patients with emphysema. Maintaining nutrition in aged care residents with a train-the-trainer intervention and nutrition coordinator The facilitated early enteral and dietary management effectiveness trial in hospitalized patients with malnutrition. A multi-center trial of the effects of oral nutritional supplementation in critically ill older inpatients. GAGE Group. Groupe Aquitain Geriatrique d'Evaluation. Hospital-made diet versus commercial supplement in postburn nutritional support. Enhancement of select foods at breakfast and lunch increases energy intakes of nursing home residents with low meal intakes. Effects of dietary supplement on functional condition and clinical outcome measured with a modified Norton scale. Medical nutrition therapy for the prevention and treatment of unintentional weight loss in residential healthcare facilities. Impact of nutritional supplementation on treatment delay and morbidity in patients with head and neck tumors treated with irradiation. Need-based intervention is an effective strategy for improving the nutritional status of older people living in a nursing home: a randomized controlled trial. No effect of 16 weeks flavor enhancement on dietary intake and nutritional status of nursing home elderly Associations between underlying disease and nutritional status following acute illness in older people. The impact of nutrition support on
body composition in cancer outpatients receiving
radiotherapy Patient satisfaction is rated higher by radiation oncology outpatients receiving nutrition intervention compared with usual care. Should oral nutritional supplementation be given to undernourished older people upon hospital discharge? A controlled trial. Two phase randomised controlled clinical trial of postoperative oral dietary supplements in surgical patients. The effect of a nutrient dense drink on mental and physical function in institutionalized elderly people Using a Montessori method to increase eating ability for institutionalised residents with dementia: a crossover design. Dietary supplementation and quality of life of older patients: a randomized, double-blind, placebo-controlled trial. Subjectively healthy elderly consuming a liquid nutrition supplement maintained body mass index and improved some nutritional parameters and perceived well-being. Short term benefits of post-operative oral dietary supplements in surgical patients. A randomized, double-blind, placebo-controlled trial of nutritional supplementation during acute illness. Nutritional supplementation according to energy and protein requirements in malnourished HIV-infected patients. Improvement of weight and fat-free mass with oral nutritional supplementation in patients with Alzheimer's disease at risk of malnutrition: a prospective randomized study. Nutritional status of elderly patients during recovery from chest infection and the role of nutritional supplementation assessed by a prospective randomized single-blind trial. Increased energy density of the home-delivered lunch meal improves 24-hour nutrient intakes in older adults. Effects of protein supplementation in chronic hemodialysis and peritoneal dialysis patients. Effects of a feeding skills training programme on nursing assistants and dementia patients. Effects of oral nutritional supplements in normally nourished or mildly undernourished geriatric patients after surgery for hip fracture: a randomized clinical trial. Nutritional supplementation in elderly medical in-patients: a double-blind placebo-controlled trial. Effect of nutritional support on clinical outcome in patients at nutritional risk. Protein energy supplements in unwell elderly patients--a randomized controlled trial. Provision of small, frequent meals does not improve energy intake of elderly residents with dysphagia who live in an extended-care facility. Physical and social functional abilities seem to be maintained by a multifaceted randomized controlled nutritional intervention among old (>65 years) Danish nursing home residents. Physical exercise and/or enriched foods for functional improvement in frail, independently living elderly: a randomized controlled trial. A hospital-based multidisciplinary approach improves nutritional status of the elderly living in long-term care facilities in middle Taiwan. Need-based nutritional intervention is effective in improving handgrip strength and Barthel Index scores of older people living in a nursing home: a randomized controlled trial. [Diet and polymer standard vs. standard in the nutritional status of elderly patients with fragility]. Exercise training and nutritional supplementation for physical frailty in very elderly people. Dietary supplementation and respiratory muscle performance in patients with COPD. A randomized, controlled, a single-blind trial of nutritional supplementation after acute stroke. Multifaceted nutritional intervention among nursing-home residents has a positive influence on nutrition and function.
BACKGROUND Low albumin level is a strong predictor of mortality and morbidity among hemodialysis patients , yet few interventions are available to improve albumin levels . Moreover , the relative importance of nutritional barriers versus inflammation in contributing to hypoalbuminemia is unclear . We sought to determine whether targeting specific nutritional barriers will improve albumin levels . METHODS We conducted a r and omized controlled trial involving 180 patients with baseline albumin levels less than 3.7 g/dL ( < 37 g/L ) at 44 long-term hemodialysis facilities . Study coordinators identified and intervened on specific barriers present among intervention patients , whereas control patients continued to receive the usual care . Barriers targeted included poor nutritional knowledge , poor appetite , help needed with shopping or cooking , low fluid intake , inadequate dialysis dose , depression , difficulty chewing , difficulty swallowing , gastrointestinal symptoms , and acidosis . RESULTS At baseline , intervention and control patients had similar albumin levels , dietary intakes , levels of inflammatory markers , and numbers of nutritional barriers . After 12 months , intervention patients had greater increases in albumin levels compared with control patients ( + 0.21 versus + 0.06 g/dL [ + 2.1 versus + 0.6 g/L ] ; P < 0.01 ) , as well as greater increases in energy intake ( + 4.1 versus -0.6 Kcal/d/kg ; P < 0.001 ) and protein intake ( + 0.13 versus -0.06 g/d/kg ; P < 0.001 ) . The intervention appeared most effective for barriers related to poor nutritional knowledge , help needed with shopping or cooking , and difficulty swallowing . About half the subjects had elevated levels of inflammatory markers , but there was no relationship between change in levels of albumin and inflammatory markers . CONCLUSION A nutrition intervention tailored to patient-specific barriers result ed in modest improvements in albumin levels regardless of levels of inflammatory markers Background Protein energy malnutrition ( PEM ) predisposes individuals to disease , delays recovery from illness and reduces quality of life . Care home residents in the United Kingdom are especially vulnerable , with an estimated 30 to 42 % at risk . Evidence for nutritional interventions to address PEM in the care home setting is lacking . Widely used techniques include food-based intervention and /or the use of prescribed oral nutritional supplements . To define outcomes and optimise the design for an adequately powered definitive trial to compare the efficacy of established nutritional interventions in this setting , a cluster r and omised feasibility trial with a 6-month intervention was undertaken . Methods Care home residents with or at risk of malnutrition were identified across six UK care home sites from September to December 2013 . Homes were cluster r and omised to st and ard care ( SC ) , food-based intervention ( FB ) or oral nutritional supplement intervention ( ONS ) , for 6 months . Key outcomes were trial feasibility and the acceptability of design , allocated interventions and outcome assessment s. Anthropometry , dietary intake , healthcare re source usage and participant-reported outcome measures were assessed at baseline and at 3 and 6 months . Results All six care homes approached were recruited and retained . Of the 110 residents at risk of malnutrition , 85 % entered the trial , and 68 % completed the 6-month intervention . Pre-specified success criteria for feasibility were met for recruitment and retention , intervention acceptability ( resident compliance ≥60 % ) and measurement of weight , body mass index ( BMI ) , mid-upper arm circumference and dietary intake ( data completeness > 80 % ) . Measurement of h and grip strength and triceps skinfold thickness was not found to be feasible in this population . The 95 % confidence interval ( CI ) data suggested sensitivity to change in dietary intake for weight , BMI and energy intake between baseline and 3 months when each intervention ( FB and ONS ) was compared with SC . Conclusions A definitive trial comparing the efficacy of nutritional support interventions in increasing weight and BMI in malnourished care home residents can be conducted . However , whilst the design was feasible , this trial has highlighted the lack of clinical ly and patient-relevant outcome measures that are appropriate for use in this setting for both research and clinical practice . In particular , this trial identified a need for a more simple measure of functional status , which considers the limitations of functional tests in the care home population .Trial registration Current Controlled Trials IS RCT N38047922 , Date assigned : 22 April 2014 Background Chile is currently undergoing a period of rapid demographic transition which has led to an increase in the proportion of older people in the population ; the proportion aged 60 years and over , for example , increased from 8 % of the population in 1980 to 12 % in 2005 . In an effort to promote healthy ageing and preserve function , the government of Chile has formulated a package of actions into the Programme of Complementary Feeding for the Older Population ( PACAM ) which has been providing a nutritional supplement to older people since 1998 . PACAM distributes micronutrient fortified foods to individuals aged 70 years and over registered at Primary Health Centres and enrolled in the programme . The recommended serving size ( 50 g/day ) of these supplements provides 50 % of daily micronutrient requirements and 20 % of daily energy requirements of older people . No information is currently available on the cost-effectiveness of the supplementation programme . Aim The aim of the CENEX cluster r and omised controlled trial is to evaluate the cost-effectiveness of an ongoing nutrition supplementation programme , and a specially design ed physical exercise intervention for older people of low to medium socio-economic status living in Santiago , Chile . Methods The study has been conceptualised as a public health programme effectiveness study and has been design ed as a 24-month factorial cluster-r and omised controlled trial conducted among 2800 individuals aged 65.0–67.9 years at baseline attending 28 health centres in Santiago . The main outcomes are incidence of pneumonia , walking capacity and change in body mass index over 24 months of intervention . Costing data ( user and provider ) , collected at all levels , will enable the determination of the cost-effectiveness of the two interventions individually and in combination . The study is supported by the Ministry of Health in Chile , which is keen to exp and and improve its national programme of nutrition for older people based on sound science-base and evidence for cost-effectiveness . Trial registration IS RCT AIMS To investigate whether a nutritional intervention in older women and men with femoral neck fracture had an effect on postoperative complications during hospitalization and on nutritional status at a four-month follow-up . METHODS The design was a r and omized controlled trial . The present study sample consisted of 157 patients aged 70 years and above with femoral neck fracture . The nutritional intervention included , among other things , a nutritional journal to detect nutrition deficiencies and protein-enriched meals for at least four days postoperatively . Further , at least two nutritional and protein drinks were served each day during the whole hospitalization and other factors that would influence the patient 's nutrition were also considered and dealt with . Postoperative complications were registered and patients were assessed using the Mini Nutritional Assessment ( MNA ) scale , including body mass index ( BMI ) , on admission and at a four-month follow-up . RESULTS Malnutrition was common and low MNA scores were associated with postoperative complications such as delirium and decubitus ulcers . There were significantly fewer days of delirium in the intervention group , seven patients in the intervention group developed decubitus ulcers vs. 14 patients in the control group and the total length of hospitalization was shorter . There were no detectable significant improvements regarding nutritional parameters between the intervention and the control group at the four-month follow-up but men improved their mean BMI , body weight and MNA scores in both the intervention and the control groups while women deteriorated in both groups . CONCLUSIONS Malnutrition was common among older people with hip fractures admitted to hospital . The nutritional intervention might have contributed to the patients suffering fewer days with delirium , fewer decubitus ulcers and shorter hospitalization but did not improve the long-term nutritional status , at least not in women . RELEVANCE TO CLINICAL PRACTICE This nutritional intervention , which was included in a multifactorial multidisciplinary intervention , is inexpensive and relatively easy to implement . It has significant effects on complications but no long-term effect on nutritional parameters , at least not in women Background Weight loss in patients with Alzheimer 's disease ( AD ) is a common clinical manifestation that may have clinical significance . Objectives To evaluate if there is a difference between nutrition education and oral nutritional supplementation on nutritional status in patients with AD . Methods A r and omized , prospect i ve 6-month study which enrolled 90 subjects with probable AD aged 65 years or older divided into 3 groups : Control Group ( CG ) [ n = 27 ] , Education Group ( EG ) [ n = 25 ] , which participated in an education program and Supplementation Group ( SG ) [ n = 26 ] , which received two daily servings of oral nutritional supplementation . Subjects were assessed for anthropometric data ( weight , height , BMI , TSF , AC and AMC ) , biochemical data ( total protein , albumin , and total lymphocyte count ) , CDR ( Clinical Dementia Rating ) , MMSE ( Mini-mental state examination ) , as well as dependence during meals . Results The SG showed a significant improvement in the following anthropometric measurements : weight ( H calc = 22.12 , p = < 0.001 ) , BMI ( H calc = 22.12 , p = < 0.001 ) , AC ( H calc = 12.99 , p = < 0.002 ) , and AMC ( H calc = 8.67 , p = < 0.013 ) compared to the CG and EG . BMI of the EG was significantly greater compared to the CG . There were significant changes in total protein ( H calc = 6.17 , p = < 0.046 ) , and total lymphocyte count in the SG compared to the other groups ( H cal = 7.94 , p = 0.019 ) . Conclusion Oral nutritional supplementation is more effective compared to nutrition education in improving nutritional status Objective To examine the prevalence of outcome reporting bias — the selection for publication of a subset of the original recorded outcome variables on the basis of the results — and its impact on Cochrane review s. Design A nine point classification system for missing outcome data in r and omised trials was developed and applied to the trials assessed in a large , unselected cohort of Cochrane systematic review s. Research ers who conducted the trials were contacted and the reason sought for the non-reporting of data . A sensitivity analysis was undertaken to assess the impact of outcome reporting bias on review s that included a single meta- analysis of the review primary outcome . Results More than half ( 157/283 ( 55 % ) ) the review s did not include full data for the review primary outcome of interest from all eligible trials . The median amount of review outcome data missing for any reason was 10 % , whereas 50 % or more of the potential data were missing in 70 ( 25 % ) review s. It was clear from the publications for 155 ( 6 % ) of the 2486 assessable trials that the research ers had measured and analysed the review primary outcome but did not report or only partially reported the results . For reports that did not mention the review primary outcome , our classification regarding the presence of outcome reporting bias was shown to have a sensitivity of 88 % ( 95 % CI 65 % to 100 % ) and specificity of 80 % ( 95 % CI 69 % to 90 % ) on the basis of responses from 62 trialists . A third of Cochrane review s ( 96/283 ( 34 % ) ) contained at least one trial with high suspicion of outcome reporting bias for the review primary outcome . In a sensitivity analysis undertaken for 81 review s with a single meta- analysis of the primary outcome of interest , the treatment effect estimate was reduced by 20 % or more in 19 ( 23 % ) . Of the 42 meta-analyses with a statistically significant result only , eight ( 19 % ) became non-significant after adjustment for outcome reporting bias and 11 ( 26 % ) would have overestimated the treatment effect by 20 % or more . Conclusions Outcome reporting bias is an under-recognised problem that affects the conclusions in a substantial proportion of Cochrane review s. Individuals conducting systematic review s need to address explicitly the issue of missing outcome data for their review to be considered a reliable source of evidence . Extra care is required during data extraction , review ers should identify when a trial reports that an outcome was measured but no results were reported or events observed , and contact with trialists should be encouraged The aims of this r and omised controlled trial were to determine if a high-intensity functional exercise program improves balance , gait ability , and lower-limb strength in older persons dependent in activities of daily living and if an intake of protein-enriched energy supplement immediately after the exercises increases the effects of the training . One hundred and ninety-one older persons dependent in activities of daily living , living in residential care facilities , and with a Mini-Mental State Examination ( MMSE ) score of ? 10 participated . They were r and omised to a high-intensity functional exercise program or a control activity , which included 29 sessions over 3 months , as well as to protein-enriched energy supplement or placebo .  Berg Balance Scale , self-paced and maximum gait speed , and one-repetition maximum in lower-limb strength were followed-up at three and six months and analysed by 2 x 2 factorial ANCOVA , using the intention-to-treat principle . At three months , the exercise group had improved significantly in self-paced gait speed compared with the control group ( mean difference 0.04 m/s , p = 0.02 ) . At six months , there were significant improvements favouring the exercise group for Berg Balance Scale ( 1.9 points , p = 0.05 ) , self-paced gait speed ( 0.05 m/s , p = 0.009 ) , and lower-limb strength ( 10.8 kg , p = 0.03 ) . No interaction effects were seen between the exercise and nutrition interventions . In conclusion , a high-intensity functional exercise program has positive long-term effects in balance , gait ability , and lower-limb strength for older persons dependent in activities of daily living . An intake of protein-enriched energy supplement immediately after the exercises does not appear to increase the effects of the training Objective : ( 1 ) To determine whether nutritional supplementation ( energy and micronutrients ) in institutionalised elderly has a positive effect on dietary intake and nutritional status . ( 2 ) To investigate whether individuals tend to compensate for the energy content of the intervention product by decreasing their habitual food consumption . Methods : A 24-week , r and omised , double-blind , placebo-controlled , intervention trial in homes for the elderly ( n=3 ) , in nursing homes ( n=3 ) and ‘ mixed ’ homes ( n=3 ) in The Netherl and s. Institutionalised elderly people ( n=176 ) older than 60 years of age , with a body mass index ⩽30 kg/m2 and a Mini-Mental State Examination score of 10 points or higher , r and omly received a nutrient-enriched drink or a placebo drink twice a day during 24 weeks in addition to their usual diet . Allocation to treatment took into account of sex , the Mini-Mental State Examination score and the plasma homocysteine level . Body weight and several nutrition-related analyses in fasting blood sample s were measured in all participants . Data on dietary intake were collected in a sub sample ( n=66 ) . Results : A significantly favourable effect ( P<0.001 ) of the intervention drink was observed on vitamin intake , mineral intake and vitamin status in blood ( for example , homocysteine decreased from 14.7 to 9.5 μmol/l in the intervention group as compared with that in the placebo group ( 17.2–15.9 ) ) . The difference in change in total energy intake between the two treatment groups was 0.8 MJ/day ( P=0.166 ) . Energy intake from food decreased in both groups to the same extent ( −0.5 MJ/day ) . Therefore , this decrease can not be considered as compensation for the energy content of the product . Conclusions : This group of institutionalised elderly people does not compensate for the energy content of a concentrated nutritional supplement . Therefore , this supplement is effective for counteracting the development of malnutrition in this population OBJECTIVE This study was conducted to determine the relationship , if any , between nutritional status , length of stay ( LOS ) in hospital , discharge placement , readmission rates , and hospital costs and charges in patients hospitalized in the medicine service . DESIGN Data regarding medical diagnosis , LOS , hospital costs , charges , discharge destination , and readmission rates were collected prospect ively from medical records and through patient interviews on patients admitted to the medical service who were classified to be at risk or not at risk for malnutrition on the basis of established criteria ( weight for height < 75 % ideal body weight , admission serum albumin level < 30 g/L , or > or = 10 % unintentional weight loss within 1 month before admission ) . SUBJECTS All patients admitted directly to any of three medicine units during December 1994 who met study criteria were included in the study . Off-service patients , transfer patients , and patients discharged before screening ( usually admitted and discharged within 72 hours ) were excluded . Data were collected on 173 patients . STATISTICAL ANALYSIS PERFORMED At-risk and not at-risk patients were compared for LOS , costs and reimbursement , and discharge placement ( to home , to home with home health care services , or to another facility for further care ) . Two sample t tests and alpha survival analysis technique were used to compare continuous variables between the two study cohorts . Nonparametric tests were used for LOS and readmission data . chi 2 Tests were used for categoric variables . An alpha level of .05 was used throughout to determine statistical significance . RESULTS Median LOS in the not-at-risk population ( n = 56 ) was significantly greater than in the not-at-risk population ( n = 117 ) : 6 days ( 25th percentile = 4 days , 75th percentile = 8 days ) vs 4 days ( 25th percentile = 3 days , 75th percentile = 7 days ) ( P < .01 ) . Mean hospitalization cost per patient was also higher in the at-risk group ( $ 6,196 vs $ 4,563 , P < .02 ) . Readmission rate per month of follow-up was not significantly different . At-risk patients were significantly less likely to be discharged home with self-care ( 23[41 % ] vs 77 [ 66 % ] , P < .05 ) . At-risk patients were significantly more likely to use home health care service than not-at-risk patients ( 17[31 % ] vs 14 or [ 12 % ] , P < .001 ) . APPLICATIONS Patients at risk for malnutrition had significantly higher LOS , costs , and home health care needs , despite the fact that 51 , or 91 % , received nutrition intervention while hospitalized . Further research should explore the use of nutrition screening and intervention before , during , and after hospitalization to ensure that appropriate nutrition intervention , as indicated by medical patients ' clinical condition and nutritional risk status , is initiated and continued Postoperative oral nutritional supplementation has been shown to be of clinical benefit . This study examined the clinical effects and cost of administration of oral supplements both before and after surgery BACKGROUND & AIMS The aim of this study was to compare food wastage and intake between the normal hospital menu and one where more energy dense but smaller portions were provided . METHODS This study was carried out on an Elderly Rehabilitation ward in a University hospital . Patients were r and omly allocated to receive either a normal or a reduced portion size fortified menu for a 14 day cycle and then swapped-over at the end of each cycle for the 56 day study . One group received a cooked breakfast and normal menus throughout the study . RESULTS All the menu combinations could meet the patients recommended intake . The fortified menu provided 14 % more energy than the normal menu . Food wastage was highest in the cooked breakfast group ( 32 % ) and lowest in the Fortified group ( 27 % ) . The total weight of wasted food was less than in the previous study . Nutritional intakes were 25 % higher on the fortified menu compared with the normal menu . The mean protein intakes were still below that recommended . All patients had higher energy intakes on the Fortified menu compared with their intake on the normal menu despite being served a lower weight of food . CONCLUSIONS We conclude from our own data and that of others that it is possible for elderly patients to achieve their nutritional targets using a combination of smaller portions of increased energy and protein density and between-meal snacks . The needs of other groups of patients also needs to be assessed in a similar way to make hospital food appropriate to the needs of the sick BACKGROUND & AIMS Aging is associated with a blunted anabolic response to dietary intake , possibly related to a decrease in systemically available amino acids ( AAs ) , which in turn may stem from increased splanchnic AA metabolism . This splanchnic sequestration can be saturated by pulse feeding ( 80 % of daily protein intake in a single meal ) , enabling increased protein synthesis . This study aim ed to evaluate the efficacy of a new nutritional strategy , termed protein pulse feeding . METHODS This prospect i ve r and omized study ( Clinical Trials.gov registration number NCT00135590 ) enrolled 66 elderly malnourished or at-risk patients in an inpatient rehabilitation unit . All were given a controlled diet for 6 weeks . In a spread diet ( SD ) group ( n = 36 ) , dietary protein was spread over the four daily meals . In a pulse diet ( PD ) group ( n = 30 ) , 72 % of dietary protein ( 1.31 g/kg weight/d on average ) was consumed in one meal at noon . The patients were evaluated at admission and at 6 weeks for body composition [ lean mass ( LM ) , appendicular skeletal muscle mass ( ASMM ) , and body cell mass ( BCM ) indices , measured by X-ray absorptiometry combined with bioelectrical impedance analysis ] ( primary outcome ) , h and grip strength , and activities of daily living ( ADL ) score . RESULTS Protein pulse feeding was significantly more efficacious than protein spread feeding in improving LM index ( mean changes from baseline for PD group : + 0.38 kg/m(2 ) ; 95 % confidence interval ( CI ) , [ 0 ; 0.60 ] ; for SD group : -0.21 kg/m(2 ) ; 95 % CI , [ -0.61 ; 0.20 ] ; p = 0.005 between the two groups ) , ASMM index ( + 0.21 kg/m(2 ) ; 95 % CI , [ 0 ; 0.34 ] and -0.11 kg/m(2 ) ; 95 % CI , [ -0.20 ; 0.09 ] ; p = 0.022 ) , BCM index ( + 0.44 kg/m(2 ) ; 95 % CI , [ 0.08 ; 0.52 ] and -0.04 kg/m(2 ) ; 95 % CI , [ -0.09 ; 0.10 ] ; p = 0.004 ) . There was no significant effect for h and -grip strength or ADL score . CONCLUSIONS This study demonstrates for the first time that protein pulse feeding has a positive , clinical ly relevant effect on lean mass in malnourished and at-risk hospitalized elderly patients In recent years , the concept of nutritional support as a part of a comprehensive cancer management program has gained increasing acceptability . However , little data is available in regard to the effect of nutritional support programs on the chronic disease state represented by recurrent or persistent cancer that characterizes patients undergoing systemic chemotherapy . In 1977 we undertook to study this problem in a r and omized prospect i ve study design ed to evaluate the effects of long-term ( 12 months ) enteral nutritional support in a group of ambulatory breast cancer patients undergoing a st and ard cytotoxic chemotherapy treatment program  , in an adjuvant or therapeutic setting . The results of this study suggest that patients with breast cancer are overweight as compared to the general population and that any significant change in initial body weight , either a gain or a loss , is associated with an increased risk of recurrent disease . Data are presented which show little or no correlation between st and ard parameters of nutritional assessment and risk of disease recurrence and /or response to chemotherapy . These data also suggest that until we better underst and the relationship between tumor and host in breast cancer patients , we offer nutritional support programs only in situations where there are specific clinical indications for such interventions BACKGROUND & AIMS Few trials have explored the effect of nutrition support on quality of life ( QoL ) . This study examined the effects of oral nutritional supplements ( ONS ) vs dietary advice on QoL in malnourished care home residents . METHODS 104 malnourished , care home residents ( medium + high risk ) , identified using the Malnutrition Universal Screening Tool ( ' MUST ' ) , ( mean age 88.5 ± 7.9y ) were r and omised to receive either oral nutritional supplements ( ONS ) ( n = 53 ) or dietary advice ( n = 51 ) for 12 weeks . Dietary intake was measured using 24 h dietary recall , and QoL assessed using EuroQol ( EQ-5D ) , including time trade off ( TTO ) ( range -0.59 to 1 ) and visual analogue scale ( VAS ) ( score 0 to 100 ) for self-perceived health . RESULTS QoL ( adjusted for baseline QOL , malnutrition risk , type of care received ( nursing or residential ) ) was significantly higher in the ONS than the dietary advice group ( intention to treat analysis at week 12 ; n = 104 ) . EQ-5D TTO scores ( mean ± SE ) were 0.50 ± 0.04 vs 0.36 ± 0.05 ( P = 0.005 ) , VAS rescaled scores were 0.54 + 0.03 vs 0.046 + 0.03 ( P = 0.006 ) and VAS scores were 61.3 ± 4.5 vs 54.6 ± 6.3 ( P = 0.533 ) for ONS vs dietary advice respectively . Total energy , protein and the majority of micronutrient intakes were significantly greater in the ONS group , with energy intake being 423 kcal greater in the ONS than the dietary advice group at week 12 . CONCLUSIONS This study in malnourished care home residents indicates that ONS can improve QoL and nutritional intake more effectively than dietary advice alone . CLINICAL TRIAL REGISTRY This trial was registered with clinical trials.gov on 10th August 2007 . Clinical trials identifier is NCT00515125http://www . clinical trials.gov/ct2/show/NCT00515125?term=nutrition+support&rank=60 A decline in dietary intake due to inactivity and , consequently , development of a suboptimal nutritional status is a major problem in frail elderly people . However , benefits of micronutrient supplementation , all-round physical exercise or a combination of both on functional biochemical and hematologic indicators of nutritional and health status in frail elderly subjects have not been tested thoroughly . A 17-wk r and omized controlled trial was performed in 145 free-living frail elderly people ( 43 men , 102 women , mean age , 78 + /- 5.7 y ) . Based on a 2 x 2 factorial design , subjects were assigned to one of the following : 1 ) nutrient-dense foods , 2 ) exercise , 3 ) both ( 1 ) and ( 2 ) or 4 ) a control group . Foods were enriched with micronutrients , frequently characterized as deficient [ 25 - 100 % of the recommended daily allowance ( RDA ) ] in elderly people . Exercises focused on skill training , including strength , endurance , coordination and flexibility . Dietary intake , blood vitamin levels and nutritional and health indicators , including (pre)albumin , ferritin , transferrin , C-reactive protein , hemoglobin and lymphocytes were measured . At baseline , 28 % of the total population had an energy intake below 6.3 MJ , up to a maximum of 93 % having vitamin intakes below two thirds of the Dutch RDA . Individual deficiencies in blood at baseline ranged from 3 % for erythrocyte glutathione reductase-alpha to 39 % for 25-hydroxy vitamin D and 42 % for vitamin B-12 . These were corrected after 17 wk in the two groups receiving the nutrient-dense foods , whereas no significant changes were observed in the control or exercise group . Biochemical and hematologic indicators at baseline were within the reference ranges ( mean albumin , 46 g/L ; prealbumin , 0.25 g/L ; hemoglobin , 8.6 mmol/L ) and were not affected by any of the interventions . The long-term protective effects of nutrient supplementation and exercise , by maintaining optimal nutrient levels and thereby reducing the initial chance of developing critical biochemical values , require further investigation . Other indicative functional variables for suboptimal nutritional status , in addition to those currently selected , should also be explored Body composition changes and loss of functionality in the elderly are related to subst and ard diets and progressive sedentariness . The aim of this study was to assess the impact of an 18-mo nutritional supplementation and resistance training program on health functioning of elders . Healthy elders aged > or = 70 y were studied . Half of the subjects received a nutritional supplement . Half of the supplemented and nonsupplemented subjects were r and omly assigned to a resistance exercise training program . Every 6 mo , a full assessment was performed . A total of 149 subjects were considered eligible for the study and 98 ( 31 supplemented and trained , 26 supplemented , 16 trained and 25 without supplementation or training ) completed 18 mo of follow-up .  