Effects Of Oral Nutritional Supplements Research Articles

Oral nutritional supplements in a randomised trial are more effective than dietary advice at improving quality of life in malnourished care home residents

Few trials have explored the effect of nutrition support on quality of life (QoL). This study examined the effects of oral nutritional supplements (ONS) vs dietary advice on QoL in malnourished care home residents. 104 malnourished, care home residents (medium+high risk), identified using the Malnutrition Universal Screening Tool ('MUST'), (mean age 88.5±7.9y) were randomised to receive either oral nutritional supplements (ONS) (n=53) or dietary advice (n=51) for 12 weeks. Dietary intake was measured using 24hdietary recall, and QoL assessed using EuroQol (EQ-5D), including time trade off (TTO) (range-0.59 to 1) and visual analogue scale (VAS) (score 0 to 100) for self-perceived health. QoL (adjusted for baseline QOL, malnutrition risk, type of care received (nursing or residential)) was significantly higher in the ONS than the dietary advice group (intention to treat analysis at week 12; n=104 ). EQ-5D TTO scores (mean±SE) were 0.50±0.04 vs 0.36±0.05 (P=0.005), VAS rescaled scores were 0.54+0.03 vs 0.046+0.03 (P=0.006) and VAS scores were 61.3±4.5 vs 54.6±6.3 (P=0.533) for ONS vs dietary advice respectively. Total energy, protein and the majority of micronutrient intakes were significantly greater in the ONS group, with energy intake being 423kcal greater in the ONS than the dietary advice group at week 12. This study in malnourished care home residents indicates that ONS can improve QoL and nutritional intake more effectively than dietary advice alone. This trial was registered with clinicaltrials.gov on 10th August 2007. Clinicaltrials identifier is NCT00515125http://www.clinicaltrials.gov/ct2/show/NCT00515125?term=nutrition+support&rank=60.

Assessment of Nutritional Status in Children With Cancer and Effectiveness of Oral Nutritional Supplements

Malnutrition is a common consequence of cancer in children, but the most effective methods of nutrition intervention are under debate. We aimed to evaluate the nutritional status of children diagnosed with cancer, and to investigate the effect of oral nutritional supplements on anthropometric measurements, biochemical parameters, and outcome. A randomized clinical study of 45 newly diagnosed cancer patients was performed. Anthropometric and biochemical data and related factors were assessed at 0, 3, and 6 months after diagnosis. On initial anthropometric assessment, prevalence of malnutrition by weight or height was found to be lower as compared with body mass index (BMI), or weight for height (WFH), or arm anthropometry. Twenty-six of the patients (55%) received oral nutritional supplement. During the second 3 months after diagnosis, there was a statistically significant decrease in number of the patients with WFH <90th percentile and BMI <5th percentile (P = .003 and P = .04, respectively). Infectious complications occurred more frequently in malnourished patients during first 3 months, and survival of children who were malnourished at the 6th month was significantly lower than that of well-nourished children (P = .003). On laboratory assessment, serum prealbumin levels of the all subjects were below normal ranges, but no relation was found for serum prealbumin or albumin levels in patients who were malnourished or not at diagnosis. Nutritional intervention is necessary to promote normal development and increase functional status as a child receives intensive treatment. Protein- and energy-dense oral nutritional supplements are effective for preventing weight loss in malnourished children.

Effect of Oral Nutritional Supplements On Hospital Outcomes in Patients Aged 65+ With Congestive Heart Failure.

1. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA. 2. Precision Health Economics (PHE), Los Angeles, CA, USA. 3. Stanford School of Medicine, Stanford University, Palo Alto, CA, USA. 4. Harris School of Public Policy Studies, University of Chicago, Chicago, IL, USA. 5. Abbott Nutrition, Columbus, OH. 6. Department of Anesthesiology, University of Colorado School of Medicine, Denver, CO, USA.

Can Oral Nutritional Supplements Improve Medicare Patient Outcomes in the Hospital?

