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

A 2-month follow-up of nutritional status was performed in forty elderly pa tients with recent hip fracture. Patients were nutritionally assessed on ad mission to our rehabilitation unit (day 0), then monthly (day 30, day 60) b y measurement of resting energy expenditure (REE), anthropometric, impedanc e and biological variables. Patients were defined as undernourished (n 13) or normally nourished (n 27) on the basis of mid-arm circumference (MAC) an d triceps skinfold thickness (TST) measurements. Seven patients recovered a walking autonomy and were discharged from the hospital before day 30 (grou p I) whereas thirteen patients were discharged after day 30 (group II); twe nty patients remained in the study at day 60 (group III). MAC and TST decre ased in normally nourished patients from group III throughout the study whe reas they did not change in group II or in undernourished patients from gro up III. REE values in relation to fat-free mass were increased compared wit h 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 wa s higher in group I and increased in group II and in undernourished patient s from group III throughout the study. In contrast, it was below the recomm ended value at day 0 and it did not significantly improve in normally nouri shed 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 oros omucoid levels did not become completely normal over this period. Our findi ngs indicate no improvement in nutritional status in undernourished patient s 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 d uration of hospitalization. A hypermetabolic state persisted during the 3 m onths after surgery.