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Review Article| Volume 21, ISSUE 9, P1207-1215.e9, September 2020

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Effects of Nutritional Interventions on Nutritional and Functional Outcomes in Geriatric Rehabilitation Patients: A Systematic Review and Meta-Analysis

      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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      References

        • Cereda E.
        • Pedrolli C.
        • Klersy C.
        • et al.
        Nutritional status in older persons according to healthcare setting: A systematic review and meta-analysis of prevalence data using MNA((R)).
        Clin Nutr. 2016; 35: 1282-1290
        • Kaiser M.J.
        • Bauer J.M.
        • Ramsch C.
        • et al.
        Frequency of malnutrition in older adults: A multinational perspective using the mini nutritional assessment.
        J Am Geriatr Soc. 2010; 58: 1734-1738
        • Marshall S.
        • Bauer J.
        • Isenring E.
        The consequences of malnutrition following discharge from rehabilitation to the community: A systematic review of current evidence in older adults.
        J Hum Nutr Diet. 2014; 27: 133-141
        • Cruz-Jentoft A.J.
        • Bahat G.
        • Bauer J.
        • et al.
        Sarcopenia: Revised European consensus on definition and diagnosis.
        Age Ageing. 2019; 48: 16-31
        • Churilov I.
        • Churilov L.
        • MacIsaac R.J.
        • et al.
        Systematic review and meta-analysis of prevalence of sarcopenia in post acute inpatient rehabilitation.
        Osteoporos Int. 2018; 29: 805-812
      1. Boston Working Group on Improving Health Care Outcomes Through Geriatric Rehabilitation.
        Med Care. 1997; 35: JS4-JS20
        • Collins J.
        • Porter J.
        The effect of interventions to prevent and treat malnutrition in patients admitted for rehabilitation: A systematic review with meta-analysis.
        J Hum Nutr Diet. 2015; 28: 1-15
        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration.
        PLoS Med. 2009; 6: e1000100
        • Wojzischke J.
        • van Wijngaarden J.
        • van den Berg C.
        • et al.
        Nutritional status and functionality in geriatric rehabilitation patients: A systematic review and meta-analysis.
        Eur Geriatr Med. 2020; 11: 195-207
      2. Higgins J.P.T. Green S. Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration version 5.1.0. 2011 (Available at:)
        www.handbook.cochrane.org
        Date accessed: March , 2011
        • Bouillanne O.
        • Curis E.
        • Hamon-Vilcot B.
        • et al.
        Impact of protein pulse feeding on lean mass in malnourished and at-risk hospitalized elderly patients: A randomized controlled trial.
        Clin Nutr. 2013; 32: 186-192
        • Poulsen I.
        • Petersen H.V.
        • Hallberg I.R.
        • et al.
        Lack of nutritional and functional effects of nutritional supervision by nurses: A quasi-experimental study in geriatric patients.
        Scan J Food Nutr. 2007; 51: 6-12
        • Higgins J.P.
        • Altman D.G.
        • Gotzsche P.C.
        • et al.
        The Cochrane Collaboration's tool for assessing risk of bias in randomised trials.
        BMJ. 2011; 343: d5928
        • Seki E.
        • Watanabe Y.
        • Shimada K.
        • et al.
        Effects of a phase III cardiac rehabilitation program on physical status and lipid profiles in elderly patients with coronary artery disease: Juntendo Cardiac Rehabilitation Program (J-CARP).
        Circ J. 2008; 72: 1230-1234
        • Volkert D.
        • Hubsch S.
        • Oster P.
        • et al.
        Nutrition support and functional status in undernourished geriatric patients during hospitalization and 6-month follow-up.
        Aging Clin Exp Res. 1996; 8: 386-395
        • Neumann M.
        • Friedmann J.
        • Roy M.A.
        • et al.
        Provision of high-protein supplement for patients recovering from hip fracture.
        Nutrition. 2004; 20: 415-419
        • Niitsu M.
        • Ichinose D.
        • Hirooka T.
        • et al.
        Effects of combination of whey protein intake and rehabilitation on muscle strength and daily movements in patients with hip fracture in the early postoperative period.
        Clin Nutr. 2016; 35: 943-949
        • Malafarina V.
        • Uriz-Otano F.
        • Malafarina C.
        • et al.
        Effectiveness of nutritional supplementation on sarcopenia and recovery in hip fracture patients. A multi-centre randomized trial.
        Maturitas. 2017; 101: 42-50
        • Myint M.W.
        • Wu J.
        • Wong E.
        • et al.
        Clinical benefits of oral nutritional supplementation for elderly hip fracture patients: A single blind randomised controlled trial.
        Age Ageing. 2013; 42: 39-45
        • Yoshimura Y.
        • Bise T.
        • Shimazu S.
        • et al.
        Effects of a leucine-enriched amino acid supplement on muscle mass, muscle strength, and physical function in post-stroke patients with sarcopenia: A randomized controlled trial.
        Nutrition. 2019; 58: 1-6
        • Buhl S.F.
        • Andersen A.L.
        • Andersen J.R.
        • et al.
        The effect of protein intake and resistance training on muscle mass in acutely ill old medical patients—a randomized controlled trial.
        Clin Nutr. 2016; 35: 59-66
        • Hegerova P.
        • Dedkova Z.
        • Sobotka L.
        Early nutritional support and physiotherapy improved long-term self-sufficiency in acutely ill older patients.
        Nutrition. 2015; 31: 166-170
        • Latham N.K.
        • Anderson C.S.
        • Lee A.
        • et al.
        A randomized, controlled trial of quadriceps resistance exercise and vitamin D in frail older people: The Frailty Interventions Trial in Elderly Subjects (FITNESS).
