Specifically, the researchers found significant changes in mental health/cognition, vitality, social functioning and general health among study participants. The findings were part of a post-hoc analysis of the 2016 NOURISH study (Nutrition effect On Unplanned ReadmIssions and Survival in Hospitalized patients).
“Malnutrition is a driver of increased use of healthcare resources and higher healthcare costs in older adults,” the researchers said. “On the other hand, targeted nutritional support to address malnutrition in [this population] has been shown to shorten length of hospital stay, reduce readmission risk, lower mortality risk and decrease costs to healthcare systems.”
Funded by Abbott Nutrition, the NOURISH study differed from other investigations in that it used specialized-ONS with macro- and micronutrients key to improving nutritional status, especially nutrients important to muscle health. These included higher protein and HMB (beta-hydroxy-beta-methylbutyrate), the active metabolite of leucine, which reduces muscle loss during hospitalization and bedrest and can help with recovery of muscle strength and function, according to the investigators.
“There is early promising evidence in animal studies that HMB may improve cognition-related outcome, such as working memory and neuronal plasticity during aging, which may offer insights regarding improvement in the mental health/cognition quality of life,” the current researchers said about the group receiving S-ONS treatment.
Post-discharge outcomes
In the original NOURISH study, the randomized, placebo-controlled, multi-center, double-blind study enrolled 652 patients, 65 years and older, some of whom were administered daily interventions with S-ONS during their hospital stay and for 90 days post-discharge. The experimental group received Tetra Paks of the specialized, nutrient-dense ready-to-drink liquid with per-serving (237 mL) contents of 350 kcal, 20 g protein, 11 g fat, 44 g carbohydrate, 1.5 g HMB plus 160 IU vitamin D and other essential micronutrients.
The post-hoc analysis assessed quality of life outcomes at 0, 30, 60 and 90 days post-discharge using self-reported short-form health surveys with respect to eight physical or mental criteria. The participants were also asked to rate for mobility, self-care, usual activities, pain/discomfort and anxiety/depression.
“Our findings are consistent with previous reports, which linked improvements in nutritional status of older adults with improvements in the physical and mental components of their quality of life,” the scientists said.
Overall, older patients who received interventions with S-ONS during their hospital stay and for 90 days post-discharge had significantly better quality of life scores compared to those who received only placebo intervention. Patients who were mildly-to-moderately malnourished at study entry had better quality of life than did severely malnourished patients, as would be expected, the researchers noted.
The study participants were admitted to the hospital due to a range of conditions, including congestive heart failure (HF), acute myocardial infarction (AMI), pneumonia, or chronic obstructive pulmonary disease (COPD). These conditions are associated with increased risk for poor outcomes and have the highest rates of hospital readmissions.
Patients with a diagnosis of AMI at the beginning of the study had better quality of life outcomes than patients with chronic conditions, which are associated with deteriorating health over time.
Interestingly, males displayed a better quality of life than females during the hospitalization period, though these sex differences didn’t appear in the post-hospitalization time frame. Researchers have suggested these distinctions could be attributed to physical activity levels, psychosocial status and socio-economic conditions.
Ongoing research
Several studies bolster the findings of the NOURISH trial and the post-hoc analysis. The latter cited a recent review which confirmed a positive correlation between nutritional status and quality of life among older people living in residential aged-care sites. Another study of community-living but chronically ill older adults attending outpatient clinics in Colombia found nutritional intervention, including dietary counseling and standard ONS for 60 days, led to significant gains in mental and physical outcomes.
“Clear guidance for prevention and treatment of malnutrition in older people is key to quality care yielding improved quality of life,” the researchers said. “It is thus important for medical professionals to meet challenges of best-practice nutritional care—early identification and treatment of malnutrition in older people along with providing patient and caregiver education on nutrition.”
Source: Clinical Nutrition
Published online ahead of print, doi: doi.org/10.1016/j.clnu.2023.09.004
“Impact of a specialized oral nutritional supplement on quality of life in older adults following hospitalization: Post-hoc analysis of the NOURISH trial”
Authors: G.E. Baggs et al.