Compliance with the supplement was 48 % , and trained subjects attended 56 % of programmed sessions . Activities of daily living remained constant in the supplemented subjects and decreased in the other groups . Body weight and fat-free mass did not change . Fat mass increased from 22.2 + /- 7.6 to 24.1 + /- 7.7 kg in all groups . Bone mineral density decreased less in both supplemented groups than in the nonsupplemented groups ( ANOVA , P < 0.01 ) . Serum cholesterol remained constant in both supplemented groups and in the trained groups , but it increased in the control group ( ANOVA , P < 0.05 ) . Upper and lower limb strength , walking capacity and maximal inspiratory pressure increased in trained subjects . In conclusion , patients who were receiving nutritional supplementation and resistance training  maintained functionality , bone mineral density and serum cholesterol levels and improved their muscle strength Twenty-one patients undergoing regular hemodialysis completed a trial of energy supplementation . Nine patients added the glucose polymer Polycose to their usual diet and 12 acted as control subjects . The supplemented patients were asked to incorporate 100 or 150 g polymer , equivalent to 1600 or 2400 kJ ( 400 or 600 kcal ) into their usual diet , daily for 6 mo . This result ed in a mean increase in energy intake of 1630 kJ ( p less than 0.05 ) and a mean weight gain of 3.1 kg ( p less than 0.005 ) . The addition of glucose polymer to the diet result ed in a mean increase in body fat of 1.8 kg and the lean body mass increased by 1.3 kg . No significant effect on plasma triglycerides , urea , or creatinine was detected . The intake of macro- and micronutrients was not adversely affected and no clinical or psychological side effects were reported . Follow-up of these patients showed that the weight gain was maintained after 6 mo . Glucose polymer was an effective energy supplement that had beneficial effects on the nutritional status of hemodialysis patients This study aim ed to evaluate whether food fortification and snacks could increase the energy and protein intakes of hospital patients . The control group of 82 consecutive admissions on medical , elderly care and orthopaedic wards ate freely from the hospital menu . Subsequently , an intervention group of 62 patients were offered fortified food and snacks , providing an extra 22.2|g protein/day and 966 kcal/day in addition to the st and ard menu . Fortification significantly increased energy intake in the intervention group ( P = 0.007 , independent sample s t-test ) , having the greatest effect on groups with the lowest energy intake , that is male and female orthopaedic , female medical and female elderly patients ( 84 cent of total ) . The increases in energy intake were 21.3 cent , 21.4 cent , 23 cent and 19.6 cent respectively . Although the increased energy and protein intake represented 25.6 cent and 22.5 cent respectively , of the supplements given , and suggested that wastage was high , it was nevertheless sufficient to remove energy deficit . We therefore propose that provision of fortified food and snacks is a convenient method of improving the nutritional intakes of hospital patients 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 BACKGROUND Nutrition support in orthopedic patients with malnutrition shortens the immobilization period . The efficacy of calcium β-hydroxy-β-methylbutyrate ( CaHMB ) , vitamin D , and protein intake on bone structure is studied and well known ; however , there is no evidence supporting the effect of combined use in orthopedic conditions . We investigated the effects of CaHMB , vitamin D , and protein supplementation on wound healing , immobilization period , muscle strength , and laboratory parameters . MATERIAL S AND METHODS This r and omized controlled study included 75 older female patients with a hip fracture admitted to orthopedic clinics . The control group received st and ard postoperative nutrition . The study group received an enteral product containing 3 g CaHMB , 1000 IU vitamin D , and 36 g protein , in addition to st and ard postoperative nutrition . Anthropometric , laboratory , wound-healing , immobilization period , and muscle strength assessment s were evaluated preoperatively and on postoperative days 15 and 30 . RESULTS Wound-healing period was significantly shorter in the CaHMB/vitamin D/protein group than in the control group ( P < .05 ) . The number of patients in the CaHMB/vitamin D/protein group who were mobile on days 15 and 30 ( 81.3 % ) was significantly higher than patients in the control group , who were mobile on days 15 and 30 ( 26.7 % ) ( P = .001 ) . Muscle strength on day 30 was significantly higher in the CaHMB/vitamin D/protein group vs the control group . CONCLUSION Nutrition of elderly patients  with a CaHMB/vitamin D/protein combination led to acceleration of wound healing , shortening of immobilization period , and increased muscle strength without changing body mass index . It also reduced dependence to bed and related complications after an orthopedic operation Short-term nutritional supplements enable an improvement in Alzheimer patients ’ nutritional status , but it remains to be seen whether they will be sufficient to improve long-term nutritional status . The aim of this study was to evaluate the long-term impact of a 3-week nutritional supplementation on the nutritional status of undernourished patients with probable mild Alzheimer disease . A 21-day prospect i ve r and omized nonblinded controlled trial was conducted . Patients were followed-up for an additional period until the 90th day after the beginning of the intervention . Intervention result ed in significant improvements in Mini Nutritional Assessment ( MNA ) score [ Mean=1.4 , st and ard deviation (SD)=0.8 vs. 0.0 ( 0.1 ) in the control group , P<0.001 ] and also in anthropometrical and serum biomarkers of Alzheimer disease ( AD ) patients ’ nutritional status . Further improvements in the AD patients ’ MNA mean score=1.4 ( SD=2.3 ) versus —0.5 ( SD=0.6 ) in the control group ( P=0.003 ) were seen at 90 days follow-up . Data show that a 3-week nutritional supplementation has a positive long-term impact on the nutritional status of undernourished patients with mild probable AD BACKGROUND & AIMS Old patients seldom reach their energy requirements . The effects of an oleic acid rich formula on energy intake and appetite were studied . METHODS Recently admitted geriatric patients ( n = 71 ) , likely to stay > 1 week were r and omised to receive 30 ml of a fat emulsion ( Calogen ( ® ) ) 3 times daily , i.e. , 420 kcal , at the regular medication rounds ( intervention group ( IG ) ) or to st and ard care ( control group ( CG )  ) . Food intake and self-rated appetite were registered at baseline , i.e. , 2 - 3 days after admission and on day 8 or the day prior to discharge . Nutritional risk screening ( NRS ) 2002 , serum lipids and fatty acid profiles were analysed . RESULTS Fifty-one subjects fulfilled the study , i.e. , 24 in the IG ( 83 ± 7 y ) and 27 controls ( 85 ± 7 y ) . NRS showed that two thirds were at risk of malnutrition . Per- protocol analyses indicated that the daily energy intake was around 50 % higher in IG compared to CG at the two measurements , respectively ( p < 0.0001 ) . The IG displayed a significantly improved appetite compared with the CG ( P = 0.021 ) . Serum lipids and fatty acid profile changed favourably by the intervention . CONCLUSIONS An energy dense oleic acid rich liquid supplement given three times daily at medication rounds to geriatric patients may result in increased energy intake and better appetite with positive effects on serum lipids . Clinical Trials.gov Identifier : NCT01042340 OBJECTIVE The objective was to determine whether provision of oral nutritional supplements , delivered by community nurses , could improve nutritional status and wound healing in home-nursed elderly . METHODS This was a double-blind , r and omized trial in 50 elderly patients referred for wound management . Patients received 237 mL/d of 4 or 8 kJ/mL of an oral nutritional supplement for 4 wk . Nutritional status was measured with the Subjective Global Assessment and the Mini-Mental State Examination question naire to determine cognitive function and wound characteristics to assess healing . Differences between variables were examined with the Mann-Whitney or Student 's t test for comparing two groups , one-way analysis of variance when there was more than two groups , and chi-square analysis for comparing two categorical variables . Associations between variables were examined with Pearson 's correlation and regression analysis . RESULTS At baseline , 34 % subjects were moderately malnourished and 8 % were severely malnourished . In both groups , there was significantly greater improvement in Mini-Mental State Examination scores at week 4 ( 95 % confidence interval -2.0 to -0.001 , P = 0.04 ) and a greater decrease in the wound effusion score ( 95 % confidence interval -2.0 to 0.0 , P = 0.045 ) . Median length of stay did not differ between groups ( P > 0.05 ) . CONCLUSIONS Malnutrition is common in elderly patients who are nursed at home for wound management . Provision of energy- and protein-dense oral supplements by community nurses is effective in improving some indices of wound healing and cognitive function in this group . Although further study is needed to determine the effect on length of stay , the nutritional needs of this vulnerable group should not be overlooked 59 elderly patients ( mean age 82 ) with femoral neck fractures were r and omised into two groups . 27 patients received daily an oral nutrition supplement ( 250 ml , 20 g protein , 254 kcal ) for a mean of 32 days ; 32 patients acted as controls . On admission most patients had nutritional deficiencies . Despite being offered adequate quantities , nutritional requirements were not met during the hospital stay . Clinical outcome was significantly better in the supplemented group ( 56 % favourable course vs 13 % in controls ) during the stay in the convalescent hospital . The rates of complications and deaths were also significantly lower in supplemented patients ( 44 % vs 87 % ) . 6 months after the fracture the rates of complications and mortality were significantly lower in supplemented patients ( 40 % vs 74 % ) . The median duration of hospital stay was significantly shorter in the supplemented group ( 24 vs 40 days ) . Thus the clinical outcome of elderly patients with femoral neck fracture can be improved by once daily dietary oral supplementation BACKGROUND Malnutrition is highly prevalent in peritoneal dialysis ( PD ) patients and is associated with a poor prognosis . Attempts to improve nutritional status with enteral supplements have yielded poor results . METHODS We performed a crossover- design trial on 13 PD patients to investigate whether these patients reduce their food intake after drinking oral nutritional supplements . Patients attended three visits in which they were administered a st and ard oral nutritional supplement either 2 hours or 30 minutes before lunch or a placebo drink 30 minutes before lunch . Lunch was provided as a self-select buffet-style meal , and food intake was measured .  Total intake was calculated by adding the nutritional content of the oral supplement . RESULTS Patients showed poor food intake , with mean values equaling only 18 % of the recommended daily intake for calories and 34 % for protein . Drinking the supplement 2 hours before lunch result ed in a significant increase compared with the placebo visit in total caloric ( 430 to 843 kcal ; P < 0.001 ) and protein intake ( 27.6 to 41.3 g ; P = 0.006 ) . No significant difference in total intake was detected between drinking the supplement 2 hours versus 30 minutes before lunch . CONCLUSION These results indicate that oral nutritional supplements administered before a meal may significantly increase caloric and protein intakes of PD patients BACKGROUND Patients who undergo surgery are at risk of malnutrition due to periods of starvation , the stress of surgery , and subsequent increase in metabolic rate . There are limited data on nutritional outcome of surgical patients . AIMS To investigate changes in nutritional status and the influence of oral supplements on nutritional status , morbidity , and quality of life in postoperative surgical patients . METHODS Entry was determined by the presence of malnutrition , as defined by a body mass index ( BMI ) ⩽20 kg/m2 , anthropometric measurements ⩽15th percentile on admission , or initiation of oral diet postoperatively and /or a weight loss of 5 % or more during the operative period . We studied 101 patients : 52 were r and omised to the treatment group ( TG ) and prescribed a 1.5 kcal/ml nutritional supplement ; 49 patients were r and omised to the control group ( CG ) and continued with routine nutritional management .  Nutritional status was assessed by weight , anthropometry , and grip strength , with measurements taken at two weekly intervals for 10 weeks . Complications , namely wound infection , chest infection , and antibiotic use were documented . Quality of life ( QOL ) was assessed using the UK SF-36 question naire . RESULTS Patients in the control group lost a maximum mean ( SD ) of 5.96 ( 4.21 ) kg in weight over a period of eight weeks while patients in group TG lost less weight overall ( maximum mean ( SD ) 3.40 ( 0.89 ) kg ( p<0.001 ) occurring at four weeks and progressively regained weight from week 4 ) . Anthropometry , grip strength , and QOL were similarly significantly different between groups ( p<0.001 ) . Fewer patients in the treatment group ( 7/52 ) required antibiotic prescriptions compared with the control group ( 15/49 ) . CONCLUSIONS Nutritional status declined for two months after discharge . Postoperative nutritional supplementation improved nutritional status , QOL , and morbidity in these patients Objectives Administration of oral nutritional supplements ( ONS ) is an effective strategy to treat and avoid malnutrition , a persisting issue in nursing homes . However , little is known about compliance in the NH population . This study aim ed to analyse the effects of compliance of NH residents with a low-volume , nutrient and energy-dense ONS  on nutritional status and to identify residents ’ characteristics associated with compliance . Design & Setting R and omized , controlled trial in nursing homes . Participants & Intervention87 nursing home residents ( 87±6y , 91 % female ) with malnutrition or at risk of malnutrition were r and omly allocated to an intervention group ( IG ) receiving 2 × 125 ml ONS ( 2.4 kcal/ml)/d for 12 weeks , or the control group ( CG ) with usual care .  Measurements ONS intake was recorded daily and compliance calculated . Low and high compliance were defined as ≤30 % and ≥80 % of provided ONS actually consumed , respectively . Body weight ( BW ) , BMI , upper-arm ( UAC ) and calf-circumference ( CC ) and MNA-SF were assessed at baseline and after 12 weeks . Associations between compliance and changes of nutritional parameters and residents ’ characteristics were analysed . Results Compliance was high in 35.7 % and low in 28.6 % of the IG ( n=42 ) . BW change was significantly higher in subjects with high compliance ( median + 3.0 ( interquartile range + 2.1;+3.8 ) kg , n=15 ) than in those with low compliance ( −0.2 ( −2.2;+1.6 ) kg , n=12 ) and CG ( −0.1 ( −1.2 ; + 0.6 ) kg , n=35 ; p<0.001 ) , and significantly correlated with compliance in IG ( r=0.691 ; p<0.001 ) . Significant differences and correlations were also identified for BMI , UAC and MNA-SF . High compliance was more often observed in residents with malnutrition ( 66.7 vs. 27.3 % ) and chewing difficulties ( 77.8 vs. 24.2 % ) than in those without these conditions . Low compliance was more prevalent in residents who were immobile ( 45.0 vs. 13.6 % ) , depressed ( 33.3 vs. 6.7 % ) or had gastrointestinal  complaints ( 50.0 vs. 17.9 % ) ( all p<0.05 ) . Conclusions A high compliance of nursing home residents with a low volume , nutrient- and energy dense ONS was related to a significantly improved nutritional status in comparison to low compliance and therefore enhanced the effectiveness of ONS . A higher compliance may be achieved by consideration of different residents ’ characteristics Objectives High rates of malnutrition have been reported in the older hospitalized patient population . This is recognised to impact on patient outcomes and health costs . This study aim ed to assess the impact of nutrition screening and intervention on these parameters . Design R and omised controlled prospect i ve study . Setting The study was performed in the acute geriatric medicine wards of the Prince of Wales Hospital , Sydney Australia . Participants All patients admitted to these wards under a geriatrician with an expected length of stay of at least 72 hours were considered for the study .Intervention Patients were screened on admission for malnutrition using the Mini Nutritional Assessment ( MNA ) tool and r and omly assigned to control or intervention groups . Intervention patients were immediately commenced on a malnutrition care plan ( MCP ) . Control patients were only commenced on a MCP if referred by clinical staff . Measurements Length of stay ( LOS ) , weight change and frequency of readmission to hospital were compared between the groups . Results 143 patients were screened . 119 were identified as malnourished ( MN ) or at risk of malnutrition ( AR ) .  Overall LOS was not different between the two groups ( control v. intervention : 13.4 ± 1.3 days v. 12.5 ± 1.2 days , p=0.64 ) . However there was a significant decrease in LOS in the MN ( control v. intervention : 19.5 ± 3days v. 10.6 ± 1.6 days , p=0.013 ) and a trend to reduced readmissions . There was no difference in weight change over admission between the groups . Without screening , clinical staff identified only a small proportion of malnourished patients ( 35 % of MN and 20 % of AR ) . Conclusions Malnutrition in the older hospital population is common . Malnutrition screening on hospital admission facilitated targeted nutrition intervention , however length of stay and representations were only reduced in older malnourished patients with an MNA score less than 17 Abstract Objective To assess the effect of family style mealtimes on quality of life , physical performance , and body weight of nursing home residents without dementia . Design Cluster r and omised trial . Setting Five Dutch nursing homes . Participants 178 residents ( mean age 77 years ) . Two wards in each home were r and omised to intervention ( 95 participants ) or control groups ( 83 ) . Intervention During six months the intervention group took their meals family style and the control group received the usual individual pre-plated service . Main outcome measures Quality of life ( perceived safety ; autonomy ; and sensory , physical , and psychosocial functioning ) , gross and fine motor function , and body weight . Results The difference in change between the groups was significant for overall quality of life ( 6.1 units , 95 % confidence interval 2.1 to 10.3 ) , fine motor function ( 1.8 units , 0.6 to 3.0 ) , and body weight ( 1.5 kg , 0.6 to 2.4 ) . Conclusion Family style mealtimes maintain quality of life , physical performance , and body weight of nursing home residents without dementia . Trial registration Clinical trials The impact of oral nutritional supplementation during an acute exacerbation of COPD on functional status was assessed through measuring change in lung function , strength testing , and general well-being .  Subjects hospitalized for an acute exacerbation of COPD ( n = 33 ) were r and omized to extra nutritional support or the regular hospital care . They consumed an additional 10 kcal/kg/d . Outcome measures were measured at 2 wk as change scores . Forced vital capacity ( % predicted ) improved in the treatment group as compared with the control group ( + 8.7 % versus -3.5 % , p = 0.015 ) , and change in FEV1 was in the same direction but not significantly different ( p = 0.099 ) . There were no changes in h and grip strength or respiratory muscle strength , but there was a trend towards more improvement in the general well-being score ( + 11.96 versus -10.25 , p = 0.066 ) . Almost all subjects were in negative nitrogen balance , indicating muscle wasting . The degree of muscle wasting was strongly correlated with the dose of corticosteroids ( r = 0.73 , p < 0.005 ) . In conclusion , it is difficult to prevent important muscle wasting in patients with COPD treated with corticosteroids , but some small gains were observed with increased dietary intake OBJECTIVES To determine why elderly nursing home patients receive liquid oral protein supplements , what nutritional assessment is utilized , and whether there is evidence of effectiveness . DESIGN Retrospective , case control study comparing patients over 65 years of age , at two nursing homes , who were served oral supplements ( OS ) at least twice daily ( n = 56 ) , with a r and om sample of non-supplemented , non-tube fed patients ( n = 53 ) . Comparisons included medical diagnoses , medications , morbidity and mortality , weight changes , laboratory test results , and functional and behavioral status . RESULTS Nursing home patients were begun on OS ( median time after admission = 2 months , range = 0 - 72 months ) primarily because of weight loss ( 71 % ) and poor appetite ( 16 % ) . Supplemented patients were below an age-adjusted body weight on admission , unlike controls , and continued to lose weight until OS were started . On OS , weight was slowly regained over 9 - 10 months in a majority of patients to approximate admission weight . Some patients on OS showed improvement in albumin , total lymphocyte count , cholesterol , or hemoglobin , but too few patients had sufficient lab tests to verify any consistent effect . Mortality was higher in OS patients ( 8 vs 2 , P = 0.057 ) , who were also somewhat older ( 87.9 vs 84.5 years ) , but there was no statistical difference in infection or hospitalization rate . MEASUREMENTS Nutritional assessment in these nursing homes consisted almost exclusively of ( 1 ) serial measurement of weight , ( 2 ) comparison of weight to ( a ) " ideal body weight " and ( b ) previous weight , and ( 3 ) a subjective evaluation of food consumption . No other anthropometric evaluations or laboratory tests were conducted for nutritional assessment . CONCLUSIONS The diagnosis of and intervention in under-nutrition in nursing home patients is frequently disorganized . In addition , nutritional assessment , either for screening or for following intervention , is hampered by the lack of convenient and unambiguous assessment tools . OS use is associated with weight gain in many nursing home patients and also improves other nutritional parameters in selected individuals 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 OBJECTIVE Aging is associated with a blunted anabolic response to dietary intake , possibly related to a decrease in systemically available amino acids ( AAs ) , which in turn may stem from increased splanchnic AA metabolism . Splanchnic sequestration can be saturated by pulse feeding ( 80 % of daily protein intake in a single meal ) , enabling increased protein synthesis . The aim of this study was to explore whether protein pulse feeding increased postpr and ial AA concentrations , and if so whether this increase persisted after 6 wk of dietary treatment . METHODS This prospect i ve r and omized study enrolled 66 elderly malnourished or at-risk patients in an inpatient rehabilitation unit . All were given a controlled diet for 6 wk . In a spread diet ( SD ) group ( n = 36 ) , dietary protein was spread over the four daily meals . In a pulse diet ( PD ) group ( n = 30 ) , 72 % of dietary protein ( averaging 1.31 g/kg body weight daily ) was consumed in one meal at noon . The patients were evaluated on day 1 and at 6 wk for plasma postpr and ial ( five times from 0 to + 180 min ) AA concentrations ( expressed as area under the curve above baseline ) . RESULTS Protein pulse feeding was more efficient than protein spread feeding at increasing plasma postpr and ial AA concentrations , notably of essential AAs . This increased postpr and ial AA bioavailability was maintained after 6 wk . CONCLUSIONS This study demonstrates that increased postpr and ial AA bioavailability induced by protein pulse feeding persists after 6 wk ( i.e. , that there is no metabolic adaptation blunting AA bioavailability ) BACKGROUND The impact of influenza infection on morbidity and mortality in the elderly population can be severe . Influenza vaccination is not very effective in this age group , which is potentially related to impaired nutritional status . We investigated the effect of a 7-month nutritional supplementation on antibody response to influenza vaccine  in elderly people . METHODS Nineteen subjects aged 65 years and older with a body mass index of 25 kg/m(2 ) or less were studied . Subjects received a complete liquid nutrition supplement containing energy , vitamins , and minerals , including enhanced levels of antioxidants or noncaloric placebo drink for 7 months . Antibody titers to influenza strains A/Sydney/5/97 ( SY ) , A/Beijing/262/95 ( BE ) , and B/Yamanashi/166/98 ( YA ) before and 28 days after vaccination were measured . Age , gender , weight , height , serum albumin , serum prealbumin , hemoglobin , and serum vitamin E at baseline were registered . RESULTS Mean fold increase upon vaccination for SY was significantly larger in the supplement group ( 2.76 + /- 0.66 ) compared to the placebo group ( 1.91 + /- 0.66 ) . These differences were not observed for YA ( 1.73 + /- 0.31 vs 1.19 + /- 0.18 ) and BE ( 4.40 + /- 2.63 vs 5.76 + /- 3.34 ) . For all three strains , there was no significant difference between groups in protective antibody levels ( HI titer > or = 40 ) after vaccination . CONCLUSIONS We conclude that provision of a complete liquid nutrition supplement including enhanced levels of antioxidants may have a beneficial effect on antibody response to influenza vaccination in the elderly population . Further confirmation of these findings and their clinical consequences should be the subject of a larger study Background : Pulmonary rehabilitation is effective in improving exercise performance and health status in chronic obstructive pulmonary disease ( COPD ) . However , the role of nutritional support in the enhancement of the benefits of exercise training has not been explored . A double blind , r and omised , controlled trial of carbohydrate supplementation was undertaken in patients attending outpatient pulmonary