ESPEN practical guideline: Clinical nutrition and hydration in geriatrics

In the paper

“as meta-analyses indicate that the mortality risk of healthy older people is lowest in the overweight range (279-281).”

What the sources say

• Disputed

  The Results report that mortality was lowest at BMI 20–<25 kg/m², below the overweight range. For participants aged 70–89, the reported nadir was BMI 24 kg/m², also below the overweight threshold of 25 kg/m². The Discussion explicitly challenges earlier claims that overweight is associated with lower mortality. (LLM, conf=0.94)

  Checked by a reasoning model — may be wrong.

  cites [279] Di Angelantonio, 2016, Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents, Lancet sourceExperimental — accuracy not yet measured
• Partly supported

  Table 2 and the Discussion (page not supplied) place the lowest estimated mortality risk in the overweight BMI range for adults aged 65 or older. The meta-analysis studied community-dwelling older adults, not a population restricted to healthy people, so the claim's health qualifier is not established by this source. (LLM, conf=0.84)

  cites [280] Winter, 2014, BMI and all-cause mortality in older adults: a meta-analysis, Am J Clin Nutr sourceExperimental — accuracy not yet measured
• Partly supported

  Table 2 reports lower all-cause mortality for the overweight category among adults aged 65 or older (HR 0.90, 95% CI 0.86–0.95, relative to normal weight). But the review does not establish that risk is lowest specifically among healthy older people: its age subgroup is not restricted to healthy participants, and it does not establish a definitive lowest-risk BMI range. (LLM, conf=0.86)

  cites [281] Flegal, 2013, Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis, JAMA sourceExperimental — accuracy not yet measured

In the paper

“and is regarded as one important contributing factor in the complex etiology of sarcopenia and frailty (1,3,4).”

What the sources say

• Supported

  The paper’s main text (indexed under Abstract; page not specified) says age-related anorexia decreases muscle mass and that sarcopenia has multiple causes. It also identifies weight loss together with sarcopenia as major causes of physical frailty and recommends treating nutritional abnormalities in older people. This supports the claim that poor nutrition is a contributing factor, rather than the sole cause, of sarcopenia and frailty. (LLM, conf=0.88)

  cites [1] Morley, 2017, Anorexia of ageing: a key component in the pathogenesis of both sarcopenia and cachexia, J Cachexia Sarcopenia Muscle source
• Partly supported

  In “Sarcopenia as a geriatric syndrome” (page not provided), the paper lists less-than-optimal diet among several contributing factors to sarcopenia. Its “Frailty” section (page not provided) describes overlap with sarcopenia and includes unintended weight loss in a frailty definition, but does not identify malnutrition as a contributing cause of frailty. (LLM, conf=0.84)

  cites [3] Cruz-Jentoft, 2010, European working group on sarcopenia in older people: sarcopenia: European consensus on definition and diagnosis. Report of the European workign group on sarcopenia in older people, Age Ageing sourceExperimental — accuracy not yet measured
• Supported

  In “Frail skeletal muscle—sarcopenia,” the paper says nutritional factors influence muscle homeostasis and identifies sarcopenia as a key component of frailty. In “The pathway to frailty,” it also says nutritional status can mediate frailty. Together, these passages support the claim that poor nutrition is a contributing factor in their complex development. (LLM, conf=0.88)

  cites [4] Clegg, 2013, Frailty in elderly people, Lancet source

In the paper

“In healthy and sick elderly persons, measurements of REE resulted in about 20 kcal/kg body weight (BW) and day (14)(15)(16).”

What the sources say

• ?Not checked — no full text of the sourcecites [14] Alix, 2007, Energy requirements in hospitalized elderly people, J Am Geriatr Soc source
• Partly supported

  The Results (Predicted resting energy expenditure; page unavailable) report measured weight-adjusted REE close to 20 kcal/kg/day in the study’s sick elderly patients: 19.1 in normal-weight patients and 22.4 in underweight patients. The paper does not establish that figure for healthy elderly people, so the claim extends beyond the population studied. (LLM, conf=0.88)

  cites [15] Gaillard, 2008, A practical approach to estimate resting energy expenditure in frail elderly people, J Nutr Health Aging sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [16] Gaillard, 2007, Energy requirements in frail elderly people: a review of the literature, Clin Nutr source

In the paper

“One study in malnourished community-dwelling older adults failed to show any effect of individual nutritional advice and physical training (83).”

What the sources say

• Partly supported

  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)

  cites [83] Lammes, 2012, Effects of nutritional intervention and physical training on energy intake, resting metabolic rate and body composition in frail elderly. a randomised, controlled pilot study, J Nutr Health Aging sourceExperimental — accuracy not yet measured

In the paper

“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).”

What the sources say

• Supported

  The Randomisation section describes a pilot RCT with separate nutrition-and-training and training-only arms. The Inclusion criteria section specifies participants aged 75 or older with unintentional weight loss and/or low BMI, consistent with nutritional risk. This paper supports its identification as one of the cited RCTs; it does not itself establish the citing document’s total of five. (LLM, conf=0.89)

  cites [83] Lammes, 2012, Effects of nutritional intervention and physical training on energy intake, resting metabolic rate and body composition in frail elderly. a randomised, controlled pilot study, J Nutr Health Aging source
• ?Not checked — no full text of the sourcecites [87] Miller, 2006, Nutritional supplementation and resistance training in nutritionally at risk older adults following lower limb fracture: a randomized controlled trial, Clin Rehabil source
• Supported

  The Introduction (page not available) says 36 elderly COPD patients with %ideal body weight below 110% were randomly allocated to supplementation or control groups; both received exercise therapy. The Method (page not available) confirms the comparison of supplementation plus exercise with exercise without the supplement. This citation identifies one of the trials in the citing authors’ five-trial count, rather than attributing that count to this paper. (LLM, conf=0.89)

  cites [94] Sugawara, 2012, Effect of anti-inflammatory supplementation with whey peptide and exercise therapy in patients with COPD, Respir Med source

In the paper

“Adequate amounts of protein are at least as important to avoid muscle atrophy and to stimulate muscle protein synthesis (93) (see recommendation 2).”

What the sources say

• Supported

  In “Nutritional Strategies for Maintaining and Rebuilding Muscle,” the paper says adequate energy is a first step, high protein intake is vital to treating or delaying muscle atrophy, and sufficient protein is the most direct way to prevent muscle loss. The same section says branched-chain amino acids promote muscle protein synthesis. (LLM, conf=0.90)

  cites [93] Argilés, 2016, Skeletal muscle regulates metabolism via interorgan crosstalk: roles in health and disease, J Am Med Dir Assoc source

In the paper

“Four of them -one in COPD patients (94), two in rehabilitation patients (95,96), one in malnourished patients with lower limb fracture (87) -reported positive effects of oral nutritional supplementation in combination with exercise training on various outcome parameters, e.g.BW (87,94,95), MNA score (95), muscle mass (95,96).”

What the sources say

• ?Not checked — no full text of the sourcecites [87] Miller, 2006, Nutritional supplementation and resistance training in nutritionally at risk older adults following lower limb fracture: a randomized controlled trial, Clin Rehabil source
• Supported

  The Introduction describes random allocation of COPD patients to nutritional supplementation or a control condition alongside exercise therapy. The Results report a significant increase in body weight after 12 weeks in the supplementation-and-exercise group. In the citing sentence, this paper is cited for the COPD trial and body-weight outcome; the MNA and muscle-mass outcomes are assigned to other citations. (LLM, conf=0.94)

  cites [94] Sugawara, 2012, Effect of anti-inflammatory supplementation with whey peptide and exercise therapy in patients with COPD, Respir Med source
• ?Not checked — no full text of the sourcecites [95] Rondanelli, 2016, Whey protein, amino acids, and vitamin D supplementation with physical activity increases fat-free mass and strength, functionality, and quality of life and decreases inflammation in sarcopenic elderly, Am J Clin Nutr source

In the paper

“as the older muscle is still able to react on anabolic stimuli of exercise training (89)(90)(91).”

What the sources say

• Supported

  The Background (‘How the intervention might work’; page not provided) says that muscles of people aged 60 and older remain adaptable, even in extreme old age, and that training can produce large strength gains. This supports the citing sentence’s general point that older muscle can respond to exercise training. (LLM, conf=0.86)

  cites [89] Liu, 2009 source
• ?Not checked — no full text of the sourcecites [90] Steib, 2010, Dose-response relationship of resistance training in older adults: a meta-analysis, Med Sci Sports Exerc source
• ?Not checked — no full text of the sourcecites [91] Giné-Garriga, 2014, Physical exercise interventions for improving performance-based measures of physical function in community-dwelling, frail older adults: a systematic review and meta-analysis, Arch Phys Med Rehabil source

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites [81] Rydwik, 2008, Effects of a physical and nutritional intervention program for frail elderly people over age 75. A randomized controlled pilot treatment trial, Aging Clin Exp Res source
• ?Not checked — no full text of the sourcecites [82] Rydwik, 2010, Effects of a physical training and nutritional intervention program in frail elderly people regarding habitual physical activity level and activities of daily living—a randomized controlled pilot study, Arch Gerontol Geriatr source
• Supported

  Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [83] Lammes, 2012, Effects of nutritional intervention and physical training on energy intake, resting metabolic rate and body composition in frail elderly. a randomised, controlled pilot study, J Nutr Health Aging source

In the paper

“Texturemodification can also make the swallowing process slower and thereby safer (105, 106).”

What the sources say

• Supported

  The “Texture modification of diet” section states that texture-modified food and thickened fluid are intended to make swallowing slower and thereby safer. This directly supports the claim’s qualified wording, “can.” (LLM, conf=0.94)

  cites [105] Wirth, 2016, Oropharyngeal dysphagia in older persons–from pathophysiology to adequate intervention: a review and summary of an international expert meeting, Clin Interv Aging source
• Partly supported

  The Treatment > Bolus modifications section says that modifying food or liquid consistency can improve swallowing safety and that thickeners reduce penetration and aspiration. It does not say that texture modification makes swallowing slower or that slowing is why it is safer; searches for slower bolus flow and transit time did not establish that mechanism. No page number is available in our copy. (LLM, conf=0.84)

  cites [106] Baijens, 2016, European society for swallowing disorders–European union geriatric medicine society white paper: oropharyngeal dysphagia as a geriatric syndrome, Clin Interv Aging sourceExperimental — accuracy not yet measured

In the paper

“Meta-analysis of four RCTs resulted in significant increases in energy and protein intake.”

What the sources say

• Supported

  The Results (Densification) state that four studies were pooled and report a significant increase in energy intake of 200.22 kcal/day. The same section reports a protein-intake increase of 7.01 g/day with a confidence interval above zero. The paper notes high heterogeneity for both outcomes. (LLM, conf=0.93)

  cites [101] Morilla-Herrera, 2016, Effectiveness of food-based fortification in older people. A systematic review and meta-analysis, J Nutr Health Aging source

In the paper

“In a systematic review that compared nasogastric tube feeding with PEG feeding in older patients with non-stroke dysphagia, a pooled analysis of nine studies involving 847 patients demonstrated no significant differences in the risk of pneumonia and overall complications (166).”

What the sources say

• Supported

  Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [166] Jaafar, 2015, Percutaneous endoscopic gastrostomy versus nasogastric feeding in older individuals with non-stroke dysphagia: a systematic review, J Nutr Health Aging source

In the paper

“Within the FOOD trial, which prospectively compared early versus delayed EN as well as PEG feeding with nasogastric feeding in dysphagic stroke patients, PEG feeding was associated with an increased risk of death or poor outcome of 7.8% (p=0.05)(165).”

What the sources say

• Supported

  The Abstract describes the FOOD trial’s comparisons of early versus delayed tube feeding and PEG versus nasogastric feeding in dysphagic stroke patients. The Results report that, in the PEG-versus-nasogastric trial, allocation to PEG was associated with a 7.8% absolute increase in death or poor outcome (p=0.05), described as of borderline significance. (LLM, conf=0.95)

  cites [165] Collaboration, 2005, Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial, Lancet source

In the paper

“Nevertheless, the effect on functionality, mortality, and quality of life remains unclear (144-155).”

