Effectiveness of multidisciplinary nutritional care on nutritional intake, nutritional status and quality of life in patients with hip fractures: a controlled prospective cohort study.

摘要

BACKGROUND & AIMS: The purpose of this study was to determine the effectiveness of a multidisciplinary intervention program on nutritional intake and of nutritional intake on nutritional status and quality of life in older patients treated for a hip fracture. METHODS: A controlled prospective cohort study included 66 patients in the control group and 61 patients in the intervention group, aged over 65 and sustaining a hip fracture with subsequent operative intervention. Postoperatively, the control group received standard nutritional care and the intervention group multidisciplinary nutritional care that focused on nutritional support during hospitalisation and a transfer of nutritional care after discharge. Nutrient intakes were monitored with food records. Nutritional status was determined by the Mini Nutritional Assessment (MNA), and bioelectrical impedance analysis was used to assess body cell mass (BCM). The EuroQol (EQ-5D) was used to assess quality of life. Patients were evaluated at admission and three months postoperatively. RESULTS: There was a significant difference in the daily energy intake of patients between both groups during the first seven days postoperatively: 1127 kcal (+/-309) in the control group and 1292 kcal (+/-280) (P = 0.002) in the intervention group. Mean protein intake in the intervention group (57 g (+/-12)) was significantly higher than in the control group (48 g (+/-14), P = 0.000). The intervention group demonstrated a significantly lower reduction of EQ-5D index scores compared with the control group (P = 0.004) after three months. At three months, significantly fewer patients in the intervention group were classified as malnourished or at risk of malnutrition. CONCLUSIONS: Among elderly patients with a hip fracture, a multidisciplinary postoperative approach of nutritional care was associated with an increase of energy and protein intake during hospitalisation. After three months follow-up there were fewer malnourished patients in the intervention group, and the decline in quality of life was lower than in the control group. There were no advantages of multidisciplinary nutritional care on body cell mass.