Amsterdam Public Health Research Institute, Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Department of Nutrition and Dietetics, Internal Medicine VU University Medical Center, Amsterdam, The Netherlands.
Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
Clin Nutr. 2019 Aug;38(4):1797-1806. doi: 10.1016/j.clnu.2018.07.023. Epub 2018 Aug 2.
BACKGROUND & AIMS: Protein-energy malnutrition is a health concern among older adults. Improving nutritional status by increasing energy and protein intake likely benefits health. We therefore aimed to investigate effects of nutritional interventions in older adults (at risk of malnutrition) on change in energy intake and body weight, and explore if the intervention effect was modified by study or participants' characteristics, analysing pooled individual participant data.
We searched for RCTs investigating the effect of dietary counseling, oral nutritional supplements (ONS) or both on energy intake and weight. Principle investigators of eligible studies provided individual participant data. We investigated the effect of nutritional intervention on meaningful increase in energy intake (>250 kcal/day) and meaningful weight gain (>1.0 kg). Logistic generalized estimating equations were performed and ORs with 95% CIs presented.
We included data of nine studies with a total of 990 participants, aged 79.2 ± 8.2 years, 64.5% women and mean baseline BMI 23.9 ± 4.7 kg/m. An non-significant intervention effect was observed for increase in energy intake (OR:1.59; 95% CI 0.95, 2.66) and a significant intervention effect for weight gain (OR:1.58; 95% CI 1.16, 2.17). Stratifying by type of intervention, an intervention effect on increase in energy intake was only observed for dietary counseling in combination with ONS (OR:2.28; 95% CI 1.90, 2.73). The intervention effect on increase in energy intake was greater for women, older participants, and those with lower BMI. Regarding weight gain, an intervention effect was observed for dietary counseling (OR:1.40; 95% CI 1.14, 1.73) and dietary counseling in combination with ONS (OR:2.48; 95% CI 1.92, 3.31). The intervention effect on weight gain was not influenced by participants' characteristics.
Based on pooled data of older adults (at risk of malnutrition), nutritional interventions have a positive effect on energy intake and body weight. Dietary counseling combined with ONS is the most effective intervention.
蛋白质-能量营养不良是老年人健康的关注点。通过增加能量和蛋白质摄入来改善营养状况可能有益于健康。因此，我们旨在调查营养干预对（有营养不良风险的）老年人能量摄入和体重变化的影响，并通过分析汇总的个体参与者数据，探讨干预效果是否受研究或参与者特征的影响。
我们检索了关于饮食咨询、口服营养补充剂（ONS）或两者联合对能量摄入和体重影响的随机对照试验（RCT）。合格研究的主要研究者提供了个体参与者数据。我们调查了营养干预对能量摄入有意义增加（>250 千卡/天）和体重有意义增加（>1.0 公斤）的效果。使用逻辑广义估计方程，并呈现比值比（OR）及其 95%置信区间（CI）。
我们纳入了 9 项研究的数据，共有 990 名参与者，年龄 79.2±8.2 岁，64.5%为女性，平均基线 BMI 为 23.9±4.7kg/m²。能量摄入增加的干预效果无统计学意义（OR：1.59；95%CI 0.95，2.66），而体重增加的干预效果有统计学意义（OR：1.58；95%CI 1.16，2.17）。按干预类型分层，仅观察到饮食咨询联合 ONS 的干预对能量摄入增加有效果（OR：2.28；95%CI 1.90，2.73）。该干预对能量摄入增加的效果在女性、年龄较大的参与者和 BMI 较低的参与者中更大。关于体重增加，饮食咨询（OR：1.40；95%CI 1.14，1.73）和饮食咨询联合 ONS（OR：2.48；95%CI 1.92，3.31）的干预效果都有统计学意义。体重增加的干预效果不受参与者特征的影响。
基于有营养不良风险的老年人的汇总数据，营养干预对能量摄入和体重有积极影响。饮食咨询联合 ONS 是最有效的干预措施。
