Karin Schläppi, Emilie Reber, Katja A Schönenberger, Zeno Stanga, Silvia Kurmann
Journal: The journal of nutrition, health & aging 2024;28(3):100170
PMID: 38308925
Older people and those admitted to hospital are at a higher risk for malnutrition. Nutritional supplements may be able to prevent malnutrition. However, there are a lack of guidelines on the optimal timing of administration and dosage, leading to reduced effects and poor compliance. This sub-analysis of a randomised control trial aimed to determine the effect of an administration method called the Medication Pass Nutritional Supplement Program (MEDPass), on older and hospitalised individuals, which focuses on nutrient supplementation three to four times per day. The results showed that of the 202 individuals included, the MEDPass administration method of supplementation had no effect on energy intake, protein intake, body weight, appetite, nausea, handgrip strength, weight, or compliance to medication compared to if supplementation was taken in the conventional manner with meals. It was concluded that the MEDPass mode of delivering nutritional supplements was not superior to the standard method of delivery. This study could be used by healthcare professionals to understand that without guidelines on when to take nutritional supplementation, some individuals may not be benefitting. However, the MEDPass method of delivery may not optimise supplementation.
OBJECTIVES
The clinical influence of nutritional risk, nutritional status, and energy density of oral nutritional supplements (ONS) in MEDPass versus conventional administration of ONS is currently unknown. The aim of this analysis was to examine whether these variables have an impact on clinical outcomes.
METHODS
Secondary analysis of the intention to treat dataset of the randomized controlled MEDPass Trial in geriatric and medical inpatients. Patients in the intervention group received 4 × 50 ml ONS during the medication rounds (MEDPass mode), while those in the control group received ONS in a non-standardized manner. The examined endpoints included energy and protein coverage, ONS intake, handgrip strength (HGS), weight, appetite nausea and 30-day mortality. Three subgroup analyses for NRS 2002 total score (3, 4 or 5-7 points), NRS 2002 impaired nutritional status score (0, 1, 2 or 3 points) and energy density of the ONS (1.5 kcal/mL or 2 kcal/mL) were performed using linear and logistic regression with interaction and mixed effect models.
RESULTS
The data of 202 patients (103 women and 99 men) at nutritional risk (NRS total 2002 score ≥3), mean (SD) age 82.2 (6.5) years were included. There was no significant difference between the groups in the primary endpoint energy coverage in all three subgroup analyses. There were also no significant differences between the groups in the secondary endpoints of protein coverage, ONS intake, HGS, weight, appetite, nausea, and 30-day mortality.
CONCLUSION
The MEDPass mode of ONS administration was not superior to the conventional mode of administration in this study. ONS with high energy density (≥2 kcal/mL) should be offered since current evidence shows a tendency towards improved appetite, increased ONS and increased energy intake.
Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.
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