Tight calorie control in geriatric patients following hip fracture decreases complications: a randomized, controlled study

Clin Nutr. 2014 Feb;33(1):23-8. doi: 10.1016/j.clnu.2013.03.005. Epub 2013 Apr 1.


Background & aims: Optimizing nutritional intake has been recommended for geriatric patients undergoing hip-fracture surgery. Whether nutritional support guided by repeated measurements of resting energy requirements (REE) improves outcomes in these patients is not known.

Methods: A randomized, controlled, unblinded, prospective, cohort study comparing provision of energy with a goal determined by repeated REE measurements using indirect calorimetry, with no intervention. Oral nutritional supplements were started 24 h after surgery and the amount adjusted to make up the difference between energy received from hospital food and measured energy expenditure.

Results: 50 Geriatric patients were included in the study. Patients in the intervention group (n = 22) received significantly higher daily energy intake than the control group (n = 28) (1121.3 ± 299.0 vs. 777.1 ± 301.2 kcal, p = 0.001). This was associated with a significantly less negative cumulative energy balance (-1229.9 ± 1763 vs. -4975.5 ± 4368 kcal, p = 0.001). A significant negative correlation was found between the cumulative energy balance and total complication rate (r = -0.417, p = 0.003) as well as for length of hospital stay (r = -0.282, p = 0.049).

Conclusion: We have demonstrated that nutritional support actively supervised by a dietician and guided by repeated measurements of REE was achievable and improved outcomes in geriatric patients following surgery for hip fractures. Clinicaltrials.gov Identifier: NCT017354435.

Keywords: CAM; CCI; CIRS-G; Charlson's comorbidity index; Confusion Assessment Method; Cumulative Illness Rating Scale for Geriatrics; Energy expenditure; FIM; Functional Independence Measure; Geriatric; Hip fracture; IC; MAC; MMSE; MNA; Mini-Mental State Examination; ONS; Tight calorie control; indirect calorimetry; mid-arm circumference; mini-nutritional assessment; oral nutritional supplements.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Dietary Supplements
  • Energy Intake*
  • Energy Metabolism
  • Female
  • Geriatric Assessment*
  • Hip Fractures / complications
  • Hip Fractures / diet therapy*
  • Hip Fractures / surgery
  • Humans
  • Male
  • Malnutrition / diet therapy*
  • Malnutrition / etiology
  • Nutritional Requirements
  • Nutritional Status
  • Nutritional Support / methods
  • Postoperative Care
  • Postoperative Complications / diet therapy
  • Postoperative Complications / prevention & control
  • Prospective Studies
  • Treatment Outcome

Associated data

  • ClinicalTrials.gov/NCT01735443