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Nutritional status and energy expenditure in elderly patients with recent hip fracture during a 2-month follow-up

Published online by Cambridge University Press:  09 March 2007

Elena Paillaud ,
Phuong-Nhi Bories ,
Jean-Claude Le Parco  and
Bernard Campillo
Elena Paillaud
Affiliation:
Service de Médecine Interne, Assistance Publique-Hôpitaux de Paris, 40 rue de Mesly, Créteil, France
Phuong-Nhi Bories
Affiliation:
Laboratoire de Biochimie, Assistance Publique-Hôpitaux de Paris, 40 rue de Mesly, Créteil, France
Jean-Claude Le Parco
Affiliation:
Service de Médecine Interne, Assistance Publique-Hôpitaux de Paris, 40 rue de Mesly, Créteil, France
Bernard Campillo*
Affiliation:
Service de Rééducation Digestive Hôpital Albert Chenevier, Assistance Publique-Hôpitaux de Paris, 40 rue de Mesly, Créteil, France
*
*Corresponding author: Dr Bernard Campillo, fax +33 1 49 81 30 13, email bernard-campillo@ach.ap-hop-paris.fr
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Abstract

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A 2-month follow-up of nutritional status was performed in forty elderly patients with recent hip fracture. Patients were nutritionally assessed on admission to our rehabilitation unit (day 0), then monthly (day 30, day 60) by measurement of resting energy expenditure (REE), anthropometric, impedance and biological variables. Patients were defined as undernourished (n 13) or normally nourished (n 27) on the basis of mid-arm circumference (MAC) and triceps skinfold thickness (TST) measurements. Seven patients recovered a walking autonomy and were discharged from the hospital before day 30 (group I) whereas thirteen patients were discharged after day 30 (group II); twenty patients remained in the study at day 60 (group III). MAC and TST decreased in normally nourished patients from group III throughout the study whereas they did not change in group II or in undernourished patients from group III. REE values in relation to fat-free mass were increased compared with normal values and were similar in the three groups on day 0; they did not change during the study. Daily energy intake in relation to body weight was higher in group I and increased in group II and in undernourished patients from group III throughout the study. In contrast, it was below the recommended value at day 0 and it did not significantly improve in normally nourished patients from group III. Serum albumin, transthyretin and transferrin levels on day 0 were below reference intervals in the three groups. Albumin levels increased in group III throughout the study. Inflammatory proteins decreased in groups II and III, with C-reactive protein levels returning to normal values in group II by day 30 and in group III at day 60, while orosomucoid levels did not become completely normal over this period. Our findings indicate no improvement in nutritional status in undernourished patients after surgery for recent hip fracture, despite an adequate energy intake. An insufficient spontaneous energy intake for normally nourished patients was associated with a delayed favourable outcome resulting in a prolonged duration of hospitalization. A hypermetabolic state persisted during the 3 months after surgery.

Keywords

Energy intakeElderlyHip fractureNutritional status
Type
Research Article
Information
British Journal of Nutrition , Volume 83 , Issue 2 , February 2000 , pp. 97 - 103
Copyright
Copyright © The Nutrition Society 2000

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