Nutritional supplementation for activities of daily living and functional ability of older people in residential facilities: A systematic review

Tsuboi, Marika; Momosaki, Ryo; Vakili, Mahdis; Abo, Masahiro

doi:10.1111/ggi.13160

Cited by 9 publications

(4 citation statements)

References 26 publications

(51 reference statements)

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“…They found significant improvements in handgrip strength (mean difference 1.65 kg, P ¼ .04), but no difference in activities of daily living, gait velocity, or preventing death. 44 In our study, the benefits of ONS was higher in those participants with lower BMI. The subgroup with highest BMI showed little benefit from the intervention.…”

Section: Discussionsupporting

confidence: 45%

“…Mean handgrip strength increased more in the intervention group (13.9%) than in the control group (7.2%) (P ¼ .055), 43 what is in line with our results. In addition, Tsuboi et al 44 performed a systematic review evaluating the effects of nutritional supplementation on activities of daily living and functional ability of older people in residential facilities. Eight clinical trials comprising 698 participants were included.…”

Section: Discussionmentioning

confidence: 99%

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Results of High-Protein, High-Calorie Oral Nutritional Supplementation in Malnourished Older People in Nursing Homes: An Observational, Multicenter, Prospective, Pragmatic Study (PROT-e-GER)

Malafarina

Masanés

Cervera-Díaz

et al. 2021

Journal of the American Medical Directors Association

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Objectives: To assess if the impact of oral nutritional supplements (ONS) on nutritional and functional status in malnourished older persons living in nursing homes shown by clinical trials are also found outside a trial setting. Design: Observational, multicenter, prospective, pragmatic study. Setting and Participants: This study was carried out in 38 nursing homes throughout Spain. Nursing home physicians recruited consecutive residents, older than 65 years, with a diagnosis of malnutrition, when a clinical decision to start ONS had been taken after unsuccessful initial management with dietary interventions. Intervention: The participants received daily 2 bottles of an energy-rich, high-protein commercial ONS for 3 months. Measures: Primary outcomes were changes in nutritional status [body weight, body mass index (BMI), and Mini Nutritional Assessment-Short Form (MNA-SF)]; secondary outcomes were functional changes [Functional Ambulation Classification, Barthel index, handgrip strength, and Short Physical Performance Battery (SPPB)], as well as safety and adherence after 12 weeks of follow-up. Results: A total of 282 residents (median age 86 years, 67% women) were included, and 244 (86.5%) completed the follow-up. At baseline, 77.3% of the participants were malnourished (BMI 19.7 kg/m 2 , interquartile range 18.3e21.8). After 12 weeks of follow-up, participants experienced significant increases in body weight (2.6 AE 3.1 kg, 5.2 AE 5.9%), BMI (1.0 AE 1.2 kg/m 2 ) and MNA-SF (4.0 AE 2.5 points). There were also significant improvements in functional status measured by the Barthel index, handgrip strength, SPPB, and gait speed. Good adherence was registered in 94.6% of the participants. No relevant side effects were found.

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Section: Discussionsupporting

confidence: 45%

Section: Discussionmentioning

confidence: 99%

Results of High-Protein, High-Calorie Oral Nutritional Supplementation in Malnourished Older People in Nursing Homes: An Observational, Multicenter, Prospective, Pragmatic Study (PROT-e-GER)

Malafarina

Masanés

Cervera-Díaz

et al. 2021

Journal of the American Medical Directors Association

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“…An interesting analysis showed that nutritional support performed by a multidisciplinary team—as recommended in the ESPEN guideline—might fare better than simple interventions in reducing mortality risk and improving quality of life [43]. A systematic review looking at studies performed in nursing homes found an effect on handgrip strength only and not in other functional parameters [44]. A further recent review focused on various treatments for anorexia of ageing, also including pharmacologic approaches and flavour enhancement, suggests that some interventions may have an impact on energy intake and body weight, but calls for methodological improvements in the field [45].…”

Section: Management Of Malnutritionmentioning

confidence: 99%

Management of Malnutrition in Older Patients—Current Approaches, Evidence and Open Questions