        J Am Geriatr Soc. 2003; 51: 291-299
        • Takeuchi I.
        • Yoshimura Y.
        • Shimazu S.
        • et al.
        Effects of branched-chain amino acids and vitamin D supplementation on physical function, muscle mass and strength, and nutritional status in sarcopenic older adults undergoing hospital-based rehabilitation: A multicenter randomized controlled trial.
        Geriatr Gerontol Int. 2019; 19: 12-17
        • Zhang Z.
        • Pereira S.L.
        • Luo M.
        • et al.
        Evaluation of blood biomarkers associated with risk of malnutrition in older adults: A systematic review and meta-analysis.
        Nutrients. 2017; 9
        • Kuzuya M.
        • Izawa S.
        • Enoki H.
        • et al.
        Is serum albumin a good marker for malnutrition in the physically impaired elderly?.
        Clin Nutr. 2007; 26: 84-90
        • Beck A.M.
        • Dent E.
        • Baldwin C.
        Nutritional intervention as part of functional rehabilitation in older people with reduced functional ability: A systematic review and meta-analysis of randomised controlled studies.
        J Hum Nutr Diet. 2016; 29: 733-745
        • Avenell A.
        • Smith T.O.
        • Curtain J.P.
        • et al.
        Nutritional supplementation for hip fracture aftercare in older people.
        Cochrane Database Syst Rev. 2016; 11: CD001880
        • Liao C.D.
        • Tsauo J.Y.
        • Wu Y.T.
        • et al.
        Effects of protein supplementation combined with resistance exercise on body composition and physical function in older adults: A systematic review and meta-analysis.
        Am J Clin Nutr. 2017; 106: 1078-1091
        • Finger D.
        • Goltz F.R.
        • Umpierre D.
        • et al.
        Effects of protein supplementation in older adults undergoing resistance training: A systematic review and meta-analysis.
        Sports Med. 2015; 45: 245-255
        • Yoshimura Y.
        • Wakabayashi H.
        • Yamada M.
        • et al.
        Interventions for treating sarcopenia: A systematic review and meta-analysis of randomized controlled studies.
        J Am Med Dir Assoc. 2017; 18: 553.e1-553.e16
        • Liao C.D.
        • Lee P.H.
        • Hsiao D.J.
        • et al.
        Effects of protein supplementation combined with exercise intervention on frailty indices, body composition, and physical function in frail older adults.
        Nutrients. 2018; 10
        • Cermak N.M.
        • Res P.T.
        • de Groot L.C.
        • et al.
        Protein supplementation augments the adaptive response of skeletal muscle to resistance-type exercise training: A meta-analysis.
        Am J Clin Nutr. 2012; 96: 1454-1464
        • Beaudart C.
        • Dawson A.
        • Shaw S.C.
        • et al.
        Nutrition and physical activity in the prevention and treatment of sarcopenia: Systematic review.
        Osteoporos Int. 2017; 28: 1817-1833
        • Tieland M.
        • Borgonjen-Van den Berg K.J.
        • van Loon L.J.
        • et al.
        Dietary protein intake in community-dwelling, frail, and institutionalized elderly people: Scope for improvement.
        Eur J Nutr. 2012; 51: 173-179
        • Artaza-Artabe I.
        • Saez-Lopez P.
        • Sanchez-Hernandez N.
        • et al.
        The relationship between nutrition and frailty: Effects of protein intake, nutritional supplementation, vitamin D and exercise on muscle metabolism in the elderly. A systematic review.
        Maturitas. 2016; 93: 89-99
        • Komar B.
        • Schwingshackl L.
        • Hoffmann G.
        Effects of leucine-rich protein supplements on anthropometric parameter and muscle strength in the elderly: A systematic review and meta-analysis.
        J Nutr Health Aging. 2015; 19: 437-446
        • Beaudart C.
        • Rabenda V.
        • Simmons M.
        • et al.
        Effects of protein, essential amino acids, B-hydroxy B-methylbutyrate, creatine, dehydroepiandrosterone and fatty acid supplementation on muscle mass, muscle strength and physical performance in older people aged 60 years and over. A systematic review on the literature.
        J Nutr Health Aging. 2018; 22: 117-130
        • Bauer J.M.
        • Verlaan S.
        • Bautmans I.
        • et al.
        Effects of a vitamin D and leucine-enriched whey protein nutritional supplement on measures of sarcopenia in older adults, the PROVIDE study: A randomized, double-blind, placebo-controlled trial.
        J Am Med Dir Assoc. 2015; 16: 740-747
        • Tieland M.
        • van de Rest O.
        • Dirks M.L.
        • et al.
        Protein supplementation improves physical performance in frail elderly people: a randomized, double-blind, placebo-controlled trial.
        J Am Med Dir Assoc. 2012; 13: 720-726
        • Tieland M.
        • Franssen R.
        • Dullemeijer C.
        • et al.
        The impact of dietary protein or amino acid supplementation on muscle mass and strength in elderly people: Individual participant data and meta-analysis of RCT's.
        J Nutr Health Aging. 2017; 21: 994-1001
        • Wandrag L.
        • Brett S.J.
        • Frost G.
        • et al.
        Impact of supplementation with amino acids or their metabolites on muscle wasting in patients with critical illness or other muscle wasting illness: A systematic review.
        J Hum Nutr Diet. 2015; 28: 313-330
        • Tsuboi M.
        • Momosaki R.
        • Vakili M.
        • et al.
        Nutritional supplementation for activities of daily living and functional ability of older people in residential facilities: A systematic review.
        Geriatr Gerontol Int. 2018; 18: 197-210
        • Hickson M.
        Nutritional interventions in sarcopenia: A critical review.
        Proc Nutr Soc. 2015; 74: 378-386