Relevant outcomes for nutrition interventions to treat and prevent malnutrition in older people: a collaborative senator-ontop and manuel delphi study
Background and aims
Research in malnutrition in older people is limited by the lack of consensus on relevant outcomes. Researchers of two European initiatives, the ‘Malnutrition in the Elderly (MaNuEL) Knowledge Hub’ (mostly experts in nutrition) and the Optimal Evidence-Based Non-drug Therapies in Older People (ONTOP) project (geriatricians) agreed to merge forces performing a systematic review of the effectiveness of nutritional interventions for the prevention and treatment of malnutrition in older persons. In a first step, we aimed to identify relevant outcomes for this review using a systematic approach and to explore if the rating of relevant outcomes differed depending on the researchers’ professional background.
Following the ONTOP protocol, we searched all outcomes used in research of nutritional interventions for the prevention and treatment of malnutrition in older people. We carried out a web-based Delphi survey using a standardized list of 13 potentially relevant outcomes among 41 experts in geriatrics and nutrition who were asked to rate each outcome from 1 to 9 points: low importance (score 1–3), important but non-critical (score 4–6), and critical (score 7–9). Participants were informed that only those outcomes rated as critical (7–9 points) would be used in the literature review. After two rounds consultation, we compared the results from each group of experts: the ONTOP group formed by 13 geriatricians and the MaNuEL group formed by 28 experts in nutrition. Mean values were used for overall rating and the Mann–Whitney U test was used to see the differences on ratings between both groups.
Mortality, morbidity, functional status, nutritional status and quality of life were considered critical outcomes by the whole group of experts. However, by analysing the ratings by the experts’ professional background, geriatricians only rated mortality, morbidity and functional status as critical, while experts in nutrition (MaNuEL group) rated nutritional status, changes in dietary intake, compliance with the intervention, quality of life, and frailty status outcomes as critical too. Two outcomes, changes in dietary intake and compliance with the intervention, were rated with a significant different between the two professional groups (p < 0.05).
Five outcomes were considered critical for research in nutritional interventions for the prevention and treatment of malnutrition in older persons: mortality, morbidity, functional status, nutritional status and quality of life by the whole panel of experts. However, more consensus is needed on the relevance of specific outcomes of nutritional interventions. Consensus processes within but also between relevant organizations are required to reach consensus and to contribute to this aim.
KeywordsMalnutrition Elderly Geriatrics Critical outcomes Nutritional interventions
The authors particularly thank the members who participated in the Delphi process to identify relevant outcomes. List of experts who were invited to join the survey: Experts from the SENATOR-ONTOP project: Dr. Hubert Blain, Montpellier, France; Dr. Regina Roller-Wirnsberger, Graz, Austria; Dr. Adalsteinn Gudmundsson, Reikiavik, Iceland; Dr. Gunnar Akner, Örebro, Sweden; Dr. Mirko Petrovic, Ghent, Belgium; Dr. Denis O’Mahony Cork, Ireland, Dr. Roy L. Soiza Aberdeen, UK; Dr. Fabiana Trotta, Ancona, Italy; Dr. Giuseppina dell’Aquila, Ancona, Italy; Dr. Iosief Abraha, Ancona, Italy; Dr. Antonio Cherubini, Ancona, Italy; Dr. Andrea Corsonello, Ancona, Italy; Dr. Fabio Salvi, Ancona, Italy. Experts from the MaNuEL Knowledge Hub project: Dr. Dorothee Volkert, Nuremberg, Germany; Dr. Karin Schindler, Vienna, Austria; Dr. Claire Sulmont Rosse, Dijon, France; Dr. Dominique Dardevet, Clermont-Ferrand, France; Dr. Isabelle Maître, Angers, France. Dr. Yves Rolland, Toulouse, France; Dr. Heiner Boeing, Nuthetal, Germany; Dr. Marta Stelmach, Nuthetal, Germany; Dr. Christine Brombach, Wädenswil, Switzerland; Dr. Gabriele Nagel, Ulm, Germany; Dr. Marion Flechtner-Mors, Ulm, Germany; Dr. Antje Hebestreit, Bremen, Germany; Dr. Maike Wolters, Bremen, Germany; Dr. Corinna Geisler, Kiel, Germany; Dr. Eva Kiesswetter, Nürnberg, Germany; Dr. Clare Corish, Dublin, Ireland; Dr. Eibhlis O’Connor, Limerick, Ireland; Dr. Eileen O’Herlihy, Cork, Ireland; Dr. Eileen Gibney, Dublin, Ireland; Dr. Ilse Reinders, Amsterdam, The Netherlands; Dr. Lisette de Groot, Wageningen, The Netherlands; Dr. Elke Naumann Nijmegen, the Netherlands, Dr. Eva Leistra, Amsterdam, The Netherlands; Dr. Ruth Teh, Auckland, New Zealand; Dr. Marjolein Visser, Amsterdam, The Netherlands; Dr. Christa Lohrmann, Graz, Austria; Dr. Virginie Van Wymelbeke, Dijon, France; Dr. Marian de van der Schueren, Nijmegen, The Netherlands.
All authors have contributed actively to this work and agreed with the final version to be submitted.
