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Chen B, Zhao H, Li M, Zhao T, Liao R, Lu J, Zou Y, Tu J, Teng X, Huang Y, Liu J, Huang P, Wu J. Effect of multicomponent intervention on malnutrition in older adults: A multicenter randomized clinical trial. Clin Nutr ESPEN 2024; 60:31-40. [PMID: 38479928 DOI: 10.1016/j.clnesp.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/01/2024] [Accepted: 01/04/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND & AIMS Malnutrition is a significant geriatric syndrome (GS) prevalent in older adults and seriously affects patient prognosis and quality of life. We assessed the impact of the multicomponent intervention of health education, dietary advice, and exercise with oral nutritional supplementation (ONS) on nutritional status, body composition, physical functions, and quality of life. METHODS This multicenter randomized clinical trial (RCT) was performed from April 2021 to April 2022. The intervention lasted for 12 weeks, and 99 older adults with malnutrition or at risk of malnutrition were enrolled in six nursing homes. All participants were randomly assigned to the control (health education plus standard diet plus exercise) or research (health education plus standard diet plus exercise plus ONS) group. The research group consumed ONS (244 kcal, 9.8g protein, and 9.6g fat per time) twice a day between meals. The primary outcomes were changes in the nutritional status and body composition from baseline to 12 weeks. The secondary outcomes were changes in physical function, quality of life and nutritional associated other blood markers. RESULTS For primary outcomes, after 12 weeks, body weight increased similarly in both treatment arms (time × treatment effect, P > 0.05). There were no between-group differences in body mass index (BMI) or mini nutritional assessment tool-short form (MNA-SF) scores (time × treatment effects, P > 0.05). The MNA-SF score from 11.0 (10.5, 12.0) to 13.0 (11.0, 13.0) in the research group and from 11.0 (10.0, 12.0) to 12.0 (11.0, 13.0) in the control group (both P < 0.05). There were no between-group differences in the skeletal muscle mass index (SMI), fat-free mass index (FFMI), appendicular skeletal muscle mass (ASMM), fat mass (FAT), or leg muscle mass (LMM) (time × treatment effects, P > 0.05). Both groups showed similar and highly significant increases in SMI, FFMI, and LMM after (P < 0.05). The research group showed an increase in fat-free mass (FFM) and ASMM and a decrease in the percent of body fat (PBF) and waist circumference (WC) (P < 0.05). For secondary outcomes, There were no between-group differences in grip strength, short physical performance battery (SPPB), 6-min walking distance (6MWD), activities of daily living (ADL), instrumental activities of daily living (IADL), frailty status (FRAIL), mini-mental state examination (MMSE), Tinetti, geriatric depression scale-15 (GDS-15), or 12-item short form survey (SF-12) (time × treatment effects, P > 0.05). Although there was no significant difference, the 6MWD changed differentially between the two treatment arms during the study period in favor of the research group. Although not significant, SF-12 scores improved after 12 weeks in both groups. No between-group differences were observed in prealbumin (PRE), c-reactive protein (CRP), vitamin D (VIT-D), insulin-like growth factor 1 (IGF-1), alanine transaminase (ALT), aspartate aminotransferase (AST), serum creatinine (Scr), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α), insulin, and adiponectin levels (time × treatment effects, P > 0.05). Insulin and adiponectin levels were significantly higher in the control group (P < 0.05). CONCLUSION The twelve-week multicomponent intervention improved the nutritional status of older people in China at risk of malnutrition. ONS may enhance the effects of exercise on muscle mass. This clinical trial was registered (https://www. CLINICALTRIALS gov). The trial number is ChiCTR2000040343.
