metricas
covid
Buscar en
Revista Española de Geriatría y Gerontología
Toda la web
Inicio Revista Española de Geriatría y Gerontología Dietas enriquecidas y suplementos nutricionales en ancianos hospitalizados
Información de la revista
Vol. 38. Núm. 4.
Páginas 226-236 (enero 2003)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 38. Núm. 4.
Páginas 226-236 (enero 2003)
Acceso a texto completo
Dietas enriquecidas y suplementos nutricionales en ancianos hospitalizados
Fortified diets and dietary supplements in elderly hospitalized patients
Visitas
11758
N. Montero*
Servicio de Geriatría. Hospital Clínico San Carlos. Madrid. España
Este artículo ha recibido
Información del artículo
Resumen

Un diagnóstico adecuado y el tratamiento temprano de la malnutrición comportan unos beneficios clínicos y económicos en los pacientes hospitalizados, especialmente en los ancianos, que son los que con más frecuencia presentan signos y síntomas de malnutrición en el momento de ingresar en un hospital. Una intervención nutricional agresiva mejora su estado nutricional, favorece el pronóstico, disminuye la tasa de reingresos e incluso podría mejorar la calidad de vida. Sin embargo, la prevalencia de malnutrición en los hospitales se mantiene elevada.

A pesar de las numerosas publicaciones realizadas, aún no existe un consenso entre los profesionales sanitarios acerca de la indicación de la suplementación habitual en los ancianos hospitalizados. En este artículo se revisan los posibles beneficios de los suplementos nutricionales orales en ancianos hospitalizados, aunque también se comentarán otros aspectos de la suplementación nutricional en este grupo de edad.

Palabras clave:
Ancianos hospitalizados
Suplementos nutricionales
Malnutrición
Abstract

The correct diagnosis and early treatment of malnutrition provides clinical and financial benefits in patients admitted to hospital, especially in elderly hospitalized patients who most frequently present signs and symptoms of malnutrition at admission. Aggressive dietary interventions improve nutritional status and prognosis, reduce the readmission rate, and could even improve quality of life. However, the prevalence of malnutrition in hospitals remains high. Despite numerous studies, consensus is lacking among health professionals on the indications for routine supplementation in elderly hospitalized patients. The present article reviews the possible benefits of oral dietary supplements in elderly inpatients as well as other aspects of dietary supplementation in this age group.

Key words:
Elderly inpatients
Dietary supplements
Malnutrition
El Texto completo está disponible en PDF
Bibliografía
[1.]
C.J. Bates, D. Benton, H.K. Biesalski, H.B. Staehelin, W. Van Staveren, P. Stehle, et al.
Nutrition and aging: a consensus statement.
J Nutr Health & Aging, 6 (2002), pp. 103-116
[2.]
F. Vetta, S. Ronzoni, G. Taglieri, M.R. Bollea.
The impact of malnutrition on the quality of life in the elderly.
Clin Nutr, 18 (1999), pp. 259-267
[3.]
J.M.D. Nightingale, J. Reeves.
Knowledge about the assessment and management of undernutrition: a pilot questionnaire in a UK teaching hospital.
Clin Nutr, 18 (1999), pp. 23-27
[4.]
H.H. Rasmussen, J. Kondrup, K. Ladefoged, M. Staun.
Clinical nutrition in Danish hospitals: a questionnaire-based investigation among physicians and nurses.
Clin Nutr, 18 (1999), pp. 153-158
[5.]
J.M. Potter, K. Klipstein, J.J. Reilly, M.A. Roberts.
The nutritional status and clinical course of acute admissions to a geriatric unit.
Age Ageing, 24 (1995), pp. 131-136
[6.]
K. Klipstein-Grobusch, J.J. Reilly, J.M. Potter, C.A. Edwards, M.A. Roberts.
Energy intake and expenditure in elderly patients admitted to hospital with acute illness.
Br J Nutr, 73 (1995), pp. 323-327
[7.]
C.A. Corish, N.P. Kennedy.
Protein-energy undernutrition in hospital in-patients.
Br J Nutr, 83 (2000), pp. 575-591
[8.]
M. Mowe, T. Bohmer.
The prevalence of undiagnosed protein calorie undernutrition in a population of hospitalised elderly patients.
J Am Geriatr Soc, 39 (1991), pp. 1089-1091
[9.]
D.H. Sullivan, S. Sun, R.C. Walls.
Protein-energy undernutrition among elderly hospitalised patients: a prospective study.
J Am Med Assoc, 281 (1999), pp. 2013-2019
[10.]
C.J. Green.
Existence, causes and consequences of disease-related malnutrition in the hospital and the community, and clinical and financial benefits of nutritional intervention.
Clin Nutr, 18 (1999), pp. 3-28
[11.]
S. Finch, W. Doyle, C. Lowe, C.J. Bates, A. Prentice, G. Smithers, et al.
National Diet and Nutrition Survey: people aged 65 years and over. Volume 1: report of the diet and nutrition survey.
[12.]
J.P. McWhirter, C.R. Pennington.
Incidence and recognition of malnutrition in hospital.
BMJ, 308 (1994), pp. 945-948
[13.]
C. Braunschweig, S. Gómez, P.M. Sheean.
Impact of declines in nutritional status on outcomes in adult patients hospitalised for more than 7 days.
J Am Diet Assoc, 100 (2000), pp. 1316-1322
[14.]
R. Gabriel, E. García.
Estado nutricional de los ancianos españoles. Estudios epidemiológicos.
Alimentación, nutrición y salud en el anciano, pp. p25-p33
[15.]
J.P. Roldán, I. Pérez, J.A. Irles, R. Martín.
Malnutrición en pacientes hospitalizados: estudio prospectivo y aleatorio.
Nutr Hosp, 10 (1995), pp. 192-198
[16.]
M.A. Martínez, M.J. Martínez, A. López, M.J. Morales, S. Cal, I. Castro, et al.
Detección del riesgo de malnutrición en ancianos hospitalizados.
Nutr Hosp, 17 (2002), pp. 22-27
[17.]
G. Akner, T. Cederholm.
Treatment of protein-energy malnutrition in chronic non-malignant disorders.
Am J Clin Nutr, 74 (2001), pp. 6-24
[18.]
A. Ramos, R. Luna, J. González, M. Hernando, A. Kazemzadeh, M.J. Martínez-Cañavate, et al.
Malnutrición en un servicio de medicina interna: influencia de los pacientes procedentes de residencias de ancianos.
An Med Intern (Madrid), 17 (2000), pp. 347-350
[19.]
M. Esteban, J. Fernández, J. Salas.
Estado nutricional de la población anciana en función del régimen de institucionalización.
Nutr Hosp, 15 (2000), pp. 105-113
[20.]
M. Mowé, T. Bohmer, E. Kindt.
Reduced nutritional status in an elderly population (> 70 y) is probable before disease and possibly contributes to the development of disease.
Am J Clin Nutr, 59 (1994), pp. 317-324
[21.]
D.H. Sullivan.
The role of nutrition in increased morbidity and mortality.
Clin Geriatr Med, 11 (1995), pp. 661-674
[22.]
K.E. Covinsky, G.E. Martín, R.J. Beyth, A.C. Justice, A.R. Sehgal, C.S. Landefeld.
The relationship between clinical assessments of nutritional status and adverse outcomes in older hospitalized medical patients.
J Am Geriatr Soc, 47 (1999), pp. 532-538
[23.]
A positive approach to nutrition as treatment: report of a working party on the role of enteral and parenteral feeding in hospital and home,
[24.]
A. Maryon Davis, A. Bristow.
Managing nutrition in hospital: a recipe for quality.
[25.]
Hospital food as treatment. The British Association for Parenteral and Enteral Nutrition (BAPEN). Maidenhead,
[26.]
D. Spalding.
«Not because they are old»: an independent inquiry into the care of older people on acute wards in general hospitals.
J Hum Nutr Diet, 12 (1999), pp. 473-474
[27.]
K. Hamilton, D. Spalding, C. Steele, S. Waldron.
An audit of nutritional care delivered to elderly inpatients in community hospitals.
J Hum Nutr Diet, 15 (2002), pp. 49-58
[28.]
A.D. Barton, C.L. Beigg, I.A. MacDonald, S.P. Allison.
High food wastage and low nutritional intakes in hospital patients.
Clin Nutr, 19 (2000), pp. 445-449
[29.]
A.D. Barton, C.L. Beigg, I.A. MacDonald, S.P. Allison.
A recipe for improving food intakes in elderly hospitalised patients.
Clin Nutr, 19 (2000), pp. 451-454
[30.]
S.P. Allison.
The uses and limitations of nutritional support.
Clin Nutr, 11 (1992), pp. 319-330
[31.]
