Nutritional supplementation for hip fracture aftercare in older people.
BACKGROUND
Older people with hip fractures are often malnourished at the time of fracture, and have poor food intake subsequently.


OBJECTIVE
To review the effects of nutritional interventions in older people recovering from hip fracture.


METHODS
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (September 2008), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 3), MEDLINE and other major databases (to July 2008).


METHODS
Randomised and quasi-randomised controlled trials of nutritional interventions for people aged over 65 years with hip fracture.


METHODS
Both authors independently selected trials, extracted data and assessed trial quality. We pooled data for primary outcomes.


RESULTS
Twenty-four randomised trials involving 1940 participants were included. Outcome data were limited and many trials were methodologically flawed. Results from 23 trials are presented here.Ten trials evaluated oral multinutrient feeds: providing non-protein energy, protein, some vitamins and minerals. Oral feeds had no statistically significant effect on mortality (16/244 versus 21/226; risk ratio (RR) 0.76, 95% confidence interval (CI) 0.42 to 1.37) or 'unfavourable outcome' (combined outcome of mortality and survivors with medical complications) (46/126 versus 41/103; RR 0.76, 95% CI 0.55 to 1.04).Four heterogenous trials examining nasogastric multinutrient feeding showed no evidence of an effect on mortality (RR 0.99, 95% CI 0.50 to 1.97). Nasogastric feeding was poorly tolerated.One trial examining nasogastric tube feeding followed by oral feeds found no evidence for an effect on mortality or complications.One trial of multinutrient intravenous feeding followed by oral supplements found a reduction in participants with complications (RR 0.21, 95% CI 0.10 to 0.46), but not in mortality (RR 0.11, 95% CI 0.01 to 2.00).Four trials testing increasing protein intake in an oral feed found no evidence for an effect on mortality (RR 1.42, 95% CI 0.85 to 2.37). Protein supplementation may have reduced the number of long term medical complications.Two trials, testing intravenous vitamin B1 and other water soluble vitamins, or oral 1-alpha-hydroxycholecalciferol (vitamin D) respectively, produced no evidence of effect.One trial, evaluating dietetic assistants to help with feeding, showed no statistically significant effect on mortality (RR 0.57, 99% CI 0.29 to 1.11).


CONCLUSIONS
Weak evidence exists for the effectiveness of protein and energy feeds. Adequately sized randomised trials with robust methodology are required. In particular, the role of dietetic assistants, and peripheral venous feeding require further evaluation.
Avenell
Alison
A
Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, UK, AB25 2ZD.
Handoll
Helen Hg
HH
D000359:Aftercare; D000368:Aged; D019587:Dietary Supplements; D006620:Hip Fractures / Q000150:complications*; D006801:Humans; D044342:Malnutrition / Q000178:diet therapy*; D018529:Nutritional Support / Q000379:methods*; D016032:Randomized Controlled Trials as Topic