rehabilitation . Methods : 85 patients with COPD were r and omised to receive a 570 kcal carbohydrate rich supplement or a non-nutritive placebo daily for the duration of a 7 week outpatient pulmonary rehabilitation programme . Primary outcome measures were peak and submaximal exercise performance using the shuttle walk tests . Changes in health status , body composition , muscle strength , and dietary macronutrient intake were also measured . Results : Patients in both the supplement and placebo groups increased shuttle walking performance and health status significantly . There was no statistically significant difference between treatment groups in these outcomes . Patients receiving placebo lost weight whereas supplemented patients gained weight . In well nourished patients ( BMI > 19 kg/m2 ) improvement in incremental shuttle performance was significantly greater in the supplemented group ( mean difference between groups : 27 ( 95 % CI 1 to 53 ) m , p<0.05 ) . Increases in incremental shuttle performance correlated with increases in total carbohydrate intake . Conclusions : When universally prescribed , carbohydrate supplementation does not enhance the rehabilitation of patients with COPD . This study suggests that exercise training results in negative energy balance that can be overcome by supplementation and that , in selected patients , this may improve the outcome of training . The finding of benefit in well nourished patients may suggest a role for nutritional supplementation beyond the treatment of weight loss in COPD Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more 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 Despite recognition that weight loss is a problem in elderly persons with probable Alzheimer 's disease ( AD ) , increasing their food intake remains a challenge . To effectively enhance intake , interventions must work with individuals ' changing needs and intake patterns . Previously , the authors reported greater food consumption at breakfast , a high-carbohydrate meal , compared with dinner , and shifts toward carbohydrate preference at dinner in those with increased behavioral difficulties , low body mass index , or both . METHODS Thirty-four nursing home residents with probable AD who ate independently participated in a r and omized , crossover , nonblinded study of two nutrition interventions . The intervention described here included replacing 12 nonconsecutive " traditional " dinners with meals high in carbohydrate but comparable to traditional dinners in protein . Measures included weighed food intake , body weight , cognitive function ( as assessed using the Severe Impairment Battery and Global Deterioration Scale ) , behavioral disturbances ( as assessed using the Neuropsychiatric Inventory-Nursing Home Version ) , and behavioral function ( as assessed using the London Psychogeriatric Rating Scale ) . RESULTS Group mean dinner and 24-hour energy intake increased during the intervention phase compared with baseline , protein intake was unaffected , and carbohydrate intake increased . Increased dinner intake , attributable to intervention foods , was achieved in 20 of 32 of participants who completed the study and was associated with increased carbohydrate preference , poorer memory , and increased aberrant motor behavior . Those with low body mass indices were the most resistant to the intervention . CONCLUSIONS Providing a high-carbohydrate meal for dinner increases food intake in seniors at later stages of the disease who are experiencing cognitive and behavioral difficulties , possibly as a result of a shift in preference for high-carbohydrate foods OBJECTIVE To test the feasibility of two models of home meal delivery with Meals-on-Wheels ( MOW ) applicants who were identified as being malnourished or " at-risk " as determined by the vali date d Mini Nutritional Assessment ( MNA ) . DESIGN A 6-month , prospect i ve comparative study of two nutrition intervention models with data collection at baseline , 3 months , and 6 months . R and omized treatment assignment was followed , with a few exceptions linked to particular client circumstances . SUBJECTS A total of 203 older adults ( age range = 60 to 90 years ) newly applying for homebound meal service were enrolled . At baseline , the body mass index ( BMI ) was 26.3+/-7.2 ( mean+/-SD ) in the " Traditional " MOW model ( 101 subjects including 30 malnourished ) , and the BMI was 27.6+/-9.0 in the " New " MOW model ( 102 subjects including 26 malnourished ) ( P = ns ) . INTERVENTION Study participants received either the Traditional MOW program of five hot meals per week , meeting 33 % of the Daily Reference Intake ( DRI ) or the restorative , comprehensive New MOW program of three meals and two snacks per day , 7 days a week , meeting 100 % of the DRI . Assessment s were conducted in the home of the participants . Main outcome measures The MNA was used to evaluate nutritional risk and status of participants at baseline , 3 months , and 6 months . St and ardized functional impairment scales , Activities of Daily Living ( ADL ) , and Instrumental Activities of Daily Living ( IADL ) evaluated limitations in activities of daily living and life management skills . Statistical analysis Comparisons between treatment groups were calculated with t tests or Wilcoxon rank-sum tests when appropriate . Comparisons among time periods between treatment groups were conducted with repeated measures analysis of variance . A general linear model was used to evaluate the relationship between change in functional status and BMI , controlling for sex . RESULTS The New MOW group gained significantly more weight between baseline and 3 months than did the Traditional MOW group ( 2.78 lb vs -1.46 lb , respectively , P = .0120 ) and again between baseline and 6 months ( 4.30 lb vs -1.72 lb , respectively , P = .0004 ) . MNA improved faster in the New MOW group . Functional change appeared to be related more to BMI and age than to treatment intervention . The malnourished participants in both groups took longer to affect positive change in nutrition measurements , with the New MOW group showing the most improvement over the 6-month measurement period . Both delivery models were well accepted . CONCLUSIONS Applicants for home meal delivery have varying nutrition needs . By addressing nutritional risk , interventions can be targeted to meet these needs . A new , restorative , comprehensive meal program improved nutritional status and decreased nutritional risk and can possibly impact independence and functionality We conducted a study design ed to evaluate the efficacy and feasibility of a multilevel self-management intervention to improve  nutritional intake in a group of older adults receiving Medicare home health services who were at especially high risk for experiencing undernutrition . The Behavioral Nutrition Intervention for Community Elders ( B-NICE ) trial used a prospect i ve r and omized controlled design to determine whether individually tailored counseling focused on social and behavioral aspects of eating result ed in increased caloric intake and improved nutrition-related health outcomes in a high-risk population of older adults . The study was guided by the theoretical approaches of the Ecological Model and Social Cognitive Theory . The development and implementation of the B-NICE protocol , including the theoretical framework , methodology , specific elements of the behavioral intervention , and assurances of the treatment fidelity , as well as the health policy implication s of the trial results , are presented in this article 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 BACKGROUND To examine whether the nutritional status of aged undernourished residents in care could be improved through dietary modification to increase energy intake but not portion size . METHODS A 12-week cluster r and omised controlled trial was carried out in 21 residential care homes . Participants comprised undernourished residents with a body mass index ( BMI ) < 18.5 kg m(-2 ) . All menus were analysed to evaluate nutrient provision . Energy and macronutrient intakes of undernourished residents were estimated using 3-day weighed food intake diaries . Those resident in homes r and omised to intervention had their usual meals enriched with energy-dense foods to a maximum of + 1673 kJ day(-1 ) . RESULTS Of 445 residents screened , 41 ( 9 % ) had a BMI < 18.5 kg m(-2 ) and entered the study . Despite adequate food provision , energy and macronutrient intakes were below UK dietary reference values . Mean ( SEM ) energy intake increased [ + 556 ( 372 ) kJ , P = 0.154 ] in residents allocated to intervention but fell in those residents in ' control homes ' receiving usual care [ -151 ( 351 ) kJ , P = 0.676 ] . Weight change [ + 1.3 ( 0.53 ) kg , P = 0.03 ] was seen in intervention residents but not in controls [ -0.2 ( 1.5 ) kg , P = 0.536 ] . Between-group differences for changes in weight and energy intake were not significant ( P = 0.08 and 0.20 , respectively ) . Six residents allocated to the intervention increased their BMI > 18.5 kg m(-2 ) ( P = 0.018 ) . CONCLUSIONS Achieving weight gain in frail older people is difficult . These results suggest that enriching food could help address undernutrition and slow chronic weight loss . Interventions of a longer duration are needed to confirm or exclude the value of food enrichment BACKGROUND & AIMS Although antiviral treatment for hepatitis C ( HCV ) is highly effective , side effects often occur , including weight loss , digestive symptoms , and impaired quality of life . We aim ed at exploring the beneficial effects of preventive nutritional support . METHODS In a r and omized controlled trial , 53 HCV patients were allocated to " on dem and " support ( n=26 : nutritional intervention if weight loss > 5 % ) or preventive support ( n=27 : regular dietary advice plus energy- and protein-rich evening snack )  . Nutritional state ( including vali date d Jamar H and Grip Strength ) , digestive symptoms ( visual analog score ) , and quality of life ( SF-36 survey ) were evaluated at baseline , and after 24 and 48 weeks of peginterferon α-2b and ribavirin treatment . RESULTS The primary end point ( weight loss at 24 weeks ) was reached in 22 patients in both groups . Weight decreased markedly in the " on dem and " group ( decrease at 24 weeks : 5.4 kg or 6.9 % , p<0.001 ) , but not in the preventive group ( decrease 0.3 kg or 0.3 % , p = n.s . ) . Jamar H and Grip Strength deteriorated in the " on dem and " group ( from 40.3 ± 15.5 kg to 32.0 ± 13.1 kg , p<0.001 ) but not in the preventive group ( from 40.7 ± 10.4 kg to 39.7 ± 8.9 kg , p = n.s . ) . Intake of energy , proteins , and fat decreased markedly in the " on dem and " group but increased in the preventive group . Although digestive symptoms and quality of life deteriorated , impairment was significantly less in the preventive group . CONCLUSIONS Preventive nutritional advice plus supplementation prevents weight loss and catabolic state during HCV antiviral therapy , with improved digestive symptoms and quality of life BACKGROUND & AIMS Oral nutritional supplements ( ONS ) are often considered for hospitalized patients with acute severe malnutrition , however the compliance to the supplements is known to be variable . The aim of our study was to investigate whether providing a lower volume of ONS at a higher frequency during medication rounds would improve the intake of the supplements . METHODS In this r and omized controlled trial , 234 malnourished in patients ( mean age 71.2 years , 55 % male , median LOS 10 days ) were r and omized to receive ONS ( 300 kcal and 12 g Protein per 125 ml serving ) in one of three different schemes . The usual care group ( n = 88 ) was offered ONS 125 ml twice per day in between meals . This was compared to two intervention groups that were offered ONS during medication rounds : intervention group 1 ( n = 66 ) received 125 ml of ONS twice per day , at 12 and 17 o'clock , and intervention group 2 ( n = 80 ) received 62 ml of ONS four times a day , at 8 , 12 , 17 and 20 o'clock . Follow-up was performed until discharge or until ONS was no longer needed , with a maximum follow-up period of 30 days . The primary outcome measure was the percentage of patients who consumed at least 75 % of the prescribed volume of ONS .  RESULTS No significant differences were observed between the control groups and intervention group 1 ( risk difference of -16.0 % ( 95 % CI -33.2 - 1.2 ) . However , the percentage of patients consuming at least 75 % of the prescribed ONS  was higher in intervention group 2 , with a risk difference 23.4 % ( 95 % CI 7.8 - 39.0 % ) and a mean increased intake of 35 ml ( 84 kcal ) per day , p < 0.001 ) . Median time ONS were taken was 5 days ( range 1 - 17 ) . CONCLUSION A higher frequency of a lower volume of ONS during medication rounds increased the compliance of patients needing ONS . Clinical trial registration number NTR2535 ; www.trialregister.nl Background Sarcopenia is strongly associated with an inadequate intake of dietary protein . Dietary protein supplementation boosts muscle-protein synthesis and increases muscle mass in the elderly . This study tested whether adding a protein-rich food , ricotta cheese , to the habitual diet increased total appendicular skeletal muscle mass and strength in elderly people . Methods Participants ( n = 40 ) , were sarcopenic elderly men and women over 60 years of age . Two comparison groups were formed at r and om and followed for 3 months : the intervention group received 210 g/day of ricotta cheese plus the habitual diet , while the control group followed the habitual diet with no additional intervention . Total appendicular skeletal muscle ( TASM ) was assessed by dual-energy X-ray absorptiometry , while strength was measured using a h and held dynamometer at baseline and after the intervention period . The primary outcomes were the percentage of relative change in TASM and strength . Results The percentage of relative change in TASM was not significant between the groups after the intervention period . Muscle strength improved in the intervention group , but showed only a tendency towards significance ( P = 0.06 ) . Secondary analysis showed that the men in the intervention group gained 270 g in TASM compared to those in the control group , and improved their fasting insulin levels ( P = 0.05 ) , muscle strength , lean body mass in the arms , and body weight variables . Conclusion The results of this study indicate that a nutritional intervention using a high- quality protein food , specifically ricotta cheese , in order to increase the amount of protein intake might not be regarded as fully promising in elderly men and women with sarcopenia . However , the gender effects on muscle strength , lean tissue in the arms , homeostatic assessment of insulin resistance , and body weight detected in this study suggest that additional research is needed on elderly male subjects with sarcopenia Elderly patients are at high risk of malnutrition and sarcopenia , promoting further morbidity which in turn decreases quality of life and increases the cl aim ing of medical services and associated costs . Early and sustained administration of oral nutritional supplements has been shown to improve the nutritional status with robust clinical benefit . Many patients however , poorly adhere to prescribed supplements , so consistent monitoring is needed . Clinical monitoring usually ends with the discharge rendering the continuation of nutritional supplement therapy in the patient 's home problematic . We developed a telemedicine based health care concept for intensive home monitoring . In a first r and omized controlled prospect i ve study we analyzed the feasibility of this innovative approach . The intervention group received oral nutritional supplements and telemedical monitoring with daily assessment of body weight , number of taken oral energy supplements and state of health .  The control group received usual care .  13 patients were included in each group , eight patients of the intervention group left the study prematurely , five patients were closely monitored and used the devices for a mean 67 ± 63.5 days . Follow up data of body weight and BMI showed no relevant differences between both groups . The results and experiences gained in this pilot study demonstrate that telemedical systems provide encouraging new options to enable an intensive monitoring of  malnourished patients . A continuous intensive therapy monitoring of this patient group however , is a particular challenge . Albeit possibilities , limitations and useful parameters were identified , which will be used to improve the conception in an ongoing prospect i ve r and omized trial BACKGROUND & AIMS The effect of nutritional supplements on mental health in older patients has received little attention so far . The aims of this trial were therefore to test the effect of nutritional support on older patient 's depressive symptoms and cognitive function . METHODS In this prospect i ve , double-blind , placebo-controlled study , we r and omly assigned 225 hospitalised acutely ill older patients to receive either normal hospital diet plus 400 mL oral nutritional supplements ( 106 subjects ) or normal hospital diet plus a placebo ( 119 subjects ) daily for 6 weeks . The composition of the supplement was such as to provide 995 kcal for energy and 100 % of the Reference Nutrient Intakes for a healthy old person for vitamins and minerals . Outcome measures were 6 weeks and 6 months changes in nutritional status , depressive symptoms and cognitive state . RESULTS R and omisation to the supplement group led to a significant increase in red-cell folate and plasma vitamin B12 concentrations , in contrast to a decrease seen in the placebo group . There were significant differences in symptoms of depression scores in the supplement group compared with the placebo group at 6 months ( p = 0.021 for between groups difference ) . The effect of supplement was seen in all patient groups including those with no symptoms of depression , mild depression and those with severe depression ( p = 0.007 ) . There was no evidence of a difference in cognitive function scores at 6 months . CONCLUSION Oral nutritional supplementation of hospitalised acutely ill older patients led to a statistically significant benefit on depressive symptoms OBJECTIVE To determine the effect of a tailored intervention on albumin levels among hemodialysis patients . DESIGN R and omized controlled trial . SETTING Eight freest and ing chronic hemodialysis units in northeast Ohio . SUBJECTS Eighty-three r and omly selected adult patients who had been on dialysis for at least 6 months and had a mean albumin < 3.7 g/dL ( bromcresol green method ) or < 3.4 g/dL ( bromcresol purple method ) for the last 3 months . To better eluci date the feasibility and outcomes of the intervention , we selected more intervention than control patients . INTERVENTION Dietitians of the 52 intervention patients determined whether any of the following potential barriers to adequate protein nutrition were present for each patient : ( 1 ) poor knowledge of protein-containing foods , ( 2 ) poor appetite , ( 3 ) needing help shopping or cooking , ( 4 ) low fluid intake , and ( 5 ) inadequate dialysis . Depending on the specific barriers present , the dietitians ( 1 ) educated patients on protein-containing foods , ( 2 ) recommended snacks for which patients had preserved appetite , ( 3 ) helped set up social supports , ( 4 ) provided recommendations on fluid intake , and /or ( 5 ) arranged for improved dialysis . Dietitians of the 31 control patients continued to provide usual care . MAIN OUTCOME MEASURES Change in albumin after 6 months , stratified as minimal change ( less than.25 g/dL increase or decrease ) , moderate improvement ( .25 to.49 g/dL increase ) , and large improvement ( increase of .50 g/dL or more ) . To examine the role of inflammatory states , we also determined serum C-reactive protein levels at the beginning and end of the trial . RESULTS Among intervention patients , 29 % had a minimal change in albumin , 44 % had a moderate improvement , and 27 % had a large improvement . Among control patients , 74 % had a minimal change in albumin , 19 % had a moderate improvement , and 6 % had a large improvement ( P < .001 for comparison of intervention and control subjects ) . About 60 % of subjects had high baseline C-reactive protein levels ( > 10 mg/L ) . However , there was little relationship between change in albumin and either baseline C-reactive protein levels or changes in C-reactive protein levels ( P = .83 ) . CONCLUSION A nutrition intervention tailored to patient-specific barriers result ed in improved albumin levels even among patients with high C-reactive protein levels . Further work is needed to refine and test this intervention on a larger sample Protein-energy undernutrition , or the possibility of its development , has been documented to occur frequently in patients on admission to hospital . Deterioration in nutritional status is known to occur in hospital . In a prospect i ve study of 594 sequential hospital admissions , we aim ed to assess the prevalence of undernutrition among patients on admission to two acute teaching hospitals in Dublin , Republic of Irel and using the widely-accepted anthropometric criteria applied in a large study from Dundee , Scotl and , UK ( McWhirter & Pennington , 1994 ) and to determine changes in nutritional status in hospital . The mean prevalence of undernutrition ( 11 % ) was considerably lower than was reported from Dundee ( 40 % ) . Unintentional weight loss before admission and functional impairment on admission occurred to a similar extent in both centres . Weight loss in hospital occurred in the same proportion of patients , but less frequently among those undernourished on admission to hospital , in Dublin compared with Dundee . The patients found to be undernourished on admission in this study had a mortality rate in hospital ( 6.5 % ) over three times that of the adequately nourished group ( 2 % ) . The magnitude of the difference in prevalence of undernutrition between the two centres can not be explained by ethnicity , case-mix or age distribution . With the secular increase in BMI in the population , the thresholds for classifying patients as undernourished or at risk of nutritional deterioration may need to be review ed . For clinical use , recent weight loss and functional status may be more appropriate variables to use in the evaluation of nutritional status on admission to hospital BACKGROUND In order to reduce protein-energy malnutrition in older people during hospitalisation an early interdisciplinary intervention is needed . We developed a protocol which includes screening for malnutrition , dysphagia and dehydration on admission , followed by immediate interventions . OBJECTIVE To assess effectiveness of the protocol on nutritional status , hospital-acquired infections and pressure sores , and to evaluate the protocol s economical feasibility . DESIGN Prospect i ve , controlled study . SETTING The inpatient geriatric service of a university hospital ( UMC Nijmegen ) and a geriatric ward of a non-academic teaching hospital ( Rijnstate Hospital , Arnhem ) . SUBJECTS 298 older patients ( > 60 years ) . METHODS One of the geriatric wards applied the protocol ( N=140 ) while the other provided st and ard care ( N=158 ) . All non-terminally ill patients admitted for more than two days were included .  Body mass was measured on admittance and discharge and hospital-acquired infections and pressure sores were scored and costs related to nutrition , infections and length of hospital stay were assessed . RESULTS There was a 0.8 kg loss ( SEM 0.3 kg ) in average weight in the st and ard care group and a 0.9 kg gain ( SEM 0.2 kg ) in the intervention group ( p<0.001 ) . The number of hospital acquired infections was significantly lower in the intervention group ( 33/140 versus 58/158 , p=0.01 ) but no significant difference in number of patients with pressure sores ( 23/140 versus 33/158 ) was found . Costs were not significantly different : 7516 versus 7908 Euro/patient for intervention versus controls , respectively . CONCLUSION An early interdisciplinary intervention approach can be effective in reducing protein-energy malnutrition and related hospital-acquired infections and appears to be economically feasible 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 BACKGROUND & AIMS There are few well- design ed studies evaluating the effect of oral nutrition supplements in patients with cancer cachexia . The aim of this study , in a posthoc analysis , was to examine the effect of dietary compliance on intake and body composition in patients with unresectable pancreatic cancer . METHODS Two hundred patients were r and omised to receive 2 cans/day of a protein and energy dense , oral nutrition supplement+/-n-3 fatty acids in an international , multi-centre r and omised trial over 8 weeks . Dietary compliance was defined a priori as consumption of a minimum of 1.5 cans/day of either supplement . Body composition , dietary intake and quality of life were measured at baseline , 4 and 8 weeks . RESULTS On average , there were significant differences in energy intake ( 501 kcal ) , protein intake ( 25.4 g ) and weight ( 1.7 kg ) between patients who were compliant with the nutrition prescription compared to noncompliant patients controlling for n-3 fatty acid r and omisation , baseline weight and quality of life . Over the 8-week period , there was significant improvement in weight only . There was no significant difference in the energy intake from meals of the total group over the 8 weeks . CONCLUSIONS Compliance with the prescription of 1.5 cans of a protein and energy dense , oral nutrition supplement + /-n-3 fatty acids improved nutrition related outcomes in untreated pancreatic cancer patients . This level of supplement intake does not inhibit meal intake Background Malnutrition is common in older people in hospital and is associated with adverse clinical outcomes including increased mortality , morbidity and length of stay . This has raised concerns about the nutrition and diet of hospital in- patients . A number of factors may contribute to low dietary intakes in hospital , including acute illness and cognitive impairment among in- patients . The extent to which other factors influence intake such as a lack of help at mealtimes , for patients who require assistance with eating , is uncertain . This study aims to evaluate the effectiveness of using trained volunteer mealtime assistants to help patients on an acute medical ward for older people at mealtimes . Methods / design The study design is quasi-experimental with a before ( year one ) and after ( year two ) comparison of patients on the intervention ward and parallel comparison with patients on a control ward in the same department . The intervention in the second year was the provision of trained volunteer mealtime assistance to patients in the intervention ward . There were three components of data collection that were repeated in both years on both wards . The first ( primary ) outcome was patients ’ dietary intake , collected as individual patient records and as ward-level balance data over 24 hour periods . The second was clinical outcome data assessed on admission and discharge from both wards , and 6 and 12 months after discharge . Finally qualitative data on the views and experience of patients , carers , staff and volunteers was collected through interviews and focus groups in both years to allow a mixed- method evaluation of the intervention . Discussion The study will describe the effect of provision of trained volunteer mealtime assistants on the dietary intake of older medical in- patients . The association between dietary intake and clinical outcomes including malnutrition risk , body composition , grip strength , length of hospital stay and mortality will also be determined . An important component of the study is the use of qualitative approaches to determine the views of patients , relatives , staff and volunteers on nutrition in hospital and the impact of mealtime assistance . Trial registration Trial registered with Clinical Trials.gov Background Malnutrition , which is associated with increased medical complications in older hospitalized patients , can be attenuated by providing nutritional supplements . Objective This study evaluates the cost effectiveness of a specialized oral nutritional supplement ( ONS ) in malnourished older hospitalized patients . Methods We conducted an economic evaluation alongside a multicenter , r and omized , controlled clinical trial ( NOURISH Study ) . The target population was malnourished older hospitalized patients in the USA . We used 90-day ( base case ) and lifetime ( sensitivity analysis ) time horizons . The study compared a nutrient-dense ONS , containing high protein and β-hydroxy-β-methylbutyrate to placebo . Outcomes included health-care costs , measured as the product of re source use and per unit cost ; quality -adjusted life-years ( QALYs ) ( 90-day time horizon ) ; life-years ( LYs ) saved ( lifetime time horizon ) ; and the incremental cost-effectiveness ratio ( ICER ) . All costs were inflated to 2015 US dollars . Results In the base-case analysis , 90-day treatment group costs averaged US$ 22,506 per person , compared to US$ 22,133 for the control group . Treatment group patients gained 0.011 more QALYs than control group subjects , reflecting the treatment group ’s significantly greater probability of survival through 90 days ’ follow-up , as reported by the clinical trial . Hence , the 90-day follow-up period ICER was US$ 33,818/QALY . Assuming a lifetime time horizon , estimated treatment group life expectancy exceeded control group life expectancy by 0.71 years . Hence , the lifetime ICER was US$ 524/LY . The follow-up period for the trial was relatively short . Some of the patients were lost to follow-up , thus reducing collection of health-care utilization data during the clinical trial . Conclusion Our findings suggest that the investigative ONS cost-effectively extends the lives of malnourished hospitalized patients OBJECTIVE To examine how improved attention to nutritional status and dietary intake , achieved through the employment of dietetic assistants ( DAs ) , will affect postoperative clinical outcome among elderly women with hip fracture . DESIGN Open prospect i ve r and omised controlled trial , comparing conventional nursing care with the additional nutritional support provided by DA . SETTING Thirty-eight bedded acute trauma ward in a teaching hospital . PARTICIPANTS All but 11 of 344 consecutive admissions with acute nonpathological hip fracture were approached . Three hundred and