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Affiliation(s)
- Bo Chen
- Department of Geriatrics, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; Jiangsu Provincial Key Laboratory of Gerontology & Geriatrics, Nanjing 210029, China; Jiangsu Provincial Innovation Center of Gerontology & Geriatrics, Nanjing 210029, China
| | - Hongye Zhao
- Department of Geriatrics, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; Department of General Practice, The First People's Hospital of Lianyungang, Lianyungang Clinical College of Nanjing Medical University, Lianyungang 222000, China
| | - Min Li
- Department of Geriatrics, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ting Zhao
- Department of Nutrition, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ruoqi Liao
- Rehabilitation Medical Center, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Lu
- Rehabilitation Medical Center, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yanzheng Zou
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Junlan Tu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Xinran Teng
- Department of Geriatrics, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yaxuan Huang
- Department of Geriatrics, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jin Liu
- Clinical Medicine Research Institution, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Peng Huang
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Jianqing Wu
- Department of Geriatrics, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; Jiangsu Provincial Key Laboratory of Gerontology & Geriatrics, Nanjing 210029, China; Jiangsu Provincial Innovation Center of Gerontology & Geriatrics, Nanjing 210029, China.
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Ellinger S, Amini AM, Haardt J, Lehmann A, Schmidt A, Bischoff-Ferrari HA, Buyken AE, Kroke A, Kühn T, Louis S, Lorkowski S, Nimptsch K, Schulze MB, Schwingshackl L, Siener R, Stangl GI, Volkert D, Zittermann A, Watzl B, Egert S. Protein intake and body weight, fat mass and waist circumference: an umbrella review of systematic reviews for the evidence-based guideline on protein intake of the German Nutrition Society. Eur J Nutr 2024; 63:3-32. [PMID: 37794213 PMCID: PMC10799103 DOI: 10.1007/s00394-023-03220-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/18/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE This umbrella review aimed to assess whether dietary protein intake with regard to quantitative (higher vs. lower dietary protein intake) and qualitative considerations (total, plant-based or animal-based protein intake) affects body weight (BW), fat mass (FM) and waist circumference (WC). METHODS A systematic literature search was conducted in PubMed, Embase and Cochrane Database of Systematic Reviews for systematic reviews (SRs) with and without meta-analyses of prospective studies published between 04 October 2007 and 04 January 2022. Methodological quality and outcome-specific certainty of evidence of the retrieved SRs were assessed by using AMSTAR 2 and NutriGrade, respectively, in order to rate the overall certainty of evidence using predefined criteria. RESULTS Thirty-three SRs were included in this umbrella review; 29 were based on randomised controlled trials, a few included cohort studies. In studies without energy restriction, a high-protein diet did not modulate BW, FM and WC in adults in general (all "possible" evidence); for older adults, overall certainty of evidence was "insufficient" for all parameters. Under hypoenergetic diets, a high-protein diet mostly decreased BW and FM, but evidence was "insufficient" due to low methodological quality. Evidence regarding an influence of the protein type on BW, FM and WC was "insufficient". CONCLUSION "Possible" evidence exists that the amount of protein does not affect BW, FM and WC in adults under isoenergetic conditions. Its impact on the reduction in BW and FM under hypoenergetic conditions remains unclear; evidence for an influence of protein type on BW, FM and WC is "insufficient".
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Affiliation(s)
- Sabine Ellinger
- Institute of Nutritional and Food Science, Human Nutrition, University of Bonn, Meckenheimer Allee 166a, 53115, Bonn, Germany.
