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Clinical nutrition

Prevalence of malnutrition in a cohort of 509 patients with acute hip fracture: the importance of a comprehensive assessment

Abstract

Backgrounds/objectives:

Malnutrition is very common in acute hip fracture (HF) patients. Studies differ widely in their findings, with reported prevalences between 31 and 88% mainly because of small sample sizes and the use of different criteria. The aim of this study was to learn the prevalence of malnutrition in a large cohort of HF patients in an comprehensive way that includes the frequency of protein–energy malnutrition, vitamin D deficiency and sarcopenia.

Subjects/methods:

A 1-year consecutive sample of patients admitted with fragility HF in a 1300-bed public University Hospital, who were assessed within the first 72 h of admission. Clinical, functional, cognitive and laboratory variables were included. Energy malnutrition (body mass index (BMI) <22 kg/m2), protein malnutrition (serum total protein <6.5 g/dl or albumin <3.5 g/dl), vitamin D deficiency (serum 25-OH-vitamin D <30 ng/dl) and sarcopenia (low muscle mass plus low grip strength) were considered.

Results:

Five hundred nine HF patients were included. The mean age was 85.6±6.9 years and 79.2% were women. Ninety-nine (20.1%) patients had a BMI <22 kg/m2. Four hundred nine patients (81.2%) had protein malnutrition. Eighty-seven (17.1%) patients had both energy and protein malnutrition. Serum vitamin D was <30 ng/ml in 466 (93%) patients. The prevalence of sarcopenia was 17.1%.

Conclusions:

Protein malnutrition and vitamin D deficiency are the rule in acute HF patients. Energy malnutrition and sarcopenia are also common. A nutritional assessment in these patients should include these aspects together.

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References

  1. Singer A, Exuzides A, Spangler L, O’Malley C, Colby C, Johnston K et al. Burden of illness for osteoporotic fractures compared with other serious diseases among postmenopausal women in the United States. Mayo Clin Proc 2015; 90: 53–62.

    Article  Google Scholar 

  2. Hernlund E, Svedbom A, Ivergård M, Compston J, Cooper C, Stenmark J et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 2013; 8: 136.

    CAS  Article  Google Scholar 

  3. Rohde G, Haugeberg G, Mengshoel AM, Moum T, Wahl AK . Two-year changes in quality of life in elderly patients with low-energy hip fractures. A case-control study. BMC Musculoskelet Disord 2010; 11: 226.

    Article  Google Scholar 

  4. González-Montalvo JI, Alarcón T, Hormigo Sánchez AI . Por qué fallecen los pacientes con fractura de cadera? [Why do hip fracture patients die?]. Med CĹin 2011; 137: 355–360.

    Google Scholar 

  5. García Lázaro M, Montero Pérez-Barquero M, Carpintero Benítez P . The role of malnutrition and other medical factors in the evolution of patients with hip fracture. An Med Interna 2004; 21: 557–563.

    PubMed  Google Scholar 

  6. Bell JJ, Bauer JD, Capra S, Pulle RC . Concurrent and predictive evaluation of malnutrition diagnostic measures in hip fracture inpatients: a diagnostic accuracy study. Eur J Clin Nutr 2014; 68: 358–362.

    CAS  Article  Google Scholar 

  7. Miller MD, Bannerman E, Daniels LA, Crotty M . Lower limb fracture, cognitive impairment and risk of subsequent malnutrition: a prospective evaluation of dietary energy and protein intake on an orthopaedic ward. Eur J Clin Nutr 2006; 60: 853–861.

    CAS  Article  Google Scholar 

  8. Eneroth M, Olsson U-B, Thorngren K-G . Nutritional supplementation decreases hip fracture-related complications. Clin Orthop Relat Res 2006; 451: 212–217.

    Article  Google Scholar 

  9. Montero Pérez-Barquero M, García Lázaro M, Carpintero Benítez P . Desnutrición como factor pronóstico en ancianos con fractura de cadera [Malnutrition as a prognostic factor in elderly patients with hip fractures]. Med Clin (Barc) 2007; 128: 721–725.

    Article  Google Scholar 

  10. Li H-J, Cheng H-S, Liang J, Wu C-C, Shyu Y-IL . Functional recovery of older people with hip fracture: does malnutrition make a difference? J Adv Nurs 2013; 69: 1691–1703.

    Article  Google Scholar 

  11. Pérez Durillo FT, Ruiz López MD, Bouzas PR, Martín-Lagos YA . Estado nutricional en ancianos con fractura de cadera [Nutritional status in elderly patients with a hip fracture]. Nutr Hosp 2010; 25: 676–681.