eighteen ( 93 % ) agreed to inclusion . Sixteen were ineligible as they were immediately transferred to another acute ward , were managed conservatively or died preoperatively . PRIMARY OUTCOME MEASURE Postoperative mortality in the acute trauma unit . SECONDARY OUTCOME MEASURES Postoperative mortality at 4 months after fracture , length of stay , energy intake and nutritional status . RESULTS DA-supported participants were less likely to die in the acute ward ( 4.1 versus 10.1 % , P = 0.048 ) . This effect was still apparent at 4 month follow-up ( 13.1 versus 22.9 % , P = 0.036 ) . DA-supported subjects had significantly better mean daily energy intake ( 1,105 kcal versus 756 kcal/24 h , 95 % CI 259 - 440 kcal/24 h , P<0.001 ) , significantly smaller reduction in mid-arm circumference during their inpatient stay ( 0.39 cm , P = 0.002 ) and nonsignificantly favourable results for other anthropometric and laboratory measurements . CONCLUSION Dietetic or nutrition assistants are being introduced in units across the UK . This , the largest ever study of nutritional support after hip fracture , shows that their employment significantly reduced patients ' risk of dying in the acute trauma unit ; an effect that persisted at 4 month follow-up 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 The grading of recommendation , assessment , development and evaluation ( GRADE ) approach is widely implemented in health technology assessment and guideline development organisations throughout the world . GRADE provides a transparent approach to reaching judgements about the quality of evidence on the effects of a health care intervention , but is complex and therefore challenging to apply in a consistent manner . Methods We developed a checklist to guide the research er to extract the data required to make a GRADE assessment . We applied the checklist to 29 meta-analyses of r and omised controlled trials on the effectiveness of health care interventions . Two review ers used the checklist for each paper and used these data to rate the quality of evidence for a particular outcome . Results For most ( 70 % ) checklist items , there was good agreement between review ers . The main problems were for items relating to indirectness where considerable judgement is required . Conclusions There was consistent agreement between review ers on most items in the checklist . The use of this checklist may be an aid to improving the consistency and reproducibility of GRADE assessment s , particularly for inexperienced users or in rapid review s without the re sources to conduct assessment s by two research ers independently Results of this study suggest that specific nursing protocol s can be design ed to promote functional feeding for demented elders in nursing homes while enhancing the mealtime environment for both the demented elders and their caregivers . By nurses altering the feeding environment ( context ) alone , subjects received more food and drink , refused less food and showed more self-feeding . Major findings were that subjects demonstrated increased independence by refusing food more often and initiating self-feeding more frequently CONTEXT Up to 80 % of people with cancer will develop weight loss and anorexia during the advanced stages of the disease . The Macmillan Weight and Eating Studies ( 2000 - 2009 ) have used the Medical Research Council complex interventions framework to develop the first psychosocial intervention for weight- and eating-related distress ( WRD and ERD ) in people with advanced cancer and their carers : The Macmillan Approach to Weight and Eating ( MAWE ) . OBJECTIVES This article reports the findings of a Phase II trial of MAWE that investigated its deliverability , acceptability , and patient-perceived effect on WRD and ERD . METHODS The Phase II trial , conducted in 2006 - 2007 , was of cluster-r and omized design , with two community palliative care teams r and omized to different arms . It used mixed methods to compare an  intervention group ( n=25 ) , the MAWE group  , which was supported by MAWE-trained clinical nurse specialists , with a group that received usual care  ( n=25 )  , the control group . RESULTS MAWE was deliverable in clinical practice and acceptable to patients . Unplanned exposure of the MAWE group to the intervention before an initial measure of WRD and ERD proved problematic to the trial process . Despite this , quantitative and qualitative analyses indicate that MAWE does not exacerbate WRD and ERD and may help patients with advanced cancer live with the weight loss and anorexia that are the symptoms of cancer cachexia syndrome . CONCLUSION A follow-on r and omized controlled trial of MAWE is warranted but should be of a revised design Objective To assess the effectiveness of health and nutrition program ( NutriAlz ) versus usual care on functional level in elderly people with dementia living at home , as well as on clinical practice related to nutrition and on the caregiver ’s burden . Design Cluster r and omized multi-centre study with one-year follow-up . Setting 11 Alzheimer out patients and day care centres ( Barcelona , Spain ) . Participants Nine hundred and forty six home-living Alzheimer patients with identified caregiver were consecutively recruited ( intervention group : 6 centres , 448 patients vs control group : 5 centres , 498 patients ) .InterventionThe intervention was a teaching and training intervention on health and nutrition program , NutriAlz , directed both to physician and main caregiver , as well as persons affected by Alzheimer ’s disease or other dementias , including a st and ardised protocol for feeding and nutrition . Main Outcome Measures The main outcome measure was the reduction in the loss of autonomy ( Activities of daily living ( ADL/IADL ) scales ) assessed at 6 and 12 months . Secondary outcomes measures were Improvement in nutritional status ( Mini Nutritional Assessment ( MNA ) , BMI , and weight changes ) , and caregiver burden ( Zarit scale ) . Results The one-year assessment was completed for 293 patients ( 65.4 % ) in the intervention group and 363 patients ( 72.9 % ) in the control group  ( usual care ) . The annual rate of ADL change was −0.83 vs −0.62 ( p=0.984 ) , and the caregiver ’s subjective burden 0.59 vs 2.36 ( p=0.681 ) in intervention and control group , respectively . MNA , however , showed an improvement ( + 0.46 vs −0.66 , p=0.028 ) , suggesting an effective nutritional behaviour . Conclusion The NutriAlz program had no effect on functional decline in Alzheimer disease patients living at home over one year , but reduced the risk for malnutrition , as recommendations concerning diet and exercise were provided Objectives Unintentional weight loss is a prevalent and costly clinical problem among nursing home ( NH ) residents . One of the most common nutrition interventions for residents at risk for weight loss is oral liquid nutrition supplementation . The purpose of this study was to determine the cost effectiveness of supplements relative to offering residents ’ snack foods and fluids between meals to increase caloric intake . Design R and omized , controlled trial . Setting Three long-term care facilities . Participants Sixty-three long-stay residents who had an order for nutrition supplementation . Intervention Participants were r and omized into one of three groups : ( 1 ) usual NH care control ; ( 2 ) supplement , or ( 3 ) between-meal snacks . For groups two and three , trained research staff provided supplements or snacks twice daily between meals , five days per week , for six weeks with assistance and encouragement to promote consumption . Measurements Research staff observed residents during and between meals for two days at baseline , weekly , and post six weeks to estimate total daily caloric intake . For both intervention groups , research staff documented residents ’ caloric intake between meals from supplements or snack items , refusal rates and the amount of staff time required to provide each intervention . Results Both interventions increased between meal caloric intake significantly relative to the control group and required more staff time than usual NH care . The snack intervention was slightly less expensive and more effective than the supplement intervention . Conclusions Offering residents a choice among a variety of foods and fluids twice per day may be a more effective nutrition intervention than oral liquid nutrition supplementation OBJECTIVES To determine whether increases in caloric intake associated with consumption of a mid-morning nutritional supplement for 3 weeks were maintained in the week after stopping the supplement and to investigate the effects of body mass index ( BMI ) and cognitive and behavioral measures on this response . DESIGN Secondary analysis of a previously published r and omized , crossover , nonblinded clinical trial . SETTING A fully accredited geriatric care facility affiliated with the University of Toronto . PARTICIPANTS Thirty institutionalized seniors with probable Alzheimer 's disease ( AD ) who ate independently .  MEASUREMENTS Investigator-weighed food intake , body weight , cognitive ( Severe Impairment Battery ; Global Deterioration Scale ) and behavioral ( Neuropsychiatric Inventory -- Nursing Home version ; London Psychogeriatric Rating Scale ) assessment s. RESULTS Individuals who responded successfully to supplementation as indicated by increases in daily energy intake were likely to maintain 58.8 % of that increase postsupplementation , although stopping the supplement was associated with decreased habitual energy intake in low- BMI individuals who reduced their daily intakes during supplementation in response to the extra calories . Cognitive/behavioral tests were not reliable predictors of postsupplement intake . CONCLUSION Institutionalized seniors with probable AD are likely to alter their usual energy intakes to maintain changes result ing from 3 weeks of supplementation . This effect may allow for rotating supplementation schedules in nursing homes that could reduce staff burden , but only for those individuals who are most likely to respond favorably . These data indicate that nutritional supplements and diet plans should be carefully prescribed in low- BMI individuals to limit variability in total energy provided and thus prevent lower-than-normal intake BACKGROUND AND OBJECTIVE To evaluate the impact of a solid nutritional supplement on the weight gain of institutionalised older adults>70 years with protein-energy malnutrition . The innovation of these high-protein and high-energy cookies was the texture adapted to edentulous patients ( Protibis ® , Solidages , France ) . DESIGN An open , multicentre , r and omised controlled trial . SETTING Seven nursing homes . PARTICIPANTS One hundred and seventy-five malnourished older adults , aged 86±8 years . INTERVENTION All participants received the st and ard institutional diet . In addition , Intervention group participants received eight cookies daily ( 11.5 g protein ; 244 kcal ) for 6 weeks ( w0-w6 ) . MEASUREMENTS Five visits ( w-4 , w0 , w6 , w10 and w18 ) . MAIN OUTCOME Percentage of weight gain from w0 to w6 ( body mass in kg ) . SECONDARY OUTCOMES Appetite , rated using a numerical scale ( 0 : no appetite to 10 : extremely good appetite ) ; current episodes of pressure ulcers and diarrhea . RESULTS Average weight increased in Intervention group ( n=88 ) compared with Control group ( n=87 ) without cookies supplementation ( + 1.6 versus -0.7 % , P=0.038 ) . Weight gain persisted 1 month ( + 3.0 versus -0.2 % , P=0.025 ) and 3 months after the end of cookies consumption ( + 3.9 versus -0.9 % , P=0.003 ) , with diarrhea reduction ( P=0.027 ) . There was a synergistic effect with liquid/creamy dietary supplements . Subgroup analysis confirmed the positive impact of cookies supplementation alone on weight increase ( P=0.024 ) , appetite increase ( P=0.009 ) and pressure ulcers reduction ( P=0.031 ) . CONCLUSION The trial suggested that , to fight against anorexia , the stimulation of touch ( finger food ; chewing , even on edentulous gums ) and hearing ( intra-oral sounds ) could be valuable alternatives to sight , smell and taste alterations OBJECTIVES To vali date a nutritional intervention programme for elderly people living in nursing homes . DESIGN In a prospect i ve , r and omized , controlled study of 88 residents , we determined nutritional status at day 0 and day 60 using a record of dietary intake , anthropometry , h and -grip strength and mini-nutritional assessment . Dietary intake , grip strength and body weight were also recorded at day 30 . We divided subjects into four groups according to their mini-nutritional assessment score . Those with a score 24 received no oral supplementation .  Those at risk of malnutrition ( with a score of 17 - 23.5 ) were r and omized to oral supplementation . Those with a score < 17 received oral supplementation . We recorded the amount of oral supplements consumed daily . RESULTS Compliance with oral supplementation was good , and daily intake averaged about 400 kcal . The total energy intake on day 60 was significantly higher in both of the groups that received supplements . Following supplementation , most subjects at risk of malnutrition improved their mini-nutritional assessment score and increased their weight ( by 1.4 + /- 0.5 kg ) . Neither the mini-nutritional assessment score nor weight improved in subjects at risk of malnutrition who did not receive supplements . Supplementation in the malnourished group result ed in a mean mini-nutritional assessment score increase ( from 13.9 + /- 2.6 to 17.1 + /- 3.9 ) and a mean weight gain of 1.5 + /- 0.4 kg . CONCLUSION Oral nutritional supplements are well accepted and result in increased daily protein and energy intake , body weight and nutritional status in most malnourished patients and in those at risk of malnutrition OBJECTIVES To determine the cost-effectiveness of two nutrition interventions on food , beverage , and supplement intake and body weight . DESIGN R and omized , controlled trial . SETTING Five skilled nursing home facilities . PARTICIPANTS Long-stay residents with orders for nutrition supplementation ( N = 154 ) . INTERVENTION Participants were r and omized into a usual care control group , an oral liquid nutrition supplement ( ONS ) intervention group , or a snack intervention group . Research staff provided ONS , according to orders or a variety of snack foods and beverages twice per day between meals , 5 days per week for 24 weeks and assistance to promote consumption . MEASUREMENTS Research staff independently weighed residents at baseline and monthly during the 24-week intervention . Resident food , beverage and supplement intake and the amount of staff time spent providing assistance were assessed for 2 days at baseline and 2 days per month during the intervention using st and ardized observation and weighed intake procedures . RESULTS The ONS intervention group took in an average of 265 calories more per day and the snack intervention group an average of 303 calories more per day than the control group . Staff time required to provide each intervention averaged 11 and 14 minutes per person per offer for ONS and snacks , respectively , and 3 minutes for usual care . Both interventions were cost-effective in increasing caloric intake , but neither intervention had a significant effect on body weight , despite positive trends . CONCLUSION Oral liquid nutrition supplements and snack offers were efficacious in promoting caloric intake when coupled with assistance to promote consumption and a variety of options , but neither intervention result ed in significant weight gain BACKGROUND & AIMS Strategies to treat malnutrition lack practicability in the hospital setting . The present study aim ed at developing and evaluating a routinely manageable concept for an improved nutritional care of malnourished in-hospital patients . METHODS A r and omized controlled intervention study was conducted . 132 risk patients defined by Nutritional Risk Screening 2002 , were r and omized to individualised nutrition support  ( intervention group [ n = 66 ] ) or  st and ard hospital care ( control group [ n = 66 ] ) . Body weight , plasma vitamin levels , quality of life , complications , antibiotic therapies , readmissions and mortality were assessed . RESULTS Nutrition interventions led to higher intakes ( mean [ st and ard deviation ] ) in energy ( 1553 [ 341 ] kcal vs. 1115 [ 381 ] kcal , p < 0.001 ) and protein ( 65.4 [ 16.4 ] g vs. 43.9 [ 17.2 ] g , p < 0.001 ) . Intervention patients ( n = 66 ) kept their body weight in comparison to control patients ( n = 66 ; 0.0 [ 2.9 ] kg vs. -1.4 [ 3.2 ] kg , p = 0.008 ) . Positive effects on plasma ascorbic acid level ( 46.7 [ 26.7 ] μmol/l vs. 34.1 [ 24.2 ] μmol/l , p = 0.010 ) , SF-36 function summary scale ( 37 [ 11 ] % vs. 32 [ 9 ] % , p = 0.030 ) , number of complications ( 4/66 vs. 13/66 , p = 0.035 ) , antibiotic therapies ( 1/66 vs. 8/66 , p = 0.033 ) and readmissions ( 17/64 vs. 28/61 , p = 0.027 ) were recorded . CONCLUSIONS Malnourished patients profit from nutrition support regarding nutrition status and quality of life . They have fewer complications , need fewer antibiotics and are less often re-hospitalised The present study was design ed to evaluate to the effect of dietary supplements on clinical outcome and nutritional status in a large group of geriatric patients ( n = 501 ) . The patients were r and omised into an experimental group which received nutritional supplementation ( 400 kcal ) as well as a st and ard hospital diet , and a control group on hospital diet alone . The nutritional state was measured on admission and after 8 and 26 weeks by anthropometry , serum protein analysis and a delayed hypersensitivity skin test . Protein energy malnutrition was defined as the presence of three or more abnormal parameters . 28.5 % of patients showed evidence of malnutrition on admission . Hospitalisation itself result ed in a gradual deterioration in nutritional status .  Nutritional supplementation generally improved nutritional state . Among those patients who were well nourished on admission , and subsequently receiving dietary supplementation , 8.3 % fulfilled malnutrition criteria after 26 weeks , while 21.1 % were considered malnourished in the control group ( p < 0.05 ) . The improvement observed in transport proteins was probably related to nutritional support and not just to the reversal of inflammation . In the initially well nourished group of more than 300 patients , the mortality rate was 8.6 % in those given nutritional support compared to 18.6 % in the control group ( p < 0.02 ) The prevention of increased bone remodeling in postmenopausal women at low 10-y risk of osteoporotic fractures essentially relies on reinforcement of environmental factors known to positively influence bone health , among which nutrition plays an important role . In institutionalized women in their mid-eighties , we previously found that consumption of fortified soft plain cheese increased vitamin D , calcium , and protein intakes , reduced bone resorption biochemical markers , particularly the serum bone specific acid phosphatase tartrate resistant acid phosphatase , isoform 5b ( TRAP 5b ) that reflects osteoclast activity , and stimulated the serum bone anabolic factor insulin-like growth factor-I ( IGF-I ) . Whether these effects occur in much younger women was tested in a prospect i ve control study . Seventy-one healthy postmenopausal women aged 56.6 ± 3.9 y ( mean ± SD ) with low spontaneous supply of both Ca and vitamin D were r and omized to consume daily ( treated , n = 36 ) or not ( controls , n = 35 ) two servings ( 2 × 100 g ) of skimmed-milk , soft plain cheese for 6 wk . The vitamin D and Ca-fortified dairy product provided daily : 661 kJ , 2.5 μg vitamin D , 400 mg calcium , and 13.8 g protein . At the end of the intervention , the decrease in TRAP 5b and the increase in IGF-I were greater in the treated than in the control group ( P < 0.02 ) . The changes in serum carboxy terminal crosslinked telopeptide of type I collagen did not differ significantly between the two groups . In conclusion , like in elderly women , consumption by healthy postmenopausal women of a vitamin D and calcium-fortified dairy product that also increases the protein intake , reduces the serum concentration of the bone resorption biomarker TRAP 5b . This response , combined with the increase in serum IGF-I , is compatible with a nutrition-induced reduction in postmenopausal bone loss rate 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 Background Clinical trials that have assessed the best approach for treating under-nutrition in old age are scarce . Objective To determine the impact of an intensive nutritional intervention program led by a dietitian on the health and nutritional status of malnourished community dwelling older adults . Methods Sixty-eight eligible participants ( age<75 ) were r and omly assigned to a Dietetic Intervention Treatment ( DIT ) , an intensive nutritional intervention led by a dietitian , or a Medical Treatment ( MT ) , a physician-led st and ard care group , with an educational booklet regarding dietary requirements and recommendations for older adults .  An additional 59 eligible participants who were unable to participate in the r and omization were included as a non-r and omized “ untreated nutrition ” group ( UNG ) . Results Over the 6-month follow-up , the DIT group showed significant improvement in cognitive function ( from 25.8±4.5 to 26.8±4 , p=0.04 ) , and depression score ( from 7.3±3.9 to 5.4 ±3.9 , p=0.04 ) compared with the change in the other 2 groups . The DIT group showed a significant improvement in intake of carbohydrates ( + 15 % vs. + 1 % in the MT and + 3 % in the UNG ) , protein ( + 8 % vs. + 2 % in the MT and −3 % in the UNG ) , vitamin B6 ( + 20 % vs. + 7 % in the MT and + 8 % in the UNG ) , and vitamin B1 ( + 22 % vs. + 11 % in the MT and 0 % in the UNG ) . The DIT group had a significantly lower cost of physician visits than the other 2 groups ( $ 172.1±232.0 vs. $ 417.2±368.0 in the MT and $ 428.1±382.3 in the UNG , p=0.005 ) . Conclusion Intensive dietary intervention was moderately effective in lowering cost of services used and improving medical and nutritional status among community dwelling older adults The effects of a nutritional support in hospitalized patients with alcoholic cirrhosis and liver failure were studied in a controlled protocol . Thirty-six patients were included , 17 were r and omly assigned to an experimental group and the rest to a control group . Experimentals received a diet aim ing at 50 kcal ( 209 kJ)/kg bodyweight/d and 1.5 g protein/kg bodyweight/d ( as proteins of high biological value ) . Controls received the st and ard diet prescribed by the attending physician . The severity of liver failure and the nutritional status on admission were similar in both groups . The measured energy intake in controls was 1813 + /- 121 kcal/d ( 7589 + /- 506 kJ/d ) and 2707 + /- 71 kcal/d ( 1131 + /- 297 kJ/d ) in experimentals ( P less than 0.001 ) . The protein intake in controls was 47 + /- 3.8 g/d and in experimentals 80 + /- 3 g/d ( P less than 0.001 ) . There were seven deaths during the study period ( two experimentals and five controls ) . No differences were observed in the evolution of liver failure , hepatic encephalopathy or nutritional status between both study groups . It is concluded that a higher energy and protein intake in these patients does not have adverse effects and is associated with a non-significant reduction in mortality BACKGROUND Hospitalized , malnourished older adults have a high risk of readmission and mortality . OBJECTIVE Evaluation of a high-protein oral nutritional supplement ( HP-HMB ) containing beta-hydroxy-beta-methylbutyrate on postdischarge outcomes of nonelective readmission and mortality in malnourished , hospitalized older adults . DESIGN Multicenter , r and omized , placebo-controlled , double-blind trial . SETTING Inpatient and posthospital discharge . PATIENTS Older ( ≥65 years ) , malnourished ( Subjective Global Assessment [ SGA ] class B or C ) adults hospitalized for congestive heart failure , acute myocardial infa rct ion , pneumonia , or chronic obstructive pulmonary disease . INTERVENTIONS St and ard-of-care plus HP-HMB ( n = 328 ) or a placebo supplement ( n = 324 ) , 2 servings/day . MEASUREMENTS Primary composite endpoint was 90-day postdischarge incidence of death or nonelective readmission . Other endpoints included 30- and 60-day postdischarge incidence of death or readmission , length of stay ( LOS ) , SGA class , body weight , and activities of daily living ( ADL ) . RESULTS The primary composite endpoint was similar between HP-HMB ( 26.8 % ) and placebo ( 31.1 % ) . No between-group differences were observed for 90-day readmission rate , but 90-day mortality was significantly lower with HP-HMB relative to placebo ( 4.8 % vs. 9.7 % ; relative risk 0.49 , 95 % confidence interval [ CI ] , 0.27 to 0.90 ; p = 0.018 ) . The number-needed-to-treat to prevent 1 death was 20.3 ( 95 % CI : 10.9 , 121.4 ) . Compared with placebo , HP-HMB result ed in improved odds of better nutritional status ( SGA class , OR , 2.04 , 95 % CI : 1.28 , 3.25 , p = 0.009 ) at day 90 , and an increase in body weight at day 30 ( p = 0.035 ) . LOS and ADL were similar between treatments . LIMITATIONS Limited generalizability ; patients represent a selected hospitalized population . CONCLUSIONS Although no effects were observed for the primary composite endpoint , compared with placebo HP-HMB  decreased mortality and improved indices of nutritional status during the 90-day observation period . CLINICAL TRIAL REGISTRATION www . Clinical Trials.govNCT01626742 BACKGROUND Undernutrition is common in hospital patients with stroke , can develop or worsen in hospital , and is associated with poor outcomes . We aim ed to establish whether routine oral nutritional supplements improve outcome after stroke . METHODS The FOOD trials are a family of three pragmatic , multicentre , r and omised controlled trials . We measured the outcomes of stroke patients who could swallow and who were r and omly allocated normal hospital diet or normal hospital diet plus oral nutritional supplements until hospital discharge . The primary outcome was death or poor outcome ( modified Rankin scale [ MRS ] grade 3 - 5 ) , 6 months after enrollment , measured unaware of treatment allocation . Analysis was by intention to treat . FINDINGS Between Nov 1 , 1996 , and July 31 , 2003 , 4023 patients were enrolled by 125 hospitals in 15 countries . Only 314 ( 8 % ) patients were judged to be undernourished at baseline .  Vital status and MRS at the end of the trial were known for 4012 and 4004 patients , respectively . Supplemented diet was associated with an absolute reduction in risk of death of 0.7 % ( 95 % CI -1.4 to 2.7 ) and an increased risk of death or poor outcome of 0.7 % ( -2.3 to 3.8 ) . INTERPRETATION We could not confirm the anticipated 4 % absolute benefit for death or poor outcome from routine oral nutritional supplements for mainly well nourished stroke patients in hospital . Our results would be compatible with a 1 % or 2 % absolute benefit or harm from oral supplements . These results do not support a policy of routine oral supplementation after stroke Malnutrition has been often suggested as contributing to both the high incidence of hip fracture in elderly people and its complications . In a recent prospect i ve controlled r and omized study , the clinical outcome of elderly patients with osteoporotic fracture of the proximal femur ( hip fracture ) improved by giving a simple oral dietary supplement . This study , however , did not prove that protein was responsible for the clinical improvement since the supplement also contained vitamins and minerals . We addressed this question by comparing the clinical outcome and bone mineral density ( BMD ) changes in elderly patients with hip fracture , receiving two different dietary supplements with different protein contents . Sixty-two patients ( mean age 82 ) admitted into the orthopedic ward for fracture of the proximal femur were r and omized into two groups . One group ( n = 33 ) received 250 ml/day of an oral nutritional supplement containing protein ( 20.4 g ) , mineral salts ( Ca : 0.525 g ) and vitamins A = 750 IU ; D3 = 25 IU ) for a mean of 38 days . A control group ( n = 29 ) received the same supplement dose , but with no protein , for the same period of time . The clinical course was significantly better in the group receiving protein , with 79 % having a favorable course as compared to 36 % ( p less than 0.02 ) in the control group during the stay in the recovery hospital . The rate of complications and deaths was also significantly lower in the protein-supplemented vs the control group ( 52 vs 80 % , p less than 0.05 ) 7 months after hip fracture . The median hospital stay was significantly lower in the protein-supplemented group ( 69 vs 102 days , p less than 0.05 ) . ( ABSTRACT TRUNCATED AT 250 WORDS Objectives The objective of this study is to assess the nutritional status , measured by the MNA , in community-dwelling elderly individuals with dementia and to identify clinical risk factors for nutritional risk or malnutrition . Design Cross-sectional analysis of a cluster r and omized clinical trial ( Nutrialz ) . Setting Community-dwelling individuals attending dementia clinics . Participants 940 individuals . Measurements The clinical scales assessed were  Mini Nutritional Assessment ( MNA ) , Eating Behaviour Scale ( EBS ) , Charlson comorbidity index , Clinical Dementia Rating ( CDR ) , Mini-Mental State Examination ( MMSE ) , Basic Activities of Daily Living ( BADL ) score , Instrumental Activities of Daily Living ( IADL ) score , Neuropsychiatric Inventory Question naire ( NPI-Q ) , Cornell depression scale and Zarit Caregiver Burden Interview .  