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Article

Oral Nutritional Supplementation in Routine Clinical Practice to Improve Physical Performance and Nutrition in Frail Adults at Risk of Falls: Preliminary Evidence

by
Ivon Y. Rivera Deras
1,*,
Ana Esther Callejón Martin
1,
Miguel Ángel Espuelas Vázquez
1,
Lilia Alejandrina Ruiz Ávila
2 and
Jesús María López Arrieta
3
1
Geriatrics Service, Functional Recovery Unit, Hospital Universitario La Paz-Cantoblanco, 28049 Madrid, Spain
2
Rehabilitation Service, Functional Recovery Unit, Hospital Universitario La Paz-Cantoblanco, 28049 Madrid, Spain
3
Instituto de Investigación Hospital Universitario La Paz (IdiPaz), 28029 Madrid, Spain
*
Author to whom correspondence should be addressed.
J. Ageing Longev. 2026, 6(1), 15; https://doi.org/10.3390/jal6010015
Submission received: 11 November 2025 / Revised: 16 January 2026 / Accepted: 20 January 2026 / Published: 22 January 2026
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Abstract

Background/Objectives: This study aimed to describe changes in physical performance and nutritional status among frail adults at risk of falls receiving muscle-targeted oral nutritional supplementation (MT-ONS) as part of routine clinical care. Methods: A prospective, open-label, single-centre, uncontrolled, descriptive study was conducted in a real-world clinical setting. Patients ≥ 70 years attending an outpatient fall clinic were consecutively recruited and assessed at baseline and after at least 90 days of MT-ONS (100% whey protein enriched with leucine and vitamin D), provided as part of a comprehensive care plan including exercise recommendations, medication review, and home adaptation advice. Sociodemographic, physical performance [Short Physical Performance Battery (SPPB)], nutritional status [Mini Nutritional Assessment-Short Form, (MNA®-SF)], walking ability [Functional Ambulation Categories (FACs)], number of falls, muscle strength (dynamometry), body composition (Tanita), health-related quality-of-life (SF-12), functional capacity (Barthel Index), and adherence data were collected. Statistics analyses were descriptive and exploratory. Results: Twenty-six participants were assessed (58% women, age: 82.1 ± 5.4 years). Mean SPPB score increased from 7.3 (±3.6) to 8.0 (±4.0) (p = 0.3). At baseline, 35% were malnourished, 42% at risk of malnutrition, and 23% well-nourished. After ≥90 days of MT-ONS, 4% were malnourished, 54% at risk, and 42% well-nourished. The number of falls decreased from 1.2 falls/month (±0.9) to 0.2 falls/month (±0.3, p < 0.0001). Favourable changes in physical performance were positively correlated with improvements in nutritional status (p = 0.03). Adherence was high (92%), largely attributed to pleasant taste (71%) and smell (58%) and positive health perceptions (58%). Conclusions: In routine clinical practice, frail adults at risk of falls who received MT-ONS, 100% whey protein enriched with leucine and vitamin D for ≥90 days, as part of a comprehensive care plan improved their physical performance and nutritional status and reduced the number of falls. These findings should be interpreted as preliminary.

