Background: Falls are a common cause of morbidity and mortality in older persons. Among well-nourished older adults at risk of vitamin D deficiency, vitamin D3 supplementation has been shown to reduce fall risk in epidemiologic studies. Malnutrition is also associated with a greater incidence of falls, but whether general nutritional intervention can affect fall risk in malnourished adults is unclear. Neelemaat and colleagues conducted a randomized controlled trial examining the effects of nutritional intervention on malnourished adults 60 years and older who had recently been hospitalized.
The Study: Eligible participants were identified on hospital screening as malnourished (i.e., body mass index of 20 kg per m2 or less, at least 5 percent unintentional weight loss in the previous month, or at least 10 percent unintentional weight loss in the previous six months). Patients were excluded if they had been diagnosed with dementia. A total of 210 participants were randomized equally between the control and intervention groups. The intervention group received standardized nutritional support, including an energy-enriched diet during hospitalization (providing 750 kcal and 30 g of protein more per day than the regular hospital menu); two bottles of oral nutritional supplementation per day (providing a total of 600 kcal, 24 g of protein, 176 IU of vitamin D3, and 364 mg of calcium per day); and an additional 500-mg calcium/400-IU vitamin D3 supplement each day. All components of nutritional support were continued for three months following discharge. Telephone counseling by a dietitian was also provided every other week after discharge. In contrast, the control group received usual care, which included nutritional support only if the patient’s treating physician prescribed it. Dietary intake, serum 25-hydroxyvitamin D levels, and fall incidents were monitored for three months after hospital discharge.
Results: No significant differences were observed between the groups at baseline, including functional limitations, body weight, grip strength, vitamin D levels, or physical activity level. At baseline, 30 of 105 persons (29 percent) in the control group and 23 of 105 persons (22 percent) in the intervention group were receiving nutritional support with a prescription from a physician or dietitian; by the end of the study, 31 percent of the control group and 84 percent of the intervention group were receiving nutritional support. Eighty percent of the intervention group adhered to the oral nutritional supplementation regimen, with a mean intake of 1.6 bottles per day (target of two per day), and 96 percent adhering to the calcium/vitamin D3 supplementation and dietetic counseling. By the end of the study, caloric intake was significantly greater in the intervention group (mean kcal per day of 2,152 versus 1,766 in the control group; P = .002), but there was no difference in the percentages of patients with serum 25-hydroxyvitamin D levels of 20 ng per mL (50 nmol per L) or greater (37 versus 47 percent for the intervention and control groups, respectively; P = .30). In total, 57 falls occurred: 16 in the intervention group and 41 in the control group. Although there was no difference in the mean number of falls per person among patients who had fallen (1.6 versus 1.7 for the intervention and control groups, respectively; P = .55), significantly more persons in the control group experienced falls (23 percent of the control group versus 10 percent of the intervention group; hazard ratio = 0.41).
Conclusion: Compared with usual care, short-term intervention with oral nutritional supplementation, vitamin D3 supplementation, and dietetic counseling significantly decreases falls in malnourished older adults.