title: A systematic review of protein and energy supplementation for hip fracture aftercare in older people.
abstract: OBJECTIVE
  To evaluate whether protein and energy supplementation influences recovery after hip fracture.
  
  
  METHODS
  Systematic review of randomised and quasi-randomised trials in people aged 65 y and over.
  
  
  METHODS
  We searched seven electronic databases from 1966 to April 2002, four journals and reference lists of relevant articles. We contacted trial investigators and experts for details of other trials.
  
  
  METHODS
  Mortality, complications and unfavourable outcome (mortality or survivors with complications) were the primary outcomes. We also sought data on length of hospital stay, functional status after hip fracture, quality of life and compliance with supplementation.
  
  
  RESULTS
  In total, 12 randomised trials involving 898 participants were included. Nine trials evaluated protein and energy supplementation (five oral and four nasogastric feeding), and a further three trials tested oral protein supplementation. Potential biases resulting from inadequate allocation concealment and lack of assessor blinding and intention-to-treat analysis, as well as the limited outcome data, mean that the results must be interpreted with caution. Pooled data from eight of the nine trials evaluating protein and energy supplements showed no evidence for an effect on mortality (relative risk 0.92, 95% CI 0.56-1.50). Limited data from only three trials showed that oral protein and energy supplements may reduce unfavourable outcome (relative risk 0.52, 95% CI 0.32-0.84).
  
  
  CONCLUSIONS
  Based on limited evidence, oral protein and energy supplementation after hip fracture may reduce unfavourable outcome. Further evidence from good-quality randomised trials is required to inform clinical practice.
authors.affiliation: Health Services Research Unit, University of Aberdeen, Aberdeen, UK. a.avenell@abdn.ac.uk
authors.forename: A
authors.initials: A
authors.lastname: Avenell
authors.forename: H H G
authors.initials: HH
authors.lastname: Handoll
mesh_terms: D000368:Aged; D004044:Dietary Proteins / Q000008:administration & dosage*; D019587:Dietary Supplements; D002149:Energy Intake; D005260:Female; D006620:Hip Fractures / Q000150:complications / Q000178:diet therapy* / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000517:prevention & control; D018529:Nutritional Support; D016017:Odds Ratio; D010349:Patient Compliance; D011183:Postoperative Complications / Q000453:epidemiology*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D004044:Dietary Proteins