Sustainable Eating Pattern to Limit Malnutrition in Older Adults

Brief Summary

Detailed Description

The SENIOR RCT is a multicenter study conducted in two North Italian Scientific Hospitalization and Treatment Institution in Pavia on older malnourished adults (≥ 65 years old). The estimated duration is 24 months, which include 6 months of nutritional intervention and a follow-up after 6 months, with an preferred starting date on January 2024. The primary objective of the SENIOR RCT is the evaluation of the efficacy of a 6 months sustainable nutrition protocol on malnourished older adults participants (diagnosed with the most recent GLIM criteria) in comparison to the hospital standard of care. Therefore, the primary endpoint is the improvement of the nutritional status between pre- and post-intervention between experimental and control group measuring the change of body weight and strength (handgrip). Secondary objectives are the change pre- and post-intervention between experimental and control group for blood biomarkers, dietary habits, quality of life and evaluation of sarcopenia. Secondary endpoints are the change pre- and post-intervention between experimental and control group for blood biomarkers, MEDI-LITE score, SF-12, diet composition, phase angle and gait speed. Participants of this study are older adults over 65 previously enrolled in the SENIOR cross-sectional study and willing to participate to the RCT phase or new enrolled patients from the two hospitals in according to the eligible criteria. Malnutrition will be diagnosed according to GLIM criteria, using Malnutrition Universal Screening Tool (MUST) as screening tool. The experimental group at the baseline will receive a nutritional assessment followed by the elaboration of a sustainable and personalized nutritional protocol by qualified dietitians. The intervention will last 6 months with a monthly evaluation of the dietary consumption of the previous 24 hour (recall-24h), followed by a final follow-up after additional 6 months. For both groups at the baseline will be measured blood biomarkers, anthropometric variables, Mediterranean diet adherence, quality of life, strength (handgrip) and locomotion (gait speed). At 3 months weight and strength will be evaluated. At 6- and 12-months baseline measurements will be repeated except for the nutritional assessment. Dietary habits will be evaluated through a Mediterranean diet questionnaire (MEDI-LITE), while quality of life will be measured with Short-Form Health Survey (SF-12) questionnaire. Anthropometric variables include weight, height (knee height and demi-span), waist circumference, and body composition (BIA). In addition, strength (handgrip) and locomotion (gait speed) will be evaluated. Strength (handgrip), Appendicular Skeletal Mass (ASM) and locomotion (gait speed) are necessary to diagnose sarcopenia according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) consensus. Malnutrition will be evaluated again at 6 months. Blood analysis will be carried out on a subgroup to evaluate the participants' inflammatory, nutritional and clinical status.

Primary Outcomes

Secondary Outcomes

• Changes pre- and post- intervention between experimental and control groups for blood creatin Kinase(24 months (baseline and 6 months))
• Changes pre- and post- intervention between experimental and control groups for glycemia.(24 months (baseline and 6 months))
• Changes pre- and post- intervention between experimental and control groups for blood insulin(24 months (baseline and 6 months))
• Changes pre- and post- intervention between experimental and control groups for blood homocysteine(24 months (baseline and 6 months))
• Changes pre- and post- intervention between experimental and control groups for complete blood count(24 months (baseline and 6 months))
• Changes pre- and post- intervention between experimental and control groups for blood cytokine(24 months (baseline and 6 months))
• Changes pre- and post- intervention between experimental and control groups for blood sodium (Na)(24 months (baseline and 6 months))
• Changes pre- and post- intervention between experimental and control groups for blood C reactive Protein (CRP)(24 months (baseline and 6 months))
• Changes pre- and post- intervention between experimental and control groups for blood vitamine D(24 months (baseline and 6 months))
• Changes pre- and post- intervention between experimental and control groups for blood vitamine B9(24 months (baseline and 6 months))
• Changes pre- and post- intervention between experimental and control groups for blood magnesium (Mg)(24 months (baseline and 6 months))
• Changes pre- and post- intervention between experimental and control groups for adherence to Mediterranean Diet(24 months (baseline, 6 months and 12 months))
• Changes pre- and post- intervention between experimental and control groups for blood transaminases(24 months (baseline and 6 months))
• Changes pre- and post- intervention between experimental and control groups for blood vitamine B12(24 months (baseline and 6 months))
• Changes pre- and post- intervention between experimental and control groups for blood potassium (K)(24 months (baseline and 6 months))
• Changes pre- and post- intervention between experimental and control groups for blood calcium (Ca)(24 months (baseline and 6 months))
• Changes pre- and post- intervention between experimental and control groups for blood iron (Fe)(24 months (baseline and 6 months))
• Changes pre- and post- intervention between experimental and control groups of fat free mass(24 months (baseline, 6 months and 12 months))
• Changes pre- and post- intervention between experimental and control groups for blood lipid profile(24 months (baseline and 6 months))
• Changes pre- and post- intervention between experimental and control groups for blood prealbumin(24 months (baseline and 6 months))
• Changes pre- and post- intervention between experimental and control groups for the dietary nutritional composition(24 months (baseline, 1 month, 2 months, 3 months, 4 months, 5 months, 6 months, 12 months))
• Changes pre- and post- intervention between experimental and control groups for blood zinc (Zn)(24 months (baseline and 6 months))
• Changes pre- and post- intervention between experimental and control groups for the quality of life(24 months (baseline, 6 months and 12 months))
• Changes pre- and post- intervention between experimental and control groups in locomotion test(24 months (baseline, 6 months and 12 months))