Protein and energy supplementation in elderly people at risk from malnutrition

  • Conclusions changed
  • Review
  • Intervention




Evidence for the effectiveness of nutritional supplements containing protein and energy, often prescribed for older people, is limited. Malnutrition is more common in this age group and deterioration of nutritional status can occur during illness. It is important to establish whether supplementing the diet is an effective way of improving outcomes for older people at risk from malnutrition.


This review examined trials for improvement in nutritional status and clinical outcomes when extra protein and energy were provided, usually as commercial 'sip-feeds'.

Search methods

We searched The Cochrane Library, MEDLINE, EMBASE, Healthstar, CINAHL, BIOSIS, CAB abstracts. We also hand searched nutrition journals and reference lists and contacted 'sip-feed' manufacturers.

Selection criteria

Randomised and quasi-randomised controlled trials of oral protein and energy supplementation in older people, with the exception of groups recovering from cancer treatment or in critical care.

Data collection and analysis

Two reviewers independently assessed trials prior to inclusion and independently extracted data and assessed trial quality. Authors of trials were contacted for further information as necessary.

Main results

Sixty-two trials with 10,187 randomised participants have been included in the review. Maximum duration of intervention was 18 months. Most included trials had poor study quality. The pooled weighted mean difference (WMD) for percentage weight change showed a benefit of supplementation of 2.2% (95% confidence interval (CI) 1.8 to 2.5) from 42 trials. There was no significant reduction in mortality in the supplemented compared with control groups (relative risk (RR) 0.92, CI 0.81 to 1.04) from 42 trials. Mortality results were statistically significant when limited to trials in which participants (N = 2461) were defined as undernourished (RR 0.79, 95% CI 0.64 to 0.97).

The risk of complications was reduced in 24 trials (RR 0.86, 95% CI 0.75 to 0.99). Few trials were able to suggest any functional benefit from supplementation. The WMD for length of stay from 12 trials also showed no statistically significant effect (-0.8 days, 95% CI -2.8 to 1.3). Adverse effects included nausea or diarrhoea.

Authors' conclusions

Supplementation produces a small but consistent weight gain in older people. Mortality may be reduced in older people who are undernourished. There may also be a beneficial effect on complications which needs to be confirmed. However, this updated review found no evidence of improvement in functional benefit or reduction in length of hospital stay with supplements. Additional data from large-scale multi-centre trials are still required.








我們搜尋了Cochrane Central Register of Controlled Trials (CENTRAL)、MEDLINE、EMBASE、Healthstar、CINAHL、BIOSIS及CAB abstracts。我們亦檢索了與營養有關的期刊和參考文獻,並與製造流質營養品的廠商聯繫。最近一次搜尋的日期為2004年3月。






本篇回顧共收錄了49個試驗,包括了4790位隨機的受試者。在收錄的試驗中,其研究品質多半不佳。在由34個試驗匯集的數據中,接受補充者之體重改變百分率的加權均數差(WMD)增加了2.3%(95%信賴區間(CI)1.9−2.7);32個試驗的整合結果顯示:與對照組相較,補充組的死亡率較低(相對風險(RR)0.74,CI 0.59−0.92);而14個試驗的整合結果顯示:產生併發症的風險並無明顯的差異(RR 0.95,95% CI 0.81−1.11)。幾乎沒有試驗可以證明營養補充有功能上的益處。而在由10個試驗匯集的數據中,住院日數的加權均數差(WMD)並無統計學上顯著的差異(WMD −1.98日,95% CI 5.20−1.24)。





此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。


對於住院或是居住在長期照護中心的老人而言,蛋白質和熱量的補充看來似乎有所幫助。 本篇的回顧者提出:營養補充可使體重小幅但一致的上升,亦有可能使死亡率降低。在各試驗中,儘管對營養補充的接受度不盡相同,但整體而言都算不錯。同時,只有少數如噁心及腹洩等副作用被報告。然而,關於研究的設計及品質,仍有問題存在。因此,我們仍需更多的研究來證實其對死亡率的益處,並且能提供蛋白質及熱量補充究竟是否能改善脆弱老人之罹病率及功能狀況的具體證據。

Plain language summary

Protein and energy supplementation in elderly people at risk from malnutrition

Much emphasis is placed on the importance of good diet, usually in relation to concern about the health risks of obesity. However it has been generally agreed that the risk of undernutrition rather than overnutrition is the main cause for concern in elderly people, particularly those who are hospitalised or institutionalised. Malnutrition has been shown to have important effects on recovery in a broad range of patients and conditions. It has been associated strongly with impaired immune response, impaired muscle and respiratory function, delayed wound healing, overall increased complications, longer rehabilitation, greater length of hospital stay and increased mortality. Oral protein and energy supplements are potentially safer and easier to administer than nasogastric enteral feeds and are therefore particularly suited to elderly people and are also widely used. However, there may be problems with the willingness and ability of older people to consume oral supplements, and supplements may not be used effectively. Even if supplements are prescribed, they may not always be given, or are given but not consumed. In addition to taste, the composition and timing of administration in relation to meals may be important. Efforts also need to be made to provide normal meals and snacks which meet the needs of elderly people and to provide assistance with feeding if required.

A total of 10,187 randomised participants from the 62 trials has been included. Maximum duration of intervention was 18 months. The reviewers suggest that supplementation appears to produce a small but consistent weight gain. There was no evidence in this updated review of a beneficial effect on mortality overall, but there may be a beneficial effect on mortality in people who are undernourished. Supplementation may also reduce the number of complications. The reported acceptance of supplements was variable between trials. Some adverse effects such as nausea or diarrhoea were reported. However, there were problems of study design and quality. More studies are required to confirm the beneficial effect on the number of complications, to establish whether there is a beneficial effect on mortality for undernourished elderly people and to provide evidence about whether protein and energy supplements can improve morbidity and functional status in frail older people.