Effect of nonmeat, high-protein supplementation on quality of life and clinical outcomes in older residents of care homes

a systematic review and meta-analysis

Alison I C Donaldson, Toby O Smith (Corresponding Author), Sarah Alder, Alexandra M Johnstone, Baukje de Roos, Lorna S Aucott, Adam L Gordon, Phyo K Myint

Research output: Contribution to journalArticle

Abstract

Context Care home residents are at risk of malnutrition owing to reduced food intake, anabolic resistance in aging muscle, and a high prevalence of medical morbidity and functional dependency. There has been limited consensus regarding the effectiveness of a high-protein diet on quality of life or clinical outcomes in care home residents. Objective The aim of this review was to evaluate the effectiveness of nonmeat, high-protein supplementation on health-related quality of life (HRQOL) and relevant clinical and nutritional outcomes in older people in a care home setting. Data Sources The following databases were searched (to February 2018) for randomized controlled trials: Embase, AMED, CINAHL, MEDLINE, the Cochrane Central Registry of Controlled Trials, OpenGrey, clinicaltrials.gov, the WHO International Clinical Trials Registry Platform, the ISRCTN registry, and the NIHR Clinical Research Network Portfolio. Study Selection Trials were selected if they assessed a nonmeat, high-protein dietary intervention provided to care home residents who were aged 65 years or older. Data Extraction Data from included trials were extracted if they assessed care home residents aged 65 years or older and compared those residents who received protein supplementation with those who did not. Trial quality was assessed using the Cochrane risk-of-bias tool. Meta-analysis was undertaken when appropriate. Results Seventeen studies with 1246 participants fulfilled the inclusion criteria. All studies were of low or moderate quality. There was no evidence of improved HRQOL when the Short Form 36 (SF-36) was used to assess outcomes (standardized mean difference [SMD] = −0.10; 95%CI, −0.51 to 0.31; P = 0.62), although significant improvement was seen in the 1 trial that used the EQ-5D instrument (SMD = 2.58; 95%CI, 2.05–3.10; P < 0.00001). Conclusions Nonmeat, high-protein oral supplements can improve markers of nutritional status in care home residents. However, there is insufficient high-quality evidence to determine the effect of such supplements on HRQOL in older adults in care homes.
Original languageEnglish
Pages (from-to)116-127
Number of pages12
JournalNutrition Reviews
Volume77
Issue number2
Early online date13 Dec 2018
DOIs
Publication statusPublished - 1 Feb 2019

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Home Care Services
Meta-Analysis
Quality of Life
Registries
Proteins
Homes for the Aged
Dietary Proteins
Nutritional Status
MEDLINE
Malnutrition
Randomized Controlled Trials
Eating
Clinical Trials
Databases
Diet
Morbidity
Muscles
Research

Keywords

  • high protein
  • care homes
  • older people
  • quality of life
  • appetite
  • ENERGY
  • EFFICACY
  • ORAL NUTRITIONAL SUPPLEMENT
  • STRENGTH
  • NUTRIENT
  • EXERCISE
  • BODY-WEIGHT
  • NURSING-HOME
  • PEOPLE
  • HEALTH

ASJC Scopus subject areas

  • Nutrition and Dietetics
  • Medicine (miscellaneous)

