Supplements and exercise effective for malnutrition and frailty: Review

By 2025 more than 20% of Europeans will be 65 or over, with a particularly rapid increase in the number of over 80s.©iStock/KatarzynaBialasiewicz

The overlap between malnutrition and frailty is such that both conditions could benefit from combining oral nutritional supplements and physical activity, a review has concluded.

The narrative review highlights the need for improved research on treatment strategies for both malnutrition and frailty, using a targeted oral nutritional supplement (ONS) intervention in older adults.

"Simple tools for screening and processes for detecting and treating these conditions together need to be developed across the continuum of care," said senior review author professor Heather Keller, who is also the leader of the University of Waterloo's Nutrition and Aging Lab.

“Frailty and malnutrition should be considered simultaneously due to the high likelihood that a patient will have both conditions together," she added.

Studies using ONS as a treatment strategy is not a new idea and a sizable body of research has been built up.

A number of reviews have been published on ONS and nutrition and/or frailty, which highlight its potential benefits on weight status and mortality, frailty indicators and nutritional status.  

While there are some consistencies identified in these reviews, mixed findings were commonplace in the outcomes linked to frailty and malnutrition.

Narrative review

Dr Keller, alongside her colleagues, created a series of reports detailing the characteristics of frailty and malnutrition.

The team focused on symptoms shared between the two conditions: weight loss, slowness and weakness.

Their narrative review believed that weight loss could be self-reported or measured, while slowness and weakness could be readily assessed using reduced walking speed and grip strength of a patient's hand.

One of the authors’ conclusions emphasised a multifaceted dietary and physical approach that could improve nutritional status and strength in frail, malnourished patients.

“Considering the overlap in prevalence in malnutrition and frailty, it has been recommended that combining oral nutritional supplements and physical activity as interventions may be the way forward for treating both conditions,” the review stated.

Europe’s elderly

One previous study on ONS and physical exercise as the intervention found a 12-week intervention with oral nutritional supplementation plus physical exercise improves function, nutritional status, and quality of life in frail institutionalised older adults.

The review is timely given Europe’s shifting demographic. Additional burdens on Europe's healthcare system are expected as the number of people aged 85 years and older is projected to rise from 14 million to 19 million by 2020 and to 40 million by 2050.

Testing and implementing diagnostic and treatment tools that detect related health conditions such as frailty and malnutrition can improve efficiency of hospital and primary care services, and ultimately patient outcomes.

Source: Applied Physiology, Nutrition, and Metabolism
Published online ahead of print: DOI: 10.1139/apnm-2016-0652
“Malnutrition or frailty? Overlap and evidence gaps in the diagnosis and treatment of frailty and malnutrition.”
Authors: Celia Laur,Tara McNicholl, Renata Valaitis, Heather Keller

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