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Can fortified foods and snacks increase the energy and protein intake of hospitalised older patients? A systematic review.
J Hum Nutr Diet. 2018 06; 31(3):379-389.JH

Abstract

BACKGROUND

Undernutrition affects over 44% of hospitalised older people, who often dislike oral nutritional supplements (ONS). This review summarises the evidence for an alternative strategy, using energy and protein dense meals (via fortification) or snacks (supplementation) to increase the dietary energy and protein intake of older inpatients.

METHODS

A search was conducted through PubMed, EMBASE, CINAHL and the Cochrane database of systematic reviews (May 1996 to May 2016) that used fortification or supplementation to increase the energy or protein intake of patients (mean age ≥60 years) in hospitals or rehabilitation centres.

RESULTS

Ten articles (546 patients, mean age 60-83 years) were identified. Compared with usual nutritional care, six studies using either energy or protein based fortification and supplementation significantly increased intake of energy (250-450 kcal day-1) or protein (12-16 g day-1). Two studies enriched menus with both energy and protein, and significantly increased both energy (698 kcal day-1 and 21 kJ kg-1) and protein (16 g and 0.2 g kg-1) intake compared to usual care. ONS was similar to supplementation in one study but superior to fortification in another. Four studies reported good acceptability of enriched products and two studies that found they were cost-effective.

CONCLUSIONS

Compared with usual nutritional care, energy- and protein-based fortification and supplementation could be employed as an effective, well-tolerated and cost-effective intervention to improve dietary intake amongst older inpatients. This strategy may be particularly useful for patients with cognitive impairment who struggle with ONS, and clinical trials are required to compare these approaches and establish their impact on functional outcomes.

Authors+Show Affiliations

Academic Geriatric Medicine, University of Southampton, Southampton General Hospital Mailpoint, Southampton, UK.Academic Geriatric Medicine, University of Southampton, Southampton General Hospital Mailpoint, Southampton, UK.Academic Geriatric Medicine, University of Southampton, Southampton General Hospital Mailpoint, Southampton, UK. National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton, UK.Academic Geriatric Medicine, University of Southampton, Southampton General Hospital Mailpoint, Southampton, UK. National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton, UK.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

29322564

Citation

Mills, S R., et al. "Can Fortified Foods and Snacks Increase the Energy and Protein Intake of Hospitalised Older Patients? a Systematic Review." Journal of Human Nutrition and Dietetics : the Official Journal of the British Dietetic Association, vol. 31, no. 3, 2018, pp. 379-389.
Mills SR, Wilcox CR, Ibrahim K, et al. Can fortified foods and snacks increase the energy and protein intake of hospitalised older patients? A systematic review. J Hum Nutr Diet. 2018;31(3):379-389.
Mills, S. R., Wilcox, C. R., Ibrahim, K., & Roberts, H. C. (2018). Can fortified foods and snacks increase the energy and protein intake of hospitalised older patients? A systematic review. Journal of Human Nutrition and Dietetics : the Official Journal of the British Dietetic Association, 31(3), 379-389. https://doi.org/10.1111/jhn.12529
Mills SR, et al. Can Fortified Foods and Snacks Increase the Energy and Protein Intake of Hospitalised Older Patients? a Systematic Review. J Hum Nutr Diet. 2018;31(3):379-389. PubMed PMID: 29322564.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Can fortified foods and snacks increase the energy and protein intake of hospitalised older patients? A systematic review. AU - Mills,S R, AU - Wilcox,C R, AU - Ibrahim,K, AU - Roberts,H C, Y1 - 2018/01/10/ PY - 2018/1/13/pubmed PY - 2019/11/7/medline PY - 2018/1/12/entrez KW - fortified KW - hospital KW - malnutrition KW - older patients KW - snacks KW - supplementation SP - 379 EP - 389 JF - Journal of human nutrition and dietetics : the official journal of the British Dietetic Association JO - J Hum Nutr Diet VL - 31 IS - 3 N2 - BACKGROUND: Undernutrition affects over 44% of hospitalised older people, who often dislike oral nutritional supplements (ONS). This review summarises the evidence for an alternative strategy, using energy and protein dense meals (via fortification) or snacks (supplementation) to increase the dietary energy and protein intake of older inpatients. METHODS: A search was conducted through PubMed, EMBASE, CINAHL and the Cochrane database of systematic reviews (May 1996 to May 2016) that used fortification or supplementation to increase the energy or protein intake of patients (mean age ≥60 years) in hospitals or rehabilitation centres. RESULTS: Ten articles (546 patients, mean age 60-83 years) were identified. Compared with usual nutritional care, six studies using either energy or protein based fortification and supplementation significantly increased intake of energy (250-450 kcal day-1) or protein (12-16 g day-1). Two studies enriched menus with both energy and protein, and significantly increased both energy (698 kcal day-1 and 21 kJ kg-1) and protein (16 g and 0.2 g kg-1) intake compared to usual care. ONS was similar to supplementation in one study but superior to fortification in another. Four studies reported good acceptability of enriched products and two studies that found they were cost-effective. CONCLUSIONS: Compared with usual nutritional care, energy- and protein-based fortification and supplementation could be employed as an effective, well-tolerated and cost-effective intervention to improve dietary intake amongst older inpatients. This strategy may be particularly useful for patients with cognitive impairment who struggle with ONS, and clinical trials are required to compare these approaches and establish their impact on functional outcomes. SN - 1365-277X UR - https://www.unboundmedicine.com/medline/citation/29322564/Can_fortified_foods_and_snacks_increase_the_energy_and_protein_intake_of_hospitalised_older_patients_A_systematic_review_ L2 - https://doi.org/10.1111/jhn.12529 DB - PRIME DP - Unbound Medicine ER -