Effectiveness of nutritional interventions in older adults at risk of malnutrition across different health care settings: Pooled analyses of individual participant data from nine randomized controlled trials

Ilse Reinders, Dorothee Volkert, Lisette C. P. G. M. de Groot, Anne Marie Beck, Ilana Feldblum, Inken Jobse, Floor Neelemaat, Marian A. E. de van der Schueren, Danit R. Shahar, Ellen T. H. C. Smeets, Michael Tieland, Jos W. R. Twisk, Hanneke A. H. Wijnhoven, Marjolein Visser

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background & aims: Protein-energy malnutrition is a health concern among older adults. Improving nutritional status by increasing energy and protein intake likely benefits health. We therefore aimed to investigate effects of nutritional interventions in older adults (at risk of malnutrition) on change in energy intake and body weight, and explore if the intervention effect was modified by study or participants’ characteristics, analysing pooled individual participant data. Methods: We searched for RCTs investigating the effect of dietary counseling, oral nutritional supplements (ONS) or both on energy intake and weight. Principle investigators of eligible studies provided individual participant data. We investigated the effect of nutritional intervention on meaningful increase in energy intake (>250 kcal/day) and meaningful weight gain (>1.0 kg). Logistic generalized estimating equations were performed and ORs with 95% CIs presented. Results: We included data of nine studies with a total of 990 participants, aged 79.2 ± 8.2 years, 64.5% women and mean baseline BMI 23.9 ± 4.7 kg/m2. An non-significant intervention effect was observed for increase in energy intake (OR:1.59; 95% CI 0.95, 2.66) and a significant intervention effect for weight gain (OR:1.58; 95% CI 1.16, 2.17). Stratifying by type of intervention, an intervention effect on increase in energy intake was only observed for dietary counseling in combination with ONS (OR:2.28; 95% CI 1.90, 2.73). The intervention effect on increase in energy intake was greater for women, older participants, and those with lower BMI. Regarding weight gain, an intervention effect was observed for dietary counseling (OR:1.40; 95% CI 1.14, 1.73) and dietary counseling in combination with ONS (OR:2.48; 95% CI 1.92, 3.31). The intervention effect on weight gain was not influenced by participants’ characteristics. Conclusions: Based on pooled data of older adults (at risk of malnutrition), nutritional interventions have a positive effect on energy intake and body weight. Dietary counseling combined with ONS is the most effective intervention.
Original languageEnglish
JournalClinical Nutrition
Early online date2018
DOIs
Publication statusPublished - 2 Aug 2018

Cite this

Reinders, Ilse ; Volkert, Dorothee ; de Groot, Lisette C. P. G. M. ; Beck, Anne Marie ; Feldblum, Ilana ; Jobse, Inken ; Neelemaat, Floor ; de van der Schueren, Marian A. E. ; Shahar, Danit R. ; Smeets, Ellen T. H. C. ; Tieland, Michael ; Twisk, Jos W. R. ; Wijnhoven, Hanneke A. H. ; Visser, Marjolein. / Effectiveness of nutritional interventions in older adults at risk of malnutrition across different health care settings: Pooled analyses of individual participant data from nine randomized controlled trials. In: Clinical Nutrition. 2018.
@article{abeef1f1b037427d83616d0fccb6667d,
title = "Effectiveness of nutritional interventions in older adults at risk of malnutrition across different health care settings: Pooled analyses of individual participant data from nine randomized controlled trials",
abstract = "Background & aims: Protein-energy malnutrition is a health concern among older adults. Improving nutritional status by increasing energy and protein intake likely benefits health. We therefore aimed to investigate effects of nutritional interventions in older adults (at risk of malnutrition) on change in energy intake and body weight, and explore if the intervention effect was modified by study or participants’ characteristics, analysing pooled individual participant data. Methods: We searched for RCTs investigating the effect of dietary counseling, oral nutritional supplements (ONS) or both on energy intake and weight. Principle investigators of eligible studies provided individual participant data. We investigated the effect of nutritional intervention on meaningful increase in energy intake (>250 kcal/day) and meaningful weight gain (>1.0 kg). Logistic generalized estimating equations were performed and ORs with 95{\%} CIs presented. Results: We included data of nine studies with a total of 990 participants, aged 79.2 ± 8.2 years, 64.5{\%} women and mean baseline BMI 23.9 ± 4.7 kg/m2. An non-significant intervention effect was observed for increase in energy intake (OR:1.59; 95{\%} CI 0.95, 2.66) and a significant intervention effect for weight gain (OR:1.58; 95{\%} CI 1.16, 2.17). Stratifying by type of intervention, an intervention effect on increase in energy intake was only observed for dietary counseling in combination with ONS (OR:2.28; 95{\%} CI 1.90, 2.73). The intervention effect on increase in energy intake was greater for women, older participants, and those with lower BMI. Regarding weight gain, an intervention effect was observed for dietary counseling (OR:1.40; 95{\%} CI 1.14, 1.73) and dietary counseling in combination with ONS (OR:2.48; 95{\%} CI 1.92, 3.31). The intervention effect on weight gain was not influenced by participants’ characteristics. Conclusions: Based on pooled data of older adults (at risk of malnutrition), nutritional interventions have a positive effect on energy intake and body weight. Dietary counseling combined with ONS is the most effective intervention.",
author = "Ilse Reinders and Dorothee Volkert and {de Groot}, {Lisette C. P. G. M.} and Beck, {Anne Marie} and Ilana Feldblum and Inken Jobse and Floor Neelemaat and {de van der Schueren}, {Marian A. E.} and Shahar, {Danit R.} and Smeets, {Ellen T. H. C.} and Michael Tieland and Twisk, {Jos W. R.} and Wijnhoven, {Hanneke A. H.} and Marjolein Visser",
year = "2018",
month = "8",
day = "2",
doi = "10.1016/j.clnu.2018.07.023",
language = "English",
journal = "Clinical Nutrition",
issn = "0261-5614",
publisher = "Churchill Livingstone",

