Food intake and weight changes in Norwegian hip fracture patients

Background: Norway has the highest rates of hip fractures worldwide. Hip fracture patients represent a vulnerable group with high mortality and morbidity after one year, and as the elderly population is increasing a consecutive increase in hip fractures is expected. Energy and protein requirements are increased during disease and inflammatory state, and muscle wasting can be expected in bedridden patients. The poor nutritional status in hip fracture patients is increasingly recognized, however, little is known about food intake and weight changes in the immediate postoperative period in Norwegian patients. Objective: To investigate energy and protein intake and weight development during the acute and rehabilitation phase after a hip fracture in Norwegian patients, and to consider the patients nutritional risk. Methods: Forty patients were recruited to the study during hospitalization for hip fracture, and were investigated at hospital (median 3 days after surgery), at a rehabilitation unit (median 15 days after surgery) and at home (median 63 days after surgery). Energy and protein intake, weight, mid-upper arm circumference and triceps skinfold were collected at all visits. Nutritional risk screening, new mobility score, bioelectrical impedance analysis, handgrip and quadriceps strength were carried out at the rehabilitation unit/ at the home of the patients. Results: We found a very low energy and protein intake at hospital where no patients reached their estimated requirements, and an improved, but still insufficient energy and protein intake at rehabilitation and at home. Eleven out of 14 patients lost weight from hospital to rehabilitation (median for the group was -2.9 kg, p = 0.048) and eight out of 12 patients lost weight from hospital to home (median for the groups was -2.2 kg, p = 0.147). Eighty percent of the patients were in nutritional risk at the rehabilitation stay. Due to the small number of patients and the high drop-out rate, most findings did not achieve statistical significance, and therefore the results have to be interpreted with care. Conclusion: In conclusion, energy and protein intake was very low in hospitalised hip fracture patients, and remained sub- optimal during rehabilitation and after returning home. A significant weight loss and a high number of patients in nutritional risk, suggest that the patients in the present study experienced a critical phase, and this issue should be investigated further