J.J.L. Breedveld-Peters

Efficacy of Nutritional Intervention in Elderly After Hip Fracture: A Multicenter Randomized Controlled Trial

Abstract Background Malnutrition after hip fracture is associated with increased rehabilitation time, complications, and mortality. We assessed the effect of intensive 3 month nutritional intervention in elderly after hip fracture on length of stay (LOS). Methods Open-label, randomized controlled trial. Exclusion criteria: age < 55 years, bone disease, life expectancy < 1 year, bedridden, using oral nutritional supplements (ONS) before hospitalization, and cognitive impairment. Intervention: weekly dietetic consultation, energy-protein–enriched diet, and ONS (400 mL per day) for 3 months. Control: usual nutritional care. Primary outcome: total LOS in hospital and rehabilitation clinic, including readmissions over 6 months (Cox regression adjusted for confounders); hazard ratio (HR) < 1.0 reflects longer LOS in the intervention group. Secondary outcomes: nutritional and functional status, cognition, quality of life, postoperative complications (6 months); subsequent fractures and all-cause mortality (1 and 5 years). Effect modification by baseline nutritional status was also tested. Results One hundred fifty-two patients were randomized (73 intervention, 79 control). Median total LOS was 34.0 days (range 4–185 days) in the intervention group versus control 35.5 days (3–183 days; plogrank = .80; adjusted hazard ratio (adjHR): 0.98; 95% CI: 0.68–1.41). Hospital LOS: 12.0 days (4–56 days) versus 11.0 days (3–115 days; p = .19; adjHR: 0.75; 95% CI: 0.53–1.06) and LOS in rehabilitation clinics: 19.5 days (0–174 days) versus 18.5 days (0–168 days; p = .82; adjHR: 1.04; 95% CI: 0.73–1.48). The intervention improved nutritional intake/status at 3, but not at 6 months, and did not affect any other outcome. No difference in intervention effect between malnourished and well-nourished patients was found. Conclusions Intensive nutritional intervention after hip fracture improved nutritional intake and status, but not LOS or clinical outcomes. Paradigms underlying nutritional intervention in elderly after hip fracture may have to be reconsidered.

PP241-MON QUALITATIVE ANALYSIS OF BARRIERS AND FACILITATORS FOR NUTRITIONAL INTERVENTION IN HIP FRACTURE PATIENTS

PP241-MON QUALITATIVE ANALYSIS OF BARRIERS AND FACILITATORS FOR NUTRITIONAL INTERVENTION IN HIP FRACTURE PATIENTS J. Breedveld-Peters1, P.L. Reijven2, C.E. Wyers1, A.A. Hendrikx1, A.D. Verburg3, J.M. Schols4,5, M.H. Prins1,6, T. van der Weijden7, P.C. Dagnelie1. 1Department of Epidemiology, CAPHRI School for Public Health, Maastricht University, 2Department Clinical Dietetics, Maastricht University Medical Centre, Maastricht, 3Department of Orthopaedic Surgery, Orbis Medical Centre, Sittard, 4Department of General Practice and Department of Health Service Research, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, 5Manager of the Medical and Paramedical Treatment Department, Vivre, 6Department of Medical Technology Assessment, Maastricht University Medical Centre, 7Department of General Practice, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands

PP065-SUN EFFECT OF NUTRITIONAL INTERVENTION ON LENGTH OF STAY, POSTOPERATIVE COMPLICATIONS, FUNCTIONAL STATUS AND MORTALITY IN HIP FRACTURE PATIENTS: A MULTI-CENTRE RANDOMISED CONTROLLED TRIAL (RCT)

PP064-SUN EFFECTS OF NUTRITIONAL INTERVENTION ON IMMUNE MARKERS IN MALNOURISHED ELDERLY F. Neelemaat1, M.A. van Bokhorst-de van der Schueren1, H.J. Bontkes2, J.C. Seidell3, S. Hougee4, A. Thijs5. 1Nutrition and Dietetics/Internal Medicine, 2Pathology, Unit Medical Immunology, VU University Medical Center, 3Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, 4Nutricia Advanced Medical Nutrition, Danone Research, Centre for Specialised Nutrition, Wageningen, 5Internal Medicine, VU University Medical Center, Amsterdam, Netherlands

SUN-P082: Comparison of the “ESPEN Guidelines on Nutrition in Cancer Patients 2016” with the Recommendations of the Dutch Dietitians in Oncology Group

Rationale: In 2016, a completely revised second version of the ‘Handbook Nutrition in Cancer’ (HNC, in Dutch) by the Dutch Dietitians Oncology Group (DDOG) was published. In this project, the DDOG evaluated similarities and potential discrepancies between DDOG recommendations and the ESPEN guidelines for the identification, prevention and treatment of reversible elements of malnutrition during and after cancer treatment. Methods: The recommendations of the DDOG, as published in the HCN, were systematically compared with the ESPEN guidelines on nutrition in cancer patients. guidelines. However, DDOG recommendations are more detailed, comprehensive, and practical. The DDOG and the ESPEN guidelines differ in that the DDOG 1) recommends the comprehensive PG-SGA and PG-SGA Short Form for screening and nutritional assessment; 2) recommends to start artificial nutrition at an earlier stage; 3) does not recommend increasing the ratio of energy from fat/energy from carbohydrates in weight-losing cancer patients with insulin resistance; 4) includes a less conservative recommendation on increasing energy intake for prevention of refeeding syndrome; and 5) supports a longer period of corticosteroid use to increase appetite (4-8 weeks vs ESPEN 1-3 weeks). Additionally Results: Overall, the DDOG recommendations are in line with the ESPEN , the DDOG does not include a specific advice for parenteral nutrition composition during intensive chemotherapy, and includes the advice to avoid fatty fish/fish oil 24 hours before and after specific chemotherapy treatment. Both guidelines recommend nutritional care to be accompanied by exercise training. Conclusion: The DDOG and ESPEN recommendations are generally in line with each other, but the DDOG recommendations are more specific and practical. DDOG and ESPEN are complementary to each other.