Nutritional status in elderly female hip fracture patients: comparison with an age-matched home living group attending day centres

Abstract

Fractured neck of femur occurs mostly in the older female population and is generally caused by falls. Malnutrition has been postulated as a factor that increases the tendency to suffer falls. Nutritional status of older female hospital patients admitted for emergency surgery for fractured neck of femur recruited (n 75), was compared with an age-matched independent-living group of females attending one of three local day centres (n 50). Dietary assessment was undertaken using three consecutive 24 h dietary recalls and, in the hip fracture group, completed menu cards were used as memory prompts. Data concerning key lifestyle characteristics were obtained using a face-to-face administered questionnaire. Blood samples were taken to determine levels of plasma albumin, transferrin, C-reactive protein (CRP), cholesterol, vitamin C, Se, Zn and total antioxidant status. Haemolysate samples were analysed for Se-dependent glutathione peroxidase activity. There were no significant differences in age between the two groups, but the hip fracture patients had lower mean values for body weight (59´6 v. 67´5 kg; P 0´005Y mindex (weight/demispan) (83´1 v. 94´4 kg/m; P , 0´0001Y calculated BMI (24´1 v. 27´5 kg/m 2 P , 0´0001Y mid-upper arm circumference; 27´1 v. 31´3 cm, P 0´001 and triceps skinfold thickness; 17´0 v. 18´9 mm, P 0´005 than the home-living group. The hip fracture patients had lower intakes of energy (4´3 v. 5´4 MJ, P 0´001Y fat P 0´025Y carbohydrate P 0´002Y protein P 0´006Y thiamine P 0´017Y vitamin B 6 P 0´001Y calcium P 0´01Y K P 0´001Y Mg P 0´001Y P P 0´001Y Fe P 0´007Y Se P 0´008 and NSP P 0´001X Mean intakes of both groups were below the estimated average requirement for energy and below the reference nutrient intakes for folate, Ca, vitamin D, Mg, K, Se and Zn. In a high percentage of the hip fracture group the dietary intake of particular nutrients fell below the lower reference nutrient intake for Se (73 %), Mg (54 %) and Fe (19 %). As expected, the fracture patients had reduced plasma albumin P , 0´0001 and increased CRP P , 0´001 values. They had higher plasma vitamin C levels P , 0´001 and lower cholesterol levels P 0´04 than the day centre attendees. There were no significant differences in plasma levels of Se, Zn, transferrin or haemolysate glutathione peroxidase activity between the two groups. However, there was evidence of under-nutrition in both groups as key anthropometric values were low, plasma nutrient and metabolite levels were below the standard reference ranges and many individuals had low dietary intakes for specified nutrients.

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

“…The data presented in this study also suggests that protein intake does not meet estimated requirements, although the shortfall is much narrower than that seen for energy intake. This is consistent with evidence from healthy elderly that suggests that protein intake is not compromised to the same degree as energy (Lumbers et al, 2001). It is, however, possible that requirements are elevated perhaps as high as 1.5 g/kg/day during periods of recovery from hip fracture (Patterson et al, 1992).…”

“…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). A wide range in daily energy intakes have been reported, 2630 kJ (Duncan et al, 2001) 7560 kJ (Bastow et al, 1983) and daily protein intakes, 26 kJ (Duncan et al, 2001) 53 g (Lawson et al, 2003).…”

“…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. food refusal, skipping meals, fluctuations in appetite) are common among cognitively impaired older adults Volicer et al, 1989).…”

“…food frequency questionnaire) (Schurch et al, 1998) or for patients post anaesthesia (e.g. 24 h recall) (Murphy et al, 2000;Lumbers et al, 2001) and few have looked specifically at those who were undernourished or nutritionally at risk on admission to the acute care setting (Bastow et al, 1983;Brown and Seabrook, 1992;Volkert et al, 1996;Murphy et al, 2000).…”

Preoperative albumin as a predictor of one-year mortality in patients with fractured neck of femur

“…It is known that patients presenting with a fractured neck of femur are at risk of PEM 8 . The extent to which this occurs is documented as well as short-term evidence of increased mortality in patients with low serum albumin 6 .…”