Protein and energy balance following femoral neck fracture in geriatric patients

Nelson, Karl M.; Richards, Ernest; Long, Calvin L.; Martin, Kathy R.; Geiger, John W.; Brooks, Stephen W.; Gandy, Roy E.; Blakemore, William S.

doi:10.1016/0026-0495(95)90290-2

Cited by 10 publications

(8 citation statements)

References 24 publications

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“…The use of anti-inflammatory medication throughout the first week of bone healing may alter this natural inflammatory process and potentially inhibit normal bone healing [49]. Furthermore, the literature provides convincing evidence that markers of cachexia, including poor appetite [8,50], involuntary weight loss, in particular lean muscle [51,52], increased REE [53-55] and decreased albumin [55,56] are commonly observed in patients recovering from PFF.…”

Section: Discussionmentioning

confidence: 99%

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?

et al. 2010

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BackgroundProximal femoral fractures are associated with increased morbidity and mortality. Pre-existing malnutrition and weight loss amongst this patient group is of primary concern, with conventional nutrition support being largely ineffective. The inflammatory response post proximal femoral fracture surgery and the subsequent risk of cachexia may explain the inability of conventional high energy high protein management to produce an anabolic response amongst these patients. Omega-3 fatty acids derived from fish oils have been extensively studied for their anti-inflammatory benefits. Due to their anti-inflammatory properties, the benefit of fish oil combined with individualized nutrition support amongst proximal femoral fracture patients post surgery is an attractive potential therapeutic strategy. The aim of the ATLANTIC trial is to assess the potential benefits of an anti-inflammatory dose of fish oil within the context of a 12 week individualised nutrition program, commencing seven days post proximal femoral fracture surgery.Methods/DesignThis randomized controlled, double blinded trial, will recruit 150 community dwelling elderly patients aged ≥65 years, within seven days of surgery for proximal femoral fracture. Participants will be randomly allocated to receive either a 12 week individualized nutrition support program complemented with 20 ml/day anti-inflammatory dose fish oil (~3.6 g eicosapentaenoic acid, ~2.4 g docosahexanoic acid; intervention), or, a 12 week individualized nutrition support program complemented with 20 ml/day low dose fish oil (~0.36 g eicosapentaenoic acid, ~0.24 g docosahexanoic acid; control).DiscussionThe ATLANTIC trial is the first of its kind to provide fish oil combined with individualized nutrition therapy as an intervention to address the inflammatory response experienced post proximal femoral fracture surgery amongst elderly patients. The final outcomes of this trial will assist clinicians in the development of effective and alternative treatment methods post proximal femoral fracture surgery which may ultimately result in a reduction in systemic inflammation, loss of weight and lean muscle and improvements in nutritional status, mobility, independence and quality of life among elderly patients.Trial RegistrationACTRN12609000241235

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Section: Discussionmentioning

confidence: 99%

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?

et al. 2010

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“…In hip fracture patients, four studies have evaluated the difference between REE estimated using predictive equations and measured REE via indirect calorimetry. Three of these studies have reported that the equations significantly underestimate measured REE by between 8 and 20 % (Jallut et al 1990;Nelson et al 1995;Paillaud et al 2000) whilst one study suggests that using the predictive equations of Owen et al (1986Owen et al ( , 1987 can either over-or underestimate REE by 30 % (Campillo et al 1992). Direct comparisons between literature findings and the findings of the present study are complicated given the variation in timing of the REE measurement (days 3, 8/9, 21, 51, 81), the range of predictive equations used for comparison (Harris & Benedict, 1919;FAO/WHO/UNU, 1985;Owen et al 1986Owen et al , 1987 and the lack of detail regarding the use of correction factors to adjust for physiological stress related to injury and surgery (Long et al 1979).…”

Section: Discussionmentioning

confidence: 99%

“…There have been four small studies (Jallut et al 1990;Campillo et al 1992;Nelson et al 1995;Paillaud et al 2000) that have reported resting energy expenditure (REE) of hip fracture patients as measured by indirect calorimetry, two of which included longitudinal data. All reported that energy expenditure predicted by equations underestimated measured energy expenditure (range 8 -30 %) and recommended that clinicians account for this by increasing the energy density or volume of the intervention.…”

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confidence: 99%

Resting energy expenditure measured longitudinally following hip fracture compared to predictive equations: is an injury adjustment required?

et al. 2005

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The present study measuring resting energy expenditure (REE; kJ/d) longitudinally using indirect calorimetry in six elderly women aged $70 years following surgery for hip fracture, describes changes over time (days 10, 42 and 84 post-injury) and compares measured values to those calculated from routinely applied predictive equations. REE was compared to REE predicted using the Harris Benedict and Schofield equations, with and without accounting for the theoretical increase in energy expenditure of 35 % secondary to physiological stress of injury and surgery. Mean (95 % CI) measured REE (kJ/d) was 4704 (4354, 5054), 4090 (3719, 4461) and 4145 (3908, 4382) for days 10, 42 and 84, respectively. A time effect was observed for measured REE, P¼0·003. Without adjusting for stress the mean difference and 95 % limits of agreement for measured and predicted REE (kJ/kg per d) for the Harris Benedict equation were 1 (29, 12), 10 (2, 18) and 9 (1, 17) for days 10, 42 and 84, respectively. The mean difference and 95 % limits of agreement for measured and predicted REE (kJ/kg per d) for the Schofield equation without adjusting for stress were 8 (23, 19), 16 (6, 26) and 16 (10, 22) for days 10, 42 and 84, respectively. After adjusting for stress, REE predicted from the Harris Benedict or Schofield equations overestimated measured REE by between 38 and 69 %. Energy expenditure following fracture is poorly understood. Our data suggest REE was relatively elevated early in recovery but declined during the first 6 weeks. Using the Harris Benedict or Schofield equations adjusted for stress may lead to overestimation of REE in the clinical setting. Further work is required to evaluate total energy expenditure before recommendations can be made to alter current practice for calculating theoretical total energy requirements of hip fracture patients.

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“…A esto se añade la pérdida sanguínea en el foco de fractura. Asimismo está descrita una alta proporción de linfopenia (8,(24)(25)(26), grados variables de deshidratación y una marcada incidencia de déficit de vitamina D (27,28). En nuestro país, se ha comunicado un déficit de vitamina D hasta en el 91% de ancianos con fractura de cadera (29).…”

Section: Características De Los Pacientes Que Sufren Una Fractura De unclassified

Importancia de la malnutrición y otros factores médicos en la evolución de los pacientes con fractura de cadera

Lázaro¹,

Pérez-Barquero²,

Benítez³

2004

An. Med. Interna (Madrid)

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As the population progressively ages, hip fractures have become increasingly common and are associated with high morbidity and mortality and a pronounced decline in functional status. Hip fractures frequently occur in elderly patients with a high rate of comorbidity and polymedication. Patients hospitalised with hip fractures often display signs of protein malnutrition and may develop medical complications requiring intrahospital care. These factors, more than simply surgical ones, unfavourably influence the vital status and functional outcome of these patients. For this reason, it is necessary to improve the management of pre-existing conditions during hospitalisation, assess and treat malnutrition and prevent medical complications to achieve optimal outcomes for these patients. With this objective, we believe that care should be provided by multidisciplinary teams in close partnership with internists.

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Protein and energy balance following femoral neck fracture in geriatric patients

Cited by 10 publications

References 24 publications

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?

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?

Resting energy expenditure measured longitudinally following hip fracture compared to predictive equations: is an injury adjustment required?

Importancia de la malnutrición y otros factores médicos en la evolución de los pacientes con fractura de cadera

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