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Compliance of nursing home residents with a nutrient- and energy-dense oral nutritional supplement determines effects on nutritional status

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The journal of nutrition, health & aging

Abstract

Objectives

Administration of oral nutritional supplements (ONS) is an effective strategy to treat and avoid malnutrition, a persisting issue in nursing homes. However, little is known about compliance in the NH population. This study aimed to analyse the effects of compliance of NH residents with a low-volume, nutrientand energy-dense ONS on nutritional status and to identify residents’ characteristics associated with compliance.

Design & Setting

Randomized, controlled trial in nursing homes.

Participants & Intervention

87 nursing home residents (87±6y, 91% female) with malnutrition or at risk of malnutrition were randomly allocated to an intervention group (IG) receiving 2×125 ml ONS (2.4 kcal/ml)/d for 12 weeks, or the control group (CG) with usual care.

Measurements

ONS intake was recorded daily and compliance calculated. Low and high compliance were defined as ≤30% and ≥80% of provided ONS actually consumed, respectively. Body weight (BW), BMI, upper-arm (UAC) and calf-circumference (CC) and MNA-SF were assessed at baseline and after 12 weeks. Associations between compliance and changes of nutritional parameters and residents’ characteristics were analysed.

Results

Compliance was high in 35.7% and low in 28.6% of the IG (n=42). BW change was significantly higher in subjects with high compliance (median +3.0 (interquartile range +2.1;+3.8) kg, n=15) than in those with low compliance (−0.2 (−2.2;+1.6) kg, n=12) and CG (−0.1 (−1.2; +0.6) kg, n=35; p<0.001), and significantly correlated with compliance in IG (r=0.691; p<0.001). Significant differences and correlations were also identified for BMI, UAC and MNA-SF. High compliance was more often observed in residents with malnutrition (66.7 vs. 27.3%) and chewing difficulties (77.8 vs. 24.2%) than in those without these conditions. Low compliance was more prevalent in residents who were immobile (45.0 vs. 13.6%), depressed (33.3 vs. 6.7%) or had gastrointestinal complaints (50.0 vs. 17.9%) (all p<0.05).

Conclusions

A high compliance of nursing home residents with a low volume, nutrient- and energy dense ONS was related to a significantly improved nutritional status in comparison to low compliance and therefore enhanced the effectiveness of ONS. A higher compliance may be achieved by consideration of different residents’ characteristics.

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Authors and Affiliations

  1. Institute for Biomedicine of Aging (IBA), Friedrich-Alexander Universität Erlangen-Nürnberg, Nürnberg, Germany

    Inken Jobse, C. C. Sieber & D. Volkert

  2. Department of Nutrition and Food Sciences (IEL) — Nutritional Physiology, University of Bonn, Bonn, Germany

    Y. Liao, M. Bartram, K. Delantonio & P. Stehle

  3. Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany

    W. Uter

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  1. Inken Jobse
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  2. Y. Liao
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Correspondence to Inken Jobse.

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Jobse, I., Liao, Y., Bartram, M. et al. Compliance of nursing home residents with a nutrient- and energy-dense oral nutritional supplement determines effects on nutritional status. J Nutr Health Aging 19, 356–364 (2015). https://doi.org/10.1007/s12603-014-0544-y

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  • DOI: https://doi.org/10.1007/s12603-014-0544-y

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