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Meta-Analysis
. 2009 Apr 15;2009(2):CD003288.
doi: 10.1002/14651858.CD003288.pub3.

Protein and energy supplementation in elderly people at risk from malnutrition

Anne C Milne  1 , Jan Potter, Angela Vivanti, Alison Avenell
Affiliations
Meta-Analysis

Protein and energy supplementation in elderly people at risk from malnutrition

Anne C Milne et al. Cochrane Database Syst Rev. .

Abstract

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 strategy: 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.

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Conflict of interest statement

One reviewer is also the author of an eligible trial (Potter 2001).

Figures

1
1
Funnel plot of comparison: 1 Oral protein and energy versus routine care, outcome: 1.1 Mortality.
1.1
1.1. Analysis
Comparison 1 Oral protein and energy versus routine care, Outcome 1 Mortality.
1.2
1.2. Analysis
Comparison 1 Oral protein and energy versus routine care, Outcome 2 Mortality: Subgroup analysis for nutritional status.
1.3
1.3. Analysis
Comparison 1 Oral protein and energy versus routine care, Outcome 3 Mortality: Subgroup analysis for kcal offered per day.
1.4
1.4. Analysis
Comparison 1 Oral protein and energy versus routine care, Outcome 4 Mortality: Subgroup analysis for age category.
1.5
1.5. Analysis
Comparison 1 Oral protein and energy versus routine care, Outcome 5 Mortality: Subgroup analysis for period of supplementation.
1.6
1.6. Analysis
Comparison 1 Oral protein and energy versus routine care, Outcome 6 Mortality: Subgroup analysis for wellness.
1.7
1.7. Analysis
Comparison 1 Oral protein and energy versus routine care, Outcome 7 Mortality: subgroup analysis for hospital or community.
1.8
1.8. Analysis
Comparison 1 Oral protein and energy versus routine care, Outcome 8 Mortality: Sensitivity analysis.
1.9
1.9. Analysis
Comparison 1 Oral protein and energy versus routine care, Outcome 9 Mortality: Subgroup analysis by diagnostic group.
1.10
1.10. Analysis
Comparison 1 Oral protein and energy versus routine care, Outcome 10 Participants with complications.
1.11
1.11. Analysis
Comparison 1 Oral protein and energy versus routine care, Outcome 11 Participants with complications: Subgroup analysis by diagnostic group.
1.12
1.12. Analysis
Comparison 1 Oral protein and energy versus routine care, Outcome 12 % Weight change.
1.13
1.13. Analysis
Comparison 1 Oral protein and energy versus routine care, Outcome 13 % Weight change: Subgroup analysis by diagnostic group.
1.14
1.14. Analysis
Comparison 1 Oral protein and energy versus routine care, Outcome 14 % Weight change sensitivity analysis.
1.15
1.15. Analysis
Comparison 1 Oral protein and energy versus routine care, Outcome 15 % Arm muscle circumference change.
1.16
1.16. Analysis
Comparison 1 Oral protein and energy versus routine care, Outcome 16 % Arm muscle circumference change: Subgroup analysis by diagnostic group.
1.17
1.17. Analysis
Comparison 1 Oral protein and energy versus routine care, Outcome 17 Length of Stay.
1.18
1.18. Analysis
Comparison 1 Oral protein and energy versus routine care, Outcome 18 Length of stay: Subgroup analysis by diagnostic group.
1.19
1.19. Analysis
Comparison 1 Oral protein and energy versus routine care, Outcome 19 Handgrip.
See this image and copyright information in PMC

Update of

References

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    1. Yamaguchi LY, Coulston AM, Lu NC, Dixon LB, Craig LD. Improvement in nutrient intake by elderly meals‐on‐wheels participants receiving a liquid nutrition supplement. Nutrition Today 1998;33(1):37‐44.
Young 2004 {published data only}
    1. Parrott MD, Young KW, Greenwood CE. Energy‐containing nutritional supplements can affect usual energy intake postsupplementation in institutionalized seniors with probable Alzheimer's disease. Journal of the American Geriatrics Society 2006;54:1382‐1387. - PubMed
    1. Young KW, Greenwood CE, Reekum R, Binns MA. Providing nutrition supplements to institutionalized seniors with probable Alzheimer's disease is least beneficial to those with low body weight status. Journal of the American Geriatrics Society 2004;52:1305‐1312. - PubMed

