口服营养支持联合或不联合运动在营养脆弱老年人营养不良管理中的应用：系统评价和荟萃分析。

Oral nutritional support with or without exercise in the management of malnutrition in nutritionally vulnerable older people: A systematic review and meta-analysis.

机构信息

Department of Nutritional Sciences, King's College London, Franklin Wilkins Building, 150 Stamford Street, London SE1 9NH, United Kingdom.

出版信息

Clin Nutr. 2018 Dec;37(6 Pt A):1879-1891. doi: 10.1016/j.clnu.2017.09.004. Epub 2017 Sep 9.

DOI:10.1016/j.clnu.2017.09.004

PMID:28969866

Abstract

BACKGROUND

Physical functioning declines with advancing age and compounds malnutrition, common in elderly populations. A dual-intervention combining oral nutritional support and exercise may delay these changes. Our aims were to assess whether exercise combined with oral nutritional support (ONS) has greater improvements on physical functioning, quality of life and nutritional status than nutrition intervention alone in nutritionally vulnerable older adults.

METHODS

Three electronic databases were searched for randomised controlled trials of older adults judged to be: sarcopenic, cachexic, frail, malnourished, and/or at risk of malnutrition, receiving ONS and exercise compared to nutrition intervention alone. Meta-analyses were performed using a fixed-effect model to calculate standardised mean difference (SMD) (hand-grip strength, limb strength, gait speed, timed up-and-go test (TUG), physical activity level and fat-free mass) or relative risk (hospitalisation) with 95% confidence intervals (CIs).

RESULTS

Eleven studies (n = 1459 participants) were included. ONS and exercise interventions varied considerably between studies. There was very low quality evidence that exercise combined with ONS compared to nutrition intervention alone resulted in significant improvements in limb strength (SMD = 0.33; 95% CI 0.13-0.53; P = 0.001) but low quality evidence of no effect on fat-free mass (SMD = -0.05; 95% CI -0.27 to 0.18; P = 0.70), physical activity level (SMD = 0.04; 95% CI -0.26 to 0.33; P = 0.81) and TUG (mean difference = -0.80; 95% CI -2.06 to 0.47; P = 0.22). Moderate quality evidence from a small number of studies found no effect on handgrip strength and QOL. Low quality evidence of faster gait speeds were found in participants receiving ONS alone compared to combined intervention (SMD = 0.38; 95% CI 0.19 to 0.56; P < 0.0001).

CONCLUSION

Combining exercise with ONS may provide additional improvements to muscle strength but had no effect on other measures of physical functioning, nutritional status or morbidity in nutritionally vulnerable older adults.

CLINICAL TRIAL REGISTRY NUMBER AND WEBSITE

This trial was registered at http://www.crd.york.ac.uk/PROSPERO/ as CRD42015027323.

摘要

背景

随着年龄的增长，身体机能下降，并加剧了老年人中常见的营养不良。口服营养补充和运动相结合的双重干预可能会延缓这些变化。我们的目的是评估在营养脆弱的老年人中，与单纯营养干预相比，口服营养补充和运动相结合的干预措施是否能更大程度地改善身体机能、生活质量和营养状况。

方法

我们在三个电子数据库中检索了以下随机对照试验：被评估为肌少症、恶病质、虚弱、营养不良和/或有营养不良风险的老年人，接受口服营养补充和运动，与单纯营养干预进行比较。使用固定效应模型进行荟萃分析，以计算标准化均数差（SMD）（握力、四肢力量、步态速度、计时起立行走测试（TUG）、身体活动水平和去脂体重）或相对风险（住院）及其 95%置信区间（CI）。

结果

纳入了 11 项研究（n=1459 名参与者）。研究之间的口服营养补充和运动干预差异很大。有非常低质量的证据表明，与单纯营养干预相比，口服营养补充和运动相结合的干预措施可显著改善四肢力量（SMD=0.33；95%CI 0.13-0.53；P=0.001），但对去脂体重（SMD=-0.05；95%CI -0.27 至 0.18；P=0.70）、身体活动水平（SMD=0.04；95%CI -0.26 至 0.33；P=0.81）和 TUG（平均差异=-0.80；95%CI -2.06 至 0.47；P=0.22）无影响。来自少数研究的中等质量证据表明，握力和生活质量无影响。与联合干预相比，单独接受 ONS 的参与者的步速较快，有较低质量的证据（SMD=0.38；95%CI 0.19 至 0.56；P<0.0001）。