The journal of nutrition, health & aging

, Volume 21, Issue 7, pp 811–818 | Cite as

Effect on body weight, quality of life and appetite following individualized, nutritional counselling to home-living elderly after rehabilitation – An open randomized trial

  • J. Andersson
  • E. Hulander
  • E. Rothenberg
  • P. Ole Iversen



We examined if individually-adapted nutritional counselling could prevent > 5% weight loss among elderly patients 3 months after discharge from a rehabilitation institution. In addition we assessed quality of life (QoL) and appetite.


An open, randomized trial.


Godthaab Health and Rehabilitation Institution in Bærum, Norway.


Patients identified as being undernourished or at risk of disease-related malnutrition using the Nutritional Risk Screening tool NRS-2002.


Shortly before discharge, patients in the intervention group received an individually-tailored nutrition plan. During the subsequent 3 months these patients were contacted 3 times via telephone calls and they received one visit at their homes, for nutrition counselling. Focus on this counselling was on optimizing meal environment, improving appetite, increasing food intake, advice on food preparation, and motivation and support.


In addition to weight, QoL and appetite were assessed using the EQ-5D questionnaire and a modified version of the Disease-Related Appetite Questionnaire, respectively.


Among 115 considered eligible for the study, 100 were enrolled (72 women and 28 men), with a mean age of 75 years and a mean body mass index of 20 kg/m2. Two in the intervention group (n = 52) and 5 in the control group (n = 48) lost > 5% of their body weight, giving an odds ratio of 0.34 (95% CI: 0.064–1.86; p = 0.22). We did not detect any significant differences in the QoL- or appetite scores between the two study groups after three months.


An individually-adapted nutritional counselling did not improve body mass among elderly patients 3 months after discharge from a rehabilitation institution. Neither quality of life nor appetite measures were improved. Possibly, nutritional counselling should be accompanied with nutritional supplementation to be effective in this vulnerable group of elderly. The trial is registered in Clinical Trials (ID: NCT01632072).


Appetite disease-related malnutrition nutritional counselling quality of life rehabilitation 