References to studies excluded from this review

Bachrach 2000 {published data only}
    1. Bachrach‐Lindstrom M, Johansson T, Unosson M, Ek AC, Wahlstrom O. Nutritional status and functional capacity after femoral neck fractures: A prospective randomized one‐year follow‐up study. Aging‐Clinical & Experimental Research 2000;12(5):366‐74. - PubMed
Barateau 1998 {published data only}
    1. Barateau M, Corompt A, Soulan J, Bourdel‐Marchasson I. Multicenter nursing study on the importance of nutritional support for the prevention of bedsores in the elderly at risk [Etude multicentrique infirmiere evaluant l'interet d'un soutien nutritionnel dans la prevention des escarres chez la personne agee a risque]. Recherche En Soins Infirmiers 1998;55:42‐9. - PubMed
Barton 2000 {published data only}
    1. Barton AD, Beigg CL, MacDonald IA, Allison SP. A recipe for improving intakes of elderly hospitalized patients. Clinical Nutrition 2000;19(6):451‐4. - PubMed
    1. Barton AD, Beigg CL, Macdonald IA, Allison SP. High food wastage and low nutritional intakes in hospital patients. Clinical Nutrition 2000;19(6):445‐9. - PubMed
Bastow 1983 {published data only}
    1. Bastow MD, Rawlings J, Allison SP. Benefits of supplementary tube feeding after fractured neck of femur: a randomised controlled trial. British Medical Journal Clinical Research Edition 1983;287:1589‐92. - PMC - PubMed
Bean 1994 {published data only}
    1. Bean N, Redden J, Goode H, Grimble G, Allison SP. Double‐blind pilot trial in elderly women with fractured femur of ornithine alpha‐ketoglutarate versus a defined formula peptide oral supplement. Proceedings of the Nutrition Society 1994;53:203A.
Beattie 2000 {published data only}
    1. Beattie AH, Prach AT, Baxter JP, Pennington CR. A randomised controlled trial evaluating the use of enteral nutritional supplements postoperatively in malnourished surgical patients. Gut 2000;46(6):813‐8. - PMC - PubMed
Beier 1996 {published data only}
    1. Beier‐Holgersen R, Boesby S. Influence of postoperative enteral nutrition on postsurgical infections. Gut 1996;39(6):833‐5. - PMC - PubMed
    1. Beier‐Holgersen R, Brandstrup B. Influence of early postoperative enteral nutrition versus placebo on cell‐mediated immunity, as measured with the Multitest(R) CMI. Scandinavian Journal of Gastroenterology 1999;34(1):98‐102. - PubMed
Bernstein 2002 {published data only}
    1. Bernstein MA, Nelson MA, Tucker KL, Layne J, Johnson E, Nuernberger A, et al. A home based nutrition intervention to increase consumption of fruits, vegetables, and calcium rich foods in community dwelling elders. Journal of the American Dietetic Association 2002;102(10):1421‐7. - PubMed
Borum 2000 {published data only}
    1. Borum ML, Lynn J, Zhong Z, Roth K, Connors AF, Desbiens N, et al. The effect of nutritional supplementation on survival in seriously ill hospitalized adults. Journal of the American Geriatrics Society 2000;48(5 Suppl):S33‐8. - PubMed
Bos 2000 {published data only}
    1. Bos C, Benamouzig R, Bruhat A, Roux C, Mahe S, Valensi P, et al. Short‐term protein and energy supplementation activates nitrogen kinetics and accretion in poorly nourished elderly subjects. American Journal of Clinical Nutrition 2000;71:1129‐37. - PubMed
Breslow 1993 {published data only}
    1. Breslow RA, Hallfrisch J, Guy DG, Crawley B, Goldberg AP. The importance of dietary protein in healing pressure ulcers. Journal of the American Geriatrics Society 1993;41(4):357‐62. - PubMed
Brocker 1994 {published data only}
    1. Brocker P, Vellas B, Albarede JL, Poynard T. A two‐centre, randomized, double‐blind trial of ornithine oxoglutarate in 194 elderly, ambulatory, convalescent subjects. Age & Ageing 1994;23(4):303‐6. - PubMed
Brown 1995 {published data only}
    1. Brown DN, Miedema BW, King PD, Marshall JB. Safety of early feeding after percutaneous endoscopic gastrostomy. Journal of Clinical Gastroenterology 1995;21(4):330‐1. - PubMed
Bunker 1994 {published data only}
