Effect of nonmeat, high-protein supplementation on quality of life and clinical outcomes in older residents of care homes: a systematic review and meta-analysis

Alison I C Donaldson, Toby O Smith (Corresponding Author), Sarah Alder, Alexandra M Johnstone, Baukje de Roos, Lorna S Aucott, Adam L Gordon, Phyo K Myint

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Context Care home residents are at risk of malnutrition owing to reduced food intake, anabolic resistance in aging muscle, and a high prevalence of medical morbidity and functional dependency. There has been limited consensus regarding the effectiveness of a high-protein diet on quality of life or clinical outcomes in care home residents. Objective The aim of this review was to evaluate the effectiveness of nonmeat, high-protein supplementation on health-related quality of life (HRQOL) and relevant clinical and nutritional outcomes in older people in a care home setting. Data Sources The following databases were searched (to February 2018) for randomized controlled trials: Embase, AMED, CINAHL, MEDLINE, the Cochrane Central Registry of Controlled Trials, OpenGrey, clinicaltrials.gov, the WHO International Clinical Trials Registry Platform, the ISRCTN registry, and the NIHR Clinical Research Network Portfolio. Study Selection Trials were selected if they assessed a nonmeat, high-protein dietary intervention provided to care home residents who were aged 65 years or older. Data Extraction Data from included trials were extracted if they assessed care home residents aged 65 years or older and compared those residents who received protein supplementation with those who did not. Trial quality was assessed using the Cochrane risk-of-bias tool. Meta-analysis was undertaken when appropriate. Results Seventeen studies with 1246 participants fulfilled the inclusion criteria. All studies were of low or moderate quality. There was no evidence of improved HRQOL when the Short Form 36 (SF-36) was used to assess outcomes (standardized mean difference [SMD] = −0.10; 95%CI, −0.51 to 0.31; P = 0.62), although significant improvement was seen in the 1 trial that used the EQ-5D instrument (SMD = 2.58; 95%CI, 2.05–3.10; P < 0.00001). Conclusions Nonmeat, high-protein oral supplements can improve markers of nutritional status in care home residents. However, there is insufficient high-quality evidence to determine the effect of such supplements on HRQOL in older adults in care homes.
Original languageEnglish
Pages (from-to)116-127
Number of pages12
JournalNutrition Reviews
Issue number2
Early online date13 Dec 2018
Publication statusPublished - 1 Feb 2019

Bibliographical note

The authors gratefully acknowledge the comments and suggestions by Dr Miles Witham, Clinical Reader in Ageing and Health, University of Dundee, Dundee, United Kingdom, and Prof Alison Avenell, Professor of Health Services Research, University of Aberdeen, Aberdeen, United Kingdom.

Author contributions. A.I.C.D., A.M.J., L.S.A., A.L.G., B.D.R., and P.K.M., conceived the study. A.I.C.D. and S.A. performed screening, selecting, and extraction of data. A.I.C.D. and S.A. also performed quality assessment. A.I.C.D. and T.O.S. conducted analyses and drafted the manuscript. All authors contributed to the writing of the manuscript.

Funding/support. No external funding supported this work. T.O.S. is supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health.

Declaration of interest. The authors have no relevant interests to declare.

Disclaimer: The abstract of this review was presented as an oral presentation at the 2017 British Geriatrics Society Spring Meeting, April 26–28, 2017, and will be published in the forthcoming supplementary issue of Age and Ageing.


  • high protein
  • care homes
  • older people
  • quality of life
  • appetite


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