Effect of oral nutritional supplements on physical functional performance in older patients at nutritional risk discharged with a rehabilitation plan: A randomised controlled trial
Alberte Jensen, Elna D. Ninh, Barbare B. Darlem, Line M. Haack, Cecilie M. Møller, Anne W. Knudsen, Frederikke E. Pudselykke, Pelle B. Petersen, Anne Marie BeckObjective
To investigate if post-discharge oral nutritional supplementation improves physical functional performance and other outcomes in older hip fracture patients at nutritional risk.
Setting
Department of Orthopaedic Surgery, Copenhagen University Hospital – Herlev and Gentofte, Herlev, Denmark.
Participants
Hip fracture patients aged ≥65 years and identified as being at nutritional risk. Of 768 individuals screened, 123 were randomised and 109 (89%) completed the 12-week follow-up.
Intervention
Participants were randomised to receive either two cans of high energy, high protein oral nutritional supplementation enriched with vitamin D and omega 3 fatty acids daily for 12 weeks after discharge or standard care.
Main measures
The primary outcome was physical functional performance assessed by the 30-s chair-stand test. Secondary outcomes included muscle mass, hand grip strength, activities of daily living, hydration status, inflammation, appetite, quality of life, energy and protein intake, and omega-3 fatty acid status.
Results
Physical functional performance improved in both groups, with no significant between-group difference in the number of repetitions performed in the intention-to-treat analysis. Protein intake increased in the intervention group (p = 0.003), while no between-group differences were observed for other outcomes. In the per-protocol analysis, the intervention group showed greater improvement in physical functional performance compared with the control group (p = 0.040). Energy and protein intake were also higher in the intervention group (p = 0.003, p = <.001),
Conclusions
Post-discharge oral nutritional supplementation increased protein intake but did not improve physical functional performance. Per-protocol findings suggest that high adherence may be necessary to achieve functional benefits.