Oral nutritional supplements in a randomised trial are more effective than dietary advice at improving quality of life in malnourished care home residents

Abstract

Few trials have explored the effect of nutrition support on quality of life (QoL). This study examined the effects of oral nutritional supplements (ONS) vs dietary advice on QoL in malnourished care home residents. 104 malnourished, care home residents (medium+high risk), identified using the Malnutrition Universal Screening Tool ('MUST'), (mean age 88.5±7.9y) were randomised to receive either oral nutritional supplements (ONS) (n=53) or dietary advice (n=51) for 12 weeks. Dietary intake was measured using 24hdietary recall, and QoL assessed using EuroQol (EQ-5D), including time trade off (TTO) (range-0.59 to 1) and visual analogue scale (VAS) (score 0 to 100) for self-perceived health. QoL (adjusted for baseline QOL, malnutrition risk, type of care received (nursing or residential)) was significantly higher in the ONS than the dietary advice group (intention to treat analysis at week 12; n=104 ). EQ-5D TTO scores (mean±SE) were 0.50±0.04 vs 0.36±0.05 (P=0.005), VAS rescaled scores were 0.54+0.03 vs 0.046+0.03 (P=0.006) and VAS scores were 61.3±4.5 vs 54.6±6.3 (P=0.533) for ONS vs dietary advice respectively. Total energy, protein and the majority of micronutrient intakes were significantly greater in the ONS group, with energy intake being 423kcal greater in the ONS than the dietary advice group at week 12. This study in malnourished care home residents indicates that ONS can improve QoL and nutritional intake more effectively than dietary advice alone. This trial was registered with clinicaltrials.gov on 10th August 2007. Clinicaltrials identifier is NCT00515125http://www.clinicaltrials.gov/ct2/show/NCT00515125?term=nutrition+support&rank=60.