Should Oral Nutritional Supplementation Be Given to Undernourished Older People upon Hospital Discharge? A Controlled Trial

Abstract

Objectives To determine whether the oral nutritional supplementation of undernourished older people upon discharge from hospital improves muscle function and reduces disability. Design Randomized controlled trial. Setting Community-based study in two centers in Scotland. Participants Two hundred fifty-three people. Intervention Randomization to oral nutritional supplementation (600 kcal/d) or control supplement of 200 kcal/d. Measurements Primary outcome (20-point activity of daily living Barthel Index) and secondary outcomes (handgrip strength, Sit-to-Stand test, and Euroquol) were measured at baseline (after discharge from the hospital and before supplement was commenced) and 8 and 16 weeks and accelerometry-measured physical activity levels at baseline and 16 weeks. Falls were recorded prospectively. Results Mean age was 82. There was no significant difference in change in Barthel score between supplement and control groups (adjusted mean difference=0.28, 95% confidence interval (CI)=-0.28-0.84). Handgrip strength improved more in the supplemented group (adjusted mean difference=1.52 kg, 95% CI=0.50-2.55; P=.004). The supplemented group exhibited modestly greater vector movement (overall activity) than controls (P=.02). There were no significant between-group differences in Sit-to-Stand test, health-related quality of life, or falls. Adherence was 38.2% in the nutritional supplement group and 50.0% in the control supplement group. Weight did not increase in the nutritional…