口服营养补充剂对髋部骨折手术后营养正常或轻度营养不良老年患者的影响：一项随机临床试验。

Effects of oral nutritional supplements in normally nourished or mildly undernourished geriatric patients after surgery for hip fracture: a randomized clinical trial.

作者信息

Botella-Carretero José I, Iglesias Borja, Balsa José A, Zamarrón Isabel, Arrieta Francisco, Vázquez Clotilde

机构信息

Unit of Clinical Nutrition and Dietetics, Department of Endocrinology and Nutrition, Hospital Ramón y Cajal, Madrid, Spain.

出版信息

JPEN J Parenter Enteral Nutr. 2008 Mar-Apr;32(2):120-8. doi: 10.1177/0148607108314760.

DOI:10.1177/0148607108314760

PMID:18407904

Abstract

BACKGROUND

Oral nutritional supplements have been recommended after orthopedic surgery in geriatric patients to reduce postoperative complications. However, tolerability of supplements could be a limitation, and their universal use is not supported by the heterogeneity of previous studies, especially in patients without malnutrition.

METHODS

This study is a randomized, controlled, open, parallel, 3-arm clinical trial comparing supplementation with protein powder dissolved in liquids to aim at 36 g of protein per day, energy and protein supplements to aim at 37.6 g of protein and 500 kcal per day, or no intervention in normally nourished or mildly undernourished patients. Outcomes were serum albumin, prealbumin, retinol-binding globulin, and body mass index, among others. Postoperative complications were also recorded.

RESULTS

Ninety patients aged 83.8 +/- 6.6 years were included. The mean ingested amount of supplements was 41.1% +/- 20.6% in the protein powder supplement group and 51.4% +/- 13.2% in the energy protein supplement group (t = 2.278, P = .027). Postoperative supplements had no effect on the nutrition status during in-hospital follow-up, as assessed by serum albumin (P = .251), prealbumin (P = .530), retinol-binding globulin (P = .552), or body mass index (P = .582). Multivariate analysis showed that length of hospital stay with an established complication until its resolution (beta = .230, P = .031), total hospital stay (beta = .450, P < .001), baseline body mass index (beta = .204, P = .045), and total daily ingested proteins per body weight (beta = .252, P = .018) were predictive variables on the change in serum albumin (R2 = 0.409, F = 11.246, P < .001).

CONCLUSIONS

Oral nutritional supplements in normally nourished or only mildly undernourished geriatric patients with hip fracture submitted to surgery may be of interest for patients with postoperative complications and long hospital stays.

摘要

背景

已建议老年患者在骨科手术后使用口服营养补充剂以减少术后并发症。然而，补充剂的耐受性可能是一个限制因素，而且先前研究的异质性并不支持其普遍使用，尤其是在没有营养不良的患者中。

方法

本研究是一项随机、对照、开放、平行的三臂临床试验，比较了三种情况：补充溶解于液体中的蛋白粉，目标是每天摄入36克蛋白质；补充能量和蛋白质补充剂，目标是每天摄入37.6克蛋白质和500千卡热量；或对营养正常或轻度营养不良的患者不进行干预。观察指标包括血清白蛋白、前白蛋白、视黄醇结合球蛋白和体重指数等。还记录了术后并发症。

结果

纳入了90名年龄为83.8±6.6岁的患者。蛋白粉补充剂组补充剂的平均摄入量为41.1%±20.6%，能量蛋白质补充剂组为51.4%±13.2%（t = 2.278，P = 0.027）。根据血清白蛋白（P = 0.251）、前白蛋白（P = 0.530）、视黄醇结合球蛋白（P = 0.552）或体重指数（P = 0.582）评估，术后补充剂对住院期间的营养状况没有影响。多变量分析显示，出现并发症直至其缓解的住院时间（β = 0.230，P = 0.031）、总住院时间（β = 0.450，P < 0.001）、基线体重指数（β = 0.204，P = 0.045）和每体重每日摄入的总蛋白质（β = 0.252，P = 0.018）是血清白蛋白变化的预测变量（R2 = 0.409，F = 11.246，P < 0.001）。