Ilse Reinders1, Dorothee Volkert2, Lisette C P G M de Groot3, Anne Marie Beck4, Ilana Feldblum5, Inken Jobse2, Floor Neelemaat6, Marian A E de van der Schueren7, Danit R Shahar5, Ellen T H C Smeets3, Michael Tieland3, Jos W R Twisk8, Hanneke A H Wijnhoven9, Marjolein Visser9. 1. Amsterdam Public Health Research Institute, Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Department of Nutrition and Dietetics, Internal Medicine VU University Medical Center, Amsterdam, The Netherlands. Electronic address: ilse.reinders@vu.nl. 2. Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany. 3. Wageningen University, Division of Human Nutrition, Wageningen, The Netherlands. 4. Herlev and Gentofte University Hospital, and Metropolitan University College, Denmark. 5. The S. Daniel Abraham International Center for Health and Nutrition, Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel. 6. Amsterdam Public Health Research Institute, Department of Nutrition and Dietetics, Internal Medicine VU University Medical Center, Amsterdam, The Netherlands. 7. Amsterdam Public Health Research Institute, Department of Nutrition and Dietetics, Internal Medicine VU University Medical Center, Amsterdam, The Netherlands; Department of Nutrition and Health, Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands. 8. Amsterdam Public Health Research Institute, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands. 9. Amsterdam Public Health Research Institute, Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, The Netherlands.
Abstract
BACKGROUND & AIMS: Protein-energy malnutrition is a health concern among older adults. Improving nutritional status by increasing energy and protein intake likely benefits health. We therefore aimed to investigate effects of nutritional interventions in older adults (at risk of malnutrition) on change in energy intake and body weight, and explore if the intervention effect was modified by study or participants' characteristics, analysing pooled individual participant data. METHODS: We searched for RCTs investigating the effect of dietary counseling, oral nutritional supplements (ONS) or both on energy intake and weight. Principle investigators of eligible studies provided individual participant data. We investigated the effect of nutritional intervention on meaningful increase in energy intake (>250 kcal/day) and meaningful weight gain (>1.0 kg). Logistic generalized estimating equations were performed and ORs with 95% CIs presented. RESULTS: We included data of nine studies with a total of 990 participants, aged 79.2 ± 8.2 years, 64.5% women and mean baseline BMI 23.9 ± 4.7 kg/m2. An non-significant intervention effect was observed for increase in energy intake (OR:1.59; 95% CI 0.95, 2.66) and a significant intervention effect for weight gain (OR:1.58; 95% CI 1.16, 2.17). Stratifying by type of intervention, an intervention effect on increase in energy intake was only observed for dietary counseling in combination with ONS (OR:2.28; 95% CI 1.90, 2.73). The intervention effect on increase in energy intake was greater for women, older participants, and those with lower BMI. Regarding weight gain, an intervention effect was observed for dietary counseling (OR:1.40; 95% CI 1.14, 1.73) and dietary counseling in combination with ONS (OR:2.48; 95% CI 1.92, 3.31). The intervention effect on weight gain was not influenced by participants' characteristics. CONCLUSIONS: Based on pooled data of older adults (at risk of malnutrition), nutritional interventions have a positive effect on energy intake and body weight. Dietary counseling combined with ONS is the most effective intervention.
BACKGROUND & AIMS: Protein-energy malnutrition is a health concern among older adults. Improving nutritional status by increasing energy and protein intake likely benefits health. We therefore aimed to investigate effects of nutritional interventions in older adults (at risk of malnutrition) on change in energy intake and body weight, and explore if the intervention effect was modified by study or participants' characteristics, analysing pooled individual participant data. METHODS: We searched for RCTs investigating the effect of dietary counseling, oral nutritional supplements (ONS) or both on energy intake and weight. Principle investigators of eligible studies provided individual participant data. We investigated the effect of nutritional intervention on meaningful increase in energy intake (>250 kcal/day) and meaningful weight gain (>1.0 kg). Logistic generalized estimating equations were performed and ORs with 95% CIs presented. RESULTS: We included data of nine studies with a total of 990 participants, aged 79.2 ± 8.2 years, 64.5% women and mean baseline BMI 23.9 ± 4.7 kg/m2. An non-significant intervention effect was observed for increase in energy intake (OR:1.59; 95% CI 0.95, 2.66) and a significant intervention effect for weight gain (OR:1.58; 95% CI 1.16, 2.17). Stratifying by type of intervention, an intervention effect on increase in energy intake was only observed for dietary counseling in combination with ONS (OR:2.28; 95% CI 1.90, 2.73). The intervention effect on increase in energy intake was greater for women, older participants, and those with lower BMI. Regarding weight gain, an intervention effect was observed for dietary counseling (OR:1.40; 95% CI 1.14, 1.73) and dietary counseling in combination with ONS (OR:2.48; 95% CI 1.92, 3.31). The intervention effect on weight gain was not influenced by participants' characteristics. CONCLUSIONS: Based on pooled data of older adults (at risk of malnutrition), nutritional interventions have a positive effect on energy intake and body weight. Dietary counseling combined with ONS is the most effective intervention.
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