    1. Bunker VW, Stansfield MF, Deacon Smith R, Marzil RA, Hounslow A, Clayton BE. Dietary supplementation and immunocompetence in housebound elderly subjects. British Journal of Biomedical Science 1994;51(2):128‐35. - PubMed
Bunout 1989 {published data only}
    1. Bunout D, Aicardi V, Hirsch S. Nutritional support in hospitalized patients with alcoholic liver disease. European Journal of Clinical Nutrition 1989;43(9):615‐21. - PubMed
Bunout 2001 {published data only}
    1. Bunout D, Barrera G, MP, Avendano M, Gattas V, Petermann M, et al. The impact of nutritional supplementation and resistance training on the health functioning of free‐living Chilean elders: results of 18 months of follow‐up. Journal of Nutrition 2001;131(9):2441S‐6S. - PubMed
Bunout 2004 {published data only}
    1. Bunout D, Barrerra, Maza P, Avendano M, Gattas V, Petermann M, Hirsch S. Effects of nutritional supplementation and resistance training on muscle strength in free living elders. Results of one year follow. Journal of Nutrition, Health and Aging 2004;8(2):68‐75. - PubMed
Cabre 1990 {published data only}
    1. Cabre E, Gonzalez‐Huix F, Abad‐Lacruz A, Esteve M, Acero D, Fernandez‐Banares F, et al. Effect of total enteral nutrition on the short‐term outcome of severely malnourished cirrhotics. A randomized controlled trial. Gastroenterology 1990;98(3):715‐20. - PubMed
Caglar 2002 {published data only}
    1. Carlar K, Fedje L, Dimmitt R, Hakim RM, Shyr Y, Ikizler TA. Therapeutic effects of oral nutritional supplementation during haemodialysis. Kidney International 2002;62:1054‐9. - PubMed
Calvey 1985 {published data only}
    1. Calvey H, Davis M, Williams R. Controlled trial of nutritional supplementation, with and without branched chain amino acid enrichment, in treatment of acute alcoholic hepatitis. Journal of Hepatology 1985;1(2):141‐51. - PubMed
Campbell 1995 {published data only}
    1. Campbell W W, Crim MC, Young V R, Joseph L J, Evans WJ. Dietary protein intake influences resistance training‐induced changes in whole‐body protein turnover. FASEB: Federation of American societies for experimental biology 1994;8(4‐5):A428.
    1. Campbell WW, Crim MC, Dallal GE, Young VR, Evans WJ. Increased protein requirements in elderly people: new data and retrospective reassessments. American Journal of Clinical Nutrition 1994;60(4):501‐9. - PubMed
    1. Campbell WW, Crim MC, Young VR, Evans WJ. Increased energy requirements and changes in body composition with resistance training in older adults. American Journal of Clinical Nutrition 1994;60(2):167‐75. - PubMed
    1. Campbell WW, Crim MC, Young VR, Joseph LJ, Evans WJ. Effects of resistance training and dietary protein intake on protein metabolism in older adults. American Journal of Physiology 1995;268(6 Pt 1):E1143‐53. - PubMed
Carr 1996 {published data only}
    1. Carr CS, Ling KD, Boulos P, Singer M. Randomised trial of safety and efficacy of immediate postoperative enteral feeding in patients undergoing gastrointestinal resection. BMJ 1996;312(7035):869‐71. - PMC - PubMed
Chee 2003 {published data only}
    1. Chee WSS, Suriah AR, Chan SP, Zaitun Y, Chan YM. The effect of milk supplementation on bone mineral density in postmenopausal Chinese women in Malaysia. Osteoporosis International 2003;14:828‐834. - PubMed
Creutzberg 2000 {published data only}
    1. Creutzberg EC, Schols AMWJ, Weling Scheepers CAPM, Buurman WA, Wouters EF. Characterisation of non response to high caloric oral nutrition therapy in depleted patients with COPD. American Journal of Respiratory and Critical Care Medicine 2000;161:745‐52. - PubMed
Daly 1992 {published data only}
    1. Daly JM, Lieberman MD, Goldfine J, Shou J, Weintraub F, Rosato EF, et al. Enteral nutrition with supplemental arginine, RNA, and omega‐3 fatty acids in patients after operation: immunologic, metabolic, and clinical outcome. Surgery 1992;112(1):56‐67. - PubMed
Danhof 1982 {published data only}
    1. Danhof IE, Huston RL. Nutritional support of geriatric patients. Jpen: Journal of Parenteral & Enteral Nutrition 1982;6(6):588.
de Jong 2000 {published data only}
