Evidence-based dietary guidance and the role of dairy products for appropriate nutrition in the elderly.

Food consumption surveys in the elderly come to the general conclusions that most elderly people outside institutions eat reasonably well. There is, however, tremendous variation in health status between older adults. The aging process is complex and influenced not only by factors intrinsic to the individual but also by extrinsic factors. The latter includes nutrition. In the various phases in the aging process, nutritional status and thus appropriate nutrition differ. Undernutrition is a great concern. In community-dwelling people older than 70 years, 5%-10% are undernourished, and for institutionalized elderly, this is up to 30%-65%. The cause is often inappropriate food consumption, and treatment is not always evidence based. National evidence-based dietary guidelines are mainly for healthy elderly people and vary between regions and even between institutes within the same region. To understand these differences, insight is required into the paradigm applied for nutritional science and the designs, selection of the older population, methodology, and endpoints of studies supplying the science behind the guidelines. A European project (Eurecca) compiles and harmonizes dietary guidelines. These activities underpin the need for sound evidence to improve the nutrition of older adults in different health phases. For frail elderly, there is also a plea to take into account results of studies on food satisfaction. First studies in this field show the effectiveness of an adapted social context for meals, appropriate nutritional care, and availability of tasty drinks and foods for selected groups of older adults. Because of the nutrient richness of dairy products and their good taste, these foods are helpful in the diet of healthy as well as frail elderly people. Key teaching points: Most elderly people eat reasonably well. There are, however, large differences in health status between elderly people and therefore also in nutrient requirements. Undernutrition is a main concern. In community-dwelling people older than 70 years, 5%-10% are undernourished, and for institutionalized elderly, this is up to 30%-65%. Evidence-based dietary guidelines are developed mainly for healthy elderly people and vary between regions. Harmonization will improve public health as well as clinical nutritional strategies. Given the nutrient density of dairy products, these products are included in balanced dietary advice for older adults.

Weight loss in head and neck cancer patients little noticed in general practice.

INTRODUCTION: In head and neck cancer patients, weight loss increases morbidity and mortality, and decreases treatment tolerance and quality of life. Early nutritional intervention has beneficial effects on these factors. AIM: We observed patients' weight courses after specialists' care and surveyed nutrition-related documentation by general practitioners (GPs). METHODS: From a Head and Neck Oncology Centre (HNOC) study, 68 patients were asked to participate in an extended general practice cohort. Twenty-six patients participated in the prospective three-monthly weight measurements during the year after HNOC care. We extracted nutritional information contained in referral letters (n = 24) and medical records from the year before referral (n = 45) and after HNOC care (n = 26). An impaired nutritional status was assigned to weight loss > or = 10% within six months or Body Mass Index (BMI) < 18.5 kg/m2 and 'at risk' to weight loss > or = 5% but < 10% within six months. RESULTS: Three (12%) participants were nutritionally impaired and two (8%) were deemed 'at risk'. Although GPs suspected a (pre-) malignancy in 11 cases (46%), only two (8%) documented weight loss or BMI and four (17%) nutrition-related complaints in their referral letters. Medical records more often contained information on nutrition-related complaints and tube feeding later in the disease course, as opposed to concern over weight loss or BMI. DISCUSSION: Therefore, we call for nutritional management in general practice, by urging practitioners to assess patients' nutritional status throughout the disease course and intervene if necessary. The passing on of related information in case of referral promotes continuity of care.

Effect of fish oil supplementation on quality of life in a general population of older Dutch subjects: a randomized, double-blind, placebo-controlled trial.

OBJECTIVES: To investigate the effect of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) supplementation on quality of life (QOL). DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Independently living individuals from the general older Dutch population. PARTICIPANTS: Three hundred two individuals aged 65 and older without depression or dementia. INTERVENTION: 1,800 mg/d EPA-DHA (n=96), 400 mg/d EPA-DHA (n=100), or placebo capsules (n=106) for 26 weeks. MEASUREMENTS: QOL was assessed using the short version of the World Health Organization QOL questionnaire (WHOQOL-BREF). The WHOQOL-BREF covers four domains: physical health, psychological health, social relationships, and satisfaction with environment. The total score range is 26 to 130, with higher scores indicating a more favorable condition. RESULTS: Mean age of the participants was 70, and 55% were male. Plasma concentrations of EPA-DHA increased 238% in the high-dose and 51% in the low-dose EPA-DHA group, reflecting excellent adherence. Median baseline total WHOQOL scores ranged from 107 to 110 in the three groups and were not significantly different from each other. After 26 weeks, the mean difference from placebo was -1.42 (95% confidence interval (CI)=-3.40-0.57) for the high-dose and 0.02 (95% CI=-1.95-1.99) for the low-dose fish oil group. Treatment with 1,800 mg or 400 mg EPA-DHA did not affect total QOL or any of the separate domains after 13 or 26 weeks of intervention. CONCLUSION: Supplementation with high or low doses of fish oil for 26 weeks did not influence the QOL of healthy older individuals.

