Effects of high-protein, high-calorie oral nutritional supplementation in malnourished older people in nursing homes: An observational, multi-center, prospective study (PROT-e-GER). Protocol and baseline population characteristics

Introduction: Malnutrition is common among older people living in nursing homes. Poor nutritional status is associated with functional loss and with worse health. Oral nutritional supplementation (ONS) can be an effective means to counteract weight loss, improve nutritional status and reduce complications in malnourished older people living in nursing homes. The main objective of this study was to assess whether ONS over 12 weeks improved the nutritional status and physical function of malnourished older people living in nursing homes. Methods: This was a multi-center, prospective, observational study carried out in 53 nursing homes in Spain. Participants were aged 65 or over. They were prescribed a high-calorie, high-protein ONS to treat well documented malnutrition. Subjects who received enteral nutrition, had special nutritional requirements, or receiving end-of-life care were excluded. Anthropometric data were recorded (weight, height and BMI) as well as scores on nutritional and functional scales (MNA-SF, Barthel index, SPPB, grip strength and Functional Ambulation Categories, FAC) at the beginning of the study and after 12 weeks. Cognitive status, comorbidities and depressive symptoms were also assessed. Frailty status was assessed using the FRAIL scale. Results: 320 participants were included, of whom 253 completed the study (mean age 84.2 +/- 7.1 years). Baseline BMI was 20.2 +/- 2.8. A high prevalence of functional impairment (Barthel Index median 45, range 15-75; median SPPB 4, range 1-6) and cognitive impairment (MMSE median 12, 7-20) was found. Discussion: This study identified a population with malnutrition and a high degree of physical and mental disability that mirrors the typical population of many nursing homes. Analysis of the results of this study will help to determine the factors associated with malnutrition and the effect of nutritional intervention in practice.