Skip to main content

Advertisement

SpringerLink
Log in

Effects of a dietetic treatment in older, undernourished, community-dwelling individuals in primary care: a randomized controlled trial

  • Original Contribution
  • Published:
European Journal of Nutrition Aims and scope Submit manuscript

Abstract

Purpose

Undernutrition is a prevalent problem in older, community-dwelling individuals. Aim of this study was to determine the effects of a dietetic treatment in older, undernourished, community-dwelling individuals.

Methods

A parallel randomized controlled trial was performed in 146 non-institutionalized, undernourished individuals aged ≥65 years in primary care. Participants were randomly assigned to the intervention (referral to and treatment by a trained dietitian) or control group (no referral). Body weight, physical performance, handgrip strength, energy intake, protein intake and fat-free mass were assessed at baseline, after 3 months and after 6 months.

Results

All randomized participants (n = 146) were included in the intention-to-treat generalized estimating equations analysis (72 in intervention and 74 in control group). No treatment effect was found on the primary outcomes body weight (β = 0.49 kg, 95 % CI: −0.15–1.12), physical performance (β = 0.15 points, 95 % CI: −0.33–0.64) and handgrip strength (β = 0.49 kg, 95 % CI: −0.62–1.60). Furthermore, no treatment effect was found for the secondary outcomes. Predefined subgroup analyses showed a treatment effect on body weight in physically active participants (β = 1.25 kg, 95 % CI: 0.70–2.11) and not in inactive participants (β = −0.20 kg, 95 % CI: −1.16–0.75).

Conclusions

After 6 months, a dietetic treatment by trained dietitians does not lead to increases in body weight and physical functioning in older, undernourished, community-dwelling individuals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Wakimoto P, Block G (2001) Dietary intake, dietary patterns, and changes with age: an epidemiological perspective. J Gerontol A Biol Sci Med Sci 56(2):65–80

    Article  Google Scholar 

  2. Meijers JM, Schols JM, van Bokhorst-de van der Schueren MA, Dassen T, Janssen MA, Halfens RJ (2009) Malnutrition prevalence in The Netherlands: results of the annual Dutch national prevalence measurement of care problems. Br J Nutr 101:417–423

    Article  CAS  Google Scholar 

  3. Chen CC, Schilling LS, Lyder CH (2001) A concept analysis of malnutrition in the elderly. J Adv Nurs 36:131–142

    Article  CAS  Google Scholar 

  4. Hickson M (2006) Malnutrition and ageing. Postgrad Med J 82:2–8

    Article  CAS  Google Scholar 

  5. Schilp J, Wijnhoven HA, Deeg DJ, Visser M (2011) Early determinants for the development of undernutrition in an older general population: longitudinal aging study Amsterdam. Br J Nutr 106:708–717

    Article  CAS  Google Scholar 

  6. Payette H, Gray-Donald K, Cyr R, Boutier V (1995) Predictors of dietary intake in a functionally dependent elderly population in the community. Am J Public Health 85:677–683

    Article  CAS  Google Scholar 

  7. Cereda E, Valzolgher L, Pedrolli C (2008) Mini nutritional assessment is a good predictor of functional status in institutionalised elderly at risk of malnutrition. Clin Nutr 27:700–705

    Article  Google Scholar 

  8. Oliveira MR, Fogaca KC, Leandro-Merhi VA (2009) Nutritional status and functional capacity of hospitalized elderly. Nutr J 8:54

    Article  Google Scholar 

  9. Keller HH, Ostbye T, Goy R (2004) Nutritional risk predicts quality of life in elderly community-living Canadians. J Gerontol A Biol Sci Med Sci 59:68–74

    Article  Google Scholar 

  10. Payette H, Coulombe C, Boutier V, Gray-Donald K (2000) Nutrition risk factors for institutionalization in a free-living functionally dependent elderly population. J Clin Epidemiol 53:579–587

    Article  CAS  Google Scholar 

  11. Corrada MM, Kawas CH, Mozaffar F, Paganini-Hill A (2006) Association of body mass index and weight change with all-cause mortality in the elderly. Am J Epidemiol 163:938–949

    Article  Google Scholar 

  12. Locher JL, Roth DL, Ritchie CS, Cox K, Sawyer P, Bodner EV, Allman RM (2007) Body mass index, weight loss, and mortality in community-dwelling older adults. J Gerontol A Biol Sci Med Sci 62:1389–1392

