Administration Of Oral Nutritional Supplements Research Articles

Correção: Cuidados de enfermagem na prevenção de quebras de pele no idoso: revisão integrativa da literatura

Introduction Skin tears are considered injuries of traumatic etiology that can result from a variety of mechanical forces, such as shear or friction forces, blunt trauma, falls, improper handling, injury caused by equipment or removal of adherent dressings. These are acute wounds that have a high probability of becoming complex chronic wounds. They cause pain, increase healthcare costs, reduce quality of life and are a source of stress for the person. They lengthen hospital stay and increase the risk of morbidities. Skin Tears are a growing problem, making it crucial to invest in this topic in order to promote their prevention and proper treatment. Objective To identify nursing care and strategies to prevent skin tears in the elderly. Methods A bibliographic survey of publications was carried out in the EBSCOhost search engine, which incorporates the CINAHL Complete, MEDLINE Complete and Cochrane Database of Systematic Reviews databases and in the PubMed database, carried out in June 2022. 26 records were returned, five meeting the inclusion criteria. The included studies (n=5) were carried out between 2012 and 2022. Results In the sample of articles, it was possible to identify the benefits of twice-daily application of topical products, moisturizing creams and emollients, and the relevance of oral administration for 8 weeks of an oral nutritional supplement in the hydration of the stratum corneum and in the elasticity of the skin, as well as the importance of primary prevention and the promotion of health education in elderly skin care. Conclusion Preventive care to avoid skin tears in the elderly focuses on the daily topical application of moisturizing creams and emollients, nutrition (administration of oral nutritional supplements with 10g of collagen peptides) and adequate hydration; to prevent cutaneous traumas by providing a safe environment with adequate devices, and through the promotion of health education.

The influence of patients’ nutritional risk, nutritional status, and energy density in MEDPass versus conventional administration of oral nutritional supplements – A secondary analysis of a randomized controlled trial

ObjectivesThe clinical influence of nutritional risk, nutritional status, and energy density of oral nutritional supplements (ONS) in MEDPass versus conventional administration of ONS is currently unknown. The aim of this analysis was to examine whether these variables have an impact on clinical outcomes. MethodsSecondary analysis of the intention to treat dataset of the randomized controlled MEDPass Trial in geriatric and medical inpatients. Patients in the intervention group received 4 × 50 ml ONS during the medication rounds (MEDPass mode), while those in the control group received ONS in a non-standardized manner. The examined endpoints included energy and protein coverage, ONS intake, handgrip strength (HGS), weight, appetite nausea and 30-day mortality. Three subgroup analyses for NRS 2002 total score (3, 4 or 5−7 points), NRS 2002 impaired nutritional status score (0, 1, 2 or 3 points) and energy density of the ONS (1.5 kcal/mL or 2 kcal/mL) were performed using linear and logistic regression with interaction and mixed effect models. ResultsThe data of 202 patients (103 women and 99 men) at nutritional risk (NRS total 2002 score ≥3), mean (SD) age 82.2 (6.5) years were included. There was no significant difference between the groups in the primary endpoint energy coverage in all three subgroup analyses. There were also no significant differences between the groups in the secondary endpoints of protein coverage, ONS intake, HGS, weight, appetite, nausea, and 30-day mortality. ConclusionThe MEDPass mode of ONS administration was not superior to the conventional mode of administration in this study. ONS with high energy density (≥2 kcal/mL) should be offered since current evidence shows a tendency towards improved appetite, increased ONS and increased energy intake.

