Early nutritional support and physiotherapy improved long-term self-sufficiency in acutely ill older patients
Abstract
Objective An acute disease is regularly associated with inflammation, decreased food intake, and low physical activity; the consequence is loss of muscle mass. However, the restoration of muscle tissue is problematic, especially in older patients. Loss of muscle mass leads to further decrease of physical activity which leads, together with recurring disease, to the progressive muscle mass loss accompanied by loss of self-sufficiency. Early nutrition support and physical activity could reverse this situation. Therefore, the aim of this study was to determine whether an active approach based on early nutritional therapy and exercise would influence the development of sarcopenia and impaired self-sufficiency during acute illness. Methods Two hundred patients >78 y were admitted to a hospital internal medicine department and participated in a prospective, randomized controlled study. The patients were randomized to a control group receiving standard treatment (n = 100) or to an intervention group (n = 100). The intervention consisted of nutritional supplements (600 kcal, 20 g/d protein) added to a standard diet and a simultaneous intensive rehabilitation program. The tolerance of supplements and their influence on spontaneous food intake, self-sufficiency, muscle strength, and body composition were evaluated during the study period. The patients were then regularly monitored for 1 y post-discharge. Results The provision of nutritional supplements together with early rehabilitatio…
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Hegerov a el al. found that ONS combined with physiotherapy did not negatively affect hospital food consumption (72.8% in the intervention group vs 71.3% in the control group, p=0.528).
“without negatively affecting the hospital food consumption (72.8% in the IG vs. 71.3% in the CG, p ¼ 0.528) [33] (Level of evidence 1þþ).”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [33]
Hegerov a el al. conducted a prospective RCT in 200 inpatients from an internal medicine department and found that provision of ONS combined with physiotherapy increased overall nutritional intake, mainly energy (1954 ± 429 kcal in the intervention group vs 1401 ± 364 kcal, p<0.001) and protein (76.3 ±16.1 in the intervention group vs 55.5 ±13.7 in the control group, p<0.001), without negatively影响
“Hegerov a el al. conducted a prospective RCT in 200 inpatients from an internal medicine department and found that the provision of ONS (combined with physiotherapy) increased the overall nutritional intake, mainly energy (1954 ± 429 kcal in the IG vs. 1401 ± 364 kcal, p < 0.001) and protein (76.3 in the IG ±16.1 vs. 55.5 in the CG ±13.7, p < 0.001), without negatively affecting the hospital food”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [33]
The Hegerov a el al. supplementation resulted in significant preservation of independence (the difference in Barthel Index values between admission and three months showed a statistically significant decline in the control group (p<0.01) vs a non-significant decline in the intervention group).
“This supplementation resulted in significant preservation of muscle mass (lean body mass difference between admission and three months after discharge was À3.5 kg in CG patients, and þ1.3 in the IG) and independence (the difference in the Barthel Index (BI) values between admission and three months showed a statistically significant decline in the CG (p < 0.01) vs. a non-significant decline in the”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [33]
The Hegerov a el al. supplementation resulted in significant preservation of muscle mass (lean body mass difference between admission and three months after discharge was -3.5 kg in control group patients and +1.3 in the intervention group).
“This supplementation resulted in significant preservation of muscle mass (lean body mass difference between admission and three months after discharge was À3.5 kg in CG patients, and þ1.3 in the IG) and independence (the difference in the Barthel Index (BI) values between admission and three months showed a statistically significant decline in the CG (p < 0.01) vs. a non-significant decline in the”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [33]
In a prospective RCT of polymorbid medical inpatients, adding ONS (600 kcal, 20 g/day protein) to standard diet from day 1 of hospitalization with intensive rehabilitation prevented the decrease in lean body mass seen in the control group during hospital stay.
“The amount of lean body mass in CG patients decreased during their hospital stay but did not change in the IG.”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [33]
Lean body mass did not reach its original value even twelve months post-discharge in the control group, but it did in the intervention group.
“Lean body mass did not reach its original value even twelve months post-discharge in the CG, but it did in the IG.”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [33]
Three months postdischarge, lean body mass was 3.5 kg lower in the control group but only 0.4 kg lower in the treated group.
“Three months postdischarge, lean body mass was 3.5 kg lower in the CG but only 0.4 kg lower in the treated group.”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [33]
Self-sufficiency measured by BI diminished during annual monitoring in both groups, but the decline was sharper in the control group.
“Regarding self-sufficiency (measured by independency in the activities of daily living through the BI, it diminished during the course of annual monitoring in both groups of patients, but the decline was sharper in the CG”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [33]
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References 27 · Cited by 73
- Authors
- Hegerová, P., Dědková, Z., & Sobotka, L.
- Affiliations
- Charles University (CZ)
- ORCID
- Hegerová, Petra
- Venue
- Nutrition
- Publisher
- Elsevier BV
- Published
- 2015-01
- Volume
- 31
- Issue
- 1
- Pages
- 166-170
- ISSN
- 0899-9007 (ISSN-L)
- OpenAlex
- W2089570508
- Cited by
- 73
- References
- 27
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 6 · 2023: 8 · 2022: 7 · 2021: 7 · 2020: 7 · 2019: 10 · 2018: 4 · 2017: 8 · 2016: 5 · 2015: 2 · 2014: 2
- FWCI
- 3.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Health Professions › Speech and Hearing › Dysphagia Assessment and Management
- Keywords
- sarcopenia, elderly patients, acute illness, dietary supplementation, protein supplementation, early rehabilitation, physiotherapy, muscle mass loss, self-sufficiency, functional independence, muscle strength, lean body mass, dietary intake, post-discharge recovery
- MeSH terms
- Aged, Aged, 80 and over, Body Composition, Energy Intake, Dietary Proteins, Humans, Nutritional Status, Prospective Studies, Quality of Life, Exercise, Body Mass Index, Critical Illness, Muscle, Skeletal, Nutritional Support, Dietary Supplements, Physical Therapy Modalities, Muscle Strength, Sarcopenia
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