Cite this

@article{d143a28c992b4993bf89fc4bd7fbf36f,
title = "Effect of nonmeat, high-protein supplementation on quality of life and clinical outcomes in older residents of care homes: a systematic review and meta-analysis",
abstract = "Context Care home residents are at risk of malnutrition owing to reduced food intake, anabolic resistance in aging muscle, and a high prevalence of medical morbidity and functional dependency. There has been limited consensus regarding the effectiveness of a high-protein diet on quality of life or clinical outcomes in care home residents. Objective The aim of this review was to evaluate the effectiveness of nonmeat, high-protein supplementation on health-related quality of life (HRQOL) and relevant clinical and nutritional outcomes in older people in a care home setting. Data Sources The following databases were searched (to February 2018) for randomized controlled trials: Embase, AMED, CINAHL, MEDLINE, the Cochrane Central Registry of Controlled Trials, OpenGrey, clinicaltrials.gov, the WHO International Clinical Trials Registry Platform, the ISRCTN registry, and the NIHR Clinical Research Network Portfolio. Study Selection Trials were selected if they assessed a nonmeat, high-protein dietary intervention provided to care home residents who were aged 65 years or older. Data Extraction Data from included trials were extracted if they assessed care home residents aged 65 years or older and compared those residents who received protein supplementation with those who did not. Trial quality was assessed using the Cochrane risk-of-bias tool. Meta-analysis was undertaken when appropriate. Results Seventeen studies with 1246 participants fulfilled the inclusion criteria. All studies were of low or moderate quality. There was no evidence of improved HRQOL when the Short Form 36 (SF-36) was used to assess outcomes (standardized mean difference [SMD] = −0.10; 95{\%}CI, −0.51 to 0.31; P = 0.62), although significant improvement was seen in the 1 trial that used the EQ-5D instrument (SMD = 2.58; 95{\%}CI, 2.05–3.10; P < 0.00001). Conclusions Nonmeat, high-protein oral supplements can improve markers of nutritional status in care home residents. However, there is insufficient high-quality evidence to determine the effect of such supplements on HRQOL in older adults in care homes.",
keywords = "high protein, care homes, older people, quality of life, appetite, ENERGY, EFFICACY, ORAL NUTRITIONAL SUPPLEMENT, STRENGTH, NUTRIENT, EXERCISE, BODY-WEIGHT, NURSING-HOME, PEOPLE, HEALTH",
author = "Donaldson, {Alison I C} and Smith, {Toby O} and Sarah Alder and Johnstone, {Alexandra M} and {de Roos}, Baukje and Aucott, {Lorna S} and Gordon, {Adam L} and Myint, {Phyo K}",
note = "The authors gratefully acknowledge the comments and suggestions by Dr Miles Witham, Clinical Reader in Ageing and Health, University of Dundee, Dundee, United Kingdom, and Prof Alison Avenell, Professor of Health Services Research, University of Aberdeen, Aberdeen, United Kingdom. Author contributions. A.I.C.D., A.M.J., L.S.A., A.L.G., B.D.R., and P.K.M., conceived the study. A.I.C.D. and S.A. performed screening, selecting, and extraction of data. A.I.C.D. and S.A. also performed quality assessment. A.I.C.D. and T.O.S. conducted analyses and drafted the manuscript. All authors contributed to the writing of the manuscript. Funding/support. No external funding supported this work. T.O.S. is supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. Declaration of interest. The authors have no relevant interests to declare. Disclaimer: The abstract of this review was presented as an oral presentation at the 2017 British Geriatrics Society Spring Meeting, April 26–28, 2017, and will be published in the forthcoming supplementary issue of Age and Ageing.",
year = "2019",
month = "2",
day = "1",
doi = "10.1093/nutrit/nuy061",
language = "English",
volume = "77",
pages = "116--127",
journal = "Nutrition Reviews",
issn = "1753-4887",
publisher = "Oxford University Press",
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TY - JOUR

T1 - Effect of nonmeat, high-protein supplementation on quality of life and clinical outcomes in older residents of care homes

T2 - a systematic review and meta-analysis

AU - Donaldson, Alison I C

AU - Smith, Toby O

AU - Alder, Sarah

AU - Johnstone, Alexandra M

AU - de Roos, Baukje

AU - Aucott, Lorna S

AU - Gordon, Adam L

AU - Myint, Phyo K

N1 - The authors gratefully acknowledge the comments and suggestions by Dr Miles Witham, Clinical Reader in Ageing and Health, University of Dundee, Dundee, United Kingdom, and Prof Alison Avenell, Professor of Health Services Research, University of Aberdeen, Aberdeen, United Kingdom. Author contributions. A.I.C.D., A.M.J., L.S.A., A.L.G., B.D.R., and P.K.M., conceived the study. A.I.C.D. and S.A. performed screening, selecting, and extraction of data. A.I.C.D. and S.A. also performed quality assessment. A.I.C.D. and T.O.S. conducted analyses and drafted the manuscript. All authors contributed to the writing of the manuscript. Funding/support. No external funding supported this work. T.O.S. is supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. Declaration of interest. The authors have no relevant interests to declare. Disclaimer: The abstract of this review was presented as an oral presentation at the 2017 British Geriatrics Society Spring Meeting, April 26–28, 2017, and will be published in the forthcoming supplementary issue of Age and Ageing.

