ORIGINAL ARTICLEEffects of dietary supplements on depressive symptoms in older patients: A randomised double-blind placebo-controlled trial☆
Introduction
The number of older people is growing rapidly worldwide. Good nutrition contributes to the health and well-being of older people and to their ability to recover from illness.1 A recent National Diet and Nutrition Survey of older people in the UK identified low biochemical status of one or more micronutrients in 40% of the older population.2 Although nutritional deficiencies in older persons are common and the impact on their physical and mental well-being is likely to be high, research on the relationship between nutritional factors and psychological health is generally lacking.3, 4
A recent review of the literature on nutrition and older people psychiatry reported that although this issue has received little attention there has been recent research on the role of micronutrients in psychiatric disorders in older adults.4 For example, low folic acid/vitamin B12 has been found to be associated with depression in older persons whereas evidence for other micronutrients is still tentative.5 The Rotterdam study has also reported a relationship between hyperhomocyteinaemia, vitamin B12 and folate deficiency and depressive disorders.5 A recent meta-analysis of trials of protein and energy supplementation in older people reported that data were limited by the poor quality of most included trials and that future trials should have sufficient power, proper concealed allocation and blinding of treatment and should focus on outcome measures of relevance to patients such as improvement in function and well-being.6
The aim of this randomised double-blind placebo-controlled study was to test the effects of nutritional support on older patient's depressive symptoms and cognitive function.
Section snippets
Study population
Functional-enabling food (FED) is a randomised, double-blind, placebo-controlled single-centre trial in which we randomised hospitalised acutely ill elderly patients to normal hospital diet plus placebo versus normal hospital diet plus oral supplements daily for 6 weeks. Details of the trial have been published elsewhere.7 Briefly, patients were eligible for the study if they met the following criteria: age ⩾65 years; stable medical condition; able to swallow and able to sign an informed
Results
Details of the recruitment and intervention process were published before.7 Briefly 445 patients were recruited and 6-month follow up was 100% for the primary outcomes of disability, length of stay, readmission, morbidity and mortality. By six months, 225/445 (51%) patients responded to the follow-up nutritional status and depression assessments. Of the 220 non-responders 51 patients had died. There was no evidence of a difference in response rates between the groups (119/222 (54%) placebo vs.
Discussion
The results of this study indicate that nutritional supplementation confers significant clinical benefit to older people during acute illness and convalescence/rehabilitation period. Patients randomised to receive supplements did achieve significant increases in red blood cell folate and vitamin B12 concentrations compared to the placebo group and this was associated with improvement in depressive symptoms.
These clinical benefits were observed despite modest degree of compliance with the
Strengths and limitations
We believe this study to be the first randomised, double-blind, placebo controlled trial to compare the effect of a 6-week protein, energy and micronutrient supplementation on hospitalised older patients’ depressive symptoms. We cannot exclude the possibility that the decrease in depressive symptoms as a result of nutritional support is a chance finding, however, it is also possible that is a real one given the improvement in micronutrients status and that mild sub-clinical micronutrient
Acknowledgements
The International Standardised Randomised Controlled Trial Number for our trial is ISRCTN01133608. This study was funded by The Health Foundation project grant. There was no conflict of interest for the authors.
References (14)
- et al.
Vitamin B12 and folate serum levels in newly admitted psychiatric patients
Clin Nutr
(2006) - et al.
A randomized controlled trial of nutritional supplements in hospitalized patients
Am J Med
(2006) - et al.
Development and validation of geriatric depression screening scale: a preliminary report
J Psychiatr Res
(1983) - et al.
The influence of nutritional status on clinical outcome after acute ischaemic stroke
Am J Clin Nutr
(1998) - et al.
Nutrition, ageing and ill-health
Br J Nutr
(1998) - et al.(1998)
- et al.
Nutrition and geriatric psychiatry: a neglected field
Curr Opin Psychiatry
(2005)
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Salah Gariballa was the lead investigator and prepared the first draft of the paper. Sarah Forster undertook subjects’ recruitment and assessments. All investigators were involved in the study design and writing of the manuscript.