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Iowa orthopedics researchers study link between nutrition and injury recovery

Research focused on nutrition interventions and food insecurity

Researchers from the University of Iowa Department of Orthopedics and Rehabilitation are investigating the relationship between malnutrition and loss of muscle and mobility in older adults who sustained a hip fracture. 

Iowa orthopedic surgeon Michael Willey, MD, in collaboration with researchers at John Hopkins University and the Slocum Center for Orthopedics & Sports Medicine in Eugene, Oregon, documented loss of muscle and mobility after hip fracture. Their goal is to identify

effective nutrition and rehabilitation interventions to prevent loss of muscle and function while preventing common complications after these injuries.

Gaps in nutrition

Patients without access to foods that meet basic human needsAs part of their study, Willey and his colleagues found that half of older adults were at risk for malnutrition or were malnourished at the time of their hip fracture. Malnutrition was associated with lower muscle mass and mobility. In the first six weeks after injury, these older adults lost 10% of their overall muscle mass. Loss of muscle correlated with loss of mobility.  

The research team’s previous work found that supplementing the patients’ diets with essential and conditional amino acids prevented loss of muscle mass after injury. These study results were published in May 2022 in the Journal of Bone and Joint Surgery. Amino acids are the building blocks for protein. They are vital for the body to perform many crucial functions such as growing and repairing muscle and tissue and boosting the immune system. 

Most people get essential amino acids from the foods they eat, but many people are deficient. Pain and limited mobility after hip fracture further limits access to healthy foods. Supplementation with essential and conditionally essential amino acids after hip fracture is a promising intervention to prevent functional decline. 

Food insecurity and fractures

This research builds off the team’s previous investigation into how commonly patients with fracture experience food insecurity, or not having adequate access to foods that meet basic nutritional needs. Food insecurity can be a serious health issue for some people who live in rural communities, have a low income, or sustain an injury that makes traveling to the store difficult. 

“Many patients have limited access to healthy foods. It’s important to understand how common food insecurity is in the orthopedic trauma population so we can better target interventions to improve outcomes,” Willey says. 

The study's purpose was to figure out how common food insecurity was in fracture patients and what risks factors make it more likely for those patients to experience food insecurity, according to Willey.  

“The multicenter approach allowed us to study a more diverse group of participants to better understand the different factors that may contribute to poor nutrition,” he says. 

The researchers found that not having access to healthy foods was a risk factor for malnutrition-related complications in patients who recently had surgery to fix a bone fracture. This risk was increased in older adults from low-income households and in households where patients lived alone. 

Future work

“About 30% of older adult patients will die in the first year after hip fracture, and only 40% will recover their pre-injury mobility. Older adults with hip fracture likely have the highest potential to benefit from nutritional interventions,” Willey says. 

The research group plans a future multicenter clinical trial that will randomly assign older adults with hip fracture to essential and conditionally essential amino acid supplements or a control. Their aim is to determine if nutrition supplementation can prevent loss of muscle, mobility, and independence. 

While there are hurdles when studying nutrition—baseline nutrition status can vary among patients, and it can be a challenge to get participants to complete an entire nutrition program, for example—Willey believes this research will help fill in major gaps in recovery odds for patients in need. 

“There is a lack of research investigating the impact of nutrition after a fracture,” Willey says. “But as we see from the previous studies, there is a huge need to expand how we help our patients recover after a traumatic injury.” 

Improving nutrition to improve recovery

Willey hopes this expanded clinical research will lead to better-designed programs that supply patients with the nutritional supplements they need to improve their diets and their recovery. 

“If hospitals adopt these kinds of programs, it will help improve the outcomes for high-risk patients who experience food insecurity,” Willey says. “It's important that we, as their care team, are doing everything we can to help them recover, including identifying obstacles and finding solutions.” 

Monday, April 3, 2023