}

Effectiveness of nutritional interventions in older adults at risk of malnutrition across different health care settings: Pooled analyses of individual participant data from nine randomized controlled trials. / Reinders, Ilse; Volkert, Dorothee; de Groot, Lisette C. P. G. M.; Beck, Anne Marie; Feldblum, Ilana; Jobse, Inken; Neelemaat, Floor; de van der Schueren, Marian A. E.; Shahar, Danit R.; Smeets, Ellen T. H. C.; Tieland, Michael; Twisk, Jos W. R.; Wijnhoven, Hanneke A. H.; Visser, Marjolein.

In: Clinical Nutrition, 02.08.2018.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Effectiveness of nutritional interventions in older adults at risk of malnutrition across different health care settings: Pooled analyses of individual participant data from nine randomized controlled trials

AU - Reinders, Ilse

AU - Volkert, Dorothee

AU - de Groot, Lisette C. P. G. M.

AU - Beck, Anne Marie

AU - Feldblum, Ilana

AU - Jobse, Inken

AU - Neelemaat, Floor

AU - de van der Schueren, Marian A. E.

AU - Shahar, Danit R.

AU - Smeets, Ellen T. H. C.

AU - Tieland, Michael

AU - Twisk, Jos W. R.

AU - Wijnhoven, Hanneke A. H.

AU - Visser, Marjolein

PY - 2018/8/2

Y1 - 2018/8/2

N2 - Background & aims: Protein-energy malnutrition is a health concern among older adults. Improving nutritional status by increasing energy and protein intake likely benefits health. We therefore aimed to investigate effects of nutritional interventions in older adults (at risk of malnutrition) on change in energy intake and body weight, and explore if the intervention effect was modified by study or participants’ characteristics, analysing pooled individual participant data. Methods: We searched for RCTs investigating the effect of dietary counseling, oral nutritional supplements (ONS) or both on energy intake and weight. Principle investigators of eligible studies provided individual participant data. We investigated the effect of nutritional intervention on meaningful increase in energy intake (>250 kcal/day) and meaningful weight gain (>1.0 kg). Logistic generalized estimating equations were performed and ORs with 95% CIs presented. Results: We included data of nine studies with a total of 990 participants, aged 79.2 ± 8.2 years, 64.5% women and mean baseline BMI 23.9 ± 4.7 kg/m2. An non-significant intervention effect was observed for increase in energy intake (OR:1.59; 95% CI 0.95, 2.66) and a significant intervention effect for weight gain (OR:1.58; 95% CI 1.16, 2.17). Stratifying by type of intervention, an intervention effect on increase in energy intake was only observed for dietary counseling in combination with ONS (OR:2.28; 95% CI 1.90, 2.73). The intervention effect on increase in energy intake was greater for women, older participants, and those with lower BMI. Regarding weight gain, an intervention effect was observed for dietary counseling (OR:1.40; 95% CI 1.14, 1.73) and dietary counseling in combination with ONS (OR:2.48; 95% CI 1.92, 3.31). The intervention effect on weight gain was not influenced by participants’ characteristics. Conclusions: Based on pooled data of older adults (at risk of malnutrition), nutritional interventions have a positive effect on energy intake and body weight. Dietary counseling combined with ONS is the most effective intervention.

AB - Background & aims: Protein-energy malnutrition is a health concern among older adults. Improving nutritional status by increasing energy and protein intake likely benefits health. We therefore aimed to investigate effects of nutritional interventions in older adults (at risk of malnutrition) on change in energy intake and body weight, and explore if the intervention effect was modified by study or participants’ characteristics, analysing pooled individual participant data. Methods: We searched for RCTs investigating the effect of dietary counseling, oral nutritional supplements (ONS) or both on energy intake and weight. Principle investigators of eligible studies provided individual participant data. We investigated the effect of nutritional intervention on meaningful increase in energy intake (>250 kcal/day) and meaningful weight gain (>1.0 kg). Logistic generalized estimating equations were performed and ORs with 95% CIs presented. Results: We included data of nine studies with a total of 990 participants, aged 79.2 ± 8.2 years, 64.5% women and mean baseline BMI 23.9 ± 4.7 kg/m2. An non-significant intervention effect was observed for increase in energy intake (OR:1.59; 95% CI 0.95, 2.66) and a significant intervention effect for weight gain (OR:1.58; 95% CI 1.16, 2.17). Stratifying by type of intervention, an intervention effect on increase in energy intake was only observed for dietary counseling in combination with ONS (OR:2.28; 95% CI 1.90, 2.73). The intervention effect on increase in energy intake was greater for women, older participants, and those with lower BMI. Regarding weight gain, an intervention effect was observed for dietary counseling (OR:1.40; 95% CI 1.14, 1.73) and dietary counseling in combination with ONS (OR:2.48; 95% CI 1.92, 3.31). The intervention effect on weight gain was not influenced by participants’ characteristics. Conclusions: Based on pooled data of older adults (at risk of malnutrition), nutritional interventions have a positive effect on energy intake and body weight. Dietary counseling combined with ONS is the most effective intervention.

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U2 - 10.1016/j.clnu.2018.07.023

DO - 10.1016/j.clnu.2018.07.023

M3 - Article

JO - Clinical Nutrition

JF - Clinical Nutrition

SN - 0261-5614

ER -