    1. Paw MJ, Jong N, Pallast EG, Kloek GC, Schouten EG, Kok FJ. Immunity in frail elderly: A randomized controlled trial of exercise and enriched foods. Medicine & Science in Sports & Exercise 2000;32(12):2005‐11. - PubMed
    1. Jong N, Paw MJ, Graaf C, Staveren WA. Effect of dietary supplements and physical exercise on sensory perception. British Journal of Nutrition 2000;83(6):605‐13. - PubMed
    1. Jong N, Paw MJ, Groot LC, Hiddink GJ, Staveren WA. Dietary supplements and physical exercise affecting bone and body composition. American Journal of Public Health 2000;90(6):947‐54. - PMC - PubMed
    1. Jong N, Paw MJ, Groot LC, Graaf C, Kok F, Staveren WA. Functional biochemical and nutrient indices in frail elderly people are partly affected by dietary supplements but not by exercise. Journal of Nutrition 1999;129(11):2028‐36. - PubMed
Devine 1996 {published data only}
    1. Devine A, Prince RL, Bell R. Nutritional effect of calcium supplementation by skim milk powder or by calcium tablets on total nutrient intake in postmenopausal women. American Journal of Clinical Nutrition 1996;64:731‐7. - PubMed
Duncan 2006 {published data only}
    1. Duncan DG, Beck SJ, Hood K, Johansen A. Using dietetic assistants to improve the outcome of hip fracture ‐ a randomised controlled trial of nutritional support in an acute trauma ward. Age and Ageing 2006;35(2):148‐53. - PubMed
Efthimou 1988 {published data only}
    1. Efthimiou J, Fleming J, Gomes C, Spiro SG. The effect of supplementary oral nutrition in poorly nourished patients with chronic obstructive pulmonary disease. American Review of Respiratory Disease 1988;137(5):1075‐82. - PubMed
Elmstahl 1987 {published data only}
    1. Elmstahl S, Steen B. Hospital nutrition in geriatric long‐term care in medicine: II. Effects of dietary supplements. Age & Ageing 1987;16:73‐80. - PubMed
Eneroth 1997 {published data only}
    1. Eneroth M, Apelqvist J, Larsson J, Persson BM. Improved wound healing in transtibial amputees receiving supplementary nutrition. International Orthopaedics 1997;21(2):104‐8. - PMC - PubMed
Eneroth 2006 {published data only}
    1. Eneroth M, Olsson UB, Thorngren KG. Nutritional supplementation decreases hip fracture‐related complications. Clinical Orthopaedics and Related Research 2006;451:212‐217. - PubMed
Espaulella 2000 {published data only}
    1. Espaulella J, Guyer H, Diaz‐Escriu F, Mellado‐Navas JA, Castells M, Pladevall M. Nutritional supplementation of elderly hip fracture patients. A randomized double‐blind placebo‐controlled trial. Age & Ageing 2000;29:425‐31. - PubMed
Eyer 1993 {published data only}
    1. Eyer SD, Micon LT, Konstantinides FN, Edlund DA, Rooney KA, Luxenberg MG. Early enteral feeding does not attenuate metabolic response after blunt trauma. Journal of Trauma‐Injury Infection & Critical Care 1993;34(5):639‐43. - PubMed
Forli 2001 {published data only}
    1. Forli L, Pedersen JI, Bjortuft O, Vatn M, Boe J. Dietary support to underweight patients with end‐stage pulmonary disease assessed for lung transplantation. Respiration 2001;68(1):51‐7. - PubMed
Fuenzalida 1990 {published data only}
    1. Fuenzalida CE, Petty TL, Jones ML, Jarett S, Harbeck RJ, Terry RW. The immune response to short‐term nutritional intervention in advanced chronic obstructive pulmonary disease. American Review of Respiratory Disease 1990;142(1):49‐56. - PubMed
Gall 1998 {published data only}
    1. Gall MJ, Grimble GK, Reeve NJ, Thomas SJ. Effect of providing fortified meals and between‐meal snacks on energy and protein intake of hospital patients. Clinical Nutrition 1998;17(6):259‐64. - PubMed
Gallager 1992 {published data only}
    1. Gallagher J, Schermbeck J, Dixon L, Labbe‐Bell M. Aggressive early management of malnutrition in hip fracture patients. Journal of Parenteral & Enteral Nutrition 1992;16(1):19S.
Ganzoni 1994 {published data only}
    1. Ganzoni A, Heilig P, Schonenberger K, Hugli O Fitting J W, Brandli O. High‐caloric nutrition in chronic obstructive lung disease [Hochkalorische Ernährung bei chronischer obstrukiver Lungenkrankheit]. Schweizerische Rundschau für Medizin Praxis 1994;83(1):13‐6. - PubMed