    Article  Google Scholar 

  13. Payette H, Coulombe C, Boutier V, Gray-Donald K (1999) Weight loss and mortality among free-living frail elders: a prospective study. J Gerontol A Biol Sci Med Sci 54:M440–M445

    Article  CAS  Google Scholar 

  14. Schilp J, Kruizenga HM, Wijnhoven AHA, Leistra E, Evers AM, van Binsbergen JJ, Deeg DJH, Visser M (2012) High prevalence of undernutrition in Dutch community-dwelling older individuals. Nutrition 28(11–12):1151–1156

    Google Scholar 

  15. CBS Statline Netherlands (2011) Elderly people live independently to increasingly older ages. CBS Statline Netherlands. http://www.cbs.nl. Accessed 12 July 2011

  16. Milne AC, Potter J, Vivanti A, Avenell A (2009) Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev:CD003288

  17. Baldwin C, Parsons TJ (2004) Dietary advice and nutritional supplements in the management of illness-related malnutrition: systematic review. Clin Nutr 23:1267–1279

    Article  Google Scholar 

  18. Weekes CE, Emery PW, Elia M (2009) Dietary counselling and food fortification in stable COPD: a randomised trial. Thorax 64:326–331

    Article  CAS  Google Scholar 

  19. Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME (2005) Dietary counseling improves patient outcomes: a prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. J Clin Oncol 23:1431–1438

    Article  Google Scholar 

  20. Feldblum I, German L, Castel H, Harman-Boehm I, Shahar DR (2011) Individualized nutritional intervention during and after hospitalization: the nutrition intervention study clinical trial. J Am Geriatr Soc 59:10–17

    Article  Google Scholar 

  21. Endevelt R, Lemberger J, Bregman J, Kowen G, Berger-Fecht I, Lander H, Karpati T, Shahar DR (2011) Intensive dietary intervention by a dietitian as a case manager among community dwelling older adults: the EDIT study. J Nutr Health Aging 15:624–630

    Article  CAS  Google Scholar 

  22. Wijnhoven HA, Schilp J, van Bokhorst-de van der Schueren MA, de Vet HC, Kruizenga HM, Deeg DJ, Ferrucci L, Visser M (2011) Development and validation of criteria for determining undernutrition in community-dwelling older men and women: the short nutritional assessment questionnaire 65+. Clin Nutr 31:351–358

    Article  Google Scholar 

  23. Han TS, Tajar A, Lean ME (2011) Obesity and weight management in the elderly. Br Med Bull 97:169–196

    Article  CAS  Google Scholar 

  24. Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    Article  CAS  Google Scholar 

  25. Pucci E, Belardinelli N, Borsetti G, Rodriguez D, Signorino M (2001) Information and competency for consent to pharmacologic clinical trials in Alzheimer disease: an empirical analysis in patients and family caregivers. Alzheimer Dis Assoc Disord 15:146–154

    Article  CAS  Google Scholar 

  26. Leibbrandt AJ, Kiefte-de Jong JC, Hogenelst MH, Snoek FJ, Weijs PJ (2010) Effects of the PRo-active Interdisciplinary self-management (PRISMA, Dutch DESMOND) program on dietary intake in type 2 diabetes outpatients: a pilot study. Clin Nutr 29:199–205

    Article  Google Scholar 

  27. Ishibashi N, Plank LD, Sando K, Hill GL (1998) Optimal protein requirements during the first 2 weeks after the onset of critical illness. Crit Care Med 26:1529–1535

    Article  CAS  Google Scholar 

  28. Roza AM, Shizgal HM (1984) The Harris Benedict equation reevaluated: resting energy requirements and the body cell mass. Am J Clin Nutr 40:168–182

    CAS  Google Scholar 

  29. Sauerwein HP, Strack van Schijndel RJ (2007) Perspective: how to evaluate studies on peri-operative nutrition? Considerations about the definition of optimal nutrition for patients and its key role in the comparison of the results of studies on nutritional intervention. Clin Nutr 26:154–158

    Article  CAS  Google Scholar 

  30. Frank E, Dunlop AL (2000) What does a patient’s outfit weight? Fam Med 32:595–596

    CAS  Google Scholar 

  31. Visser M, Launer LJ, Deurenberg P, Deeg DJ (1997) Total and sports activity in older men and women: relation with body fat distribution. Am J Epidemiol 145:752–761