Graphical Abstract

1. Introduction

Frailty is a common condition among older adults, characterised by declines in physical performance, strength, endurance, and overall physiological function [1]. It reflects an underlying state of poor health and increased vulnerability and is associated with a higher risk of adverse outcomes, including falls—a major concern for older adults [2]. Frailty affects up to 26% of older individuals [3], and both frailty and prefrailty have been linked to increased mortality in this population [4].
Frailty arises from age-related physiological changes, notably the decline in muscle mass and function [5,6] Sarcopenia, the progressive loss of skeletal muscle mass and strength, is a key contributor [7], impairing physical function and increasing the risk of falls and fractures in older adults.
In Spain, the prevalence of falls in older adults ranges from 32% to 45%, with recurrent falls occurring in 36% to 51% of cases [8,9]. Beyond physical injuries, such as bone fractures and other traumatic injuries [10], falls can also result in psychological consequences, including persistent fear of falling, which can be equally detrimental to health and functional independence [11]. Combined, these effects can lead to disability, increased care needs, and loss of independence, negatively impacting health-related quality of life (HRQoL) and healthcare costs [12,13]. In high-income countries, approximately 1% of total healthcare expenditure is attributable to fall-related care in older adults [14].
Malnutrition is a major risk factor that worsens frailty and sarcopenia in older adults [15]. In this population, protein–energy malnutrition (PEM) and anabolic resistance are distinct yet synergistic contributors to frailty. PEM is characterised by insufficient intake of energy and protein relative to metabolic needs, leading to loss of body mass, reduced immune function, and poorer clinical outcomes. It is particularly prevalent in frail, community-dwelling older individuals due to anorexia of ageing, comorbidity, and functional barriers to adequate nutrition. By contrast, anabolic resistance reflects an age-related blunting of muscle protein synthesis responses to dietary protein and exercise, meaning that even when intake is adequate by standard criteria, muscle does not effectively synthesise new protein. This phenomenon is linked to impaired activation of key signalling pathways such as mTOR and contributes to sarcopenia and functional decline independent of intake [16,17].
Poor nutritional status accelerates muscle wasting, reduces strength, and impairs mobility, increasing the likelihood of falls and related complications [18]. Thus, adequate nutrition is critical for preventing and managing frailty. Maintaining muscle mass and function is essential for preserving physical independence in older individuals, and nutritional interventions, such as oral nutritional supplementation (ONS), offer a targeted approach to addressing these deficiencies [19,20].
Muscle-targeted oral nutritional supplementation (MT-ONS) typically contains a blend of high-quality proteins and essential nutrients, such as vitamins [21]. It aims to address both pathways. High-quality whey protein provides essential amino acids and is rapidly digested, leading to robust post-prandial increases in plasma amino acids, which are necessary substrates for MPS. Enrichment with leucine further enhances stimulation of the mTOR pathway, counteracting aspects of anabolic resistance by providing a stronger anabolic signal per unit of protein ingested. Studies show that leucine-enriched whey protein can increase lean muscle mass and strength in older adults, particularly when combined with resistance training [22,23]. MT-ONS also increases total energy and protein intake, directly addressing PEM and helping to restore or maintain body mass and muscle. Co-supplementation with vitamin D may support neuromuscular function and reduce inflammation [24], which may be particularly relevant in frail older adults, among whom vitamin D insufficiency is highly prevalent in Spain. Primary care data report deficiency or insufficiency rates exceeding 60% in individuals aged over 75 years [25]. Also, MT-ONS has positive effects on bone mineral density in sarcopenic older adults [26].
Several studies have shown that MT-ONS improves both nutritional status and physical performance in frail individuals, especially in cases of weight loss or undernutrition [27,28,29]. Additionally, MT-ONS decreases the number of older adults who fall and the number of fall incidents [12]. Adequate protein and caloric intake through ONS helps to prevent or reverse sarcopenia and frailty, preserving muscle mass, enhancing strength, and improving overall physical function [19].
When incorporated into multimodal care approaches, MT-ONS may support muscle health and physical function in frail older adults at risk of falls. Accordingly, this study aims to describe real-world changes in physical performance, nutritional status, and fall occurrence among frail adults attending an outpatient fall clinic who received MT-ONS as part of routine clinical care. By documenting these outcomes, the study sought to contribute real-world evidence to inform the potential role of MT-ONS within multimodal care approaches for the management of frailty in general medicine and geriatric settings.

2. Materials and Methods

2.1. Design

This prospective, open-label, descriptive, single-arm, single-centre, uncontrolled study involved a cohort of frail older adults at risk of falls who attended the outpatient fall clinic at the Cantoblanco Geriatric Daycare Unit at La Paz University Hospital in Madrid, Spain. As part of a comprehensive, multicomponent plan for physical recovery and fall prevention, participants received MT-ONS within an approach aimed at supporting physical performance, nutritional status, muscle health, and overall quality of life.
The primary objective of the study was to assess changes in physical performance after a minimum of 90 days of MT-ONS, compared to baseline. Secondary objectives included changes in nutritional status, number of falls, muscle strength, weight, quality of life, and functional capacity, as well as adherence to the ONS regimen.

2.2. Study Population

Participants satisfying the following inclusion criteria were eligible to enter the study: age ≥ 70 years, presence of 3 or more criteria from the Fried frailty score [30,31], history of three or more falls in the last six months, referred to and actively attending the Cantoblanco Geriatric Daycare Unit, and able to provide written consent for study participation. Key exclusion criteria included refusal or intolerance to MT-ONS, current enteral nutrition, severe cognitive impairment, and serious concomitant illnesses that precluded patient participation. Detailed selection and exclusion criteria are provided in Supplementary Table S1.

