Wendeline Wouters-Wesseling

A randomised, double-blind assessment of the effect of nutritional supplementation on the prevention of pressure ulcers in hip-fracture patients.

BACKGROUND & AIMS Malnutrition is a risk factor for development of pressure ulcers (PU). Nutritional supplementation may thus reduce the incidence of PU. We investigated the effect of nutritional supplementation on incidence of PU in hip-fracture patients at risk of developing PU. METHODS Hip-fracture patients (n=103) were included in this double-blind, randomised, placebo-controlled trial. They received 400 ml daily of a supplement enriched with protein, arginine, zinc and antioxidants (n=51) or a non-caloric, water-based placebo supplement (n=52). Presence and stage of PU were assessed daily for 28 days or until discharge (median: 10 days during supplementation). RESULTS Incidence of PU was not different between supplement (55%) and placebo (59%), but incidence of PU stage II showed a 9% difference (difference: 0.091; 95% CI: 0.07-0.25) between supplement (18%) and placebo (28%). Of patients developing PU 57% developed it by the second day. Time of onset (days) showed a trend (P=0.090) towards later onset of PU with supplement (3.6+/-0.9) than placebo (1.6+/-0.9). CONCLUSIONS Hip-fracture patients develop PU at an early stage. Nutritional supplementation may not prevent PU at this stage, but contributes possibly to a delayed onset and progression of PU. Nutritional supplementation may be more effective if initiated earlier.

Study of the effect of a liquid nutrition supplement on the nutritional status of psycho-geriatric nursing home patients.

Objectives: To evaluate the acceptance of a multinutrient liquid nutrition supplement in psycho-geriatric nursing home patients and the effect on weight, plasma nutrients and activities of daily life.Design: Double-blind, placebo-controlled 12-week intervention study.Setting: Two nursing homes in Boxtel, The Netherlands.Subjects: Forty-two (body mass index (BMI) <23 kg/m2 for men or <25 kg/m2 for women) psycho-geriatric nursing home patients aged 60 y or over.Interventions: Provision with a complete micronutrient-enriched liquid nutrition supplement of 125 ml and 0.6 MJ (135 kcal) or placebo twice daily during daytime between main meals. Study parameters were assessed at 0, 6 and 12 weeks.Main Outcome for Measures: Weight, Barthel index of daily activities, several plasma values (albumin, C-reactive protein (CRP), homocysteine, thiamine, thiamine diphosphate (TDF), vitamin B6, vitamin B12, folic acid, vitamin D), bowel function.Results: The supplement was well accepted. Thirty-five patients completed the intervention period (16 control group; 19 supplement group). Baseline daily nutrient intake was low. A statistically significant improvement was observed for body weight (difference between groups 2.2 kg, P=0.03), and homocysteine, vitamin B1, TDF, vitamin B6, vitamin B12, folate and vitamin D in the supplement group compared to the placebo group. No significant difference was observed in the Barthel index (mean difference −0.3±1.1 for both groups). No difference in occurrence of diarrhoea was observed.Conclusions: The study shows that nutritional supplementation is well accepted and can improve the nutritional status of psycho-geriatric nursing home patients.Sponsorship: Numico Research BV.

Alpha-lactalbumin combined with a regular diet increases plasma Trp-LNAA ratio.

Brain serotonin influences food intake and mood. It is synthesised from tryptophan (Trp) of which uptake in the brain is dependent on plasma ratio of tryptophan to the sum of other large neutral amino acids (Trp-LNAA). A carbohydrate-rich diet increases this ratio, whereas a protein-rich diet decreases it. Yet, if the protein source is alpha-lactalbumin the ratio increases. It is, however, unknown whether this also happens in the context of a regular diet (15% protein). We studied the effect of an alpha-lactalbumin supplement combined with regular diet on plasma Trp-LNAA ratio, serum prolactin (marker of serotonin synthesis), food intake, appetite, macronutrient preference and mood. Eighteen healthy males participated in a double-blind, randomised, placebo-controlled, crossover study. One hour after breakfast they received a drink containing alpha-lactalbumin and carbohydrates (AS) or carbohydrates (PS) only. Plasma Trp-LNAA ratio, serum prolactin, food intake, appetite, macronutrient preference and mood were assessed before and 90 min after consumption of the supplement. Changes of plasma Trp-LNAA ratio differed (P<.001) between both supplements, increasing by 16% after AS and decreasing by 17% after PS. Decrease of serum prolactin was slightly smaller after AS than after PS (P=.083). Appetite, food intake, macronutrient preference or mood did not differ between supplements. We conclude that an alpha-lactalbumin-enriched supplement combined with a regular diet increases plasma Trp-LNAA ratio and may influence serum prolactin, but we could not demonstrate effects on appetite, food intake, macronutrient preference and mood.