Goris 2003 {published data only}
    1. Goris AM, Vermeeren MA, Wouters EF, Schols AM, Westerterp KR. Energy balance in depleted ambulatory patients with chronic obstructive pulmonary disease: the effect of physical activity and oral nutritional supplementation. British Journal of Nutrition 2003;89:725‐729. - PubMed
Harrington 2004 {published data only}
    1. Harrington M, Bennett T, Jakobsen J, Ovesen L, Brot C, Flynn A, et al. The effect of a high‐protein, high sodium diet on calcium and bone metabolism in post‐menopausal women and its interaction with vitamin D receptor genotype. British Journal of Nutrition 2004;91(1):41‐51. - PubMed
Hartgrink 1998 {published data only}
    1. Hartgrink HH, Wille J, Konig P, Hermans J, Breslau PJ. Pressure sores and tube feeding in patients with a fracture of the hip: a randomized clinical trial. Clinical Nutrition 1998;17(6):287‐92. - PubMed
Hickson 2004 {published data only}
    1. Hickson M, Bulpitt C, Nunes M, Peters R, Cooke J, Nicholl C, Frost G. Does additional feeding support provided by health care assistants improve nutritional status and outcome in acutely ill older in‐patients? ‐ A randomised control trial. Clinical Nutrition 2004;23(1):69‐77. - PubMed
Hogarth 1996 {published data only}
    1. Hogarth MB, Marshall P, Lovat LB, Palmer AJ, Frost CG, Fletcher AE, et al. Nutritional supplementation in elderly medical in‐patients: a double‐blind placebo‐controlled trial. Age & Ageing 1996;25:453‐57. - PubMed
Houwing 2003 {published data only}
    1. Houwing RH, Rozendaal M, Wouters‐Wesseling W, Beulens JW, Buskens E, Haalboom JR. A randomised, double‐blind assessment of the effect of nutritional supplementation on the prevention of pressure ulcers in hip‐fracture patients. Clinical Nutrition 2003;22(4):401‐5. - PubMed
Hurson 1995 {published data only}
    1. Hurson M, Regan MC, Kirk SJ, Wasserkrug HL, Barbul A. Metabolic effects of arginine in a healthy elderly population. Journal of Parenteral & Enteral Nutrition 1995;19(3):227‐30. - PubMed
Jamieson 1997 {published data only}
    1. Jamieson CP, Norton B, Day T, Lakeman M, Powell‐Tuck J. The quantitative effect of nutrition support on quality of life in outpatients. Clinical Nutrition 1997;16(1):25‐8.
Johansen 2004 {published data only}
    1. Johansen NN, Kondrup J, Plum LM, Bak L, Norregaard P, Bunch E, et al. Effect of nutritional support on clinical outcome in patients at risk. Clinical Nutrition 2004;23(4):539‐50. - PubMed
Johansson 2002 {unpublished data only}
    1. Johansson T. Displaced femoral neck fractures: A prospective randomized study of clinical outcome, nutrition and costs. Linkoping University Medical Dissertations No 731 2002.
Keane 1998 {published data only}
    1. Keane EM, Healy M, O'Moore R, Coakley D, Walsh JB. Vitamin D‐fortified liquid milk: benefits for the elderly community‐based population. Calcified Tissue International 1998;62(4):300‐2. - PubMed
Keele 1997 {published data only}
    1. Keele AM, Bray MJ, Emery PW, Duncan HD, Silk DBA. Two phase randomised controlled trial of post operative dietary supplements in surgical patients. Gut 1997;40:393‐9. - PMC - PubMed
    1. Keele AM, Bray MJ, Emery PW, Silk DBA. A randomised controlled clinical trial of post operative oral dietary supplements in surgical patients. Journal of Parenteral and Enteral Nutrition 1995;19 Suppl 1:21S.
Kemen 1991 {published data only}
    1. Kemen M, Homan HH, Mumme A, Zumtobel V. Is intact protein superior for postoperative enteral nutrition than hydrolyzed protein?. Clinical Nutrition 1991;Supp 1:37.
Kerrigan 1996 {published data only}
    1. Kerrigan ER, Maxwell J, Siegel C. Dispensing of a calorically dense oral supplement with medication pass: a creative approach to oral supplementation. Journal of the American Dietetic Society 1996;96(9):A32.
Kiel 1992 {published data only}
    1. Kiel ML, Gilbert SK, James KD, Powell MS. Enhancing weight gain in long‐term care residents through a protein‐calorie supplemented mechanically altered diet. Journal of the American Dietetic Association 1992;92 Suppl:A91.