2.3. Recruitment and Assessment

All participants fulfilling the selection criteria were consecutively recruited in accordance with usual clinical practice. Participants were assessed at baseline (visit 1, V1) and at least 90 days after the initiation of MT-ONS (visit 2, V2) (Figure 1).
At baseline, demographic data (age, gender, marital status, place of residence) and clinical data (laboratory tests, pharmaceutical treatment, physical performance, nutritional status, number of falls, ambulation ability, muscle strength, weight, body composition, and physical functionality) were collected. Physical performance was evaluated using the Short Physical Performance Battery (SPPB) [32,33,34,35]. Nutritional status was assessed with the Mini Nutritional Assessment—Short Form (MNA®-SF) [36,37]. Walking ability was analysed using the Functional Ambulation Categories (FAC) [38]. Body composition was measured using a Tanita device BC-545N (Tanita Corporation, Tokyo, Japan) [39], muscle strength was assessed with a handheld dynamometer (SAEHAN Spring hand dynamometer SH5002, Saehan Corporation, South Korea) [33], and HRQoL was documented using the 12-item short-form health survey (SF-12) questionnaire [40]. Participants’ ability to perform basic activities of daily living was evaluated with the Barthel Index [41,42]. Adherence to the MT-ONS was assessed at V2. Adherence was measured using a 5-point Likert scale (always, almost always, sometimes, almost never, never). Participants adhering always or almost always were asked to indicate the reason for adhering to the MT-ONS (pleasant taste, pleasant smell, impression of improving overall health, ability to walk, pleasant appearance and texture, provides an extra and necessary amount of proteins, and provides an extra and necessary amount of calories). Laboratory parameters and information on pharmacological treatment were extracted from participants’ clinical records by the study investigators and used for descriptive purposes.

2.4. Intervention

The MT-ONS was hypercaloric and hyperproteic 100% serum lactoprotein enriched with leucine and vitamin D [43] (Supplementary Table S2). Participants were recommended to take two bottles (200 mL/bottle) daily for at least 90 days. Participants were also advised to follow other general dietary recommendations, the Vivifrail physical exercise program [44], and to consider structural adaptation at home (Supplementary Table S3).
The Vivifrail project is an international program for the Promotion of Physical Exercise for the prevention of frailty and falls in older adults, part of the Strategy for the promotion of Health and Quality of Life in the European Union [44]. The objective is to maintain a level of functionality that ensures the highest possible degree of autonomy for everyone.
Additionally, medication was reconciled to resolve prescription discrepancies, simplify therapies, and personalise the therapeutic plan [45].

2.5. Statistical Analysis

Descriptive statistics were applied, including the calculation of percentages, means, standard deviations, medians, interquartile ranges, and minimum and maximum values. Comparisons between two dependent variables were performed using Student’s t-test for normally distributed data; otherwise, the non-parametric Wilcoxon–Mann–Whitney test was used. Spearman’s correlation was employed to assess the relationships between changes in physical performance and changes in other outcomes, such as MNA®-SF, number of falls, walking ability, weight, body mass index (BMI), and Barthel Index.
For exploratory purposes, subgroup analyses were conducted to characterise baseline factors among participants who showed improvements in the SPPB score and MNA®-SF during follow-up. From the total study population (N = 26), participants who demonstrated an increase in SPPB score (N = 16) and those with improved nutritional status (N = 15) were descriptively compared with the overall cohort in terms of baseline weight, BMI, walking stability, number of falls per month, MNA®-SF scores, SPPB scores, and handgrip strength. An inferential regression model was applied on an exploratory basis to examine the association between changes in nutritional status and physical performance [46].

2.6. Ethical Considerations

Participants were provided with an information sheet detailing the study’s name, objectives, sponsors, data protection and processing procedures, and the voluntary nature of participation. All participants signed a written consent form. The study received approval from the Clinical Research Ethics Committee at La Paz University Hospital in Madrid, Spain (Number 07/2022, approved on 5 April 2022). Clinical trial number not applicable.

