Top

BMC Geriatrics

Published in:

Open Access 01-12-2022 | Nutrition | Research

Effect of individually tailored nutritional counselling on protein and energy intake among older people receiving home care at risk of or having malnutrition: a non-randomised intervention study

Authors: Tarja Kaipainen, Sirpa Hartikainen, Miia Tiihonen, Irma Nykänen

Published in: BMC Geriatrics | Issue 1/2022

Abstract

Background

With ageing, food intake may decrease and lead to an insufficient nutrient intake causing protein-energy malnutrition (PEM) which is associated with adverse health effects and increased mortality. The aim of this study was to investigate the effects of individually tailored dietary counseling focused on protein intake among home care clients with PEM or at risk of developing PEM. The secondary aim was to study the intake of energy and other nutrients.

Methods

This intervention study is part of the non-randomised population-based multidisciplinary Nutrition, Oral Health and Medication study (NutOrMed study). The intervention group comprised 112 and the control group 87 home care clients (≥75 years) with PEM or risk of PEM. PEM was defined by Mini Nutritional Assessment score < 24 and/or plasma albumin < 35 g/L. The nutrients intake was assessed from 24-hour dietary recall at the baseline and after the six-month intervention. The intervention consisted of an individually tailored dietary counseling; the persons were instructed to increase their food intake with protein and energy dense food items, the number of meals and consumption of protein-, energy- and nutrient-rich snacks for six months.

Results

After the six-month nutritional intervention, the mean change in protein intake increased 0.04 g/kgBW (95% CI 0.05 to 0.2), fibre 0.8 g (95% CI 0.2 to 4.3), vitamin D 8.5 μg (95% CI 0.7 to 4.4), E 0.6 mg (95% CI 0.4 to 2.2), B12 0.7 μg (95% CI 0.02 to 2.6), folate 8.7 μg (95% CI 1.5 to 46.5), iron 0.4 mg 95% CI 0.6 to 2.4), and zinc 0.5 mg (95% CI 0.6 to 2.2) in the intervention group compared with the control group. The proportion of those receiving less than 1.0 g/kg/BW protein decreased from 67 to 51% in the intervention group and from 84 to 76% in the control group. Among home care clients with a cognitive decline (MMSE< 18), protein intake increased in the intervention group by 0.2 g/kg/BW (p = 0.048) but there was no change in the control group.

Conclusion

An individual tailored nutritional intervention improves the intake of protein and other nutrients among vulnerable home care clients with PEM or its risk and in persons with cognitive decline.

Trial registration

ClinicalTrials.gov: NCT02214758. Date of trial registration: 12/08/2014.

Crichton M, Craven D, Mackay H, Marx W, de van der Schueren M, Marshall S. A systematic review, meta-analysis and meta-regression of the prevalence of protein-energy malnutrition: associations with geographical region and sex. Age Ageing. 2019;48(1):38–48. https://doi.org/10.1093/ageing/afy144.

Finnish institute for health and welfare. Older people services undergoing a change – Home care. 2019. https://thl.fi/en/web/ageing/older-people-services-undergoing-a-change/home-care.

van der Pols-Vijlbrief R, Wijnhoven HA, Schaap LA, Terwee CB, Visser M. Determinants of protein-energy malnutrition in community-dwelling older adults: a systematic review of observational studies. Ageing Res Rev. 2014;18:112–31. https://doi.org/10.1016/j.arr.2014.09.001.CrossRefPubMed

Engelheart S, Akner G. Dietary intake of energy, nutrients and water in elderly people living at home or in nursing home. J Nutr Health Aging. 2015;19(3):265–72. https://doi.org/10.1007/s12603-015-0440-0.CrossRefPubMed

Borg S, Verlaan S, Hemsworth J, Mijnarends DM, Schols JM, Luiking YC, et al. Micronutrient intakes and potential inadequacies of community-dwelling older adults: a systematic review. Br J Nutr. 2015;113(8):1195–206. https://doi.org/10.1017/S0007114515000203.CrossRefPubMedPubMedCentral

Robinson SM, Reginster JY, Rizzoli R, Shaw SC, Kanis JA, Bautmans I, et al. Does nutrition play a role in the prevention and management of sarcopenia? Clin Nutr. 2018;37(4):1121–32. https://doi.org/10.1016/j.clnu.2017.08.016.CrossRefPubMed

Engelheart S, Brummer RJ, Bertéus FH. Meal patterns in relation to energy and protein intake in older adults in home health care. Clin Nutr ESPEN. 2020;35:180–7. https://doi.org/10.1016/j.clnesp.2019.10.003.CrossRefPubMed

Marshall S, Craven D, Kelly J, Isenring E. A systematic review and meta-analysis of the criterion validity of nutrition assessment tools for diagnosing protein-energy malnutrition in the older community setting (the MACRo study). Clin Nutr. 2018;37(6):1902–12. https://doi.org/10.1016/j.clnu.2017.09.022.CrossRefPubMed

Guyonnet S, Rolland Y. Screening for Malnutrition in Older People. Clin Geriatr Med. 2015;31(3):429–37. https://doi.org/10.1016/j.cger.2015.04.009.CrossRefPubMed

10.

