A systematic review of protein and energy supplementation for hip fracture aftercare in older people

Abstract

Objectives: To evaluate whether protein and energy supplementation influences recovery after hip fracture. Design: Systematic review of randomised and quasi-randomised trials in people aged 65 y and over. Data sources: We searched seven electronic databases from 1966 to April 2002, four journals and reference lists of relevant articles. We contacted trial investigators and experts for details of other trials. Main outcome measures: Mortality, complications and unfavourable outcome (mortality or survivors with complications) were the primary outcomes. We also sought data on length of hospital stay, functional status after hip fracture, quality of life and compliance with supplementation. Results: In total, 12 randomised trials involving 898 participants were included. Nine trials evaluated protein and energy supplementation (five oral and four nasogastric feeding), and a further three trials tested oral protein supplementation. Potential biases resulting from inadequate allocation concealment and lack of assessor blinding and intention-to-treat analysis, as well as the limited outcome data, mean that the results must be interpreted with caution. Pooled data from eight of the nine trials evaluating protein and energy supplements showed no evidence for an effect on mortality (relative risk 0.92, 95% CI 0.56-1.50). Limited data from only three trials showed that oral protein and energy supplements may reduce unfavourable outcome (relative risk 0.52, 95% CI 0.32-0.84). Conclusion: Based on limited evidence, oral protein and energy supplementation after hip fracture may reduce unfavourable outcome. Further evidence from good-quality randomised trials is required to inform clinical practice.

Dietary Supplementation During Musculoskeletal Injury

“…These results are similar in nature to the benefits of protein supplementation in recovery after hip fracture in elderly subjects (3). However, further studies in a specific musculoskeletal injury population are warranted to confirm these benefits to the wider population.…”

A trial assessing N-3 as treatment for injury-induced cachexia (ATLANTIC trial): does a moderate dose fish oil intervention improve outcomes in older adults recovering from hip fracture?

“…This includes the provision of dietary education and counselling in the way of dietary modifications, food fortification and oral supplementation to ensure individual energy, protein and other nutrient requirements are achieved. This is particularly critical given the lack of evidence that oral supplementation alone is effective at improving clinical outcomes in this patient group [16]. …”

“…A systematic review of the literature highlighted that most nutrition support provided for PFF patients is based on the provision of a standard volume of high caloric oral supplement rather than individualised dietary requirements [16]. One of the primary limitations of a standard approach is the failure to be patient orientated and tailor dietary therapy to each individual's energy and protein deficits associated with pre-existing malnutrition and inadequate dietary intakes post PFF surgery [16]. …”

A study of a pathway to reduce pressure ulcers for patients with a hip fracture

“…Part six, emphasised that the patients were supposed to be given a higher priority on the waiting list for surgery (Grimes et al, 2002;Hommel et al, 2003). Part seven, was the introduction of a nutritional drink given twice a day postoperatively (Avenell and Handoll, 2003).…”