S. Klein, J. Kinney, K. Jeejeebhoy, D. Alpers, M. Hellerstein, M. Murray, et al.
Nutrition support in clinical practice: review of published data and recommendations for future research directions.
J Parent Enteral Nutr, 21 (1997), pp. 133-156
[32.]
R. Incalzi, O. Capparella, A. Gemma, F. Landi, F. Pagano, L. Cipriani, et al.
Inadequate caloric intake: a risk factor for mortality of geriatric patients in the acute-care hospital.
Age Ageing, 27 (1998), pp. 303-310
[33.]
S.E. Gariballa.
Malnutrition in hospitalized elderly patients: when does it matter?.
Clin Nutr, 20 (2001), pp. 487-491
[34.]
M. Unosson, J. Larsson, A.C. Ek, P. Bjurulf.
Effects of dietary supplement on functional condition and clinical outcome measured with a modified Norton Scale.
Clin Nutr, 11 (1992), pp. 134-139
[35.]
C.M. Williams, L.T. Driver, J. Older, J.W. Dickerson.
A controlled trial of sipfeed supplements in elderly orthopaedic patients.
Eur J Clin Nutr, 43 (1989), pp. 267-274
[36.]
C.R. Hankey, J. Summerbell, H. Wynne.
The effect of dietary supplementation continuing care elderly people.
J Hum Nutr Diet, 6 (1993), pp. 317-322
[37.]
P.G. Stableforth.
Supplement feeds and nitrogen and calorie balance following femoral neck fracture.
Br J Surg, 73 (1986), pp. 651-655
[38.]
A. Olin, P. Osterberg, K. Hadell, I. Armyr, S. Jerstrom, O. Ljungqvist.
Energyenriched hospital food to improve energy intake in elderly patients.
J Parent Enteral Nutr, 20 (1996), pp. 93-97
[39.]
M.J. Gall, G.K. Grimble, N.J. Reeve, S.J. Thomas.
Effect of providing fortified meals and between-meal snacks on energy and protein intake of hospital patients.
Clin Nutr, 17 (1998), pp. 259-264
[40.]
N. De Jong, M.J. Paw, C. De Graaf, W.A. Van Staveren.
Effect of dietary supplements and physical exercise on sensory perception, appetite, dietary intake and body weight in frail elderly subjects.
Br J Nutr, 83 (2000), pp. 605-613
[41.]
N. De Jong, A. Chin, M.J. Paw, L.C. De Groot, C. De Graaf, W.A. Van Staveren.
Functional, biochemical and nutrient indices in frail elderly people are partly affected by dietary supplements but not by exercise.
J Nutr, 129 (1999), pp. 2028-2036
[42.]
Working Group on the Nutrition of Elderly People of the Committee on Medical Aspects of Food Policy.
The nutrition of elderly people. Department of Health Report on Health and Social Subjects.
[43.]
D.R. Thomas, W. Ashmen, J.E. Morley, W.J. Evans.
Nutritional management in long-term care: development of a clinical guideline.
J Gerontol Med Sc, 55 (2000), pp. M725-M734
[44.]
Position of the American Dietetic Association: nutrition, aging and the continuum of care.
J Am Diet Assoc, 100 (2000), pp. 580-595
[45.]
Guidelines for detection and management of malnutrition. A report by the Malnutrition Advisory Group, a Standing Committee of The British Association for Parenteral and Enteral Nutrition (BAPEN). Maidenhead,
[46.]
Consejo Interterritorial del Sistema Nacional de Salud.
Guía de práctica clínica de nutrición enteral domiciliaria.
[47.]
M. Capo.
Intervención nutricional en la persona de edad avanzada.
Importancia de la nutrición en la persona de la edad avanzada, pp. p26-p27
[48.]
C. Steigh, P. Glassman, F. Fajardo.
Physician and dietitian prescribing of a commercially available oral nutritional supplement.
Am J Managed Care, 4 (1998), pp. 567-572
[49.]
J.M. Potter.
Oral supplements in the elderly.
Curr Opin Clin Nutr Metab Care, 4 (2001), pp. 21-28
[50.]
J.M. Potter, M.A. Roberts, J.H. McColl, J.J. Reilly.
Protein energy supplements in unwell elderly patients: a randomised controlled trial.
J Parent Enteral Nutr, 25 (2001), pp. 323-329
[51.]