    Article  CAS  Google Scholar 

  32. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49:M85–M94

    Article  CAS  Google Scholar 

  33. Westenbrink S, Jansen-van der Vliet M, Brants HAM, Van der Heijden LJM, Hulshof KFAM, Langius JAE (2006) NEVO Dutch food composition table 2006. The Netherlands Nutrition Centre, The Hague, The Netherlands

    Google Scholar 

  34. Kyle UG, Genton L, Karsegard L, Slosman DO, Pichard C (2001) Single prediction equation for bioelectrical impedance analysis in adults aged 20–94 years. Nutrition 17:248–253

    Article  CAS  Google Scholar 

  35. Kyle UG, Genton L, Slosman DO, Pichard C (2001) Fat-free and fat mass percentiles in 5225 healthy subjects aged 15 to 98 years. Nutrition 17:534–541

    Article  CAS  Google Scholar 

  36. Milne AC, Avenell A, Potter J (2006) Meta-analysis: protein and energy supplementation in older people. Ann Intern Med 144:37–48

    Article  CAS  Google Scholar 

  37. Stel VS, Smit JH, Pluijm SM, Visser M, Deeg DJ, Lips P (2004) Comparison of the LASA physical activity questionnaire with a 7-day diary and pedometer. J Clin Epidemiol 57:252–258

    Article  Google Scholar 

  38. Tidermark J, Ponzer S, Carlsson P, Soderqvist A, Brismar K, Tengstrand B, Cederholm T (2004) Effects of protein-rich supplementation and nandrolone in lean elderly women with femoral neck fractures. Clin Nutr 23:587–596

    Article  CAS  Google Scholar 

  39. Wouters-Wesseling W, Van Hooijdonk C, Wagenaar L, Bindels J, de Groot L, Van Staveren W (2003) The effect of a liquid nutrition supplement on body composition and physical functioning in elderly people. Clin Nutr 22:371–377

    Article  CAS  Google Scholar 

  40. Bonnefoy M, Cornu C, Normand S, Boutitie F, Bugnard F, Rahmani A, Lacour JR, Laville M (2003) The effects of exercise and protein-energy supplements on body composition and muscle function in frail elderly individuals: a long-term controlled randomised study. Br J Nutr 89:731–739

    Article  CAS  Google Scholar 

  41. Edington J, Barnes R, Bryan F, Dupree E, Frost G, Hickson M, Lancaster J, Mongia S, Smith J, Torrance A, West R, Pang F, Coles SJ (2004) A prospective randomised controlled trial of nutritional supplementation in malnourished elderly in the community: clinical and health economic outcomes. Clin Nutr 23:195–204

    Article  CAS  Google Scholar 

Download references

Acknowledgments

We thank all participants of NPCS for their participation. We are grateful to all dietitians, research assistants, home care nurses and general practitioners who collaborated in our study. This study was applied by the Dutch Malnutrition Steering Group and supported by funding from the Ministry of Health, Welfare and Sports of the Netherlands.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands

    Janneke Schilp, Hinke M. Kruizenga, Hanneke A. H. Wijnhoven & Marjolein Visser

  2. Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands

    Janneke Schilp, Hinke M. Kruizenga, Hanneke A. H. Wijnhoven & Marjolein Visser

  3. Dutch Malnutrition Steering Group, Amsterdam, The Netherlands

    Janneke Schilp, Hinke M. Kruizenga, Jaap J. van Binsbergen & Marjolein Visser

  4. Department of Nutrition and Dietetics, Internal Medicine and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands

    Hinke M. Kruizenga

  5. Department Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    Jaap J. van Binsbergen

  6. Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands

    Marjolein Visser

Authors
  1. Janneke Schilp
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hinke M. Kruizenga
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hanneke A. H. Wijnhoven
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jaap J. van Binsbergen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marjolein Visser
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Janneke Schilp or Marjolein Visser.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schilp, J., Kruizenga, H.M., Wijnhoven, H.A.H. et al. Effects of a dietetic treatment in older, undernourished, community-dwelling individuals in primary care: a randomized controlled trial. Eur J Nutr 52, 1939–1948 (2013). https://doi.org/10.1007/s00394-013-0495-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00394-013-0495-9

Keywords

Search

Navigation