Low postoperative dietary intake is associated with worse functional course in geriatric patients up to 6 months after hip fracture

Abstract

We examined the relationship between postoperative dietary intake (DI) of geriatric hip fracture (HF) patients and their functional and clinical course until 6 months after hospital discharge. In eighty-eight HF patients $ 75 years, postoperative DI was estimated with plate diagrams of main meals over four postoperative days. DI was stratified as .50, .25-50, #25 % of meals served. Functional status according to Barthel index (activities of daily living) and patients' mobility level before fracture, postoperatively, at discharge and 6 months later were assessed and related to DI levels. In-hospital complications were recorded according to clinical diagnosis. Associations were evaluated using x 2 and Kruskal -Wallis tests, and repeated-measures ANOVA and ANCOVA. Postoperatively, 28 % of participants ate .50 %, 43 % ate .25 -50 % and 28 % # 25 % of meals served. Irrespective of pre-fracture functional status, patients with DI # 25 % had significantly lower Barthel index scores at all times after surgery (all P,0·05) and ANOVA revealed a significant time £ DI interaction effect (P¼ 0·047) on development of Barthel index scores that remained significant after adjustment for potential confounders. Patients with DI .50 % more often had regained their pre-fracture mobility level than those with DI #25 % at discharge (.50 %: 36 %; . 25-50 %: 10 %; # 25 %: 0 %; P¼ 0·001) and 6 months after discharge (88; 87; 68 %; P¼ 0·087) and had significantly less complications (median 2 (25th -75th percentile 1-3); 3 (25th -75th percentile 2 -4); 3 (25th -75th percentile 3-4); P¼ 0·012). To conclude, geriatric HF patients had very low postoperative voluntary DI and thus need specific nutritional interventions to achieve adequate DI to support functional and clinical recovery.

Assessing the Effect of Preoperative Nutrition on Upper Body Function in Elderly Patients Undergoing Elective Abdominal Surgery

“…In our study, 64% of well‐nourished patients had recovered their HGS at 24 weeks, as compared with 44% of mildly to moderately malnourished patients. This is consistent with previous findings based on short‐term recovery at time of discharge and long‐term recovery over a 24‐week postoperative period, which suggest that well‐nourished patients may recover faster than malnourished individuals postoperatively . Overall, for this cohort, only 61% of patients had recovered to baseline HGS values at 24 weeks postsurgery.…”

“…This is consistent with previous findings based on short-term recovery at time of discharge and long-term recovery over a 24-week postoperative period, which suggest that wellnourished patients may recover faster than malnourished individuals postoperatively. 32,33 Overall, for this cohort, only 61% of patients had recovered to baseline HGS values at 24 weeks postsurgery. The fact that a significant number of patients had not recovered at 24 weeks is not surprising and is similar to previous research reporting that recovery of HGS among the elderly is protracted past 24 weeks.…”

ESPEN guidelines on nutrition in dementia

“…The grade of evidence (GOE) was determined by a number of factors, starting with the number and type of research studies [2]. Grading from High to Very Low was used to rate the quality of the underlying evidence and the level of certainty for effect (Table 1) [3].…”

Clinical application of the basic definition of malnutrition proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN): Comparison with classical tools in geriatric care

“…Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Malnutrition is highly frequent in older in-patients, with a prevalence ranging from 49%to 67% (Campos del Portillo et al, 2015) (Marshall, Young, Bauer, & Isenring, 2016) (Strakowski, Strakowski, & Mitchell, 2002); the highest prevalence was observed in postacute care settings (Strakowski et al, 2002).Malnutrition and related syndromes, such as sarcopenia and frailty (Cederholm et al, 2015) are associated with longer hospital stays (Agarwal et al, 2013) (Correia, Perman, & Waitzberg, 2017)(Sanz-París et al, 2016, infectious and non-infectious clinical complications (Carlsson, Haglin, Rosendahl, & Gustafson, 2013) (Nunes, Flores, Mielke, Thumé, & Facchini, 2016), poor (Arinzon, Fidelman, Zuta, Peisakh, & Berner, 2005) (Cerri et al, 2015) (Goisser et al, 2015) (Luk, Chiu, Tam, & Chu, 2011) (Wakabayashi & Sashika, 2014), lack of recovery during three-month follow-up (Sánchez-Rodríguez et al, 2014), and increased risk of adverse outcomes following discharge, institutionalization, use of health care resources, readmissions, mortality, and costs (Agarwal et al, 2013) (Correia et al, 2017) (Curtis et al, 2017) (Hamirudin, Charlton, & Walton, 2016).…”

“…For instance, clinical manifestations may include unintentional weight loss (Cederholm et al, 2015) (Evans et al, 2008) (Reuben et al, 1995) (Wirth et al, 2016) (White et al, 2012), reduced anthropometry (body mass index [BMI], calf circumference) (Bahat et al, 2012) (Rolland et al, 2014), and changes in behavior (i.e. reduced food intake, anorexia) (Agarwal et al, 2013) (Goisser et al, 2015) (Reuben et al, 1995) (White et al, 2012).…”