Kretser 2000 {published and unpublished data}
    1. Kretser A, Kerr W, Voss T, Ackman A, Squires M, Edison NJ, et al. Improving nutritional and functional outcomes in homebound elders via an aggressive 21 meal per week home delivery program. Journal of the American Dietetic Association 2000;100(9):A91.
Kumagai 1999 {published data only}
    1. Kumagai S, Shibata H, Watanabe S, Suzuki T, Haga H, Osada H, et al. An intervention trial to postpone aging in competent elderly. Trial of nutritional improvement in the retirement home. Nippon Koshu Eisei Zasshi ‐ Japanese Journal of Public Health 1999;46(11):1003‐12. - PubMed
Lau 2001 {published data only}
    1. Lau EM, Woo J, Lam V, Hong A. Milk supplementation of the diet of postmenopausal Chinese women on a low calcium intake retards bone loss. Journal of Bone Mineral Research 2001;16(9):1704‐9. - PubMed
Lawson 2000 {published data only}
    1. Doshi MK, Lawson R, Ingoe LE, Colligan JM, Barton JR, Cobden I. Effect of nutritional supplementation on clinical outcome in post‐operative orthopaedic patients. Clinical Nutrition 1998;17 Suppl 1:30.
    1. Lawson RM, Doshi MK, Ingoe LE, Colligan JM, Barton JR, Cobden I. Compliance of orthopaedic patients with post operative oral nutritional supplementation. Clinical Nutrition 2000;19(3):171‐5. - PubMed
Lewis 1987 {published data only}
    1. Lewis MI, Belman MJ, Dorr‐Uyemura L. Nutritional supplementation in ambulatory patients with chronic obstructive pulmonary disease. American Review of Respiratory Disease 1987;135(5):1062‐68. - PubMed
Neumann 2004 {published and unpublished data}
    1. Jensen G. personal communication. 6 Jan 2005.
    1. Neumann M, Friedmann J, Roy MA, Jensen GL. Provision of high‐protein supplement for patients recovering from hip fracture. Nutrition 2004;20:415‐419. - PubMed
    1. Neumann MM, Friedmann JM, Jensen GL. [Provision of high protein supplement for patients recovering from hip fracture]. Journal of Parenteral and Enteral Nutrition 2004;28(Suppl 1):S30. - PubMed
Nickerson 1998 {published data only}
    1. Nickerson JA, Langkamp‐Henken B, Stechmiller JK, Bley LL, Greishaw S, Herrlinger‐Garcia KA. Oral and metabolic tolerance of supplemental arginine in elderly nursing home residents with pressure ulcers. Journal of Parenteral & Enteral Nutrition 1998;22 Suppl:75.
Olin 1998 {published data only}
    1. Odlund Olin A, Armyr I, Soop M, Ljungqvist E, Jerstrom S, Classon I, et al. Energy enriched meals improve energy intake in elderly residents in a nursing home. Clinical Nutrition 1998;17 Suppl1:31. - PubMed
Otte 1989 {published data only}
    1. Otte KE, Ahlburg P, D'Amore F, Stellfeld M. Nutrition repletion in malnourished patients with emphysema. Jpen: Journal of Parenteral & Enteral Nutrition 1989;13(2):152‐6. - PubMed
Pardy 1986 {published data only}
    1. Pardy RL, Knowles JL, Fairbarn MS, Chan‐Yan C. Supplemental nutrition does not alter respiratory muscle strength (RMS) or endurance (RME) in ambulatory COPD. American Review of Respiratory Disease 1986;133:A204.
Paton 2004 {published data only}
    1. Paton NI, Chua Y, Earnest A, Chee CBA. Randomised controlled trial of nutritional supplementation in patients with newly diagnosed tuberculosis and wasting. American Journal of Clinical Nutrition 2004;80(2):460‐5. - PubMed
Planas 2005 {published data only}
    1. Planas M, Alvarez J, Garcia‐Peris PA, Cuerda C, Lucas P, Castella M, et al. Nutritional support and quality of life in stable chronic obstructive pulmonary disease (COPD) patients. Clinical Nutrition 2005;24:433‐441. - PubMed
Price 2006 {published data only}
    1. Price RJ, McMurdo ME, Anderson AS. A personalized snack‐based intervention for hip fracture patients: development, feasibility and acceptability. Journal of Human Nutrition and Dietetics 2006;19(2):139‐145. - PubMed
Pupim 2002 {published data only}
    1. Pupim LCB, Ribeiro C de B, Salgueiro NCS, Yamazaki WM, Ramalho HJ, Barberato JB, et al. [Bioquimicos e de composicao corporal de pacientes em hemodialise]. Review of Brasilian Medicine 2002;59(1/2):55‐62.
