The Effect of Protein and Resistance Training on Muscle Mass, Muscle Strength and Functional Ability in Acutely Ill Old Medical Patients; a Randomized Controlled Trial

Intervention:

The interventions during hospitalization and after discharge are undertaken in a standardized manner and have been described in detail in Standardized Operational Procedures. They are summarized in the following.

The Nutritional Intervention during hospitalization aims to reduce loss of muscle mass by supplying sufficient protein to meet the accelerated demands as a consequence of the stress-induced catabolism. The aim of the intervention is to achieve a protein intake of 1.7 g per kg body weight per day. If the body mass index exceeds 30 the body weight corresponding to BMI 30 is used to calculate the aim for protein intake.

On the day of inclusion an individual diet plan is made by an authorized clinical dietitian. Besides covering the high protein requirement the diet plan is calculated to meet the individual requirement for energy, liquids and micronutrients. Energy requirement is estimated individually according to the Nutritional Risk Screening 2002 (Kondrup et al. 2003). This method takes the increased demands during stress metabolism into account. The estimated energy requirement aims for weight maintenance, and not weight gain or loss. The weight is monitored daily during hospitalization, taking into account the loss or gain of edema, to evaluate if the energy intake is balanced with outputs.

The fluid requirement is calculated individually, and considers the reduced ability of the kidney to concentrate urine during stress and that the high protein diet will generate larger amounts of ammonium and urea. Furthermore, patients receive a daily vitamin and mineral tablet.