The preparation of this paper was supported by the MAlNUtrition in the ELderly (MaNuEL) knowledge hub. This work is supported by the Joint Programming Initiative ‘Healthy Diet for a Healthy Life’. The funding agencies supporting this work are (in alphabetical order of participating Member State): Austria: Federal Ministry of Science, Research and Economy (BMWFW); France: Ecole Supérieure d’Agricultires (ESA); Germany: Federal Ministry of Food and Agriculture (BMEL) represented by Federal Office for Agriculture and Food (BLE); Ireland: Department of Agriculture, Food and the Marine (DAFM), and the Health Research Board (HRB); Spain: Instituto de Salud Carlos III, and the SENATOR trial (FP7-HEALTH-2012-305930); The Netherlands: The Netherlands Organisation for Health Research and Development (ZonMw).
The authors from Spain have only received Grants from the SENATOR trial funded by the European Union Seventh Framework Programme (FP7/2007–2013) under Grant agreement no. 305930.
Compliance with ethical standards
Conflict of interest
Dr. Correa-Pérez reports Grants from EUROPEAN UNION FP7 PROGRAM (FP7/2007–2013) under Grant agreement no. 305930, during the conduct of the study; Dr. Cruz-Jentoft reports Grants from EUROPEAN UNION FP7 PROGRAM, during the conduct of the study; Dr. Volkert reports grants from Medical Nutrition Industrie (MNI), Grants from Nestlé Nutrition Institute, outside the submitted work; Dr. Lozano-Montoya has nothing to disclose; Dr. Visser has nothing to disclose.
The ONTOP-SENATOR project has been approved by the Ethics Committee from the coordinator site University College Cork (Cork, Ireland), and by the local Ethics Committee from the Hospital Universitario Ramón y Cajal (IRYCIS) (Madrid, Spain) where this work was conducted.
For this type of study, informed consent is not required.
- 3.Agarwal E, Ferguson M, Banks M, Batterham M, Bauer J, Capra S et al (2013) Malnutrition and poor food intake are associated with prolonged hospital stay, frequent readmissions, and greater in-hospital mortality: results from the Nutrition Care Day Survey 2010. Clin Nutr 32:737–745. https://doi.org/10.1016/j.clnu.2012.11.021 CrossRefPubMedGoogle Scholar
- 11.Health Council of the Netherlands (2011) Undernutrition in the elderly. Health Council Netherlands, HagueGoogle Scholar
- 13.SENATOR-project.eu n.d. https://www.senator-project.eu/ (accessed May 11, 2017)
- 14.Soiza RL, Subbarayan S, Antonio C, Cruz-Jentoft AJ, Petrovic M, Gudmundsson A et al (2017) The SENATOR project: developing and trialling a novel software engine to optimize medications and nonpharmacological therapy in older people with multimorbidity and polypharmacy. Ther Adv Drug Saf 8:81–85. https://doi.org/10.1177/2042098616675851 CrossRefPubMedGoogle Scholar
- 15.Abraha I, Cruz-Jentoft A, Soiza RL, O’Mahony D, Cherubini A (2015) Evidence of and recommendations for non-pharmacological interventions for common geriatric conditions: the SENATOR-ONTOP systematic review protocol. BMJ Open 5:e007488. https://doi.org/10.1136/bmjopen-2014-007488 CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Hsu C-C (2007) The Delphi technique: making sense of consensus. Pract Assess Res Eval 12:1–8Google Scholar
- 19.Abraha I, Trotta F, Rimland JM, Cruz-Jentoft A, Lozano-Montoya I, Soiza RL et al (2015) Efficacy of non-pharmacological interventions to prevent and treat delirium in older patients: a systematic overview. The SENATOR project ONTOP series. PLoS One 10:1–31. https://doi.org/10.1371/journal.pone.0123090 CrossRefGoogle Scholar
- 20.Vélez-Díaz-Pallarés M, Lozano-Montoya I, Abraha I, Cherubini A, Soiza RL, O’Mahony D et al (2015) Nonpharmacologic interventions to heal pressure ulcers in older patients: an overview of systematic reviews (The SENATOR-ONTOP Series). J Am Med Dir Assoc 16:448–469. https://doi.org/10.1016/j.jamda.2015.01.083 CrossRefPubMedGoogle Scholar
- 21.Lozano-Montoya I, Vélez-Díaz-Pallarés M, Abraha I, Cherubini A, Soiza RL, O’Mahony D et al (2016) Nonpharmacologic interventions to prevent pressure ulcers in older patients: an overview of systematic reviews (The Software ENgine for the Assessment and optimization of drug and non-drug therapy in older peRsons [SENATOR] definition of optimal evidence. J Am Med Dir Assoc 17:370.e1–370.e10. https://doi.org/10.1016/j.jamda.2015.12.091 CrossRefGoogle Scholar
- 22.Lozano-Montoya I, Correa-Pérez A, Abraha I, Soiza RL, Cherubini A, O’Mahony D et al (2017) Nonpharmacological interventions to treat physical frailty and sarcopenia in older patients: a systematic overview–the SENATOR Project ONTOP Series. Clin Interv Aging 12:721–740. https://doi.org/10.2147/CIA.S132496 CrossRefPubMedPubMedCentralGoogle Scholar
- 23.SurveyMonkey Inc. San Mateo, California, USA n.d. https://www.surveymonkey.com (accessed September 1, 2016)
- 25.Munk T, Tolstrup U, Beck AM, Holst M, Rasmussen HH, Hovhannisyan K et al (2016) Individualised dietary counselling for nutritionally at-risk older patients following discharge from acute hospital to home: a systematic review and meta-analysis. J Hum Nutr Diet 29:196–208. https://doi.org/10.1111/jhn.12307 CrossRefPubMedGoogle Scholar