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F. Neelemaat, M.A.E. van Bokhorst-de van der Schueren, H.J. Bontkes, J.C. Seidell, S. Hougee, A. Thijs

J Aging Res Clin Practice 2013;2(1):91-98

Introduction: Both malnutrition and advanced age are known to negatively impact the immune system. The aim of this exploratory randomized controlled trial was to study the effects of a composite nutritional intervention on immune markers, endocrine markers and a selection of micronutrients in malnourished ill elderly patients. Patients and methods: Malnourished elderly patients (> 60 yrs) newly admitted to the departments of general internal medicine of a university medical center were randomised to receive either usual care plus a multi-component nutritional intervention (energy and protein enriched diet, comprising oral nutritional support, calcium-vitamin D supplement, telephone counselling by a dietitian) for three months post-discharge or usual care alone. Immune markers (interleukins, complement, C-reactive protein, albumin, TNF-α), endocrine markers (growth factors) and micronutrients (iron, ferritin, vitamin A, E and D), were measured at baseline and three months following hospital discharge. Results: In the parent study 210 patients were included, 105 in each group. This study is a subanalysis of 89 patients (46 patients in the intervention group and 43 in the control group) of whom both baseline and final measurement of immune markers, endocrine markers and micronutrients were available. This selection of patients appeared to be in a better health status compared to the total group. At baseline, most of the analysed immune markers, endocrine markers and micronutrients showed values within the normal range, with no statistically significant differences between intervention group and control group. Most immune markers, endocrine markers and micronutrients tended to improved over time, without statistically significant differences between groups, except for vitamin D (p=0.008), confirming the supplementation of vitamin D in the intervention group. Conclusion: A three months nutritional intervention in malnourished ill elderly patients had no measurable additional influence on measured immune markers, endocrine markers and selected micronutrients. The improved outcomes were presumably caused by patients’ improved health status during time.

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