A Cochrane review [Abstract] 1 included 24 studies with a total of 1 940 subjects aged 65 years or older. The quality of the trials was poor. Oral multinutrient feeds (providing non-protein energy, protein, some vitamins and minerals) had no statistically significant effect on mortality (16/244 versus 21/226; RR 0.76, 95% CI 0.42 to 1.37; 10 studies) or on 'unfavourable outcome' (combined outcome of mortality and survivors with medical complications) (46/126 versus 41/103; RR 0.76, 95% CI 0.55 to 1.04). Four trials examining nasogastric multinutrient feeding showed no evidence of an effect on mortality (RR 0.99, 95% CI 0.50 to 1.97) but the studies were heterogeneous regarding case mix. Nasogastric feeding was poorly tolerated. There was insufficient information for other outcomes. One trial examining nasogastric tube feeding followed by oral feeds found no evidence for an effect on mortality or complications. One trial of multinutrient intravenous feeding followed by oral supplements found a reduction in participants with complications (RR 0.21, 95% CI 0.10 to 0.46), but not in mortality (RR 0.11, 95% CI 0.01 to 2.00). Increasing protein intake in an oral feed was not shown to have an effect on mortality (RR 1.42, 95% CI 0.85 to 2.37; 4 studies). Protein supplementation may have reduced the number of long term medical complications. Two trials, testing intravenous vitamin B1 and other water soluble vitamins, or 1-alpha-hydroxycholecalciferol (an active form of vitamin D) respectively, produced no evidence of effect for either supplement. One trial, evaluating dietetic assistants to help with feeding, showed a trend for a reduction in mortality (RR 0.57, 99% CI 0.29 to 1.11).
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment, inadequate intention-to-treat adherence, inadequate follow up) and by imprecise results (limited study size for each comparison).
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