What the sources say

• ?Not checked — no full text of the sourcecites [144] Callahan, 2000, Outcomes of percutaneous endoscopic gastrostomy among older adults in a community setting, J Am Geriatr Soc source
• ?Not checked — no full text of the sourcecites [145] James, 2005, Nutrition support (tube feeding) as a rehabilitation intervention, Arch Phys Med Rehabil source
• ?Not checked — no full text of the sourcecites [146] Jaul, 2006, Tube feeding in the demented elderly with severe disabilities, Isr Med Assoc J: Isr Med Assoc J
• ?Not checked — no full text of the sourcecites [147] Weaver, 1993, Evaluation of the benefits of gastric tube feeding in an elderly population, Arch Fam Med source
• ?Not checked — no full text of the sourcecites [148] Kaw, 1994, Long-term follow-up of consequences of percutaneous endoscopic gastrostomy (PEG) tubes in nursing home patients, Dig Dis Sci source
• ?Not checked — no full text of the sourcecites [149] Nair, 2000, Hypoalbuminemia is a poor predictor of survival after percutaneous endoscopic gastrostomy in elderly patients with dementia, Am J Gastroenterol source
• ?Not checked — no full text of the sourcecites [150] Sanders, 2000, Gastrostomy feeding in the elderly after acute dysphasgic stroke, J Nutr Health Aging
• ?Not checked — no full text of the sourcecites [151] Horn, 2005, Stroke rehabilitation patients, practice, and outcomes: is earlier and more aggressive therapy better?, Arch Phys Med Rehabil source
• ?Not checked — no full text of the sourcecites [152] Verhoef, 2001, Patient outcomes related to percutaneous endoscopic gastrostomy placement, J Clin Gastroenterol source
• Partly supported

  The Background (page unavailable) says PEG feeding may not enhance quality of life and that studies in stroke survivors question its advantages for survival and morbidity. The paper also describes physical limitations, but it does not establish that effects on functionality remain unclear; its discussion concerns PEG feeding rather than enteral nutrition generally. (LLM, conf=0.83)

  cites [153] Jordan, 2006, Percutaneous endoscopic gastrostomies: the burden of treatment from a patient perspective, J Adv Nurs sourceExperimental — accuracy not yet measured

In the paper

“Several studies demonstrate some improvement of nutritional state after initiation of EN in older patients (129,130,(138)(139)(140)(141)(142)(143).”

What the sources say

• ?Not checked — no full text of the sourcecites [129] Klose, 2003, Nutritional status and quality of life in patients with percutaneous endoscopic gastrostomy (PEG) in practice: prospective one-year follow-up, Dig Dis Sci source
• ?Not checked — no full text of the sourcecites [130] Donini, 2009, Predicting the outcome of artificial nutrition by clinical and functional indices, Nutrition source
• Not checked yetcites [138] Abitbol, 2002, Percutaneous endoscopic gastrostomy in elderly patients, Gastroenterol Clin Biol
• ?Not checked — no full text of the sourcecites [139] Vetta, 1996, Role of aging in malnutrition and in restitution of nutritional parameters by tube feeding, Arch Gerontol Geriatr source
• Supported

  The Participants section describes older nursing-home residents starting formula feeding, predominantly by tube. The Results report weight gain after feeding began and maintenance of serum albumin levels; the Discussion likewise reports an initial weight gain. This supports the cited paper as one of the studies showing some improvement in nutritional state. (LLM, conf=0.90)

  cites [140] Levinson, 2005, Is it possible to increase weight and maintain the protein status of debilitated elderly residents of nursing homes?, J Gerontol Series A: Biol Sci Med Sci source
• ?Not checked — no full text of the sourcecites [141] Peck, 1990, Long-term enteral feeding of aged demented nursing home patients, J Am Geriatr Soc source
• Partly supported

  The Discussion (page not available) reports that early nutritional interventions in long-term care improved nutritional status. It describes changes to the feeding environment and staff assistance, not improvement after initiation of enteral nutrition; that specific part of the claim is unsupported. (LLM, conf=0.82)

  cites [142] Donini, 2011, Predicting the outcome of long-term care by clinical and functional indices: the role of nutritional status, J Nutr Health Aging sourceExperimental — accuracy not yet measured
• Partly supported

  The Discussion (page unavailable) says that a normal BMI can be maintained or achieved by tube-feeding, which supports a possible improvement in one measure of nutritional state. But this study did not assess residents before and after initiation of enteral nutrition; it also reports a high prevalence of malnutrition among tube-fed residents. It therefore does not demonstrate improvement after initiation. (LLM, conf=0.82)

  cites [143] Volkert, 2011, Prevalence of malnutrition in orally and tube-fed elderly nursing home residents in Germany and its relation to health complaints and dietary intake, Gastroenterol Res Pract sourceExperimental — accuracy not yet measured

In the paper

“Aspiration pneumonia is suggested to be mainly caused by the bacterial content of aspirated saliva and not by the saliva itself, or a minimal oral intake (170, 171).”

What the sources say

• Supported

  In ‘Feeding strategies after stroke’ (Recommendation 25; page not provided), the guideline states that aspiration pneumonia is caused by bacteria in saliva, not saliva itself. It also recommends additional oral intake for most conscious, tube-fed patients with dysphagic stroke, according to the severity of their dysphagia, supporting the claim’s qualified point about minimal oral intake. (LLM, conf=0.88)

  cites [170] Wirth, 2013, Guideline clinical nutrition in patients with stroke, Exp Transl Stroke Med source
• ?Not checked — no full text of the sourcecites [171] Leibovitz, 2003, Pathogenic colonization of oral flora in frail elderly patients fed by nasogastric tube or percutaneous enterogastric tube, J Gerontol A Biol Sci Med Sci source

In the paper

“However, survival very much depends on the indication and selection of patients (132-137).”

What the sources say

• ?Not checked — no full text of the sourcecites [132] Sanders, 2000, Survival analysis in percutaneous endoscopic gastrostomy feeding: a worse outcome in patients with dementia, Am J Gastroenterol source
• ?Not checked — no full text of the sourcecites [133] Light, 1995, Predictive factors for early mortality after percutaneous endoscopic gastrostomy, Gastrointest Endosc source
• ?Not checked — no full text of the sourcecites [134] Rimon, 2005, Percutaneous endoscopic gastrostomy; evidence of different prognosis in various patient subgroups, Age Ageing source
• ?Not checked — no full text of the sourcecites [135] Gaines, 2009, Dementia and cognitive impairment are not associated with earlier mortality after percutaneous endoscopic gastrostomy, J Parenter Enteral Nutr source
• ?Not checked — no full text of the sourcecites [136] Wirth, 2012, Complications and mortality after percutaneous endoscopic gastrostomy in geriatrics: a prospective multicenter observational trial, J Am Med Dir Assoc source
• Supported

  The Background says mortality after PEG placement is relatively high in acute illness and certain patient groups, and stresses proper patient selection. The Discussion reports that certain diagnoses were associated with higher in-hospital mortality and calls for careful evaluation of the indication for PEG placement. (LLM, conf=0.91)

  cites [137] Smoliner, 2012, Basic geriatric assessment does not predict in-hospital mortality after PEG placement, BMC Geriatr source

In the paper

“Adverse side effects were not increased (six RCTs).”

What the sources say

• Supported

  The ‘Putative side effects of treatment’ section reports no difference between supplemented and control groups in pooled data from six studies. The finding concerns reported side effects, principally vomiting and diarrhoea, and is rated very low-quality evidence. (LLM, conf=0.91)

  cites [182] Avenell, 2016, Nutritional supplementation for hip fracture aftercare in older people, Cochrane Database Syst Rev source

In the paper

“A recent high-quality Cochrane review and meta-analysis included 41 randomized trials involving 3,881 patients with a hip fracture (182).”

What the sources say

• Partly supported

  The Main results report 41 trials involving 3,881 participants, and Data synthesis describes pooled analyses. However, the Design section specifies that only 37 were randomized controlled trials; the other four were quasi-randomized. The review also rates the available evidence low or very low quality, though that does not itself establish the quality of the review. (LLM, conf=0.90)

  cites [182] Avenell, 2016, Nutritional supplementation for hip fracture aftercare in older people, Cochrane Database Syst Rev sourceExperimental — accuracy not yet measured

In the paper

“High-quality cohort studies which have adjusted for key confounding factors have consistently found that older adults with raised serum osmolality (>300 mOsm/kg or equivalent) have an increased risk of mortality (216-218)”

What the sources say

• Partly supported

  The Outcome table reports that measured plasma osmolality >296 mOsm/kg on admission was associated with higher three-month mortality after adjustment for key confounders (OR 2.4). The Results give a mean age of 73.2 years, but the cohort comprised acute stroke patients, not older adults generally; the tested threshold was >296, not >300 mOsm/kg. (LLM, conf=0.88)

  cites [216] Bhalla, 2000, Influence of raised plasma osmolality on clinical outcome after acute stroke, Stroke sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [217] Stookey, 2004, Plasma hypertonicity: another marker of frailty?, J Am Geriatr Soc source
• ?Not checked — no full text of the sourcecites [218] Wachtel, 1991, Hyperosmolarity and acidosis in diabetes mellitus: a three-year experience in Rhode Island, J Gen Intern Med source

In the paper

“A non-systematic review of studies reporting serum osmolality in older adults suggests that, low intake dehydration is common in older adults (214), especially in those who are more vulnerable and frail, living in residential or long-term care institutions or admitted to hospital.”

• Also stated in: § 65) All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. (R63, Grade GPP, strong consensus 100%) Commentary · hedged

  “A non-systematic review of studies reporting serum osmolality in older adults suggests that low-intake dehydration is common in this group (214), especially in older adults who J o u r n a l P r e -p r o o f are more vulnerable and frail, living in residential or long-term care institutions or admitted to hospital.”

What the sources say

• Supported

  The Abstract says that, despite variation between studies, dehydration is common among older adults and rates among those admitted to hospital are often high. Its table reports dehydration in residential and long-term care populations, and the discussion describes long-term care residents as frail. The paper also links elevated serum osmolality to insufficient fluid intake. (LLM, conf=0.89)

  cites [214] Hooper, 2016, Why, oh why, are so many older adults not drinking enough fluid? Dehydration in long-term care, J Acad Nutr Diet source

In the paper

“When we take in too little fluid (drink too little) the fluid within and around our cells becomes more concentrated, raising the osmolality of serum and plasma (221)(222)(223)(224).”

What the sources say

• ?Not checked — no full text of the sourcecites [221] Cheuvront, 2010, Biological variation and diagnostic accuracy of dehydration assessment markers, Am J Clin Nutr source
• Supported

  In “Two critical caveats to understanding osmotic responses to dehydration” (page not specified), the paper states that plasma osmolality rises with dehydration caused by fluid restriction when the water deficit exceeds about 2% of body mass. The Introduction adds that ordinary variations in fluid intake are compensated for, so the claim applies when drinking too little produces a meaningful water deficit. (LLM, conf=0.90)

  cites [222] Cheuvront, 2013, Physiologic basis for understanding quantitative dehydration assessment, Am J Clin Nutr source
• Partly supported

  The Results (page unavailable) explain that inadequate water replacement causes dehydration throughout the body and discuss the osmotic effects of water loss. In the water-deprivation experiment, plasma chloride rose, but serum sodium did not change significantly; the paper does not report a measured rise in serum or plasma osmolality. (LLM, conf=0.82)

  cites [223] Nadal, 1941, A comparison between dehydration from salt loss and from water deprivation, J Clin Invest sourceExperimental — accuracy not yet measured

In the paper

“No effect on mortality risk was found.”

What the sources say

• Supported

  The Mortality section reports no clear difference in mortality between oral-supplement and control groups across 15 studies (RR 0.81, 95% CI 0.49 to 1.32). This supports the claim that no effect was found, but does not establish that supplementation has no effect: the evidence was low quality and the confidence interval allows for lower or higher mortality. (LLM, conf=0.91)

  cites [182] Avenell, 2016, Nutritional supplementation for hip fracture aftercare in older people, Cochrane Database Syst Rev source

In the paper

“The methodological quality of all included trials was judged to be low to very low.”

