Jobse I, Liao Y, Bartram M, Delantonio K, Uter W, Stehle P, Sieber C C, Volkert D
Dr. Inken Jobse, Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg, Koberger Str. 60, D-90408 Nürnberg, Germany, Tel. +49 911 5302 96150, Fax + 49 911 5302 96151, E-mail:
J Nutr Health Aging. 2015 Mar;19(3):356-64. doi: 10.1007/s12603-014-0544-y.
Administration of oral nutritional supplements (ONS) is an effective strategy to treat and avoid malnutrition, a persisting issue in nursing homes. However, little is known about compliance in the NH population. This study aimed to analyse the effects of compliance of NH residents with a low-volume, nutrient- and energy-dense ONS on nutritional status and to identify residents' characteristics associated with compliance.
Randomized, controlled trial in nursing homes.
87 nursing home residents (87 ± 6y, 91% female) with malnutrition or at risk of malnutrition were randomly allocated to an intervention group (IG) receiving 2 x 125 ml ONS (2.4 kcal/ml)/d for 12 weeks, or the control group (CG) with usual care.
ONS intake was recorded daily and compliance calculated. Low and high compliance were defined as ≤ 30% and ≥ 80% of provided ONS actually consumed, respectively. Body weight (BW), BMI, upper-arm (UAC) and calf-circumference (CC) and MNA-SF were assessed at baseline and after 12 weeks. Associations between compliance and changes of nutritional parameters and residents' characteristics were analysed.
Compliance was high in 35.7% and low in 28.6% of the IG (n=42). BW change was significantly higher in subjects with high compliance (median +3.0 (interquartile range +2.1;+3.8) kg, n=15) than in those with low compliance (-0.2 (-2.2;+1.6) kg, n=12) and CG (-0.1 (-1.2; +0.6) kg, n=35; p<0.001), and significantly correlated with compliance in IG (r=0.691; p<0.001). Significant differences and correlations were also identified for BMI, UAC and MNA-SF. High compliance was more often observed in residents with malnutrition (66.7 vs. 27.3%) and chewing difficulties (77.8 vs. 24.2%) than in those without these conditions. Low compliance was more prevalent in residents who were immobile (45.0 vs. 13.6%), depressed (33.3 vs. 6.7%) or had gastrointestinal complaints (50.0 vs. 17.9%) (all p<0.05).
A high compliance of nursing home residents with a low volume, nutrient- and energy dense ONS was related to a significantly improved nutritional status in comparison to low compliance and therefore enhanced the effectiveness of ONS. A higher compliance may be achieved by consideration of different residents' characteristics.
口服营养补充剂（ONS）的使用是治疗和避免营养不良的有效策略，而营养不良是养老院中长期存在的问题。然而，对于养老院人群中口服营养补充剂的依从性知之甚少。本研究旨在分析养老院居民对小容量、营养和能量密集型口服营养补充剂的依从性对营养状况的影响，并确定与依从性相关的居民特征。
养老院中的随机对照试验。
87名患有营养不良或有营养不良风险的养老院居民（87±6岁，91%为女性）被随机分配到干预组（IG），接受每日2次、每次125毫升的口服营养补充剂（2.4千卡/毫升），持续12周，或分配到接受常规护理的对照组（CG）。
每天记录口服营养补充剂的摄入量并计算依从性。低依从性和高依从性分别定义为实际摄入提供的口服营养补充剂的≤30%和≥80%。在基线和12周后评估体重（BW）、体重指数（BMI）、上臂围（UAC）、小腿围（CC）和微型营养评定简表（MNA-SF）。分析依从性与营养参数变化及居民特征之间的关联。
干预组（n=42）中35.7%的居民依从性高，28.6%的居民依从性低。依从性高的受试者（中位数+3.0（四分位间距+2.1；+3.8）千克，n=15）的体重变化显著高于依从性低的受试者（-0.2（-2.2；+1.6）千克，n=12）和对照组（-0.1（-1.2；+0.6）千克，n=35；p<0.001），并且与干预组的依从性显著相关（r=0.691；p<0.001）。在BMI、UAC和MNA-SF方面也发现了显著差异和相关性。与没有这些情况的居民相比，患有营养不良（66.7%对27.3%）和咀嚼困难（77.8%对24.2%）的居民更常出现高依从性。依从性低在行动不便（45.0%对13.6%）、抑郁（33.3%对6.7%）或有胃肠道不适（50.0%对17.9%）的居民中更为普遍（所有p<0.05）。
与低依从性相比，养老院居民对小容量、营养和能量密集型口服营养补充剂的高依从性与营养状况的显著改善相关，因此提高了口服营养补充剂的有效性。考虑不同居民的特征可能会实现更高的依从性。