    PubMed  Google Scholar 

  12. Ponzer S, Tidermark J, Brismar K, Soderqvist A, Cederholm T . Nutritional status, insulin-like growth factor-1 and quality of life in elderly women with hip fractures. Clin Nutr 1999; 18: 241–246.

    CAS  Article  Google Scholar 

  13. Drevet S, Bioteau C, Mazire S, Couturier P, Merloz P, Tonetti J et al. Prevalence of protein-energy malnutrition in hospital patients over 75 years of age admitted for hip fracture. Orthop Traumatol Surg Res 2014; 100: 669–674.

    CAS  Article  Google Scholar 

  14. Hoekstra JC, Goosen JHM, de Wolf GS, Verheyen CCPM . Effectiveness of multidisciplinary nutritional care on nutritional intake, nutritional status and quality of life in patients with hip fractures: a controlled prospective cohort study. Clin Nutr 2011; 30: 455–461.

    Article  Google Scholar 

  15. Hida T, Ishiguro N, Shimokata H, Sakai Y, Matsui Y, Takemura M et al. High prevalence of sarcopenia and reduced leg muscle mass in Japanese patients immediately after a hip fracture. Geriatr Gerontol Int 2013; 13: 413–420.

    Article  Google Scholar 

  16. Ballokova A, Hubbard R, Peel N, Fialova D, Onder G . Correlation between protein intake and sarcopenia in older adults with hip fracture. J Frailty Aging 2014; 3: 63.

    Google Scholar 

  17. Vázquez M, Perez Cano R . Prevalence of sarcopenia in Andalusian patients immediately after a hip fracture. J Frailty Aging 2014; 3: 76.

    Google Scholar 

  18. Dixon T, Mitchell P, Beringer T, Gallacher S, Moniz C, Patel S et al. An overview of the prevalence of 25-hydroxy-vitamin D inadequacy amongst elderly patients with or without fragility fracture in the United Kingdom. Curr Med Res Opin 2006; 22: 405–415.

    CAS  Article  Google Scholar 

  19. Lauretani F, Frondini C, Davoli ML, Martini E, Pellicciotti F, Zagatti A et al. Vitamin D supplementation is required to normalize serum level of 25OH-vitamin D in older adults: an observational study of 974 hip fracture inpatients. J Endocrinol Invest 2012; 35: 921–924.

    CAS  PubMed  Google Scholar 

  20. Guo JJ, Yang H, Qian H, Huang L, Guo Z, Tang T . The effects of different nutritional measurements on delayed wound healing after hip fracture in the elderly. J Surg Res 2010; 159: 503–508.

    CAS  Article  Google Scholar 

  21. González-Montalvo JI, Alarcón T, Mauleón JL, Gil-Garay E, Gotor P, Martín-Vega A . The orthogeriatric unit for acute patients: a new model of care that improves efficiency in the management of patients with hip fracture. Hip Int 2009; 20: 229–235.

    Article  Google Scholar 

  22. Holden MK, Gill KM, Magliozzi MR, Nathan J, Piehl-Baker L . Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness. Phys Ther 1984; 64: 35–40.

    CAS  Article  Google Scholar 

  23. Mahoney FI, Barthel DW . Functional evaluation: the Barthel index. Md State Med J 1965; 14: 61–65.

    CAS  PubMed  Google Scholar 

  24. Martínez de la Iglesia J, Dueñas Herrero R, Carmen Onís Vilches M, Aguado Taberné C, Albert Colomer C, Luque Luque R . Adaptación y validación al castellano del cuestionario de Pfeiffer (SPMSQ) para detectar la existencia de deterioro cognitivo en personas mayores e 65 años [Cross-cultural adaptation and validation of Pfeiffer’s test (Short Portable Mental Status Questionnaire [SPMSQ]) to screen cognitive impairment in general population aged 65 or older]. Med Clin (Barc) 2001; 117: 129–134.

    Article  Google Scholar 

  25. Auyeung TW, Lee JSW, Kwok T, Leung J, Leung PC, Woo J . Estimation of stature by measuring fibula and ulna bone length in 2443 older adults. J Nutr Health Aging 2009; 13: 931–936.

    CAS  Article  Google Scholar 

  26. Masanes F, Culla A, Navarro-Gonzalez M, Navarro-Lopez M, Sacanella E, Torres B et al. Prevalence of sarcopenia in healthy community-dwelling elderly in an urban area of Barcelona (Spain). J Nutr Health Aging 2012; 16: 184–187.

    CAS  Article  Google Scholar 

  27. Cederholm T, Bosaeus I, Barazzoni R, Bauer J, Van Gossum A, Klek S et al. Diagnostic criteria for malnutrition - an ESPEN Consensus Statement. Clin Nutr 2015; 34: 335–340.