Medpass versus conventional administration of oral nutritional supplements – A randomized controlled trial

Medpass versus conventional administration of oral nutritional supplements – A randomized controlled trial

Complete blood profile of children diagnosed with asymptomatic urinary tract infection: oral nutritional supplement (ONS) intervention

Background: Young children are at high risk of urinary tract infections (UTI) that present as asymptomatic non-specific signs without clinical presentation. UTIs put children at risk of malnutrition, and thus early diagnosis, nutritional management, and medication are important. The administration of oral nutritional supplements (ONS) with an energy intake of 400 kcal/day is thought to be an effective strategy to provide balanced nutritional needs. Objectives: This study aims to investigate the clinical symptoms and growth pattern of young children with UTIs and with clinical symptoms of poor feeding and growth faltering who received medical treatment and nutritional intervention for three months. Methods: A cross-sectional analytical study was conducted from January 2019 to December 2020 at the outpatient installation unit of Husada Utama Hospital. Subjects were children aged one to five years old, with the main complaint of poor feeding and constant weight gain. UTIs were identified according to the urine culture results. If the count exceeded 100.000 cfu/ml, it was determined as a urinary tract infection. Results: A total of 37 children were enrolled in this study and received diet advice, ONS, and medication. The proportion of boys was higher than girls in this study (21 to 16, respectively). Undernutrition was experienced by 14 subjects (37.84%) who were stunted or severely stunted (13 subjects or 35.14%), underweight or severely underweight (seven subjects or 18.92%), and wasted (four or 10.81%). It was shown that ONS improves mean corpuscular volume (MCV) and mean corpuscular haemoglobin (MCH) significantly, and slightly increased haemoglobin though there was no significant difference. White blood cell (WBC) and lymphocyte levels reduced after ONS intervention. Conclusion: Nutritional intervention with ONS improves erythropoiesis (MCV and MCH) but reduces WBC and lymphocytes in children with UTIs.

Cuidados de enfermagem na prevenção de quebras de pele no idoso: revisão integrativa da literatura

Introduction Skin tears are considered injuries of traumatic etiology that can result from a variety of mechanical forces, such as shear or friction forces, blunt trauma, falls, improper handling, injury caused by equipment or removal of adherent dressings. These are acute wounds that have a high probability of becoming complex chronic wounds. They cause pain, increase healthcare costs, reduce quality of life and are a source of stress for the person. They lengthen hospital stay and increase the risk of morbidities. Skin Tears are a growing problem, making it crucial to invest in this topic in order to promote their prevention and proper treatment. Objective To identify nursing care and strategies to prevent skin tears in the elderly. Methods A bibliographic survey of publications was carried out in the EBSCOhost search engine, which incorporates the CINAHL Complete, MEDLINE Complete and Cochrane Database of Systematic Reviews databases and in the PubMed database, carried out in June 2022. 26 records were returned, five meeting the inclusion criteria. The included studies (n=5) were carried out between 2012 and 2022. Results In the sample of articles, it was possible to identify the benefits of twice-daily application of topical products, moisturizing creams and emollients, and the relevance of oral administration for 8 weeks of an oral nutritional supplement in the hydration of the stratum corneum and in the elasticity of the skin, as well as the importance of primary prevention and the promotion of health education in elderly skin care. Conclusion Preventive care to avoid skin tears in the elderly focuses on the daily topical application of moisturizing creams and emollients, nutrition (administration of oral nutritional supplements with 10g of collagen peptides) and adequate hydration; to prevent cutaneous traumas by providing a safe environment with adequate devices, and through the promotion of health education.

The analysis of oral nutritional supplements related aspects among patients with digestive system cancer.

OBJECTIVE: Malnutrition-related disease particularly occur in patients with digestive system cancer. The administration of oral nutritional supplements (ONSs) is one of the methods of nutritional support recommended for oncological patients. The primary aim of this study was to assess the consumption-related aspects of ONSs among patients with digestive system cancer. The secondary aim was to assess the impact of ONSs consumption on the quality of life of these patients. PATIENTS AND METHODS: The current study included 69 patients with digestive system cancer. The assessment of ONSs-related aspects among cancer patients was conducted using a self-designed questionnaire, which has been accepted by Independent Bioethics Committee. RESULTS: Among all patients, 65% of participants declared that they consumed ONSs. Patients consumed various types of ONSs. However, the most common were protein products (40%) and standard products (37.78%). Only 4.44% of patients consumed products with immunomodulatory ingredients. Nausea was the most commonly (15.56%) observed side effect after ONSs consumption. Considering particular types of ONSs, side effects were the most commonly declared by patients who consumed standard products (p=0.157). The easy product availability in the pharmacy was noted by 80% of participants. However, 48.89% of patients assessed the cost of ONSs as not acceptable (48.89%). 46.67% of studied patients did not observe the improvement of quality of life after ONSs consumption. CONCLUSIONS: We have demonstrated that patients with digestive system cancer consumed various period, amount, and types of ONSs. Side effects after ONSs consumption occur rarely. However, the improvement of quality of life related to ONSs consumption was not noted in almost half of participants. ONSs are easily available in pharmacy.