Results 5.2 % of participants were classified as being malnourished , 42.6 % as being at risk of malnutrition and 52.2 % as well nourished . Malnutrition by type of dementia was more frequent in Lewy bodies dementia ( 18.2 % ) than in the other types . Worse nutritional status is significantly related to more advanced age and worse cognitive , functional and behavioural profile , as well as increased burden for caregivers . Presence of behavioural symptoms is significantly related to worse nutritional level for all NPI-Q symptoms but depression , exaltation , lack of inhibition and irritability . The items more strongly related to malnutrition are appetite/feeding and hallucinations . Dependence in any basic or instrumental ADL is significantly related to higher risk of malnutrition . Dependence on feeding is a strongly related risk factor , while food preparation is only a moderate one . A logistic regression model to predict at risk/malnutrition kept as significant risk factors EBS ( Odds Ratio ( OR ) 0.84 , 95%CI 0.78 to 0.91 ) , Cornell ( OR 1.12 , 95%CI 1.09 to 1.16 ) , the number of dependent BADL ( OR 1.29 , 95%CI 1.17 to 1.42 ) , age ( OR 1.04 , 95%CI 1.02–1.06 ) , MMSE ( OR 0.95 , 95%CI 0.92 to 0.98 ) and Charlson ( OR 1.18 , 95%CI 1.05 to 1.34 ) . A similar model built for prediction of malnutrition retained as significant covariables only EBS , Cornell and the number of dependent BADL . Conclusion These results will allow a better underst and ing of the clinical stage previous to malnutrition . An adequate diagnosis and treatment of identified modifiable factors like functional impairment , eating behaviours and depression could delay or avoid malnutrition BACKGROUND & AIMS Especially in older adults , maintaining muscle mass is essential to perform activities of daily living . This requires a sufficient protein intake . However , protein intake in hospitalized older adults is often insufficient . Thus far different nutrition intervention strategies have failed to show success in reaching sufficient protein intake in hospitalized older adults . The effect of recently developed protein-enriched bread and drinking yoghurt on protein intake is still unknown . Therefore , the objective of this study was to examine the effect of protein-enriched bread and drinking yoghurt on the protein intake of acute hospitalized older adults ( ≥55 years ) . METHODS This study was performed as a single blind r and omized controlled trial in 47 hospitalized elderly acutely admitted to a university hospital . During three consecutive days participants received either ad libitum protein-enriched bread and drinking yoghurt or normal , non-enriched products as part of their daily meals . The protein-enriched bread contained 6.9 g of protein per serving and the normal bread 3.8 g of protein . For drinking yoghurt this was 20.0 g and 7.5 g of protein per serving respectively . The products were almost isocaloric . Food intake of participants was measured and nutritional values were calculated according to the Dutch Food Composition Table . An independent sample t-test was used to compare protein intake between the intervention and control group . RESULTS Analyses illustrate a protein intake in the intervention group of 75.0 ± 33.2 g per day versus 58.4 ± 14.5 g in the control group ( p = 0.039 ) . Intervention patients had a mean protein intake of 1.1 g/kg/day , with 36 % of the patients reaching the minimum requirement of 1.2 g/kg/day ; in control patients this was 0.9 g/kg/day ( p = 0.041 ) and 8 % ( p = 0.030 ) . Bread and drinking yoghurt contributed almost equally to the increased intake of protein in the intervention group . CONCLUSIONS The use of protein-enriched bread and drinking yoghurt , consumed as part of regular meals , is a promising and feasible solution to increase the protein intake of acutely ill patients . It needs to be confirmed whether the use of these products will also result in a better clinical outcome . Clinical Trials.gov ID number : NCT01907152 OBJECTIVE Community-based adult-care facilities ( ACFs ) with fewer than 25 beds provide homes for persons with disabilities who can not live independently . The staff in these facilities are not required to have any formal foodservice training , yet they provide meals for the residents . The objective of this study was to evaluate the quality of foodservices before and after a foodservice training program . DESIGN Forty-six ACFs from six health-unit areas throughout the province of British Columbia were enrolled in the study , which involved a pretest-posttest design over a 5-month period . The health units were r and omly assigned to one of three programs . INTERVENTION The ACFs received either a training workshop plus foodservice manual developed specifically for ACFs , the manual only , or no intervention . MAIN OUTCOME MEASURES Facilities were audited on performance in food purchasing , menu planning , food safety , and food storage . These areas were rated according to established minimum government regulations and other foodservice st and ards . Differences between the two audit scores ( postintervention score minus preintervention score ) were analyzed for each program section . Group comparisons were done using analysis of covariance procedures , with the initial score being the covariable . RESULTS No treatment effect was found on performance for food purchasing and food storage . Training via workshop plus manual result ed in a significant improvement in audit scores for menu planning and food safety compared with training via the manual alone . APPLICATION Dietitians should consider providing foodservice training workshops for similar types of facilities . The benefits of providing a manual alone are negligible Background / objectives : To examine whether dietary interventions promote intakes of fruit , vegetable , fish and lower salt intake were effective in preventing  cognitive decline in older people . Dietary factors have been associated with cognitive function in older people . Subjects/ methods : A total of 429 non-demented subjects in 14 old age hostels , with an average age of 83 years , were r and omly assigned by hostel to have either regular group dietary counselling and menu changes or advice on hostel menu only . Food and salt intakes were estimated at regular intervals by 24-h recall or food record and fasting urinary sodium , respectively . The primary outcome was cognitive decline as defined by an increase in clinical dementia rating scale score . Secondary clinical outcomes were mini mental state examination , category fluency test , body weight , blood pressures and health-related quality of life . Results : At baseline , the intervention group had more men and lower fish intake . When compared with control group , the intervention group had significantly less decline in intakes of fruit and fish . At month 33 % , 22.2 % and 27.2 % of intervention and control group subjects had cognitive decline , respectively ( Unadjusted P=0.285 , χ2 test ) . There were no significant group changes in secondary clinical outcomes . On subgroup analysis , fewer cognitively normal subjects in intervention group had cognitive decline at month 24 ( adjusted P=0.065 ) . Conclusions : Dietary interventions in older people were effective in maintaining fruit and fish intake , but this did not lead to a significant reduction in cognitive decline BACKGROUND undernourishment is common in elderly hip fracture patients and has been linked to poorer recovery and increased post-operative complications . OBJECTIVE to determine whether a nutritional supplement may ( i ) help elderly patients return to pre-fracture functional levels 6 months post-fracture and ( ii ) decrease fracture-related complications and mortality . DESIGN a double-blind , r and omized , placebo-controlled clinical trial . SETTING a county hospital near Barcelona . SUBJECTS 171 patients , aged 70 and older , hospitalized for hip fracture between July 1994 and July 1996 . METHODS we r and omized patients to intervention ( n = 85 ) or control ( n = 86 ) group . Patients received a nutritional supplement containing 20 g of protein and 800 mg of calcium or placebo for 60 days . We determined functional levels by the Barthel index , the mobility index and by the use of walking aids . We performed assessment s during hospitalization and at 2 and 6 months post-fracture . FINDINGS the two groups were comparable at study entry . We observed no differences in return to functional status 6 months post-fracture ( 61 % intervention group vs 55 % in control group ) nor in fracture-related mortality ( 13 % in intervention group vs 10 % in control group ) . The intervention group suffered fewer in-hospital [ odds ratio 1.88 ( 95 % CI 1.01 - 3.53 ) , P = 0.05 ] and total complications [ odds ratio 1.94 ( 95 % CI 1.02 - 3.7 ) , P = 0.04 ] than the control group . CONCLUSION based on our results , we can not recommend routine nutritional supplementation of all elderly hip fracture patients . While nutritional supplementation may be useful in decreasing complications , this reduction does not result in improvement in functional recovery and nor does it decrease fracture-related mortality . Selected patients may , however , benefit from nutritional supplementation BACKGROUND The effects of residence in an acute geriatrics-based ward ( AGW )  with emphasis on early rehabilitation and discharge planning for older patients with acute medical illnesses were assessed . Outcome and use of re sources were compared with those of patients treated in general medical wards ( MWs ) . A per- protocol rather than intention-to-treat analysis was performed . METHODS A r and omized trial with 3-months follow-up . A total of 190 patients aged 70 years and older were r and omized to an acute geriatrics-based ward , and 223 patients were r and omized to general medical wards . RESULTS The two groups were comparable at inclusion . However , after care in the AGW , 71 % of patients could be discharged directly home compared with 64 % of those treated in MWs ( relative risk 1.17 ; 95 % CI , 0.93 - 1.49 ) . The length of stay was shorter in the AGW ( mean 5.9 vs 7.3 days ; P = .002 ) . The proportion of patients in geriatric or other hospital wards or in nursing homes did not differ , but the proportion of AGW patients in sheltered living tended to be lower ( P = .085 ) . At the follow-up , case fatality , ADL function , psychological well-being , need for daily personal assistance , drug consumption , need for readmission to hospital , and total health care costs after discharge did not differ between the two groups . Poor global outcome was observed in 37 % of AGW and 34 % of MW patients . CONCLUSIONS A geriatric approach with greater emphasis on early rehabilitation and discharge planning in the AGW shortened the length of hospital stay and may have reduced the need for long-term institutional living . This occurred despite patients in an acute geriatric ward not having better medical or functional outcome than older acute patients treated in general medical wards Background Loss of muscle mass is common among old people living in institutions but trials that evaluate interventions aim ed at increasing the muscle mass arc lacking . Objective , participants and interventionThis r and omized controlled trial was performed to evaluate the effect of a high intensity functional exercise program and a timed protein-enriched drink on muscle mass in 177 people aged 65 to 99 with severe physical or cognitive impairments , and living in residential care facilities . Design Three-month high-intensity exercise was compared with a control activity and a protein-enriched drink was compared with a placebo drink A bioeicctrical impedance spectrometer ( BIS ) was used in the evaluation The amount of muscle mass and body weight ( BW ) were followed-up at three and six months and analyzed in a 2 × 2 factorial ANCOVA , using the intention to treat principle , and controlling for baseline values . Results At 3-month follow-up there were no differences in muscle mass and BW between the exercise and the control group or between the protein and the placebo group . No interaction effects were seen between the exercise and nutritional intervention . Long term negative effects on muscle mass and BW was seen in the exercise group at the 6-month follow-up . Conclusion A three month high-intensity functional exercise program did not increase the amount of muscle mass and an intake of a protein-enriched drink immediately after the exercise did not induce any additional effect on muscle mass . There were negative long term effects on muscle mass and BW , indicating that it is probably necessary to compensate for an increased energy dem and when offering a high-intensity exercise program Background and aims : Lack of compliance on the part of old participants has been reported in several r and omised nutritional intervention studies . However , lack of compliance by staff may also have a significant impact on the effect of interventions . The aim of this paper is to test the hypothesis that , in an intervention study with focus on nutrition , exercise and oral care in old nursing home residents , lack of compliance by staff rather than residents is the major problem . Methods : An eleven week r and omized , controlled trial in seven nursing homes , with nutrition , exercise and oral care strategies , and 62 residents in the intervention group .  Staff and research ers documented compliance of residents with the various strategies , including notes about problems . Results : The nutrition and exercise strategies  were well accepted by participating residents . The main reason for non-compliance may be related to staff problems . Up to one-sixth of the planned nutrition interventions were not documented as having been given to the residents . Conclusions : Lack of compliance by staff rather than residents seemed to be the main problem . In order to improve compliance in future studies , more focus should be put on the effect of practical implementation on staff . Insight into these matters may give valuable information to counteract staff problems , facilitate implementation in long term , and hence improve the benefits of nutrition interventions BACKGROUND Oral nutritional supplements have been recommended after orthopedic surgery in geriatric patients . This has been shown to be effective even in normally nourished or mildly undernourished geriatric patients . Whether perioperative administration of these products is also effective and suitable is not known . METHODS R and omized , controlled , open , paralleled two-arms clinical trial , comparing energy-protein supplements ( 40 g of protein and 400 kcal per day ) , with no intervention in normally nourished or mildly undernourished patients . Outcomes were serum proteins , body mass index , postoperative complications among others . RESULTS 60 Elderly patients were included . Patients in the intervention group ( n = 30 ) ingested 52.2 ± 12.1 % of the prescribed supplements per day for 5.8 ± 1.8 days before surgery and until hospital discharge . There was a significant change in serum albumin at follow-up ( F = 22.536 , P < 0.001 ) , and between the two groups ( F = 5.763 , P = 0.002 ) , favouring the intervention . The same was observed for serum prealbumin ( F = 6.654 , P = 0.001 within subjects , F = 2.865 , P = 0.045 for interaction ) . Logistic regression showed that only supplemented proteins per day ( OR[95%CI ] = 0.925[0.869 - 0.985 ] ) were associated with less postoperative complications ( R(2 ) = 0.323 , χ(2 ) = 11.541 , P = 0.003 ) . CONCLUSION Perioperative supplements in geriatric patients with hip fracture su bmi tted to surgery showed better recovery of plasma proteins . Higher daily protein intakes were associated with less postoperative complications Two education interventions involving personalized messages after nutrition screening in older adults were compared to determine changes in nutrition knowledge and risk behaviour . Of 150 older adults r and omly selected from a local seniors ' centre , 61 completed baseline screening and a demographic and nutrition knowledge question naire and were r and omized to one of two groups . Group A received personalized letters plus an educational booklet , and Group B received personalized letters only . All material s were sent through the mail . Forty-four participants completed post-test question naires to determine change in knowledge and risk behaviour . Both groups had reduced nutrition risk scores and increased knowledge scores at post-test . After the intervention , a significant difference was observed in knowledge change by treatment group . Group A participants experienced greater gains in knowledge , with a mean gain of 5.43 points , than did those in Group B , who had a mean gain of 1.36 points ( p=0.018 ) . Screening and education with print material s have the potential to change risk behaviour and nutrition knowledge in older adults . A specially design ed booklet on older adults ' nutrition risk factors plus a personalized letter provide an effective education strategy for older adults after screening BACKGROUND Social facilitation and meal ambiance have beneficial effects on food intake in healthy adults . Extrapolation to the nursing home setting may lead to less malnutrition among the residents . Therefore , we investigate the effect of family-style meals on energy intake and the risk of malnutrition in Dutch nursing home residents . METHODS In 2002 and 2003 , a r and omized controlled trial was conducted among 178 residents ( mean age 77 years ) in five Dutch nursing homes . Within each home , two wards were r and omized into an intervention ( n = 94 ) and a control group ( n = 84 ) . For 6 months , the intervention group received their meals family style , and the control group received the usual individual preplating services . Outcome measures were intakes of energy ( kJ ) , carbohydrates ( g ) , fat ( g ) , and protein ( g ) and Mini Nutritional Assessment ( MNA ) score ( 0 - 30 ) . RESULTS The change in daily energy intake between the control and intervention group differed significantly ( 991 kJ ; 95 % confidence interval [ CI ] , 504 - 1479 ) . The difference in intake of macronutrients was 29.2 g ( 95 % CI , 13.5 - 44.9 ) for carbohydrate , 9.1 g ( 95 % CI , 2.9 - 15.2 ) for fat , and 8.6 g ( 95 % CI , 3.4 - 13.6 ) for protein . The percentage of residents in the intervention group classified by the MNA as malnourished decreased from 17 % to 4 % , whereas this percentage increased from 11 % to 23 % in the control group . CONCLUSIONS Family-style meals stimulate daily energy intake and protect nursing home residents against malnourishment . Therefore , replacement of the preplating meal services with family-style meals in nursing homes is recommended 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 Malnutrition is common in sick elderly people on admission to hospital and in the community . We conducted a r and omised controlled trial to determine if nutritional supplementation after discharge from hospital improved nutritional status and functional outcomes , or reduced health-care costs . METHODS Elderly malnourished subjects were r and omised to 8 weeks of supplementation or no supplementation post discharge , and followed up for 24 weeks . Weight , body mass index , anthropometrics , h and grip strength , quality of life and requirements for health-care professionals ' services and social services were measured throughout the study . RESULTS Nutritional status improved significantly from baseline to week 24 in the intervention group ( P<0.05 ) , but not in the control group . There was no significant difference in nutritional status between groups at week 24 . H and grip strength improved significantly in the intervention group during supplementation , and was significantly different from that of the control group at week 8 , but decreased thereafter . There was no significant difference in quality of life or health economic outcomes between groups at week 24 . CONCLUSIONS In already malnourished elderly subjects , it may be too late to expect to improve function or quality of life or to reduce health-care costs simply by providing nutritional supplements after hospitalisation . Prevention is key . All elderly patients should be nutritionally assessed as part of their routine care , and appropriate intervention initiated early OBJECTIVES To construct a training protocol for spaced retrieval ( SR ) and to investigate the effectiveness of SR and Montessori-based activities in decreasing eating difficulty in older residents with dementia . METHODS A single evaluator , blind , and r and omized control trial was used . Eighty-five residents with dementia were chosen from three special care units for residents with dementia in long-term care facilities in Taiwan . To avoid any confounding of subjects , the three institutions were r and omized into three groups : spaced retrieval , Montessori-based activities , and a control group . The invention consisted of three 30 - 40 min sessions per week , for 8 weeks . RESULTS After receiving the intervention , the Edinburgh Feeding Evaluation in Dementia ( EdFED ) scores and assisted feeding scores for the SR and Montessori-based activity groups were significantly lower than that of the control group . However , the frequencies of physical assistance and verbal assistance for the Montessori-based activity group after intervention were significantly higher than that of the control group , which suggests that residents who received Montessori-based activity need more physical and verbal assistance during mealtimes . In terms of the effects of nutritional status after intervention , Mini-Nutritional Assessment ( MNA ) in the SR group was significantly higher than that of the control group . CONCLUSION This study confirms the efficacy of SR and Montessori-based activities for eating difficulty and eating ability . A longitudinal study to follow the long-term effects of SR and Montessori-based activities on eating ability and nutritional status is recommended BACKGROUND It was hypothesized that energy intake in hospitalized elderly patients could be improved by increasing the density of energy of the food and that the volume of food actually consumed , even with a higher energy content than the normal , would not change with servings of high energy-dense hospital food . METHODS Thirty-six elderly patients ( 52 to 96 years ) of both sexes , long-term treated at two comparable wards , participated in this study . The patients were given 6 weeks of regular hospital food ( RHF , 1670 kcal/d , 7.0 MJ ) and 6 weeks of high-energy food ( HE , 2520 kcal/d , 10.5 MJ ) . The volume of food was kept constant . A crossover study design was used . Food intake , energy intake , body weight , and modified functional condition ( Norton scale ) were measured . RESULTS Regardless of type of food ( RHF or HE ) and time of day ( lunch or dinner ) , he food portion size ( volume of food ) intake was the same , approximately 80 % of the portions consumed . HE led to a 40 % increase in energy intake ( from 25 + /- 1 during RHF to 35 + /- 2 kcal/kg/d , p < .0001 ) , which result ed in a 3.4 % increase in body weight ( p < .001 ) after 3 weeks of HE . Only minimal changes in functional condition were found . The cost of HE was substantially lower ( -85 % ) than any other mean available for improvement of energy intake . CONCLUSIONS A significant increase in energy intake can be achieved by higher energy density in regular hospital food and that HE does not cause a decrease in the volume of the food consumed . These findings suggest that it is the volume of food rather than the energy that limits voluntary energy intake of hospital food in elderly hospitalized patients OBJECTIVES The aim of this study was to evaluate the effect of oral functional training and nutrient supplements to improve the nutrition of malnourished elderly people in a nursing home . BACKGROUND Malnutrition is a frequent problem in the elderly requiring long-tem care ; however , it is not clear whether oral functional training can be effective to improve nutrition . SUBJECTS AND METHODS Fourteen subjects of 82 residents ( mean age 85.7+or-6.2 years ) in a nursing home , who had a serum albumin level of < or=3.8 g/dl and understood the purpose of this study , were r and omly divided into two groups of seven : one group served as the supplement group ( mean age 87.0+/- 4.9 years ) to which a high-calorie and high-protein diet was provided , and the other as the oral training plus supplement group ( mean age 84.6+/- 10.1 years ) to which oral functional training was given by a dental hygienist once a week as well as the above diet .  Nutritional status was evaluated using serum biochemical values as indices at 4 months after the start of the intervention . RESULTS In the supplement group , serum albumin was 3.44+/- 0.36 g/dl at the start of the study ( before intervention ) and 3.24+/- 0.45 g/dl at 4 months after intervention . In the oral training plus supplement group , it was 3.56+/- 0.22 g/dl before intervention and significantly increased to 3.70+/- 0.33 g/dl after intervention ( p<0.05 : Wilcoxon signed-rank test ) . CONCLUSION Nutritional supplements alone were not adequate , but with oral functional training to maintain and improve feeding function , nutritional improvement in the elderly could be observed AIMS To follow weight changes in patients with moderate and severe dementia and analyse how these changes related to biological and psychological parameters after staff education and support in integrity promoting care . A further aim was to describe meal environment and routines relative to the intervention . BACKGROUND Weight loss in patients with dementia and in particular Alzheimer 's disease is common . The aetiology appears multifactorial with the meal environment and a decreased independence while eating among the factors . METHOD Over a three-month intervention period , an integrity-promoting care training programme was conducted with the staff of a long-term ward . Alzheimer 's disease patients , 18 from an intervention ward and 15 from a control ward were included and possible effects were evaluated . Weighing was conducted at the start and after completion of the intervention . Weight changes were analysed in relation to psychological and biochemical parameters . In addition , the staff wrote diaries about , for example changes made in the environment and in their work . RESULTS The most prominent difference observed was weight increases in 13 of 18 patients compared with two of 15 patients in the control ward . No weight changes were related to the type of dementia . The individual weight changes correlated significantly to changes in the intellectual functions . Relationships between weight change , increased motor function and increased appetite were non-significant . There was no significant relationship between weight changes and changes in biochemical parameters . According to the staff , increased contact with the patients and a more pleasant atmosphere result ed when the meal environment and routines were changed . RELEVANCE TO CLINICAL PRACTICE Weight gain in patients with moderate and severe dementia was achieved by adjusting the meal environment to the individual 's needs . Staff education was profitable , as increased competence seemed to promote individually adapted feeding situations . Ensuring good meal situations need to be given high priority BACKGROUND & AIMS Malnutrition is common in the elderly and increases morbidity and mortality . Most attempts to reverse malnutrition have used liquid supplements , but the findings are inconsistent . This study tests a new approach using a r and omised-controlled design . The aim was to examine whether health care assistants , trained to provide additional support with feeding , can improve acutely ill elderly in- patients ' clinical outcomes . METHODS The study was carried out on three acute medicine for the elderly wards at Hammersmith Hospitals NHS Trust , London . In all , 592 patients , all over 65 years old , were recruited . RESULTS The results showed that the median time patients received feeding support was 16 days , and the assisted group was given less intravenous antibiotics  ( P=0.007 ) . However , the groups did not differ in markers of nutritional status , Barthel score , grip strength , length of stay or mortality . CONCLUSION It was concluded that the use of health care assistants in this specialised role , in an acute setting , without change to the food provision or without targeting higher risk patients , reduced the need for intravenous antibiotics . However , the intervention did not improve nutritional status or have an effect on length of stay in the time span studied . The results highlight the difficulties of improving the intake of acutely ill elderly patients during a hospital stay INTRODUCTION The prevalence of hyponutrition in hospitalized patients in our setting is 53 % . The therapeutic approach is controversial . OBJECTIVES To determine whether an early nutritional intervention in hospitalized patients by means of oral nutritional support  can improve their prognosis regarding decreased morbimortality and hospital stay . MATERIAL AND METHODS R and omized prospect i ve study comprised by a treatment group and a control group of malnourished patients hospitalized at the Internal Medicine and Respiratory Medicine Departments . The nutritional diagnosis was made by using the Subjective Global Assessment . Groups B and C were assigned to receive the hospital diet according to their needs and pathology ( control group ) and the treatment group also received a st and ard nutritional supplement . We recorded the development of infections , pressure ulcers , hospitalization days , mortality , and weight . RESULTS We performed more than 1,700 Subjective Global Assessment s. Five hundred and thirty seven patients ( 264 treated and 273 controls ) were followed-up until hospital discharge or death . We did not find statistically significant differences in mortality , hospital stay , or occurrence of complications between the treatment group and the control group . The treatment group presented statistically significant weight increase as compared with the control group . CONCLUSIONS We could not demonstrate benefits when using the oral nutritional supplement in terms of mortality , hospital stay , infectious complications , or pressure ulcers . The significant weight increase in the treatment group allowed us concluding that the supplement effectively treated hyponutrition in this group . This new clinical status implies a better prognosis , as it has already been shown . However , this could not be observed by means of the study parameters . Long-term studies are required to determine for how long this nutritional improvement can be sustained , implying a better prognosis in the long run Background : Undernutrition is common in older people admitted to hospital , but little is known about how nutritional state changes after discharge . Objective : This r and omised controlled trial was design ed to examine the effect of oral nutritional supplementation of undernourished very old people prepared to take supplements after hospital discharge following acute illness . Methods : Participants aged ≧75 years with a BMI ≤24 kg/m2 and triceps skin fold thickness or mid-arm muscle circumference below the 10th centile and /or weight loss ≧5 % during an acute hospital stay were allocated at r and om to either oral nutritional supplementation for 8 weeks from hospital discharge or to usual care . Primary outcome was change in weight , secondary outcomes