大腿骨近位部骨折のリハ栄養RCTプロトコール

大腿骨近位部骨折の高齢者に対するリハ栄養のRCTプロトコール論文です。

Malafarina V, Uriz-Otano F, Gil-Guerrero L, Iniesta R, Zulet MA, Martinez JA.Study protocol: High-protein nutritional intervention based on β-hydroxy-β-methylbutirate, vitamin D3 and calcium on obese and lean aged patients with hip fractures and sarcopenia. The HIPERPROT-GER study. Maturitas. 2013 Oct;76(2):123-8.

介入群ではリハ病棟入院中に30日間、ensure plus advanceという栄養剤を1日2本飲んでもらい、ADL改善を一次アウトカムとしています。リハ栄養の介入研究を考えている方には読んでほしい論文です。

ちなみにensure plus advanceは1本220mlで、1.5kcal/ml、蛋白質22%、脂質29%、糖質47%、フラクトオリゴ糖1%です。HMBが0.55g/100ml、ビタミンDが227UI/100ml、カルシウムが160mg/100mlです。こういうリハ栄養用の栄養剤を日本でも販売してほしいですね。

Abstract

INTRODUCTION:

Loss of muscle strength is associated with falls, which, in turn, are the main cause of hip fractures in elderly people. The factors that most influence loss of strength in elderly people are a decrease in muscle mass, i.e. sarcopenia, and an increase in fat, i.e. obesity.

METHODS:

A prospective randomized clinical trial among patients who have undergone an operation for a traumatic hip fracture and who are aged 65 or above will be implemented. We shall compare a control diet against a high-protein diet enriched with β-hydroxy-βmethylbutirate, calcium and vitamin D. The diet will be administered during 30 days of hospitalization in the orthopaedic geriatric rehabilitation unit. There will be 50 patients in each arm of the study. The main objective is to assess whether the experimental diet, together with rehabilitation, improves functional recovery, measured on the Barthel index. Secondary objectives are to assess changes in body composition and the prevalence of sarcopenia, obesity and mortality one year after the hip fracture. We shall also assess whether there is a relationship between specific inflammatory markers, sarcopenia and functional recovery.

CONCLUSIONS:

Ageing is accompanied by changes in body composition that increase the risk of falls and progressive functional loss. These factors are a public health problem because they are highly associated with disability in older people. The present study seeks to gain knowledge of those factors that are most often associated with the onset of disability and those that can be modified through diet.