Malnutrition and mealtime ambiance in nursing homes.

Inadequate nutritional intake is the predominant cause of malnutrition in older persons. It is one of the most common and devastating conditions in nursing home residents. It is multifactorial and treatment or nutrition care plans should try to address the main causes. Such plans often include means to stimulate appetite to prevent or treat anorexia. One important stimulus, which can be modulated easily, is the meal ambiance. This article deals with the theory or mechanism behind this meal ambiance stimulus, discusses some study results, and makes practical recommendations.

No effect on intake and liking of soup enhanced with mono-sodium glutamate and celery powder among elderly people with olfactory and/or gustatory loss.

Mono-sodium glutamate (MSG) and/or flavors may improve palatability and intake in elderly people. Whether this improvement is related to a decline in chemosensory sensitivity is unclear. We examined the effect of flavor-enhanced tomato soup (1,200 mg/l MSG (0.12% MSG) + 3 g/l celery powder) versus non-enhanced soup on intake and liking in 120 older adults (72+/-6 years). Olfactory and gustatory performance was measured. For the whole group, no difference in intake (198 g vs. 203 g) (P =0.97), liking (6.6 vs. 6.7) (P =0.99) and strength (7.2 vs. 7.2) (P =0.76) between the soups was found. Intake (P =0.52), liking (P =0.90) and strength (P =1.00) between the soups were not different within the low olfactory/low gustatory group. Intake and liking of the flavor-enhanced soup was not increased within elderly with low chemosensory sensitivity. Enhancing flavors to increase intake and liking may not be a uniform approach due to the heterogeneity in chemosensory losses among elderly people.

A reappraisal of the impact of dairy foods and milk fat on cardiovascular disease risk.

BACKGROUND: This review provides a reappraisal of the potential effects of dairy foods, including dairy fats, on cardiovascular disease (CVD)/coronary heart disease (CHD) risk. Commodities and foods containing saturated fats are of particular focus as current public dietary recommendations are directed toward reducing the intake of saturated fats as a means to improve the overall health of the population. A conference of scientists from different perspectives of dietary fat and health was convened in order to consider the scientific basis for these recommendations. AIMS: This review and summary of the conference focus on four key areas related to the biology of dairy foods and fats and their potential impact on human health: (a) the effect of dairy foods on CVD in prospective cohort studies; (b) the impact of dairy fat on plasma lipid risk factors for CVD; (c) the effects of dairy fat on non-lipid risk factors for CVD; and (d) the role of dairy products as essential contributors of micronutrients in reference food patterns for the elderly. CONCLUSIONS: Despite the contribution of dairy products to the saturated fatty acid composition of the diet, and given the diversity of dairy foods of widely differing composition, there is no clear evidence that dairy food consumption is consistently associated with a higher risk of CVD. Thus, recommendations to reduce dairy food consumption irrespective of the nature of the dairy product should be made with caution.

Do dietary patterns in older men influence change in homocysteine through folate fortification? The Normative Aging Study.

OBJECTIVE: We aimed to describe the difference in B-vitamin intake and in plasma B-vitamin and homocysteine concentrations before and after folic acid fortification, in relation to dietary patterns. DESIGN: The Normative Aging Study (NAS) is a longitudinal study on ageing. Between 1961 and 1970, 2280 male volunteers aged 21-80 years (mean 42 years) were recruited. Dietary intake data have been collected since 1987 and assessment of plasma B vitamins and homocysteine was added in 1993. SETTING: Boston, Massachusetts, USA. SUBJECTS: In the present study, 354 men who had completed at least one FFQ and one measurement of homocysteine, both before and after the fortification period, were included. RESULTS: Three dietary patterns were identified by cluster analysis: (i) a prudent pattern, with relatively high intakes of fruit, vegetables, low-fat milk and breakfast cereals; (ii) an unhealthy pattern, with high intakes of baked products, sweets and added fats; and (iii) a low fruit and vegetable but relatively high alcohol intake pattern. Dietary intake and plasma concentrations of folate increased significantly (P < 0.05) among all dietary patterns after the fortification period. Homocysteine tended to decrease in supplement non-users and in subjects in the high alcohol, low fruit and vegetable dietary pattern (both P = 0.08). CONCLUSIONS: After fortification with folic acid, folate intake and plasma folate concentration increased significantly in all dietary patterns. There was a trend towards greatest homocysteine lowering in the high alcohol, low fruit and vegetable group.

