Improvement of weight and fat-free mass with oral nutritional supplementation in patients with Alzheimer's disease at risk of malnutrition: a prospective randomized study. Nutrition support using the American Dietetic Association medical nutrition therapy protocol for radiation oncology patients improves dietary intake compared with standard practice. Benefits of nutritional supplementation in free-living, frail, undernourished elderly people: a prospective randomized community trial. Dietary counseling improves patient outcomes: a prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. Should oral nutritional supplementation be given to undernourished older people upon hospital discharge? A controlled trial. The effect of oral nutritional supplements on head and neck cancer. Nutritional impact of supplementation in the INCAP longitudinal study: analytic strategies and inferences. Perioperative nutritional support: a randomised clinical trial. Nutritional supplementation and dietary advice in geriatric patients at risk of malnutrition.
To study the effects of oral nutritional supplements (OS) on body weight, body composition, nutritional status, and cognition in elderly patients with Alzheimer's disease (AD).
                Prospective, randomized, controlled study.
                Geriatric wards and day care centers in the Toulouse area, France.
                Ninety-one subjects with AD aged 65 and older at risk of undernutrition as evaluated using the Mini Nutritional Assessment.
                After randomization, 46 patients (intervention group) received 3-month OS. The other 45 patients (control group) received usual care.
                Weight, body composition (evaluated using dual-energy x-ray absorptiometry), cognitive function, activities of daily living, eating behavior, and dietary intakes were evaluated at the beginning of the study and at 3 months and 6 months. Supplement compliance was recorded each day.
                Between baseline and 3 months, energy and protein intakes significantly improved in the intervention group, resulting in a significant increase in weight and fat-free mass, but no significant changes were found for dependence, cognitive function, or biological markers. The nutritional benefit was maintained in the intervention group after discontinuation of OS at 3 months.
                Three-month daily OS significantly improves body weight. It is practicable and effective, and the patients accepted it well. The improvement that was observed even in the control group showed that caregiver education is an important factor in maintaining the nutritional status of patients with AD. Moreover, regular courses of OS may help to maintain the increase in fat-free mass and improve the nutritional status of these patients. A randomized controlled trial previously conducted in radiation oncology patients demonstrated that nutrition intervention had a beneficial impact on body weight, nutritional status, and quality of life compared with standard practice, but it did not report on dietary intake data.
                To determine the impact of nutrition intervention compared with standard practice on dietary intake in outpatients receiving radiotherapy.
                Prospective, randomized, controlled trial.
                Sixty consecutive radiation oncology outpatients (51 men and nine women; age 61.9+/-14 years [mean+/-standard deviation]).
                Australian private radiotherapy facility.
                Patients were randomly assigned to receive either nutrition intervention (n=29) (nutrition counseling following the American Dietetic Association [ADA] medical nutrition therapy [MNT] protocol for radiation oncology) or standard practice (n=31) (general nutrition talk and booklet).
                Dietary intake (protein, energy, fiber) assessed at baseline and at 4, 8, and 12 weeks after starting radiotherapy.
                Repeated-measures analysis of variance done on an intention to treat basis.
                The nutrition intervention group had a higher mean total energy (P=0.029) and protein intake (P<0.001) compared with the standard practice group. Mean intake per kilogram of body weight for the nutrition intervention group ranged from 28 to 31 kcal/kg/day compared with 25 to 29 kcal/kg/day for the standard practice group (P=0.022). The nutrition intervention group had a higher mean protein intake (1.1 to 1.3 g/kg/day) compared with the standard practice group (1.0 to 1.1 g/kg/day) (P=0.001). Although the change in fiber intake between the groups was not significant, there was a trend in the anticipated direction (P=0.083).
                Intensive nutrition intervention following the ADA MNT protocol results in improved dietary intake compared with standard practice and seems to beneficially impact nutrition-related outcomes previously observed in oncology outpatients receiving radiotherapy. The ADA MNT protocol for radiation oncology is a useful guide to the level of nutrition support required. To evaluate the impact of nutritional supplementation on nutritional status, muscle strength, perceived health, and functional status in a population of community-living, frail, undernourished elderly people.
                A 16-week intervention study in which subjects were randomized to an experimental or a control group and visited in their home on a monthly basis. Outcome variables were measured at the start and end of the study at subjects' homes by a dietitian blinded to treatment assignment.
                83 elderly people (experimental group: n=42; control group: n=41; mean age=80+/-7 years) receiving community home-care services and at high risk for undernutrition.
