OBJECTIVE: We compared clinical outcomes with a standard (Ensure) or a high-protein (Boost HP) liquid nutritional supplement for older adults recovering from hip fracture surgery in a rehabilitation hospital.METHODS: This randomized, double-blind, parallel-group study compared the clinical effectiveness of a standard (Ensure) with a high-protein (Boost HP) liquid nutritional supplement among patients (n = 46) 60 y or older who recently underwent surgical repair of a hip fracture. Patients were encouraged to drink at least two 8-oz cans (17.8 g/d protein for Ensure versus 30 g/d protein for Boost HP) per day for 28 d. Study measurements included change in Functional Independence Measure between rehabilitation admission and discharge, length of rehabilitation stay, laboratory measures (i.e., serum albumin, prealbumin, and C-reactive protein), physical activity energy expenditure by 7-d triaxial accelerometry, and dietary intake by three random, telephonic, 24-h dietary recalls.RESULTS: There were no significant group differences with respect to age, sex, acute hospital days, hip fracture assessment parameters, or surgical treatment. Consumption of supplement (260 oz/28 d of Ensure versus 239 oz/28 d of Boost HP) was comparable. There were no differences in complication or adverse event rates during the study. The Boost HP group consumed more protein than the Ensure group (63 versus 50 g, P < 0.048) and had a greater improvement in serum albumin over the 28-d supplementation period (+0.7 versus +0.2 g/dL, P < 0.019). The Boost HP group also consumed more fiber (12 versus 8 a), calcium (821 versus 639 mg), vitamin K (66 versus 45 mug), and phosphorus (1035 versus 833 mg) than did the Ensure group. Rehabilitation length of stay was shorter in the Boost HP than in the Ensure group, although this trend did not reach statistical significance (23 versus 28 d, P = 0.27). Outcome differences were not detected in the Functional Independence Measure.CONCLUSIONS: Supplementation was well tolerated in this population and contributed significantly to total dietary intake. Consumption of a high-protein liquid nutritional supplement may offer some benefits by improving visceral protein status. (C)Elsevier Inc. 2004.

OBJECTIVE:To test the feasibility of two models of home meal delivery with Meals-on-Wheels (MOW) applicants who were identified as being malnourished or "at-risk" as determined by the validated Mini Nutritional Assessment (MNA).DESIGN:A 6-month, prospective comparative study of two nutrition intervention models with data collection at baseline, 3 months, and 6 months. Randomized treatment assignment was followed, with a few exceptions linked to particular client circumstances.SUBJECTS:A total of 203 older adults (age range = 60 to 90 years) newly applying for homebound meal service were enrolled. At baseline, the body mass index (BMI) was 26.3+/-7.2 (mean+/-SD) in the "Traditional" MOW model (101 subjects including 30 malnourished), and the BMI was 27.6+/-9.0 in the "New" MOW model (102 subjects including 26 malnourished) (P = ns).INTERVENTION:Study participants received either the Traditional MOW program of five hot meals per week, meeting 33% of the Daily Reference Intake (DRI) or the restorative, comprehensive New MOW program of three meals and two snacks per day, 7 days a week, meeting 100% of the DRI. Assessments were conducted in the home of the participants. Main outcome measures The MNA was used to evaluate nutritional risk and status of participants at baseline, 3 months, and 6 months. Standardized functional impairment scales, Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL) evaluated limitations in activities of daily living and life management skills. Statistical analysis Comparisons between treatment groups were calculated with t tests or Wilcoxon rank-sum tests when appropriate. Comparisons among time periods between treatment groups were conducted with repeated measures analysis of variance. A general linear model was used to evaluate the relationship between change in functional status and BMI, controlling for sex.RESULTS:The New MOW group gained significantly more weight between baseline and 3 months than did the Traditional MOW group (2.78 lb vs -1.46 lb, respectively, P =.0120) and again between baseline and 6 months (4.30 lb vs -1.72 lb, respectively, P =.0004). MNA improved faster in the New MOW group. Functional change appeared to be related more to BMI and age than to treatment intervention. The malnourished participants in both groups took longer to affect positive change in nutrition measurements, with the New MOW group showing the most improvement over the 6-month measurement period. Both delivery models were well accepted.CONCLUSIONS:Applicants for home meal delivery have varying nutrition needs. By addressing nutritional risk, interventions can be targeted to meet these needs. A new, restorative, comprehensive meal program improved nutritional status and decreased nutritional risk and can possibly impact independence and functionality.

OBJECTIVE: The purpose of this study was to determine whether energy expenditure estimated from physical activity and energy intake were equivalent to total daily energy expenditure in an elderly rural population.METHODS: Twenty-seven elderly male (n = 14) and female (n = 13) subjects (mean age. 74 y) were recruited from a rural Pennsylvania population. Over a 2-wk period, total daily energy expenditure was measured by doubly labeled water (TEE) and estimated from 7-d physical activity recall factors multiplied by A eight (PA(WT)). estimated basal metabolic rate (PA(BMR)) and resting energy expenditure from indirect calorimetry, (PA(REE)). and energy intake from 3-d self-reported diet records (EI). Analysis of variance was used to determine significant %vithin-subject differences in physical activity, energy intake, and energy expenditure.RESULTS: PA(REE) (men: 13.69 +/- 3.23 MJ, women: 9.51 +/- 2.40 MJ) and PA(BMR) (men: 13.69 +/- 2.99 MJ, women: 10.15 +/- 2.21 MJ) were not significantly different from TEE (men: 12.43 +/- 1.63 MJ, women: 9.44 +/- 0.90 MJ). EI (men: 8.66 +/- 2.34 MJ. women: 7.12 +/- 0.93 MJ) was significantly less than TEE, and PA(WT) (men: 17.03 +/- 4.07 MJ. women: 12.86 +/- 3.41 MJ) was significantly greater than TEE.CONCLUSIONS: Whereas 7-d physical activity recall determined with an age-and gender-specific estimate of resting metabolic rate or measured using indirect calorimetry accurately estimated TEE for this group of rural elderly, self-reported diet records consistently underestimated and physical activity recall determined with weight alone consistently overestimated energy expenditure measured by doubly labeled water.

Identifying patients who may benefit from home enteral nutrition support, managing the tube feeding regimen, and coordinating patient follow‐up present unique challenges and opportunities for the health care team. The Geisinger Clinic of the Penn State Geisinger Health System, Danville, Pennsylvania, assembled a multidisciplinary team comprising a dietitian, a nurse, a social worker, and a physician to address the concerns of patients receiving home enteral nutrition. A coordinated effort among the patient, caregivers, and health care team is essential for the successful discharge and management of home enteral nutrition patients.