A novel oral nutritional supplement improves gait speed and mitochondrial functioning compared to standard care in older adults with (or at risk of) undernutrition: results from a randomized controlled trial

Abstract

Undernutrition in older adults is mainly addressed by oral nutritional supplements, which do not affect physical functioning. In this study, we tested a novel oral nutritional supplement that included whey and casein protein, ursolic acid, free branch-chained amino acids and vitamin D against a standard supplement. We included older adults (>65y) with (or at risk of) undernutrition (n=82) and randomized them to 12 weeks of novel or standard supplement. Both groups showed significant increases in body mass. No within or between-group differences in lean body mass were observed. Fat mass increased significantly more in the standard than the novel supplement group (time*treatment effect P=0.045). The novel supplement group showed a larger improvement in walking performance on distances of 4m (treatment x time interaction P=0.048) and 400m (treatment x time interaction P=0.038) than the standard treatment group. Gene sets related to mitochondrial functioning and oxidative phosphorylation were upregulated in the novel supplement group and downregulated in the standard supplement group. We conclude that a 12-week intervention with the novel supplement improved walking performance both during short and long distance as compared to a standard supplement, which can largely be explained by increased mitochondrial functioning in the group receiving the novel supplement.

Protein intake and bone mineral density: Cross‐sectional relationship and longitudinal effects in older adults

“…This study included data from participants of four previously published trials under the acronyms NU‐AGE (New dietary strategies addressing the specific needs of elderly population for healthy ageing in Europe), ProMO (Evaluating the Efficacy of a Novel Oral Supplement in Tackling Malnutrition in the Elderly), ProMuscle (Protein Supplementation and Exercise Strategy to Promote Muscle Protein Anabolism in Frail Elderly People) and PiP (ProMuscle in Practice) 8–11 . Table 1 presents their inclusion and exclusion criteria and methods of dietary and BMD assessment.…”

“…7 There are several potential mechanisms through which increased protein intake can maintain or improve BMD, but current evidence of an association or effect is inconclusive, and large trials are scarce. We therefore integrated data from four trials that included either (pre-)frail, undernourished or healthy older adults [8][9][10][11] to investigate the cross-sectional association between dietary protein and BMD and the effects of protein supplementation for 12-24 weeks on BMD. A further aim was to investigate if there were any differences between intakes of total, plant and animal protein in relation to BMD.…”

The Association between Malnutrition and Physical Performance in Older Adults: A Systematic Review and Meta-Analysis of Observational Studies

“…Interventions with combinations of supplementation with counseling or exercise were inconsistent ( 14 ). Some other intervention studies in MN or at-risk populations ( 14 ) show improvements in walking distance, but not HGS and SPPB ( 112 ), or performance improvements only in subgroups at 1 of 3 time points ( 113 ) in community-dwelling older adults.…”

“…Overall, as expected, it appears that malnutrition in older adults is associated with low physical performance, despite overall poor to moderate quality (no “good” NOS scores) of the studies. Perhaps the complexity and diversity in the origin of malnutrition and its relation to physical performance underlie the inconsistencies of intervention studies on this topic, and interventions should take into account the underlying etiology ( 81 , 112 ). However, low study quality and remaining heterogeneity in measurements imply that strong conclusions cannot be drawn and corrections for confounders are mostly lacking.…”

Estimation of the proportion of treatment effect explained by a high‐dimensional surrogate

“…To illustrate our proposed procedure, we studied a randomized clinical trial of the effect of a new oral nutrition supplement on the physical functioning of older adults, compared to the effect of a standard supplement. 43 Undernutrition is a common medical condition in older adults and can result in a loss of skeletal muscle mass and impaired physical functioning. 44,45 Undernutrition is generally treated with oral nutrition supplements which contain specific amounts of macronutrients and micronutrients.…”