Energy Balance in Elderly Patients after Surgery for a Femoral Neck Fracture

Jallut, D; Tappy, Luc; Kohut, Mojmír; Bloesch, D.; Munger, Ronald G.; Schütz, Y.; Chioléro, R.; Felber, J. P.; Livio, J. J.; Jéquier, E

doi:10.1177/0148607190014006563

Cited by 74 publications

(33 citation statements)

References 16 publications

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“…Experimental protocol (Figure 1) At inclusion, resting energy expenditure was measured for 60 min in the morning after an overnight fast using indirect calorimetry (ventilated hood method) (Jallut et al, 1990). Every participant thereafter took part in two metabolic investigations, separated by at least 21 days.…”

Section: Methodsmentioning

confidence: 99%

Mechanisms of action of β-glucan in postprandial glucose metabolism in healthy men

et al. 2001

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Objective: To assess whether b-glucan (which is fermented in the colon) lowers postprandial glucose concentrations through mechanisms distinct from a delayed carbohydrate absorption and inhibits de novo lipogenesis. Design: Administration of frequent small meals each hour over 9 h allows a rate of intestinal absorption to be reached which is independent of a delayed absorption. A group of 10 healthy men received either an isoenergetic diet containing 8.9 gaday b-glucan or without b-glucan for 3 days. On the third day, the diet was administered as fractioned meals ingested every hour for 9 h. Setting: Laboratory for human metabolic investigations. Subjects: Ten healthy male volunteers. Main outcome measures: Plasma glucose and insulin concentrations, glucose kinetics, glucose oxidation, de novo lipogenesis. Results: On the third day, plasma glucose and free fatty acid concentrations, carbohydrate and lipid oxidation, and energy expenditure were identical with b-glucan and cellulose. Plasma insulin concentrations were, however, 26% lower with b-glucan during the last 2 h of the 9 h meal ingestion. Glucose rate of appearance at steady state was 12% lower with b-glucan. This corresponded to a 21% reduction in the systemic appearance rate of exogenous carbohydrate with b-glucan, while endogenous glucose production was similar with both diets. De novo lipogenesis was similar with and without b-glucan. Conclusion: Administration of frequent meals with or without b-glucan results in similar carbohydrate and lipid metabolism. This suggests that the lowered postprandial glucose concentrations which are observed after ingestion of a single meal containing b-glucan are essentially due to a delayed and somewhat reduced carbohydrate absorption from the gut and do not result from the effects of fermentation products in the colon. Descriptors: glucose production; de novo lipogenesis; substrate oxidation

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Section: Methodsmentioning

confidence: 99%

Mechanisms of action of β-glucan in postprandial glucose metabolism in healthy men

et al. 2001

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“…People with hip fractures, who are often under-nourished at the time of the fracture (Mansell et al, 1990;Lumbers et al, 1996;Maffulli et al, 1999), have poor food intakes in hospital (Bastow et al, 1983a;Jallut et al, 1990;Patterson et al, 1992;Lumbers et al, 1999). Under-nutrition leads to mental apathy, reduced muscle power, and impaired cardiac function and immunity (Keys et al, 1950;Lesourd, 1997); these increase the tendency to develop postoperative complications and hinder recovery.…”

Section: Introductionmentioning

confidence: 99%

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

Avenell

Handoll

2003

Eur J Clin Nutr

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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.

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“…It has been reported that the nutritional status of these patients deteriorates further during admission (Jallut et al, 1990;Brown and Seabrook, 1992;Unosson et al, 1995;Paillaud et al, 2000;Bachrach-Lindstrom et al, 2001) and that being undernourished has an adverse impact on recovery (Bastow et al, 1983;Koval et al, 1999). Despite this, very few studies provide information of sufficient detail to inform clinical practice.…”

Section: Introductionmentioning

confidence: 99%

“…Factors influencing decline in nutritional status during admission in this patient group are likely to be numerous including lack of recognition and treatment of undernutrition (McWhirter and Pennington, 1994;Miller et al, 2001) and increased dietary requirements (Jallut et al, 1990;Paillaud et al, 2000). In addition poor appetite and oral dietary intake are likely to be significant contributing factors, with studies consistently reporting dietary energy intakes below estimated requirements (Older et al, 1980;Stableforth, 1986;Brown and Seabrook, 1992;Lumbers et al, 2001).…”

Section: Introductionmentioning

confidence: 99%

“…In many intake studies cognitive impairment is an exclusion criteria (Bastow et al, 1983;Jallut et al, 1990;Brown and Seabrook, 1992;Patterson et al, 1992;Sullivan et al, 1998;Murphy et al, 2000;Lawson et al, 2003;Eneroth et al, 2005) or has not been reported (Hessov, 1977;Older et al, 1980;Dickerson et al, 1984;Stableforth, 1986;MollerMadsen et al, 1988;Delmi et al, 1990;Hartgrink et al, 1998). Those studies that have included patients with cognitive impairment have not reported intake data according to cognitive status (Volkert et al, 1996;Duncan et al, 2001;Lumbers et al, 2001), despite evidence that eating behaviours associated with decreased dietary intake (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Lower limb fracture, cognitive impairment and risk of subsequent malnutrition: a prospective evaluation of dietary energy and protein intake on an orthopaedic ward

Miller¹,

Bannerman

Daniels

et al. 2006

Eur J Clin Nutr

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Objective: To report the dietary energy and protein intake of undernourished older adults (with and without cognitive impairment) admitted to hospital following a lower limb fracture and to determine whether dietary intakes met estimated requirements. Design: An observational study of a sequential sample. Setting: The orthopaedic ward of a South Australian metropolitan teaching hospital. Subjects: Sixty-eight patients aged X70 years screened as undernourished and admitted to hospital following lower limb fracture (50% cognitively impaired) provided 3 to 5 days of dietary data. Major outcome methods: Dietary energy and protein intake. Methods: Dietary assessment using plate waste methodology and snack record charts commenced within 6 days postinjury and continued for up to five consecutive days or until discharge. Estimated resting energy requirements were calculated and adjusted for activity equivalent to bed rest and physiological stress. Protein requirements were calculated as 1 g/kg/day. Cognition was assessed using the Short Portable Mental Status Questionnaire. Results: Cognitively impaired participants and those without cognitive impairment consumed, mean (95% CI) respectively, 3661 kJ/day (3201, 4121) versus 4208 kJ/day (3798, 4619) and 38 g (33, 44) versus 47 g (41, 52) protein/day. Cognitively impaired participants consumed mean (95% CI) 48% (43, 53) of estimated total energy expenditure and 78% (69, 87) of estimated protein requirements. Conclusions: Orthopaedic fracture patients at greatest nutritional risk, including those with cognitive impairment, do not achieve estimated energy or protein requirements from diet alone. Effective methods of achieving requirements in this vulnerable group are needed before improvements in outcomes will be observed.

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Energy Balance in Elderly Patients after Surgery for a Femoral Neck Fracture

Cited by 74 publications

References 16 publications

Mechanisms of action of β-glucan in postprandial glucose metabolism in healthy men

Mechanisms of action of β-glucan in postprandial glucose metabolism in healthy men

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

Lower limb fracture, cognitive impairment and risk of subsequent malnutrition: a prospective evaluation of dietary energy and protein intake on an orthopaedic ward

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