were h and grip strength and anthropometry . Results : Of 198 patients eligible to participate , 136 patients ( mean age 85 years ) were r and omised and 76/136 ( 56 % ) completed the study . Twenty percent ( 13/66 ) of the intervention group withdrew after only 2 weeks , citing intolerance of the supplements . Using intention-to-treat analysis , body weight increased by a mean of 1.6 and 2.2 % in the control and intervention groups , respectively , but this between-group difference was not significant ( p = 0.188 ) . However , h and grip strength increased more ( p = 0.055 ) in the intervention group ( 13.9 % ) than in the control group ( 7.2 % ) . Conclusions : Oral nutritional supplementation was associated with a greater increase in h and grip strength than in non-supplemented controls and this observation merits further study OBJECTIVE To determine if oral nutritional supplementation improved wound healing in malnourished patients with diabetic foot ulcers when compared with a placebo . METHOD This prospect i ve r and omised controlled double-blind trial involved patients aged over 60 with diabetes mellitus and a Wagner grade I-II foot ulcer of over four weeks ' duration . Patients received either 400 ml ( 400 kcal ) oral nutritional supplementation ( n = 26 ) or 400 ml placebo ( n = 27 ) daily for six months . Patients were followed monthly for six months and after one and two years . RESULTS A third of the patients were classified as having protein-energy malnutrition at inclusion , with no difference between the two groups . Critical leg ischaemia was more common in the intervention group than in the placebo group ( p = 0.008 ) . Nine patients in the intervention group ( 35 % ) and four in the placebo group ( 15 % ) dropped out of the study ( not significant ) . Of those who completed the study , the wound had healed at six months in eight out of 23 patients ( 41 % ) ( placebo ) and in seven out of 17 ( 35 % ) ( intervention ) ( not significant ) . Twenty-four per cent of patients with protein-energy malnutrition at inclusion had healed at six months compared with 50 % of those without it ( not significant ) . CONCLUSION This is the first study to evaluate the possible benefits of nutritional supplementation on diabetic foot ulcers . A third of patients were malnourished . We encountered several method ological problems and were unable to demonstrate an improved wound healing rate in these patients OBJECTIVES --To assess whether intervention by a health visitor could reduce the number of fractures , over a four year period , in those aged 70 and over . DESIGN --R and omised , controlled trial ; r and omisation by household . SETTING --General practice in a market town . SUBJECTS -- Of 863 patients aged 70 and over on the practice records , 674 were traced and successfully interviewed ; 350 were assigned to the intervention group , 324 as controls . INTERVENTION -- The people in the intervention group were allocated to the care of a health visitor . The approach was four pronged : assessment and correction of nutritional deficiencies , including reducing smoking and alcohol intake ; assessment and referral of medical conditions such as heart block or inappropriate medication ; assessment and correction of environmental hazards in the home such as poor lighting ; assessment and improvement of fitness -- for example , exercise classes for the moderately fit . The intervention continued for four years . MAIN OUTCOME MEASURE -- Fracture rate over four years . RESULTS --The incidence of fractures was 5 % ( 16/350 ) in the intervention group and 4 % ( 14/324 ) in the control group ( difference not significant ) . CONCLUSIONS --A health visitor visiting a group of people aged 70 and over and using simple preventive measures had no effect on the incidence of fractures 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 BACKGROUND Weight loss in patients with cancer is common and associated with a poorer survival and quality of life . Benefits from nutritional interventions are unclear . The present study assessed the effect of dietary advice and /or oral nutritional supplements on survival , nutritional endpoints and quality of life in patients with weight loss receiving palliative chemotherapy for gastrointestinal and non-small cell lung cancers or mesothelioma . METHODS Participants were r and omly assigned to receive no intervention , dietary advice , a nutritional supplement or dietary advice plus supplement before the start of chemotherapy . Patients were followed for 1 year . Survival , nutritional status and quality of life were assessed . RESULTS In total , 256 men and 102 women ( median age , 66 years ; range 24 - 88 years ) with gastrointestinal ( n = 277 ) and lung ( n = 81 ) cancers were recruited . Median ( range ) follow-up was 6 ( 0 - 49 ) months . One-year survival was 38.6 % ( 95 % confidence interval 33.3 - 43.9 ) . No differences in survival , weight or quality of life between groups were seen . Patients surviving beyond 26 weeks experienced significant weight gain from baseline to 12 weeks , although this was independent of nutritional intervention . CONCLUSIONS Simple nutritional interventions did not improve clinical or nutritional outcomes or quality of life . Weight gain predicted a longer survival but occurred independently of nutritional intervention BACKGROUND Malnutrition is prevalent among nursing home residents in Hong Kong .  Nutrient dense oral supplements and yoghurt are unpopular among the Chinese older people because of their unfamiliar tastes and relatively high costs . Vitamin and mineral supplements do not address the problem of protein calorie undernutrition . Milk powder may be a suitable alternative supplement , but diarrhoea result ing from lactase deficiency is common in Chinese people . OBJECTIVE We hypothesized that a low lactose milk powder would be better tolerated in Chinese nursing home residents and result in improvement in nutritional intake without reducing habitual intake . DESIGN Forty-seven residents were r and omized to receive milk powder twice daily , or no supplement for seven weeks . Twenty-four hour food record , body weight , upper limb skinfold thicknesses and midarm circumference , grip strength , Barthel Index , and abbreviated mental test score were carried out at baseline and at seven weeks . RESULTS The overall compliance was nearly 100 % , and no subjects developed diarrhoea . Compared with controls , milk supplementation increased intake of calcium , vitamin D , vitamin A , riboflavin and potassium . There was no significant reduction in habitual dietary intake in supplemented subjects . There was a trend of weight gain in supplemented subjects , though this did not reach statistical significance . There was no change in h and grip strength , mental function and disability level . CONCLUSION The study shows that low lactose milk powder is a well-accepted nutritional supplement without reducing habitual dietary intake Abstract Objectives : To determine incidence of malnutrition among patients on admission to hospital , to monitor their changes in nutritional status during stay , and to determine awareness of nutrition in different clinical units . Design : Prospect i ve study of consecutive admissions . Setting : Acute teaching hospital . Subjects : 500 patients admitted to hospital : 100 each from general surgery , general medicine , respiratory medicine , orthopaedic surgery , and medicine for the elderly . Main outcome measures : Nutritional status of patients on admission and re assessment on discharge , review of case notes for information about nutritional status . Results : On admission , 200 of the 500 patients were undernourished ( body mass index less than 20 ) and 34 % were overweight ( body mass index > 25 ) . The 112 patients reassessed on discharge had mean weight loss of 5.4 % with greatest weight loss in those initially most undernourished . But the 10 patients referred for nutritional support showed mean weight gain of 7.9 % . Review of case notes revealed that , of the 200 undernourished patients , only 96 had any nutritional information documented . Conclusion : Malnutrition remains a largely unrecognised problem in hospital and highlights the need for education on clinical nutrition OBJECTIVES This study determined the effect of enriched foods and all-around physical exercise on bone and body composition in frail elderly persons . METHODS A 17-week r and omized , controlled intervention trial , following a 2 x 2 factorial design --(1 ) enriched foods , ( 2 ) exercise , ( 3 ) both , or ( 4 ) neither -- was performed in 143 frail elderly persons ( aged 78.6 + /- 5.6 years ) .  Foods were enriched with multiple micronutrients ; exercises focused on skill training , including strength , endurance , coordination , and flexibility . Main outcome parameters were bone and body composition . RESULTS Exercise preserved lean mass ( mean difference between exercisers and non-exercisers : 0.5 kg + /- 1.2 kg ; P < .02 ) . Groups receiving enriched food had slightly increased bone mineral density ( + 0.4 % ) , bone mass ( + 0.6 % ) , and bone calcium ( + 0.6 % ) compared with groups receiving non-enriched foods , in whom small decreases of 0.1 % , 0.2 % , and 0.4 % , respectively , were found . These groups differed in bone mineral density ( 0.006 + /- 0.020 g/cm2 ; P = .08 ) , total bone mass ( 19 + /- g ; P = .04 ) , and bone calcium ( 8 + /- 21 g ; P = .03 ) . CONCLUSIONS Foods containing a physiologic dose of micronutrients slightly increased bone density , mass , and calcium , whereas moderately intense exercise preserved lean body mass in frail elderly persons Prevention of pressure ulcers is fundamental to safe care of nursing home residents yet the role of hydration in pressure ulcer prevention has not been systematic ally examined . This r and omized clinical trial was undertaken to determine whether administration of supplemental fluid to nursing home residents at risk for pressure ulcers would enhance collagen deposition , increase estimated total body water , augment subcutaneous tissue oxygenation , and was safe . After a baseline period , 64 subjects were r and omized to receive the fluid volume prescribed or additional fluid ( prescribed plus 10 mL/kg ) for 5 days . Participants ' potential to heal as measured with hydroxyproline was low at baseline and did not increase significantly during treatment when additional fluid was systematic ally provided . Fluid intake increased significantly during treatment . Estimates of total body water and subcutaneous oxygen did not increase , indicating hydration was not improved . Supplemental fluid did not result in overhydration as measured by clinical parameters . Further work is needed to examine the relationship between fluid intake and hydration in nursing home residents as well as the role of hydration in pressure ulcer prevention BACKGROUND Swallowing dysfunction after stroke is common , but there is little reliable evidence for how the disorder should be managed . This study compared st and ard low-intensity and high-intensity behavioural interventions with usual care for dysphagia . METHODS 306 patients with clinical dysphagia admitted to hospital with acute stroke were r and omly assigned to receive usual care ( n=102 ) , prescribed by the attending physician ; st and ard low-intensity intervention ( n=102 ) , comprising swallowing compensation strategies and diet prescription three times weekly for up to a month ; or st and ard high-intensity intervention and dietary prescription ( n=102 ) , at least daily for up to a month . The primary outcome measure was survival free of an abnormal diet at 6 months . Analysis was done by intention to treat . This study is registered with Clinical Trials.gov , number NCT00257764 . FINDINGS 60 patients died and three patients were lost to follow up before the 6-month analysis . Of patients r and omly allocated usual care , 56 % ( 57/102 ) survived at 6 months free of an abnormal diet compared with 67 % ( 136/204 ) allocated st and ard swallowing therapy ( relative risk 1.19 , 95 % CI 0.98 - 1.45 ) . St and ard swallowing therapy was associated with a non-significant trend toward a reduction in death ( 0.80 , 0.5 - 1.3 ) , institutionalisation ( 0.69 , 0.4 - 1.1 ) , and dependency ( 1.05 , 0.8 - 1.3 ) ; a significant reduction in swallowing-related medical complications ( 0.73 , 0.6 - 0.9 ) , chest infection ( 0.56 , 0.4 - 0.8 ) , and death or institutionalisation ( 0.73 , 0.55 - 0.97 ) ; and a significant rise in the proportion of patients regaining swallowing function ( 1.41 , 1.03 - 1.94 ) by 6 months . Compared with usual care and low-intensity therapy , high-intensity therapy was associated with an increased proportion of patients who returned to a normal diet ( p=0.04 ) and recovered swallowing ( p=0.02 ) by 6 months . INTERPRETATION These data show a consistent trend towards more favourable outcomes in dysphagic stroke patients who are assigned a st and ard programme of early behavioural swallowing intervention , including active therapeutic approaches and dietary modification BACKGROUND New evidence indicates that increased dietary protein ingestion promotes health and recovery from illness , and also maintains functionality in older adults . The present study aim ed to investigate whether a novel food service concept with protein-supplementation would increase protein and energy intake in hospitalised patients at nutritional risk . METHODS A single-blinded r and omised controlled trial was conducted . Eighty-four participants at nutritional risk , recruited from the departments of Oncology , Orthopaedics and Urology , were included . The intervention group ( IG ) received the protein-supplemented food service concept . The control group ( CG ) received the st and ard hospital menu . Primary outcome comprised the number of patients achieving ≥75 % of energy and protein requirements . Secondary outcomes comprised mean energy and protein intake , body weight , h and grip strength and length of hospital stay . RESULTS In IG , 76 % versus 70 % CG patients reached ≥75 % of their energy requirements ( P = 0.57 ) ; 66 % IG versus 30 % CG patients reached ≥75 % of their protein requirements ( P = 0.001 ) . The risk ratio for achieving ≥75 % of protein requirements : 2.2 ( 95 % confidence interval = 1.3 - 3.7 ) ; number needed to treat = 3 ( 95 % confidence interval = 2 - 6 ) . IG had a higher mean intake of energy and protein when adjusted for body weight ( CG : 82 kJ kg(-1 ) versus IG : 103 kJ kg(-1 ) , P = 0.013 ; CG : 0.7 g protein kg(-1 ) versus 0.9 g protein kg(-1 ) , P = 0.003 ) . Body weight , h and grip strength and length of hospital stay did not differ between groups . CONCLUSIONS The novel food service concept had a significant positive impact on overall protein intake and on weight-adjusted energy intake in hospitalised patients at nutritional risk Background Nutritional approach to the deterioration of bone integrity and increased fracture risk appears to be particularly appropriate in elderly women living in nursing homes . Objective To investigate the beneficial effect of the consumption of soft plain cheese on bone resorption markers in institutionalized elderly women . Design Prospect i ve , r and omized crossover controlled study . Setting Six French nursing homes or other institutions for elderly . Participants Institutionalized women ≥ 65 years old with low vitamin D status and calcium intake below 700 mg/day . InterventionConsumption of soft plain cheese made of semi-skimmed milk which was fortified by both vitamin D3 ( + 1.25µg/100 g ) and milk extracted Ca , thus achieving a total Ca content of 151 mg/100 g as compared to about 118 mg/100 g for st and ard fresh cheese . Two servings were taken every day during the 6 weeks that preceded or followed a period of 6 weeks without soft plain cheese consumption . Measurements The primary end point was the change in serum carboxy terminal cross-linked telopeptide of type I collagen ( CTX ) selected as a marker of bone resorption . Results 29 women aged 73–94 yr were selected , 21 of them with mean age 87.2±6.1 years remained compliant The intervention increased calcium and protein intakes by 51 % ( 904±228 vs. 599±122 mg/d ) and 33 % ( 74.2±17.1 vs. 55.6±12.7 g/d , mean±SD ) , respectively . The dietary intervention was associated with a statistically significant increase in serum levels of both 25OHD and IGF-I , while those of PTH , CTX and TRAP5b were significantly reduced . Compliance was 93,4 % . The daily consumption of two servings of soft plain cheese was well accepted in terms of tastiness and appetite suited portion size . Conclusion This r and omized crossover controlled trial demonstrates that in elderly women living in nursing homes , the consumption of soft plain cheese increasing the supply of vitamin D , calcium and proteins , could reduce bone resorption and thereby reduce the risk of incidental fragility fractures in the long term OBJECTIVES To examine whether providing a midmorning nutrition supplement increases habitual energy intake in seniors with probable Alzheimer 's disease ( AD ) and to investigate the effects of body weight status and cognitive and behavioral function on the response to the intervention . DESIGN R and omized , crossover , nonblinded clinical trial . SETTING A fully accredited geriatric teaching facility affiliated with the University of Toronto 's Medical School with a home for the aged . PARTICIPANTS Thirty-four institutionalized seniors with probable AD who ate independently . INTERVENTION Nutrition supplements were provided between breakfast and lunch for 21 consecutive days and compared with 21 consecutive days of habitual intake . MEASUREMENTS Investigator-weighed food intake , body weight , cognitive function ( Severe Impairment Battery and Global Deterioration Scale ) , behavioral disturbances ( Neuropsychiatric Inventory-Nursing Home Version ) , and behavioral function ( London Psychogeriatric Rating Scale ) . RESULTS Relative to habitual intake , group mean analyses showed increased 24-hour energy , protein , and carbohydrate intake during the supplement phase , but five of 31 subjects who finished all study phases completely compensated for the energy provided by the supplement by reducing lunch intake , and 24-hour energy intake was enhanced in only 21 of 31 subjects . Compensation at lunch was more likely in subjects with lower body mass indices , increased aberrant motor behavior , poorer attention , and increased mental disorganization/confusion . CONCLUSION Nutrition supplements were least likely to enhance habitual energy intake in subjects who would normally be targeted for nutrition intervention-those with low body weight status . Those likely to benefit include those with higher body mass indices , less aberrant motor problems , less mental disorganization , and increased attention The aims of the study were to investigate the relationship between nutritional state and the development of  pressure sores  and to test the hypothesis that supplementary nutritional support might prevent pressure sore development and improve healing .  Newly admitted long-term care patients hospitalised for more than 3 weeks were included and r and omised into an experimental and a control group . The nutritional state was evaluated using serum protein analyses , anthropometry and the delayed hypersensitivity skin test . Further , the patients ' condition was assessed weekly using a modified Norton scale . The experimental group received extra nutritional support . Significantly more patients with protein-energy malnutrition had , or developed , pressure sores . Regression analyses indicated albumin , mobility , activity and food intake as predictors for pressure sores . Patients who received extra nutritional support tended to develop fewer pressure sores and to heal existing pressure sores to a greater extent than the control group , although this did not reach statistical significance Patients with chronic obstructive pulmonary disease ( COPD ) often suffer from weight loss . The aim of the present study was to gain insight into the energy balance of depleted ambulatory COPD patients , in relation to their habitual level of physical activity and consumption of oral nutritional supplements .  Clinical ly stable and weight-stable patients ( n 20 ; BMI 19.8+/- SD 2.0 kg/m2 ) were studied 1 and 3 months after rehabilitation or recovery in the clinic and were at r and om assigned to a control or intervention group with regard to nutritional supplementation .  Energy intake was measured with a 7 d food record .  Energy expenditure was estimated from a simultaneous 7 d assessment of physical activity with a tri-axial accelerometer for movement registration in combination with measured BMR . Body mass was measured at several time points . The body mass remained stable in both groups after 1 or 3 months and mean energy balances were comparable for both groups . The mean body-mass change between month 1 and 3 was negatively related to the mean physical activity level ( r -0.49 ; P=0.03 ) . Weight change over the 3 months was negatively associated with the physical activity level . These results suggest that knowledge about the individual physical activity level is necessary for the estimation of the energy need of the COPD patient INTRODUCTION Wasting is the cardinal feature of tuberculosis , but not much documentary evidence supporting food supplements exists . This study was done to assess the effects of food supplements on body weight , physical function , quality of life and treatment outcomes in patients with tuberculosis and wasting . METHODS The study was conducted in 30 Anganwadi centres of 16 villages in the catchment area of Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation and the Gannavaram Directly Observed Treatment Short Course chemotherapy centre from August 2005 to December 2005 . A total of 100 patients participated in the study . Patients who were started on anti-tubercular therapy within the previous two weeks were r and omly assigned to either the control or the food supplement group . At the end of three months , their body weight was measured and physical function and quality of life were assessed . Treatment outcomes were assessed at the one-year follow-up for both groups . RESULTS Patients who received supplements had a significant increase in body weight ( 8.6 percent versus 2.6 percent , p-value less than 0.001 ) and maximum grip strength ( p-value less than 0.001 ) , a higher sputum conversion rate ( p-value is 0.039 ) , a higher treatment completion rate ( p-value is 0.031 ) and improvements in the quality of life scores . CONCLUSION Intake of food supplements result ed in a definitive increase in body weight and physical function in our study sample . Improvements can be observed in all areas , including psychologically , physiologically , socially and in the treatment outcomes AIM To analyse the influence of serving method on compliance and consumption of nutritional supplement drinks in older adults with cognitive impairment . BACKGROUND Oral nutritional supplement drinks have positive benefits on increasing nutritional status in undernourished older people leading to weight gain . However , consumption of these drinks is low and therefore limits their effectiveness . DESIGN This study was a non-blind r and omized control trial where participants either consumed nutritional supplement drinks in a glass/beaker or consumed them through a straw inserted directly into the container . METHOD Participants with long-st and ing cognitive impairment were recruited from nursing homes ( n = 31 ) and hospitals ( n = 14 ) . Participants were r and omized to serving method . Nursing and care staff were instructed to give the supplement drinks three times per day on alternate days over a week by the allocated serving method . The research er weighed the amount of supplement drink remaining after consumption . Data were collected over 12 months in 2011 - 2012 . RESULTS Forty-five people participated in this study , mean age 86·7 ( sd 7·5 ) years . After r and omization , there was no significant difference between the baseline characteristics of the two groups . Participants r and omized to consume nutritional drinks from a glass/beaker drank statistically significantly more than those who consumed them via a straw inserted directly into the container . However , supplements allocated to be given in a glass/beaker were more frequently omitted . CONCLUSION Nutritional supplement drinks should be given to people with dementia who are able to feed themselves in a glass or a beaker if staffing re sources allow ( NIHR CSP ref 31101 ) The potential nutritional and clinical benefits of sip-feed supplements were investigated by means of a controlled trial in elderly female patients admitted for orthopaedic surgery . A nutritional risk assessment procedure ( Nutritional Risk Question naire , NRQ ) was used to identify patients who might benefit from supplementation . Patients identified as high risk who did not receive supplements  showed significant losses in triceps skinfold thickness ( TSF ) and mid-upper arm muscle circumference ( MUAMC ) measurements during hospitalization . Such changes were not observed in high-risk supplemented patients , but significant losses of MUAMC were also recorded in a group of patients who failed to comply with the supplement . No differences in biochemical parameters , muscle function , or clinical outcome were observed between supplemented and unsupplemented and non-compliant patients . The problems of poor compliance to sip-feed supplements and failure to observe clinical benefit in supplemented patients are discussed We examined the effect of nutritional supplementation for 13 wk on anthropometric , pulmonary function , and immunological status in malnourished ambulant patients with pulmonary emphysema ( EP ) . The study was placebo controlled , r and omized and double blind . Twenty-eight patients were included . Thirteen patients in the fed group were provided with a nutritional formula providing 20 % protein , 30 % fat , and 50 % carbohydrate , 1 Kcal/ml , 400 ml/day . The control group was provided with a reference product of the same consistency and taste containing 0.1 Kcal/ml , 400 ml/day for 13 wk . The fed group had a mean weight gain of 1.5 kg during the study period , the control group increased concomitantly 0.16 kg , the difference being significant ( p less than 0.01 ) . Sum of four skinfolds increased 2.7 mm in the fed group , and decreased 0.9 mm in the control group the difference being significant ( p less than 0.01 ) . No difference were observed regarding pulmonary function or immunological status . We also found a high habitual energy intake in our study group ( 204 % Basal Energy Expenditure ) . We conclude that nutritional supplementation produce weight gain in malnourished patients with EP , but it does not change other indices of well-being Objective To investigate the impact of a train-the-trainer program on the nutritional status of older people in residential care . Design Prospect i ve , r and omized controlled study . Setting Eight nursing homes in Southeast Queensl and , Australia . Participants InterventionResidents from four nursing homes were r and omly selected for a nutrition education program coordinated by Nutrition Coordinators .  Residents from the other four nursing homes ( control ) received usual care . Measurements The Subjective Global Assessment was used to determine prevalence of malnutrition at baseline and six months post intervention . The Resident Classification Scale measured functional dependency . Prescribed diet , fluids , oral hygiene status and allied health referrals were obtained by chart audit . Results Approximately half the residents were well nourished with 49.4 % moderately or severely malnourished . Residents in the intervention group were more likely to maintain or improve their nutritional status compared with the control group who were more likely to experience a deterioration ( P=0.027 ) . The odds of the control group being malnourished post test was 1.6 times more likely compared with the intervention group but this did not reach statistical significance ( P=0.1 ) . Conclusion The results of the study encourage the implementation of a Nutrition Coordinator program to maintain nutritional status of aged care residents . Nevertheless , malnutrition rates continue to be unacceptably high . In a rapidly aging society , the aged care sector needs to confront malnutrition and provide better re sources for staff to take measures against this problem BACKGROUND The prevalence of malnutrition in the hospitalized setting is 30 % to 55 % . Previous studies reported an association of malnutrition with an increased hospital length of stay ( LOS ) , morbidity , and mortality of patients . This study evaluated the role of early nutrition intervention on LOS , diagnosis coding of malnutrition cases , calculating case mix index , and reducing delays in implementing nutrition support to patients . METHODS Demographic data , anthropometric measurements , LOS , and serum albumin levels were collected from 400 patients in 2 medical wards to determine the prevalence of malnutrition and potential delays in nutrition consultation . Based on these results , a nutrition intervention study was conducted in 1 ward ; the other ward served as a control . Patients were classified as normally nourished or malnourished . Multivariate general linear regressions were used to reveal the impact of intervention on the change in LOS , controlling for other potential confounding factors on the cohort and a subset with severe malnutrition . RESULTS Of the 400 patients assessed , 53 % had malnutrition . Multiple general linear regressions showed that nutrition intervention  reduced LOS an average of 1.93 days in the cohort group and 3.2 days in the severe malnourished group . Case mix index and female gender were positively associated with LOS in the malnourished group . Nutrition intervention reduced the delays in implementing nutrition support to patients by 47 % . CONCLUSIONS Results highlight the positive impact of nutrition intervention in terms of reduced LOS in malnourished hospital patients . Reduction in LOS with diagnosis coding of malnutrition cases yielded substantial economic benefits 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 Nutritional support is an important aspect of the management of burn patients . Nutrition supplementation can be achieved either by ' hospital-made ' or ' commercial ' diets . Commercial diets are efficacious but expensive and sometimes not easily available . This study was undertaken to compare the efficacy and tolerance of a hospital-made diet with a commercial diet .  