50EFFECT OF NON-MEAT, HIGH PROTEIN SUPPLEMENTATION ON QUALITY OF LIFE AND CLINICAL OUTCOMES FOR OLDER PEOPLE LIVING IN CARE HOMES: SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Background: Malnutrition affects one third of older people living in care homes. This is associated with several poor outcomes which may negatively impact quality of life (QOL). There is a particular risk of protein energy malnutrition which may be addressed by high protein oral nutritional supplements. The purpose of this study was to perform a systematic review and meta-analysis of randomised controlled trials (RCTs) performed in care homes, using a non-meat, high protein intervention to assess the effect of supplementation on QOL and clinical outcomes in older people. Method(s): We searched EMBASE, AMED, CINAHL, MEDLINE, and the Cochrane Registry of Clinical Trials, OpenGrey, clinicaltrials.gov, the WHO clinical trial registry and the ISRCTN and NIHR trial portfolio (inception to 1st April 2016) for RCTs assessing a non-meat, high-protein dietary intervention; for people aged > 65 years; and conducted in residents in care homes. We excluded trials where participants were recruited during acute hospital or rehabilitation unit admissions, or conducted in sheltered housing. Two reviewers independently assessed trials for inclusion, extracted data, and assessed trial quality and risk of bias using Cochrane Risk of Bias tool. Result(s): Searches identified 375 potentially relevant papers of which 17 papers from 16 trials with 1246 participants fulfilled the inclusion criteria. Meta-analysis of four trials which reported on QOL outcome showed no significant effect of protein supplementation (standardised mean difference (SMD): 0.57; 95% CI: -0.77 to 1.90; p = 0.41; 4 trials). Among trials reporting on adverse events there was no significant difference in the number reported (Risk ratio (RR): 1.11; 95% CI: 0.70 to 1.76; 7 trials) and likewise for those reporting on deaths (RR: 0.53; 95% CI: 0.22 to 1.25; 4 trials). Meta-analysis showed significant increase in mean body weight (MD: 3.30; 95% CI 2.05 to 4.55; p < 0.00001; 7 trials) and mean body mass index (MD 1.24; 95% CI: 0.79 to 1.70; p < 0.00001; 5 trials). There was a strong risk of selection and performance bias due to the lack of blinding in the majority of studies (14 trials; 88%). Conclusion(s): High-protein oral supplements can improve markers of nutritional status (body weight and BMI) in care home residents. However there is insufficient high-quality evidence to determine the effect of non-meat, high protein interventions for older adults in care homes with regard to QOL.