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A systematic review of protein and energy supplementation for hip fracture aftercare in older people

European Journal of Clinical Nutrition volume 57, pages 895–903 (2003)Cite this article

Abstract

Objectives: To evaluate whether protein and energy supplementation influences recovery after hip fracture.

Design: Systematic review of randomised and quasi-randomised trials in people aged 65 y and over.

Data sources: We searched seven electronic databases from 1966 to April 2002, four journals and reference lists of relevant articles. We contacted trial investigators and experts for details of other trials.

Main outcome measures: Mortality, complications and unfavourable outcome (mortality or survivors with complications) were the primary outcomes. We also sought data on length of hospital stay, functional status after hip fracture, quality of life and compliance with supplementation.

Results: In total, 12 randomised trials involving 898 participants were included. Nine trials evaluated protein and energy supplementation (five oral and four nasogastric feeding), and a further three trials tested oral protein supplementation. Potential biases resulting from inadequate allocation concealment and lack of assessor blinding and intention-to-treat analysis, as well as the limited outcome data, mean that the results must be interpreted with caution.

Pooled data from eight of the nine trials evaluating protein and energy supplements showed no evidence for an effect on mortality (relative risk 0.92, 95% CI 0.56–1.50). Limited data from only three trials showed that oral protein and energy supplements may reduce unfavourable outcome (relative risk 0.52, 95% CI 0.32–0.84).

Conclusion: Based on limited evidence, oral protein and energy supplementation after hip fracture may reduce unfavourable outcome. Further evidence from good-quality randomised trials is required to inform clinical practice.

Sponsorship: Medical Research Council, Chief Scientist Office of the Scottish Executive Health Department.

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Acknowledgements

We are grateful for the helpful comments from the following during production of the Cochrane review: Dr Stuart Bruce, Professor William Gillespie, Dr Ronald Koretz, Professor Rajan Madhok, Professor Gordon Murray, Mr Martyn Parker, Professor Gwyn Seymour and Professor Marc Swiontkowski. We thank Professor Simon Allison, Ms Melinda Bopp, Dr Katrina Brown, Professor Ian Cameron, Ms Heidi Guyer, Dr Henk Hartgrink, Dr Ronald Koretz and Dr Dennis Sullivan for providing further information about trials. We thank Dr Ronald Koretz for help with hand searching the Journal of Parenteral and Enteral Nutrition. We particularly thank Professor Adrian Grant for his constructive comments. We thank the anonymous referees for their comments.

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Authors and Affiliations

  1. Health Services Research Unit, University of Aberdeen, Aberdeen, UK

    A Avenell

  2. based at the Department of Orthopaedic Surgery, School of Health and Social Care, University of Teesside, Royal Infirmary of Edinburgh, Little France, Edinburgh, UK

    H H G Handoll

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  1. A Avenell
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  2. H H G Handoll
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Contributions

Guarantors: A Avenell and H Handoll.

Contributors: AA initiated the review, wrote the first draft of the protocol, undertook the subject-specific literature search, contacted trialists and wrote the first draft of the review. Both authors assessed and extracted data from trials and devised the analyses. HH provided methodological support at all stages and critically rewrote the review and subsequent drafts.

Potential conflict of interest: none known.

Supported by the Medical Research Council (AA); Chief Scientist Office of the Scottish Executive Health Department (AA, HHGH). The Health Services Research Unit is funded by the Chief Scientist Office of the Scottish Executive Health Department; however, the views expressed are those of the authors.

Corresponding author

Correspondence to A Avenell.

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Avenell, A., Handoll, H. A systematic review of protein and energy supplementation for hip fracture aftercare in older people. Eur J Clin Nutr 57, 895–903 (2003). https://doi.org/10.1038/sj.ejcn.1601623

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