Volkert D, Beck AM, Cederholm T, Cruz-Jentoft A, Goisser S, Hooper L, et al. ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr. 2019;38(1):10–47. https://doi.org/10.1016/j.clnu.2018.05.024.CrossRefPubMed

11.

Leij-Halfwerk S, Verwijs MH, van Houdt S, Borkent JW, Guaitoli PR, Pelgrim T, et al. Prevalence of protein-energy malnutrition risk in European older adults in community, residential and hospital settings, according to 22 malnutrition screening tools validated for use in adults ≥65 years: A systematic review and meta-analysis. Maturitas. 2019;126:80–9. https://doi.org/10.1016/j.maturitas.2019.05.006.CrossRefPubMed

12.

van der Pols-Vijlbrief R, Wijnhoven HAH, Bosmans JE, Twisk JWR, Visser M. Targeting the underlying causes of undernutrition. Cost-effectiveness of a multifactorial personalized intervention in community-dwelling older adults: A randomized controlled trial. Clin Nutr. 2017;36(6):1498–508. https://doi.org/10.1016/j.clnu.2016.09.030.

13.

Sieber CC. Malnutrition and sarcopenia. Aging Clin Exp Res. 2019;31(6):793–8. https://doi.org/10.1007/s40520-019-01170-1.CrossRefPubMed

14.

Marshall S, Agarwal E, Young A, Isenring E. Role of domiciliary and family carers in individualised nutrition support for older adults living in the community. Maturitas. 2017;98:20–9. https://doi.org/10.1016/j.maturitas.2017.01.004.CrossRefPubMed

15.

Volkert D, Chourdakis M, Faxen-Irving G, Frühwald T, Landi F, Suominen MH, et al. Espen guidelines on nutrition in dementia. Clin Nutr. 2015;34(6):1052–73. https://doi.org/10.1016/j.clnu.2015.09.004.CrossRefPubMed

16.

Pölönen S, Tiihonen M, Hartikainen S, Nykänen I. Individually Tailored Dietary Counseling among Old Home Care Clients - Effects on Nutritional Status. J Nutr Health Aging. 2017;21(5):567–72. https://doi.org/10.1007/s12603-016-0815-x.CrossRefPubMed

17.

Stow R, Ives N, Smith C, Rick C, Rushton A. A cluster randomised feasibility trial evaluating nutritional interventions in the treatment of malnutrition in care home adult residents. Trials. 2015;16:433. https://doi.org/10.1186/s13063-015-0952-2.CrossRefPubMedPubMedCentral

18.

Tiihonen M, Autonen-Honkonen K, Ahonen R, Komulainen K, Suominen L, Hartikainen S, et al. NutOrMed -optimising nutrition, oral health and medication for older home care clients-study protocol. BMC Nutrition. 2015;1:13. https://doi.org/10.1186/s40795-015-0009-7.CrossRef

19.

Finnish institute for health and welfare. Vitality in later years– food recommendation for older adults. 2020;9:15.

20.

AivoDiet by Mashie, Turku, Finland.

21.

Guigoz Y, Vellas B, Garry PJ. Assessing the nutritional status of the elderly: The mini nutritional assessment as part of the geriatric evaluation. Nutr Rev. 1996;54(1 Pt 2):S59–65. https://doi.org/10.1111/j.1753-4887.1996.tb03793.x.

22.

Guigoz Y, Lauque S, Vellas BJ. Identifying the elderly at risk for malnutrition. The mini nutritional assessment. Clin Geriatr Med. 2002;18(4):737–57. https://doi.org/10.1016/s0749-0690(02)00059-9.

23.

Soini H, Routasalo P, Lagström H. Characteristics of the Mini-Nutritional Assessment in elderly home-care patients. Eur J Clin Nutr. 2004;58(1):64–70. https://doi.org/10.1038/sj.ejcn.1601748.CrossRefPubMed

24.

Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S, et al. The mini nutritional assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition. 1999;15(2):116–22. https://doi.org/10.1016/s0899-9007(98)00171-3.CrossRefPubMed

25.

Bassey EJ. Demi-span as a measure of skeletal size. Ann Hum Biol. 1986;13(5):499–502.CrossRef

26.

Hickson M, Frost G. A comparison of three methods for estimating height in the acutely ill elderly population. J Hum Nutr Diet. 2003;16(1):13–20.CrossRef

27.

Cabrerizo S, Cuadras D, Gomez-Busto F, Artaza-Artabe I, Marin-Ciancas F, Malafarina V. Serum albumin and health in older people: Review and meta-analysis. Maturitas. 2015;81(1):17–27. https://doi.org/10.1016/j.maturitas.2015.02.009.CrossRefPubMed

28.

Groll DL, To T, Bombardier C, Wright JG. The development of a comorbidity index with physical function as the outcome. J Clin Epidemiol. 2005;58(6):595–602. https://doi.org/10.1016/j.jclinepi.2004.10.018.CrossRefPubMed

29.

