An innovative solid oral nutritional supplement to fight weight loss and anorexia: open, randomised controlled trial of efficacy in institutionalised, malnourished older adults

Background and objective: to evaluate the impact of a solid nutritional supplement on the weight gain of institutionalised older adults > 70 years with protein-energy malnutrition. The innovation of these high-protein and high-energy cookies was the texture adapted to edentulous patients (Protibis (R), Solidages, France). Design: an open, multicentre, randomised controlled trial. Setting: seven nursing homes. Participants: one hundred and seventy-five malnourished older adults, aged 86 +/- 8 years. Intervention: all participants received the standard institutional diet. In addition, Intervention group participants received eight cookies daily (11.5 g protein; 244 kcal) for 6 weeks (w0-w6). Measurements: five visits (w-4, w0, w6, w10 and w18). Main outcome: percentage of weight gain from w0 to w6 (body mass in kg). Secondary outcomes: appetite, rated using a numerical scale (0: no appetite to 10: extremely good appetite); current episodes of pressure ulcers and diarrhea. Results: average weight increased in Intervention group (n = 88) compared with Control group (n = 87) without cookies supplementation (+1.6 versus -0.7%, P = 0.038). Weight gain persisted 1 month (+3.0 versus -0.2%, P = 0.025) and 3 months after the end of cookies consumption (+3.9 versus -0.9%, P = 0.003), with diarrhea reduction (P = 0.027). There was a synergistic effect with liquid/creamy dietary supplements. Subgroup analysis confirmed the positive impact of cookies supplementation alone on weight increase (P = 0.024), appetite increase (P = 0.009) and pressure ulcers reduction (P = 0.031). Conclusion: the trial suggested that, to fight against anorexia, the stimulation of touch (finger food; chewing, even on edentulous gums) and hearing (intra-oral sounds) could be valuable alternatives to sight, smell and taste alterations.