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Randomized Controlled Trial
. 2018 Sep 11;73(10):1429-1437.
doi: 10.1093/gerona/gly030.

Efficacy of Nutritional Intervention in Elderly After Hip Fracture: A Multicenter Randomized Controlled Trial

Caroline E Wyers  1   2   3 , Petronella L M Reijven  4 , José J L Breedveld-Peters  5 , Karlijn F M Denissen  6 , Martijn G M Schotanus  7 , Martien C J M van Dongen  1 , Simone J P M Eussen  6 , Ide C Heyligers  8 , Piet A van den Brandt  9   10 , Paul C Willems  11 , Svenhjalmar van Helden  12   13 , Pieter C Dagnelie  6   14
Affiliations
Randomized Controlled Trial

Efficacy of Nutritional Intervention in Elderly After Hip Fracture: A Multicenter Randomized Controlled Trial

Caroline E Wyers et al. J Gerontol A Biol Sci Med Sci. .

Abstract

Background: Malnutrition after hip fracture is associated with increased rehabilitation time, complications, and mortality. We assessed the effect of intensive 3 month nutritional intervention in elderly after hip fracture on length of stay (LOS).

Methods: Open-label, randomized controlled trial. Exclusion criteria: age < 55 years, bone disease, life expectancy < 1 year, bedridden, using oral nutritional supplements (ONS) before hospitalization, and cognitive impairment. Intervention: weekly dietetic consultation, energy-protein-enriched diet, and ONS (400 mL per day) for 3 months. Control: usual nutritional care. Primary outcome: total LOS in hospital and rehabilitation clinic, including readmissions over 6 months (Cox regression adjusted for confounders); hazard ratio (HR) < 1.0 reflects longer LOS in the intervention group. Secondary outcomes: nutritional and functional status, cognition, quality of life, postoperative complications (6 months); subsequent fractures and all-cause mortality (1 and 5 years). Effect modification by baseline nutritional status was also tested.

Results: One hundred fifty-two patients were randomized (73 intervention, 79 control). Median total LOS was 34.0 days (range 4-185 days) in the intervention group versus control 35.5 days (3-183 days; plogrank = .80; adjusted hazard ratio (adjHR): 0.98; 95% CI: 0.68-1.41). Hospital LOS: 12.0 days (4-56 days) versus 11.0 days (3-115 days; p = .19; adjHR: 0.75; 95% CI: 0.53-1.06) and LOS in rehabilitation clinics: 19.5 days (0-174 days) versus 18.5 days (0-168 days; p = .82; adjHR: 1.04; 95% CI: 0.73-1.48). The intervention improved nutritional intake/status at 3, but not at 6 months, and did not affect any other outcome. No difference in intervention effect between malnourished and well-nourished patients was found.

Conclusions: Intensive nutritional intervention after hip fracture improved nutritional intake and status, but not LOS or clinical outcomes. Paradigms underlying nutritional intervention in elderly after hip fracture may have to be reconsidered.

Trial registration: ClinicalTrials.gov NCT00523575.

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Figures

Figure 1.
Figure 1.
Flow chart. Patients were excluded based on the exclusion criteria in the order given in the figure, so subsequent exclusion criteria were not checked.
Figure 2.
Figure 2.
Kaplan-Meier plots for intervention and control group of total length of stay (LOS) in hospital and rehabilitation clinics (A), LOS in hospital (B), and rehabilitation clinics (C) separately. Hospital readmissions until six months postoperatively are included. The X-axis represents LOS (in days), the Y-axis represents the cumulative proportion of patients discharged from hospital and/or rehabilitation clinic. A hazard ratio <1.0 reflects a lower rate of discharge (i.e. longer LOS) in the intervention group.
Figure 3.
Figure 3.
Kaplan-Meier plot of 5 year mortality in intervention and control group. The X-axis represents follow-up time in years, the Y-axis represents the proportion of patients still alive. A hazard ratio <1.0 reflects a lower mortality rate (i.e. longer survival) in the intervention group.
See this image and copyright information in PMC

Comment in

  • JPEN Journal Club 39. Validating a Surrogate.
    Koretz RL. Koretz RL. JPEN J Parenter Enteral Nutr. 2019 Jan;43(1):170-172. doi: 10.1002/jpen.1456. Epub 2018 Oct 9. JPEN J Parenter Enteral Nutr. 2019. PMID: 30299547 No abstract available.

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