Tikkanen P, Nykänen I, Lönnroos E, Sipilä S, Sulkava R, Hartikainen S. Physical Activity at Age of 20–64 Years and Mobility and Muscle Strength in Old Age: A Community-Based Study. J Gerontol A Biol Sci Med Sci. 2012;67(8):905–10. https://doi.org/10.1093/gerona/gls005.CrossRefPubMed

30.

Sheikh JI, Yesavage JA. Geriatric Depression Scale (GDS). Recent evidence and development of a shorter version. Clin Gerontol. 1986;5(1-2):165–73. https://doi.org/10.1300/J018v05n01_09.

31.

Mahoney FI, Barthel DW. Functional evaluation: The Barthel index. Maryland State Med J. 1965;14:61–5.

32.

Lawton MP, Brody EM. Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3):179–86.CrossRef

33.

Folstein M, Folstein S, McHugh P. Mini-mental state: a practical method of grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98. https://doi.org/10.1016/0022-3956(75)90026-6.CrossRefPubMed

34.

McCambridge J, Witton J, Elbournec DR. Systematic review of the Hawthorne effect: New concepts are needed to study research participation effects. J Clin Epidemiol. 2014;67(3):267–77. https://doi.org/10.1016/j.jclinepi.2013.08.015.CrossRefPubMedPubMedCentral

35.

Nykänen I, Rissanen TH, Sulkava R, Hartikainen S. Effects of individual dietary counseling as part of a comprehensive geriatric assessment (CGA) on nutritional status: a population-based intervention study. J Nutr Health Aging. 2014;18(1):54–8. https://doi.org/10.1007/s12603-013-0342-y.CrossRefPubMed

36.

Bauer J, Biolo G, Cederholm T, Cesari M, Cruz-Jentoft AJ, Morley JE, et al. Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. J Am Med Dir Assoc. 2013;14(8):542–59. https://doi.org/10.1016/j.jamda.2013.05.021.CrossRefPubMed

37.

Bastone A, Ferriolli E, Pfrimer K, Moreira B, Diz J, Dias J, et al. Energy Expenditure in Older Adults Who Are Frail: A Doubly Labeled Water Study. J Geriatr Phys Ther. 2019;42(3):E135–E141. https://doi.org/10.1519/JPT.0000000000000138.

38.

Suominen MH, Puranen TM, Jyväkorpi SK, Eloniemi-Sulkava U, Kautiainen H, Siljamäki-Ojansuu U, et al. Nutritional guidance improves nutrient intake and quality of life and may prevent falls in aged persons with Alzheimer Disease living with a spouse (nuad trial). J Nutr Health Aging. 2015;19(9):901–7. https://doi.org/10.1007/s12603-015-0558-0.CrossRefPubMed

39.

Wysokiński A, Sobów T, Kłoszewska I, Kostka T. Mechanisms of the anorexia of aging-a review. Age (Dordr). 2015;37(4):9821. https://doi.org/10.1007/s11357-015-9821-x.

40.

Nihtilä A, Tuuliainen E, Komulainen K, Autonen-Honkonen K, Nykänen I, Hartikainen S, et al. Preventive oral health intervention among old home care clients. Age Ageing. 2017;46(5):846–51. https://doi.org/10.1093/ageing/afx020.CrossRefPubMed

41.

Kaartinen N, Tapanainen H, Reinivuo H, Pakkala H, Aalto S, Raulio S, et al. The national FINDIET 2017 survey. Helsinki: Finnish institute for health and welfare; 2020. https://doi.org/10.2903/sp.efsa.2020.EN-1914.

42.

Polusna K, Ruprich J, de Vries JHM, Jakubikova M, van’t Veer P. Misreporting of energy and micronutrient intake estimated by food records and 24 hour recalls, control and adjustment methods in practice. Br J Nutr. 2009;101(2):S73–85. https://doi.org/10.1017/S0007114509990602.

43.

Hung Y, Wijnhove H, Visser M, Verbeke V. Appetite and Protein Intake Strata of Older Adults in European union: Socio-Demographic and Health Charasteristics, Diet-Related and Physical Activity Behaviours. Nutrients. 2019;11(4):777. https://doi.org/10.3390/nu11040777.CrossRefPubMedCentral

Title: Effect of individually tailored nutritional counselling on protein and energy intake among older people receiving home care at risk of or having malnutrition: a non-randomised intervention study
Authors: Tarja Kaipainen
Sirpa Hartikainen
Miia Tiihonen
Irma Nykänen
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Nutrition
Care
Malnutrition
Published in: BMC Geriatrics / Issue 1/2022
Electronic ISSN: 1471-2318
DOI: https://doi.org/10.1186/s12877-022-03088-2

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2022

Longitudinal associations of housework with frailty and mortality in older adults: Singapore Longitudinal Ageing Study 2

A non-interventional cross-sectional re-contact study investigating the relationship between overactive bladder and frailty in older adults in Japan

Health among workers retiring after the state pension age: a longitudinal and comparative study

Building a new life: a qualitative study of how family carers deal with significant changes

Mortality risks of body mass index and energy intake trajectories in institutionalized elderly people: a retrospective cohort study

The influence mechanism of community-built environment on the health of older adults: from the perspective of low-income groups

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials