Commentary

Perhaps justifiably, most of the attention paid by the medical community to nutritional status lately has focused on the health risks of an oversupply of calories. The thorough review and meta-analysis by Milne et al turns our attention to the hazard posed by malnutrition in older adults, and specifically to the utility of treatment with food supplements. Even in the developed world, malnutrition among patients in hospital is prevalent¹ and is generally found to be associated with poorer health outcomes.²

Milne et al found a substantial benefit after oral protein and energy supplements both in reduced mortality and length of hospital stay (3.4 d shorter, 95% CI 0.7 to 6.1), corroborated by a small (1.3 kg) but consistent increase in patient weight. Overall functional status was difficult to assess, but improvement in specific measures, such as number of falls, activity rating, and forced vital capacity, was reported in several studies. Although the underlying studies were rarely of optimal quality or even placebo controlled, all were RCTs. Because most included patients were not malnourished, the benefit could have been greater if supplementation had been targeted to malnourished (mini nutritional assessment score <17) elderly persons. Which components of nutritional supplements (calories, protein, vitamins, and minerals) were responsible for the benefit could not be determined. A large clinical trial would be needed to answer the mechanism question.

Although we have much to learn, the common sense notion that improving nutritional status improves health, combined with the results of careful, conservative analyses such as this one, adds to our comfort level as practitioners in placing greater emphasis on the nutritional status of older patients. The lesson we take away from this review is that we should pursue the diagnosis and treatment of poor nutritional health as vigorously as we pursue abnormal blood tests or physical examination findings.