Background and aims
Older adult hip fracture patients are at high risk of malnutrition (1), but research exploring postoperative dietary intake remains limited. Previous studies have relied on visual estimation methods, which may lack precision (2). Resting Energy Expenditure (REE) can be used to calculate the nutritional intake of adults in an acute illness state (3). The aim of this study was to observe if postoperative dietary intake of older adult hip fracture patients met individual REE needs. Secondary aims were to examine associations between dietary intake, length of hospital stay (LOS), comorbidities, and postoperative complications.
Methods
This was a prospective cohort study of older adult hip fracture patients (> 60yrs) requiring surgical repair recruited over four weeks. Data were collected on patient characteristics and food diary data was collected using a digital weighing scale for all hospital meals from the day of surgery to postoperative day (POD) three inclusive. Descriptive data were analysed in Microsoft Excel, and we used a statistical package for regression analysis to explore variables of interest (4). REE was calculated according to current guidance (3) and adjusted according to acute factors regarding hip fracture surgery as appropriate. The study was registered with ClinicalTrials.gov (NCT06451679).
Results
Twenty-one patients were consecutively recruited (80.5 ± 8.9 years) and fourteen patients completed the food diary. The REE intake for completed food diaries ranged from 645.6 kcal (2701.2 kJ) to 6419.8 kcal (26860.4 kJ). In relation to the primary aim, one participant (male) met their REE needs for the food diary inclusive. Regarding secondary aims, linear regression analysis of the percentage of REE met and LOS demonstrated that dietary intake on POD one was linked with a longer LOS (95% CI, -0.11 to -0.02, p=0.01). An increased ASA (American Society of Anaesthesiologists) grade was associated with reduced dietary intake, but this was not statistically significant. In relation to postoperative complications, a reduced appetite was the most reported complication across all participants regardless of completing the food diary (n = 13) and higher in females (57.1%) than males (4.8%).
Conclusion
Only one patient achieved their REE over the course of the food diary which may indicate that current nutritional strategies require further development to meet the needs of this patient group. The observed association between dietary intake on POD one and a longer LOS indicates targeted support for older adult hip fracture patients would be beneficial.

References
Avenell et al. (2016) Cochrane Database Syst Rev 11(11), 1465-1858
Heighington-Wansbrough and Gemming (2022) Clin Nutr ESPEN 52, 296-316
Todorovic and Mafrici (2018) A Pocket Guide for Clinical Nutrition. British Dietetic Association.
JASP Team (2024) JASP (Version 0.19.3) [Computer software]

Background and aims
Older adult hip fracture patients are at high risk of malnutrition (1), but research exploring postoperative dietary intake remains limited. Previous studies have relied on visual estimation methods, which may lack precision (2). Resting Energy Expenditure (REE) can be used to calculate the nutritional intake of adults in an acute illness state (3). The aim of this study was to observe if postoperative dietary intake of older adult hip fracture patients met individual REE needs. Secondary aims were to examine associations between dietary intake, length of hospital stay (LOS), comorbidities, and postoperative complications.
Methods
This was a prospective cohort study of older adult hip fracture patients (> 60yrs) requiring surgical repair recruited over four weeks. Data were collected on patient characteristics and food diary data was collected using a digital weighing scale for all hospital meals from the day of surgery to postoperative day (POD) three inclusive. Descriptive data were analysed in Microsoft Excel, and we used a statistical package for regression analysis to explore variables of interest (4). REE was calculated according to current guidance (3) and adjusted according to acute factors regarding hip fracture surgery as appropriate. The study was registered with ClinicalTrials.gov (NCT06451679).
Results
Twenty-one patients were consecutively recruited (80.5 ± 8.9 years) and fourteen patients completed the food diary. The REE intake for completed food diaries ranged from 645.6 kcal (2701.2 kJ) to 6419.8 kcal (26860.4 kJ). In relation to the primary aim, one participant (male) met their REE needs for the food diary inclusive. Regarding secondary aims, linear regression analysis of the percentage of REE met and LOS demonstrated that dietary intake on POD one was linked with a longer LOS (95% CI, -0.11 to -0.02, p=0.01). An increased ASA (American Society of Anaesthesiologists) grade was associated with reduced dietary intake, but this was not statistically significant. In relation to postoperative complications, a reduced appetite was the most reported complication across all participants regardless of completing the food diary (n = 13) and higher in females (57.1%) than males (4.8%).
Conclusion
Only one patient achieved their REE over the course of the food diary which may indicate that current nutritional strategies require further development to meet the needs of this patient group. The observed association between dietary intake on POD one and a longer LOS indicates targeted support for older adult hip fracture patients would be beneficial.

References
1. Avenell et al. (2016) _Cochrane Database Syst Rev_ 11(11), 1465-1858
2. Heighington-Wansbrough and Gemming (2022) _Clin Nutr ESPEN_ 52, 296-316
3. Todorovic and Mafrici (2018) _A Pocket Guide for Clinical Nutrition_. British Dietetic Association.
4. JASP Team (2024) JASP (Version 0.19.3) [Computer software]

Postoperative acute dietary intake of older adults following hip fracture repair: a weighed food diary pilot observational study

This meeting includes plenary lectures from the leading experts in the field, supported by evolving science insights from Early Career Researchers. The meeting will highlight some causes of undernutrition in later life, evaluate methods used to identify and monitor older adults at risk of undernutrition and explore advances in management and prevention.