Neelemaat F, van Keeken S, Langius J A E, de van der Schueren M A E, Thijs A, Bosmans J E
M.A.E. de van der Schueren, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands, tel. +31-20-4443410,
J Nutr Health Aging. 2017;21(8):855-860. doi: 10.1007/s12603-017-0939-7.
Previous analyses have shown that a post-discharge individualized nutritional intervention had positive effects on body weight, lean body mass, functional limitations and fall incidents in malnourished older patients. However, the impact of this intervention on survival has not yet been studied.
The objective of this randomized controlled study was to examine the effect of a post-discharge individualized nutritional intervention on survival in malnourished older patients.
Malnourished older patients, aged ≥ 60 years, were randomized during hospitalization to a three-months post-discharge nutritional intervention group (protein and energy enriched diet, oral nutritional supplements, vitamin D3/calcium supplement and telephone counseling by a dietitian) or to a usual care regimen (control group). Survival data were collected 4 years after enrollment. Survival analyses were performed using intention-to-treat analysis by Log-rank tests and Cox regression adjusted for confounders.
The study population consisted of 94 men (45%) and 116 women with a mean age of 74.5 (SD 9.5) years. There were no statistically significant differences in baseline characteristics. Survival data was available in 208 out of 210 patients. After 1 and 4 years of follow-up, survival rates were respectively 66% and 29% in the intervention group (n=104) and 73% and 30% in the control group (n=104). There were no statistically significant differences in survival between the two groups 1 year (HR= 0.933, 95% CI=0.675-1.289) and 4 years after enrollment (HR=0.928, 95% CI=0.671-1.283).
The current study failed to show an effect of a three-months post-discharge multi-component nutritional intervention in malnourished older patients on long-term survival, despite the positive effects on short-term outcome such as functional limitations and falls.
既往分析表明，出院后个体化营养干预对营养不良老年患者的体重、瘦体重、功能受限及跌倒事件具有积极影响。然而，该干预对生存的影响尚未得到研究。
本随机对照研究旨在探讨出院后个体化营养干预对营养不良老年患者生存的影响。
年龄≥60岁的营养不良老年患者在住院期间被随机分为出院后为期三个月的营养干预组（富含蛋白质和能量的饮食、口服营养补充剂、维生素D3/钙补充剂以及营养师电话咨询）或常规护理方案组（对照组）。入组4年后收集生存数据。采用意向性分析，通过对数秩检验和校正混杂因素的Cox回归进行生存分析。
研究人群包括94名男性（45%）和116名女性，平均年龄为74.5（标准差9.5）岁。基线特征无统计学显著差异。210例患者中有208例可获得生存数据。随访1年和4年后，干预组（n = 104）的生存率分别为66%和29%，对照组（n = 104）分别为73%和30%。两组在入组1年（风险比=0.933，95%置信区间=0.675 - 1.289）和4年后的生存无统计学显著差异（风险比=0.928，95%置信区间=0.671 - 1.283）。
本研究未能显示出院后为期三个月的多组分营养干预对营养不良老年患者的长期生存有影响，尽管该干预对功能受限和跌倒等短期结局有积极作用。