Rana 1992 {published data only}
    1. Rana SK, Bray J, Menzies‐Gow N, Jameson J, James JJP, Frost P, et al. Short term benefits of post‐operative oral dietary supplements in surgical patients. Clinical Nutrition 1992;11(6):337‐44. - PubMed
Remsburg 2001 {published data only}
    1. Remsburg RE, Luking A, Baran P, Radu C, Pineda D, Bennett RG, et al. Impact of a buffet‐style dining program on weight and biochemical indicators of nutritional status in nursing home residents: A pilot study. Journal of the American Dietetic Association 2001;101(12):1460‐3. - PubMed
Rogers 1992 {published data only}
    1. Rogers RM, Donahoe M, Constantino J. Physiologic effects of oral supplemental feeding in malnourished patients with chronic obstructive pulmonary disease: a randomised control study. American Review of Respiratory Disease 1992;146:1511‐7. - PubMed
Schurch 1998 {published data only}
    1. Bonjour JP, Schurch MA, Chevalley P, Ammann P, Rizzoli R. Protein Intake, IGF‐1 and osteoporosis. Osteoporosis International 1997;7 Suppl 3:S36‐42. - PubMed
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    1. Schurch MA, Rizzoli R, Slosman D, Bonjour JP. Protein supplements increase serum IGF‐1 and decrease proximal femur bone loss in patients with recent hip fracture. In: Papapoulos SE, Lips P, Pols HA, Johnston CC, Delmas PD editor(s). Osteoporosis. Amsterdam: Elsevier, 1996:327‐9.
    1. Schurch MA, Rizzoli R, Slosman D, Vadas L, Vergnaud P, Bonjour JP. Protein supplements increase serum insulin‐like growth factor‐I levels and attenuate proximal femur bone loss in patients with recent hip fracture. A randomized double‐blind placebo‐controlled trial. Annals of Internal Medicine 1998;128(10):801‐9. - PubMed
Seri 1984 {published data only}
    1. Seri S, Aquilio E. Effects of early nutritional support in patients with abdominal trauma. Italian Journal of Surgical Sciences 1984;14(3):223‐7. - PubMed
Seven 2003 {published data only}
    1. Seven H, Calis AB, Turgot S. A randomised controlled trial of early oral feeding in laryngectomized patients. Laryngoscope 2003;113:1076‐9. - PubMed
Slodkowski 1994 {published data only}
    1. Slodkowski M, Pawlowski W, Pertkiewics M, Majewska K, Cebulski W, Szczygiel B. Clinical evaluation of the manufactured Terapin II diet. Polski Tygodnik Lekarski 1994;49(23‐24):526‐9. - PubMed
Smedley 2004 {published data only}
    1. Smedley F, Bowling T, James M, Stokes E, Goodger C, O'Connor O, et al. Randomised clinical trial of the effects of pre‐operative and postoperative oral nutritional supplements on clinical course and cost of care. British Journal of Surgery 2004;91(8):983‐90. - PubMed
Stauffer 1986 {published data only}
    1. Stauffer JL, Carbone JE, Bendoski MT. Effects of diet supplementation on anthropometric and laboratory nutritional parameters in malnourished ambulatory patients with severe chronic obstructive pulmonary disease (COPD). American Review of Respiratory Disease 1986;133:A204.
Storm 1998 {published data only}
    1. Storm D, Eslin R, Porter ES, Musgrave K, Vereault D, Patton C, et al. Calcium supplementation prevents seasonal bone loss and changes in biochemical markers of bone turnover in elderly New England women: a randomized placebo‐controlled trial. Journal of Clinical Endocrinology & Metabolism 1998;83(11):3817‐25. - PubMed
Sullivan 1998 {published data only}
    1. Sullivan DH, Nelson CL, Bopp MM, Puskarich‐May CL, Walls RC. Nightly enteral nutrition support of elderly fracture patients: a phase I trial. Journal of the American College of Nutrition 1998;17(1):155‐61. - PubMed
Tkatch 1992 {published data only}
    1. Bonjour JP, Rapin CH, Rizzoli R, Tkatch L, Delmi M, Chevalley T, et al. Hip fracture, femoral bone mineral density, and protein supply in elderly patients. In: Munro H, Schlierf editor(s). Nutrition of the elderly. Nestle nutrition workshop series. Vol. 29, New York: Raven Press, 1992:151‐9.
    1. Tkatch L, Rapin CH, Rizzoli R, SlosmanD, Nydegger V, Vasey H, et al. Benefits of oral protein supplementation in elderly patients with fracture of the proximal femur. Journal of the American College of Nutrition 1992;11(5):519‐25. - PubMed
