Need-based intervention is an effective strategy for improving the nutritional status of older people living in a nursing home: A randomized controlled trial

Background: Nutrition is a key element in geriatric health. Protein-energy malnutrition is common in institutionalized persons. Objective: This study examined the effectiveness of a need-based "routine screening and timely intervention" strategy in improving the nutritional status of persons living in nursing homes. Design: A 24-week randomized, double-blind, controlled trial. Setting: A privately managed geriatric nursing home in Taiwan. Participants: Ninety-two ≥65-year old persons who were ≤25kg/m2, >1 month residence, able to self-feed or receive oral feeding, without acute infection and non-bed-ridden. Methods: Prospective participants were stratified by gender and then randomly assigned to either the control group (n=45) or the intervention group (n=47). Each subject in the intervention group was given a 50g/day soy-protein-based nutritional supplement if he/she was rated as undernourished according to the Mini Nutritional Assessment (MNA, score ≤24) and BMI ≤24kg/m2. The supplement contained 9.5g protein, 250kcal energy and all essential micro-nutrients. The supplementation would be suspended once either one of the "at risk" condition was corrected. Nutritional rating with the MNA took place at baseline and every 4 weeks during the trial. Biochemical indicators were measured at baseline, mid-point (week-12) and end-point (week-24). Results were analyzed with the two-sample t-test, and the generalized estimating equations (GEE) controlled for demographic and health-related variables. Results: Of the 92 subjects, 82 completed the trial; 7 withdrew and 3 died during the trial. Results showed that the need-based intervention was an effective and appropriate strategy for improving the nutritional status of persons at risk of undernourishment. The intervention significantly improved body weight, BMI, mid-arm circumference, calf circumference, and serum albumin and cholesterol concentrations at all intervals (all p< 0.05). However, the intervention did not significantly improve hematocrit, hemoglobin or lymphocyte count status. Conclusions: Results suggest that the need-based nutritional intervention can be a practical and useful strategy for improving the nutritional status of persons living in nursing homes and save on healthcare cost. The potential application of this strategy deserves the attention of health planners.