    CAS  Article  Google Scholar 

  28. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010; 39: 412–423.

    Article  Google Scholar 

  29. González-Montalvo JI, Alarcón T, Gotor P, Queipo R, Velasco R, Hoyos R et al. Prevalence of sarcopenia in acute hip fracture patients and its influence on short-term clinical outcome. Geriatr Gerontol Int 2015; 16: 1021–1027. ..

    Article  Google Scholar 

  30. Koval KJ, Maurer SG, Su ET, Aharonoff GB, Zuckerman JD . The effects of nutritional status on outcome after hip fracture. J Orthop Trauma 1999; 13: 164–169.

    CAS  Article  Google Scholar 

  31. Nuotio M, Tuominen P, Luukkaala T . Association of nutritional status as measured by the Mini-Nutritional Assessment Short Form with changes in mobility, institutionalization and death after hip fracture. Eur J Clin Nutr 2016; 70: 393–398.

    CAS  Article  Google Scholar 

  32. Steihaug OM, Gjesdal C, Bogen B, Kristoffersen M, Ranhoff AH . Detección de problemas en pacientes geriátricos con fractura de cadera. Importancia de la colaboración entre traumatólogo y geriatra [Detection of health conditions in elderly patients with a hip fracture. Importance of collaboration between orthopedic an geriatric specialists]. Rev Ortop Traumatol 2007; 51: 144–151.

    Article  Google Scholar 

  33. Steihaug OM, Gjesdal C, Bogen B, Kristoffersen M, Ranhoff AH . Prevalence of sarcopenia in hip fracture patients and clinical associations. Eur Geriatr Med 2015, Vol 6, Supplement 1, p S7.

  34. Cabrerizo S, Cuadras D, Gomez-Busto F, Artaza-Artabe I, Marín-Ciancas F, Malafarina V . Serum albumin and health in older people: review and meta analysis. Maturitas 2015; 81: 17–27.

    CAS  Article  Google Scholar 

  35. Chen L-K, Liu L-K, Woo J, Assantachai P, Auyeung T-W, Bahyah KS et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc 2014; 15: 95–101.

    Article  Google Scholar 

  36. Morley JE, Abbatecola AM, Argiles JM, Baracos V, Bauer J, Bhasin S et al. Sarcopenia with limited mobility: an international consensus. J Am Med Dir Assoc 2011; 12: 403–409.

    Article  Google Scholar 

  37. Cesari M, Fielding RA, Pahor M, Goodpaster B, Hellerstein M, van Kan GA et al. Biomarkers of sarcopenia in clinical trials-recommendations from the International Working Group on Sarcopenia. J Cachexia Sarcopenia Muscle 2012; 3: 181–190.

    Article  Google Scholar 

  38. Cruz-Jentoft AJ, Landi F, Schneider SM, Zúñiga C, Arai H, Boirie Y et al. Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS). Age Ageing 2014; 43: 748–759.

    Article  Google Scholar 

  39. Anbar R, Beloosesky Y, Cohen J, Madar Z, Weiss A, Theilla M et al. Tight calorie control in geriatric patients following hip fracture decreases complications: a randomized, controlled study. Clin Nutr 2014; 33: 23–28.

    CAS  Article  Google Scholar 

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Acknowledgements

We thank Rocío Queipo (Preventive Medicine Department, Universidad Autónoma de Madrid, Madrid, Spain) for her invaluable help in statistics. The study was supported in part by a grant (Grant to Emerging Research Groups 2012) from the Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ) PI-1334; a grant from the ISCIII Fondos FEDER (RETICEF RD 06/0013/1013 and RD12/0043/0019) from the Instituto de Investigación Biomédica IdiPAZ, Hospital Universitario La Paz, Madrid, Spain (FONDA Cohort Study, PI-1334 Project) and by a grant from Nestlé Health Science, Barcelona, Spain.

Author contributions

JIG-M and TA designed and directed the FONDA cohort. MDB, TA and AO designed the methodology and carried out the statistical analysis. MDB, JIG-M, RM and RR performed the literature review update. MDB and JIG-M drafted the first version of the manuscript. All co-authors corrected the subsequent versions of the manuscript and approved the final version.

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Correspondence to M Díaz de Bustamante.

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Díaz de Bustamante, M., Alarcón, T., Menéndez-Colino, R. et al. Prevalence of malnutrition in a cohort of 509 patients with acute hip fracture: the importance of a comprehensive assessment. Eur J Clin Nutr 72, 77–81 (2018). https://doi.org/10.1038/ejcn.2017.72

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  • DOI: https://doi.org/10.1038/ejcn.2017.72

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