S. Brosnan, B. Margetts, J. Munro, C. Passey, H. Rivers.
on behalf of the Wessex Dietetic Managers Group. The reported use of dietary supplements (sip feeds) in hospitals in Wessex, UK.
Clin Nutr, 20 (2001), pp. 445-449
[52.]
R.M. Lawson, M.K. Doshi, L.E. Ingoe, J.M. Colligan, J.R. Barton, I. Cobden.
Compliance of orthopaedic patients with postoperative oral nutritional supplementation.
Clin Nutr, 19 (2000), pp. 171-175
[53.]
M.B. Hogarth, P. Marshall, L.B. Lovat, C.G. Palmer, A.E. Frost, C.G. Fletcher, et al.
Nutritional supplementation in elderly medical in-patients: a doubleblind placebo-controlled trial.
Age Ageing, 25 (1996), pp. 453-457
[54.]
A. Carver, A.M. Dobson.
Effect of the dietary supplementation of elderly demented hospital residents.
J Hum Nutr Diet, 8 (1995), pp. 389-394
[55.]
E. Joosten, B. Vander Elst.
Does nutritional supplementation influence the voluntary dietary intake in an acute geriatric hospitalized population?.
Aging, 13 (2001), pp. 391-394
[56.]
D. Volkert, S. Hubsch, P. Oster, G. Schlierf.
Nutritional support and functional status in undernourished geriatric patients during hospitalization and 6 month follow up.
Aging Clin Exp Res, 8 (1996), pp. 386-395
[57.]
M.M. Wilson, R. Purushothaman, J.E. Morley.
Effect of liquid dietary supplements on energy intake in the elderly.
Am J Clin Nutr, 75 (2002), pp. 944-947
[58.]
J. Woo, S.C. Ho, Y.T. Mak, L.K. Law, A. Cheung.
Nutritional status of elderly patients during recovery from chest infection and the role of nutritional supplementation assessed by a prospective randomized single blind trial.
Age Aging, 23 (1994), pp. 40-48
[59.]
H. Saudny-Unterberger, J.G. Martin, K. Gray-Donald.
Impact of nutritional support on functional status during an acute exacerbation of chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 156 (1997), pp. 794-799
[60.]
I.M. Ferreira, D. Brooks, Y. Lacasse, R.S. Goldstein.
Nutritional support for individuals with COPD: a meta-analysis.
Chest, 161 (2000), pp. 745-752
[61.]
A.C. Milne, J. Potter, A. Avenell.
Protein and energy supplementation in elderly people at risk from malnutrition (Cochrane Review).
The Cochrane Library, (2002),
[62.]
S. Vlaming, A. Biehler, E.M. Hennessey, C.P. Jamieson, S. Chattophadhyay, O.A. Obeid, et al.
Should the food intake of patients admitted to acute hospital services be routinely supplemented? A randomized placebo controlled trial.
Clin Nutr, 20 (2001), pp. 517-526
[63.]
C. Bos, R. Benamouzig, A. Bruhat, C. Roux, P. Valensi, F. Ferriere, et al.
Nutritional status after short-term dietary supplementation in hospitalised malnourished geriatric patients.
Clin Nutr, 20 (2001), pp. 225-233
[64.]
M.L. Borum, J. Lynn, Z. Zhong, K. Roth, A.F. Connors, N.A. Desbiens, et al.
The effect of nutritional supplementation on survival in seriously ill hospitalized adults: an evaluation of the SUPPORT data. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments.
J Am Geriatr Soc, 48 (2000), pp. 33-38
[65.]
J. Larsson, M. Unosson, A.C. Ek, L. Nilsson, S. Thorslund, P. Bjurulfp.
Effect of dietary supplement on nutritional status and clinical outcome on 501 geriatric patients: a randomised study.
Clin Nutr, 9 (1990), pp. 179-184
[66.]
M. Delmi, C.H. Rapin, J.M. Bengoa, P.D. Delmas, H. Vasey, T.P. Bonjour.
Dietary supplementation in elderly patients with fractured neck of the femur.
Lancet, 335 (1990), pp. 1013-1016
[67.]
M.A. Schurch, R. Rizzoli, D. Slosman, L. Vadas, P. Vergnaud, J.P. Bonjour.
Protein supplements increase serum insulin-like growth factor-I levels and attenuate proximal femur bone loss in patients with recent hip fracture. A randomised, double blind, placebo-controlled trial.
Ann Intern Med, 128 (1998), pp. 801-809
[68.]
