Nutritional supplementation for hip fracture aftercare in older people

Hdl Handle:
http://hdl.handle.net/10149/95608
Title:
Nutritional supplementation for hip fracture aftercare in older people
Authors:
Avenell, A. (Alison); Handoll, H. H. G. (Helen)
Affiliation:
University of Teesside. Research Institute of Health Sciences & Social Care. Centre of Rehabilitation Sciences.
Citation:
Avenell, A. and Handoll, H. H. G. (2010) 'Nutritional supplementation for hip fracture aftercare in older people', The Cochrane Database of Systematic Reviews; 1
Publisher:
Wiley-Blackwell
Journal:
The Cochrane Database of Systematic Reviews
Issue Date:
2010
URI:
http://hdl.handle.net/10149/95608
DOI:
10.1002/14651858.CD001880.pub5
Abstract:
Background: Older people with hip fractures are often malnourished at the time of fracture, and have poor food intake subsequently. Objectives: To review the effects of nutritional interventions in older people recovering from hip fracture. Search strategy: 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). Selection criteria: Randomised and quasi-randomised controlled trials of nutritional interventions for people aged over 65 years with hip fracture. Data collection and analysis: Both authors independently selected trials, extracted data and assessed trial quality. We pooled data for primary outcomes. Main 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). Authors' 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.
Type:
Article
Language:
en
Keywords:
aftercare; dietary supplements; hip fractures; malnutrition; nutritional support; randomized controlled trials; aged; humans
ISSN:
1469-493X
Rights:
In return for the grant of the licence, the author(s) shall have the following rights: The right to post the review as an electonic file on the author's own website and/or the author's institution's website, using the PDF version of the review available in the Cochrane Database of Systematic Reviews. [Advice from CEO of The Cochrane Collaboration]
Citation Count:
0 [Web of Science, 06/04/2010]

Full metadata record

DC FieldValue Language
dc.contributor.authorAvenell, A. (Alison)en
dc.contributor.authorHandoll, H. H. G. (Helen)en
dc.date.accessioned2010-04-06T09:48:12Z-
dc.date.available2010-04-06T09:48:12Z-
dc.date.issued2010-
dc.identifier.citationThe Cochrane Database of Systematic Reviews; 1en
dc.identifier.issn1469-493X-
dc.identifier.doi10.1002/14651858.CD001880.pub5-
dc.identifier.urihttp://hdl.handle.net/10149/95608-
dc.description.abstractBackground: Older people with hip fractures are often malnourished at the time of fracture, and have poor food intake subsequently. Objectives: To review the effects of nutritional interventions in older people recovering from hip fracture. Search strategy: 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). Selection criteria: Randomised and quasi-randomised controlled trials of nutritional interventions for people aged over 65 years with hip fracture. Data collection and analysis: Both authors independently selected trials, extracted data and assessed trial quality. We pooled data for primary outcomes. Main 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). Authors' 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.en
dc.language.isoenen
dc.publisherWiley-Blackwellen
dc.rightsIn return for the grant of the licence, the author(s) shall have the following rights: The right to post the review as an electonic file on the author's own website and/or the author's institution's website, using the PDF version of the review available in the Cochrane Database of Systematic Reviews. [Advice from CEO of The Cochrane Collaboration]en
dc.subjectaftercareen
dc.subjectdietary supplementsen
dc.subjecthip fracturesen
dc.subjectmalnutritionen
dc.subjectnutritional supporten
dc.subjectrandomized controlled trialsen
dc.subjectageden
dc.subjecthumansen
dc.titleNutritional supplementation for hip fracture aftercare in older peopleen
dc.typeArticleen
dc.contributor.departmentUniversity of Teesside. Research Institute of Health Sciences & Social Care. Centre of Rehabilitation Sciences.en
dc.identifier.journalThe Cochrane Database of Systematic Reviewsen
ref.citationcount0 [Web of Science, 06/04/2010]en
or.citation.harvardAvenell, A. and Handoll, H. H. G. (2010) 'Nutritional supplementation for hip fracture aftercare in older people', The Cochrane Database of Systematic Reviews; 1-
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