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The loss of lean body mass, muscle strength and physical function causes significant problems in older adults. Protein and amino acid supplements can preserve muscle strength but the effect on function is variable. We conducted a systematic literature review and meta-analysis to investigate the effect of protein and amino acid supplementation on fat-free mass, muscle strength and physical function in malnourished, frail, sarcopenic, dependent or elderly with acute or chronic conditions, with or without rehabilitation exercise. Databases searched included Medline, BIOSIS, CINAHL, Cochrane Library, EBM Reviews, Embase, Pre-Medline, ProQuest, PubMed and Scopus. Retrieved articles were assessed by two reviewers using the Cochrane Risk of Bias (ROB) Tool. In all, thirty nine randomised controlled trails (n 4274) were included. The studies used a range of protein or essential amino acid (EAA) supplements in a variety of settings, including hospital, community and long-term care. Only seven studies had low ROB and no effect of supplementation was found on any outcomes. Analysis of all thirty-nine studies suggest protein and EAA supplements may improve fat-free mass, muscle strength and physical function (standardised mean difference 0·21–0·27, all P

Aim This study aimed to determine the strategies used by dietitians to assess, treat and monitor elderly patients diagnosed with, or at increased risk of, malnutrition and to compare these with evidence-based guidelines and the current literature. Methods An online survey was distributed to members of the Dietitians Association of Australia (DAA) working in an inpatient/outpatient facility or private practice/consultancy. Dietitians working with elderly people (≥65 years old) were invited to participate. The survey was informed by DAA's evidence-based guidelines and was pre-tested. Responses of dietitians were analysed by years of experience, service setting and approaches taken to assess and manage malnutrition. Results One hundred sixty surveys were returned. Fourteen per cent of respondents worked in services that had no malnutrition policies. A Subjective Global Assessment tool was used by 59% of respondents and 95% recommended oral nutrition supplements when malnutrition or risk of malnutrition was diagnosed. Eighty-three per cent focused on increasing both energy and protein intake; however, 64% of respondents did not consider the nature of the protein source and only 62% discussed sarcopenia. Patients at risk of malnutrition were monitored slightly less frequently than those with diagnosed malnutrition. Conclusions Respondents generally use practices that align with current assessment and treatment practice guidelines and use validated assessment tools; however, at sites where no policies exist, protocols are needed. Treatment protocols exist in less than 50% of workplaces, suggesting that specific malnutrition treatment guidelines for the elderly may be needed.

BACKGROUND: Malnutrition resulting from inadequate protein, energy, or micronutrient intake has been identified as an independent risk factor for the development of pressure ulcers in older adult patients and is associated with increased morbidity and death. OBJECTIVE: To assess the relationship between albumin, the standard biochemical marker of nutritional adequacy, and amino acid status in people with wounds. METHODS: The authors performed tests for serum albumin, prealbumin, and amino acid profiles on 18 consecutive hospital patients with wounds and 7 patients without wounds. RESULTS: A low level of the essential amino acids tryptophan and histidine was a common finding in older people with wounds. Of the 18 consecutive wound cases, 16 (88.9%) were found to be deficient in tryptophan, histidine, or both. Moreover, levels were generally found to be lower than those in the group without wounds. The levels of all other amino acids were essentially normal for all patients. Finally, although serum albumin is often used as a surrogate marker of amino acid adequacy or nutritional status, clinically abnormal albumin had poor specificity (63.2%), poor sensitivity (60.7%), and low positive predictive value (70.8%) for the identification of a low tryptophan or histidine level. CONCLUSIONS: People with wounds are a relatively at-risk group and are likely to be overlooked in terms of micronutrient deficiencies, and these findings have important implications in terms of potential specific targeting of nutrient supplementation.

Ageing is associated with an increased incidence of diabetes, impaired immunity and numerous physiological, social and economic changes. Another under-recognised change to significantly impact on health outcomes and quality of life is the drastic loss of lean body mass. New concepts have recently emerged which indicate that different types of protein sources supply constituents differentially according to digestion rate, and that amino acids have roles additional to muscle synthesis. This review explores the benefits of higher protein intakes in older people and how the protein source may provide differential benefits. In particular, whey protein is more quickly digested than either casein or soy, and provides a faster and potentially greater net source of available nutrients and essential amino acids essential for maintaining better health.