MEDPass versus conventional administration of oral nutritional supplements – A randomized controlled trial comparing coverage of energy and protein requirements

The use of oral nutritional supplements (ONS) in the hospital setting is important to reach individual protein and energy goals in patients at risk for malnutrition. Compliance with ONS can be challenging but may be improved by prescribing ONS in smaller portions with medication rounds (MEDPass). We compared the likelihood of meeting energy and protein requirements in patients receiving ONS with MEDPass versus conventional ONS administration. The MEDPass Trial is a randomized, controlled, open-label superiority trial conducted on medical and geriatric wards in a University Hospital in Switzerland. The MEDPass group was allocated to receive 50ml of ONS four times per day with the medication rounds. The control group received ONS per conventional care between the meals. The primary outcome was the percentage of energy in relation to the individual requirement. Secondary outcomes included the coverage of protein intake in relation to the individual requirement, the amount of daily consumed ONS, the course of handgrip strength (HGS), body weight appetite and nausea. Furthermore, we compared 30-day mortality and hospital length of stay (LOS) was studied in medical patients. From November 22nd, 2018 until November 30th, 2021, 204 patients were included in the trial (MEDPass group n=100, control group n=104). A total of 203 patients at nutritional risk were analyzed in the intention-to-treat analysis (ITT). Regarding the primary endpoint, there was no difference in the coverage of energy requirement between the MEDPass and control group (82 vs. 85% (Δ-3%, 95%CI -11 to 4%), p=0.38). Similarly, no differences were found for the secondary outcomes including coverage of protein requirement (101 vs. 104% (Δ-3%, 95% CI -12 -7%), p=0.57, average daily intake of ONS (170 vs 173ml (Δ - 3ml, 95% CI -14 to 8ml), p=0.58) and 30-day mortality (3 vs. 8 patients, OR 0.4 (95% CI 0.1-1.4), p=0.15). The course of HGS, body weight, appetite and nausea did not differ between the groups (p=0.29, p=0.14, p=0.65 and p=0.94, respectively). The per protocol analysis including 178 patients showed similar results. Within this controlled trial setting, we found a high compliance for ONS intake and high coverage of protein requirements but no further improvement when ONS was administered using MEDPass compared to conventional care. MEDPass administration may provide an alternative that is easy to integrate into nursing routines, which may lead to lower workload with cost benefits and reduction of food waste. ClinicalTrials.gov: NCT03761680.

Energy and protein intake in medical and geriatric inpatients with MEDPass versus conventional administration of oral nutritional supplements: study protocol for the randomized controlled MEDPass Trial