Improving nutritional management within high-risk groups.

The current pitfalls and future possibilities of nutritional management are discussed by two patients with tongue cancer who have suffered from substantial weight loss. Their nutritional problems are illustrative of those among other (cancer) patient groups. The main concerns are the lack of early case finding and dietary treatment, and insufficient nutritional information transfer through referral letters. The GP as a central and longitudinal caretaker faces challenges in improving nutritional management.

Encounters for common illnesses in general practice increased in obese patients.

BACKGROUND: Obese patients are known to have more chronic medical conditions. OBJECTIVE: To compare the frequency of encounter for episodes of the 10 most common illnesses in general practice between obese and non-overweight patients. METHODS: Data were derived from the Continuous Morbidity Registration, containing data from four general practices in and around Nijmegen (The Netherlands). In this research and registration network, a matched cohort study was performed. Each obese patient (body mass index > or = 30 kg/m(2)), aged 20-75 years, was matched for age, gender, socio-economic status and general practice, to approximately two patients without the diagnosis 'overweight' or 'obesity'. Over a period of 5 years (January 1, 2000 to December 31, 2004), the frequency of encounter for episodes of the 10 most common illnesses was compared, taking chronic medical conditions into account. RESULTS: At the start, 550 patients with obesity could be identified and were matched to 954 controls. Obese patients presented more common illnesses than non-overweight patients (incidence rate ratio 1.28, 95% confidence interval 1.12-1.47), in particular common cold (without fever), myalgia of the upper girdle, dermatophytosis and bruise (contusion, haematoma). CONCLUSION: Obese patients present more common illnesses to their GP, such as common cold (without fever), myalgia of the upper girdle, dermatophytosis and bruise (contusion, haematoma). This is in addition to their higher co-morbidity of chronic medical conditions.

Effect of fish-oil supplementation on mental well-being in older subjects: a randomized, double-blind, placebo-controlled trial.

BACKGROUND: It is suggested that a low intake of fish and/or n-3 PUFA is associated with depressed mood. However, results from epidemiologic studies are mixed, and randomized trials have mainly been performed in depressed patients, yielding conflicting results. OBJECTIVE: We investigated the effect of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on mental well-being in a double-blind, placebo-controlled trial. DESIGN: Independently living individuals (n = 302) aged > or =65 y were randomly assigned to consume 1800 mg/d EPA+DHA, 400 mg/d EPA+DHA, or placebo capsules for 26 wk. Changes in mental well-being were assessed as the primary outcome with the Center for Epidemiologic Studies Depression Scale (CES-D), Montgomery-Asberg Rating Scale (MADRS), Geriatric Depression Scale (GDS-15), and Hospital Anxiety and Depression Scale (HADS-A). RESULTS: Plasma concentrations of EPA+DHA increased by 238% in the high-dose and 51% in the low-dose fish-oil group compared with the placebo group, reflecting excellent compliance. Baseline CES-D scores ranged from 5.9 to 6.8 in the 3 groups and were not significantly different between groups. Mean changes in CES-D scores after 26 wk were -0.2, 0.2, and -0.4 (P = 0.87) in the high-dose fish oil, low-dose fish oil, and placebo groups, respectively. Treatment with neither 1800 mg nor 400 mg EPA+DHA differentially affected any of the measures of mental well-being after 13 or 26 wk of intervention compared with placebo. CONCLUSIONS: In this randomized, double-blind, placebo-controlled trial we observed no effect of EPA+DHA supplementation for 26 wk on mental well-being in the general older population studied. This trial was registered at clinicaltrials.gov as NCT00124852.

Dairy products as essential contributors of (micro-) nutrients in reference food patterns: an outline for elderly people.

