Clinical benefits of oral nutritional supplementation for elderly hip fracture patients: a single blind randomised controlled trial.
BACKGROUND
malnutrition is an important risk factor for poor outcome in patients recovering after hip fracture surgery. This study aimed to investigate the clinical, nutritional and rehabilitation effects of an oral nutritional supplementation (ONS) in an inpatient rehabilitation setting.


METHODS
this was an observer-blinded randomised controlled trial of elderly post-surgical proximal femoral fracture patients. A ready-to-use oral liquid nutritional supplementation (18-24 g protein and 500 kcal per day) in addition to hospital diet was compared with hospital diet only. Both groups received usual rehabilitation therapy and oral calcium and vitamin D supplements. Outcomes were compared at discharge from rehabilitation and after 4 weeks of discharge. The primary outcome parameters were the serum albumin level, the body mass index (BMI), the functional independence measure (FIM) and the elderly mobility scale (EMS). Secondary outcome parameters were frequency of complications, inpatient length of stay, mortality and acute hospital use within 6 months after discharge.


RESULTS
a total of 126 patients were recruited, 65 in the supplementation arm and 61 in the control arm. There was a significant difference in change in BMI with a decrease of 0.25 and 0.03 kg/m(2) in the ONS group and 0.72 and 0.49 kg/m(2) in the control group at hospital discharge and follow-up, respectively (P = 0.012). The length of stay in rehabilitation ward was shortened by 3.80 (SE = 1.81, P = 0.04) days favouring the ONS group. The total number of infection episodes was also reduced significantly. No difference was observed in the rate of change of the serum albumin level, the FIM and the EMS.


CONCLUSIONS
clinical and nutritional benefits were seen in this trial but rehabilitation benefits could not be demonstrated.
Department of Rehabilitation, Kowloon Hospital, Rehabilitation Building, 147A Argyle Street, Kowloon, Hong Kong. maww@ha.org.hk
Ma Wai Wai
MW
Myint
Jenny
J
Wu
Euann
E
Wong
Suk Ping
SP
Chan
Tze Shing Jess
TS
To
Mei Wa Rosanna
MW
Chau
Kwai Hing
KH
Ting
Pui Man
PM
Fung
Kit Sing Derrick
KS
Au
D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D004044:Dietary Proteins / Q000627:therapeutic use*; D019587:Dietary Supplements; D002149:Energy Intake; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000150:complications / Q000178:diet therapy* / Q000401:mortality / Q000534:rehabilitation; D006801:Humans; D007297:Inpatients; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D007902:Length of Stay; D008297:Male; D012709:Serum Albumin / Q000032:analysis; D016037:Single-Blind Method
D004044:Dietary Proteins; D012709:Serum Albumin; D007334:Insulin-Like Growth Factor I