Highlights
- •Oral nutritional supplementation improves functional recovery and body composition.
- •β-Hydroxy-β-methylbutyrate preserves muscle mass in elderly patients who have had a hip fracture.
- •Oral nutritional supplementation improves nutritional aspects during rehabilitation.
- •High-protein supplements and β-hydroxy-β-methylbutyrate may prevent the onset of sarcopenic obesity.
Abstract
Background and objectives
Functional deterioration and reduced mobility in elderly patients with a hip fracture
are associated with a loss of both muscle mass and function (sarcopenia). The aim
of this study was to assess whether oral nutritional supplementation (ONS) improves
muscle mass and nutritional markers (BMI, proteins) in elderly patients with hip fracture.
Methods
Patients aged 65 years and over with hip fractures admitted to either of two rehabilitation
facilities were included. Patients with diabetes, with Barthel index scores <40 prior
to the fracture or with pathological fractures were excluded. A random-numbers generator
was used to randomly allocate patients to the intervention group (IG) or the control
group (CG). Those in the IG received a standard diet plus ONS in the form of two bottles
a day of β-hydroxy-β-methylbutyrate (HMB), while those in the CG received a standard
diet only. The intervention was not blinded.
In order to assess changes in body mass index (BMI), anthropometric parameters were
recorded at both admission and discharge. Patients’ functional situation was evaluated
using the Barthel index (BI) and the Functional Ambulation Categories (FAC) score.
Muscle mass was assessed using bioelectrical impedance analysis, which allowed us
to calculate appendicular lean mass (aLM). The outcome variable was the difference
between aLM upon discharge, minus aLM upon admission (Δ-aLM).
Results
Of the 107 randomised patients (IG n55, CG n52), 49 finished the study in the IG and
43 in the CG. BMI and aLM were stable in IG patients, whilst these parametres decreased
in the CG. A significant difference was observed between the two groups (p < 0.001, and p = 0.020 respectively). The predictive factors for Δ-aLM were ONS (p = 0.006), FAC prior to fracture (p < 0.001) and BI prior to fracture (p = 0.007).
The concentration of proteins (p = 0.007) and vitamin D (p.001) had increased more in the IG than in the CG.
Conclusion
A diet enriched in HMB improves muscle mass, prevents the onset of sarcopenia and
is associated with functional improvement in elderly patients with hip fractures.
Orally administered nutritional supplements can help to prevent the onset of sarcopenic
obesity.
Trial registration: www.clinicaltrials.gov identifier: NCT01404195, registered 22 July 2011, HYPERPROT-GER Study.
Keywords
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Article info
Publication history
Published online: April 21, 2017
Accepted:
April 18,
2017
Received:
November 11,
2016
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