                Provision of a nutrient-dense protein-energy liquid supplement and encouragement to improve intake from other foods.
                Anthropometric indexes, handgrip strength, isometric elbow flexion and leg extension strength, lower extremity function, perceived health, and functional status.
                Study groups were compared on an "intention to treat" basis using analysis of variance for repeated measures and unpaired and paired t tests and their nonparametric equivalents where appropriate.
                Total energy intake (1,772 vs 1,440 kcal; P<.001) and weight gain (1.62 vs 0.04 kg; P<.001) were higher in the supplemented group. No significant changes were observed with respect to other anthropometric indexes, muscle strength, or functional variables; however, beneficial effects were observed in emotional role functioning (P<0.01) and number of days spent in bed (P=.04).
                Nutrition intervention is feasible in free-living, frail, undernourished elderly people and results in significant improvement of nutritional status with respect to energy and nutrient intake and weight gain. Weight loss can be stopped and in some cases reversed; however, increased physical activity may also be required to improve health and functional status. To investigate the impact of dietary counseling or nutritional supplements on outcomes in cancer patients: nutritional, morbidity, and quality of life (QoL) during and 3 months after radiotherapy.
                A total of 111 colorectal cancer outpatients referred for radiotherapy, stratified by staging, were randomly assigned: group 1 (G1; n = 37), dietary counseling (regular foods); group 2 (G2; n = 37), protein supplements; and group 3 (G3; n = 37), ad libitum intake. Nutritional intake (diet history), status (Ottery's Subjective Global Assessment), and QoL (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire version 3.0) were evaluated at baseline, at the end, and 3 months after radiotherapy.
                At radiotherapy completion, energy intake increased in G1/G2 (P < or = .04), G1 more than G2 (P = .001), and decreased in G3 (P < .01). Protein intake increased in G1/G2 (P < or = .007), G1 less than G2 (not significant), and decreased in G3 (P < .01). At 3 months, G1 maintained nutritional intake and G2/G3 returned to baseline. After radiotherapy and at 3 months, rates of anorexia, nausea, vomiting, and diarrhea were higher in G3 (P < .05). At radiotherapy completion, in G1 all QoL function scores improved proportionally to adequate intake or nutritional status (P < .05); whereas in G2 only three of six function scores improved proportionally to protein intake (P = .04), and in G3 all scores worsened (P < .05). At 3 months, G1 patients maintained/improved function, symptoms, and single-item scores (P < .02); in G2, only few function and symptom scales improved (P < .05); in G3, QoL remained as poor as after radiotherapy. In G1/G2, respectively, improvement/deterioration of QoL correlated with better or poorer intake or nutritional status (P < .003).
                During radiotherapy, both interventions positively influenced outcomes; dietary counseling was of similar or higher benefit, whereas even 3 months after RT, it was the only method to sustain a significant impact on patient outcomes. To determine whether the oral nutritional supplementation of undernourished older people upon discharge from hospital improves muscle function and reduces disability.
                Randomized controlled trial.
                Community-based study in two centers in Scotland.
                Two hundred fifty-three people.
                Randomization to oral nutritional supplementation (600 kcal/d) or control supplement of 200 kcal/d.
                Primary outcome (20-point activity of daily living Barthel Index) and secondary outcomes (handgrip strength, Sit-to-Stand test, and Euroquol) were measured at baseline (after discharge from the hospital and before supplement was commenced) and 8 and 16 weeks and accelerometry-measured physical activity levels at baseline and 16 weeks. Falls were recorded prospectively.
                Mean age was 82. There was no significant difference in change in Barthel score between supplement and control groups (adjusted mean difference=0.28, 95% confidence interval (CI)=-0.28-0.84). Handgrip strength improved more in the supplemented group (adjusted mean difference=1.52 kg, 95% CI=0.50-2.55; P=.004). The supplemented group exhibited modestly greater vector movement (overall activity) than controls (P=.02). There were no significant between-group differences in Sit-to-Stand test, health-related quality of life, or falls. Adherence was 38.2% in the nutritional supplement group and 50.0% in the control supplement group. Weight did not increase in the nutritional supplement group as a whole, but on-treatment analysis adjusting for adherence showed a mean weight gain of 1.17 kg (95% CI=0.07-2.27; P=.04) more than in controls.