| | | | | | | | | | - Heike A Bischoff-Ferrari
- Department of Aging Medicine and Aging Research, University Hospital and University of Zurich, Zurich, Switzerland
- City Hospital Zurich, Zurich, Switzerland
| | - Anette E Buyken
- Institute of Nutrition, Consumption and Health, Faculty of Natural Sciences, Paderborn University, Paderborn, Germany
| | - Anja Kroke
- Department of Nutritional, Food and Consumer Sciences, Fulda University of Applied Sciences, Fulda, Germany
| | - Tilman Kühn
- The Institute for Global Food Security, Queen's University Belfast, Belfast, Northern Ireland, UK
- Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health (HIGH), Heidelberg, Germany
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria
- Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Sandrine Louis
- Department of Physiology and Biochemistry of Nutrition, Max Rubner-Institut, Karlsruhe, Germany
| | - Stefan Lorkowski
- Institute of Nutritional Sciences, Friedrich Schiller University Jena, Jena, Germany
- Competence Cluster for Nutrition, Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Jena, Germany
| | - Katharina Nimptsch
- Molecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine (MDC), Helmholtz Association, Berlin, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Roswitha Siener
- Department of Urology, University Stone Center, University Hospital Bonn, Bonn, Germany
| | - Gabriele I Stangl
- Institute of Agricultural and Nutritional Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Armin Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Bernhard Watzl
- Department of Physiology and Biochemistry of Nutrition, Max Rubner-Institut, Karlsruhe, Germany
| | - Sarah Egert
- Institute of Nutritional and Food Science, Nutritional Physiology, University of Bonn, Bonn, Germany
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Delsoglio M, Griffen C, Syed R, Cookson T, Saliba H, Vowles A, Davies S, Willey N, Thomas J, Millen N, Odeh N, Longstaff J, Westran N, Allan L, Offer H, Howell C, Sanders M, Gaffigan K, Garrett K, Foster S, Salt A, Carter E, Moore S, Bergin N, Roper J, Alvarez J, Voss C, Connolly T, MacDonald C, Thrower T, Sills D, Baxter J, Manning R, Gray L, Voas K, Richardson S, Hurren AM, Murphy D, Blake S, McArdle P, Walsh S, Booth L, Albrich L, Ashley-Maguire S, Allison J, Brook S, Capener R, Hubbard GP, Stratton RJ. A multi-center prospective study of plant-based nutritional support in adult community-based patients at risk of disease-related malnutrition. Front Nutr 2023; 10:1297624. [PMID: 38024371 PMCID: PMC10667471 DOI: 10.3389/fnut.2023.1297624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction There is an emerging need for plant-based, vegan options for patients requiring nutritional support. Methods Twenty-four adults at risk of malnutrition (age: 59 years (SD 18); Sex: 18 female, 6 male; BMI: 19.0 kg/m2 (SD 3.3); multiple diagnoses) requiring plant-based nutritional support participated in a multi-center, prospective study of a (vegan suitable) multi-nutrient, ready-to-drink, oral nutritional supplement (ONS) [1.5 kcal/mL; 300 kcal, 12 g protein/200 mL bottle, mean prescription 275 mL/day (SD 115)] alongside dietary advice for 28 days. Compliance, anthropometry, malnutrition risk, dietary intake, appetite, acceptability, gastrointestinal (GI) tolerance, nutritional goal(s), and safety were assessed. Results Patients required a plant-based ONS due to personal preference/variety (33%), religious/cultural reasons (28%), veganism/reduce animal-derived consumption (17%), environmental/sustainability reasons (17%), and health reasons (5%). Compliance was 94% (SD 16). High risk of malnutrition ('MUST' score ≥ 2) reduced from 20 to 16 patients (p = 0.046). Body weight (+0.6 kg (SD 1.2), p = 0.02), BMI (+0.2 kg/m2 (SD 0.5), p = 0.03), total mean energy (+387 kcal/day (SD 416), p < 0.0001) and protein intake (+14 g/day (SD 39), p = 0.03), and the number of micronutrients meeting the UK reference nutrient intake (RNI) (7 vs. 14, p = 0.008) significantly increased. Appetite (Simplified Nutritional Appetite Questionnaire (SNAQ) score; p = 0.13) was maintained. Most GI symptoms were stable throughout the study (p > 0.06) with no serious adverse events related. Discussion This study highlights that plant-based nutrition support using a vegan-suitable plant-based ONS is highly complied with, improving the nutritional outcomes of patients at risk of malnutrition.
