Survival in malnourished older patients receiving post-discharge nutritional support; long-term results of a randomized controlled trial

• Published in: The Journal of nutrition, health & aging Vol. 21; no. 8; pp. 855 - 860
• Main Authors: Neelemaat, F., van Keeken, S., Langius, J. A. E., de van der Schueren, M. A. E., Thijs, A., Bosmans, J. E.
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01-10-2017; Springer Nature B.V
• Subjects: Aged; Aging; Evidence-based medicine; Female; Geriatrics/Gerontology; Hospitalization; Humans; Male; Malnutrition; Medicine; Medicine & Public Health; Middle Aged; Neurosciences; Nutrition; Nutritional Support - methods; Older people; Primary Care Medicine; Quality of Life Research; Older patients; RCT; Malnutrition; Survival; Nutritional intervention; nutritional intervention; older patients; survival
• ISSN: 1279-7707; 1760-4788
• DOI: 10.1007/s12603-017-0939-7

Background
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
Objective
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.
Methods
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.
Results
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).
Conclusion
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.