3. Results

3.1. Study Population

A total of 43 participants were recruited between 1 June 2022 and 19 January 2024. Of these, 26 (60%) completed the study. The mean age was 82 years (±standard deviation, SD) (±5.4), 58% were women, 54% were in a relationship, and 69% lived accompanied (Table 1).
Regarding their clinical characteristics at baseline (visit 1), comorbidities that could contribute to an increased risk of falls were present in less than 20% of participants. Specifically, 19% had visual impairments, 15% had cognitive impairments, and 11% had hearing impairments or Parkinson’s disease. In contrast, more than 70% of participants were on pharmacological treatments, such as antihypertensives or diuretics, which could potentially compromise balance and increase the risk of falls in frail individuals (Supplementary Table S4).
At baseline, the mean SPPB score was 7.3 (±3.6). The mean number of falls per month was 1.2 (±0.9). In total, 81% of participants experienced at least one fall per month, and 16% experienced two or more falls per month. According to the FAC, 58% walked independently, while 42% required supervision or assistance.
Nutritional assessment using the MNA®-SF score showed that 35% of participants were malnourished, and 42% were at risk of malnutrition, with a mean MNA®-SF score of 9.31 (±2.41) for the entire cohort. The median weight was 66.6 kg (±11.88), and the median body mass index (BMI) was 25.9 (±4.41). Muscle strength was 15.6 kg (±8.65) for the right hand and 12.6 kg (±5.48) for the left hand.
In total, 92% of participants had a Barthel Index score of ≥60 at baseline. More than 80% of participants perceived their general health as moderate or good (Table 2).

3.2. Functional and Nutritional Characteristics at Visit 2

The mean duration of MT-ONS exposure between V1 and V2 was 141 days (±36.5). The mean SPPB score increased by 0.7 points at V2 (Figure 2). In total, 16 out of 26 participants (61.5%) showed an improvement in physical performance. Item analysis of the SPPB revealed the greatest gains in the tandem stand balance test (mean change: 0.46 [±0.95]) and in the ability to complete five chair stands without using arms (mean change: 0.27 [±1.12]) (Supplementary Table S5). The number of falls per month decreased to 0.2 (±0.3). Overall, seven falls were reported across the cohort of participants during the follow-up period. At V2, 73% of participants reported no falls, while 27% experienced one fall per month (Table 2).
Nutritional status improved in 15 out of 26 participants (57.7%) according to the MNA®-SF. The proportion of participants classified as malnourished decreased from 35% to 4%, while the proportion of well-nourished individuals increased from 23% to 42%, with 54% remaining at risk of malnutrition (Figure 3). The mean MNA®-SF score increased by 1.7 points at V2 (Table 2).
Overall, 73% of participants (19/26) either gained or maintained their weight, with a mean weight gain of 2 kg (±2.82). Muscle strength increased by an average of 1.2 kg (±4.90) in the left hand and by an average of 0.1 kg (±2.64) in the right hand. Walking ability remained stable, with 92% of participants maintaining their mobility.
Patient-reported health status also improved, with 42% rating their health as good at V1, rising to 54% at V2 (Table 2). The percentage of participants reporting limitations in achieving their desired activities due to emotional problems decreased from 46% at V1 to 15% at V2. Similarly, the impact of physical or emotional health problems on social activities decreased from 31% at V1 to 15% at V2 (Supplementary Table S6).
In total, 92% of participants always or almost always followed the MT-ONS recommendations due to pleasant taste (71%), smell (58%), and good health perception (58%) (Supplementary Figure S1).

3.3. Physical Performance, Muscle Strength, and Nutritional Status

Improvements in physical performance (SPPB) at V2 were positively correlated with greater muscle strength (rho = 0.415, p = 0.02) and enhanced nutritional status according to the MNA®-SF scores (rho = 0.498, p = 0.01) (Supplementary Table S7). The inferential regression model identified a positive linear association between changes in MNA®-SF and SPPB scores, indicating that greater changes in nutritional status (higher MNA®-SF scores) were associated with greater changes in physical performance (higher SPPB scores) (Figure 4).

3.4. Physical Performance and Health-Related Quality of Life

The analysis of SPPB components in relation to HRQoL items from the SF-12 (physical, role-related physical, and social functioning) revealed a strong positive correlation between improvements in the ability to perform five chair stands without using arms and accomplishing more in daily activities despite physical health limitations (rho = 0.686, p < 0.001). This suggests that individuals with increased lower limb strength at V2 felt less restricted in performing their regular daily activities and experienced better physical functioning.

3.5. BMI, Muscle Strength, and Gait Stability as Predictors of SPPB Improvement

Participants with improved SPPB scores showed a statistically significant increase in BMI (p = 0.007) and muscle strength (p = 0.017), whereas these changes were not significant in the overall study population (p = 0.182 and p = 0.106, respectively). Gait stability also improved significantly in the SPPB improvement group (p = 0.024), but this was not observed in the total population (p = 0.446). MNA®-SF scores improved significantly in both groups (Supplementary Table S8).

3.6. BMI, Muscle Strength, Physical Performance, and Improved MNA®-SF

Participants with improved MNA®-SF scores showed a statistically significant increase in physical performance, as measured by the SPPB (p = 0.012), an effect that was not observed in the overall study population (p = 0.11). Additionally, participants with better nutritional status exhibited significant increases in BMI (p = 0.008) and muscle strength (p = 0.049), whereas no significant changes were observed in the overall population (Supplementary Table S9).

4. Discussion

In this exploratory, real-world study, frail community-dwelling adults who met at least three criteria of Fried’s Frailty Phenotype and were at increased risk of falls received MT-ONS (100% whey protein enriched with leucine and vitamin D) as part of a comprehensive care plan that also included exercise and home environment recommendations. This intervention aimed to enhance physical performance, walking stability, and overall nutritional status and to reduce the number of falls. The cohort shared similar demographic and clinical characteristics with frail octogenarians described in other Spanish studies [47,48,49].
Despite there being common risk factors for falls, such as visual, hearing, or cognitive impairments, fewer than 20% of participants had these conditions. This suggests that although these comorbidities were present, they were likely not the primary contributors to fall risk in this population. Instead, medication use, particularly those medications that can impair balance, may be a more relevant risk factor, highlighting the importance of careful monitoring of pharmacological treatments [50,51].
A recent meta-analysis comparing various interventions for fall prevention in older adults found that multicomponent interventions, typically combining nutritional support and physical exercise, are associated with a significant reduction in fall incidence [52]. This was also evident in the present study, where participants received recommendations for both nutrition and physical exercise as part of a comprehensive approach to fall prevention. In line with these findings, the Global Guideline for Falls in Older Adults (2022) recommends nutritional optimisation (grade of recommendation: 1; level of evidence: B) and the inclusion of exercise training (grade of recommendation: 1; level of evidence: C) as part of a multidomain strategy for fall prevention [14]. Other studies have also reported that individualised multicomponent interventions, including nutritional support aimed at enhancing physical performance, reduced mobility disability and prevented a decline in HRQoL and basic activities of daily living in older adults with frailty and sarcopenia [27,53].
Physical performance was assessed using the SPPB, a validated tool for evaluating lower-body function in older adults [54]. At baseline (V1), participants exhibited a range of physical abilities from moderate limitations to good function. The follow-up (V2) data revealed modest but meaningful improvements in SPPB scores, particularly in balance and lower body strength. Although these improvements might seem minor, they are significant for this frail population as they can lead to increased walking stability and improved ability to perform daily tasks that require strength, mobility, and precision [54]. In this study, increased lower body strength may have contributed significantly to reducing falls, improving physical independence, and enhancing overall HRQoL, largely explained by perceived improvements in physical functioning and role-related physical activities. Lower body performance as assessed by components of the SPPB is a strong predictor of fall risk in older adults, indicating that gains in strength and lower extremity function are clinically meaningful; poorer SPPB performance is associated with increased risk of future falls, while improvements in physical performance measures correlate with better functional independence and have been linked to enhanced quality-of-life outcomes in older populations [35,55]. Previous research has shown that handgrip strength is only weakly to moderately associated with functional outcomes in older adults and may not adequately reflect overall functional capacity, suggesting that improvements in SPPB can occur independently of changes in handgrip strength [56,57].
Nutritional status also improved significantly, with 57.7% of participants showing better outcomes at V2. The decrease in malnourished individuals and increase in those classified as well-nourished highlight the positive impact of the MT-ONS intervention. An average increase of 1.7 points in the MNA®-SF score reinforces these nutritional gains. However, over half of the cohort remained at risk of malnutrition, emphasising the need for ongoing nutritional support to prevent disability, as highlighted in previous studies [48,58]. Although the MNA®-SF was initially developed as a screening tool rather than a diagnostic instrument, accumulating evidence supports its use for longitudinal monitoring. The MNA®-SF captures domains that are particularly responsive to clinical change in frail older adults, including dietary intake, recent weight loss, mobility, acute illness, psychological stress, and neuropsychological status [59]. Changes in these domains often precede measurable alterations in biochemical markers or body composition and are therefore highly relevant in real-world clinical settings [60,61].
In this cohort, improved nutritional status was linked to gains in physical performance, suggesting a positive relationship between better nutrition and physical function. However, not all participants who improved their nutrition also showed enhanced physical performance. While some improved in both domains, others only saw improvements in nutritional status without corresponding physical gains, indicating that other factors beyond nutritional status likely influence physical performance in this population [62].
Likewise, increases in BMI, muscle strength, and gait stability were predictive of improved physical performance, suggesting a potential causal link between these factors and enhanced functional outcomes. A meta-analysis found that low muscle mass, strength, and physical performance were positively associated with dependency in ADL and IADL [63].
Although hydration status can influence bioelectrical impedance analysis (BIA) estimates, the use of a standardised Tanita measurement protocol, repeated within-subject assessments, exclusion of participants with unstable clinical conditions, and the concordance of BIA-derived changes with functional outcomes support the reliability of the observed body composition changes at the group level. In line with this, a recent systematic review and meta-analysis reported that BIA demonstrates moderate diagnostic accuracy for sarcopenia in older adults, showing the clinical and research utility of BIA-derived muscle mass measures in geriatric populations [64].
Several limitations should be acknowledged. The descriptive, single-centre, open-label design without a control group limits causal inference. No a priori power calculation was performed, given the exploratory, real-world nature of the study; accordingly, regression analyses were conducted for exploratory purposes only. In addition, regression to the mean may have contributed to the observed reduction in fall frequency, as participants were often referred following periods of increased falls. Analyses were restricted to completers, as follow-up data were unavailable for non-completers, which raises the possibility of attrition bias and reflects outcomes under conditions of higher adherence. The consecutive inclusion of participants in a routine clinical setting may have introduced selection as well as potential recall and reporting bias, eventually favouring individuals with better functional status or greater access to care. In addition, the small, convenience-based sample size limits generalisability and renders the findings preliminary, suggesting potential associations that warrant confirmation in larger, more robust studies. No formal robustness or outlier analyses were undertaken.
In addition, nutritional biomarkers related to MT-ONS components, such as serum 25-hydroxyvitamin D concentrations, were not measured, precluding assessment of changes in nutritional status or correction of baseline deficiencies and their potential contribution to outcomes. The intervention combined MT-ONS with medication review and recommendations for exercise and home fall-prevention measures. Adherence to exercise, medicines, and detailed nutritional intake was not captured, which may also have influenced the results. The limited and non-standardised follow-up duration may also have attenuated the observed effects, potentially underestimating the full impact of nutritional recovery and functional improvement following MT-ONS. The results should be interpreted as exploratory.
Although this study did not evaluate whether the observed improvements were maintained beyond the intervention period, the favourable changes in body composition, together with improvements in nutritional status indicators, support the potential benefits of nutritional support in enhancing physical performance among frail older patients at risk of falls.

5. Conclusions

This study shows that MT-ONS 100% whey protein enriched with leucine and vitamin D, as part of a comprehensive care plan, can lead to improvements in physical performance and nutritional status, contributing to fall reduction in frail older adults at risk of falls. While the overall improvements in physical function and nutrition are modest, the decrease in the number of falls is significant. Continued nutritional support and individualised interventions targeting physical performance, muscle strength, and walking stability are essential for preventing further decline and promoting functional independence in frail older adults. This preliminary evidence needs to be confirmed through more robust clinical studies, including randomised controlled trials designed to isolate the effects of MT-ONS from other components of multimodal interventions.

Supplementary Materials

The following supporting information can be downloaded at https://www.mdpi.com/article/10.3390/jal6010015/s1, Figure S1. Adherence; Table S1. Inclusion and exclusion criteria; Table S2. Oral nutritional supplementation composition, 100 mL; Table S3. Additional recommendations at baseline; Table S4. Clinical characteristics, at baseline (visit 1); Table S5. SPPB scores and mean differences between visit 1 and 2 per item in the SPPB; Table S6. HRQoL in visit 1 and 2; Table S7. Spearman correlation between changes in physical performance and nutritional status and the change in other outcomes; Table S8. Subgroup analysis of participants who improved SPPB; Table S9. Subgroup analysis of participants who improved MNA-SF.

Author Contributions

Conceptualisation, I.Y.R.D., A.E.C.M., M.Á.E.V., L.A.R.Á. and J.M.L.A.; investigation, L.A.R.Á., A.E.C.M., M.Á.E.V., L.A.R.Á. and J.M.L.A.; methodology, L.A.R.Á. and J.M.L.A.; project administration, L.A.R.Á.; supervision, L.A.R.Á. and J.M.L.A.; writing—review and editing, L.A.R.Á., A.E.C.M., M.Á.E.V., L.A.R.Á. and J.M.L.A. All authors have read and agreed to the published version of the manuscript.

Funding

Danone Nutricia SL provided financial support to develop the study and write the manuscript.

Institutional Review Board Statement

This study was conducted in accordance with the Declaration of Helsinki, and approved by the Clinical Research Ethics Committee at La Paz University Hospital in Madrid, Spain (Number 07/2022).

