Nutritional supplements after hip fracture: poor compliance limits effectiveness

Background: Undernutrition and weight loss are important determinants of clinical outcome in older patients after hip fracture but the effectiveness of nutritional support programs in routine clinical practice remains controversial. Aims of the project: To determine if oral nutritional supplements given daily for 28 days after hip fracture surgery could prevent weight loss and/or lead to improved clinical outcomes (mortality rates, discharge destination, activities of daily living or length of hospital stay) in non-malnourished community-dwelling older women with hip fracture. Methods: One hundred and nine women with BMI range 20–30 kg/m2 were allocated to either nutritional supplements (352 kcal/day) or usual hospital nutrition using a quasi-randomisation technique. Body weight changes were monitored at 4 and 8 weeks and clinical outcomes were recorded at discharge and at 6 months. Results: No significant differences in weight change or clinical outcomes were seen between the two groups. Compliance with consuming the nutritional supplements was quite variable and there was a significant negative correlation between the amount of supplement consumed and subsequent weight change (r=−0.36, P=0.019). Conclusions: Poor compliance with oral nutritional supplements is an important determinant of the effectiveness of oral nutritional interventions in preventing weight loss after hip fracture. Whilst this may explain the lack of clinical improvements seen, our data do not support the routine use of oral nutritional supplements in non-malnourished hip fracture patients.