Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany.
J Am Med Dir Assoc. 2013 Aug;14(8):628.e1-8. doi: 10.1016/j.jamda.2013.05.011. Epub 2013 Jun 25.
Although oral nutritional supplements (ONS) are known to be effective to treat malnutrition in the elderly, evidence from nursing home populations, including individuals with dementia, is rare, especially with regard to functionality and well-being. A known barrier for ONS use among elderly is the volume that needs to be consumed, resulting in low compliance and thus reduced effectiveness. This study aimed to investigate the effects of a low-volume, energy- and nutrient-dense ONS on nutritional status, functionality, and quality of life (QoL) of nursing home residents.
Randomized controlled intervention trial.
Six nursing homes in Nürnberg and Fuerth, Germany.
Nursing home residents affected by malnutrition or at risk of malnutrition.
Random assignment to intervention (IG) and control group (CG), receiving 2 × 125 mL ONS (600 kcal, 24 g protein) per day and routine care, respectively, for 12 weeks.
Nutritional (weight, body mass index [BMI], upper arm and calf circumferences, MNA-SF) and functional parameters (handgrip strength, gait speed, depressive mood [GDS], cognition [MMSE], activities of daily living [Barthel ADL]) as well as QoL (QUALIDEM) were assessed at baseline (T1) and after 12 weeks (T2). ONS intake was registered daily and compliance calculated.
A total of 77 residents (87 ± 6 y, 91% female) completed the study; 78% had dementia (MMSE <17) and 55% were fully dependent (ADL ≤30). Median compliance was 73% (IQR 23.5%-86.5%) with median intake of 438 (141-519) kcal per day. Body weight, BMI, and arm and calf circumferences increased in the IG (n = 42) and did not change in the CG (n = 35). Changes of all nutritional parameters except MNA-SF significantly differed between groups in favor of the IG (P < .05). GDS, handgrip strength, and gait speed could not be assessed in 46%, 38%, and 49% of participants at T1 and/or T2, because of immobility and cognitive impairment. In residents able to perform the test at both times, functionality remained stable in IG and CG, except for ADLs, deteriorating in both groups. From 10 QoL categories, "positive self-perception" increased in IG (78 [33-100] to 83 [56-100]; P < .05) and tended to decrease in CG (100 [78-100] to 89 [56-100]; P = .06), "being busy" significantly dropped in CG (33 [0-50] to 0 [0-50]; P < .05).
Low-volume, nutrient- and energy-dense ONS were well accepted among elderly nursing home residents with high functional impairment and resulted in significant improvements of nutritional status and, thus, were effective to support treatment of malnutrition. Assessment of function was hampered by dementia and immobility, limiting the assessment of functionality, and highlighting the need for better tools for elderly with functional impairments. ONS may positively affect QoL but this requires further research.
尽管口服营养补充剂（ONS）已被证明可有效治疗老年人营养不良，但来自疗养院人群（包括痴呆症患者）的证据很少，尤其是在功能和幸福感方面。老年人使用 ONS 的一个已知障碍是需要消耗的体积，这导致依从性低，从而降低了有效性。本研究旨在调查低体积、高能量和高营养 ONS 对疗养院居民营养状况、功能和生活质量（QoL）的影响。
随机对照干预试验。
德国纽伦堡和福尔特的六家疗养院。
受营养不良或有营养不良风险的疗养院居民。
随机分配到干预组（IG）和对照组（CG），每天分别接受 2×125 毫升 ONS（600 卡路里，24 克蛋白质）和常规护理，持续 12 周。
营养（体重、体重指数[BMI]、上臂和小腿周长、MNA-SF）和功能参数（握力、步态速度、抑郁情绪[GDS]、认知[MMSE]、日常生活活动[Barthel ADL]）以及 QoL（QUALIDEM）在基线（T1）和 12 周后（T2）进行评估。ONS 摄入量每天记录并计算依从性。
共有 77 名居民（87±6 岁，91%为女性）完成了研究；78%患有痴呆症（MMSE<17），55%完全依赖（ADL≤30）。中位依从率为 73%（IQR 23.5%-86.5%），每日摄入 438（141-519）卡路里。IG（n=42）的体重、BMI 以及臂部和小腿周长增加，而 CG（n=35）没有变化。除 MNA-SF 外，所有营养参数的变化在 IG 与 CG 之间均有显著差异，有利于 IG（P<0.05）。在 T1 和/或 T2 时，由于运动障碍和认知障碍，46%、38%和 49%的参与者无法评估 GDS、握力和步态速度。在能够在两次测试中进行测试的参与者中，IG 和 CG 的功能保持稳定，除了 ADLs 恶化，IG 和 CG 的功能都没有变化。在 10 个 QoL 类别中，IG 的“积极自我认知”增加（78[33-100]至 83[56-100]；P<0.05），CG 则呈下降趋势（100[78-100]至 89[56-100]；P=0.06），CG 的“忙碌”显著下降（33[0-50]至 0[0-50]；P<0.05）。
低体积、高营养和高能量 ONS 在功能严重受损的老年疗养院居民中得到了很好的接受，并显著改善了营养状况，因此对治疗营养不良有效。由于痴呆和运动障碍，功能评估受到阻碍，限制了功能评估，强调了需要为功能受损的老年人提供更好的工具。ONS 可能会对 QoL 产生积极影响，但这需要进一步研究。