BackgroundDisease-related malnutrition is highly prevalent in hospitalized medical and geriatric inpatients. It is associated with negative outcomes such as muscle wasting, decline of functional status, and increased morbidity and mortality. Oral nutritional supplements (ONS) are frequently used in nutritional therapy to increase intake. However, compliance to ONS is often limited and maybe improved by prescribing ONS in small portions timed with the medication (MEDPass). However, it is unknown whether the MEDPass administration enhances patients’ total energy and protein intake.MethodsThe MEDPass Trial is a randomized, controlled, open-label superiority trial. Patients in the MEDPass group receive 50 ml of ONS four times per day, distributed with the medication rounds. Patients in the control group receive ONS between meals. The primary outcome is average daily energy intake (% of calculated daily requirement). For our power analysis, we assumed that administration of ONS in the MEDPass administration mode increases energy intake by at least 10% (i.e., by 200 kcal for an average energy requirement of 2200 kcal/day). Thus, with the inclusion of 200 patients, this trial has 80% power to demonstrate that intervention group patients have an average intake of 2200 kcal/day (SD 500 kcal) versus 2000 kcal/day (SD 500 kcal) in control group patients. Energy and protein intakes from ONS and all food consumed are monitored continuously throughout the hospital stay and are statistically compared to the patient’s requirements. Secondary outcomes include average daily protein intake (% of calculated daily requirement), average intake of ONS/day, the course of body weight, handgrip strength, appetite, and nausea. Furthermore, hospital length of stay and 30-day mortality are assessed. The primary statistical analysis will be performed as an intention-to-treat analysis adjusted for the stratification factors used in randomization.DiscussionTo our knowledge, this is the first randomized controlled trial assessing total energy and protein intake for the entire hospitalization period in patients receiving MEDPass versus conventional ONS administration. Thus, the MEDPass Trial will fill a gap and answer this relevant clinical question.Trial registrationClinicalTrials.gov NCT03761680. Registered on 3 December 2018. Kofam.ch SNCTP000003191. Registered on 15 October 2018

A Low-Cost, Intradialytic, Protein-Rich Meal Improves the Nutritional Status in Chinese Hemodialysis Patients

Short-term administration of oral nutritional supplements can improve the nutritional status of hemodialysis patients. However, such treatment is associated with high cost. The aim of the present trial was to evaluate the benefits of the short-term administration of a low-cost, intradialytic, protein-rich meal on selected parameters of the nutritional status in Chinese patients undergoing hemodialysis. This was a 6-month single-center, prospective interventional study. Stable hemodialysis patients aged ≥18 years with a concentration of serum albumin <40 g/L were eligible for inclusion in this study. Patients allocated to the intervention group (IG) received nutritional counseling plus a low-cost, intradialytic, protein-rich meal thrice weekly over a period of 3 months, followed by a treatment-free period of 3 months. Patients allocated to the control group (CG) received nutritional counseling alone. Changes in serum albumin and body composition were investigated. At the start of the study, both groups were similar except for the levels of C-reactive protein (P = .034) and hemoglobin (P=.003). At the end of the study period, the level of serum albumin (P = .001) was significantly increased with increased protein intake in the IG (P = .048). However, this difference was not sustained during the follow-up period after termination of therapy. In the IG, the levels of serum albumin were significantly decreased between months 3 and 6 (P < .001), whereas those in the CG remained unchanged. There were no statistically significant differences observed between the two groups in the levels of C-reactive protein and body composition. The short-term administration of a low-cost, intradialytic, protein-rich meal (i.e., 200 mL milk plus two egg whites) resulted in a significant improvement in the levels of serum albumin versus nutritional counseling alone. This inexpensive nutritional intervention was feasible for the treatment of Chinese patients undergoing hemodialysis.

Compliance of nursing home residents with a nutrient- and energy-dense oral nutritional supplement determines effects on nutritional status.

Administration of oral nutritional supplements (ONS) is an effective strategy to treat and avoid malnutrition, a persisting issue in nursing homes. However, little is known about compliance in the NH population. This study aimed to analyse the effects of compliance of NH residents with a low-volume, nutrient- and energy-dense ONS on nutritional status and to identify residents' characteristics associated with compliance. Randomized, controlled trial in nursing homes. 87 nursing home residents (87 ± 6y, 91% female) with malnutrition or at risk of malnutrition were randomly allocated to an intervention group (IG) receiving 2 x 125 ml ONS (2.4 kcal/ml)/d for 12 weeks, or the control group (CG) with usual care. ONS intake was recorded daily and compliance calculated. Low and high compliance were defined as ≤ 30% and ≥ 80% of provided ONS actually consumed, respectively. Body weight (BW), BMI, upper-arm (UAC) and calf-circumference (CC) and MNA-SF were assessed at baseline and after 12 weeks. Associations between compliance and changes of nutritional parameters and residents' characteristics were analysed. Compliance was high in 35.7% and low in 28.6% of the IG (n=42). BW change was significantly higher in subjects with high compliance (median +3.0 (interquartile range +2.1;+3.8) kg, n=15) than in those with low compliance (-0.2 (-2.2;+1.6) kg, n=12) and CG (-0.1 (-1.2; +0.6) kg, n=35; p<0.001), and significantly correlated with compliance in IG (r=0.691; p<0.001). Significant differences and correlations were also identified for BMI, UAC and MNA-SF. High compliance was more often observed in residents with malnutrition (66.7 vs. 27.3%) and chewing difficulties (77.8 vs. 24.2%) than in those without these conditions. Low compliance was more prevalent in residents who were immobile (45.0 vs. 13.6%), depressed (33.3 vs. 6.7%) or had gastrointestinal complaints (50.0 vs. 17.9%) (all p<0.05). A high compliance of nursing home residents with a low volume, nutrient- and energy dense ONS was related to a significantly improved nutritional status in comparison to low compliance and therefore enhanced the effectiveness of ONS. A higher compliance may be achieved by consideration of different residents' characteristics.

Development of a telemedical monitoring concept for the care of malnourished geriatric home-dwelling patients: A pilot study

Elderly patients are at high risk of malnutrition and sarcopenia, promoting further morbidity which in turn decreases quality of life and increases the claiming of medical services and associated costs. Early and sustained administration of oral nutritional supplements has been shown to improve the nutritional status with robust clinical benefit. Many patients however, poorly adhere to prescribed supplements, so consistent monitoring is needed. Clinical monitoring usually ends with the discharge rendering the continuation of nutritional supplement therapy in the patient's home problematic. We developed a telemedicine based health care concept for intensive home monitoring. In a first randomized controlled prospective study we analyzed the feasibility of this innovative approach. The intervention group received oral nutritional supplements and telemedical monitoring with daily assessment of body weight, number of taken oral energy supplements and state of health. The control group received usual care. 13 patients were included in each group, eight patients of the intervention group left the study prematurely, five patients were closely monitored and used the devices for a mean 67±63.5 days. Follow up data of body weight and BMI showed no relevant differences between both groups.The results and experiences gained in this pilot study demonstrate that telemedical systems provide encouraging new options to enable an intensive monitoring of malnourished patients. A continuous intensive therapy monitoring of this patient group however, is a particular challenge. Albeit possibilities, limitations and useful parameters were identified, which will be used to improve the conception in an ongoing prospective randomized trial.

Prevalencia de desnutrición e influencia de la suplementación nutricional oral sobre el estado nutricional en ancianos institucionalizados

Background: Nutritional supplementation might be an effective strategy for improving the nutritional status and the quality of life of institutionalized fragile elderly. Objectives: The prevalence of malnutrition and its relation with disease, and the influence of dietary supplementation by means of oral formulas on the nutritional status of elderly nursing home residents were assessed. Methods: Two studies were carried out, one a cross-sectional survey in 31 subjects and the other a longitudinal-sectional survey in 19 subjects, both groups living in a public nursing home in the city of Murcia (SE Spain). Body mass index (BMI), serum albumin concentration (ALB) and geriatric nutritional risk index (GNRI) were assessed as markers of potential malnutrition. Illnesses were ascertained from medical records. Results and Discussion: The prevalence of malnutrition of the total collective was high (30%), and especially in the fragile subjects (50%). The administration of oral nutritional supplements in the usual diet for 12 months significantly increased ALB and GNRI, and had no effect on body weigh and BMI. Jointly, these effects decreased the in the number of subjects at high nutritional risk and increased the number of subjects with a low or zero risk of malnutrition. Conclusion: The administration of oral nutritional supplements in the usual diet of this elderly collective is an effective clinical strategy in nutritional therapy.

