title: An innovative solid oral nutritional supplement to fight weight loss and anorexia: open, randomised controlled trial of efficacy in institutionalised, malnourished older adults.
abstract: OBJECTIVE
  To evaluate the impact of a solid nutritional supplement on the weight gain of institutionalised older adults>70 years with protein-energy malnutrition. The innovation of these high-protein and high-energy cookies was the texture adapted to edentulous patients (Protibis®, Solidages, France).
  
  
  METHODS
  An open, multicentre, randomised controlled trial.
  
  
  METHODS
  Seven nursing homes.
  
  
  METHODS
  One hundred and seventy-five malnourished older adults, aged 86±8 years.
  
  
  METHODS
  All participants received the standard institutional diet. In addition, Intervention group participants received eight cookies daily (11.5 g protein; 244 kcal) for 6 weeks (w0-w6).
  
  
  METHODS
  Five visits (w-4, w0, w6, w10 and w18).
  
  
  RESULTS
  Percentage of weight gain from w0 to w6 (body mass in kg).
  
  
  RESULTS
  Appetite, rated using a numerical scale (0: no appetite to 10: extremely good appetite); current episodes of pressure ulcers and diarrhea.
  
  
  RESULTS
  Average weight increased in Intervention group (n=88) compared with Control group (n=87) without cookies supplementation (+1.6 versus -0.7%, P=0.038). Weight gain persisted 1 month (+3.0 versus -0.2%, P=0.025) and 3 months after the end of cookies consumption (+3.9 versus -0.9%, P=0.003), with diarrhea reduction (P=0.027). There was a synergistic effect with liquid/creamy dietary supplements. Subgroup analysis confirmed the positive impact of cookies supplementation alone on weight increase (P=0.024), appetite increase (P=0.009) and pressure ulcers reduction (P=0.031).
  
  
  CONCLUSIONS
  The trial suggested that, to fight against anorexia, the stimulation of touch (finger food; chewing, even on edentulous gums) and hearing (intra-oral sounds) could be valuable alternatives to sight, smell and taste alterations.
authors.affiliation: MICORALIS Laboratory, School of Dentistry, University Nice Sophia Antipolis, Nice, France Department of Dentistry, Nice University Hospital, Nice, France.
authors.forename: Valerie
authors.initials: V
authors.lastname: Pouyssegur
authors.affiliation: Department of Geriatrics, Nice University Hospital, Nice, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Brocker
authors.affiliation: Department of Nutrition, Nice University Hospital, Nice, France.
authors.forename: Stéphane M
authors.initials: SM
authors.lastname: Schneider
authors.affiliation: Fondation Pauliani, Nice, France.
authors.forename: Jean Luc
authors.initials: JL
authors.lastname: Philip
authors.affiliation: EHPAD Tiers Temps, Nice, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Barat
authors.affiliation: La Serena, Clinique Saint Georges, Nice, France.
authors.forename: Ewa
authors.initials: E
authors.lastname: Reichert
authors.affiliation: EHPAD Les Jardins de la Clairière, Nice, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Breugnon
authors.affiliation: EHPAD Mariposa, Nice, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Brunet
authors.affiliation: EHPAD Les Amaryllis, Nice, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Civalleri
authors.affiliation: EHPAD Sainte Juliette, Nice, France.
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Solere
authors.affiliation: EHPAD Villa Foch, Nice, France.
authors.forename: Line
authors.initials: L
authors.lastname: Bensussan
authors.affiliation: MICORALIS Laboratory, School of Dentistry, University Nice Sophia Antipolis, Nice, France Department of Dentistry, Nice University Hospital, Nice, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Lupi-Pegurier
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000855:Anorexia / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D001066:Appetite; D004044:Dietary Proteins / Q000008:administration & dosage; D004644:Emotions; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005526:Food, Formulated; D005602:France; D015577:Geriatric Assessment; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D009735:Nursing Homes; D015596:Nutrition Assessment; D009752:Nutritional Status; D011502:Protein-Energy Malnutrition / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D015430:Weight Gain; D015431:Weight Loss
chemical_list: D004044:Dietary Proteins
keywords: anorexia; diarrhea; dietary supplement; older people; pressure ulcer; protein-energy malnutrition