NUTRITIONAL INTERVENTION DURING HOSPITALIZATION IN MALNOURISHED PATIENTS
F. Bon, P. Manckoundia, P. Pfitzenmeyer, V. VanWymelbeke
J Aging Res Clin Practice 2012;1(3):213--218
Background: Malnutrition affects up to 60% of older people at hospital. Objective: To diagnose the nutritional status of patients admitted to a geriatric care unit and to assess the effects of specific nutritional followup to improve the nutritional status of hospitalised patients compared with standard care in the same care unit. Design and intervention: Patients were 75 years and older were able to eat normally and the malnourished status was evaluated by either a MNA short-form score < 11 points or albumin (alb) level < 35g/L or transthyretin (TTR) < 0.2 g/L. The study comprised two groups: the interventional group (IG) received specific nutritional intervention for a maximum of 20 days and the control group (CG) received no specific encouragement other than that usually provided in the care unit when malnutrition was detected. At admission, day 0, the MNA, anthropometric data, autonomy levels (ADL, IADL), cognitive and depressive status, blood parameters (Alb, TTR and C-reactive protein, CRP) and 3-day food intake were measured. At day 10, ADL and 3-day food intake were measured. Finally at day 20, blood parameters and 3-day food intake were measured. Subjects: The nutritional status of all patients admitted to the geriatric care unit was systematically assessed and fifty hospitalised elderly people (87.2 ± 5.9 years old) were recruited in the geriatric unit to participate in the study with specific nutritional follow-up (IG n = 22; CG n = 28). Statistical analysis: All data are presented as mean ± standard deviation (SD) for all patients for the interventional and control groups. Student t-test was used to determine the effect of nutritional intervention on blood samples and food intake. Results: 478 people were hospitalised in the acute geriatric care unit, age was 85.6 ± 6.4 years and the length of stay 20.1 ± 10.9 days. Among these, 61.5% were malnourished and 73 accepted to participate in the study. Complete results were obtained for analysis for 50 patients. On admission, the average blood parameters, in particular alb and TTR were low and CRP was high, which showed an inflammatory status. After 10d of intervention, changes in levels of alb, TTR and CRP were highly significant in the IG (p=0.005 for alb; p=0.0003 for TTR; p=0.0004 for CRP). In the CG, changes in TTR and CRP were also significant (p=0.001 for TTR and p=0.003 for CRP). An increase in TTR values occurred in only 67.8% of patients in the CG against 86.4% in the IG. An increase in calorie intake was noted for 72.7% of the IG against only 46.4% of the CG. Conclusion: Intervention given to patients during the first 10 days of the hospital stay can re-initiate food intake, and thus improve blood parameters. However the nutritional intervention does not lead to better outcomes compared to usual care.