SHIELD: Oral supplements keep malnutrition at bay in older adults

Oral nutritional supplements (ONS), containing beta-hydroxy-beta-methylbutyrate (HMB) and vitamin D, when supplemented with dietary counselling, improves functional and nutritional outcomes among community-dwelling older adults, according to the recent Singapore study Strengthening Health in Elderly Through Nutrition (SHIELD).

“To our knowledge, this is the largest, double-blind, randomized, placebo-controlled trial over 6 months investigating the effects of ONS containing HMB along with dietary counselling on clinical, nutritional, and functional outcomes,” the researchers said.

SHIELD randomly assigned 805 older adults (mean age, 74.15±0.26 years; 60.2 percent female) 1:1 to receive either the ONS intervention or a parallel placebo. Both arms received dietary counselling. The two groups were comparable at baseline, with similar levels of physical activity and dietary intake; the only exception was handgrip endurance, which was better in the intervention group. [Clin Nutr 2020;doi:10.1016/j.clnu.2020.10.015]

After 180 days, a significantly greater proportion of patients in the intervention group achieved the primary composite outcome, which was survival without hospital (re)admission and with weight gain of ≥5 percent (33.4 percent vs 8.7 percent; p<0.001).

The researchers pointed out that such difference was due to the weight gain component, which was a more frequent occurrence in the intervention arm (36.2 percent vs 9.4 percent; p<0.001). The significant advantage of ONS over placebo emerged as early as day 30 and persisted until the final follow-up.

On the other hand, survival (99.5 percent vs 99.0 percent) and no hospital (re)admissions (93.8 percent vs 93.3 percent) were comparable between the two groups.

Similarly, the likelihood of having a better nutritional status, as defined by a lower Malnutrition Universal Screening Tool (MUST) risk score, was significantly better among participants in the ONS arm (odds ratio [OR], 2.69, 95 percent confidence interval [CI], 1.97–3.65; p<0.001). This was despite comparable proportions of patients in either group classified as high risk for malnutrition.

ONS patients had greater odds of improvements in vitamin D status than placebo comparators (OR, 4.23, 95 percent Ci, 3.04–5.90; p<0.001). Functional outcomes were likewise improved, with better handgrip and leg strength outcomes in the intervention arm at day 180.

The efficacy of ONS did not come with additional safety concerns, the researchers pointed out. Adverse events (AE) were detected in 14 percent and 12 percent of the intervention and placebo participants, respectively; serious AEs were reported in 6 percent and 7 percent, respectively. None of the serious AEs were deemed related to ONS.

“Changes in nutrition care, such as early screening for malnutrition risk and incorporating ONS in the management of malnutrition, are critical in helping older adults live an independent and meaningful life, while avoiding debilitating adverse health outcomes related to malnutrition,” the researchers said.

“Implementation of nutritional policies targeting this population will not only positively impact health outcomes, but also reduce escalating healthcare costs due to rapidly aging population worldwide,” they added.