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Affiliation(s)
- Marta Delsoglio
- Research & Innovation, Nutricia Ltd., Trowbridge, United Kingdom
| | - Corbin Griffen
- Research & Innovation, Nutricia Ltd., Trowbridge, United Kingdom
| | | | | | | | - Amanda Vowles
- Trowbridge Health Centre, Trowbridge, United Kingdom
| | | | | | | | - Nicola Millen
- Cowplain Family Practice, Waterlooville, United Kingdom
| | - Nour Odeh
- Cowplain Family Practice, Waterlooville, United Kingdom
| | | | - Naomi Westran
- Department of Nutrition and Dietetics, Royal Surrey NHS Foundation Trust, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Lindsey Allan
- Department of Nutrition and Dietetics, Royal Surrey NHS Foundation Trust, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Hannah Offer
- Dietetic Department, Thorpe Health Centre, Norfolk Community Health and Care NHS Trust, Norwich, United Kingdom
| | - Chloe Howell
- Dietetic Department, Thorpe Health Centre, Norfolk Community Health and Care NHS Trust, Norwich, United Kingdom
| | - Meg Sanders
- Dietetic Department, Thorpe Health Centre, Norfolk Community Health and Care NHS Trust, Norwich, United Kingdom
| | - Kirsty Gaffigan
- Dietetic Department, Thorpe Health Centre, Norfolk Community Health and Care NHS Trust, Norwich, United Kingdom
| | - Kirby Garrett
- Dietetic Department, Thorpe Health Centre, Norfolk Community Health and Care NHS Trust, Norwich, United Kingdom
| | - Sally Foster
- Nutrition and Dietetic Department, North Tyneside District General Hospital, Tyne and Wear, United Kingdom
| | - Agnes Salt
- Nutrition and Dietetic Department, North Tyneside District General Hospital, Tyne and Wear, United Kingdom
| | - Emily Carter
- Nutrition and Dietetic Department, North Tyneside District General Hospital, Tyne and Wear, United Kingdom
| | - Sarah Moore
- Nutrition and Dietetic Department, North Tyneside District General Hospital, Tyne and Wear, United Kingdom
| | - Nick Bergin
- Department of Nutrition and Dietetics, Airedale General Hospital, Keighley, West Yorkshire, United Kingdom
| | - Jane Roper
- Warden Lodge Medical Practice, Cheshunt, United Kingdom
| | - Joe Alvarez
- Warden Lodge Medical Practice, Cheshunt, United Kingdom
| | | | | | | | | | - Darren Sills
- Nutrition and Dietetics, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, United Kingdom
| | - Janet Baxter
- Department Nutrition and Dietetics, Kings Cross Hospital, Dundee, United Kingdom
| | - Rhonda Manning
- Department Nutrition and Dietetics, Kings Cross Hospital, Dundee, United Kingdom
| | - Lynsey Gray
- Dietetics, Victoria Integrated Care Centre, Helensburgh, United Kingdom
| | - Karen Voas
- Dietetic Department, Betsi Cadwaladr University Health Board, Denbighshire, United Kingdom
| | - Scot Richardson
- James Alexander Family Practice, Bransholme South Health Centre, Hull, United Kingdom
| | - Anne-Marie Hurren
- James Alexander Family Practice, Bransholme South Health Centre, Hull, United Kingdom
| | | | | | - Paul McArdle
- Birmingham Community Nutrition, Birmingham, United Kingdom
| | - Sinead Walsh
- Birmingham Community Nutrition, Birmingham, United Kingdom
| | - Lucy Booth
- Birmingham Community Nutrition, Birmingham, United Kingdom
| | | | | | | | - Sarah Brook
- Dietetics, Princess Royal Health Centre, Huddersfield, United Kingdom
| | - Rebecca Capener
- Research & Innovation, Nutricia Ltd., Trowbridge, United Kingdom
| | - Gary P. Hubbard
- Research & Innovation, Nutricia Ltd., Trowbridge, United Kingdom
| | - Rebecca J. Stratton
- Research & Innovation, Nutricia Ltd., Trowbridge, United Kingdom
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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Szklarzewska S, Mottale R, Engelman E, De Breucker S, Preiser JC. Nutritional rehabilitation after acute illness among older patients: A systematic review and meta-analysis. Clin Nutr 2023; 42:309-336. [PMID: 36731161 DOI: 10.1016/j.clnu.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/18/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND & AIMS Acute illness can lead to disability and reduced quality of life in older patients. The aim of this systematic review was to evaluate the effect of nutritional rehabilitation provided during and after hospitalisation for an acute event on functional status, muscle mass, discharge destination and quality of life of older patients. METHODS The protocol for this systematic review was registered in PROSPERO (CRD42021264971). Articles were searched using Scopus, Medline, Google Scholar and Clinical. TRIALS gov. For studies included in the meta-analysis, Hedges'g standardized mean difference effect size was calculated and transformed in odds ratios. RESULTS We identified 7383 articles, of which 45 publications (41 trials, n = 8538 participants, mean age 80.35 ± 7.01 years.) were eligible for the systematic review. Patients were hospitalized for acute medical diseases (n = 6925) and fractures (n = 1063). The interventions included supplementation with a fixed amount of oral nutritional supplements (ONS, n = 17 trials), individualized diet plan (n = 3), combination of physical exercise with nutrition therapy (n = 14 trials), combination of anabolic agents with nutrition therapy (n = 5 trials). Overall nutritional rehabilitation improved functional status (Odds ratio 1.63 [1.15; 2.3], p = 0.003) and muscle mass (Odds ratio 2.61 [1.22; 5.5], p = 0.01), but not the quality of life or the discharge destination. CONCLUSION Nutritional rehabilitation was found to improve functional status and muscle mass. There is a need for larger studies involving older hospitalized patients.
