Nutritional Guidance Improves Nutrient Intake and Quality of Life, and May Prevent Falls in Aged Persons with Alzheimer Disease Living with a Spouse (NuAD Trial)

Abstract

Objective: The aim was to examine the effect of tailored nutritional guidance on nutrition, health-related quality of life (HRQoL) and falls in persons with Alzheimer disease (AD).

Design: Randomised controlled trial.

Setting and participants: Persons with AD living with a spouse.

Intervention: Tailored nutritional guidance with home visits during one year. The control group received a written guide about nutrition in older adults and all community-provided normal care.

Measurements: The primary outcome measure was weight change, and secondary outcomes included changes in protein and micronutrient intakes from three-day food records, HRQoL (15D) and rate of falls.

Results: Of the participants (n = 78) with AD (mean age 77.4, 69% males), 40% were at risk for malnutrition, 77% received < 1.2 g/bodyweight (kg) of protein at baseline. We found no difference in weight change between the groups. At 12 months, the mean change in protein intake was 0.05 g/bodyweight (kg) (95% CI -0.06 to 0.15) in the intervention group (IG), and -0.06 g/kg (95% CI -0.12 to 0.02) in the control group (CG) (p = 0.031, adjusted for baseline value, age, sex, MMSE and BMI). Participants' HRQoL improved by 0.006 (95% CI -0.016 to 0.028) in the IG, but declined by -0.036 (95% CI -0.059 to 0.013) in the CG (p = 0.007, adjusted for baseline value, age, sex, MMSE and BMI). Dimensions that differed included mental functioning, breathing, usual activities and depression. The fall rate was 0.55 falls/person per year (95% CI 0.34 to 0.83) in the IG, and 1.39 falls/person per year (95% CI 1.04 to 1.82) in the CG (IRR 0.55; 95% CI 2.16 to 6.46; p < 0.001 adjusted for age, sex and MMSE).

Conclusions: Tailored nutritional guidance improves nutrition and HRQoL, and may prevent falls among AD people living with a spouse.