We analyzed the effect of oral nutritional supplement (ONS) use on 30-day readmission rates, length of stay (LOS), and episode costs in hospitalized Medicare patients (≥65), and subsets of patients diagnosed with acute myocardial infarction (AMI), congestive heart failure (CHF) or pneumonia (PNA). Propensity-score matching and instrumental variables were used to analyze ONS and non-ONS episodes from the Premier Research Database (2000-2010). ONS use was associated with reductions in probability of 30-day readmission by 12.0% in AMI and 10.1% in CHF. LOS decreases of 10.9% in AMI, 14.2% in CHF, and 8.5% in PNA were associated with ONS, as were decreases in episode costs in AMI, CHF and PNA of 5.1%, 7.8% and 10.6%, respectively. The effect on LOS and episode cost was greatest for the Any Diagnosis population, with decreases of 16.0% and 15.8%, respectively. ONS use in hospitalized Medicare patients ≥65 is associated with improved outcomes and decreased healthcare costs, and is therefore relevant to providers seeking an inexpensive, evidence-based approach for meeting Affordable Care Act quality targets.

Compliance of energy-dense, small volume oral nutritional supplements in the daily clinical practice on a geriatric ward--an observational study.

Compliance is important in optimizing the clinical effectiveness of oral nutritional supplements (ONS). Small volume, energy-dense ONS (ED-ONS; ≥ 2 kcal/ml) have been shown to improve compliance in clinical trial settings. However, data from clinical practice is still lacking. The aim of the present study was to evaluate the effect of ED-ONS on the compliance in an observational set-up to obtain data from daily clinical practice on a geriatric ward. Geriatric inpatients, undernourished or at risk of undernutrition received two servings of either ED-ONS (125 ml, 2.4 kcal/ml: Nutridrink Compact Energy, Nutricia) or a standard ONS (S-ONS; 200 ml, 1.5 kcal/ml: Nutridrink) as part of their daily routine care. Patients were allocated to a group according to availability of beds and placement on the ward. Compliance (kcal/day and % of prescribed volume) was assessed by weighing returned bottles. Data were analyzed via Mixed Model for Repeated Measures. Forty-seven patients received ED-ONS, and 61 patients received S-ONS. Compliance was significantly higher with ED-ONS in geriatric inpatients compared to S-ONS ( 378 ± 14.0 kcal/day vs. 337 ± 13.6 kcal/day (mean ± SEM), p = 0.039, 63.0 ± 2.34% vs. 56.2 ± 2.26%, p = 0.039). Moreover, a trend (p=0.078) was observed towards an increasing difference in compliance over time. This study shows that compliance to ED-ONS is significantly better than to S-ONS in daily clinical practice. Although small, the difference in compliance seems to increase over time, suggesting clinical relevance with longer treatment.

Effect of oral nutritional supplementation on wound healing in diabetic foot ulcers: a prospective randomized controlled trial.

AimsAmong people with diabetes, 10–25% will experience a foot ulcer. Research has shown that supplementation with arginine, glutamine and β-hydroxy-β-methylbutyrate may improve wound repair. This study tested whether such supplementation would improve healing of foot ulcers in persons with diabetes.MethodsAlong with standard of care, 270 subjects received, in a double-blinded fashion, (twice per day) either arginine, glutamine and β-hydroxy-β-methylbutyrate or a control drink for 16 weeks. The proportion of subjects with total wound closure and time to complete healing was assessed. In a post-hoc analysis, the interaction of serum albumin or limb perfusion, as measured by ankle–brachial index, and supplementation on healing was investigated.ResultsOverall, there were no group differences in wound closure or time to wound healing at week 16. However, in subjects with an albumin level of ≤ 40 g/l and/or an ankle–brachial index of < 1.0, a significantly greater proportion of subjects in the arginine, glutamine and β-hydroxy-β-methylbutyrate group healed at week 16 compared with control subjects (P = 0.03 and 0.008, respectively). Those with low albumin or decreased limb perfusion in the supplementation group were 1.70 (95% CI 1.04–2.79) and 1.66 (95% CI 1.15–2.38) times more likely to heal.ConclusionsWhile no differences in healing were identified with supplementation in non-ischaemic patients or those with normal albumin, addition of arginine, glutamine and β-hydroxy-β-methylbutyrate as an adjunct to standard of care may improve healing of diabetic foot ulcers in patients with risk of poor limb perfusion and/or low albumin levels. Further investigation involving arginine, glutamine and β-hydroxy-β-methylbutyrate in these high-risk subgroups might prove clinically valuable.

