* Fit for Your Life Program, Hebrew Rehabilitation Center for Aged, Boston, MA. ** Epidemiology Department, Massachusetts Eye and Ear Infirmary, Boston, MA. *** School of Exercise and Sport Science, Faculty of Health Sciences, University of Sydney, Lidcombe, Australia. **** Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA. ***** Donald W. Reynolds Department of Geriatrics, University of Arkansas Medical Center. Little Rock, AK. Correspondence: Professor Maria A. Fiatarone Singh, School of Exercise and Sport Science, University of Sydney, Cumberland Campus, East Street, P.O. Box 170, Lidcombe, NSW 1825, Australia o 612 9351 9755 (phone) o 612 9351 9204 (fax) o m.singh@cchs.usyd.edu.au o This project was supported in part with federal funds from NIA grants 1) UO1AG09078 2) PHS (AG04390), 3) NIA training grant #T32AG00209, 4) USDA contract number 53-3K06-5-10, 5) Food and Agriculture Science National Needs Graduate Fellowship Program number 94-38420-0971, and The Brookdale Foundation. The contents of this publication do not necessarily reflect the views or policies of the USDA nor does mention of trade names, commercial products, or organizations imply endorsement by the US government.

Abstract: Background: Frail institutionalized elders have a high prevalence of nutritional risk factors, undernutrition, weight loss, and nutrition-related morbidity and excess mortality. Little information is available on effective means to intervene in this setting. Hypotheses: We tested the hypothesis that addition of multinutrient oral supplements to the diet of frail elders would improve their overall nutritional status and functional level. Methods: Fifty nursing home residents aged 88±1 yr. were followed for 10 weeks in the course of a randomized controlled trial of supplementation with a multinutrient liquid supplement vs. a non-nutritive placebo drink. Three-day food weighing was used to analyze their habitual dietary intake before and during the final week of the intervention. Nutritional status was further assessed with nutritional biochemistries, anthropometric measurements, and body composition analysis as well as physical and functional performance tests. Results: The nutritional supplement was consumed with high compliance, but did not significantly augment total caloric intake. Supplementation was associated with significant reductions in total energy, protein, fat, water, fiber, and many vitamins and minerals in the habitual diet of these nursing home residents. Nutritional status improved in terms of folate levels in serum, but no other measured vitamin or mineral indices. Body composition analysis revealed a small gain in weight, increases in fat stores, but no improvement in lean tissue mass associated with supplemention. No physical performance or functional gains were associated with supplementation. Conclusion: Short-term nutritional supplementation in elders at nutritional risk is offset by simultaneous reduction in voluntary food intake. It seems likely that changing other components of energy expenditure such as physical activity levels or basal metabolism may be required to produce overall improvements in nutritional intake in this setting. (Journ. of Nutr. Health & Aging 2000; 1: 5-12)