L. Tkatch, C.H. Rapin, R. Rizzoli, D. Slosman, V. Nydegger, H. Vasey, et al.
Benefits of oral protein supplementation in elderly patients with fracture of the proximal femur.
J Am Coll Nutr, 11 (1992), pp. 519-525
[69.]
J. Espaulella, H. Guyer, F. Díaz-Escriu, J.A. Mellado-Navas, M. Castells, M. Pladevall.
Nutritional supplementation of elderly hip fracture patients. A randomized, double blind, placebo-controlled trial.
Age Ageing, 29 (2000), pp. 425-431
[70.]
S.E. Gariballa, N. Taub, S.G. Parker, C.M. Castleden.
A randomised, controlled, single-blind trial of nutritional supplementation after acute stroke.
J Parent Enteral Nutr, 22 (1998), pp. 315-319
[71.]
I. Bourdel-Marchasson, M. Barateau, V. Rondeau, L. Dequae-Merchadou, N. Salles-Montaudon, J.P. Emeriau, et al.
A multicentric trial of the effects of oral nutritional supplementation in critically ill older inpatients.
Nutrition, 16 (2000), pp. 1-5
[72.]
A. Avenell, H.H.G. Handoll.
Nutritional supplementation for hip fracture aftercare in the elderly (Cochrane review).
The Cochrane Library, (2001),
[73.]
D.H. Sullivan, R.C. Walls.
Impact of nutritional status on morbidity in a population of geriatric rehabilitation patients.
J Am Geriatr Soc, 42 (1994), pp. 471-477
[74.]
A. Dávalos, W. Ricart, F. González-Huix, S. Soler, J. Marrugat, A. Molins, et al.
Effect of malnutrition after acute stroke on clinical outcome.
Stroke, 7 (1996), pp. 1028-1032
[75.]
I. Bourdel-Marchasson, M. Barateau, N. Salles-Montaudon, J.P. Emeriau, C. Sourgen, S. Richard-Harston, et al.
Prospective audits of quality of malnutrition, recognition and nutritional support in critically ill elderly patients.
Clin Nutr, 18 (1999), pp. 233-240
[76.]
R.A. Breslow, J. Hallfrisch, D.G. Guy, B. Crawly, A.P. Goldberg.
The importance of dietary protein in healing pressure ulcers.
J Am Geriatr Soc, 41 (1993), pp. 357-362
[77.]
B.M. Lesourd.
Nutrition and immunity in the elderly: modification of immune responses with nutritional treatments.
Am J Clin Nutr, 66 (1997), pp. 478-484
[78.]
C.S. Chima, K. Barco, M.A. Dewitt, M. Maeda, J.C. Teran, K.D. Mullen.
Relationship of nutritional status to length of stay, hospital costs, and discharge status of patients hospitalised in the medicine service.
J Am Diet Assoc, 97 (1997), pp. 975-978
[79.]
S.P. Allison.
Cost-effectiveness of nutrition support in the elderly.
Proc Nutr Soc, 54 (1995), pp. 693-699
[80.]
M. Lumbers, L. Driver, R. Howland, M. Older, C. Williams.
Nutritional status and clinical outcome in elderly female surgical orthopaedic patients.
Clin Nutr, 15 (1996), pp. 101-107
[81.]
A.M. Beck, U.N. Balknas, P. Furst, K. Hasunen, L. Jones, U. Keller, et al.
Food and nutritional care in hospitals: how to prevent undernutrition. Report and guidelines from the Council of Europe.
Clin Nutr, 20 (2001), pp. 455-460
[82.]
British Dietetic Association: Nutrition Advisory Group for the Elderly Have you got a small appetite?.
Your guide to eating well.
British Dietetic Association, (1995),
[83.]
R. Stratton, E. Marinos.
Are oral nutritional supplements of benefit to patients in the community? Findings from a systematic review.
Curr Opin Clin Nutr Metab Care, 3 (2000), pp. 311-315
[84.]
E. Venegas, M. Soto, M.V. Cózar, J.L. Pereira, H. Romero, P.P. García-Luna.
Suplementos nutricionales ¿Son útiles?.
Nutr Hosp, 15 (2000), pp. 49-57

Este trabajo ha sido posible gracias a una beca de estudios concedida por la Sociedad Española de Geriatría y Gerontología y Vegenat en junio de 2001.

Copyright © 2003. Sociedad Española de Geriatría y Gerontología
Opciones de artículo
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos