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Therapeutics

Ornithine oxoglutarate improved nutritional status in elderly patients after hospital discharge

ACP J Club. 1995 Jan-Feb;122:16. doi:10.7326/ACPJC-1995-122-1-016

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• Letter: Ornithine oxoglutarate improved nutrition in elderly patients


Source Citation

Brocker P, Vellas B, Albarede AL, Poynard T. A two-centre, randomized double-blind trial of ornithine oxoglutarate in 194 elderly, ambulatory, convalescent subjects. Age Ageing. 1994 Jul;23:303-6.


Abstract

Objective

To determine whether ornithine oxoglutarate (OGO) given to elderly patients after hospital discharge increases nutritional status and quality of life and decreases the cost of medical care.

Design

4-month randomized, double-blind, placebo-controlled trial.

Setting

2 hospitals in France.

Patients

194 patients (mean age 74 y) who were living independently after hospital discharge. Inclusion criteria were age > 65 years; eating without assistance; and recovering from respiratory, infectious, or malignant disease. Exclusion criteria were life-threatening illness; cancer requiring radiation therapy, chemotherapy, or surgery within 4 months; or medication thought to interfere with outcome assessment.

Intervention

98 patients were allocated to OGO, 10 mg, and 96 were allocated to placebo with the same energy content. Patients took OGO for 2 months and then were followed for another 2 months. All OGO was given in 5-g sachets to be dispersed in 200 mL of flavored solution or in yogurt, a milk-based dessert, or stewed fruit for consumption after the midday meal. Follow-up was 87%.

Main outcome measures

Asthenia, appetite, nutritional status, body weight, muscular circumference, quality of life, and total medical costs (medical visits, hospitalizations, prescriptions, physiotherapy, and nursing care). Patients were assessed at 1, 2, and 4 months.

Main results

At 1 month, patients receiving OGO had increased appetite for meat, a higher overall appetite score, and greater weight gain (1230 vs 493 g) when compared with patients receiving placebo (P for all comparisons < 0.001). At 2 months, patients receiving OGO had a higher nutritional status (P < 0.001), better overall appetite (P < 0.001), greater appetite for meat (P < 0.001) and weight gain (P < 0.01) (Table), and improved quality of life (P < 0.001), but no difference was noted in medical costs. By 4 months, patients receiving OGO had a lower total medical cost (2586 {U.S. $437}* vs 4089 French francs [FF] {U.S. $692}*, P < 0.05) based on fewer home visits by nurses (P < 0.01) and physicians (P < 0.05) and lower mean costs of prescriptions (P < 0.05).

Conclusion

Ornithine oxoglutarate given to elderly patients discharged from the hospital led to increased weight gain, higher nutritional status, better appetite, improved quality of life and, after 4 months, lower total medical costs.

Source of funding: LOGEAIS Laboratory, France.

For article reprint: Dr. P. Brocker, Centre Hospitalier, Hopital de Cimiez, 4-AV Reine Victoria, 06003 Nice Cedex, France. FAX 011-4-92-03-40.32.

*Conversion rate used was for January 1994 (U.S. $1 = 5.91 FF).


Table. Ornithine oxoglutarate (OGO) vs placebo in elderly patients discharged from hospital

Outcomes at 60 d OGO Placebo Mean difference* (95% CI)
Weight gain (g) 2172 925 1247 (729 to 1765)

*Numbers calculated from data in article.


Commentary

Approximately 40% to 70% of elderly patients who are hospitalized or institutionalized have malnutrition. The health consequences of malnutrition in elderly patients are far-reaching. They include, in addition to the direct medical effects of excess morbidity and mortality, socioeconomic factors of high health care system use and associated expense. Few nutritional interventions show an overall beneficial effect on medical and economic outcome.

When OGO was originally used to treat patients with cirrhosis in an attempt to decrease blood ammonia levels and to decrease hepatic encephalopathy, improved nutritional status was noted. The mechanism of this improvement is not completely understood. OGO may increase appetite and have anabolic effects, and likely the contributions of ornithine and α2-ketoglutarate are synergistic. Brocker and colleagues evaluated OGO in the treatment of malnutrition in elderly ambulatory patients who were recovering from acute illnesses. The OGO-treated group showed improved indices of nutrition, quality of life, and total costs of medical treatment.

The authors are to be congratulated for measuring relevant clinical outcomes and for determining the overall costs involved. This study, however, raises additional issues: 1) What is the exact mechanism of action of OGO? and 2) Was the weight gain caused by added muscle or by fat and water?

Caution must be used when treating patients with OGO who are malnourished. OGO can cause hypoglycemia when given in excess to patients who are starving or have diarrhea. In addition, OGO is not currently approved for use in North America. Further studies are needed to determine the efficacy and safety of OGO compared with other nutritional interventions.

John R. Saltzman, MD
University of Massachusetts Medical CenterWorcester, Massachusetts, USA