Clinical Nutrition Open Science (Apr 2022)
Protein intake in hospitalized older patients after hip fracture: Pilot feasibility study evaluating ESPEN guidelines for geriatrics
Abstract
Summary: Background & Aim: Older patients with hip fracture are often malnourished or at risk of developing malnutrition. Poor oral food intake and difficulties reaching the recommended protein intake have been reported in this population. Recently published ESPEN guidelines for geriatrics recommend oral nutritional supplements (ONS) providing at least 30 g protein/day. The aim of the study was to assess the feasibility of implementing these ESPEN recommendations in a real-world setting. Methods: Patients ≥65 years with a hip fracture admitted to the orthopaedic ward at Herlev-Gentofte University Hospital, Copenhagen, Denmark were included in a single-arm study. Patients received standard care and were offered two servings ONS daily (Nutridrink Compact Protein, 18 g protein/125 ml serving), at breakfast and pre-bedtime, from first postoperative day until hospital discharge. Protein and energy intake from hospital food, beverages, and study ONS were recorded during hospitalization. Achievement of target ONS (30 g protein/day from ONS) and adherence to ONS prescription by serving time were calculated. Further total protein intake was compared to 1.0, 1.2 and 1.5 g/kg BW/day and specifically at postoperative day 4 to 1.2 g/kg BW/day. Data are presented as median [IQR]. Results: Forty patients (70% women) with a median age of 86.5 years were included. Only five patients met the recommended 30 g protein/day from ONS during hospitalization. Overall adherence to ONS during hospitalization was 58.2% [33.3–75.0]; highest at breakfast (66.7% [44.9–100]) compared to pre-bedtime (48.8% [5.0–66.7]). Total daily protein intake was 48.7 g [34.9–56.1], of which 18.5 g [11.7–27.0] came from ONS, 23.2 g [14.6–29.0] from food and 6.2 g [1.5–10.00] from beverages. At postoperative day 4, 17 of the 40 patients were still in the hospital. The median total protein intake on day 4 was 0.5 g/kg BW/day [0.4–0.8], representing 42.2% [29.2–64.4] of 1.2 g/kg BW/day. Only three of the 17 patients achieved 100% of the protein reference level. Conclusion: The recommended intake of 30 g protein/day from ONS during hospital stay was met in a minority of this population of older patients with hip fracture, with low adherence to ONS prescription as an important barrier. However, ONS substantially contributed to the daily protein intake since protein intake from food was also very low. These insights should be used to inform further research aiming to discover ways to improve dietary intake with multiple dietary strategies, tailored to individual needs.
