Effects of nutritional intervention and physical training on energy intake, resting metabolic rate and body composition in frail elderly. A randomised, controlled pilot study
Open accessAbstract
OBJECTIVES: To analyse the effect of nutritional intervention and physical training on energy intake, resting metabolic rate (RMR) and body composition in the frail elderly. DESIGN: Open, randomised, controlled pilot treatment study. SETTING: Community-based research centre. PARTICIPANTS: Ninety-six community-dwelling frail elderly people aged 75 and older, 40% men. INTERVENTION: Four treatment arms: i) individual nutritional advice and group sessions on nutrition for the elderly, ii) physical training 2 x 45 minutes per week for 3 months, iii) combined nutritional and physical intervention and iv) control group. MEASUREMENTS: The outcomes were energy intake (4-day food diary); resting metabolic rate (indirect calorimetry) and body composition (anthropometry) performed at baseline, after 3 months' intervention (completed by 79 individuals), and as a follow-up at 9 months (completed by 64 individuals). RESULTS: The training group showed a significantly increased RMR at 3 months. Otherwise, there were no observed differences within or between the four groups. There was no correlation over time between energy intake, RMR and fat free mass. The participants with a low energy intake who managed to increase their energy intake during the study ('responders') had a statistically significantly lower BMI (21 vs. 24) and a lower fat percentage (23 vs. 30) at baseline than the 'non-responders'. The 'non-responders' showed a small but statistically significant decrease in body fat percentage at F1, and in body weight, BMI and FFM at 9 months (F3). CONCLUSION: Individual nutrition counselling and physical exercise had no effect on energy intake, RMR or fat free mass in community-dwelling frail elderly people aged 75 and older. Interventions in frail elderly people should be targeted according to the needs of the individual patients. The issues of randomisation, targeting and responders in are problematised and discussed.
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One study in malnourished community-dwelling older adults failed to show any effect of individual nutritional advice and physical training.
“One study in malnourished community-dwelling older adults failed to show any effect of individual nutritional advice and physical training (83).”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [83]
The Abstract conclusion reports no effect of individual nutrition counselling and physical exercise on energy intake, resting metabolic rate or fat-free mass in community-dwelling frail adults aged 75 and older. But the Results say only three of 93 participants were classified as malnourished, so the claim mischaracterizes the study population. The Discussion also reports a small, statistically significant increase in resting metabolic rate in the training group, making “any effect” too broad. (LLM, conf=0.90)
Experimental — accuracy not yet measuredSeven RCTs of low or acceptable quality were found using a four-factorial design with an exercise group and a control group in addition to the two aforementioned intervention groups.
“Seven RCTs (low/acceptable quality) were found using a four factorial design with an exercise group and a control group in addition to the two aforementioned intervention groups (81)(82)(83)(84)(85)(86)(87)(88).”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [83]
In that study, independent of the interventions, participants who needed to increase energy intake by at least 20% but failed lost weight and fat-free mass, whereas no changes were observed in those reaching this goal.
“However, in this study independent of the interventions, participants who needed to increase their energy intake by ≥ 20% to reach their energy requirements but failed this goal lost weight and fat-free mass during the intervention period whereas no changes were observed in those reaching this goal (83).”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [83]
Five RCTs were identified comparing combined exercise and nutrition interventions to singular exercise interventions in older people with malnutrition or at risk of malnutrition.
“Five RCTs were identified comparing combined exercise and nutrition interventions to singular exercise interventions in older people with malnutrition or at risk of J o u r n a l P r e -p r o o f malnutrition (83,87,(94)(95)(96).”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [83]
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Additional file 3 of Reversing frailty in older adults: a scoping review
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Additional file 2 of Reversing frailty in older adults: a scoping review
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Additional file 4 of Reversing frailty in older adults: a scoping review
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Additional file 1 of Reversing frailty in older adults: a scoping review
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- Authors
- Lammes, E., Rydwik, E., & Akner, G.
- Affiliations
- Karolinska University Hospital (SE)
- Karolinska Institutet (SE)
- Örebro University Hospital (SE)
- Corresponding author
- Akner, Gunnar
- ORCID
- Rydwik, E.
- Venue
- The Journal of nutrition, health and aging
- Publisher
- Elsevier BV
- Published
- 2012-02
- Volume
- 16
- Issue
- 2
- Pages
- 162-167
- ISSN
- 1279-7707 (ISSN-L)
- PMC
- PMC12878046
- OpenAlex
- W1995619624
- Cited by
- 47
- References
- 29
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 6 · 2023: 2 · 2022: 4 · 2021: 3 · 2020: 7 · 2019: 1 · 2018: 5 · 2017: 4 · 2016: 1 · 2015: 3 · 2014: 1 · 2013: 2
- FWCI
- 0.65
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The journal of nutrition health & aging (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Keywords
- frail elderly, dietary intervention, nutrition counseling, exercise training, energy intake, resting metabolic rate, body composition, fat-free mass, body fat percentage, community-dwelling older adults, responder analysis
- MeSH terms
- Aged, Aged, 80 and over, Basal Metabolism, Body Composition, Energy Intake, Calorimetry, Indirect, Female, Follow-Up Studies, Humans, Male, Pilot Projects, Exercise, Frail Elderly, Treatment Outcome, Nutritional Sciences
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