Background

Food fortification as part of the food-first approach in nursing homes is a strategy that may increase energy and protein intake.

Objectives

This review aimed to determine the effect of nutrition interventions using fortification, nutrient-dense or enriched food and/or drinks on energy and protein intake in residents living in nursing homes, compared to the standard menu with or without oral nutritional support products. The secondary aim was to identify and synthesise outcomes of these interventions on weight change, nutritional status, acceptability, cost-effectiveness, and cost-benefit.

Methods

A systematic search of seven databases was undertaken. After reviewing all titles/abstracts then full-text papers, key data were extracted and synthesised narratively and through meta-analysis. The quality of included studies was assessed using the Quality Criteria Checklist for Primary Research.

Results

Of 3,098 articles retrieved, 16 were included, 13 in the meta-analysis. There were 891 participants, with the study duration ranging from four to 26 weeks. The groups receiving the fortified diet had a significantly higher energy intake (Hedges’ g = 0.69 (CI 0.36-1.03), p<0.0001) and protein intake (Hedges’ g = 0.46 (CI 0.17-0.74), p=0.003) compared with the groups receiving the standard menu +/- ONS. The meta-analysis revealed I² values of 77% for energy (p<0.0001) and 60% for protein (p=0.003), indicating considerable statistical heterogeneity across included studies. Benefits to weight and nutritional status of residents were recorded in some studies. Where reported, cost-effectiveness and cost-benefit of menu fortification/supplementation were variable.

Conclusions

This systematic review with meta-analyses has shown that fortified menus may significantly increase energy and protein intakes compared with standard menus in nursing homes. As such, the findings of this review support further use of fortified diets in this setting. Further research is warranted comparing food fortification to standard menus, with a particular focus on evaluating the effect on weight, nutritional status and cost-effectiveness of the intervention.

Study registration: PROSPERO no. CRD42020162796

Tweetable Abstract

This systematic review shows that fortified menus may significantly increase energy and protein intakes compared with standard menus in nursing homes.

中文翻译：

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强化、营养丰富和丰富的食物和基于饮料的营养干预措施能否增加住院老年护理居民的能量和蛋白质摄入量？具有荟萃分析的系统评价

背景

作为养老院食物优先方法的一部分，食品强化是一种可以增加能量和蛋白质摄入量的策略。

目标

本综述旨在确定使用强化、营养密集或富含食物和/或饮料的营养干预对住在疗养院的居民的能量和蛋白质摄入量的影响，与含或不含口服营养支持产品的标准菜单进行比较。次要目的是确定和综合这些干预措施在体重变化、营养状况、可接受性、成本效益和成本效益方面的结果。

方法

对七个数据库进行了系统搜索。在查看所有标题/摘要和全文论文后，通过元分析提取和综合叙述性的关键数据。纳入研究的质量使用初级研究质量标准清单进行评估。

结果

在检索到的 3,098 篇文章中，16 篇被纳入，13 篇被纳入荟萃分析。共有 891 名参与者，研究持续时间从 4 周到 26 周不等。相比之下，接受强化饮食的组的能量摄入量（Hedges' g = 0.69（CI 0.36-1.03），p<0.0001）和蛋白质摄入量（Hedges' g = 0.46（CI 0.17-0.74），p=0.003）显着更高与接收标准菜单 +/- ONS 的组。荟萃分析显示 ，能量的I ²值为 77% (p<0.0001)，蛋白质的I ²值为 60% (p=0.003)，表明纳入研究之间存在相当大的统计异质性。一些研究记录了居民体重和营养状况的益处。在报告中，菜单强化/补充的成本效益和成本效益是可变的。

结论

这项荟萃分析的系统评价表明，与疗养院的标准菜单相比，强化菜单可能会显着增加能量和蛋白质的摄入量。因此，本综述的结果支持在这种情况下进一步使用强化饮食。需要进一步研究将食品强化与标准菜单进行比较，特别关注评估干预对体重、营养状况和成本效益的影响。

学习注册：PROSPERO no. CRD42020162796

推文摘要

该系统评价表明，与疗养院的标准菜单相比，强化菜单可能会显着增加能量和蛋白质的摄入量。