Informed Consent Statement

Informed consent was obtained from all subjects involved in this study.

Data Availability Statement

Data are contained within the article and Supplementary Materials.

Acknowledgments

We thank Silvia Paz Ruiz and Lena Huck at SmartWorking4U for their support in the design of the study, data management, interpretation of results, and writing of the manuscript; Jordi Ollé (Conceptos Claros) for statistical analysis and Isabel Gotor Miserachs (Selenus) for graphical design in collaboration with SmartWorking4U.

Conflicts of Interest

The authors declare no conflicts of interest.

Abbreviations

The following abbreviations are used in this manuscript:
ADLActivities of Daily Living
BMIBody Mass Index
FACFunctional Ambulation Categories
HRQoLHealth-related Quality of Life
IADLInstrumental Activities of Daily Living
MNA®-SFMini Nutritional Assessment—Short Form
MT-ONSMuscle-Targeted Oral Nutritional Supplementation
ONSOral Nutritional Supplementation
SDStandard Deviation
SF-1212-item Short Form Health Survey
SPPBShort Physical Performance Battery
V1Visit 1 (Baseline)
V2Visit 2 (Follow-up)

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Figure 1. Study schedule. FACs: Functional Ambulation Categories; MNA®-SF: Mini Nutritional Assessment—Short Form; ONS: oral nutritional supplementation; SPPB: Short Physical Performance Battery.
Figure 1. Study schedule. FACs: Functional Ambulation Categories; MNA®-SF: Mini Nutritional Assessment—Short Form; ONS: oral nutritional supplementation; SPPB: Short Physical Performance Battery.
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Figure 2. Comparison of mean total SPPB scores between visit 1 and visit 2 for the total study population. SPPB: Short Physical Performance Battery.
Figure 2. Comparison of mean total SPPB scores between visit 1 and visit 2 for the total study population. SPPB: Short Physical Performance Battery.
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Figure 3. Comparison of nutritional status between visit 1 and visit 2, in percentage of participants in each MNA®-SF group. MNA®-SF: Mini Nutritional Assessment Short Form.
Figure 3. Comparison of nutritional status between visit 1 and visit 2, in percentage of participants in each MNA®-SF group. MNA®-SF: Mini Nutritional Assessment Short Form.
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Figure 4. Scatter plot correlation between changes in MNA®-SF and SPPB scores. MNA®-SF: Mini Nutritional Assessment Short Form; SPPB: Short Physical Performance Battery.
Figure 4. Scatter plot correlation between changes in MNA®-SF and SPPB scores. MNA®-SF: Mini Nutritional Assessment Short Form; SPPB: Short Physical Performance Battery.
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Table 1. Baseline demographic characteristics.
Table 1. Baseline demographic characteristics.
CharacteristicValue
Age, years (±SD)82 (±5.4)
Gender
Female, n (%)15 (58%)
Male, n (%)11 (42%)
Marital status
Single, n (%)1 (4%)
In a relationship, n (%)14 (54%)
Married, n (%)2 (8%)
Divorced, n (%)0 (0%)
Widow, n (%)9 (34%)
Household living conditions
Alone, n (%)8 (31%)
Accompanied, n (%)18 (69%)
Institution0 (0%)
SD: standard deviation.
Table 2. Nutritional and functional characteristics, at baseline (visit 1) and follow up (visit 2).
Table 2. Nutritional and functional characteristics, at baseline (visit 1) and follow up (visit 2).
CharacteristicsVisit 1Visit 2p-Value
Nutritional status: MNA®-SF score
12–14 points, well-nourished, n (%)6 (23%)11 (42%)NA
8–11 points, at risk of malnutrition, n (%)11 (42%)14 (54%)NA
0–7 points, malnourished, n (%)9 (35%)1 (4%%)NA
MNA®-SF score, mean (±SD)9.31 (±2.41)10.96 (±1.87)0.006
Laboratory (nutritional) parameters
Serum albumin levels (g/dL) mean (±SD)4.0 (±0.51)4.3 (±0.59)NA
Cholesterol levels (md/dL) mean (±SD)156.0 (±38.9)156.0 (±34.67)NA
Lymphocyte count (×1000/µL) mean (±SD)1.5 (±0.60)1.5 (±0.59)NA
Weight, kg (±SD)66.6 (±11.88)68.4 (±12.54)0.03
BMI25.9 (6.61)26.7 (±4.33)0.89
Body composition: Tanita
Muscle mass (%)42%42%0.82
Total body water (%)48%47%0.49
Body fat (%)34%34%0.94
Bone mass, kg (±SD)3.1 (±4.09)3.1 (±4.16)1.00
Visceral fat, mean (±SD)17.1 (±17.71)16.2 (±7.20)0.74
Metabolic age, mean (±SD)73.6 (±9.55)74.9 (±9.48)0.29
Lower body physical function: SPPB score, mean (±SD)7.3 (±3.56)8.0 (±4.03)0.31
Good physical function (SPPB scores 10–12), n (%)7 (27%)14 (54%)NA
Mild limitations (SPPB scores 7–9), n (%)9 (35%)3 (12%)NA
Moderate limitations (SPPB scores 4–6), n (%)5 (19%)3 (12%)NA
Severe physical limitations (SPPB scores 0–3), n (%)5 (19%)6 (22%)NA
Number of falls/month, mean (±SD)1.2 (±0.9)0.2 (±0.3)<0.001
Number of falls/month, n (%)
05 (19%)19 (73%)NA
117 (65%)7 (27%)NA
21 (4%)0 (0%)NA
32 (8%)0 (0%)NA
41 (4%)0 (0%)NA
Walking ability: FAC score
5: normal deambulation, n (%)6 (22%)9 (35%)NA
4: able to walk anywhere but with obvious limp or need of technical assistance, n (%)8 (31%)6 (22%)NA
3: able to walk inside and outside of home but limited distances, n (%)9 (35%)9 (35%)NA
2: only able to walk on flat surfaces and known spaces like home, n (%)3 (12%)1 (4%)NA
1: requires external help to be able to walk, n (%)0 (0%)1 (4%)NA
Dynamometry
Muscle strength right hand, kg (±SD)15.6 (±8.65)15.7 (±9.19)0.42
Muscle strength left hand, kg (±SD)12.6 (±5.48)13.9 (±6.61)0.10
Independence to perform basic activities of daily living: Barthel Index score
≥60 points (independent), n (%)24 (92%)25 (96%)NA
<60 points (dependant), n (%)2 (8%)1 (4%)NA
Barthel Index score, mean (±SD)81.35 (±15.59)84.04 (±17.49)0.08
SF-12 score, general health perception
Excellent, n (%)1 (4%)1 (4%)NA
Very good, n (%)2 (8%)0 (0%)NA
Good, n (%)11 (42%)14 (54%)NA
Moderate, n (%)11 (42%)9 (35%)NA
Bad, n (%)1 (4%)2 (8%)NA
BMI: body mass index, FAC: Functional Ambulation Category, MNA®-SF: Mini Nutritional Assessment Short Form SD: standard deviation, SPPB: Short Physical Performance Battery; NA: not applicable.
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MDPI and ACS Style