  1. 1.
    Stratton RJ, Green, CJ, Elia, M. Disease-related malnutrition: an evidence-based approach to treatment. CABI Publishing, Wallingford. 2003Google Scholar
  2. 2.
    Beck AM, Balknas UN, Camilo ME, Furst P, Gentile MG, Hasunen K, et al. Practices in relation to nutritional care and support-report from the Council of Europe. Clin Nutr 2002;21:351–354.CrossRefPubMedGoogle Scholar
  3. 3.
    Mowe M, Bosaeus I, Rasmussen HH, Kondrup J, Unosson M, Rothenberg E, et al. Insufficient nutritional knowledge among health care workers? Clin Nutr 2008;27:196–202.CrossRefPubMedGoogle Scholar
  4. 4.
    Forde R, Pedersen R, Nortvedt P, Aasland OG. Enough resources to the care of the elderly? J Nor Med Assoc 2006;126:1913–1916.Google Scholar
  5. 5.
    McWhirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital. BMJ 1994;308:945–948.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Beck AM, Balknas UN, Furst P, Hasunen K, Jones L, Keller U, et al. Food and nutritional care in hospitals: how to prevent undernutrition-report and guidelines from the Council of Europe. Clin Nutr 2001;20:455–460.CrossRefPubMedGoogle Scholar
  7. 7.
    van Wayenburg CA, van de Laar FA, van Weel C, van Staveren WA, van Binsbergen JJ. Nutritional deficiency in general practice: a systematic review. Eur J Clin Nutr 2005;59 Suppl 1:S81–S87.CrossRefPubMedGoogle Scholar
  8. 8.
    Baldwin C, Spiro A, Ahern R, Emery PW. Oral nutritional interventions in malnourished patients with cancer: a systematic review and meta-analysis. J Nat Cancer Inst 2012;104:371–385.CrossRefPubMedGoogle Scholar
  9. 9.
    Feldblum I, German L, Castel H, Harman-Boehm I, Shahar DR. Individualized nutritional intervention during and after hospitalization: the nutrition intervention study clinical trial. J Am Ger Soc 2011;59:10–17.CrossRefGoogle Scholar
  10. 10.
    Directorate of Health in Norway, 2009. Nasjonal faglige retningslinjer for forebygging og behandling av underernæring. Accessed 16 July 2016.Google Scholar
  11. 11.
    Directorate of Health in Norway, 2012. Ernæringskompetanse i helse-og omsorgstjenesten. Accessed 16 July 2016.Google Scholar
  12. 12.
    Turner L, Shamseer L, Altman DG, Weeks L, Peters J, Kober T, et al. Consolidated standards of reporting trials (CONSORT) and the completeness of reporting of randomised controlled trials (RCTs) published in medical journals. Cochrane Database System Rev 2012;11:Mr000030.Google Scholar
  13. 13.
    Kondrup J, Rasmussen HH, Hamberg O, Stanga Z. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 2003;22:321–336.CrossRefPubMedGoogle Scholar
  14. 14.
    Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003;22:415–421.CrossRefPubMedGoogle Scholar
  15. 15.
    Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med 2001;33:337–343.CrossRefPubMedGoogle Scholar
  16. 16.
    Norden J, Gronberg AM, Bosaeus I, Forslund HB, Hulthen L, Rothenberg E, et al. Nutrition impact symptoms and body composition in patients with COPD. Eur J Clin Nutr 2015;69:256–261.CrossRefPubMedGoogle Scholar
  17. 17.
    Wilson MM, Thomas DR, Rubenstein LZ, Chibnall JT, Anderson S, Baxi A, et al. Appetite assessment: simple appetite questionnaire predicts weight loss in community-dwelling adults and nursing home residents. Am J Clin Nutr 2005;82:1074–1081.PubMedGoogle Scholar
  18. 18.
    Droogsma E, van Asselt D, De Deyn PP. Weight loss and undernutrition in community-dwelling patients with Alzheimer’s dementia: From population based studies to clinical management. Zeitschrift Gerontol Ger 2015;48:318–324.CrossRefGoogle Scholar
  19. 19.
    Allard JP, Keller H, Jeejeebhoy KN, Laporte M, Duerksen DR, Gramlich L, et al. Decline in nutritional status is associated with prolonged length of stay in hospitalized patients admitted for 7 days or more: A prospective cohort study. Clin Nutr 2016;35:144–152.CrossRefPubMedGoogle Scholar
  20. 20.
    van Bokhorst-de van der Schueren MA, Guaitoli PR, Jansma EP, de Vet HC. Nutrition screening tools: does one size fit all? A systematic review of screening tools for the hospital setting. Clin Nutr 2014;33:39–58.CrossRefPubMedGoogle Scholar
  21. 21.
    Zhuang CL, Wang SL, Huang DD, Pang WY, Lou N, Chen BC, et al. Risk factors for hospital readmission after radical gastrectomy for gastric cancer: a prospective study. PloS One 2015;10:e0125572.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Goisser S, Schrader E, Singler K, Bertsch T, Gefeller O, Biber R, et al. Malnutrition according to Mini Nutritional Assessment is associated with severe functional impairment in geriatric patients before and up to 6 months after hip fracture. J Am Med Dir Assoc 2015;16:661–667.CrossRefPubMedGoogle Scholar
  23. 23.
    Drevet S, Bioteau C, Maziere S, Couturier P, Merloz P, Tonetti J, et al. Prevalence of protein-energy malnutrition in hospital patients over 75 years of age admitted for hip fracture. Orthop Traumatol Surg Res 2014;100:669–674.CrossRefPubMedGoogle Scholar
  24. 24.
    Stratton RJ, Hebuterne X, Elia M. A systematic review and meta-analysis of the impact of oral nutritional supplements on hospital readmissions. Age Res Rev 2013;12:884–897.CrossRefGoogle Scholar
  25. 25.
    Lee HO, Han SR, Choi SI, Lee JJ, Kim SH, Ahn HS, et al. Effects of intensive nutrition education on nutritional status and quality of life among postgastrectomy patients. Ann Surg Treat Res 2016;90:79–88.CrossRefPubMedGoogle Scholar
  26. 26.
    Nykanen 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;18:54–58.CrossRefPubMedGoogle Scholar
  27. 27.
    Xu ZR, Tan ZJ, Zhang Q, Gui QF, Yang YM. Clinical effectiveness of protein and amino acid supplementation on building muscle mass in elderly people: a metaanalysis. PloS One 2014;9:e109141.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Hamirudin AH, Charlton K, Walton K. Outcomes related to nutrition screening in community living older adults: A systematic literature review. Arch Gerontol Ger 2016;62:9–25.CrossRefGoogle Scholar
  29. 29.
    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;14:542–559.CrossRefPubMedGoogle Scholar
  30. 30.
    Verlaan S, Aspray TJ, Bauer JM, Cederholm T, Hemsworth J, Hill TR, et al. Nutritional status, body composition, and quality of life in community-dwelling sarcopenic and non-sarcopenic older adults: A case-control study. Clin Nutr doi: 2015;10.1016/j.clnu.2015.11.013Google Scholar
  31. 31.
    Kim KI, Lee JH, Kim CH. Impaired health-related quality of life in elderly women is associated with multimorbidity: results from the Korean National Health and Nutrition Examination Survey. Gender Med 2012;9:309–318.CrossRefGoogle Scholar
  32. 32.
    Parsons EL, Stratton RJ, Cawood AL, Smith TR, Elia M. Oral nutritional supplements in a randomised trial are more effective than dietary advice at improving quality of life in malnourished care home residents. Clin Nutr 2016;doi: 10.1016/j.clnu.2016.01.002.Google Scholar
  33. 33.
    Norman K, Pirlich M, Smoliner C, Kilbert A, Schulzke JD, Ockenga J, et al. Cost-effectiveness of a 3-month intervention with oral nutritional supplements in disease-related malnutrition: a randomised controlled pilot study. Eur J Clin Nutr 2011;65:735–742.CrossRefPubMedGoogle Scholar
  34. 34.
    Yang Y, Rowen D, Brazier J, Tsuchiya A, Young T, Longworth L. An exploratory study to test the impact on three «bolt-on» items to the EQ-5D. Value in health: J Int Soc Pharmacoeconom Outcomes Res 2015;18:52–60.CrossRefGoogle Scholar

Copyright information

© Serdi and Springer-Verlag France 2017

Authors and Affiliations

  • J. Andersson
    • 1
    • 2
  • E. Hulander
    • 1
    • 2
  • E. Rothenberg
    • 3
  • P. Ole Iversen
    • 1
  1. 1.Department of NutritionBlindern, OsloNorway
  2. 2.Godthaab Health and Rehabilitation InstitutionBekkestuaNorway
  3. 3.Kristianstad UniversityKristianstadSweden

Personalised recommendations