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Affiliation(s)
- Sylwia Szklarzewska
- Department of Geriatric Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
| | - Raphael Mottale
- Department of Internal Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Sandra De Breucker
- Department of Geriatric Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Charles Preiser
- Medical Direction, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Moloney L, Jarrett B. Nutrition Assessment and Interventions for the Prevention and Treatment of Malnutrition in Older Adults: An Evidence Analysis Center Scoping Review. J Acad Nutr Diet 2021; 121:2108-2140.e6. [PMID: 34581276 DOI: 10.1016/j.jand.2020.09.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/04/2020] [Indexed: 12/21/2022]
Abstract
Older adults living in the community or long-term residence such as a nursing home are at increased risk for malnutrition due to factors such as depression and isolation. The purpose of this scoping review is to identify the best available research that evaluates the validity and reliability of nutrition assessment tools, and the effectiveness of nutrition interventions to prevent or treat malnutrition among older adults. A literature search was conducted in Medline, Embase, CINAHL, and Cochrane Central databases to identify clinical trials, published in the English language, evaluating assessment and intervention methods aimed to treat or prevent malnutrition among older adults living in the community or their long-term residence such as nursing homes. Articles were screened by 2 reviewers, then data were extracted and narratively synthesized. The literature search retrieved 20,937 articles and 197 articles were included in narrative synthesis. A total of 73 assessment articles were identified, 36 of which were validity and reliability trials. A total of 122 intervention articles were identified, the majority of which were randomized controlled trials. A few of the most commonly evaluated interventions were oral nutrition supplements, medical nutrition therapy, fortification and enrichment, and nutrition education. Several systematic reviews were identified, however, that did not meet the criteria of this review. There is a need to conduct systematic reviews for nutrition assessment and intervention trials to guide development of evidence-based nutrition practice recommendations for older adults living in the community or their long-term residence.
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Affiliation(s)
- Lisa Moloney
- Academy of Nutrition and Dietetics, Evidence Analysis Center, Chicago, IL.
| | - Brittany Jarrett
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
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Werner SS, Binder N, Toews I, Schünemann HJ, Meerpohl JJ, Schwingshackl L. Use of GRADE in evidence syntheses published in high-impact-factor nutrition journals: A methodological survey. J Clin Epidemiol 2021; 135:54-69. [PMID: 33588024 DOI: 10.1016/j.jclinepi.2021.02.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/08/2021] [Accepted: 02/09/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To identify and describe the use of the GRADE approach for rating the certainty of evidence in nutrition systematic reviews (SRs). STUDY DESIGN AND SETTING We systematically searched for SRs using GRADE that were published between 2015 and 2019 in the 10 "nutrition" journals with the highest impact factor according to the JCR 2018. RESULTS Out of 800 SRs, 55 SRs of randomized control trials (RCTs) and/or nonrandomized studies (NRSs) used GRADE. Forty-seven SRs (5.9%) rated the outcome specific certainty of evidence (n = 36 in 2018/2019). We identified a total of 465 certainty of evidence outcome ratings (n = 335 RCT ratings), ranging from very-low (28.8%) to low (41%), moderate (26.5%), and high (3.7%). Very-low and high certainty of evidence ratings accounted for 61.4% and 0.8% of ratings in SRs of NRSs, compared to 16.1% and 4.8% in SRs of RCTs. Certainty of evidence was downgraded mostly for risk of bias (37.8%) and imprecision (33%) in SRs of RCTs and for imprecision (32.7%), risk of bias (29.4%) and inconsistency (29%) in SRs of NRSs. CONCLUSION Our study suggests a need for directing more attention toward strengthening acceptance of GRADE as well as building knowledge of the GRADE methodology in nutrition evidence synthesis.