Effects of oral nutritional supplementation in the management of malnutrition in hospital and post-hospital discharged patients in India: a randomised, open-label, controlled trial.

Hospital malnutrition is a significant problem that still remains under-recognised and under-treated in India. The present study assessed the effects of oral nutritional supplementation (ONS) in conjunction with dietary counselling versus dietary counselling (control) alone in malnourished patients when given in hospital and post-hospital discharge. The present study was conducted in nine private and four public hospitals. Patients from various medical wards were screened for malnutrition using modified Subjective Global Assessment (mSGA) and randomised to control (n = 106) or ONS (n = 106) for 12 weeks. Two servings (460 mL) of ONS were prescribed daily, providing 432 kcal, 16 g of protein and 28 micronutrients. The primary outcome was weight gain over 12 weeks. Other outcomes included change in body mass index (BMI), serum pre-albumin, albumin and C-reactive protein levels, energy and nutrient intakes, and handgrip strength at weeks 4, 8 and 12, as well as mSGA score at week 12. The mean age of patients was 39 years. Fifty-five percent were males and 90.3% were moderately malnourished (mSGA score B) at baseline. At week 12, ONS significantly improved certain parameters compared to control: weight (2.0 versus 0.9 kg; P < 0.001), BMI (0.76 versus 0.37 kg m(-2) ; P < 0.001) and energy intake per day (560 versus 230 kcal; P < 0.05). There were no differences in biochemical parameters and mSGA score between groups. Additionally, patients on ONS who were more functionally impaired at baseline had significantly greater weight gain and improved handgrip strength scores than controls. ONS use throughout hospital stay and post-hospital discharge significantly improved energy intake and weight in malnourished Indian patients. Those patients with poorer functional status at baseline demonstrated the most benefit.

Effect of oral nutritional supplementation on cognitive status in community dwelling elderly with sarcopenia and malnutrition (124.3)

Past research suggests that age‐related cognitive decline is associated with compromised nutritional and functional status. Much of this literature has focused on either institutionalized elderly or healthy community‐dwelling elderly. The purpose of this study was to determine whether oral nutritional supplementation (ONS) can improve cognitive status in community‐dwelling older adults with malnutrition and sarcopenia.Older adults (N=285; 65‐95 yrs) from 8 countries across Europe and North America completed a 24‐week ONS intervention trial. Sarcopenia was determined using the European Working Group on Sarcopenia in Older People (EWGSOP) definition. Cognitive status was assessed by Mini‐Mental State Exam (MMSE).MMSE scores did not change significantly in the overall study population. In a subgroup of malnourished, sarcopenic older adults who began the intervention with cognitive impairment (MMSE score 蠄 26, n = 74), MMSE scores significantly improved from baseline to 12 weeks (p = 0.004) and from baseline to 24 weeks (p = 0.03). These data demonstrated that in community elderly with malnutrition and sarcopenia, ONS maintained cognitive status and even improved cognitive status in the subgroup with cognitive impairment.Grant Funding Source: Supported by Abbott Nutrition

Effectiveness of Oral Nutritional Supplements on Malnourished Hemodialysis Patients

Effectiveness of Oral Nutritional Supplements on Malnourished Hemodialysis Patients

PP034-SUN THE EFFECTS OF A HIGH ENERGY DENSE, SMALL VOLUME ORAL NUTRITIONAL SUPPLEMENT ON COMPLIANCE IN THE DAILY CLINICAL PRACTICE OF A GERIATRIC WARD

Compliance is key for optimizing the clinical effectiveness of oral nutritional supplements (ONS). High energy-dense ONS (≥2 kcal/ml) have been shown to improve compliance in clinical trial settings 1 . Data on compliance in daily clinical practice are largely lacking. The aim of the present observational study was to evaluate the effect of a high energy-dense, low volume ONS on compliance in daily clinical practice.