The nutrient richness of dairy products is widely recognized, but mainly low fat or skimmed versions are generally advocated given the proportion of saturated fatty acids in milk fat. The question arises how to appraise this nutrient richness relative to the contribution of the saturated fraction of dairy fat. We reviewed available data--collected from elderly people--on nutrient contributions by dairy products in The Netherlands, on the relevance of nutrients specifically supplied by dairy products and shown to be associated with ageing-related functional losses, and from prospective studies in selected elderly populations in Europe on the impact of dietary and lifestyle factors on morbidity and mortality. In the current daily food pattern of older adults in The Netherlands dairy products provide significant to substantial amounts of protein and a number of minerals and vitamins relevant for healthy ageing. Especially in the frail elderly it will be difficult to replace dairy products by other foods. Dietary advice should focus on an adequate supply of energy, protein and micronutrients rather than on avoiding saturated fats. For the younger healthy 65 + we estimated that including lower fat dairy products rather their whole fat equivalents, may help to improve the dietary pattern. However, prospective analyses on morbidity and mortality do not suggest that moderate dietary intake of dairy products is associated with increased cardiovascular disease risk in this age group. In dietary risk-benefit analyses the ultimate perspective should be the nutritional status, the risk profile of the target group and the place of the foods in the dietary pattern. Such analyses need more sophisticated methods than currently available and applied in this paper. In Europe initiatives have been taken to develop such methods.

Design characteristics of food frequency questionnaires in relation to their validity.

The authors investigated the role of food frequency questionnaire (FFQ) design, including length, use of portion-size questions, and FFQ origin, in ranking subjects according to their nutrient intake. They also studied the ability of the FFQ to detect differences in energy intake between subgroups and to assess energy and protein intake. In a meta-analysis of 40 validation studies, FFQs with longer food lists (200 items) were better than shorter FFQs at ranking subjects for most nutrients; results were statistically significant for protein, energy-adjusted total fat, and energy-adjusted vitamin C. The authors found that FFQs that included standard portions had higher correlation coefficients for energy-adjusted vitamin C (0.80 vs. 0.60, p < 0.0001) and protein (0.69 vs. 0.61, p = 0.03) than FFQs with portion-size questions. However, it remained difficult from this review to analyze the effects of using portion-size questions. FFQs slightly underestimated gender differences in energy intake, although level of energy intake was underreported by 23% and level of protein intake by 17%. The authors concluded that FFQs with more items are better able to rank people according to their intake and that they are able to distinguish between subpopulations, even though they underestimated the magnitude of these differences.

The association of betaine, homocysteine and related metabolites with cognitive function in Dutch elderly people.

The importance of the one-carbon metabolites, choline and homocysteine, to brain function is well known. However, the associations between the one-carbon metabolites choline, betaine, methionine and dimethylglycine with cognition in elderly are unclear. We therefore examined the associations of these metabolites with cognition in a double-blind, placebo-controlled trial. Individuals (n 195) were randomized to receive daily oral capsules with either 1000 microg cobalamin (vitamin B12), or 1000 microg cobalamin plus 400 microg folic acid, or placebo for 24 weeks. Concentrations of homocysteine, methionine, choline, betaine and dimethylglycine were assessed before and after 12 and 24 weeks of treatment. Cognitive function, including domains of attention, construction, sensomotor speed, memory and executive function, was assessed before and after 24 weeks of treatment. At baseline, elevated plasma homocysteine was associated with lower performance of attention, construction, sensomotor speed and executive function. In addition, betaine was positively associated with better performance of construction, sensomotor speed and executive function, whereas elevated concentrations of methionine were positively associated with sensomotor speed. Daily combined supplementation with cobalamin plus folic acid decreased total homocysteine concentrations by 36%, and increased betaine concentrations by 38%. Participants with the largest increases in betaine concentrations showed a borderline significant (P = 0.07) higher memory performance compared to those without it. Although this trial observed associations of homocysteine and betaine with cognitive domains prior to supplementation, decreased concentrations of homocysteine were not related to improved cognitive performance. There was a tendency of participants with the largest increases in betaine concentrations to show the greatest improvement in memory function.

No effect of 16 weeks flavor enhancement on dietary intake and nutritional status of nursing home elderly.