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Context Care home residents are at risk of malnutrition owing to reduced food intake, anabolic resistance in aging muscle, and a high prevalence of medical morbidity and functional dependency. There has been limited consensus regarding the effectiveness of a high-protein diet on quality of life or clinical outcomes in care home residents. Objective The aim of this review was to evaluate the effectiveness of nonmeat, high-protein supplementation on health-related quality of life (HRQOL) and relevant clinical and nutritional outcomes in older people in a care home setting. Data Sources The following databases were searched (to February 2018) for randomized controlled trials: Embase, AMED, CINAHL, MEDLINE, the Cochrane Central Registry of Controlled Trials, OpenGrey, clinicaltrials.gov, the WHO International Clinical Trials Registry Platform, the ISRCTN registry, and the NIHR Clinical Research Network Portfolio. Study Selection Trials were selected if they assessed a nonmeat, high-protein dietary intervention provided to care home residents who were aged 65 years or older. Data Extraction Data from included trials were extracted if they assessed care home residents aged 65 years or older and compared those residents who received protein supplementation with those who did not. Trial quality was assessed using the Cochrane risk-of-bias tool. Meta-analysis was undertaken when appropriate. Results Seventeen studies with 1246 participants fulfilled the inclusion criteria. All studies were of low or moderate quality. There was no evidence of improved HRQOL when the Short Form 36 (SF-36) was used to assess outcomes (standardized mean difference [SMD] = −0.10; 95%CI, −0.51 to 0.31; P = 0.62), although significant improvement was seen in the 1 trial that used the EQ-5D instrument (SMD = 2.58; 95%CI, 2.05–3.10; P < 0.00001). Conclusions Nonmeat, high-protein oral supplements can improve markers of nutritional status in care home residents. However, there is insufficient high-quality evidence to determine the effect of such supplements on HRQOL in older adults in care homes.

AB - Context Care home residents are at risk of malnutrition owing to reduced food intake, anabolic resistance in aging muscle, and a high prevalence of medical morbidity and functional dependency. There has been limited consensus regarding the effectiveness of a high-protein diet on quality of life or clinical outcomes in care home residents. Objective The aim of this review was to evaluate the effectiveness of nonmeat, high-protein supplementation on health-related quality of life (HRQOL) and relevant clinical and nutritional outcomes in older people in a care home setting. Data Sources The following databases were searched (to February 2018) for randomized controlled trials: Embase, AMED, CINAHL, MEDLINE, the Cochrane Central Registry of Controlled Trials, OpenGrey, clinicaltrials.gov, the WHO International Clinical Trials Registry Platform, the ISRCTN registry, and the NIHR Clinical Research Network Portfolio. Study Selection Trials were selected if they assessed a nonmeat, high-protein dietary intervention provided to care home residents who were aged 65 years or older. Data Extraction Data from included trials were extracted if they assessed care home residents aged 65 years or older and compared those residents who received protein supplementation with those who did not. Trial quality was assessed using the Cochrane risk-of-bias tool. Meta-analysis was undertaken when appropriate. Results Seventeen studies with 1246 participants fulfilled the inclusion criteria. All studies were of low or moderate quality. There was no evidence of improved HRQOL when the Short Form 36 (SF-36) was used to assess outcomes (standardized mean difference [SMD] = −0.10; 95%CI, −0.51 to 0.31; P = 0.62), although significant improvement was seen in the 1 trial that used the EQ-5D instrument (SMD = 2.58; 95%CI, 2.05–3.10; P < 0.00001). Conclusions Nonmeat, high-protein oral supplements can improve markers of nutritional status in care home residents. However, there is insufficient high-quality evidence to determine the effect of such supplements on HRQOL in older adults in care homes.

KW - high protein

KW - care homes

KW - older people

KW - quality of life

KW - appetite

KW - ENERGY

KW - EFFICACY

KW - ORAL NUTRITIONAL SUPPLEMENT

KW - STRENGTH

KW - NUTRIENT

KW - EXERCISE

KW - BODY-WEIGHT

KW - NURSING-HOME

KW - PEOPLE

KW - HEALTH

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UR - http://www.mendeley.com/research/effect-nonmeat-highprotein-supplementation-quality-life-clinical-outcomes-older-residents-care-homes

U2 - 10.1093/nutrit/nuy061

DO - 10.1093/nutrit/nuy061

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EP - 127

JO - Nutrition Reviews

JF - Nutrition Reviews

SN - 1753-4887

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