Effectiveness of food-based fortification in older people a systematic review and meta-analysis
Open accessAbstract
BACKGROUND: Early intervention with nutritional support has been found to stop weight loss in older people malnourished or at risk of malnutrition. Enriched food could be a more attractive alternative to improve meals, than conventional oral nutritional supplements. AIMS: To determine the effectiveness of food-based fortification to prevent risk of malnutrition in elderly patients in community or institutionalized elderly patients. METHODS: A systematic review was conducted of randomized controlled trials, quasi-experimental, and interrupted time series including a longitudinal analysis. PARTICIPANTS: Elderly patients who are institutionalized, hospitalized or community-dwelling, with a minimum average age of 65 years. All type of patient groups, with the exception of people in critical care, or those who were recovering from cancer treatment, were included. INTERVENTION: Studies had to compare food-based fortification against alternatives. Studies that used oral nutritional supplementation such as commercial sip feeds, vitamin or mineral supplements were excluded. The search was conducted in Cochrane, CINAHL, PubMed, EMBASE, LILACS, and Cuiden. An independent peer review was carried out. RESULTS: From 1011 studies obtained, 7 were included for the systematic review, with 588 participants. It was possible to perform meta-analysis of four studies that provided results on caloric and protein intake. Food-based fortification yielded positive results in the total amount of ingested calories and protein. Nevertheless, due to the small number of participants and the poor quality of some studies, further high quality studies are required to provide reliable evidence. IMPLICATIONS FOR PRACTICE: Despite the limited evidence, due to their simplicity, low cost, and positive results in protein and calories intake, simple dietary interventions based on the food-based fortification or densification with protein or energy of the standard diet could be considered in patients at risk of malnutrition.
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In another systematic literature review of seven RCTs, meta-analysis of four RCTs resulted in significant increases in energy and protein intake.
“Meta-analysis of four RCTs resulted in significant increases in energy and protein intake.”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [101]
Due to heterogeneity, small numbers of participants and poor quality of some studies, further high-quality studies are required to provide reliable evidence on food fortification.
“Due to the heterogeneity of the studies, small numbers of participants and poor quality of some studies, the authors concluded that further high-quality studies are required to provide reliable evidence (101).”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [101]
Simple dietary interventions based on food-based fortification or densification with protein or energy of the standard diet could be considered in patients at risk of malnutrition because of their effect on total energy and protein intakes.
“simple 434 dietary interventions based on the food-based fortification or densification with protein or 435 energy of the standard diet could be considered in patients at risk of malnutrition because its 436 effect on the total amount of energy and protein intakes.”
From ESPEN guideline on hospital nutrition (2021) · cites this paper as [25]
Eight studies investigate the effect of dietary enrichment.
“Eight studies investigate the effect of dietary enrichment [25-32].”
From ESPEN guideline on hospital nutrition (2021) · cites this paper as [25]
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- Authors
- Morilla-Herrera, J. C., Martín-Santos, F. J., Caro-Bautista, J., Saucedo-Figueredo, C., García-Mayor, S., & Morales-Asencio, J. M.
- Venue
- The Journal of nutrition, health and aging
- Publisher
- Elsevier BV
- Published
- 2016-02
- Volume
- 20
- Issue
- 2
- Pages
- 178-184
- ISSN
- 1279-7707 (ISSN-L)
- PMC
- PMC12877586
- OpenAlex
- W1818371539
- Semantic Scholar
- 0c85c8785a73b259414b8057dfde27aab8a09660
- Cited by
- 78
- References
- 24
- Citations by year
- 2026: 6 · 2025: 2 · 2024: 9 · 2023: 7 · 2022: 11 · 2021: 12 · 2020: 6 · 2019: 7 · 2018: 8 · 2017: 8 · 2016: 2
- FWCI
- 0.74
- 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)
- Repositorio Institucional de la Universidad de Málaga (University of Málaga) (submittedVersion, cc-by-nc-nd)
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutrition and Health Studies
- Keywords
- malnutrition prevention, older adults, protein intake, energy intake, institutionalized elderly, community-dwelling older adults, dietary intervention, nutritional support
- MeSH terms
- Aged, Aged, 80 and over, Energy Intake, Dietary Proteins, Female, Food, Fortified, Health Services for the Aged, Humans, Male, Nutritional Status, Dietary Supplements, Malnutrition
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