What the sources say

• Partly supported

  The Main results section says the 41 trials were often methodologically flawed, while the Quality of the evidence section rates the evidence for primary outcomes as low to very low. The review does not judge every included trial’s methodological quality as low to very low; the quoted rating applies to the evidence, not to each trial. (LLM, conf=0.88)

  cites [182] Avenell, 2016, Nutritional supplementation for hip fracture aftercare in older people, Cochrane Database Syst Rev sourceExperimental — accuracy not yet measured

In the paper

“The use of ONS mostly leads to a significant increase in energy and nutrient intake.”

What the sources say

• Partly supported

  The Compliance section (page unavailable) reports that one supplemented group had significantly higher daily energy and protein intake during the first 11 postoperative days. The review does not establish that this happens in most hip-fracture patients or trials; it reports variable supplement consumption, and the high-protein-versus-lower-protein comparison found no significant difference in energy intake. (LLM, conf=0.84)

  cites [182] Avenell, 2016, Nutritional supplementation for hip fracture aftercare in older people, Cochrane Database Syst Rev sourceExperimental — accuracy not yet measured

In the paper

“and it has recently been observed that these risk factors are very common in older hospitalized patients (173).”

What the sources say

• Supported

  The Discussion reports that 69.9% of the older patients studied were at risk of refeeding syndrome under NICE criteria and describes a high prevalence of its risk factors. The Conclusion likewise says these risk factors were relatively prevalent among older patients acutely admitted to geriatric hospitals. Page numbers were not provided in our copy. (LLM, conf=0.94)

  cites [173] Pourhassan, 2018, Prevalence of risk factors for the refeeding syndrome in older hospitalized patients, J Nutr Health Aging source

In the paper

“Unfortunately, the assessment of fluid intake is often highly inaccurate in older adults.”

What the sources say

• ?Could not verify

  The ‘Patterns of Beverage Consumption’ section describes observing and weighing drinks consumed by 22 older care-home residents, but does not evaluate whether fluid-intake assessments are accurate. Searches for inaccurate assessment and measurement or recording errors found no passage addressing the claim. (LLM, conf=0.74)

  cites [231] Jimoh, 2016, Patterns of beverage consumption in older adults living in UK long-term care, Gerontol sourceExperimental — accuracy not yet measured

In the paper

“Work with a set of European cohorts of older adults has suggested that most existing serum osmolarity equations are not diagnostically accurate to calculate serum osmolality in older adults (225,229).”

What the sources say

• Supported

  The Abstract Results report that only 5 of 39 equations showed reasonable agreement with directly measured osmolality across five cohorts of older people. The Discussion likewise says many widely used equations poorly predicted measured osmolality. This supports the claim that most equations assessed were not diagnostically accurate in older adults. (LLM, conf=0.92)

  cites [225] Hooper, 2015, Diagnostic accuracy of calculated serum osmolarity to predict dehydration in older people: adding value to pathology lab reports, BMJ Open source
• Partly supported

  The Methods evaluate 38 equations, and the Results (Assessment of absolute bias; Bland–Altman analysis) identify only four with the smallest differences from measured osmolality, supporting the concern about most equations’ predictive accuracy. But diagnostic accuracy was assessed only for selected equations, and the Discussion says the findings are specific to frail older people in residential care, not older adults generally. Page numbers are unavailable in our copy. (LLM, conf=0.85)

  cites [229] Siervo, 2014, Accuracy of prediction equations for serum osmolarity in frail older people with and without diabetes, Am J Clin Nutr sourceExperimental — accuracy not yet measured

In the paper

“Fluid intake may also be reduced voluntarily, e.g. because of issues about getting to the toilet and continence (8,226,253).”

What the sources say

• ?Not checked — no full text of the sourcecites [8] Hodgkinson, 2003, Maintaining oral hydration in older adults: a systematic review, Int J Nurs Pract source
• Supported

  The paper states that older people’s oral fluid intake may fall because of physical limitations, unmet daily-living needs, and decisions aimed at controlling continence. This supports the citing sentence’s examples of difficulty getting to the toilet and voluntarily drinking less because of continence concerns. (LLM, conf=0.90)

  cites [226] Hooper, 2017 source
• ?Not checked — no full text of the sourcecites [253] Godfrey, 2012, An exploration of the hydration care of older people: a qualitative study, Int J Nurs Stud source

In the paper

“The Cochrane systematic review of diagnostic accuracy of simple signs and tests for dehydration in older adults (aged at least 65 years old) described in recommendation 64 also found no evidence of the utility of bioelectrical impedance in the assessment of hydration status in older adults in four included studies (237).”

What the sources say

• Partly supported

  The Findings report that BIA resistance at 50 kHz was assessed in four studies, but met the review’s sensitivity and specificity criteria in only two; the largest study did not confirm its diagnostic accuracy. The Applicability section describes weaker evidence for its utility, while the Discussion says BIA assessment of intracellular or extracellular water should not be used individually. Thus the review does not support the categorical claim that it found no evidence of utility for bioelectrical impedance. (LLM, conf=0.88)

  cites [237] Hooper, 2015, Clinical symptoms, signs and tests for identification of impending and current water-loss dehydration in older people, Cochrane Database Syst Rev sourceExperimental — accuracy not yet measured

In the paper

“In older adults, renal function is often poor so that renal parameters no longer accurately signal low-intake dehydration (7,225,226).”

What the sources say

• Partly supported

  Section 6 says kidney function declines with age and that reduced urine-concentrating ability may make urinary markers of dehydration less useful in older people. The claim overstates this tentative conclusion as renal parameters no longer accurately signaling low-intake dehydration; the passage does not establish that broader, definitive claim. (LLM, conf=0.86)

  cites [7] Hooper, 2014, Water-loss dehydration and aging, Mech Ageing Dev sourceExperimental — accuracy not yet measured
• Supported

  The Background (page not provided) says the serum urea/creatinine ratio is not useful for indicating hydration status when kidneys function poorly, which it describes as common in older adults. It also says urinary measures do not indicate hydration status in older adults. (LLM, conf=0.93)

  cites [225] Hooper, 2015, Diagnostic accuracy of calculated serum osmolarity to predict dehydration in older people: adding value to pathology lab reports, BMJ Open source
• Supported

  The paper’s Abstract (page not provided) says creatinine-based measures are unhelpful in people with limited renal function and that urinary measures are poor indicators of dehydration in older adults. The Discussion (page not provided) reports reduced renal function in a substantial proportion of the older DRIE participants. Together, these support the paraphrase. (LLM, conf=0.90)

  cites [226] Hooper, 2017 source

In the paper

“In addition, total body water is reduced, and many older adults use medications such as diuretics and laxatives which increase fluid losses (247-251).”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [247] American Medical Directors Association, 2009
• ?Could not verify

  The Results (Nutritional and physical status) report dehydration rates among care-home residents, but do not measure total body water or compare it across ages. A search for reduced body water with ageing found no passage addressing that claim in our copy. (LLM, conf=0.72)

  cites [248] Kenkmann, 2010, Health, wellbeing and nutritional status of older people living in UK care homes: an exploratory evaluation of changes in food and drink provision, BMC Geriatr sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [249] Mentes, 2006, Use of a urine color chart to monitor hydration status in nursing home residents, Biol Res Nurs source
• ?Not checked — no full text of the sourcecites [250] Olde Rikkert, 1997, Validation of multi-frequency bioelectrical impedance analysis in detecting changes in fluid balance of geriatric patients, J Am Geriatr Soc source
• Not checked yetcites [251] Olde Rikkert, 2009, Heat waves and dehyration in the elderly: recognising the early warning signs can save lives, BMJ

In the paper

“It found that none was consistently useful in indicating hydration status in older adults (237).”

What the sources say

• Supported

  The Data collection and analysis section states that no tests were found consistently useful in diagnosing current water-loss dehydration. The Authors’ conclusions likewise advise against using individual signs or tests to indicate dehydration in older people. Page numbers are not available in the supplied passages. (LLM, conf=0.93)

  cites [237] Hooper, 2015, Clinical symptoms, signs and tests for identification of impending and current water-loss dehydration in older people, Cochrane Database Syst Rev source

In the paper

“The causes of low-intake dehydration in older adults appear to be varied and inter-related and have been examined in several non-systematic reviews (7,8,242).”

What the sources say

• Supported

  Section 6 says there are many reasons besides reduced thirst why older people may not drink enough. Section 7 and its ‘Problems’ subsection describe interacting personal, physical, social, environmental, and care-related barriers to drinking, supporting the claim that the causes are varied and inter-related. (LLM, conf=0.93)

  cites [7] Hooper, 2014, Water-loss dehydration and aging, Mech Ageing Dev source
• ?Not checked — no full text of the sourcecites [8] Hodgkinson, 2003, Maintaining oral hydration in older adults: a systematic review, Int J Nurs Pract source
• Supported

  The Introduction describes causes of dehydration in older adults as multifactorial and identifies several reasons for inadequate fluid intake, including physical disability and restricting intake because of incontinence-related embarrassment. Sections 3 and 10 add impaired thirst and a cycle in which dementia can lead to forgetting to drink, dehydration, and further cognitive decline. Together, these support varied and inter-related causes of low-intake dehydration. (LLM, conf=0.91)

  cites [242] El-Sharkawy, 2014, The pathophysiology of fluid and electrolyte balance in the older adult surgical patient, Clin Nutr source

In the paper

“A recent study in residential care compared staff-completed drinks intake assessment with J o u r n a l P r e -p r o o f direct observation over 24 hours for 22 older adults, finding a very low correlation (r=0.122)(231).”

What the sources say

• Partly supported

  The ‘Patterns of Beverage Consumption’ section (page not provided) describes 22 older adults in care homes whose drinks were observed and weighed by a researcher during waking hours and by care staff overnight. It does not report a comparison with a separate staff-completed intake assessment or the claimed correlation of r=0.122; researcher observation also did not cover the full 24 hours. (LLM, conf=0.88)

  cites [231] Jimoh, 2016, Patterns of beverage consumption in older adults living in UK long-term care, Gerontol sourceExperimental — accuracy not yet measured

In the paper

“We have evidence that when older adults record their own drinks intake it is more accurate than that assessed by care staff (236).”

What the sources say

• Partly supported

  The Discussion reports that resident-completed Drinks Diaries performed better than staff-completed intake charts. The study was a small pilot among care-home residents able and willing to write, so it does not establish that self-recording is more accurate for older adults generally. (LLM, conf=0.85)

  cites [236] Jimoh, 2015, Assessment of a self-reported Drinks Diary for the estimation of drinks intake by care home residents: fluid Intake Study in the Elderly (FISE), J Nutr Health Aging sourceExperimental — accuracy not yet measured

In the paper

“However, one equation (osmolarity = 1.86 × (Na+ + K+) + 1.15 × glucose + urea + 14 (all measured in mmol/L)) usefully predicted serum osmolality in people aged ≥65 years with and without diabetes, poor renal function, dehydration, in men and women, in the community, residential care, and hospital, with a range of ages, health, cognitive and functional status (225,229).”

