Abstract
Objectives
It has been recognized that nutritional interventions play a role in improving the
nutritional and functional status of older persons. This systematic review summarizes
the evidence on nutritional and functional outcomes of nutritional interventions alone
or in combination with physical exercise in geriatric rehabilitation patients.
Design
Eight electronic databases were searched until July 1, 2019 to identify nutritional
intervention studies in patients aged ≥60 years who were admitted to geriatric rehabilitation.
A meta-analysis was performed to quantify intervention effects on serum albumin, muscle
mass, and hand grip strength (HGS).
Results
A total of 1962 studies were screened and 13 included in the systematic review. Studies
were heterogeneous in interventions (4 nutritional interventions, 6 physical exercise + nutritional
intervention, 1 timing of protein provision, 1 exercise + dietary advice, 1 nutrition-related
nursing care) and outcomes. Among the 9 interventions that tested oral nutritional
supplements (ONS) with protein, with or without exercise, 7 studies reported protein
intake and 6 showed increased protein intakes, 2 of 5 studies showed increased albumin
levels, and 5 of 9 reported an improvement in functional outcomes (BI, Functional
Independence Measure, mobility). Meta-analyses showed no significant intervention
effects on albumin [standardized mean difference (SMD) 0.45, 95% confidence interval
(CI) −0.14, 1.04 (4 studies)], muscle mass [mean difference (MD) 2.14 kg, 95% CI –2.17,
6.45 (3 studies)], and HGS [SMD –0.04, 95% CI –0.55, 0.63 (3 studies)], but was based
on a very limited number of studies.
Conclusions and Implications
Only a limited number of studies with heterogeneous nutritional interventions and
outcomes were available in the geriatric rehabilitation population. Studies that included
ONS improved nutritional outcomes, especially protein intake and albumin levels. Functional
outcomes improved in the majority of reporting studies. This indicates benefits of
protein supplementation, with or without exercise, in this population. Future well-designed
and well-powered clinical trials are needed to clarify existing controversial aspects.
Keywords
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Article info
Publication history
Published online: July 25, 2020
Footnotes
Funding sources: This study was supported by Danone Nutricia Research.
Conflicts of interest: J.v.W., C.v.d.B., A.C.Y., and Y.L. are employees of Danone Nutricia Research. J.W. and R.D. declare no conflicts of interest. J.B. reports personal fees from Fresenius, Nestlé, Novartis, Pfizer, Bayer, and grants and personal fees from Danone Nutricia, outside the submitted work.
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