Tschepe 1985 {published data only}
    1. Tschepe A, Holm E, Leweling H, Staedt U, Weber K. Oral administration of branched chain amino acids (BCAA) in patients with liver cirrhosis. A double‐blind, randomized crossover study. Clinical Nutrition 1985;4 Suppl:40.
Vargas 1995 {published data only}
    1. Vargas M, Puig A, Maza M, Morales P, Vargas D, Bunout D, et al. Effects of an inspiratory muscle training program and nutritional support in patients with chronic obstructive lung disease. Revista Medica De Chile 1995;123(10):1225‐34. - PubMed
Vermeeren 2001 {published data only}
    1. Vermeeren MAP, Wouters EF, Nelissen LH, Lier A, Hofman Z, Schols AM. Acute effect of different nutritional supplements on symptoms and functional capacity in patients with chronic obstructive pulmonary disease. American Journal of Clinical Nutrition 2001;73:295‐301. - PubMed
Von Meyenfeldt 1990 {published data only}
    1. Meyenfeldt MF, Soeters PB, Vente JP, Berlo CL, Rouflart MM, Jong KP, et al. Effect of branched chain amino acid enrichment of total parenteral nutrition on nitrogen sparing and clinical outcome of sepsis and trauma: a prospective randomized double blind trial. British Journal of Surgery 1990;77(8):924‐9. - PubMed
Wachtler 1995 {published data only}
    1. Wachtler P, Axel Hilger RA, Konig W, Bauer KH, Kemen M, Koller M. Influence of a pre‐operative enteral supplement on functional activities of peripheral leukocytes from patients with major surgery. Clinical Nutrition 1995;14(5):275‐82. - PubMed
Wara 1985 {published data only}
    1. Wara P, Hessov I. Nutritional intake after colorectal surgery: a comparison of a traditional and new post operative regime. Clinical Nutrition 1985;4:225. - PubMed
Williams 1989 {published data only}
    1. Driver L. Evaluation of supplemental nutrition in elderly orthopaedic patients [PhD thesis]. Surrey, UK: Univ. of Surrey, 1994.
    1. Driver LT, Lumbers M, Older J, Williams CM. A controlled trial of sip‐feed supplements and compliance. Proceedings of the Nutrition Society 1990;49:173A.
    1. Williams CM, Driver L, Older J, Dickerson JW. The use of a nutritional risk score in identifying patients who may benefit from sip‐feed supplementation in hospital. Proceedings of the Nutrition Society 1988;47:135A.
    1. Williams CM, Driver LT, Older J, Dickerson JW. A controlled trial of sip‐feed supplements in elderly orthopaedic patients. European Journal of Clinical Nutrition 1989;43(4):267‐74. - PubMed
Wilson 1986 {published data only}
    1. Wilson DO, Rogers RM, Sanders MH, Pennock BE, Reilly JJ. Nutritional intervention in malnourished patients with emphysema. American Review of Respiratory Disease 1986;134(4):672‐7. - PubMed
Wisten 2005 {published data only}
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Wong 2004 {published data only}
    1. Wong S Y, Lau E M, Lau W W, Lynn H S. Is dietary counselling effective in increasing dietary calcium, protein and energy intake in patients with osteoporotic fractures? A randomized controlled clinical trial. Journal of Human Nutrition & Dietetics 2004;17:359‐364. - PubMed
Yeh 2000 {published data only}
    1. Yeh SS, Wu SY, Lee TP, Olson JS, Stevens MR, Dixon T, et al. Improvement in quality‐of‐life measures and stimulation of weight gain after treatment with megestrol acetate oral suspension in geriatric cachexia: results of a double‐blind, placebo‐controlled study. Journal of the American Geriatrics Society 2000;48(5):485‐92. - PubMed

References to ongoing studies

Cameron 2003 {published data only}
    1. Au L, Cameron I, Kurrle S, Uy C. Effectiveness of oral nutritional supplementation for older women with hip and other fractures. Australian Society of Geriatric Medicine Annual Meeting. 2003 June 16‐18.
CENEX 2007 {published data only}
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Elia 2007 {published data only}
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Kvamme 2007 {published data only}
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