TY - JOUR
T1 - Effectiveness of nutritional interventions in older adults at risk of malnutrition across different health care settings
T2 - Pooled analyses of individual participant data from nine randomized controlled trials
AU - Reinders, Ilse
AU - Volkert, Dorothee
AU - de Groot, Lisette C.P.G.M.
AU - Beck, Anne Marie
AU - Feldblum, Ilana
AU - Jobse, Inken
AU - Neelemaat, Floor
AU - de van der Schueren, Marian A.E.
AU - Shahar, Danit R.
AU - Smeets, Ellen T.H.C.
AU - Tieland, Michael
AU - Twisk, Jos W.R.
AU - Wijnhoven, Hanneke A.H.
AU - Visser, Marjolein
N1 - Publisher Copyright:
© 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism
PY - 2019/8/1
Y1 - 2019/8/1
N2 - Background & aims: Protein-energy malnutrition is a health concern among older adults. Improving nutritional status by increasing energy and protein intake likely benefits health. We therefore aimed to investigate effects of nutritional interventions in older adults (at risk of malnutrition) on change in energy intake and body weight, and explore if the intervention effect was modified by study or participants’ characteristics, analysing pooled individual participant data. Methods: We searched for RCTs investigating the effect of dietary counseling, oral nutritional supplements (ONS) or both on energy intake and weight. Principle investigators of eligible studies provided individual participant data. We investigated the effect of nutritional intervention on meaningful increase in energy intake (>250 kcal/day) and meaningful weight gain (>1.0 kg). Logistic generalized estimating equations were performed and ORs with 95% CIs presented. Results: We included data of nine studies with a total of 990 participants, aged 79.2 ± 8.2 years, 64.5% women and mean baseline BMI 23.9 ± 4.7 kg/m2. An non-significant intervention effect was observed for increase in energy intake (OR:1.59; 95% CI 0.95, 2.66) and a significant intervention effect for weight gain (OR:1.58; 95% CI 1.16, 2.17). Stratifying by type of intervention, an intervention effect on increase in energy intake was only observed for dietary counseling in combination with ONS (OR:2.28; 95% CI 1.90, 2.73). The intervention effect on increase in energy intake was greater for women, older participants, and those with lower BMI. Regarding weight gain, an intervention effect was observed for dietary counseling (OR:1.40; 95% CI 1.14, 1.73) and dietary counseling in combination with ONS (OR:2.48; 95% CI 1.92, 3.31). The intervention effect on weight gain was not influenced by participants’ characteristics. Conclusions: Based on pooled data of older adults (at risk of malnutrition), nutritional interventions have a positive effect on energy intake and body weight. Dietary counseling combined with ONS is the most effective intervention.
AB - Background & aims: Protein-energy malnutrition is a health concern among older adults. Improving nutritional status by increasing energy and protein intake likely benefits health. We therefore aimed to investigate effects of nutritional interventions in older adults (at risk of malnutrition) on change in energy intake and body weight, and explore if the intervention effect was modified by study or participants’ characteristics, analysing pooled individual participant data. Methods: We searched for RCTs investigating the effect of dietary counseling, oral nutritional supplements (ONS) or both on energy intake and weight. Principle investigators of eligible studies provided individual participant data. We investigated the effect of nutritional intervention on meaningful increase in energy intake (>250 kcal/day) and meaningful weight gain (>1.0 kg). Logistic generalized estimating equations were performed and ORs with 95% CIs presented. Results: We included data of nine studies with a total of 990 participants, aged 79.2 ± 8.2 years, 64.5% women and mean baseline BMI 23.9 ± 4.7 kg/m2. An non-significant intervention effect was observed for increase in energy intake (OR:1.59; 95% CI 0.95, 2.66) and a significant intervention effect for weight gain (OR:1.58; 95% CI 1.16, 2.17). Stratifying by type of intervention, an intervention effect on increase in energy intake was only observed for dietary counseling in combination with ONS (OR:2.28; 95% CI 1.90, 2.73). The intervention effect on increase in energy intake was greater for women, older participants, and those with lower BMI. Regarding weight gain, an intervention effect was observed for dietary counseling (OR:1.40; 95% CI 1.14, 1.73) and dietary counseling in combination with ONS (OR:2.48; 95% CI 1.92, 3.31). The intervention effect on weight gain was not influenced by participants’ characteristics. Conclusions: Based on pooled data of older adults (at risk of malnutrition), nutritional interventions have a positive effect on energy intake and body weight. Dietary counseling combined with ONS is the most effective intervention.
KW - Dietary counseling
KW - Oral nutritional supplements
KW - Protein-energy malnutrition
KW - Undernutrition
KW - Weight gain
UR - http://www.scopus.com/inward/record.url?scp=85051411096&partnerID=8YFLogxK
U2 - 10.1016/j.clnu.2018.07.023
DO - 10.1016/j.clnu.2018.07.023
M3 - Article
C2 - 30115460
AN - SCOPUS:85051411096
SN - 0261-5614
VL - 38
SP - 1797
EP - 1806
JO - Clinical Nutrition
JF - Clinical Nutrition
IS - 4
ER -
