Ready-Made Oral Nutritional Supplements Improve Nutritional Outcomes and Reduce Health Care Use-A Randomised Trial in Older Malnourished People in Primary Care.

Trevor R Smith,Emily R Walters,Natasha Guildford,Rebecca J Stratton,Abbie L Cawood

doi:10.3390/nu12020517

Abstract

Large trials assessing oral nutritional supplements (ONS) and dietary advice (DA) in primary care are lacking. This study examined effects of ONS + DA versus DA on intake, weight, QoL, healthcare use and satisfaction in malnourished free-living older people. Three hundred and eight people (71.5 ± 10.7y) were randomised to receive ONS + DA (n154) or DA (n154) for 12 weeks. At baseline, 4, 8, 12 weeks, intake, weight, QoL, healthcare use and satisfaction were measured. ONS + DA group (mean daily intake ONS 480 kcal; 21 g protein; 80% compliance) had significantly greater total energy and protein intakes (+401 kcal/d, p < 0.001; +15 g/d, p < 0.001) and weight gain (+0.8 kg; p < 0.001) compared to DA. QoL improved in both groups over time with a significant improvement in index with ONS + DA (p = 0.009). Significantly more participants found ONS + DA made a difference for them (p = 0.011), but no differences were found between groups using Euroqol. Compared to DA, healthcare use reduced with ONS + DA, (HCP visits by 34%, emergency admissions 50%, LOS 62%). Acceptability of both interventions was high (ONS 96%, DA 95%), with significantly more participants satisfied with ONS (89%) than DA (73%) (p = 0.009). This trial in primary care indicates that ONS are acceptable, make a difference to patients, significantly improve intake and weight, and reduce health care use with potential savings.

Highlights

Disease-related malnutrition (DRM), is a common problem that adversely affects body form and function [1]. This often results in lack of energy, more disease complications, slower recovery from illness, and impaired health-related quality of life (QoL) [1]
Nutrients 2020, 12, 517 the total public expenditure on health and social care (£23.5 billion in the UK) [2]. This economic report highlights the importance of identifying and managing malnutrition as the health and social care costs of a malnourished person are 3–4 times greater each year compared to a non-malnourished person [2]
Plus dietary advice (DA) provided as a diet sheet or DA alone for a period of 12 weeks

Summary

Introduction

Disease-related malnutrition (DRM), is a common problem that adversely affects body form and function [1] This often results in lack of energy, more disease complications, slower recovery from illness, and impaired health-related quality of life (QoL) [1]. These patient outcomes place increased clinical and economic demands on primary and secondary care [2]. Nutrients 2020, 12, 517 the total public expenditure on health and social care (£23.5 billion in the UK) [2] This economic report highlights the importance of identifying and managing malnutrition as the health and social care costs of a malnourished person are 3–4 times greater each year compared to a non-malnourished person [2].

Methods

Results

Conclusion