Helen, an 82-year-old California woman, has always been on-the-go. Up until a few years ago, she was working three days a week cooking meals for the homeless and exercising frequently. While she still continues a fairly busy routine – taking water aerobics classes when it’s warm and visiting family nearby – her life was put on hold when she had unexpected heart issues two years ago.

When Helen went into the hospital, doctors found she was malnourished, a condition defined simply by a lack of nutrients in your diet, and which affects up to 1 in 2 older adults who enter the hospital.^1-3 As a result, Helen was asked to join a study where she was given a specialized oral nutrition supplement (ONS) twice a day and told to continue for 90 days after she left the hospital.

Results from the study, called NOURISH, were published recently in Clinical Nutrition and shed light on the importance of the specialized nutrition that Helen, and many others in the study, took while recovering from a heart or lung disease. The study, supported by Abbott, found that the group of malnourished seniors with a heart or lung disease who drank the specialized nutrition supplement was associated with a significantly lower (50 percent) death rate 90 days following their hospitalization.⁴

Malnutrition: Surprisingly Common

Helen is not alone – many adults are not able to get the nutrition they need as they get older. Malnutrition is a condition that’s causing a ripple effect on our health and health system. There are a variety of factors that contribute to malnourishment in older adults: illness, disability, appetite loss, poverty or a combination of these factors. A chronic disease, like congestive heart failure or chronic obstructive pulmonary disease (COPD), can often be associated with malnutrition in seniors – a startling fact, as almost 2 out of 3 adults (65 and up) are diagnosed with two or more chronic conditions.⁵ If you're malnourished and have to go to the hospital, it gets tougher.

When a person is very ill, their muscles (or lean body mass) can start to break down to defend the body from that major health issue, and the body doesn't have the energy to maintain or rebuild it. When this happens, things like longer recovery times, chances of complications, being readmitted back to the hospital or even death become possibilities.⁶

"If you're admitted to the hospital, you need to first be treated for whatever illness or injury sent you there in the first place," said Refaat Hegazi, MD, PhD, Abbott medical director and a study author. "But it's the job of the healthcare provider to look at the patient's whole condition and how they can help improve their patient's overall health and recovery time. Nutrition must be part of the conversation."

Nutrition as Standard of Care

The NOURISH study provides another example of why nutrition should be part of that conversation. The two-year, double-blind study looked at the role of a specialized nutrition supplement with high protein, HMB* (a muscle-preserving ingredient) and Vitamin D compared to a placebo supplement on rates of readmissions or death. Participants in the NOURISH study included 652 malnourished adults, aged 65 or older, who were admitted to the hospital and suffered from a heart or lung disease.

When researchers looked at the primary composite (i.e. combined) endpoint of the study of hospital readmissions or death 90 days after hospitalization , the results showed no significant differences between the group who received the specialized nutrition supplement and the group who received the placebo. However, when researchers did additional analyses and evaluated the components individually, they found:

• Those who received the specialized nutrition supplement were associated with a significantly lower (50 percent) mortality rate.
• That the two groups had similar rates of hospital readmissions.

"One of the biggest takeaways from this study, for both healthcare professionals and seniors, is the power of nutrition’s impact to our health," said Nicolaas E. Deutz, MD, PhD, Center for Translational Research in Aging & Longevity, Department of Health and Kinesiology, Texas A&M University, and lead study author. "Preventative measures like a flu shot for seniors have become a standard of medical care. We need to incorporate nutrition as a similar standard of care, especially when it comes to older adults who already are, or are at risk, for malnutrition."

Researchers also saw that those same patients who drank the specialized nutrition supplement had improved body weight, nutritional status and Vitamin D levels after leaving the hospital.

"I've always considered myself a healthy eater but I realize as I get older, I have less energy than I did before and often turn to what is convenient," Helen said. "Even after the study was completed, I continued to use a nutrition supplement. And as soon as I got better from my surgery, I found I had more energy and could get back to doing some of the things I love to do every day. "

About the Study

The NOURISH study took place across 78 different hospitals and sites in the U.S. with more than 650 patients. It is one of the largest nutrition clinical studies of its kind, conducted by researchers from institutions including Texas A&M University, Medical University of South Carolina, East Carolina University, Emory University School of Medicine and the University of Illinois at Urbana-Champaign. More information about the study here.

*HMB (β-hydroxy-β-methylbutyrate) has been demonstrated in older adults to help maintain their muscle health as they age or when ill – even helping minimize muscle loss during bedrest.⁷

References

¹Coats KG et al. J Am Diet Assoc. 1993; 93: 27-33.
²Giner M et al. Nutrition. 1996; 12: 23-29.
³Thomas DR et al. Am J Clin Nutr. 2002; 75: 308-313.
⁴Deutz NE et al. Clin Nutr; 2016 [Epub ahead of print]. http://dx.doi.org/10.1016/j.clnu.2015.12.010.
⁵CDC "The State of Aging & Health in America 2013" Accessed December 2015 http://www.cdc.gov/features/agingandhealth/state_of_aging_and_health_in_america_2013.pdf
⁶Gariballa S et al. Clin Nutr. 2013;32(5):772-776.
⁷Deutz N et al. Clin Nutr. 2013; 32: 704-712.