Benefits of nutritional supplementation in free-living, frail, undernourished elderly people: A prospective randomized community trial

Objective To evaluate the impact of nutritional supplementation on nutritional status, muscle strength, perceived health, and functional status in a population of community-living, frail, undernourished elderly people. Design A 16-week intervention study in which subjects were randomized to an experimental or a control group and visited in their home on a monthly basis. Outcome variables were measured at the start and end of the study at subjects' homes by a dietitian blinded to treatment assignment. Subjects/setting 83 elderly people (experimental group: n=42; control group: n=41; mean age=80+/-7 years) receiving community home-care services and at high risk for undernutrition. Intervention Provision of a nutrient-dense protein-energy liquid supplement and encouragement to improve intake from other foods. Outcome measures Anthropometric indexes, handgrip strength, isometric elbow flexion and leg extension strength, lower extremity function, perceived health, and functional status. Statistical analyses Study groups were compared on an "intention to treat" basis using analysis of variance for repeated measures and unpaired and paired t tests and their nonparametric equivalents where appropriate. Results Total energy intake (1,772 vs 1,440 kcal; P<.001) and weight gain (1.62 vs 0.04 kg; P<.001) were higher in the supplemented group. No significant changes were observed with respect to other anthropometric indexes, muscle strength, or functional variables; however, beneficial effects were observed in emotional role functioning (P<0.01) and number of days spent in bed (P=.04). Applications/conclusions Nutrition intervention is feasible in free-living, frail, undernourished elderly people and results in significant improvement of nutritional status with respect to energy and nutrient intake and weight gain. Weight loss can be stopped and in some cases reversed; however, increased physical activity may also be required to improve health and functional status.