Prevalence of malnutrition and influence of oral nutritional supplementation on nutritional status in institutionalized elderly

Nutritional supplementation might be an effective strategy for improving the nutritional status and the quality of life of institutionalized fragile elderly. The prevalence of malnutrition and its relation with disease, and the influence of dietary supplementation by means of oral formulas on the nutritional status of elderly nursing home residents were assessed. Two studies were carried out, one a cross-sectional survey in 31 subjects and the other a longitudinal-sectional survey in 19 subjects, both groups living in a public nursing home in the city of Murcia (SE Spain). Body mass index (BMI), serum albumin concentration (ALB) and geriatric nutritional risk index (GNRI) were assessed as markers of potential malnutrition. Illnesses were ascertained from medical records. The prevalence of malnutrition of the total collective was high (39%), and especially in the fragile subjects (50%). The administration of oral nutritional supplements in the usual diet for 12 months significantly increased ALB and GNRI, and had no effect on body weigh and BMI. Jointly, these effects decreased the in the number of subjects at high nutritional risk and increased the number of subjects with a low or zero risk of malnutrition. The administration of oral nutritional supplements in the usual diet of this elderly collective is an effective clinical strategy in nutritional therapy.

Nutritional support and quality of life in stable chronic obstructive pulmonary disease (COPD) patients

Nutritional depletion is a common problem in chronic obstructive pulmonary disease (COPD) patients. It is caused, to a large extent, by an imbalance between low-energy intake and high-energy requirements. This problem adversely affects morbidity and mortality. However, the use of nutritional supplements to reach their energy necessities requires optimisation between positive and adverse effects on outcome before being used systematically as part of their comprehensive care. The aim of our study was to investigate the effects of oral nutritional repletion on quality of life in stable COPD patients. Prospective, randomised and multi-centre study. Stable COPD patients with a body mass index 22, a fat-free mass index 16, and/or a recent involuntary weight loss (5% during last month, or 10% during the last 3 months) were studied. Exclusion criteria were to present signs of an airway infection, to have a cardiovascular, neurological, or endocrine disease, to be treated with oral steroids, immunosuppressors or oxygen therapy at home, and to receive nutritional supplements. During 12 weeks, patients were encouraged to ingest a total daily defined energy intake. Randomly, in patients from group A the total daily energy load was Resting Energy Expenditure (REE)x1.7, and those from group B, REE x1.3. Total daily energy intake was achieved with regular food plus, if necessary, oral nutritional supplement rich in proteins (with 50% of whey protein), with predominance of carbohydrates over fat, and enriched in antioxidants. Primary end-point variable was quality of life. Secondary end-point outcomes included body weight, body composition, lung function, handgrip strength, and compliance with the energy intake previously planned. Data were treated with a SAS System. Student's test, Wilcoxon's rank sum test, and Mann-Whitney's test were used. At baseline both groups of patients were comparable. All patients needed oral nutritional supplements to achieve total daily defined energy intake. After 12 weeks of follow-up, patients in both groups significantly increased energy intake. Patients in group A increased body weight (P=0.001), triceps skin fold thickness (P=0.009) and body fat mass (P=0.02), and decreased body fat-free mass index (P=0.02). In this group a marked increase in airflow limitation was observed. A tendency to increase body weight and handgrip strength, and to decrease airflow limitation was observed in patients from group B. Furthermore, patients in the later group showed a significant improvement in the feeling of control over the disease (P=0.007) and a tendency to better the other criteria in a quality of life scale. According to our results, total daily energy intake of REE x 1.3 is preferable to REE x 1.7 in mild stable COPD patients. The administration of oral nutritional supplements, rich in proteins (with 50% of whey protein), with predominance of carbohydrates over fat, and enriched in antioxidants, to achieve total daily defined energy intake in patients in group B was followed by a significant improvement of one criteria (mastery) among many others in a quality of life scale.