Twenty patients with burns ranging from 20 - 50 per cent TBSA were studied to compare the efficacy and tolerance of the ' hospital-made ' diet with ' commercial ' preparations . Patients were divided into two groups of 10 each and r and omised within each group to receive either a hospital-made diet ( five patients ) or a commercial diet ( five patients ) . Efficacy of diet was assessed by evaluation of nutritional status , graft take , number of surgical procedures and duration of hospital stay . Tolerance was assessed by recording side effects such as nausea , vomiting , abdominal distention and diarrhoea . Both diets were well tolerated by all patients . There was no significant difference in nutritional status , number of surgical procedures , percentage of graft take and duration of hospital stay on either diet , suggesting that hospital-made diets are similar in efficacy and tolerance but cheaper and more easily available . They are a good alternative to ' commercial ' diets , especially in poor patients OBJECTIVE Nursing facilities often provide enhanced or fortified foods as part of a " food-first " approach to increasing nutrient intakes in residents with inadequate intakes or who are experiencing weight loss . The study objective was to determine whether energy and protein enhancement of a small number of menu items would result in increased three-meal ( breakfast , lunch , and supper ) calorie and protein intakes in long-term care residents . DESIGN A r and omized cross-over design was used to compare investigator-weighed food intakes under three menu conditions : control ( no meals enhanced ) ; lunch only enhanced ; and both breakfast and lunch enhanced . Two breakfast foods ( juice and hot cereal ) and two lunch foods ( soup and potato side dish ) were chosen for enhancement . SUBJECTS/ SETTING Participants were 33 nursing home residents from a facility in South Florida ( average age=87.3 years ) . STATISTICAL ANALYSIS Repeated- measures analysis of variance was used to test the effects of the within-subjects factor ( control , lunch enhanced , breakfast and lunch enhanced conditions ) , the between-subjects factor ( smaller vs bigger eater ) , and the interaction on intakes ( gram , kilocalories , and protein ) . RESULTS Results revealed that bigger eaters consumed considerably more calories when breakfast foods , but not lunch foods , were enhanced . Smaller eaters achieved an increase in energy intake when either breakfast or lunch was enhanced . Overall daily protein intakes were not substantially increased by food enhancement . These data suggest that for an enhanced food program to be most effective for smaller eaters , who are at greatest risk for undernutrition and weight loss , it should include several enhanced foods at more than one meal Elderly long-term care patients ( n = 501 ) were r and omly allocated to receive dietary supplementation ( 400 kcal/day ) in addition to a normal hospital diet , or normal hospital diet only , for 26 weeks . The patients ' functional condition was assessed by a modified Norton scale comprising mental condition , activity , mobility , food intake , fluid intake , incontinence and general physical state . Nutritional status was assessed by anthropometry , serum protein analysis and delayed hypersensitivity skin tests . Improvements during the first 8 weeks were seen in activity and general physical condition in the supplemented group , and in mobility and general physical condition in the control group . After 8 weeks the supplemented group showed a significantly higher level of activity ( p < 0.05 ) compared to the control group . We conclude that in long-term geriatric care nutritional supplements help to maintain and improve the patients function OBJECTIVES To identify the rate of  unintentional weight loss ( UWL ) in adults following their admission into residential healthcare facilities , assess the effectiveness of a new medical nutrition therapy ( MNT ) protocol for the prevention and treatment of UWL , and describe nutrition assessment and intervention activities of dietitians . DESIGN Prospect i ve intervention study in which volunteer dietitians  were r and omly assigned to usual nutrition care ( UC ) or MNT protocol care ( MNT-PC ) groups . Dietitians recruited newly admitted residents and tracked their weights for up to 6 months using st and ardized weighing procedures . Data on weight outcomes and nutrition care activities were abstract ed from medical records and compared between study groups . Subjects/ setting s Thirty-one dietitians from 29 facilities completed the field test ( 16 MNT-PC , 13 UC ) . Medical record data were available for 394 residents ( 223 MNT-PC , 171 UC ) , and complete weight trend data were available for 364 residents ( 200 MNT-PC , 164 UC ) . INTERVENTION The new MNT protocol for UWL in residential facilities emphasized assessment ; intervention ( including weighing frequency ) ; communication with staff , medical doctor , family , and resident ; and re assessment . Main outcome measures Rate of UWL and weight status 90 days after admission and weight status 90 days after identification of UWL . Statistical analyses Chi;(2 ) , Independent t test , analysis of variance , and multiple regression using the general linear model . RESULTS Fourteen of 364 residents ( 4 % ) were admitted with significant preexisting weight loss , which was successfully treated in eight residents during the first 90 days . Substantial unintentional weight loss ( > or=5 % in any 30 days ) developed in 78 residents ( 21 % ) . MNT-PC dietitians were more likely to identify UWL . When UWL was identified , and , after providing nutrition care to these residents for an additional 90 days , 32 of 61 residents ( 52 % ) maintained or gained weight . Dietitians in UC and MNT-PC groups were equally successful in treating preexisting or postadmission unintentional weight loss when it was identified . Differences were found in nutrition care activities . MNT-PC dietitians reported more nutrition assessment activities , whereas UC dietitians reported more intervention activities . Conclusions /applications Nutrition care protocol s with st and ardized weighing procedures can increase the identification of UWL in the residential healthcare environment . Improved identification supports the additional assessment activities used by MNT-PC dietitians . Similar outcomes for UC and MNT-PC groups when UWL was identified indicate that usual nutrition care was already a high st and ard of care for intervention Twenty-three patients with head and neck cancer were r and omly allocated , regardless of pretreatment nutrition status , to receive either radiotherapy alone ( 12 patients ) or radiotherapy plus nutritional oral supplementation ( 11 patients ) with high-protein nutritional powder of balanced nutrient content ( Ensure ) .  Nutrition status was assessed subjectively and objective ly for all patients before and at weekly intervals during the course of irradiation . All patients who received nutritional supplementation experienced an increase in body weight and in triceps skin-fold thickness , whereas 58 % of the other group had weight loss ( p = 0.001 ) . Irradiation had to be suspended in 5 of the 12 patients who received no nutritional support because of severe mucosal reaction and /or poor performance status . All patients who received nutritional supplementation during radiotherapy had their course of irradiation without interruption BACKGROUND Nutrition is a key element in geriatric health . Protein-energy malnutrition is common in institutionalized persons . OBJECTIVE This study examined the effectiveness of a need-based " routine screening and timely intervention " strategy in improving the nutritional status of persons living in nursing homes . DESIGN A 24-week r and omized , double-blind , controlled trial . SETTING A privately managed geriatric nursing home in Taiwan . PARTICIPANTS Ninety-two ≥65-year old persons who were ≤25kg/m(2 ) , > 1 month residence , able to self-feed or receive oral feeding , without acute infection and non-bed-ridden . METHODS Prospect i ve participants were stratified by gender and then r and omly assigned to either the control group ( n=45 ) or the intervention group ( n=47 ) . Each subject in the intervention group was given a 50g/day soy-protein-based nutritional supplement if he/she was rated as undernourished according to the Mini Nutritional Assessment ( MNA , score ≤24 ) and BMI ≤24kg/m(2 ) . The supplement contained 9.5 g protein , 250kcal energy and all essential micro-nutrients . The supplementation would be suspended once either one of the " at risk " condition was corrected . Nutritional rating with the MNA took place at baseline and every 4 weeks during the trial . Biochemical indicators were measured at baseline , mid-point ( week-12 ) and end-point ( week-24 ) . Results were analyzed with the two- sample t-test , and the generalized estimating equations ( GEE ) controlled for demographic and health-related variables . RESULTS Of the 92 subjects , 82 completed the trial ; 7 withdrew and 3 died during the trial . Results showed that the need-based intervention was an effective and appropriate strategy for improving the nutritional status of persons at risk of undernourishment . The intervention significantly improved body weight , BMI , mid-arm circumference , calf circumference , and serum albumin and cholesterol concentrations at all intervals ( all p<0.05 ) . However , the intervention did not significantly improve hematocrit , hemoglobin or lymphocyte count status . CONCLUSIONS Results suggest that the need-based nutritional intervention can be a practical and useful strategy for improving the nutritional status of persons living in nursing homes and save on healthcare cost . The potential application of this strategy deserves the attention of health planners There is a lack of data to support the long-term effect of flavor enhancement on food intake and nutritional status . Our aim was to determine if daily addition of 700 mg flavor and /or 300 mg monosodium glutamate ( MSG ) to the animal protein part of the cooked meal for 16 weeks leads to an increase in energy intake and in body weight in nursing home elderly . We performed a single blind r and omized 16 weeks parallel study consisting of a  control group ( n=23 ) , a  MSG group ( n=19 ) , a  flavor group ( n=19 ) and a flavor plus MSG  group ( n=22 ) . Main outcome measures were intake of the cooked meal , which was measured by weighing back leftovers during 14 days and body weight . Both were measured before and at the end of the intervention period . After 16 weeks , energy intake and body weight did not increase within the control group , the flavor group , the flavor plus MSG group and the MSG group . Between the groups , no differences were found in changes in energy intake and body weight . Enhancing the taste of a cooked meal with flavor and /or MSG does not lead to a higher energy intake and body weight among nursing home elderly . More research is needed to determine the efficacy of flavor enhancement on intake and nutritional status BACKGROUND & AIMS Undernutrition in hospitalised patients is likely to be contributed to by the dual action of the underlying disease and acute catabolism associated with it . The aim of this study was to measure the association between underlying disease and nutritional status in acutely ill older patients . METHODS Four hundred and forty-five r and omly selected patients had their nutritional status assessed from anthropometric , haematological and biochemical data within 72h of admission , at 6 weeks and at 6 months . Data were also collected on age , disability , chronic illness , medications , smoking and acute-phase response . RESULTS Patients admitted with chronic obstructive pulmonary disease ( COPD ) , heart failure and falls had significantly lower anthropometric measurements compared with all study population s than for example those admitted with ischaemic heart disease ( IHD ) , chest infections and for elective hip surgery . Nutritional status has deteriorated between admission and 6 weeks among those with COPD , heart failure and falls compared with all study population s. Over 6-months 33 ( 52 % ) COPD patients and 14 ( 39 % ) heart failure patients were readmitted to hospital compared with 137 ( 35 % ) patients of all study population s. Nutritional supplements lead to a limited but significant benefit in transferrin and red cell folate among patients with heart failure and IHD . CONCLUSION In older patients , underlying diseases have variable contributions to the poor nutritional status associated with acute illness Abstract .This study investigated the change in body composition in 36 cancer out patients receiving radiotherapy to the head and neck area ( mean age : 63 ± 15 years ) r and omised to receive either nutrition intervention ( NI ; n=15 ) or usual care ( UC ; n=21 ) . Body weight and composition were measured at the commencement of radiotherapy and 3 months later . The UC group lost significantly more weight ; mean decrease = 4.3 kg , than the NI group : mean decrease = 1.1 kg ( t(30)=-2.5 , p=0.019 ) . Fat-free mass loss was significantly higher in the UC group with a mean loss of 2.2 kg versus 0.3 kg in the NI group ( t(30)=- 2.3 , p=0.029 ) . Body composition as measured by foot-to-foot bioelectrical impedance analysis provides more information than weight alone and can allow for tailoring of NI BACKGROUND Satisfaction with services has been considered vital for the provision of quality health care , however , there are few published papers utilizing patient satisfaction with nutrition services as a measurable outcome . METHOD A r and omized , controlled trial investigating the impact of nutrition intervention ( NI ) vs. usual care ( UC ) in 54 ambulatory oncology patients receiving radiotherapy to the gastrointestinal or head and neck area demonstrated beneficial impacts in terms of body weight , nutritional status , quality of life and bowel health . This study reports the changes in patient satisfaction that were associated with these improved outcomes for patients receiving NI compared with UC . The patient satisfaction with clinical nutrition services question naire was used to measure overall satisfaction and satisfaction with four components of nutrition services 12 weeks after patients commenced radiotherapy . RESULTS Patients receiving NI rated satisfaction higher for staff interpersonal skills ( P < 0.001 ) , perceived health benefits ( P = 0.008 ) , staff presentation skills ( P = 0.044 ) and for overall patient satisfaction with nutrition services ( P = 0.002 ) . There were no significant differences between those patients receiving NI or UC for the nutrition supplements factor ( P = 0.191 ) . CONCLUSIONS These data suggest that patients receiving NI perceive nutrition as being beneficial and of higher importance to their health than those receiving UC . This may lead to increased compliance with the nutrition prescription and help explain the better outcomes observed in the NI group compared with the UC group . Patient satisfaction with nutrition services should be conducted regularly to act as a quality -control measure and target areas for improvement OBJECTIVES To determine whether the oral nutritional supplementation of undernourished older people upon discharge from hospital improves muscle function and reduces disability . DESIGN R and omized controlled trial . SETTING Community-based study in two centers in Scotl and . PARTICIPANTS Two hundred fifty-three people . INTERVENTION R and omization to oral nutritional supplementation ( 600 kcal/d ) or control supplement of 200 kcal/d . MEASUREMENTS Primary outcome ( 20-point activity of daily living Barthel Index ) and secondary outcomes ( h and grip strength , Sit-to-St and test , and Euroquol ) were measured at baseline ( after discharge from the hospital and before supplement was commenced ) and 8 and 16 weeks and accelerometry-measured physical activity levels at baseline and 16 weeks . Falls were recorded prospect ively . RESULTS Mean age was 82 . There was no significant difference in change in Barthel score between supplement and control groups ( adjusted mean difference=0.28 , 95 % confidence interval (CI)=-0.28 - 0.84 ) . H and grip strength improved more in the supplemented group ( adjusted mean difference=1.52 kg , 95 % CI=0.50 - 2.55 ; P=.004 ) . The supplemented group exhibited modestly greater vector movement ( overall activity ) than controls ( P=.02 ) . There were no significant between-group differences in Sit-to-St and test , health-related quality of life , or falls . Adherence was 38.2 % in the nutritional supplement group and 50.0 % in the control supplement group . Weight did not increase in the nutritional supplement group as a whole , but on-treatment analysis adjusting for adherence showed a mean weight gain of 1.17 kg ( 95 % CI=0.07 - 2.27 ; P=.04 ) more than in controls . CONCLUSION Oral nutritional supplementation  of undernourished older people upon hospital discharge did not reduce disability , despite improving h and grip strength and modestly increasing objective ly measured physical activity levels . Lack of an effect of the nutritional supplement used in this study may have been due to low adherence , suggesting that different approaches to nutritional supplementation need to be tested in this population BACKGROUND : Previous work has shown that the administration of oral dietary supplements to patients who have undergone gastrointestinal surgery results in clinical ly significant short term benefits . AIMS : This study aim ed firstly to re-evaluate these short term effects , and secondly to establish whether there are any long term benefits . SUBJECTS : One hundred patients admitted for elective moderate or major gastrointestinal surgery . METHODS : In the inpatient phase , patients were r and omised to receive a normal ward diet postoperatively , or the same diet supplemented with an oral dietary supplement . In the outpatient phase , patients were further r and omised to receive their home diet , or their home diet supplemented with the oral dietary supplement for four months . RESULTS : During the inpatient phase , patients treated with oral supplements had a significantly improved nutritional intake and lost less weight ( 2.2 , 95 % confidence interval ( 95 % CI ) 0.9 kg ) compared with control patients ( 4.2 ( 0.78 ) kg , p < 0.001 ) . Supplemented patients maintained their h and grip strength whereas control patients showed a significant reduction in grip strength ( p < 0.01 ) . Subjective levels of fatigue increased significantly above preoperative levels in control patients ( p < 0.01 ) but not in the supplemented group . Twelve patients in the control group developed complications compared with four in the supplemented group ( p < 0.05 ) . In the outpatient phase , supplemented patients had improved nutrient intakes but there were no significant differences in indices of nutritional status or wellbeing between the groups . CONCLUSIONS : The prescription of oral dietary supplements to patients who have undergone gastrointestinal surgery results in clinical ly significant benefits . These benefits , however , are restricted to the inpatient phase 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 AIMS To investigate the efficacy of applying a Montessori intervention to improve the eating ability and nutritional status of residents with dementia in long-term care facilities . BACKGROUND An early intervention for eating difficulties in patients with dementia can give them a better chance of maintaining independence and reduce the risk of malnutrition . METHODS An experimental crossover design was employed . Twenty-nine residents were chosen from two dementia special care units in metropolitan Taipei . To avoid contamination between participants in units using both Montessori and control interventions , two dementia special care units were r and omly assigned into Montessori intervention ( I1 ) and routine activities ( I2 ) sequence groups . A two-period crossover design was used , with 15 residents assigned to Montessori intervention sequence I ( I1 , I2 ) and 14 residents assigned to Montessori intervention sequence II ( I2 , I1 ) . On each intervention day , residents were given their assigned intervention . Montessori intervention was provided in 30-min sessions once every day , three days per week , for eight weeks . There was a two-week washout period between each intervention . RESULTS There was a significant reduction in the Edinburgh Feeding Evaluation in Dementia score for the Montessori intervention period but not for the routine activities period , while the mean differences for the Eating Behavior Scale score , self-feeding frequency and self-feeding time were significantly higher than those of the routine activities period . Except for the Mini-Nutritional Assessment score post-test being significantly less than the pre-test for the routine activities period , no significant differences for any other variables were found for the routine activities period . CONCLUSION This study confirms the efficacy of a Montessori intervention protocol on eating ability of residents with dementia . Adopting Montessori intervention protocol s to maintain residents ' self-feeding ability in clinical practice is recommended . RELEVANCE TO CLINICAL PRACTICE Montessori-based activities could provide caregivers with an evidence -based nursing strategy to deal with eating difficulties of people with dementia OBJECTIVES To test the effect of nutritional support on older patient 's quality of life .  DESIGN Double-blind , r and omized , placebo-controlled trial conducted from March 2001 to January 2004 . SETTING United Kingdom . PARTICIPANTS Two hundred twenty-five hospitalized acutely ill older patients . INTERVENTION Normal hospital diet plus 400-mL oral nutritional supplements daily for 6 weeks . The composition of the supplement was such as to provide 995 kcal for energy and 100 % of the Reference Nutrient Intakes for a healthy older person for vitamins and minerals . MEASUREMENTS Baseline , 6-week , and 6-month nutritional status and quality of life . RESULTS R and omization to the supplement group led to significantly better quality -of-life scores than in the placebo group at 6 months but not at 6 weeks , after adjustment for baseline quality of life , age , and sex . The effect of supplementation was seen in higher physical function , role physical , and social function scores . Corresponding treatment effects were 7.0 ( 95 % confidence interval (CI)=0.5 - 13.6 , P=.04 ) , 10.2 ( 95 % CI=0.1 - 20.2 , P=.047 ) , and 7.8 ( 95 % CI=0.0 - 15.5 , P=.05 ) , respectively . There was no evidence of difference in Barthel scores at 6 months . CONCLUSION Oral nutritional supplementation of acutely ill hospitalized older patients led to a statistically significant benefit in quality of life OBJECTIVE To evaluate regular use of a liquid nutrition supplement by subjectively healthy elderly persons in terms of body mass index , nutrient intake , selected biochemical parameters , and perceived quality -of-life changes , and to identify advantages and limitations of use . DESIGN A 16-week intervention study in which subjects were assigned r and omly to either a supplemented group or a control group and compared in terms of intergroup and intragroup differences in weight , food intake , blood values , and quality -of-life indexes . Adherence to protocol was monitored by monthly visits with an interviewer and food intake records . SUBJECTS/ SETTING Seventy-one independent living , older Canadian adults ( mean age = 70 + /- 7 years ) consuming on average less than 4 servings of fruit and vegetables daily and a supplement-free diet before the study . Subjects were without functional limitations and did not require therapeutic diets or medical treatments that affect nutritional status . Data were collected in home interviews . Blood for analysis was obtained from a sub sample of 36 subjects . INTERVENTION Inclusion of six 235-mL cans of liquid nutrition supplement weekly into the self-selected dietary patterns of the supplemented group . STATISTICAL ANALYSIS Results were analyzed by Student t tests or Wilcoxon rank sum test , analysis of variance , and multiple stepwise regression . RESULTS Body mass index , energy intake , and consumption of fruit and vegetables did not change throughout the study . In the supplemented group , statistically significant increases occurred from baseline to termination of the study in these nutrients : protein , calcium , iron , magnesium , and folate . Serum albumin , folate , ferritin , hemoglobin , and zinc values were within the normal range for the supplemented and control groups . Scores for the Medical Outcomes Study 36-Item Short-Form Health Status scales increased for the supplemented group from baseline to termination for vitality and general health perception . Values for the General Well-Being Question naire improved for anxiety and general well-being . Of the dietary predictors , folate intake explained the most variance for vitality and for general well-being , 8.6 % and 14.2 % , respectively . APPLICATIONS A liquid nutrition supplement could be recommended to the elderly when energy maintenance and increases in nutrient intake are necessary and convenience is an important consideration . Dietetics professionals should address the issues of affordability of the supplement , the role of food in achieving nutritional adequacy , and overall quality of life of clients . Folate intake as a predictor of perceived general well-being and vitality requires further investigation The present study was undertaken to investigate the short term clinical efficacy of oral dietary supplements administered post-operatively to patients undergoing predetermined moderate to severe gastrointestinal surgery . Trial end points for comparison included effects of oral dietary supplements on nutritional intake , nutritional status and incidence of serious complications .  54 patients who were scheduled to undergo predetermined moderate to major gastrointestinal surgical procedures entered the study . They were r and omly assigned to receive a normal ward diet post-operatively or the same diet supplemented ad libitum by an oral nutritional sip feed . The study period was defined as commencing from the day patients were adjudged to be capable of ingesting ' free fluids ' to the day of hospital discharge . 