Protein-enriched hospital diet after fragility fracture: no short-term benefit

Design

Single-centre randomised controlled trial with observational reference group

Population

100 adults aged 70 or over at nutritional risk after fragility fracture

Primary outcome

In-hospital complications, surgical site infection and mobility at discharge

Effect

No significant difference; complications 45% overall

The NuTra trial screened 218 patients aged 70 or over admitted with fragility fractures to a single level I trauma centre, mean age 82. The 100 at nutritional risk on either of two screening tools were randomised to a protein-enriched diet targeting 1.5 to 2.0 g/kg/day or standard hospital food; the 118 not at risk formed an observational reference group.

Medical complications occurred in 45% overall, with no difference between groups. Albumin fell and CRP rose during admission in all groups alike. Functional mobility, length of stay and discharge destination were not improved by the protein diet. Patients at nutritional risk were frailer and more comorbid, and more often went to institutional care; comorbidity, not the intervention, was independently associated with discharge destination.

The lesson is not that nutrition does not matter, but that a few days of extra protein in hospital cannot reverse the frailty that malnutrition signals. The trial was small, single-centre and retrospectively registered. Nutrition support for these patients probably needs to continue through rehabilitation and home, alongside exercise, to have a chance of changing outcomes.

• Screen every older adult with a fragility fracture for malnutrition on admission.
• Treat a positive nutrition screen as a marker of frailty and plan comprehensive geriatric assessment.
• Continue nutritional support beyond discharge rather than relying on the inpatient stay.
• Combine nutrition with early mobilisation and rehabilitation.
• Do not expect an inpatient protein diet alone to shorten stay or prevent complications.

Why it matters

Malnutrition in a hip fracture patient is a sign of wider vulnerability that a hospital menu cannot fix.

Don't overread it

A small single-centre trial of in-hospital feeding cannot show that longer-term nutritional support is ineffective.

The statistics, in plain English

With 46 and 54 patients in the randomised arms, the trial could only detect large differences. 'No difference' here means no large short-term effect, not proof that protein supplementation is useless.

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