There is a lack of data to support the long-term effect of flavor enhancement on food intake and nutritional status. Our aim was to determine if daily addition of 700 mg flavor and/or 300 mg monosodium glutamate (MSG) to the animal protein part of the cooked meal for 16 weeks leads to an increase in energy intake and in body weight in nursing home elderly. We performed a single blind randomized 16 weeks parallel study consisting of a control group (n=23), a MSG group (n=19), a flavor group (n=19) and a flavor plus MSG group (n=22). Main outcome measures were intake of the cooked meal, which was measured by weighing back leftovers during 14 days and body weight. Both were measured before and at the end of the intervention period. After 16 weeks, energy intake and body weight did not increase within the control group, the flavor group, the flavor plus MSG group and the MSG group. Between the groups, no differences were found in changes in energy intake and body weight. Enhancing the taste of a cooked meal with flavor and/or MSG does not lead to a higher energy intake and body weight among nursing home elderly. More research is needed to determine the efficacy of flavor enhancement on intake and nutritional status.

Effect of family-style meals on energy intake and risk of malnutrition in dutch nursing home residents: a randomized controlled trial.

BACKGROUND: Social facilitation and meal ambiance have beneficial effects on food intake in healthy adults. Extrapolation to the nursing home setting may lead to less malnutrition among the residents. Therefore, we investigate the effect of family-style meals on energy intake and the risk of malnutrition in Dutch nursing home residents. METHODS: In 2002 and 2003, a randomized controlled trial was conducted among 178 residents (mean age 77 years) in five Dutch nursing homes. Within each home, two wards were randomized into an intervention (n = 94) and a control group (n = 84). For 6 months, the intervention group received their meals family style, and the control group received the usual individual preplating services. Outcome measures were intakes of energy (kJ), carbohydrates (g), fat (g), and protein (g) and Mini Nutritional Assessment (MNA) score (0-30). RESULTS: The change in daily energy intake between the control and intervention group differed significantly (991 kJ; 95% confidence interval [CI], 504-1479). The difference in intake of macronutrients was 29.2 g (95% CI, 13.5-44.9) for carbohydrate, 9.1 g (95% CI, 2.9-15.2) for fat, and 8.6 g (95% CI, 3.4-13.6) for protein. The percentage of residents in the intervention group classified by the MNA as malnourished decreased from 17% to 4%, whereas this percentage increased from 11% to 23% in the control group. CONCLUSIONS: Family-style meals stimulate daily energy intake and protect nursing home residents against malnourishment. Therefore, replacement of the preplating meal services with family-style meals in nursing homes is recommended.

Sources and severity of self-reported food intolerance after ileal pouch-anal anastomosis.

Data on food intolerance after ileal pouch-anal anastomosis are scarce. The aim of this study was to identify foods causing intolerance and to determine the nature and severity of reported symptoms. Patients from the Dutch Crohn's and Ulcerative Colitis Association were mailed a survey on food intolerance; 105 (31% men) of 137 patients took part. They all reported intolerance to one or more foods. Common symptoms (scored from 0=absent to 10=severe), included diarrhea (mean score=5.8), fatigue (mean score=5.5), and thirst (mean score=4.6). Spicy foods, cabbage, and citrus fruits (or juice) were most likely to decrease stool consistency, increase stool frequency, or cause perianal irritation. Onions, cabbage, or leeks were reported by 28% of the patients to cause flatulence. The urge to defecate was stronger after a cooked meal (45% within (1/2) hour) than after sandwiches (15% within (1/2) hour). Foods reported to increase stool consistency were potato products, bread, and bananas. This study demonstrates that food intolerance is a common, albeit mild, problem after ileal pouch-anal anastomosis. Food and nutrition professionals should encourage patients to base their food choices on individual tolerance as long as no (patho-) physiological-based evidence to the contrary is available.

The effect of repeated exposure to fruit drinks on intake, pleasantness and boredom in young and elderly adults.

The effect of a repeated monotonous exposure on ad libitum intake, pleasantness and boredom in elderly people in a real life situation is unclear. We therefore investigated the effects of repeated exposure to ad libitum intake of three orange-based drinks on boredom and acceptance in young and elderly people. Young (n=32) and elderly women (n=36) participated in a randomized within subjects cross over trial with three intervention periods of 12 days each followed by a 2-day wash out period. During each intervention period, the participants received 1 L of one type of drink per day. The three drinks varied in sweetness intensity. Intake was measured by weighing the returned packets and pleasantness, boredom and sweetness were rated on a 10-point scale. For the young women, mean consumption of the three drinks (p<0.01) and pleasantness decreased (p<0.01) and boredom increased (p<0.001). For the elderly women, consumption increased (p=0.03) whereas pleasantness (p=0.34) and boredom (p=0.40) were stable. In the young women, the orange peach drink which had the highest sugar content contributed the most to the effect of the repeated exposure. The consumption and pleasantness ratings for this drink decreased (r=-1.05, p=0.01 and r=-0.07, p=0.007, respectively) and boredom increased (r=0.12, p<0.001). In conclusion, elderly women experienced no increased boredom whereas young women did.