Pressure ulcer risk in hip fracture patients

Hip fracture patients have a high risk of pressure ulcers (PU). We followed 121 hip fracture patients for the development of pressure ulcers and evaluated a risk assessment tool for sensitivity and specificity. More than half of the patients presented with PU, mostly stage I. Risk factors for PU were high age and the length of time on the operating table. The risk assessment tool had a low predictive value, however. It is thus hard to predict which patients will develop PU and which will not. Accordingly, we propose maximum preventive measures against PU for all patients presenting with hip fractures.

Early nutritional supplementation immediately after diagnosis of infectious disease improves body weight in psychogeriatric nursing home residents

Background and aims: Many elderly people with Alzheimer’s disease experience weight loss. Illness and inadequate regain after a period of illness are considered as contributory causes of progressive weight loss in psychogeriatric patients. We studied whether early use of a liquid nutrition supplement immediately after onset of acute illness from infection can prevent weight loss in elderly psychogeriatric nursing home residents. Methods: Randomised controlled trial of 5 weeks after the onset of illness. Thirty-four psychogeriatric nursing home residents (aged ±65 yrs) completed the study period. A liquid nutrition supplement (200 ml) once daily immediately after diagnosis of infection or standard treatment (enriched food after referral to a dietician) were provided. Body weight, mid-upper arm circumference, calf circumference, triceps skin fold thickness, dietary energy intake, and need for care were measured. Results: Weight change during the study period was significantly different between the standard (−0.4 kg) and supplement (+0.8 kg) groups (p=0.040). No significant differences were observed in changes of midupper arm circumference, triceps skin fold thickness, calf circumference or energy intake between groups. Conclusions: Early provision of a liquid nutrition supplement immediately after onset of acute illness from infection leads to weight gain in elderly psychogeriatric nursing home residents.

Biochemical Antioxidant Levels Respond to Supplementation with an Enriched Drink in Frail Elderly People

Objective: To investigate whether a drink enriched with essential vitamins and minerals can improve biochemical status of enzymatic and non-enzymatic antioxidants in frail elderly people. Methods: A six-month randomized, double blind, placebo controlled intervention study. Frail elderly people 65 years of age or older, with a body mass index (BMI) below 25 kg/m2 and residing in a home for the elderly or in sheltered housing. Enriched (with essential vitamins and minerals in 30% to 150% of RDA and higher levels of antioxidants) drink (n = 28) or placebo (n = 27) to be taken twice a day in addition to the normal food consumed. Plasma levels of vitamin C, vitamin E, antioxidant capacity (TEAC), cysteine, uric acid and whole blood levels of total thiol and glutathione peroxidase (GSH-Px), dietary intake. Results: Changes in vitamin E (16 ± 2 vs. 2 ± 1 mmol/L), vitamin C (37 ± 5 vs. 1 ± 5 mmol/L), TEAC (38 ± 15 vs. −10 ± 11 mmol/L Trolox eq) and cysteine (17 ± 10 vs. 0.4 ± 6 mmol/L) were significantly different between groups (p < 0.05). There was a trend towards significant changes in erythrocyte glutathione peroxidase (−0.2 ± 3 vs. −10 ± 7 U/mg Hb, p = 0.097). Baseline dietary intake of antioxidant vitamins was below 2/3 RDA for a substantial proportion (43% to 76%) of subjects. Conclusions: Supplementation with an enriched drink can raise plasma levels of enzymatic and non-enzymatic antioxidants in frail elderly people.