Intervention Review

Protein and energy supplementation in elderly people at risk from malnutrition

  1. Anne C Milne2,
  2. Jan Potter1,*,
  3. Angela Vivanti3,
  4. Alison Avenell4

Editorial Group: Cochrane Metabolic and Endocrine Disorders Group

Published Online: 15 APR 2009

Assessed as up-to-date: 29 NOV 2007

DOI: 10.1002/14651858.CD003288.pub3


How to Cite

Milne AC, Potter J, Vivanti A, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD003288. DOI: 10.1002/14651858.CD003288.pub3.

Author Information

  1. 1

    South East Sydney and Illawarra Area Health Service, Aged Care Southern Hospital Network, Wollongong, New South Wales, Australia

  2. 2

    Aberdeen, Aberdeenshire, Scotland, UK

  3. 3

    Princess Alexandra Hospital, Department of Nutrition and Dietetics, Woolloongabba, Queensland, Australia

  4. 4

    University of Aberdeen, Health Services Research Unit, Aberdeen, UK

*Jan Potter, Aged Care Southern Hospital Network, South East Sydney and Illawarra Area Health Service, LMB 8808, South Coast Mail Centre , Wollongong, New South Wales, 2521, Australia. Jan.Potter@SESIAHS.HEALTH.NSW.GOV.AU.

Publication History

  1. Publication Status: Edited (conclusions changed)
  2. Published Online: 15 APR 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

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.

Objectives

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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

對有營養不良風險之老年人的蛋白質與熱量補充

臨床上常見處方給老年人含蛋白質和熱量的營養補充,但有關其效益之證據,仍然有限。營養不良的情形於此一年齡層極為常見,患病時更容易出現營養狀況的惡化。因此,確定飲食補充是否能有效地改善有營養不良風險之老年人的預後,是很重要的。

目標

本文檢驗給予額外蛋白質與熱量的補充通常是流質成品對於營養狀況及臨床結果改善之試驗的證據。

搜尋策略

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。

選擇標準

老年人以口服補充蛋白質及熱量的隨機對照試驗及準隨機對照試驗,但排除癌症治療及重症照護的群組.

資料收集與分析

二位回顧者各自獨立評估要納入哪些試驗、截取數據並評估各試驗的研究品質。如需要更進一步的資訊,我們亦會聯繫試驗的原作者。

主要結論

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)。

作者結論

對老年人的營養補充可使體重小幅但一致的上升;同時,亦有可能降低死亡率。然而,並無證據顯示營養補充對臨床結果、功能上的益處或是住院日數的縮短有所幫助。因此,我們仍需要來自大規模、多中心試驗的更多資料。

翻譯人

本摘要由臺灣大學附設醫院林志弘翻譯。

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

總結

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。