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Older people with hip fractures are often malnourished at the time of their fracture and many have poor food intake while in hospital. Malnutrition may hinder recovery after hip fracture. We reviewed the effects of nutritional interventions in older people recovering from hip fracture.

The 24 randomised controlled trials included in this review involved 1940 participants. The trials had methodological flaws that may affect the validity of their results. Ten trials examined the use of additional feeds by mouth providing non-protein energy, protein, some vitamins and minerals. Pooled data from these trials found that there may be a possibility of a reduction in ‘unfavourable outcome’ (combined outcome of mortality and survivors with medical complications), but no effect on mortality.

Four trials examined nasogastric tube feeding, where liquid food is delivered via a tube inserted into the nose and passed down into the stomach, with non-protein energy, protein, some vitamins and minerals. These trials provided very limited data but tube feeding, which was poorly tolerated, did not seem to make a difference to mortality.

One trial found nasogastric tube feeding followed by oral feeds did not seem to affect mortality or complications.

One trial examined giving feed into a vein initially, then by mouth. This did not seem to affect mortality but might reduce complications.

Increasing protein intake in an oral feed was tested in four trials. Protein supplementation may have reduced the number of long term complications, but it did not seem to make a difference to mortality alone.

Two trials examining intravenous vitamin B1 and other water soluble vitamins, or a form of vitamin D given orally, did not alter outcomes.

One unpublished study comparing ornithine alpha-ketoglutarate with an isonitrogenous peptide supplement found very weak evidence of a delay in the onset of complications but not their occurrence.

One trial, evaluating dietetic assistants to help improve nutritional intake found a trend for a reduction in mortality.

Some evidence exists for the effectiveness of protein and energy feeds, but overall the evidence for the effectiveness of nutritional supplementation remains weak. The role of dietetic assistants, and peripheral intravenous feeding require further evaluation. Trials are required which overcome the defects of the reviewed studies, particularly inadequate size and trial methods. Cochrane 2010



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