栄養良好な大腿骨頸部骨折の栄養介入

もう1つ同じグループの、栄養状態良好～軽度低栄養の大腿骨頸部骨折患者に対する栄養介入のランダム化比較試験を紹介します。

Botella-Carretero JI, Iglesias B, Balsa JA, Zamarrón I, Arrieta F, Vázquez C: Effects of oral nutritional supplements in normally nourished or mildly undernourished geriatric patients after surgery for hip fracture: a randomized clinical trial. JPEN J Parenter Enteral Nutr. 2008 Mar-Apr;32(2):120-8.

リサーチクエスチョンは、

P：大腿骨頸部骨折の高齢患者に
I：術後に経口栄養剤を投与すると（蛋白質36gのみの群と、蛋白質37.6g、エネルギー500kcalの群）
C：経口栄養剤を投与しない場合と比較して
O：退院時の血清アルブミン、プレアルブミン、レチノール結合蛋白が改善するか
D：マスキングのないRCT

です。

MNAの平均得点は対照群19.4、蛋白質群18.7、エネルギー群20.5です。結果ですが、白丸が対照群、黒丸ら蛋白群、黒四角がエネルギー群です。3群間で血清アルブミン、プレアルブミン、レチノール結合蛋白に統計学的有意差を認めませんでした。BMI、AC、TSFも同様に統計学的有意差を認めませんでした。

栄養状態良好～軽度低栄養の大腿骨頸部骨折患者に対する術後の栄養介入で、血清アルブミン、プレアルブミン、レチノール結合蛋白は明らかな改善を認めないという結論になります。やはり低栄養と判定される大腿骨頸部骨折患者に対して、栄養＋運動介入をしたいところです。

Abstract
BACKGROUND: Oral nutritional supplements have been recommended after orthopedic surgery in geriatric patients to reduce postoperative complications. However, tolerability of supplements could be a limitation, and their universal use is not supported by the heterogeneity of previous studies, especially in patients without malnutrition.

METHODS: This study is a randomized, controlled, open, parallel, 3-arm clinical trial comparing supplementation with protein powder dissolved in liquids to aim at 36 g of protein per day, energy and protein supplements to aim at 37.6 g of protein and 500 kcal per day, or no intervention in normally nourished or mildly undernourished patients. Outcomes were serum albumin, prealbumin, retinol-binding globulin, and body mass index, among others. Postoperative complications were also recorded.

RESULTS: Ninety patients aged 83.8 +/- 6.6 years were included. The mean ingested amount of supplements was 41.1% +/- 20.6% in the protein powder supplement group and 51.4% +/- 13.2% in the energy protein supplement group (t = 2.278, P = .027). Postoperative supplements had no effect on the nutrition status during in-hospital follow-up, as assessed by serum albumin (P = .251), prealbumin (P = .530), retinol-binding globulin (P = .552), or body mass index (P = .582). Multivariate analysis showed that length of hospital stay with an established complication until its resolution (beta = .230, P = .031), total hospital stay (beta = .450, P < .001), baseline body mass index (beta = .204, P = .045), and total daily ingested proteins per body weight (beta = .252, P = .018) were predictive variables on the change in serum albumin (R2 = 0.409, F = 11.246, P < .001).

CONCLUSIONS: Oral nutritional supplements in normally nourished or only mildly undernourished geriatric patients with hip fracture submitted to surgery may be of interest for patients with postoperative complications and long hospital stays