What the sources say

• Supported

  The Abstract (Results; page not provided) gives the exact equation and says it appeared useful in people aged ≥65 across the stated health and demographic subgroups. The Discussion (page not provided) explicitly extends this finding to free-living older people, residential care residents, and people receiving emergency or hospital care. (LLM, conf=0.94)

  cites [225] Hooper, 2015, Diagnostic accuracy of calculated serum osmolarity to predict dehydration in older people: adding value to pathology lab reports, BMJ Open source
• Partly supported

  The Discussion reports that the stated equation best predicted measured serum osmolality in frail older people with and without diabetes; the Results include participants with differing hydration status, ages, and cognitive and physical abilities. But the Methods recruited only residential-care residents and excluded people with renal failure. The Discussion says applicability to community-dwelling older people and those with renal failure needs testing; this paper does not establish performance in hospitals either. Page numbers were not supplied in our copy. (LLM, conf=0.91)

  cites [229] Siervo, 2014, Accuracy of prediction equations for serum osmolarity in frail older people with and without diabetes, Am J Clin Nutr sourceExperimental — accuracy not yet measured

In the paper

“In addition, total body water is reduced, and many older adults use medications such as diuretics and laxatives which increase fluid losses (247-251).”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [247] American Medical Directors Association, 2009
• Partly supported

  The Abstract (Results; page not provided) reports that 45% of the frail older care-home residents were on diuretics, supporting that part of the claim. The paper does not report laxative use, state that these medications increased fluid losses, or address reduced total body water. (LLM, conf=0.87)

  cites [248] Kenkmann, 2010, Health, wellbeing and nutritional status of older people living in UK care homes: an exploratory evaluation of changes in food and drink provision, BMC Geriatr sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [249] Mentes, 2006, Use of a urine color chart to monitor hydration status in nursing home residents, Biol Res Nurs source
• ?Not checked — no full text of the sourcecites [250] Olde Rikkert, 1997, Validation of multi-frequency bioelectrical impedance analysis in detecting changes in fluid balance of geriatric patients, J Am Geriatr Soc source
• Not checked yetcites [251] Olde Rikkert, 2009, Heat waves and dehyration in the elderly: recognising the early warning signs can save lives, BMJ

In the paper

“On average, staff assessments were 700 ml/d lower than direct observation would suggest.”

What the sources say

• ?Could not verify

  The “Patterns of Beverage Consumption” section (page not provided) reports drinks observed and weighed by a researcher during waking hours and by care staff overnight. It gives intake figures but does not compare staff assessments with direct observation or report a 700 ml/d difference. Searches for that figure and comparison found no supporting passage. (LLM, conf=0.74)

  cites [231] Jimoh, 2016, Patterns of beverage consumption in older adults living in UK long-term care, Gerontol sourceExperimental — accuracy not yet measured

In the paper

“Beer and lager are hydrating and may also be appropriate for some older adults (not needing to restrict alcohol for medical or social reasons).”

What the sources say

• Supported

  The Discussion reports that the alcohol in the lager tested did not increase diuresis compared with other drinks. The Results section also identifies no significant difference between lager and still water in urine output or net fluid balance over the measured period. This supports the hydration claim for the lager studied; the citation does not establish whether it is appropriate for older adults. (LLM, conf=0.87)

  cites [257] Maughan, 2016, A randomized trial to assess the potential of different beverages to affect hydration status: development of a beverage hydration index, Am J Clin Nutr source

In the paper

“The use of pre-thickened drinks rather than drinks thickened with powder at the point of use was also better at supporting fluid intake post-stroke (110).”

What the sources say

• Supported

  The guideline’s Recommendation 54 commentary reports that, in a study of 24 patients with dysphagic acute stroke, those not on specialist stroke units drank almost 100% more pre-thickened fluid than powder-thickened fluid (P = 0.04). This supports the cited comparison, although the reported result concerns that subgroup. (LLM, conf=0.90)

  cites [110] Burgos, 2017, ESPEN guideline on clinical nutrition in Neurology, Clin Nutr source

In the paper

“Interventions working in young adults cannot simply be extrapolated to older populations with low muscle mass and frailty (282).”

What the sources say

• Supported

  In the treatment discussion, the paper says treatment differs from that in younger people primarily because older adults are more vulnerable to muscle loss during intentional weight loss. The “Lifestyle interventions: Diet and exercise” section also calls for exercise to preserve lean mass and slow progression to frailty. These passages support adapting interventions rather than simply extrapolating them from younger adults. (LLM, conf=0.91)

  cites [282] Cetin, 2014, Obesity in the elderly: more complicated than you think, Cleve Clin J Med source

In the paper

“There is good evidence from two randomized controlled trials (RCTs) that the hydration potential for most non-alcoholic drinks is very similar to those of water (257,258).”

What the sources say

• Supported

  The Beverage Hydration Index results report higher fluid retention than still water for four of the 13 tested drinks: full-fat milk, skimmed milk, oral rehydration solution, and orange juice. The other tested drinks did not show a reported difference, supporting the claim that most had hydration effects similar to water. The finding concerns the drinks and post-ingestion period tested, not every non-alcoholic drink. (LLM, conf=0.89)

  cites [257] Maughan, 2016, A randomized trial to assess the potential of different beverages to affect hydration status: development of a beverage hydration index, Am J Clin Nutr source
• ?Not checked — no full text of the sourcecites [258] Grandjean, 2000, The effect of caffeinated, non-caffeinated, caloric and non-caloric beverages on hydration, J Am Coll Nutr source

In the paper

“Observational data have suggested that the number of drinks offered to older adults in residential care is strongly positively associated with their fluid intake (8,231).”

What the sources say

• ?Not checked — no full text of the sourcecites [8] Hodgkinson, 2003, Maintaining oral hydration in older adults: a systematic review, Int J Nurs Pract source
• Partly supported

  The “Patterns of Beverage Consumption” section (page not provided) reports an observational study of fluid intake in 22 care-home residents and suggests that more opportunities to drink may improve intake. It does not report the number of drinks offered or establish a strong positive association between that number and fluid intake. (LLM, conf=0.83)

  cites [231] Jimoh, 2016, Patterns of beverage consumption in older adults living in UK long-term care, Gerontol sourceExperimental — accuracy not yet measured

In the paper

“Twelve RCTs were identified that compared the effects of a dietary weight loss intervention alone to a combination of the same dietary intervention with an exercise intervention in older persons (288)(289)(290)(291)(292)(293)(294)(295)(296)(297)(298)(299).”

What the sources say

• ?Not checked — no full text of the sourcecites [288] Messier, 2004, Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial, Arthritis Rheum source
• Supported

  The Methods > Intervention passage describes a randomized trial with a diet group and a diet–exercise group receiving both the same weight-management program and exercise training. The Abstract > Methods identifies participants as obese adults aged 65 or older. This paper supports its identification as one of the cited RCTs; the count of twelve is the citing authors’ aggregation, not a finding attributed to this individual trial. (LLM, conf=0.92)

  cites [289] Villareal, 2011, Weight loss, exercise, or both and physical function in obese older adults, N Engl J Med source
• ?Not checked — no full text of the sourcecites [290] Avila, 2010, Effect of moderate intensity resistance training during weight loss on body composition and physical performance in overweight older adults, Eur J Appl Physiol source
• Supported

  The Methods (Subjects and Experimental Protocol) describe a randomized trial in older adults comparing a dietary weight-loss intervention alone with the same dietary intervention plus exercise. The Discussion explicitly calls it a direct comparison within a randomized clinical trial. This paper is cited as one of the twelve trials; the count is the citing authors’ tally, not a finding attributed to this individual paper. (LLM, conf=0.92)

  cites [291] Frimel, 2008, Exercise attenuates the weight-loss-induced reduction in muscle mass in frail obese older adults, Med Sci Sports Exerc source
• Supported

  The Methods (Study design; page not provided) state that eligible volunteers were randomized to six months of diet therapy or diet plus exercise training. They also state that the dietary and behavioral intervention was identical in the two groups, apart from a slightly higher prescribed caloric intake in the exercise group. This paper therefore supports its citation as one of the twelve trials, rather than independently establishing the total of twelve. (LLM, conf=0.93)

  cites [292] Shah, 2009, Diet and exercise interventions reduce intrahepatic fat content and improve insulin sensitivity in obese older adults, Obesity (Silver Spring) source
• Supported

  The Abstract identifies this paper as a randomized controlled trial in older adults comparing weight loss alone with weight loss plus aerobic or resistance training. The Weight loss section states that all three arms received the same dietary weight-loss intervention. This confirms the paper as one of the trials described, though it does not establish the citing document’s total of twelve trials. (LLM, conf=0.93)

  cites [293] Rejeski, 2017, Community weight loss to combat obesity and disability in at-risk older adults, J Gerontol A Biol Sci Med Sci source
• Supported

  The Abstract’s Design, Setting, and Participants section identifies this as a randomized clinical trial of adults aged 55 or older. The Methods’ Interventions section confirms that it compared a diet-only group with a group receiving the same diet intervention plus exercise. This citation supports identifying the paper as one of the trials in the citing sentence. (LLM, conf=0.92)

  cites [294] Messier, 2013, Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial, JAMA source
• Supported

  The Methods describe a dietary weight-loss group and a group receiving the same dietary intervention plus exercise in older adults. The Methods also state that participants with impaired glucose tolerance or impaired fasting glucose were randomized between the groups; participants with type 2 diabetes were assigned to the exercise group without randomization. The paper therefore fits as one of the cited intervention studies, though it does not itself establish the total of twelve. (LLM, conf=0.88)

  cites [295] Chomentowski, 2009, Moderate exercise attenuates the loss of skeletal muscle mass that occurs with intentional caloric restriction-induced weight loss in older, overweight to obese adults, J Gerontol A Biol Sci Med Sci source
• Supported

  The Methods (Experimental design and Diet) describe women randomly assigned to sedentary or resistance-training groups while receiving the same controlled, energy-restricted diet. The Subjects section identifies participants as women aged 61–78. This paper supports its inclusion as one of the cited trials; the count of twelve refers to the citing document's collection of studies, not to this paper alone. (LLM, conf=0.90)

  cites [296] Campbell, 2009, Resistance training preserves fat-free mass without impacting changes in protein metabolism after weight loss in older women, Obesity (Silver Spring) source
• Supported

  The Research Design and Methods (pp. 1–2) identify this paper as one randomized trial in adults aged 60–80 comparing moderate weight loss plus resistance training with moderate weight loss plus a flexibility-control program. The citation identifies one of the twelve trials, rather than attributing the total of twelve to this paper. (LLM, conf=0.91)

  cites [297] Dunstan, 2002, High-intensity resistance training improves glycemic control in older patients with type 2 diabetes, Diabetes Care source

In the paper

“Although these findings are based on studies in younger adults (257, 258), there is little reason to believe that they would not apply to older adults.”

What the sources say

• Partly supported

  The Pre-Trial Standardization/Exclusion criteria section says participants were healthy men aged 18–35, and the Urine output and fluid balance section reports differences in fluid retention among beverages. The Discussion considers extrapolation to a longer time scale, but not to older adults. The source therefore supports the findings in younger adults, not the claim that they would also apply to older adults. Page numbers were not available in our copy. (LLM, conf=0.85)

  cites [257] Maughan, 2016, A randomized trial to assess the potential of different beverages to affect hydration status: development of a beverage hydration index, Am J Clin Nutr sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [258] Grandjean, 2000, The effect of caffeinated, non-caffeinated, caloric and non-caloric beverages on hydration, J Am Coll Nutr source

In the paper

“Drinks providing fluid with a hydrating effect on our bodies include water, sparkling water, flavored water, hot or cold tea, coffee, milk and milky drinks, fruit juices, soups, sports or soft drinks and smoothies (257).”

What the sources say

• Partly supported

  The Drinks and drink preparation section lists water, sparkling water, tea, coffee, milk, orange juice, cola and a sports drink among the beverages tested. The Abstract reports their short-term hydration responses. The paper does not test flavored water, soups or smoothies, so it does not support the full list attributed to it. (LLM, conf=0.88)

  cites [257] Maughan, 2016, A randomized trial to assess the potential of different beverages to affect hydration status: development of a beverage hydration index, Am J Clin Nutr sourceExperimental — accuracy not yet measured

In the paper

“Current expert recommendations regarding weight reduction in older people primarily refer to cases of obesity that are associated with comorbidities and obesity-related adverse health effects (276)(277)(278)282).”

What the sources say

• Supported

  The ‘Who Should Lose Weight and What Are the Concerns?’ section recommends weight loss for older people only when obesity is accompanied by weight-related comorbidities or functional limitations that may benefit. The Conclusion likewise limits treatment to obese patients with functional impairments, metabolic complications, or obesity-related diseases. (LLM, conf=0.94)

  cites [276] Mathus-Vliegen, 2012, Prevalence, pathophysiology, health consequences and treatment options of obesity in the elderly: a guideline, Obes Facts source
• ?Not checked — no full text of the sourcecites [277] Visvanathan, 2012, Australian and New Zealand Society for Geriatric Medicine: position statement-obesity and the older person, Australas J Ageing source
• ?Not checked — no full text of the sourcecites [278] Villareal, 2005, Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, the Obesity Society, Obesity source
• Supported

  In the treatment recommendations section, Cetin and Nasr advise caution about recommending weight loss solely on the basis of body weight. They recommend intentional weight loss for high-risk older adults, including those with cardiovascular disease, type 2 diabetes, or metabolic syndrome, while suggesting weight maintenance rather than aggressive loss for older adults in good health. (LLM, conf=0.90)

  cites [282] Cetin, 2014, Obesity in the elderly: more complicated than you think, Cleve Clin J Med source

In the paper

“which included cohorts of older adults not labeled as having dementia but where a cognitive assessment showed that on average cognitive impairment was present (63,219,264), as it is in most care home populations.”

What the sources say

• Partly supported

  The Results (page unavailable) say that, in some reviewed interventions, dementia or mild cognitive impairment was inferred from cognitive scores or the care setting rather than a stated diagnosis. That supports the point about some cohorts not labeled as having dementia, but the review does not establish that cognitive impairment is present on average in most care home populations. (LLM, conf=0.82)

  cites [63] Bunn, 2016, Effectiveness of interventions to indirectly support food and drink intake in people with dementia: eating and Drinking Well IN dementiA (EDWINA) systematic review, BMC Geriatr sourceExperimental — accuracy not yet measured
• Partly supported

  The Results (page unavailable) say that cognitive impairment was assumed from cognitive scores or setting in 12 included interventions, and that most interventions took place in institutional or hospital settings. This supports the narrower point that some studied cohorts had cognitive impairment without a stated dementia diagnosis, but it does not establish that cognitive impairment is present on average in most care home populations. (LLM, conf=0.78)

  cites [219] Abdelhamid, 2016, Effectiveness of interventions to directly improve, maintain or facilitate food and drink intake in people with dementia: eating and Drinking Well IN dementiA (EDWINA) systematic review and meta-analysis, BMC Geriatr sourceExperimental — accuracy not yet measured
• Partly supported

  The Methods (Criteria for inclusion; page unavailable) allowed studies whose participants had cognitive scores indicating impairment, and the Results (page unavailable) say dementia or MCI was sometimes inferred from cognitive scores or setting. These selected cohorts do not establish that cognitive impairment is present on average in most care home populations. (LLM, conf=0.78)

  cites [264] Bunn, 2016, Effectiveness of interventions to indirectly improve, maintain or facilitate food and drink intake in people with dementia: eating and Drinking Well IN dementiA (EDWINA) systematic review and meta-analysis, BMC Geriatr sourceExperimental — accuracy not yet measured

In the paper

“In addition, in the FOOD trial, which was performed in patients with dysphagic stroke, early EN was associated with an absolute reduction in the risk of death of 5.8% (p=0.09)(165).”

What the sources say

• Supported

  The Results passage reports that, in the early-versus-avoid trial, early tube feeding was associated with a 5.8% absolute reduction in risk of death (p=0.09). The Trial design and participants passage identifies the enrolled patients as having dysphagia after stroke. The reported reduction was not statistically significant. (LLM, conf=0.95)

  cites [165] Collaboration, 2005, Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial, Lancet source

In the paper

“In ten trials, a weight-reducing diet alone resulted in the desired weight loss, which consisted of fat mass as well as lean mass (290)(291)(292)(294)(295)(296)(297)(298)(299).”

What the sources say

• ?Not checked — no full text of the sourcecites [290] Avila, 2010, Effect of moderate intensity resistance training during weight loss on body composition and physical performance in overweight older adults, Eur J Appl Physiol source
• Supported

  Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [291] Frimel, 2008, Exercise attenuates the weight-loss-induced reduction in muscle mass in frail obese older adults, Med Sci Sports Exerc source
• Partly supported

  Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [292] Shah, 2009, Diet and exercise interventions reduce intrahepatic fat content and improve insulin sensitivity in obese older adults, Obesity (Silver Spring) sourceExperimental — accuracy not yet measured
• Partly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [293] Rejeski, 2017, Community weight loss to combat obesity and disability in at-risk older adults, J Gerontol A Biol Sci Med Sci sourceExperimental — accuracy not yet measured
• Partly supported

  Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [294] Messier, 2013, Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial, JAMA sourceExperimental — accuracy not yet measured
• Supported

  Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [295] Chomentowski, 2009, Moderate exercise attenuates the loss of skeletal muscle mass that occurs with intentional caloric restriction-induced weight loss in older, overweight to obese adults, J Gerontol A Biol Sci Med Sci source
• Supported

  Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [296] Campbell, 2009, Resistance training preserves fat-free mass without impacting changes in protein metabolism after weight loss in older women, Obesity (Silver Spring) source
• Supported

  Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [297] Dunstan, 2002, High-intensity resistance training improves glycemic control in older patients with type 2 diabetes, Diabetes Care source
• Supported

  Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [298] Kitzman, 2016, Effect of caloric restriction or aerobic exercise training on peak oxygen consumption and quality of life in obese older patients with heart failure with preserved ejection fraction: a randomized clinical trial, JAMA source
• Supported

  Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [299] Amati, 2008, Separate and combined effects of exercise training and weight loss on exercise efficiency and substrate oxidation, J Appl Physiol (1985) source

In the paper

“Moreover, for several physical and strengthperformance measures, greater improvements were observed in the combined groups than in the diet-only groups (288-291, 293-297, 299).”

What the sources say

• ?Not checked — no full text of the sourcecites [288] Messier, 2004, Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial, Arthritis Rheum source
• Supported

  The Results report greater improvement in the Physical Performance Test and functional status in the diet–exercise group than in the diet-only group. The Strength, Balance, Gait, and Quality of Life section also reports a 35% increase in total one-repetition maximum with diet plus exercise, compared with 3% with diet alone. Page numbers are not provided in our copy. (LLM, conf=0.92)

  cites [289] Villareal, 2011, Weight loss, exercise, or both and physical function in obese older adults, N Engl J Med source
• ?Not checked — no full text of the sourcecites [290] Avila, 2010, Effect of moderate intensity resistance training during weight loss on body composition and physical performance in overweight older adults, Eur J Appl Physiol source
• Partly supported

  The Results report greater improvements in several strength measures in the diet-plus-exercise group: one-repetition maximum strength increased for five exercises, while the diet-only group showed no change. The paper gives baseline physical-frailty measures, but the passages found do not report follow-up changes in physical-performance measures, so that part of the claim is not supported by this source. (LLM, conf=0.84)

  cites [291] Frimel, 2008, Exercise attenuates the weight-loss-induced reduction in muscle mass in frail obese older adults, Med Sci Sports Exerc sourceExperimental — accuracy not yet measured
• Supported

  The Primary Outcomes section reports greater improvement in 400-m walk time for the combined weight-loss-plus-activity groups than for weight loss alone. The Conclusion’s Figure 4 text also reports greater gains in body-mass-normalized knee extensor strength for both exercise groups than for weight loss alone, supporting the strength-performance part of the claim. (LLM, conf=0.88)

  cites [293] Rejeski, 2017, Community weight loss to combat obesity and disability in at-risk older adults, J Gerontol A Biol Sci Med Sci source
• Partly supported

  The Results (Pain and Function; Mobility and HRQL, page not provided) show better function and a longer 6-minute walk distance in the diet-plus-exercise group than in the diet-only group. The paper describes strength training as part of the intervention but does not report a strength-performance improvement; its walk-speed comparison between those groups was not significant. (LLM, conf=0.86)

  cites [294] Messier, 2013, Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial, JAMA sourceExperimental — accuracy not yet measured
• Partly supported

  The Results and Discussion report that the diet-plus-exercise group lost less fat-free mass and normal-density muscle than the diet-only group. Those are body-composition measures, not physical or strength-performance measures. The Discussion explicitly notes that a muscular strength or power test was not included, so this paper cannot support the claimed performance improvements. (LLM, conf=0.84)

  cites [295] Chomentowski, 2009, Moderate exercise attenuates the loss of skeletal muscle mass that occurs with intentional caloric restriction-induced weight loss in older, overweight to obese adults, J Gerontol A Biol Sci Med Sci sourceExperimental — accuracy not yet measured
• Partly supported

  The Results (Muscle strength; page not provided) report 12–34% gains in maximal strength in the diet-plus-resistance-training group, while strength was unchanged in the sedentary diet group. This supports greater improvement on several strength measures, but the paper does not report corresponding physical-performance measures. (LLM, conf=0.84)

  cites [296] Campbell, 2009, Resistance training preserves fat-free mass without impacting changes in protein metabolism after weight loss in older women, Obesity (Silver Spring) sourceExperimental — accuracy not yet measured
• Supported

  The Changes in muscle strength section (p. 5) reports greater gains in upper- and lower-body strength with resistance training plus weight loss than with weight loss alone at six months. The Changes in anthropometric and body composition section (p. 4) also reports a relative improvement in lean body mass. These support the claim about several measures, though the paper found no between-group difference in weight, waist circumference, or fat mass. (LLM, conf=0.88)

  cites [297] Dunstan, 2002, High-intensity resistance training improves glycemic control in older patients with type 2 diabetes, Diabetes Care source
• Partly supported

  The Results (page unavailable) report greater improvements in peak aerobic capacity, gross efficiency, and exercise economy in the combined exercise-and-diet group than in the diet-only group. The paper does not report strength-performance measures, so it supports the physical-fitness comparison but not that part of the claim. (LLM, conf=0.88)

  cites [299] Amati, 2008, Separate and combined effects of exercise training and weight loss on exercise efficiency and substrate oxidation, J Appl Physiol (1985) sourceExperimental — accuracy not yet measured

In the paper

“A systematic literature search found six high-quality SLRs that have assessed the efficacy of ONS versus usual care in older persons (114-121).”

What the sources say

• Partly supported

  The Objectives section identifies this as a systematic review of supportive dietary interventions in malnourished or at-risk adults, and the Nutritional intake section compares oral nutritional supplements with usual care. It is therefore relevant to the cited group of reviews, but its scope is broader than ONS efficacy in older persons alone. The paper also does not establish the citing search’s count of six reviews or its assessment that they were high-quality. (LLM, conf=0.85)

  cites [114] Baldwin, 2016, Supportive interventions for enhancing dietary intake in malnourished or nutritionally at-risk adults, The Cochrane Libr sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [115] Bally, 2016, Nutritional support and outcomes in malnourished medical inpatients: a systematic review and meta-analysis, JAMA Intern Med source
• ?Not checked — no full text of the sourcecites [116] Beck, 2013, Oral nutritional support of older (65 years+) medical and surgical patients after discharge from hospital: systematic review and meta-analysis of randomized controlled trials, Clin Rehabil source
• ?Not checked — no full text of the sourcecites [117] Milne, 2002, Protein and energy supplementation in elderly people at risk from malnutrition, Cochrane Database Syst Rev source
• ?Not checked — no full text of the sourcecites [118] Milne, 2005, Protein and energy supplementation in elderly people at risk from malnutrition, Cochrane Database Syst Rev source
• ?Not checked — no full text of the sourcecites [119] Milne, 2009, Protein and energy supplementation in elderly people at risk from malnutrition, Cochrane Database Syst Rev source
• ?Not checked — no full text of the sourcecites [120] Stratton, 2013, A systematic review and meta-analysis of the impact of oral nutritional supplements on hospital readmissions, Ageing Res Rev source
• ?Not checked — no full text of the sourcecites [121] Cawood, 2012, Systematic review and meta-analysis of the effects of high protein oral nutritional supplements, Ageing Res Rev source

In the paper

“in the US dehydration prevalence did not differ between for-profit and not-for-profit homes (220).”

What the sources say

• Supported

  The Discussion explicitly reports no difference in dehydration prevalence between US for-profit and not-for-profit homes. Table 4 also lists a nonsignificant comparison for the US study (OR 1.02, 95% CI 0.91–1.15). (LLM, conf=0.95)

  cites [220] Bunn, 2015, Increasing fluid intake and reducing dehydration risk in older people living in long-term care: a systematic review, J Am Med Dir Assoc source

In the paper

“A small single study implied that high contrast red cups helped support drinking in nine men with dementia (220).”

What the sources say

• Supported

  The Discussion reports that a small pre-posttest study found increased fluid intake in nine men with Alzheimer disease using high-contrast red cups rather than white cups. The Drinking vessel characteristics section reports the increase in the proportion consumed and notes that findings were not repeated with other colors or contrasts. (LLM, conf=0.94)

  cites [220] Bunn, 2015, Increasing fluid intake and reducing dehydration risk in older people living in long-term care: a systematic review, J Am Med Dir Assoc source

In the paper

“Supplementary overnight EN was overall poorly tolerated.”

What the sources say

• Supported

  The review’s Main results section states that nasogastric feeding was poorly tolerated. Its Methods section describes the feeding as given nightly or overnight, supporting the claim about supplementary overnight enteral nutrition. Page numbers are unavailable in our copy. (LLM, conf=0.90)

  cites [182] Avenell, 2016, Nutritional supplementation for hip fracture aftercare in older people, Cochrane Database Syst Rev source

In the paper

“multi-component strategies across their institutions for support adequate drinks intake have been clearly shown to prevent or treat low-intake dehydration in older adults.”

What the sources say

• Partly supported

  The Discussion reports that 6 of 9 multicomponent interventions showed a trend toward increased fluid intake. But the Discussion and Conclusion caution that high risk of bias left the effectiveness of many strategies unproven; the review does not establish that these strategies clearly prevent or treat low-intake dehydration. (LLM, conf=0.89)

  cites [220] Bunn, 2015, Increasing fluid intake and reducing dehydration risk in older people living in long-term care: a systematic review, J Am Med Dir Assoc sourceExperimental — accuracy not yet measured

In the paper

“in Canada for-profit ownership was associated with increased hospital admissions for dehydration”

What the sources say

• Supported

  The Discussion explicitly reports that, in Canada, for-profit ownership was associated with increased hospital admissions for dehydration. The ownership section specifies that admission rates were higher for for-profit than not-for-profit facilities after adjustment for resident and facility factors. (LLM, conf=0.95)

  cites [220] Bunn, 2015, Increasing fluid intake and reducing dehydration risk in older people living in long-term care: a systematic review, J Am Med Dir Assoc source

In the paper

“Only two observational studies were performed in older populations (176, 177).”

What the sources say

• Supported

  The Study design and subjects section identifies this as a case-control study of hospitalised patients aged 65 or older. The conclusion says the findings suggest many patients had refeeding syndrome. This supports citing the paper as one of the observational studies in older populations; the count of two is the citing authors’ synthesis. (LLM, conf=0.87)

  cites [176] Kagansky, 2005, Hypophosphataemia in old patients is associated with the refeeding syndrome and reduced survival, J Intern Med source
• ?Not checked — no full text of the sourcecites [177] Lubart, 2009, Mortality after nasogastric tube feeding initiation in long-term care elderly with oropharyngeal dysphagia–the contribution of refeeding syndrome, Gerontology source

In the paper

“Furthermore, this review calls attention to the subgroup of patients with pre-existing dementia, where the effect of multi-component interventions remains uncertain.”

What the sources say

• Supported

  The review’s “Multi-component interventions” section explicitly says that effectiveness in patients with dementia remains uncertain. Its “Subgroup analysis by cognitive impairment” explains that only one trial reported delirium incidence for 50 patients with pre-existing dementia, and its results were too imprecise to draw a conclusion. (LLM, conf=0.95)

  cites [197] Siddiqi, 2016 source

In the paper

“A more recent Cochrane review focusing on hospitalized non-ICU patients reached similar conclusions: multi-component interventions reduced the incidence of delirium compared to usual care in medical and surgical settings (197).”

What the sources say

• Supported

  The Main results section reports that multi-component interventions reduced delirium incidence compared with usual care, with similar effect sizes in medical and surgical settings. The review concerns hospitalised non-ICU patients. (LLM, conf=0.95)

  cites [197] Siddiqi, 2016 source

In the paper

“The systematic review described before/in recommendation 62 suggests that multicomponent interventions including increased staff awareness, assistance with drinking, support using the toilet and a greater variety of drinks on offer may be effective (220).”

What the sources say

• Supported

  The Discussion reports that six of nine multicomponent interventions showed a trend toward increased fluid intake, particularly those involving greater drink choice, staff awareness, and assistance with drinking and toileting. The claim’s cautious “may be effective” is consistent with the Conclusion’s warning that effectiveness remains unproven because of high risk of bias. (LLM, conf=0.93)

  cites [220] Bunn, 2015, Increasing fluid intake and reducing dehydration risk in older people living in long-term care: a systematic review, J Am Med Dir Assoc source

In the paper

“No clear relationships were observed between staffing levels and dehydration prevalence(220, 262, 263).”

What the sources say

• Supported

  The Discussion states that the US observational study found no apparent effect of staff grade or staffing hours per day on dehydration prevalence. This supports the citing sentence’s cautious wording, “no clear relationships.” (LLM, conf=0.93)

  cites [220] Bunn, 2015, Increasing fluid intake and reducing dehydration risk in older people living in long-term care: a systematic review, J Am Med Dir Assoc source
• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [262] Dyck, 2004
• ?Not checked — no full text of the sourcecites [263] Dyck, 2007, Nursing staffing and resident outcomes in nursing homes: weight loss and dehydration, J Nurs Care Qual source

In the paper

“The review identified 19 intervention and four observational studies from seven countries”

What the sources say

• Supported

  The Selection of Studies section (page not supplied) reports 23 included studies: 19 intervention and 4 observational. It lists studies from the United States, Canada, the UK, Ireland, Germany, Japan, and Taiwan—seven countries. (LLM, conf=0.94)

  cites [220] Bunn, 2015, Increasing fluid intake and reducing dehydration risk in older people living in long-term care: a systematic review, J Am Med Dir Assoc source

In the paper

“Effects on nutritional status, length of hospital stay and functional status were inconsistent (182).”

What the sources say

• Partly supported

  The Length of stay section reports variable effects, and the Functional status and level of care required section reports differing functional findings across trials. The passages on nutritional status describe participants’ baseline status and subgroup analyses, not inconsistent effects of supplementation on nutritional status; that part of the claim is not supported by the passages found. Page numbers were not available in our copy. (LLM, conf=0.82)

  cites [182] Avenell, 2016, Nutritional supplementation for hip fracture aftercare in older people, Cochrane Database Syst Rev sourceExperimental — accuracy not yet measured

In the paper

“Volume depletion (reduced volume of extracellular fluids only, due to loss of fluids and electrolytes, also called salt loss or extracellular dehydration) occurs without raised serum or plasma osmolality”

What the sources say

• ?Not checked — no full text of the sourcecites [221] Cheuvront, 2010, Biological variation and diagnostic accuracy of dehydration assessment markers, Am J Clin Nutr source
• Supported

  The ‘Two Critical Caveats to Understanding Osmotic Responses to Dehydration’ section identifies volume depletion as salt-depletion dehydration or isotonic hypovolemia and says the accompanying solute loss produces little change in plasma osmolality. The ‘Limitations of Use of Osmometry for Assessment of Dehydration’ section also states that plasma osmolality is of no use for detecting volume depletion. (LLM, conf=0.94)

  cites [222] Cheuvront, 2013, Physiologic basis for understanding quantitative dehydration assessment, Am J Clin Nutr source
• Partly supported

  The Results (page unavailable) describe salt loss reducing extracellular and plasma volume, while serum sodium and plasma chloride concentrations fell in Experiment IA. This is consistent with volume depletion without increased osmolality, but the paper does not report a direct serum or plasma osmolality measurement. (LLM, conf=0.82)

  cites [223] Nadal, 1941, A comparison between dehydration from salt loss and from water deprivation, J Clin Invest sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [224] Thomas, 2008, Understanding clinical dehydration and its treatment, JAMDA source

In the paper

“The evidence suggests that multicomponent interventions may be effective (220).”

What the sources say

• Supported

  The Discussion reports that 6 of 9 multicomponent interventions showed a trend toward increased fluid intake among older people in long-term care. The claim’s cautious wording, “may be effective,” fits that finding, although the Conclusion cautions that high risk of bias prevented the review from demonstrating effectiveness definitively. (LLM, conf=0.93)

  cites [220] Bunn, 2015, Increasing fluid intake and reducing dehydration risk in older people living in long-term care: a systematic review, J Am Med Dir Assoc source

In the paper

“Further, weight loss, whether intentional or not, enhances the age-related loss of muscle mass”

What the sources say

• Partly supported

  The Nutrition and Diet section says diet-induced weight loss reduces fat-free mass and could exacerbate age-related muscle loss. The claim presents that possibility as certain and extends it to unintentional weight loss, which the cited passage does not address. The section Who Should Lose Weight and What Are the Concerns? likewise discusses muscle loss as a possible adverse effect of intentional weight loss. (LLM, conf=0.88)

  cites [276] Mathus-Vliegen, 2012, Prevalence, pathophysiology, health consequences and treatment options of obesity in the elderly: a guideline, Obes Facts sourceExperimental — accuracy not yet measured
• Partly supported

  The “CETIN AND NASR” section says intentional weight loss reduces skeletal muscle and that older patients have already lost muscle mass. “Intentional vs unintentional weight loss” reports a slight decline in lean body mass with intentional weight loss, but does not establish the same effect for unintentional weight loss. The “SARCOPENIA: LOSS OF MUSCLE WITH AGE” section distinguishes age-related muscle loss from wasting associated with involuntary weight loss. Page numbers are unavailable in our copy. (LLM, conf=0.83)

  cites [282] Cetin, 2014, Obesity in the elderly: more complicated than you think, Cleve Clin J Med sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [283] Parr, 2013, ‘Sarcobesity’: a metabolic conundrum, Maturitas source

In the paper

“Experts generally agree that there is usually no need for overweight older people to lose weight (274-278)”

What the sources say

• ?Not checked — no full text of the sourcecites [274] Garvey, 2016, American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity, Endocr Pract source
• Not checked yetcites [275] American College of Cardiology/American Heart Association Task Force on Practice Guidelines OEP, 2014, Expert Panel Report: guidelines (2013) for the management of overweight and obesity in adults, Obesity (Silver Spring)
• Supported

  The Conclusion states that weight-loss treatment should be offered to older patients who are obese, rather than overweight by BMI definition, and who have conditions that could benefit from it. The ‘Who Should Lose Weight and What Are the Concerns?’ section likewise restricts weight-loss recommendations to obese older patients with relevant complications or functional limitations. (LLM, conf=0.93)

  cites [276] Mathus-Vliegen, 2012, Prevalence, pathophysiology, health consequences and treatment options of obesity in the elderly: a guideline, Obes Facts source
• ?Not checked — no full text of the sourcecites [277] Visvanathan, 2012, Australian and New Zealand Society for Geriatric Medicine: position statement-obesity and the older person, Australas J Ageing source
• ?Not checked — no full text of the sourcecites [278] Villareal, 2005, Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, the Obesity Society, Obesity source

In the paper

“In geriatric acute care and rehabilitation hospital units, nutritional assessment and implementation of a nutritional care plan have been shown to improve energy and protein intake, serum proteins and health-related quality of life of the patients (39).”

What the sources say

• ?Not checked — no full text of the sourcecites [39] Babineau, 2008, Outcomes of screening and nutritional intervention among older adults in healthcare facilities, Can J Diet Pract Res source

In the paper

“Five RCTs (all performed in the hospital setting) were identified providing evidence for comprehensive individualized nutritional interventions in older persons with malnutrition or at risk of malnutrition (43)(44)(45)(46)(47).”

What the sources say

• ?Not checked — no full text of the sourcecites [43] Rufenacht, 2010, Nutritional counseling improves quality of life and nutrient intake in hospitalized undernourished patients, Nutrition source
• ?Not checked — no full text of the sourcecites [44] Starke, 2011, Short-term individual nutritional care as part of routine clinical setting improves outcome and quality of life in malnourished medical patients, Clin Nutr source
• ?Not checked — no full text of the sourcecites [45] Ha, 2010, Individual, nutritional support prevents undernutrition, increases muscle strength and improves QoL among elderly at nutritional risk hospitalized for acute stroke: a randomized, controlled trial, Clin Nutr source

In the paper

“Implementation of a screening and treatment protocol at a geriatric hospital unit including regular team meetings improved BW and hospital-acquired infections compared to standard care (40).”

What the sources say

• Not checked yetcites [40] Rypkema, 2004, Cost-effectiveness of an interdisciplinary intervention in geriatric inpatients to prevent malnutrition, J Nutr Health Aging

In the paper

“and improved nutritional status, wellbeing, and quality of mealtimes in demented nursing home residents (42).”

What the sources say

• ?Not checked — no full text of the sourcecites [42] Biernacki, 2001, Improving the nutritional status of people with dementia, Br J Nurs source

In the paper

“Four relevant RCTs with several sub-studies of low to acceptable quality focusing on multimodal and multidisciplinary interventions (combining more than two intervention strategies) were identified (48)(49)(50)(51)(52)(53)(54)(55)(56)(57):”

What the sources say

• ?Not checked — no full text of the sourcecites [48] Beck, 2016, Multidisciplinary nutritional support for undernutrition in nursing home and home-care: a cluster randomized controlled trial, Nutrition source
• ?Not checked — no full text of the sourcecites [49] Beck, 2008, Multifaceted nutritional intervention among nursing-home residents has a positive influence on nutrition and function, Nutrition source
• ?Not checked — no full text of the sourcecites [50] Beck, 2010, Physical and social functional abilities seem to be maintained by a multifaceted randomized controlled nutritional intervention among old (>65 years) Danish nursing home residents, Arch Gerontol Geriatr source

In the paper

“No effect was found regarding the length of hospital stay (44,45).”

What the sources say

• ?Not checked — no full text of the sourcecites [44] Starke, 2011, Short-term individual nutritional care as part of routine clinical setting improves outcome and quality of life in malnourished medical patients, Clin Nutr source
• ?Not checked — no full text of the sourcecites [45] Ha, 2010, Individual, nutritional support prevents undernutrition, increases muscle strength and improves QoL among elderly at nutritional risk hospitalized for acute stroke: a randomized, controlled trial, Clin Nutr source

In the paper

“Additionally, all three studies showed benefits concerning the quality of life in the group receiving individual nutritional J o u r n a l P r e -p r o o f care compared to the group with usual care (43)(44)(45).”

What the sources say

• ?Not checked — no full text of the sourcecites [43] Rufenacht, 2010, Nutritional counseling improves quality of life and nutrient intake in hospitalized undernourished patients, Nutrition source
• ?Not checked — no full text of the sourcecites [44] Starke, 2011, Short-term individual nutritional care as part of routine clinical setting improves outcome and quality of life in malnourished medical patients, Clin Nutr source
• ?Not checked — no full text of the sourcecites [45] Ha, 2010, Individual, nutritional support prevents undernutrition, increases muscle strength and improves QoL among elderly at nutritional risk hospitalized for acute stroke: a randomized, controlled trial, Clin Nutr source

In the paper

“In one study, ambulatory patients older than 75 years following a low salt, low cholesterol or diabetic diet for 11 ± 6 years were found to be at increased risk of malnutrition compared to ageand gender-matched controls (60).”

What the sources say

• ?Not checked — no full text of the sourcecites [60] Zeanandin, 2012, Impact of restrictive diets on the risk of undernutrition in a free-living elderly population, Clin Nutr source

In the paper

“In one of these studies, a significant increase in BW is reported after three months compared to the control group (72).”

What the sources say

• ?Not checked — no full text of the sourcecites [72] Charras, 2010, Sharing meals with institutionalized people with dementia: a natural experiment, J Gerontol Soc Work source

In the paper

“One of them found that enhancing the energy density of food items regularly served in a homedelivered meals program increased lunch and 24-hour energy and nutrient intakes in a 1day intervention (76).”

What the sources say

• ?Not checked — no full text of the sourcecites [76] Silver, 2008, Increased energy density of the home-delivered lunch meal improves 24-hour nutrient intakes in older adults, J Am Diet Assoc source

In the paper

“A meta-analysis of four of the five studies included (including one RCT) resulted J o u r n a l P r e -p r o o f in significantly improved daily energy and protein intake in patients with mealtime assistance.”

What the sources say

• ?Not checked — no full text of the sourcecites [68] Tassone, 2015, Should we implement mealtime assistance in the hospital setting? A systematic literature review with meta-analyses, J Clin Nurs source

In the paper

“One guideline (99) and one SLR (100) were found which examined the effectiveness of individualized nutritional counseling in older persons with malnutrition or at risk of malnutrition.”

What the sources say

• Not checked yetcites [99] 2016, National Clinical Guideline for exercise and nutrition to old people with geriatric problems, DHMA
• ?Not checked — no full text of the sourcecites [100] Munk, 2016, Individualised dietary counselling for nutritionally at-risk older patients following discharge from acute hospital to home: a systematic review and meta-analysis, J Hum Nutr Diet source

In the paper

“The new meals on wheels group gained significantly more weight than the traditional meals on wheels group (75).”

What the sources say

• ?Not checked — no full text of the sourcecites [75] Kretser, 2003, Effects of two models of nutritional intervention on homebound older adults at nutritional risk, J Am Diet Assoc source

In the paper

“No RCT was found comparing a combined exercise and nutrition intervention with a singular nutritional intervention in older people with malnutrition or at risk of malnutrition using a two-factorial design.”

In the paper

“In institutionalized older people, J o u r n a l P r e -p r o o f eating and feeding problems are widespread and should also be identified, e.g. by informal observation during meals, and eliminated as far as possible by appropriate remedial actions (58).”

What the sources say

• ?Not checked — no full text of the sourcecites [58] Keller, 2006, Meal rounds: an essential aspect of quality nutrition services in long-term care, J Am Med Dir Assoc source

In the paper

“The EFSA reviewed the literature and recommended an Adequate Intake (AI) of 2.0 L/day for women and 2.5 L/day for men of all ages (from a combination of drinking water, beverages, and food) (32).”

What the sources say

• Not checked yetcites [32] 2010, Scientific opinion on dietary reference values for water, EFSA J

In the paper

“Conversely, fiber-containing products for EN have been shown to contribute to normal bowel function (24)(25)(26)(27)(28)(29)(30) and are, thus, generally recommended.”

What the sources say

• ?Not checked — no full text of the sourcecites [24] Zarling, 1994, Effect of dietary oat and soy fiber on bowel function and clinical tolerance in a tube feeding dependent population, J Am Coll Nutr source
• ?Not checked — no full text of the sourcecites [25] Shankardass, 1990, Bowel function of long-term tube-fed patients consuming formulae with and without dietary fiber, JPEN - J Parenter Enter Nutr source
• ?Not checked — no full text of the sourcecites [26] Homann, 1994, Reduction in diarrhea incidence by soluble fiber in patients receiving total or supplemental enteral nutrition, JPEN - J Parenter Enter Nutr source

In the paper

“We take fluid from drinks and foods, but drinks or beverages account for 70 to 80% of fluid consumed (33).”

What the sources say

• ?Not checked — no full text of the sourcecites [33] Kant, 2009, Intakes of plain water, moisture in foods and beverages, and total water in the adult US population - nutritional, meal pattern, and body weight correlates: national Health and Nutrition Examination Surveys 1999-2006, Am J Clin Nutr source

In the paper

“Minimal requirements of ill older persons are estimated to be between 27 and 30 kcal/kg (16).”

What the sources say

• ?Not checked — no full text of the sourcecites [16] Gaillard, 2007, Energy requirements in frail elderly people: a review of the literature, Clin Nutr source

In the paper

“Growing evidence from experimental and epidemiological research suggests that older people might need higher amounts of protein than younger adults for optimal preservation of lean body mass, body functions, and health.”

In the paper

“Based on usual physical activity levels between 1.2 and 1.8, total energy expenditure amounts to 24 to 36 kcal/kg.”

In the paper

“Muscle disuse and periods of bed rest can further exacerbate the degradation of muscle mass and strength (80).”

What the sources say

• ?Not checked — no full text of the sourcecites [80] Kortebein, 2007, Effect of 10 days of bed rest on skeletal muscle in healthy older adults, JAMA source

In the paper

“Altogether, these studies support the need for adequate amounts of energy and protein during periods of exercise interventions.”

In the paper

“Regarding the length of the intervention, subgroup analysis in the meta-analyses from Milne et al. from 2002 (117) and 2005 (118) showed a consistently statistically significant impact of ONS on mortality when supplementation was continued for 35 days or more compared to less than 35 days.”

What the sources say

• ?Not checked — no full text of the sourcecites [117] Milne, 2002, Protein and energy supplementation in elderly people at risk from malnutrition, Cochrane Database Syst Rev source
• ?Not checked — no full text of the sourcecites [118] Milne, 2005, Protein and energy supplementation in elderly people at risk from malnutrition, Cochrane Database Syst Rev source

In the paper

“Greater weight gain (111), higher energy and protein intake (104, 112) and better quality of life (112) are reported in the ONS group than dietary counseling (111, 112) or additional snack foods (113).”

What the sources say

• ?Not checked — no full text of the sourcecites [112] Parsons, 2017, Oral nutritional supplements in a randomised trial are more effective than dietary advice at improving quality of life in malnourished care home residents, Clin Nutr source

In the paper

“In the underlying systematic search, J o u r n a l P r e -p r o o f no literature assessing the effects of texture-modified food was found”

What the sources say

• ?Not checked — no full text of the sourcecites [108] Andersen, 2013, Systematic review and evidence based recommendations on texture modified foods and thickened fluids for adults (18 years) with oropharyngeal dysphagia, e-SPEN source

In the paper

“In general, the survival after insertion of a percutaneous endoscopic gastrostomy (PEG) in geriatric patients is poor.”

What the sources say

• ?Not checked — no full text of the sourcecites [131] Mitchell, 2000, Survival after percutaneous endoscopic gastrostomy placement in older persons, J Gerontol Series A: Biol Sci Med Sci source

In the paper

“In an additional relevant trial in older long-term-care residents at risk of malnutrition, the offering of three snacks between main meals and before bed resulted in an increase in energy intake by about 30% after three and after six weeks (104).”

What the sources say

• ?Not checked — no full text of the sourcecites [104] Turic, 1998, Nutrition supplementation enables elderly residents of long-term-care facilities to meet or exceed RDAs without displacing energy or nutrient intakes from meals, J Am Diet Assoc source

In the paper

“A J o u r n a l P r e -p r o o f meta-analysis demonstrated the survival of 81% after one month, 56% after six months and 38% after one year (131).”

What the sources say

• ?Not checked — no full text of the sourcecites [131] Mitchell, 2000, Survival after percutaneous endoscopic gastrostomy placement in older persons, J Gerontol Series A: Biol Sci Med Sci source

In the paper

“Thus, individual RCTs suggest that nutritional interventions may support the improvement of functional status post-discharge.”

In the paper

“Greater weight gain (111), higher energy and protein intake (104, 112) and better quality of life (112) are reported in the ONS group than dietary counseling (111, 112) or additional snack foods (113).”

What the sources say

• ?Not checked — no full text of the sourcecites [104] Turic, 1998, Nutrition supplementation enables elderly residents of long-term-care facilities to meet or exceed RDAs without displacing energy or nutrient intakes from meals, J Am Diet Assoc source
• ?Not checked — no full text of the sourcecites [112] Parsons, 2017, Oral nutritional supplements in a randomised trial are more effective than dietary advice at improving quality of life in malnourished care home residents, Clin Nutr source

In the paper

“The effect of EN is generally not well studied.”

