title: Early nutritional support and physiotherapy improved long-term self-sufficiency in acutely ill older patients.
abstract: OBJECTIVE
  An acute disease is regularly associated with inflammation, decreased food intake, and low physical activity; the consequence is loss of muscle mass. However, the restoration of muscle tissue is problematic, especially in older patients. Loss of muscle mass leads to further decrease of physical activity which leads, together with recurring disease, to the progressive muscle mass loss accompanied by loss of self-sufficiency. Early nutrition support and physical activity could reverse this situation. Therefore, the aim of this study was to determine whether an active approach based on early nutritional therapy and exercise would influence the development of sarcopenia and impaired self-sufficiency during acute illness.
  
  
  METHODS
  Two hundred patients >78 y were admitted to a hospital internal medicine department and participated in a prospective, randomized controlled study. The patients were randomized to a control group receiving standard treatment (n = 100) or to an intervention group (n = 100). The intervention consisted of nutritional supplements (600 kcal, 20 g/d protein) added to a standard diet and a simultaneous intensive rehabilitation program. The tolerance of supplements and their influence on spontaneous food intake, self-sufficiency, muscle strength, and body composition were evaluated during the study period. The patients were then regularly monitored for 1 y post-discharge.
  
  
  RESULTS
  The provision of nutritional supplements together with early rehabilitation led to increased total energy and protein intake while the intake of standard hospital food was not reduced. The loss of lean body mass and a decrease in self-sufficiency were apparent at discharge from the hospital and 3 mo thereafter in the control group. Nutritional supplementation and the rehabilitation program in the study group prevented these alterations. A positive effect of nutritional intervention and exercise during the hospital stay was apparent at 6 mo post-discharge.
  
  
  CONCLUSIONS
  The early nutritional intervention together with early rehabilitation preserves muscle mass and independence in ill older patients hospitalized because of acute disease.
authors.affiliation: Third Department of Medicine, Medical Faculty and Faculty Hospital Hradec Kralove, Charles University, Prague, Czech Republic. Electronic address: petra.hegerova@fnhk.cz.
authors.forename: Petra
authors.initials: P
authors.lastname: Hegerová
authors.affiliation: Third Department of Medicine, Medical Faculty and Faculty Hospital Hradec Kralove, Charles University, Prague, Czech Republic.
authors.forename: Zuzana
authors.initials: Z
authors.lastname: Dědková
authors.affiliation: Third Department of Medicine, Medical Faculty and Faculty Hospital Hradec Kralove, Charles University, Prague, Czech Republic.
authors.forename: Luboš
authors.initials: L
authors.lastname: Sobotka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001823:Body Composition; D015992:Body Mass Index; D016638:Critical Illness / Q000534:rehabilitation* / Q000628:therapy*; D004044:Dietary Proteins / Q000008:administration & dosage; D019587:Dietary Supplements; D002149:Energy Intake; D015444:Exercise; D006801:Humans; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000378:metabolism; D009752:Nutritional Status; D018529:Nutritional Support; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D011788:Quality of Life; D055948:Sarcopenia / Q000534:rehabilitation / Q000628:therapy
chemical_list: D004044:Dietary Proteins
keywords: Elderly; Lean body mass; Nutrition; Self-sufficiency