The effect of oral nutritional supplements on habitual dietary quality and quantity in frail elders.
BACKGROUND
Frail institutionalized elders have a high prevalence of nutritional risk factors, undernutrition, weight loss, and nutrition-related morbidity and excess mortality. Little information is available on effective means to intervene in this setting.


OBJECTIVE
We tested the hypothesis that addition of multinutrient oral supplements to the diet of frail elders would improve their overall nutritional status and functional level.


METHODS
Fifty nursing home residents aged 88+/-1 yr. were followed for 10 weeks in the course of a randomized controlled trial of supplementation with a multinutrient liquid supplement vs. a non-nutritive placebo drink. Three-day food weighing was used to analyze their habitual dietary intake before and during the final week of the intervention. Nutritional status was further assessed with nutritional biochemistries, anthropometric measurements, and body composition analysis as well as physical and functional performance tests.


RESULTS
The nutritional supplement was consumed with high compliance, but did not significantly augment total caloric intake. Supplementation was associated with significant reductions in total energy, protein, fat, water, fiber, and many vitamins and minerals in the habitual diet of these nursing home residents. Nutritional status improved in terms of folate levels in serum, but no other measured vitamin or mineral indices. Body composition analysis revealed a small gain in weight, increases in fat stores, but no improvement in lean tissue mass associated with supplemention. No physical performance or functional gains were associated with supplementation.


CONCLUSIONS
Short-term nutritional supplementation in elders at nutritional risk is offset by simultaneous reduction in voluntary food intake. It seems likely that changing other components of energy expenditure such as physical activity levels or basal metabolism may be required to produce overall improvements in nutritional intake in this setting.
Fiatarone Singh
M A
MA
School of Exercise and Sport Science, University of Sydney, Cumberland Campus, East Street, P.O. Box 170, Lidcombe, NSW 1825, Australia m.singh@cchs.usyd.edu.au.
Bernstein
M A
MA
Ryan
A D
AD
O'Neill
E F
EF
Clements
K M
KM
Evans
W J
WJ
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001823:Body Composition; D019587:Dietary Supplements; D002149:Energy Intake; D005260:Female; D005492:Folic Acid / Q000097:blood; D016330:Frail Elderly; D006801:Humans; D008297:Male; D009735:Nursing Homes; D009752:Nutritional Status; D010349:Patient Compliance; D010919:Placebos
D010919:Placebos; D005492:Folic Acid