Systematic review of non-pharmacological interventions to prevent or treat malnutrition in older people. The SENATOR (ONTOP series) and MaNuEL Knowledge Hub project

A. Correa-Pérez (1) , J. Abraha (2, 3) , A. Collinson (4, 5) , Dominique Dardevet (6) , L. de Groot (7) , Marian A. E. de van Der Schueren (8, 9) , A. Hebestreit (10) , M. Hickson (4, 5) , J. Jaramillo-Hidalgo (11) , I. Lozano-Montoya (1, 12) , D. O’mahony (13) , Rl Soiza (14) , M. Visser , D. Volkert (15) , M. Olters (10) , A. Cruz Jentoft (1) , Andrea Cherubini (2, 3)

1 Servicio de Geriatrıa.
2 Geriatria, Accettazione geriatrica e Centro di ricerca per l’invecchiamento
3 Italian National Research Center on Aging
4 Institute of Health and Community
5 Plymouth University
6 UNH - Unité de Nutrition Humaine
7 Division of Human Nutrition and Health
8 department of nutrition and health
9 department of nutrition and dietetics
10 Leibniz Institute for Prevention Research and Epidemiology - BIPS
11 Servicio de Geriatrıa
12 Servicio de Medicina Interna
13 Department of Geriatric Medicine
14 Department of Medicine for the Elderly
15 Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg

Introduction: Systematic reviews (SRs) on malnutrition suggest that energy and protein intake can be improved, but results for functional or clinical outcomes have been inconclusive. Following the ONTOP methodology, we aimed to perform a review of SRs of non-pharmacological interventions in older patients with well-defined malnutrition using relevant outcomes agreed by a broad panel of experts. Method: SPubMed, Cochrane, EMBASE, and CINHAL databases were searched for SRs. Primary studies from those SRs, in any setting, were included. Quality assessment was made using Cochrane and GRADE criteria. Results: Nineteen primary studies from seventeen SRs were included. The most frequent intervention was oral nutritional supplementation (ONS) compared with usual care (11 RCTs). Meta-analysis was only feasible for six studies assessing changes in body weight (BW) and two studies for body mass index (BMI) at follow-up. Neither showed beneficial effects of the intervention [mean difference (95% CI) BW 0.59 (- 0.08, 1.96); BMI 0.31 (- 0.17, 0.79)]. No beneficial effects of ONS treatment in MNA scores, muscle strength, activities of daily living, timed Up&Go, quality of life and mortality were found. Other intervention studies (dietary counselling and ONS, ONS combined with exercise, nutrition delivery systems) could not be pooled and results of individual studies were inconsistent. The overall quality of the evidence was very low due to risk of bias and small sample size. Conclusions: This review does not show beneficial effects of ONS or other non-pharmacological interventions versus usual care on nutritional, functional or other health outcomes in older malnourished patients. High quality research studies are urgently needed in this area

Domaines: Alimentation et Nutrition

A. Correa-Pérez, J. Abraha, A. Collinson, Dominique Dardevet, L. de Groot, et al.. Systematic review of non-pharmacological interventions to prevent or treat malnutrition in older people. The SENATOR (ONTOP series) and MaNuEL Knowledge Hub project. 14th EuGMS, International Congress of the European Geriatric Medicine Society "Advancing Geriatric Medicine in a Modern World", Oct 2018, Berlin, Germany. Editions Springer, European Geriatric Medicine, 9 (Suppl 1), pp.S1-S367, 2018, European Geriatric Medicine. ⟨10.1007/s41999-018-0097-4⟩. ⟨hal-01902827⟩