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Affiliation(s)
- Sarah S Werner
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nadine Binder
- Institute of Digitalization in Medicine, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Ingrid Toews
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, Department of Medicine, McMaster University, Hamilton, Canada
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Seemer J, Kiesswetter E, Blawert A, Fleckenstein D, Gloning M, Bader-Mittermaier S, Sieber CC, Wurm S, Volkert D. An Individualised Nutritional Intervention Concept for Nursing Home Residents with or at Risk of Malnutrition: An enable Study. Geriatrics (Basel) 2020; 6:2. [PMID: 33375372 PMCID: PMC7838920 DOI: 10.3390/geriatrics6010002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/19/2020] [Accepted: 12/23/2020] [Indexed: 01/12/2023] Open
Abstract
Dietary intake and requirements in nursing home (NH) residents vary individually, but concepts for individualised interventions are currently lacking. Therefore, we present an individualised modular nutritional intervention concept for NH residents with (risk of) malnutrition and describe its application and acceptability. Three enrichment modules-a sweet and a savoury protein cream (40 g, 125 kcal, 10 g protein) and a protein-energy drink (250 mL, 220 kcal, 22 g protein)-were offered to residents of two German NHs single or in combination in five levels of enrichment from level 0 (no enrichment) to 4 (all enrichment modules) to compensate for individual energy and protein deficiencies. Residents with chewing and/or swallowing difficulties received reshaped instead of usual texture-modified meals. The intervention concept was applied to 55 residents (Mean age of 84 ± 8 years, 76.0% female, 25.5% malnutrition). Despite (risk of) malnutrition, 18.2% received no enrichment (level 0). Level 1 was allocated to 10.9%, level 2 to 27.3%, level 3 to 20.0% and level 4 to 23.6% of the residents. 32.7% received reshaped texture-modified meals (RTMM). Participants consuming RTMM were more often assigned to level 4 than residents receiving usual meals (38.8% vs 16.2%). We proposed and successfully applied an individualised modular nutritional intervention concept to NH residents with (risk of) malnutrition. In the next step, the effects of the concept and its transferability to other NHs need to be demonstrated.
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Affiliation(s)
- Johanna Seemer
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany; (E.K.); (C.C.S.); (D.V.)
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany; (E.K.); (C.C.S.); (D.V.)
| | - Anne Blawert
- Section Social Medicine and Prevention, Institute of Community Medicine, Universitätsmedizin Greifswald, 17475 Greifswald, Germany; (A.B.); (S.W.)
| | - Daniela Fleckenstein
- Fraunhofer-Institute for Process Engineering and Packaging, 85354 Freising, Germany; (D.F.); (S.B.-M.)
| | - Marina Gloning
- Institute of Food Technology, Hochschule Weihenstephan-Triesdorf, 85354 Freising, Germany;
| | | | - Cornel C. Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany; (E.K.); (C.C.S.); (D.V.)
- Department of Medicine, Kantonsspital Winterthur, 8400 Winterthur, Switzerland
| | - Susanne Wurm
- Section Social Medicine and Prevention, Institute of Community Medicine, Universitätsmedizin Greifswald, 17475 Greifswald, Germany; (A.B.); (S.W.)
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany; (E.K.); (C.C.S.); (D.V.)
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