Volkert

Beck

Cederholm

et al. 2019

JCM

144

120

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Malnutrition is widespread in older people and represents a major geriatric syndrome with multifactorial etiology and severe consequences for health outcomes and quality of life. The aim of the present paper is to describe current approaches and evidence regarding malnutrition treatment and to highlight relevant knowledge gaps that need to be addressed. Recently published guidelines of the European Society for Clinical Nutrition and Metabolism (ESPEN) provide a summary of the available evidence and highlight the wide range of different measures that can be taken—from the identification and elimination of potential causes to enteral and parenteral nutrition—depending on the patient’s abilities and needs. However, more than half of the recommendations therein are based on expert consensus because of a lack of evidence, and only three are concern patient-centred outcomes. Future research should further clarify the etiology of malnutrition and identify the most relevant causes in order to prevent malnutrition. Based on limited and partly conflicting evidence and the limitations of existing studies, it remains unclear which interventions are most effective in which patient groups, and if specific situations, diseases or etiologies of malnutrition require specific approaches. Patient-relevant outcomes such as functionality and quality of life need more attention, and research methodology should be harmonised to allow for the comparability of studies.

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“…These results, combined with our findings, therefore suggest that older persons with malnutrition and those at risk may not benefit from a nutritional intervention with regard to handgrip strength. On the other hand, there are also studies reporting positive effects, such as the systematic review that examined studies conducted in nursing homes [40]. We cannot exclude that handgrip strength is less sensitive to intervention changes than other measures of muscle strength.…”

Section: Discussionmentioning

confidence: 99%

Effects of Nutritional Interventions in Older Adults with Malnutrition or at Risk of Malnutrition on Muscle Strength and Mortality: Results of Pooled Analyses of Individual Participant Data from Nine RCTs

et al. 2023

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Nutritional intervention studies in older adults with malnutrition aim to improve nutritional status. Although these studies show a significant gain in body weight, there is inconsistent evidence of clinical effectiveness on muscle strength and mortality. This study aimed to examine the effects of nutritional interventions on muscle strength and risk of mortality in older adults (malnourished or at risk) and explore whether these effects are influenced by participant characteristics. Individual participant data were used from nine RCTs (community setting, hospital and long-term care; duration 12–24 weeks and included oral nutritional supplements, dietary counseling, or both). Handgrip strength (HGS) was measured in seven RCTs and six RCTs obtained mortality data. A ≥3 kg increase in HGS was considered clinically relevant. Logistic generalized estimating equations analyses (GEE) were used to test intervention effectiveness. GEE showed no overall treatment effect (OR 1.11, 95% CI 0.78–1.59) on HGS. A greater, but not statistically significant, effect on HGS was observed for older (>80 years) versus younger participants. No significant treatment effect was observed for mortality (OR 0.78, 95% CI 0.42–1.46). The treatment effect on mortality was greater but remained non-significant for women and those with higher baseline energy or protein intake. In conclusion, no effects of nutritional interventions were observed on HGS and mortality in older adults (malnourished or at risk). While the treatment effect was modified by some baseline participant characteristics, the treatment also lacked an effect in most subgroups.

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Nutritional supplementation for activities of daily living and functional ability of older people in residential facilities: A systematic review

Cited by 9 publications

References 26 publications

Results of High-Protein, High-Calorie Oral Nutritional Supplementation in Malnourished Older People in Nursing Homes: An Observational, Multicenter, Prospective, Pragmatic Study (PROT-e-GER)

Results of High-Protein, High-Calorie Oral Nutritional Supplementation in Malnourished Older People in Nursing Homes: An Observational, Multicenter, Prospective, Pragmatic Study (PROT-e-GER)

Management of Malnutrition in Older Patients—Current Approaches, Evidence and Open Questions

Effects of Nutritional Interventions in Older Adults with Malnutrition or at Risk of Malnutrition on Muscle Strength and Mortality: Results of Pooled Analyses of Individual Participant Data from Nine RCTs

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