Effect of oral vitamin B-12 with or without folic acid on cognitive function in older people with mild vitamin B-12 deficiency: a randomized, placebo-controlled trial.

BACKGROUND: Vitamin B-12 deficiency is associated with cognitive impairment in older people. However, evidence from randomized trials of the effects of vitamin B-12 supplementation on cognitive function is limited and inconclusive. OBJECTIVE: The objective was to investigate whether daily supplementation with high doses of oral vitamin B-12 alone or in combination with folic acid has any beneficial effects on cognitive function in persons aged >/=70 y with mild vitamin B-12 deficiency. DESIGN: In a double-blind, placebo-controlled trial, 195 subjects were randomly assigned to receive 1000 microg vitamin B-12, 1000 microg vitamin B-12 + 400 microg folic acid, or placebo for 24 wk. Vitamin B-12 status was assessed on the basis of methylmalonic acid, total homocysteine (tHcy), and holotranscobalamin (holoTC) concentrations before and after 12 and 24 wk of treatment. Cognitive function was assessed before and after 24 wk of treatment with the use of an extensive neuropsychologic test battery that included the domains of attention, construction, sensomotor speed, memory, and executive function. RESULTS: Vitamin B-12 status did not change significantly after treatment in the placebo group; however, oral vitamin B-12 supplementation corrected mild vitamin B-12 deficiency. Vitamin B-12 + folic acid supplementation increased red blood cell folate concentrations and decreased tHcy concentrations by 36%. Improvement in memory function was greater in the placebo group than in the group who received vitamin B-12 alone (P = 0.0036). Neither supplementation with vitamin B-12 alone nor that in combination with folic acid was accompanied by any improvement in other cognitive domains. CONCLUSION: Oral supplementation with vitamin B-12 alone or in combination with folic acid for 24 wk does not improve cognitive function.

Effect of family style mealtimes on quality of life, physical performance, and body weight of nursing home residents: cluster randomised controlled trial.

OBJECTIVE: To assess the effect of family style mealtimes on quality of life, physical performance, and body weight of nursing home residents without dementia. DESIGN: Cluster randomised trial. SETTING: Five Dutch nursing homes. PARTICIPANTS: 178 residents (mean age 77 years). Two wards in each home were randomised to intervention (95 participants) or control groups (83). INTERVENTION: During six months the intervention group took their meals family style and the control group received the usual individual pre-plated service. MAIN OUTCOME MEASURES: Quality of life (perceived safety; autonomy; and sensory, physical, and psychosocial functioning), gross and fine motor function, and body weight. RESULTS: The difference in change between the groups was significant for overall quality of life (6.1 units, 95% confidence interval 2.1 to 10.3), fine motor function (1.8 units, 0.6 to 3.0), and body weight (1.5 kg, 0.6 to 2.4). CONCLUSION: Family style mealtimes maintain quality of life, physical performance, and body weight of nursing home residents without dementia. TRIAL REGISTRATION: Clinical trials NCT00114582.

Early nutritional supplementation immediately after diagnosis of infectious disease improves body weight in psychogeriatric nursing home residents.

BACKGROUND AND AIMS: Many elderly people with Alzheimer's disease experience weight loss. Illness and inadequate regain after a period of illness are considered as contributory causes of progressive weight loss in psychogeriatric patients. We studied whether early use of a liquid nutrition supplement immediately after onset of acute illness from infection can prevent weight loss in elderly psychogeriatric nursing home residents. METHODS: Randomised controlled trial of 5 weeks after the onset of illness. Thirty-four psychogeriatric nursing home residents (aged > or =65 yrs) completed the study period. A liquid nutrition supplement (200 ml) once daily immediately after diagnosis of infection or standard treatment (enriched food after referral to a dietician) were provided. Body weight, mid-upper arm circumference, calf circumference, triceps skin fold thickness, dietary energy intake, and need for care were measured. RESULTS: Weight change during the study period was significantly different between the standard (-0.4 kg) and supplement (+0.8 kg) groups (p = 0.040). No significant differences were observed in changes of mid-upper arm circumference, triceps skin fold thickness, calf circumference or energy intake between groups. CONCLUSIONS: Early provision of a liquid nutrition supplement immediately after onset of acute illness from infection leads to weight gain in elderly psychogeriatric nursing home residents.