Effect of oral nutritional supplements on physical functional performance in older patients at nutritional risk discharged with a rehabilitation plan: A randomised controlled trial

Objective: To investigate if post-discharge oral nutritional supplementation improves physical functional performance and other outcomes in older hip fracture patients at nutritional risk. Setting: Department of Orthopaedic Surgery, Copenhagen University Hospital – Herlev and Gentofte, Herlev, Denmark. Participants: Hip fracture patients aged ≥65 years and identified as being at nutritional risk. Of 768 individuals screened, 123 were randomised and 109 (89%) completed the 12-week follow-up. Intervention: Participants were randomised to receive either two cans of high energy, high protein oral nutritional supplementation enriched with vitamin D and omega 3 fatty acids daily for 12 weeks after discharge or standard care. Main measures: The primary outcome was physical functional performance assessed by the 30-s chair-stand test. Secondary outcomes included muscle mass, hand grip strength, activities of daily living, hydration status, inflammation, appetite, quality of life, energy and protein intake, and omega-3 fatty acid status. Results: Physical functional performance improved in both groups, with no significant between-group difference in the number of repetitions performed in the intention-to-treat analysis. Protein intake increased in the intervention group (p = 0.003), while no between-group differences were observed for other outcomes. In the per-protocol analysis, the intervention group showed greater improvement in physical functional performance compared with the control group (p = 0.040). Energy and protein intake were also higher in the intervention group (p = 0.003, p = <.001), Conclusions: Post-discharge oral nutritional supplementation increased protein intake but did not improve physical functional performance. Per-protocol findings suggest that high adherence may be necessary to achieve functional benefits.