In the paper

“Greater weight gain (111), higher energy and protein intake (104, 112) and better quality of life (112) are reported in the ONS group than dietary counseling (111, 112) or additional snack foods (113).”

What the sources say

• ?Not checked — no full text of the sourcecites [111] Gray-Donald, 1995, Randomized clinical trial of nutritional supplementation shows little effect on functional status among free-living frail elderly, J Nutr source

In the paper

“Two of the included studies found a positive effect on functional outcomes (handgrip (122) and activities of daily living ( 123)).”

What the sources say

• ?Not checked — no full text of the sourcecites [122] McMurdo, 2009, Should oral nutritional supplementation be given to undernourished older people upon hospital discharge? A controlled trial, J Am Geriatr Soc source
• ?Not checked — no full text of the sourcecites [123] Woo, 1994, Nutritional status of elderly patients during recovery from chest infection and the role of nutritional supplementation assessed by a prospective randomized single-blind trial, Age Ageing source

In the paper

“Nevertheless, insufficient dietary intake is described in older persons with dysphagia receiving texture-modified diets (20)(21)(22)107).”

What the sources say

• ?Not checked — no full text of the sourcecites [20] Bannerman, 2011, Dietary and fluid intakes of older adults in care homes requiring a texture modified diet: the role of snacks, J Am Med Dir Assoc source
• ?Not checked — no full text of the sourcecites [21] Wright, 2005, Comparison of energy and protein intakes of older people consuming a texture modified diet with a normal hospital diet, J Hum Nutr Diet source
• ?Not checked — no full text of the sourcecites [22] Nowson, 2003, Energy, protein, calcium, vitamin D and fibre intakes from meals in residential care establishments in Australia, Asia Pac J Clin Nutr

In the paper

“Thus, nutritional interventions are likely to need time to be effective on nutritional status and other clinical outcomes.”

In the paper

“This effect was no longer observed in the updated review in 2009 (119), and this issue was not addressed in other SLRs.”

What the sources say

• ?Not checked — no full text of the sourcecites [119] Milne, 2009, Protein and energy supplementation in elderly people at risk from malnutrition, Cochrane Database Syst Rev source

In the paper

“High protein ONS that provided > 400 kcal/day (16 trials) contained in mean 29% of protein (20 -40%).”

In the paper

“Food fortification (or dietary enrichment) by using natural foods (e.g.oil, cream, butter, eggs) or specific nutrient preparations (e.g.maltodextrin, protein powder) can increase energy and protein density of meals and beverages and thus enable an increased intake by eating similar amounts of food.”

In the paper

“At present, also no studies about the effects of enrichment of texture-modified diets are available”

In the paper

“All we know about EN therefore mainly comes from observational trials.”

In the paper

“Compliance was higher in older than in younger patients.”

What the sources say

• ?Not checked — no full text of the sourcecites [127] Hubbard, 2012, A systematic review of compliance to oral nutritional supplements, Clin Nutr source

In the paper

“However, sufficient data in patients without dysphagia are not available.”

In the paper

“Most patients on EN can consume some amount of food and drinks orally.”

In the paper

“Complication rates of EN are reported to be generally low (160), but in individual patients, both nasogastric tube feeding and PEG feeding may be harmful (136, 161).”

What the sources say

• ?Not checked — no full text of the sourcecites [160] Schrag, 2007, Complications related to percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review, J Gastrointestin Liver Dis

In the paper

“Several risk factors for early mortality after PEG insertion were identified, e.g.dementia, urinary tract infection, previous aspiration and diabetes (132-136, 149, 156-159).”

What the sources say

• ?Not checked — no full text of the sourcecites [132] Sanders, 2000, Survival analysis in percutaneous endoscopic gastrostomy feeding: a worse outcome in patients with dementia, Am J Gastroenterol source
• ?Not checked — no full text of the sourcecites [133] Light, 1995, Predictive factors for early mortality after percutaneous endoscopic gastrostomy, Gastrointest Endosc source
• ?Not checked — no full text of the sourcecites [134] Rimon, 2005, Percutaneous endoscopic gastrostomy; evidence of different prognosis in various patient subgroups, Age Ageing source
• ?Not checked — no full text of the sourcecites [135] Gaines, 2009, Dementia and cognitive impairment are not associated with earlier mortality after percutaneous endoscopic gastrostomy, J Parenter Enteral Nutr source
• ?Not checked — no full text of the sourcecites [136] Wirth, 2012, Complications and mortality after percutaneous endoscopic gastrostomy in geriatrics: a prospective multicenter observational trial, J Am Med Dir Assoc source
• ?Not checked — no full text of the sourcecites [149] Nair, 2000, Hypoalbuminemia is a poor predictor of survival after percutaneous endoscopic gastrostomy in elderly patients with dementia, Am J Gastroenterol source
• ?Not checked — no full text of the sourcecites [156] Abuksis, 2000, Percutaneous endoscopic gastrostomy: high mortality rates in hospitalized patients, Am J Gastroenterol source
• ?Not checked — no full text of the sourcecites [157] Chong, 2006, Percutaneous endoscopic gastrostomy outcomes: can patient profiles predict mortality and weaning?, Singap Med J
• ?Not checked — no full text of the sourcecites [158] Janes, 2005, Percutaneous endoscopic gastrostomy: 30-day mortality trends and risk factors, J Postgrad Med
• ?Not checked — no full text of the sourcecites [159] Shah, 2005, Survival after percutaneous endoscopic gastrostomy: the role of dementia, J Nutr Health Aging

In the paper

“In general, frequent dislodgement of nasogastric tubes is associated with poor EN, which is a concern when using nasogastric tubes.”

In the paper

“These data do not J o u r n a l P r e -p r o o f support a policy of early initiation of PEG feeding in dysphagic stroke patients.”

In the paper

“It was shown and it is obvious that immobilization of the subject leads to loss of fat-free mass and notably skeletal muscle mass, in particular in older persons (80).”

What the sources say

• ?Not checked — no full text of the sourcecites [80] Kortebein, 2007, Effect of 10 days of bed rest on skeletal muscle in healthy older adults, JAMA source

In the paper

“There is some evidence that older adults with low-intake dehydration have poorer outcomes than those who are well-hydrated (215).”

What the sources say

• ?Not checked — no full text of the sourcecites [215] Lindner, 2009, Tonicity balance in patients with hypernatremia acquired in the intensive care unit, Am J Kidney Dis source

In the paper

“To date, there is not sufficient evidence that special ONS (e.g.high in protein) has additional beneficial effects for these patients.”

In the paper

“When indicated, PN should be initiated immediately due to the risk of loss of independence in older patients and because even short-term starvation in the acutely ill older person leads to loss of lean body mass which can be critical especially in older patients.”

In the paper

“A large overlap between the risk of malnutrition according to common screening tools and the risk of RFS was observed in the same patient group ( 174”

What the sources say

• ?Not checked — no full text of the sourcecites [174] Pourhassan, 2017, Risk factors of refeeding syndrome in malnourished older hospitalized patients, Clin Nutr source

In the paper

“and one showed an associated doubling in risk of 4-year disability (217).”

What the sources say

• ?Not checked — no full text of the sourcecites [217] Stookey, 2004, Plasma hypertonicity: another marker of frailty?, J Am Geriatr Soc source

In the paper

“Age per se is not a reason to exclude patients from PN.”

In the paper

“182) included one RCT of low quality that evaluated three days of perioperative peripheral PN followed by seven days of ONS compared with standard care in 80 patients with a fractured hip (184, 185).”

What the sources say

• ?Not checked — no full text of the sourcecites [184] Eneroth, 2005, Insufficient fluid and energy intake in hospitalised patients with hip fracture. A prospective randomised study of 80 patients, Clin Nutr source
• ?Not checked — no full text of the sourcecites [185] Eneroth, 2006, Nutritional supplementation decreases hip fracture-related complications, Clin Orthop Relat Res source

In the paper

“In addition, sedation and physical restraints may also lead to cognitive deterioration and should, therefore, be avoided.”

In the paper

“This shorttime combined intervention increased total fluid and energy intake to near-optimal levels during the hospital stay.”

What the sources say

• ?Not checked — no full text of the sourcecites [185] Eneroth, 2006, Nutritional supplementation decreases hip fracture-related complications, Clin Orthop Relat Res source

In the paper

“This poor ability to assess drink intake in residential and nursing care facilities has been reported numerous times (232-235).”

What the sources say

• ?Not checked — no full text of the sourcecites [232] Chidester, 1997, Fluid intake in the institutionalized elderly [corrected] [published erratum appears in J AM DIET ASSOC 1997 Jun; 97(6): 584], J Am Diet Assoc source
• ?Not checked — no full text of the sourcecites [233] Kayser-Jones, 1999, Factors contributing to dehydration in nursing homes: inadequate staffing and lack of professional supervision, J Am Geriatr Soc source
• ?Not checked — no full text of the sourcecites [234] Reid, 2004, Improving the monitoring and assessment of fluid balance, Nurs Times
• ?Not checked — no full text of the sourcecites [235] Simmons, 2000, Nutritional intake monitoring for nursing home residents: a comparison of staff documentation, direct observation, and photography methods, J Am Geriatr Soc source

In the paper

“Clinical judgment is also highly fallible in older adults (227).”

What the sources say

• ?Not checked — no full text of the sourcecites [227] Thomas, 2004, Physician misdiagnosis of dehydration in older adults, J Am Med Dir Assoc source

In the paper

“Given costs and prevalence of dehydration in older people, a cut point of 295 mOsm/L will identify most adults with low-intake dehydration (sensitivity 85%, specificity 59%) and should trigger advice and support with drinking and fluid intake.”

In the paper

“For these reasons, the US Panel on Dietary Reference Intakes for Electrolytes and Water stated ''The primary indicator of hydration status is plasma or serum osmolality'' (36).”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [36] 2004

In the paper

“Moreover, the common weight-regain after a weight-reducing diet is predominantly a regain in fat mass and not in lean mass (283).”

What the sources say

• ?Not checked — no full text of the sourcecites [283] Parr, 2013, ‘Sarcobesity’: a metabolic conundrum, Maturitas source

In the paper

“On the other hand, as weight loss in older persons may have harmful effects due to the loss of lean mass (see commentary to recommendation 54), the decision for or against weight reduction shall always be taken at the individual level.”

In the paper

“Thus, older adults are at high risk of dehydration due to drinking insufficient amounts of fluids and should be encouraged to consume adequate amounts of drinks.”

In the paper

“Strict dietary regimens, like diets with very low energy intake (<1000 kcal/day), are strongly discouraged in the older population due to the risk of developing malnutrition and promoting functional decline (60,278,283).”

What the sources say

• ?Not checked — no full text of the sourcecites [60] Zeanandin, 2012, Impact of restrictive diets on the risk of undernutrition in a free-living elderly population, Clin Nutr source
• ?Not checked — no full text of the sourcecites [278] Villareal, 2005, Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, the Obesity Society, Obesity source
• ?Not checked — no full text of the sourcecites [283] Parr, 2013, ‘Sarcobesity’: a metabolic conundrum, Maturitas source

In the paper

“There is a common myth, which should be J o u r n a l P r e -p r o o f dispelled, that in order to be hydrated we need to drink plain water -this is not the case.”

In the paper

“Some studies show that a substantial weight loss has frequently occurred before the initiation of EN, i.e. on average 11.4 kg in the study byLoser et al. (128, 136).”

What the sources say

• ?Not checked — no full text of the sourcecites [128] Loser, 1998, Enteral long-term nutrition via percutaneous endoscopic gastrostomy (PEG) in 210 patients a four-year prospective study, Dig Dis Sci source
• ?Not checked — no full text of the sourcecites [136] Wirth, 2012, Complications and mortality after percutaneous endoscopic gastrostomy in geriatrics: a prospective multicenter observational trial, J Am Med Dir Assoc source

In the paper

“Although this result was not statistically significant, this trend is an additional argument for early initiation of EN, in the absence of evidence from other randomized trials.”