A randomised, controlled trial of the effects of an energy‐dense supplement on energy intake, appetite and blood lipids in malnourished community‐based elderly patients
Authors: Hubbard G.P. , Bolch R. , Holdoway A. , Beams A. , Kerr A. , Robertson D. , Stratton R.J. 
Published: July 2008

Background:  Disease‐related malnutrition is common in the elderly and if left untreated may have severe consequences (Stratton & Elia, 2003). One of the strategies used to combat malnutrition is the use of high‐energy, low‐volume [18.8 kJ mL−1 (4.5 kcal ml−1)] nutritional supplements. This study aimed to investigate the effects of an energy dense supplement on energy intake, appetite and blood lipids in elderly patients at risk of malnutrition.

Methods:  In this randomised, controlled, parallel study, 42 community‐based patients (mean (SD) age: 84 (7.0) years, mean body mass index (BMI): 20.9 (3.5) kg m−2), identified as being at medium or high risk of malnutrition [Malnutrition Universal Screening Tool (MUST) (Elia, 2003)] were randomised (using standard randomisation methods) to receive either; (i) 1674 kJ day−1 (400 kcal day−1) (in 3 × 30 mL doses) of an energy‐dense supplement (Calogen, Nutricia®) (n = 19) or (ii) dietary advice in the form of a standardised dietary advice sheet (n = 23), for 4 weeks. Energy intake, appetite, blood lipids [i.e. total cholesterol, low density lipoprotein (LDL) cholesterol (subset analysis only)], body weight, gastro‐intestinal tolerance, product compliance and product acceptability were assessed during the 4 week study. Results are presented as mean (SD). Paired t‐test and one way anova statistical analyses were undertaken using SPSS v15. Ethical approval for this study was obtained from the appropriate committee.

Results:  Supplementation with the energy dense supplement significantly increased mean total daily energy intake by +1736 kJ (+415 kcal, P = 0.009) from 6456 (2330) kJ [1543 (557) kcal] to 8192 (1477) kJ [1958 (353) kcal], with no significant effect on voluntary food intake or appetite scores (for hunger, fullness and desire to eat). In the dietary advice group, although mean total daily energy intake was also significantly increased by +1105 kJ (+264 kcal, P = 0.026) from 5623 (2107) kJ [1344 (503) kcal] to 6728 (2029) kJ [1608 (485) kcal], it was significantly lower than in the energy dense group [‐1464 kJ (‐350 kcal), P = 0.012] at week 4. Both energy‐dense and dietary advice groups maintained weight during the study. No significant adverse effects on blood lipid concentrations were observed in either group, with a significant decrease in total cholesterol concentrations [from 4.26 (1.0) mM to 3.96 (0.8) mM, P = 0.03] and LDL cholesterol concentrations [from 2.32 (0.6) mM to 2.06 (0.5) mM, P = 0.03] in the energy dense group (subset analysis, n = 9). Both supplementation with energy dense supplement and dietary advice were well tolerated with no gastro‐intestinal side effects. The energy dense supplement was well accepted with >80% of patients rating it as pleasant and convenient, with an enjoyable taste. Compliance with the energy dense supplement was high, with 95% of patients consuming the recommended dose of 3 × 30 mL throughout the study.

Discussion:  This study in elderly patients with or at risk of malnutrition suggests that the energy dense supplement is effective in significantly improving total intakes of energy with no suppression of appetite or voluntary dietary intake, enabling patients to maintain weight and that the energy dense supplement is well tolerated and accepted, with excellent compliance and no adverse effects on blood lipids.

Conclusions:  This randomised controlled trial suggests that an energy‐dense supplement is an effective, well tolerated and safe method of providing energy supplementation for the management of elderly patients with or at risk of malnutrition in clinical practice.

References  Elia, M. (2003) The “MUST” report. Nutritional screening for adults: a multidisciplinary responsibility. Redditch, UK: BAPEN. Available at http://www.bapen.org.uk (accessed on 15 March 2008).

Stratton, R.J., Green, C.J. & Elia, M. (2003) Disease‐related malnutrition: an evidence‐based approach. Oxford: CABI publishing.