40 patients ( 20 in each group ) completed the study . The mean daily energy intake ( KCal/day ) assessed from 7 day food diaries was significantly higher in the treatment group ( 1833 + /- SEM 99 ) than in the control group ( 1108 + /- 56 , p < 0.0001 ) . This increase occurred not only as a consequence of energy intake from the oral dietary supplements ( 470 + /- 30 ) but also because more energy was consumed from the ward diet by the treatment than the control patients ( 1353 + /- 92 vs 1108 + /- 56 , p < 0.02 ) . The mean daily protein intake g/day in the treatment group ( 66.0 + /- 3.4 ) was also greater than in the control group ( 52.9 + /- 29 p < 0.0001 ) . This difference was due solely to the intake in protein from the oral dietary supplements ( 15.7 + /- 1.0 ) , protein intake from the ward diet being similar in the treatment ( 50.1 + /- 3.2 ) and control ( 52.9 + /- 29 ) groups . Patients in the treatment group maintained their pre-operative weight where as control patients had lostsignificant amount of their pre-operative weight by study day 3 ( 4.5 + /- 12 kg and by discharge ( 4.7 + /- 1.2 kg , p < 0.02 ) . Pre-operative muscle function as evidence d by grip strength dynamometry decreased to a greater extent in the control than treatment group patients by study day 3 ( 14.6 + /- 2.2 KPa vs 2.8 + /- 2.4 < 0.03 ) and by discharge ( 10.4 + /- 3.1 KPa vs 0.10 + /- 1.9 p < 0.03 ) . The incidence of serious infections ( pneumonia , wound infection ) was significantly higher in the control group ( 10 ) than in the treatment group ( 3 , p < 0.02 ) . It is concluded that the prescription of oral dietary supplements on an ad libitum basis to post-operative patients undergoing moderate to major gastrointestinal surgery results in clinical ly significant short term benefits PURPOSE The study tested whether nutritional support of older patients during acute illness leads to a clinical benefit . METHODS In this r and omized , double-blind , placebo-controlled study , we r and omly assigned 445 hospitalized patients aged 65 to 92 years to receive either a normal hospital diet plus 400 mL oral nutritional supplements ( 223 subjects ) or a normal hospital diet plus a placebo ( 222 subjects ) daily for 6 weeks . The composition of the supplement was such as to provide 995 kcal of energy and 100 % of the Reference Nutrient Intakes for vitamins and minerals for a healthy older person . Patients had three assessment s : at baseline , at 6 weeks , and at 6 months post-r and omization . Outcome measures were 6 months of disability , non-elective readmission and length of hospital stay , discharge destination , morbidity , and mortality . RESULTS R and omization to the supplement group led to a significant improvement in nutritional status . Over 6 months , 65 patients ( 29 % ) in the supplements group were readmitted to the hospital compared with 89 patients ( 40 % ) in the placebo group ( adjusted hazard ratio 0.68 [ 95 % confidence interval 0.49 - 0.94 ] ) . The mean length of hospital stay was 9.4 days in the supplements group compared with 10.1 days in the placebo group . Thirty-two people ( 14 % ) died in the supplement group compared with 19 people ( 9 % ) in the placebo group at 6 months ( adjusted hazard ratio 1.65 [ 95 % confidence interval , 0.93 - 2.92 ] ) . CONCLUSION Oral nutritional supplementation of acutely ill patients improved nutritional status and led to a statistically significant reduction in the number of non-elective readmissions To evaluate the effects of nutritional supplements on nitrogen and energy balances , body composition and immune parameters , HIV-infected malnourished adult out patients were prospect ively studied . Forty-six patients ( 4 females and 42 males ; 37 + /- 12 y ) were supplemented with a polymeric diet ( PD ) or regular foods ( RF ) on two consecutive 45-day periods on a crossover design . Weight , skinfold thicknesses , plasma albumin ( PA ) , CD4 and CD8 lymphocyte counts ( LC ) , resting energy expenditure ( REE ) and urinary nitrogen excretion were measured at baseline , 45 and 90-day . Food intake was weekly recorded by food surveys . Thirty-five patients completed the protocol ( 18 in Group 1:PD-->RF ; 17 in Group 2:RF-->PD ) . In both groups , weight , fat free mass ( FFM ) , energy balance ( EB ) and nitrogen balance ( NB ) increased significantly after PD , whereas LC and PA remained unchanged in both groups . The best results in terms of weight gain were obtained in the PD group and PD plus zidovudine subgroup ( n = 8) during the first 45 days ( weight gain/FFM gain : 4.8/2.6 kg and 6.8/3.1 kg , respectively ) . Nutritional supplement with PD , according to the EB and NB goals , was well tolerated and permitted to achieve a significant weight and FFM gain over a 90-day follow-up OBJECTIVES To study the effects of oral nutritional supplements ( OS ) on body weight , body composition , nutritional status , and cognition in elderly patients with Alzheimer 's disease ( AD ) . DESIGN Prospect i ve , r and omized , controlled study . SETTING Geriatric wards and day care centers in the Toulouse area , France . PARTICIPANTS Ninety-one subjects with AD aged 65 and older at risk of undernutrition as evaluated using the Mini Nutritional Assessment . INTERVENTION After r and omization , 46 patients ( intervention group ) received 3-month OS . The other 45 patients ( control group ) received usual care . MEASUREMENTS Weight , body composition ( evaluated using dual-energy x-ray absorptiometry ) , cognitive function , activities of daily living , eating behavior , and dietary intakes were evaluated at the beginning of the study and at 3 months and 6 months . Supplement compliance was recorded each day . RESULTS Between baseline and 3 months , energy and protein intakes significantly improved in the intervention group , result ing in a significant increase in weight and fat-free mass , but no significant changes were found for dependence , cognitive function , or biological markers . The nutritional benefit was maintained in the intervention group after discontinuation of OS at 3 months . CONCLUSION Three-month daily OS significantly improves body weight . It is practicable and effective , and the patients accepted it well . The improvement that was observed even in the control group showed that caregiver education is an important factor in maintaining the nutritional status of patients with AD . Moreover , regular courses of OS may help to maintain the increase in fat-free mass and improve the nutritional status of these patients We examined changes in the nutritional status of elderly patients with chest infection for a period of 3 months after discharge from hospital , including the effects of nutritional supplementation on well-being and functional status as well as on nutritional indices . Eighty-one subjects admitted to an acute medical ward aged 65 years and over with chest infection were recruited consecutively , and r and omized to receive supplement ( 500 ml of Ensure liquid daily ) for 1 month , or no supplement , on discharge . Assessment at baseline , 1 , 2 and 3 months included a question naire to determine health , mental and functional status , and anthropometric measurements . Biochemical nutritional status was assessed at baseline , 1 and 3 months , and  dietary intake  ( 24 h recall method ) at 1 and 3 months . During recovery , both supplement and non-supplement groups showed improvement in various measures of well-being and biochemical status . In addition , the former group showed improvement in more anthropometric measurements , in thiamine and pyridoxine status , while the non-supplement group showed a lower level of functional ability after 3 months . Various measures of well-being and biochemical status of the water-soluble vitamins were better in the supplement groups . We conclude that nutritional supplementation may have a role in helping elderly patients to recover from chest infections As food intake declines with aging , older adults develop energy and nutrient inadequacies . It is important to design practical approaches to combat insufficient dietary intakes to decrease risk for acute and chronic diseases , illness , and injury . Manipulating the energy density of meals has improved energy intakes in institutional setting s , but the effects on community-residing older adults who are at nutrition risk have not been investigated . The aim of this study was to determine whether enhancing the energy density of food items regularly served in a home-delivered meals program would increase lunch and 24-hour energy and nutrient intakes . In a r and omized crossover counterbalanced design , 45 older adult Older American Act Nutrition Program participants received a regular and enhanced version of a lunch meal on alternate weeks . The types of foods , portion sizes ( gram weight ) , and appearance of the lunch meal was held constant . Consumption of the enhanced meal increased average lunch energy intakes by 86 % ( P<0.001 ) and 24-hour energy intakes by 453 kcal ( from 1,423.1+/-62.2 to 1,876.2+/-78.3 kcal , P<0.001 ) . The 24-hour intakes of several key macronutrients and micronutrients also improved . These data suggest that altering the energy density of regularly served menu items is an effective strategy to improve dietary intakes of free-living older adults OBJECTIVE We evaluated the impact of oral protein supplementation given during hemodialysis and peritoneal dialysis on nutritional status , number of hospitalizations , and length of stay . DESIGN We used a r and omized crossover design in which serum albumin , normalized protein catabolic rate ( nPCR ) , total hospitalizations , and length of stay were compared in patients who received protein supplements with those who did not . The study was conducted for 1 year ( November 2005 to October 2006 ) . SETTING This study was conducted at an outpatient dialysis facility . SUBJECTS Forty-nine patients were treated with hemodialysis or peritoneal dialysis for at least 3 months . RESULTS The nPCR significantly increased by month 4 of treatment from a baseline of 1.05 to 1.16 ( P = .007 ) . The control group had a significant decline in nPCR during the first 6 months , from 1.11 to 0.98 ( P = .038 ) . Improvement was evident in albumin by month 3 , from 3.49 to 3.52 ( P = .035 ) , but this was not sustained . In the second 6 months , the control group had a significant drop , from 3.35 to 3.19 ( P = .014 ) , and the difference between the protein-supplementation and control groups was significant during the second 6 months ( P = .037 ) . The nPCR also dropped significantly ( P = .024 ) for the control group in the second 6 months . When protein supplementation ended , weight dropped significantly for those with a body mass index of < 20 . Trends toward a reduction in hospitalization admissions and hospital days were seen in both crossover treatment groups . CONCLUSIONS In-center supplementation of protein generally improves serum markers of nutrition overall , and when it is discontinued , these markers decline . Larger studies are needed to confirm the trends that we observed regarding nutritional markers and reductions in hospitalizations and hospitalization days AIMS AND OBJECTIVES The purpose s of this study were to develop a comprehensive feeding skills training programme for nursing assistants and to test the effects of this training programme on their knowledge , attitude and behaviour and the outcome of dementia patients including total eating time , food intake and feeding difficulty . BACKGROUND Dementia patients have a high probability of feeding problems that result in a substantial risk of malnutrition . Assisting residents with eating is a major task for nursing assistants and they require better training to provide adequate quality of nutritional care . DESIGN METHODS A quasi-experimental study was conducted . Two convenience-chosen dementia-specialized long-term care facilities in North Taiwan were r and omly assigned into either a control or a treatment group . Sixty-seven nursing assistants were enrolled ( treatment : 31 ; control : 36 ) . Twenty nursing assistants and the same number of dementia patients were observed during mealtime . The treatment group participated in a feeding skills training programme including three hours of in-service classes and one hour of h and s-on training , whereas the control group did not receive any training . RESULTS The treatment group had significantly more knowledge ( F = 47.7 , P < 0.001 ) , more positive attitude ( F = 15.75 , P = 0.001 ) and better behaviours ( t = 6.0 , P < 0.001 ) than the control group after the intervention . Dementia patients in the treatment group had significantly longer total eating time ( t = 2.7 , P < 0.05 ) and higher Edinburgh Feeding Evaluation in Dementia scores ( more feeding difficulty ) ( t = 2.1 , P < 0.05 ) than the control group . There was no significant difference on food intake between the two groups ( t = 0.8 , P = 0.49 ) . CONCLUSION This feeding skills training programme has been found to change nursing assistants ' knowledge , attitude , and behaviour as well as increasing the eating time for the dementia patients . RELEVANCE TO CLINICAL PRACTICE This study raises attention regarding on-the-job training for nursing assistants . Furthermore , the feeding problems among dementia patients should be further explored as well as the nutritional care 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 The aim of this study was to assess the effect of vitamin and /or glucose energy supplementation in elderly medical patients on an intention-to-treat basis . One hundred and six elderly medical in- patients were entered into a double-bind placebo-controlled factorial trial of glucose energy and vitamin supplementation . Supplementation was given for 1 month . This trial was design ed to detect a > 2 kg increase in weight and > 3 g/l increase in serum albumin between active and placebo supplementation in 100 patients with 90 % power ( p < 0.05 ) . Other outcome measures included changes in Barthel activities of daily living , length of stay , and mental test score ( MTS ) . No interaction between vitamin and glucose supplementation was demonstrated . Active energy supplementation with glucose alone was associated with a + 0.6 kg change in weight and + 0.7 g/l change in albumin [ 95 % confidence interval ( CI ) -0.8 , + 2.0 and -1.3 , + 2.8 , respectively ] . The respective changes for active vitamin supplementation were -0.6 kg for weight and + 0.5 g/l for albumin ( 95 % CI -2.1 , + 0.8 and -1.5 , + 2.6 , respectively ) . There were no significant differences in mental test score , Barthel score , or length of stay between the two groups . Compliance with the  glucose energy supplementation  was poor with only one-third of patients consuming more than 50 % of the offered drink . We conclude that the giving of glucose alone and /or vitamin supplementation in elderly patient is of no benefit on an intention-to-treat basis BACKGROUND & AIMS Undernourished patients have an increased risk of complications and a prolonged hospital stay , compared to those who are not undernourished . The aim of this study was to evaluate the effect of nutritional intervention in a r and om sample of hospitalized patients at nutritional risk . METHODS A r and omized , controlled trial of  nutritional intervention in 212 patients . Intervention consisted of a specialized nutritional team ( nurse and dietician ) who attended patients and staff for motivation , detailed a nutritional plan , assured delivery of prescribed food and gave advice on enteral or parenteral nutrition when appropriate . The control group received the st and ard regime used in the department . The primary endpoint was the part of the length of stay ( LOS ) that was considered to be sensitive to nutritional support , design ated LOSNDI . The nutritional discharge index ( NDI ) consists of three objective criteria : ( 1 ) the patient is able to manage toilet visits without assistance , reflecting mobilization ; ( 2 ) the patient is without fever ( tp < 38 degrees C ) , reflecting absence of infection ; and ( 3 ) the patient has no intravenous access , reflecting absence of complications in general . On the day when all three criteria were fulfilled , hospital stay was no longer considered to be sensitive to nutritional support . Actual LOS is also reported . Incidence and severity of complications were recorded to explain LOSNDI findings . As a secondary endpoint , quality of life was evaluated by the Short Form 36 ( SF-36 ) question naire . RESULTS Intervention led to an intake of > or = 75 % of requirements in 62 % of the intervention patients , as compared to 36 % of the control patients . Rates of complications , mean LOSNDI and LOS were not significantly different between the two study groups . However , among patients with complications a difference in LOSNDI between intervention patients ( 14 + /- 2 days , mean + /- SE ) and control patients ( 20 + /- 2 days ) was statistically significant ( P = 0.015 ) . In the same patients , LOS was 17 + /- 2 days in the intervention group and 22 + /- 2 days in the control group ( P = 0.028 ) . The SF-36 question naire did not show a significant effect of treatment . CONCLUSIONS Protein and energy intake of nutritionally at-risk patients was increased which result ed in shortening of the part of the length of stay that was considered to be sensitive to nutritional support ( LOSNDI ) and shorter length of stay ( LOS ) among patients with complications 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 Malnutrition and dehydration are potential consequences of dysphagia , a common swallowing disorder among elderly individuals . Providing smaller , more frequent meals has been suggested ( but not demonstrated ) to improve energy intake among this group . Accordingly , this study was design ed to assess whether the same energy content in five vs three daily meals would improve energy intake .  Thirty-seven residents of an extended-care facility , aged older than 65 years , previously evaluated for dysphagia , and receiving a texture-modified diet  , agreed to participate in a crossover study with r and om assignment to three or five meals during an initial 4-day study period , followed by the opposite meal pattern in a second period . Six were excluded from analysis , as their medical condition deteriorated before or during the study . Food and fluids consumed by participants during each study period were weighed before and after each meal . Average energy intakes were similar between the three- and five-meal patterns ( 1,325+/-207 kcal/day vs 1,342+/-177 kcal/day , respectively ; P=0.565 ) ; fluid intake was higher with five meals ( 698+/-156 mL/day ) vs three ( 612+/-176 mL/day ; P=0.003 ) . Because offering five daily feedings did not improve energy intakes when compared with three , dietitians caring for this vulnerable group might need to consider other nutrition intervention strategies The purpose was to test the hypothesis that a multifaceted 11 weeks r and omized controlled intervention would have a significant influence of functional abilities in old nursing home residents . Participants were 121 old ( > 65 years ) residents in seven Danish nursing homes . The intervention consisted of nutrition ( chocolate , homemade oral supplements ) , group exercise ( moderate intensity ) and oral care . Measurements taken were weight , body mass index ( BMI ) , energy and protein intake , and functional abilities ( activities of daily living = ADL , cognitive performance , and social engagement ) . The results showed that the nutrition and exercise were well accepted . After 11 weeks the change in % weight ( 1.3 vs. -0.6 % , p=0.005 ) , % BMI ( 0.4 vs. -0.2 % , p=0.003 ) , energy intake ( 0.7 vs. -0.3 MJ/day , p=0.084 ) and protein intake ( 5 vs. -2g/day , p=0.012 ) was higher in the intervention group than in the control group . Also , after 11 weeks , social and physical function had decreased in the control group but was unchanged in the intervention group . The difference between groups was significant in relation to social engagement ( p=0.009 ) . After the end of the intervention both groups had lost weight and physical function . Cognitive performance did not change , at any time . In conclusion , it seems possible to maintain social ( and physical ) functional abilities in old nursing home residents by means of a multifaceted intervention OBJECTIVE To examine the effects of an exercise program and an enriched food regimen on physical functioning of frail elderly persons . DESIGN A 17-week r and omized , placebo-controlled trial . SETTING Community . PARTICIPANTS One hundred fifty-seven independently living frail elderly ( mean age , 78.7 + /- 5.6yr ) . INTERVENTION Thirty-nine subjects participated in a twice weekly group exercise design ed to improve daily functioning ; 39 subjects daily ate foods enriched with vitamins and minerals ( at 25%-100 % of the recommended daily allowances ) ; 42 subjects exercised and ate enriched foods ; and 37 subjects served as controls . Nonexercising groups followed a social program ; nonsupplement groups received the same food products without the micronutrients . MAIN OUTCOME MEASURES Functional performance based on 6 performance tests , physical fitness based on 7 fitness tests , and disabilities based on the self-reported ability to perform 16 daily activities . RESULTS Performance sum scores were significantly enhanced in trained ( + 8 % ) compared with nontrained subjects ( -8 % ) ( difference in change : 1.9 points , p < .001 , adjusted for baseline scores ) . Fitness sum scores were significantly enhanced as well ( + 3 % in trained vs -2 % in nontrained ) ( difference in change : 0.9 points , p = .05 , adjusted for baseline scores ) . No exercise effects on the disability score were observed . Consumption of enriched products did not affect performance , fitness , or disability scores . CONCLUSION Our comprehensive exercise program , design ed for widespread applicability , enhanced physical performance and fitness in a population of frail elderly . Daily consumption of micronutrient enriched foods showed no functional benefits within 17 weeks Improvement in nutritional status using two different care models was assessed in 374 elderly people ( mean + /- S.D. age = 78.8+/-7.2 years ) living in eight long-term care facilities in middle Taiwan . The subjects were divided into two groups using r and omized block design ; a hospital-based multidisciplinary team was responsible for the care of the intervention group , and the control group received usual care for 6 months . A structured question naire , anthropometric measurements , and biomedical markers were checked for each subject before and after the intervention . No significant differences were observed in age , height , weight , body mass index , hemoglobin , and albumin between the intervention ( n = 125 ) and control ( n = 249 ) groups at baseline . After 6 months of intervention , 83 subjects in the intervention group and 182 subjects in the control group had completed the study . The change in albumin level was greater in the intervention group ( 1.58 g/l ) than in the control group ( 0.15 g/l , p < 0.05 ) . The prevalence of hypoalbuminemia ( albumin < 35 g/l ) decreased from 69.2 % to 52.9 % in the intervention group and from 70.3 % to 67.0 % in the control group . In conclusion , a hospital-based multidisciplinary care effectively improved the nutritional status of elderly patients living in long-term care facilities in middle Taiwan BACKGROUND Nutritional status is associated with physical functioning in older people . Protein-energy malnutrition can limit functional performance . OBJECTIVES This study examined the effectiveness of a " need-based intervention " on improving the physical functioning of older adults living in nursing homes . DESIGN A 24-week r and omized , double-blind , controlled trial . SETTING S A privately managed geriatric nursing home in Taiwan . PARTICIPANTS Ninety-two persons who were ≥65 years old , ≤25 kg/m(2 ) , > 1 month residence , non-bed-ridden , without acute infection , and able to self-feed or receive oral feeding . METHODS Qualified participants were stratified by gender and then r and omly assigned to either the control group ( n=45 ) or the intervention group ( n=47 ) . Each participant in the intervention group would receive a 50 g/day soy-protein-based nutritional supplement when he/she was rated as undernourished , defined as Mini Nutritional Assessment score ≤24 and body mass index ≤24 kg/m(2 ) . The supplement contained 9.5 g protein , 250 kcal energy , and all essential micronutrients . The supplementation would be suspended if either one of the two " at risk " conditions was not met at the next measurement ( every 4 weeks ) . H and grip strength and Barthel Index were measured at baseline , mid-point ( week 12 ) , and end-point ( week 24 ) of the trial . Results were analyzed with Student 's t-test and by the Generalized Estimating Equations controlled for nutritional status . RESULTS The intervention significantly improved ( a ) h and grip strength of the older adults at weeks 12 and 24 , and ( b ) the overall Barthel Index at week 24 ( all p<0.05 ) according to the Generalized Estimating Equations . CONCLUSIONS " Need-based intervention " can be an effective and useful strategy for improving the physical functioning of older adults living in nursing homes , without adverse effects . The results probably are the indirect results of the improved nutritional status . The study highlights the importance of routine screening and timely intervention in geriatric care . The applicability of this need-based strategy to community-living older adults is an important issue and should be evaluated . We can probably reap a greater benefit by eliminating the risk of malnutrition at the emerging stage BACKGROUND The elderly patients with fragility show different physiological changes , so they are given polymeric diets to maintain and /or alter their nutritional status . The aim of this paper is to demonstrate the effect of changing a st and ard polymeric diet and a st and ard diet on nutritional status in elderly patients with fragility . METHODS Clinical r and omized controlled trial in 23 elderly patients , 70 years of age or older , with fragility , hospitalized in a Internal Medicine Unity in a period from July to December 2014 .  Nutritional status was determined through Minimum Nutritional Consulting ( MNA ) and body mass index ( BMI ) . Descriptive statistics , Chi square , Student t test and McNemar . RESULTS In the G1 : 12 patients were in the G2 and 11 , a positive change was observed in the nutritional status G1 initially being 14.00 ( malnutrition ) and end 22.75 ( risk of malnutrition ) . According to BMI ( kg/m2 ) was evident at the beginning 25 % of patients ( 3 ) with mild malnutrition , but the final results show figures with a zero percentage of malnourished patients . CONCLUSIONS The use of st and ard polymeric diet  increases body weight , BMI and nutritional status in elderly patients with fragility BACKGROUND Although disuse of skeletal muscle and undernutrition are often cited as potentially reversible causes of frailty in elderly people , the efficacy of interventions targeted specifically at these deficits has not been carefully studied . METHODS We conducted a r and omized , placebo-controlled trial comparing progressive resistance exercise training , multinutrient supplementation , both interventions , and neither in 100 frail nursing home residents over a 10-week period . RESULTS The mean ( + /- SE ) age of the 63 women and 37 men enrolled in the study was 87.1 + /- 0.6 years ( range , 72 to 98 ) ; 94 percent of the subjects completed the study .  Muscle strength increased by 113 + /- 8 percent in the subjects who underwent exercise training , as compared with 3 + /- 9 percent in the nonexercising subjects ( P < 0.001 ) . Gait velocity increased by 11.8 + /- 3.8 percent in the exercisers but declined by 1.0 + /- 3.8 percent in the nonexercisers ( P = 0.02 ) . Stair-climbing power also improved in the exercisers as compared with the nonexercisers ( by 28.4 + /- 6.6 percent vs. 3.6 + /- 6.7 percent , P = 0.01 ) , as did the level of spontaneous physical activity . Cross-sectional thigh-muscle area increased by 2.7 + /- 1.8 percent in the exercisers but declined by 1.8 + /- 2.0 percent in the nonexercisers ( P = 0.11 ) . The nutritional supplement had no effect on any primary outcome measure . Total energy intake was significantly increased only in the exercising subjects who also received nutritional supplementation . CONCLUSIONS High-intensity resistance exercise training is a feasible and effective means of counteracting muscle weakness and physical frailty in very elderly people . In contrast , multi-nutrient supplementation without concomitant exercise does not reduce muscle weakness or physical frailty We studied the effects of oral nutritional supplementation on respiratory muscle ( RM ) performance in 25 ambulatory patients with severe chronic obstructive pulmonary disease ( COPD ) . There was a relationship between body weight and anthropometric parameters of nutritional status ( triceps skinfold thickness [ r = 0.67 ; p less than 0.005 ] , midarm muscle circumference ( r = 0.53 ; p less than 0.005 ) , but body weight did not correlate with daily caloric intake , serum albumin , transferrin , or blood lymphocyte count . None of these measurements of nutritional status correlated with any measure of RM strength or endurance . In a r and omized observer-blinded crossover trial , patients were allocated to one of two groups . In the first eight weeks of the study , group A received nutritional supplementation , and patients in group B were control subjects . In the second eight weeks , patients in group A were control subjects , and group B received supplement .  Mean daily caloric intake and body weight increased in both groups while receiving supplement ( both p less than 0.05 ) . Calories provided by the supplement were frequently substituted for normal dietary calories . Any increases in RM performance in the group receiving supplement were matched by increases ( due to learning ) in controls . We conclude that oral dietary supplements have no important effects on RM performance in ambulatory patients with COPD BACKGROUND Although stroke patients who do not have difficulty swallowing may be at risk of undernutrition and worsening nutritional status during hospitalization , optimum methods for nutrition intervention in stroke patients have not been established . AIM To examine the feasibility of enteral sip feeding as an effective nutrition intervention after acute stroke . METHODS Forty-two acute ischemic stroke in patients with impaired nutritional status who did not have difficulty swallowing within 1 week after the stroke were entered into a single-blind , r and omized , controlled , prospect i ve study of enteral sip feeding .  Twenty-one patients were r and omized to receive daily oral food supplements for 4 weeks in addition to the hospital food , and 21 patients received only the hospital food for the same period . Main outcome measures were energy and protein intakes during the intervention period , change in nutritional status , disability , infective complications , length of stay , and mortality during hospitalization and at 3 months . RESULTS Two patients , one from each group , were lost to follow-up immediately after r and omization . Twenty patients received oral nutritional supplementation . The energy intake was significantly greater in the supplemented group : 1807 + /- 318 vs 1084 + /- 343 kcal/d ( mean + /- SD ; p < .0001 ) ( estimated treatment effect , 723 kcal/d ; 95 % confidence interval [ CI ] , 498 to 947 ) , as was protein intake : 65.1 + /- 13.8 vs 44.1 + /- 12.8 g/d ( p < .001 ) ( estimated treatment effect , 21.0 g/d ; 95 % CI , 11.7 to 30.3 ) . There also were significant differences between the two groups in the changes in serum albumin and serum iron concentrations between r and omization and at follow-up . There was a trend to lower mortality at 3 months in the supplemented group with two deaths ( 10 % ) compared with seven deaths ( 35 % ) in the control group ( p = .127 , relative risk , 0.29 ; 95 % CI , 0.07 to 1.21 ) . CONCLUSIONS This study suggests that enteral sip feeding is effective in improving nutritional intake and status in stroke patients who do not have swallowing difficulties . There also may be some beneficial effects on clinical outcome , but larger studies are required to confirm this observation and define more precisely the magnitude of any favorable effects OBJECTIVE We tested the hypothesis that a multifaceted 11-wk intervention comprising nutrition , group exercise , and oral care would have a significant influence on nutrition and function in elderly ( > or=65 y ) nursing-home residents . METHODS The study was an 11-wk r and omized controlled intervention study with nutrition ( chocolate and homemade oral supplements ) , group exercise twice a week ( 45 - 60 min , moderate intensity ) , and oral care intervention one to two times a week , with the aim of improving nutritional status and function in elderly nursing-home residents . A follow-up visit was made 4 mo after the end of the intervention . Assessment s were weight , body mass index , dietary intake , h and grip strength , Senior Fitness Test , Berg 's Balance Scale , and the prevalence of plaque . RESULTS A total of 121 subjects ( 61 % ) accepted the invitation and 62 were r and omized to the intervention group . Six of these dropped out during the 11 wk . At the 4-mo follow-up there were 15 deaths in the intervention group and 8 in the control group . The nutrition and exercise were well tolerated . After 11 wk the change in percentage of weight ( P = 0.005 ) , percentage of body mass index ( P = 0.003 ) , energy intake ( P = 0.084 ) , protein intake ( P = 0.012 ) , and Berg 's Balance Scale ( P = 0.004 ) was higher in the intervention group than in the control group . In addition , the percentage of subjects whose functional tests improved was higher in the intervention group . Both groups lost the same percentage of weight after the intervention ( P = 0.908 ) . The total percentage of weight loss from baseline to follow-up was higher in the control group ( P = 0.019 ) . Oral care was not well accepted and the prevalence of plaque did not change . CONCLUSION It is possible to improve nutrition and function in elderly nursing-home residents by means of a multifaceted intervention consisting of chocolate , homemade supplements , group exercise , and oral care
BACKGROUND Supportive interventions such as serving meals in a dining room environment or the use of assistants to feed patients are frequently recommended for the management of nutritionally vulnerable groups .
Such interventions are included in many policy and guideline documents and have implication s for staff time but may incur additional costs , yet there appears to be a lack of evidence for their efficacy .
OBJECTIVES To assess the effects of supportive interventions for enhancing dietary intake in malnourished or nutritionally at-risk adults .