Rivera Deras, I.Y.; Callejón Martin, A.E.; Espuelas Vázquez, M.Á.; Ruiz Ávila, L.A.; López Arrieta, J.M. Oral Nutritional Supplementation in Routine Clinical Practice to Improve Physical Performance and Nutrition in Frail Adults at Risk of Falls: Preliminary Evidence. J. Ageing Longev. 2026, 6, 15. https://doi.org/10.3390/jal6010015

AMA Style

Rivera Deras IY, Callejón Martin AE, Espuelas Vázquez MÁ, Ruiz Ávila LA, López Arrieta JM. Oral Nutritional Supplementation in Routine Clinical Practice to Improve Physical Performance and Nutrition in Frail Adults at Risk of Falls: Preliminary Evidence. Journal of Ageing and Longevity. 2026; 6(1):15. https://doi.org/10.3390/jal6010015

Chicago/Turabian Style

Rivera Deras, Ivon Y., Ana Esther Callejón Martin, Miguel Ángel Espuelas Vázquez, Lilia Alejandrina Ruiz Ávila, and Jesús María López Arrieta. 2026. "Oral Nutritional Supplementation in Routine Clinical Practice to Improve Physical Performance and Nutrition in Frail Adults at Risk of Falls: Preliminary Evidence" Journal of Ageing and Longevity 6, no. 1: 15. https://doi.org/10.3390/jal6010015

APA Style

Rivera Deras, I. Y., Callejón Martin, A. E., Espuelas Vázquez, M. Á., Ruiz Ávila, L. A., & López Arrieta, J. M. (2026). Oral Nutritional Supplementation in Routine Clinical Practice to Improve Physical Performance and Nutrition in Frail Adults at Risk of Falls: Preliminary Evidence. Journal of Ageing and Longevity, 6(1), 15. https://doi.org/10.3390/jal6010015

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