                Oral nutritional supplementation of undernourished older people upon hospital discharge did not reduce disability, despite improving handgrip strength and modestly increasing objectively measured physical activity levels. Lack of an effect of the nutritional supplement used in this study may have been due to low adherence, suggesting that different approaches to nutritional supplementation need to be tested in this population. Fifty ambulatory patients with head and neck cancer treated by definitive radiation therapy at the Fox Chase Cancer Center were prospectively studied to determine the effect of oral nutritional supplements on both nutritional status and treatment response. Nutritional supplements maintained serum albumin during and post treatment. Nutritional supplements were shown to increase total protein and total calorie intake rather than displace these nutrients in usual food intake. Equal weight loss occurred in both the supplemented and non-supplemented groups during the observation period of 6 months, with the same or greater amount of weight loss registered 10 weeks after the start of treatment. Food supplements did not affect treatment response or complications, nor did they offer any survival advantage. From 1969 to 1977 a supplementation trial was conducted in Guatemala to ascertain the effects on physical and behavioral outcomes of improved nutrition in pregnant women and in preschool children. This paper reviews different strategies to analyze the effect of the intervention on physical growth. One strategy compares outcomes in two villages that were randomly allocated to receive Atole, a supplement containing high amounts of protein and energy, with values in two other villages that received Fresco, a beverage containing no protein and little energy. Both supplements contained micronutrients. This comparison of village means gives a probability significance statement (P < 0.005) that the difference in growth was because of the supplement intervention, although it does not specify the aspect of the intervention that caused the effect. Complementary strategies increase the credibility that the effect of the supplement was nutritional. Thus, analysis of the dose response with increasing supplement intake within the villages excludes the possibility that the above findings were the result of knowing which villages received which supplement (i.e., measuring biases). A greater effect in those most likely to respond nutritionally also increases the credibility that the mechanism was nutritional. In studying other behavioral and biomedical impacts of this supplementation intervention, analyses for credibility should always be included. Ever since methods of artificial nutritional support became available, attempts have been made using this form of treatment to reduce mortality and morbidity in surgical patients. Many trials have addressed this question, but very few have given a meaningful answer because of conceptual and methodological flaws. We therefore undertook a prospective randomised trial investigating the effects of at least 10 days pre-operative total parenteral nutrition (TPN) (n = 51) or total enteral nutrition (TEN) (n = 50) providing 150% basal energy expenditure (BEE) non-protein energy, to reduce major postoperative complications and mortality in a homogeneous patient group with signs of depletion. 50 patients served as a depleted control group (D) and 49 patients served as a non-depleted reference group (ND) and were operated upon without delay. Depleted control patients suffered significantly more septic complications than did patients in the non-depleted reference group (p < 0.05). There was no significant difference, however, in septic complications between either of the nutritional support groups and the non-depleted control group. In high risk patients, with weight loss >10% of body weight and over 500 ml blood loss during operation, a significant decrease in major complications was observed (p < 0.05) as a result of nutritional support. We conclude that pre-operative nutritional support, in patients with severe depletion, results in a reduction in major complications to a degree that justifies its routine use in this selected group of patients. Effects of combined nutritional treatment of patients at risk of protein-energy malnutrition (PEM) discharged from a geriatric service were evaluated.
                Patients (n=108, age 85+/-6 years) at risk of malnutrition according to the short form of the mini nutritional assessment were randomly allocated to dietary counseling, including liquid and multivitamin supplementation, i.e. intervention (I, n=51) and to controls (C, n=57). Body weight, biochemical indices (e.g. insulin-like growth factor I (IGF-I)), Katz activities of daily living (ADL) index, mini mental status examination (MMSE) and quality of life (QoL) by SF-36 were assessed at the start of the study and after 4 months. Statistical analyses were performed on "intention-to-treat" and on "treated-as-protocol" bases.
                Fifty-four patients, 29 in the I-group (86+/-7 years, 66% females) and 25 in the C-group (85+/-7 years, 72% females) completed the study according to the protocol. Both modes of analysis revealed a significant positive effect of the combined nutritional intervention on weight maintenance. Treated-as-protocol analyses showed that Katz ADL index improved in the I-group (p<0.001; p<0.05 between the groups). Serum IGF-I levels increased in the I-group (p<0.001), but were unchanged in the C-group (p=0.07 between the groups). QoL was assessed to be low and had not changed after nutritional treatment.
                Combined nutritional intervention prevented weight loss and improved ADL functions in discharged geriatric patients at risk of malnutrition.
There was insufficient evidence found to support the effectiveness of nutritional support for AKI. Further high quality studies are required to provide reliable evidence of the effect and safety of nutritional support.