Age and Ageing, Vol 29, 425-431, Copyright © 2000 by British Geriatrics Society
J Espaulella, H Guyer, F Diaz-Escriu, J Mellado-Navas, M Castells and M Pladevall
Background. Undernourishment is common in elderly hip
fracture patients and has been linked to poorer recovery and increased
post-operative complications.Objective. To determine
whether a nutritional supplement may (i) help elderly patients return to
pre-fracture functional levels 6 months post-fracture and (ii) decrease
fracture-related complications and mortality.Design. A
double-blind, randomized, placebo-controlled clinical
trial.Setting. A county hospital near
Barcelona.Subjects. 171 Patients, aged 70 and older,
hospitalized for hip fracture between July 1994 and July
1996.Method. We randomized patients to intervention
(n=85) or control (n=86) group.
Patients received a nutritional supplement containing 20 g of protein and
800 mg of calcium or placebo for 60 days. We determined functional levels
by the Barthel index, the mobility index and by the use of walking aids. We
performed assessments during hospitalization and at 2 and 6 months
post-fracture.Findings. The two groups were comparable
at study entry. We observed no differences in return to functional status 6
months post-fracture (61% intervention group vs 55% in
control group) nor in fracture-related mortality (13% in intervention group
vs 10% in control group). The intervention group
suffered fewer in-hospital [odds ratio 1.88 (95% CI 1.01-3.53),
P0.05] and total complications [odds ratio 1.94 (95%
CI 1.02-3.7), P0.04] than the control
group.Conclusion. Based on our results, we cannot
recommend routine nutritional supplementation of all elderly hip fracture
patients. While nutritional supplementation may be useful in decreasing
complications, this reduction does not result in improvement in functional
recovery and nor does it decrease fracture-related mortality. Selected
patients may, however, benefit from nutritional
supplementation.Keywords: aged, dietary supplements,
geriatric assessment, hip fractures, nutrition, randomized controlled
trials
ARTICLES
Nutritional supplementation of elderly hip fracture patients. A randomized, double-blind, placebo-controlled trial
Department of Geriatrics, Hospital de la Santa Creu de Vic, Barcelona, Spain; Departments of Clinical Epidemiology, Orthopaedics and Dietetics, Hospital General de Vic, Barcelona, Spain; Corresponding author; Fax: +34 93 8856761; E-mail: hguyer@hgv.es
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