title: Tight calorie control in geriatric patients following hip fracture decreases complications: a randomized, controlled study.
abstract: OBJECTIVE
  Optimizing nutritional intake has been recommended for geriatric patients undergoing hip-fracture surgery. Whether nutritional support guided by repeated measurements of resting energy requirements (REE) improves outcomes in these patients is not known.
  
  
  METHODS
  A randomized, controlled, unblinded, prospective, cohort study comparing provision of energy with a goal determined by repeated REE measurements using indirect calorimetry, with no intervention. Oral nutritional supplements were started 24 h after surgery and the amount adjusted to make up the difference between energy received from hospital food and measured energy expenditure.
  
  
  RESULTS
  50 Geriatric patients were included in the study. Patients in the intervention group (n = 22) received significantly higher daily energy intake than the control group (n = 28) (1121.3 ± 299.0 vs. 777.1 ± 301.2 kcal, p = 0.001). This was associated with a significantly less negative cumulative energy balance (-1229.9 ± 1763 vs. -4975.5 ± 4368 kcal, p = 0.001). A significant negative correlation was found between the cumulative energy balance and total complication rate (r = -0.417, p = 0.003) as well as for length of hospital stay (r = -0.282, p = 0.049).
  
  
  CONCLUSIONS
  We have demonstrated that nutritional support actively supervised by a dietician and guided by repeated measurements of REE was achievable and improved outcomes in geriatric patients following surgery for hip fractures. Clinicaltrials.gov Identifier: NCT017354435.
authors: Nutrition Unit, Rabin Medical Center, Petah Tikva, Israel; School of Nutritional Sciences, The Robert H Smith Faculty of Agriculture, Food and Environmental Quality Sciences, Hebrew University, Jerusalem, Israel.
authors: R
authors: R
authors: Anbar
authors: Department of Geriatrics, Rabin Medical Center, Petah Tikva and Sackler School of Medicine, Tel Aviv University, Israel.
authors: Y
authors: Y
authors: Beloosesky
authors: Department of General Intensive Care, Rabin Medical Center, Petah Tikva and Sackler School of Medicine, Tel Aviv University, Israel.
authors: J
authors: J
authors: Cohen
authors: School of Nutritional Sciences, The Robert H Smith Faculty of Agriculture, Food and Environmental Quality Sciences, Hebrew University, Jerusalem, Israel.
authors: Z
authors: Z
authors: Madar
authors: Department of Geriatrics, Rabin Medical Center, Petah Tikva and Sackler School of Medicine, Tel Aviv University, Israel.
authors: A
authors: A
authors: Weiss
authors: Department of General Intensive Care, Rabin Medical Center, Petah Tikva and Sackler School of Medicine, Tel Aviv University, Israel.
authors: M
authors: M
authors: Theilla
authors: Nutrition Unit, Rabin Medical Center, Petah Tikva, Israel.
authors: T
authors: T
authors: Koren Hakim
authors: Nutrition Unit, Rabin Medical Center, Petah Tikva, Israel.
authors: S
authors: S
authors: Frishman
authors: Department of General Intensive Care, Rabin Medical Center, Petah Tikva and Sackler School of Medicine, Tel Aviv University, Israel. Electronic address: psinger@clalit.org.il.
authors: P
authors: P
authors: Singer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019587:Dietary Supplements; D002149:Energy Intake; D004734:Energy Metabolism; D005260:Female; D015577:Geriatric Assessment; D006620:Hip Fractures / Q000150:complications / Q000178:diet therapy* / Q000601:surgery; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000178:diet therapy* / Q000209:etiology; D009751:Nutritional Requirements; D009752:Nutritional Status; D018529:Nutritional Support / Q000379:methods; D011182:Postoperative Care; D011183:Postoperative Complications / Q000178:diet therapy / Q000517:prevention & control; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: CAM; CCI; CIRS-G; Charlson's comorbidity index; Confusion Assessment Method; Cumulative Illness Rating Scale for Geriatrics; Energy expenditure; FIM; Functional Independence Measure; Geriatric; Hip fracture; IC; MAC; MMSE; MNA; Mini-Mental State Examination; ONS; Tight calorie control; indirect calorimetry; mid-arm circumference; mini-nutritional assessment; oral nutritional supplements