Background: The worldwide ageing demographic trend has resulted in a growing number of frail elderly who are in the last stages of autonomous living. Oral nutritional interventions for the frail elderly address the body’s natural weight loss, sometimes reversing weight loss, though the literature is not of one accord. No review of nutritional interventions has been conducted for community-dwelling frail elderly, who are most likely to benefit from these interventions and delay adverse outcomes. Objective: (i) This systematic review analyzes results from randomized controlled trials of oral nutrition interventions for the community-dwelling frail elderly to determine their efficacy in making gains in nutritional and functional status. (ii) The secondary objective is to analyze the quality of the studies in this review and draw conclusions for further areas of development in the field of nutrition in elderly care. Methods: Randomized controlled trials of oral nutritional supplements were searched in The Cochrane Library and PubMed, and hand searched in reference lists of systematic reviews. These interventions targeted protein-energy deficiency and included oral supplementation or supplementation paired with exercise compared to a placebo or usual practice. Community-dwelling frail elderly not institutionalized or hospitalized were eligible. Studies targeting disease-specific elderly were excluded. Results: Out of 120 search results, six trials were included in this review. A small weight gain from oral nutritional interventions among frail community-dwelling elderly was reported in five out of six studies. Functional status did not improve significantly with the interventions. Studies used unstandardized definitions and different ways to measure outcomes, resulting in heterogeneity. Conclusions: The few and poor quality of studies demonstrates the need for more studies of better quality and homogeneity assessing oral nutritional interventions for nutritional and functional gain in frail elderly who are not yet suffering from adverse outcomes. / published_or_final_version / Public Health / Master / Master of Public Health

Hypothesis. We hypothesized that contrary to "normal aging," frail elderly women would have a heightened resting energy expenditure per kg fat free mass (REE/kg FFM) and thermic effect of food (TEF) response. / Methods. 13 healthy (H) [X +/- SEM: 81.4 +/- 1.1 yr] and 9 frail elderly women (F) [84.7 +/- 1.6 yr], free from acute conditions underwent REE and TEF measurements (liquid standard mixed meal: 720 kcal, 58% carbohydrate, 14% protein, 28% fat) using ventilated hood indirect calorimetry. Anthropometric and body composition measurements, thyroid hormones, cortisol, cytokines and catecholamine concentrations, and physical activity (PASE) and mobility ("time up and go" TUG) scores were related to the results obtained. / Results. H had a faster TUG: 10.2 +/- 1.6 vs. 21.0 +/- 9.3 s (p=0.001), greater PASE score: 179.2 +/- 116.1 vs. 47.1 +/- 26.2 (p=0.003), greater triiodothyronine [T3]: 5.1 +/- 0.6 vs. 4.3 +/- 0.4 rhomol/L (p=0.003) and lower cortisol concentrations: 351.1 +/- 19.9 vs. 474.5 +/- 43.6 nmol/L (p=0.011). In H vs. F: REE/kg FFM was 1044 +/- 20.4, 1021 +/- 23.7 kcal/day (NS) and TEF response as expressed as % of REE was 18.4 +/- 5.6, 19.5 +/- 4.2 (NS). The time course of glucose (p=0.043) and insulin from 90 minutes onwards (P=0.013) suggested insulin resistance in F. REE was positively correlated with FFM, percent body fat and [T3] (r>0.499, p<0.021). / Conclusion. REE/kg FFM and TEF response was not different between H and F and thus the greater prevalence of malnutrition in F, cannot be explained by these parameters.

We assessed the nutritional status and physical function of 121 women (79.4 +/- 6.6 y, 26.8 +/- 5.6 kg/m2) and 61 men (78.6 +/- 8.3 y, 26.6 +/- 4.7 kg/m2) participating in the Geriatric Day Hospital. According to a composite index of malnutrition, 19% of them were found malnourished whereas the Mini-Nutritional Assessment, a validated nutritional screening tool, found that 56% of the elderly were malnourished or at risk for malnutrition. Malnourished persons, as determined by the composite index, had a lower lean body mass (LBM) by bioelectrical impedance analysis compared with the well-nourished group (40.5 +/- 9.7 vs. 42.0 +/- 8.7 kg, p = 0.0001). LBM correlated significantly with handgrip strength (r = 0.34, p = 0.0001) but not with gait speed (r = 0.04, p = 0.27). There were no significant differences between nutritional states for any of the two tests of physical function. The score of the MNA, correlated with gait speed (r = 0.24, p = 0.02) but the performance at the physical tests was not different according to the nutritional status defined by this tool. We conclude that malnutrition is relatively prevalent among frail persons participating in the Geriatric Day Hospital and that malnutrition is one among many other factors that contribute to their low level of physical performance. As such, a nutritional intervention may be of benefit in improving the physical function of frail elderly persons who are malnourished.

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