The effect of oral nutritional supplementation on selected pathology and anthropometric markers of health status in middle aged men

This study was aimed at determining whether treatment with nutritional supplementation would improve pathology measures of disease risk. A total of twenty (20) healthy males, 30-60 years of age, served as participants. Participants were randomly divided into an Active Group (AG) (n=10) and a Placebo Group (PG) (n=10). Participants took the treatment (with active or placebo ingredients) for 90 days. On day 1 and 90th day blood samples were collected and analysed for cardiovascular disease risk markers (HDL, LDL, Triglycerides, total cholesterol and C reactive protein). To evaluate renal function urea, electrolytes creatinine and g GFR were analysed. White cell count and differential count were used as indicators of immune function. Vit B12 and s-folate were also analysed. No significant differences were found between the pre-test and post-test readings in the PG, whilst the AG experienced significant differences between the pre- and posttest in sodium and s-folate readings. On sodium readings the AG presented more cases with significantly lower levels during the post-test whilst s-folate was statistically higher during the post-test. No significant changes were found in any of the other pathology disease markers. It can be concluded despite the significant improvement in folic acid and sodium level observed in the AG participants that the nutritional supplement rich in folic acid, Vit B6, Vit B1, Vit B12, zinc, calcium, amino acid, Vit E and Vit C used for a period of 90 days has no effect on selected pathology markers of health status in middle-aged sedentary men. Key words: Supplementation, groups, health status, sedentary, sodium, s-folate.

Effects of oral nutritional supplementation on nutritional status in malnourished chronic hemodialysis patients

Effects of oral nutritional supplementation on nutritional status in malnourished chronic hemodialysis patients

Effects of Oral Nutritional Supplements in Normally Nourished or Mildly Undernourished Geriatric Patients After Surgery for Hip Fracture: A Randomized Clinical Trial

Oral nutritional supplements have been recommended after orthopedic surgery in geriatric patients to reduce postoperative complications. However, tolerability of supplements could be a limitation, and their universal use is not supported by the heterogeneity of previous studies, especially in patients without malnutrition. This study is a randomized, controlled, open, parallel, 3-arm clinical trial comparing supplementation with protein powder dissolved in liquids to aim at 36 g of protein per day, energy and protein supplements to aim at 37.6 g of protein and 500 kcal per day, or no intervention in normally nourished or mildly undernourished patients. Outcomes were serum albumin, prealbumin, retinol-binding globulin, and body mass index, among others. Postoperative complications were also recorded. Ninety patients aged 83.8 +/- 6.6 years were included. The mean ingested amount of supplements was 41.1% +/- 20.6% in the protein powder supplement group and 51.4% +/- 13.2% in the energy protein supplement group (t = 2.278, P = .027). Postoperative supplements had no effect on the nutrition status during in-hospital follow-up, as assessed by serum albumin (P = .251), prealbumin (P = .530), retinol-binding globulin (P = .552), or body mass index (P = .582). Multivariate analysis showed that length of hospital stay with an established complication until its resolution (beta = .230, P = .031), total hospital stay (beta = .450, P < .001), baseline body mass index (beta = .204, P = .045), and total daily ingested proteins per body weight (beta = .252, P = .018) were predictive variables on the change in serum albumin (R2 = 0.409, F = 11.246, P < .001). Oral nutritional supplements in normally nourished or only mildly undernourished geriatric patients with hip fracture submitted to surgery may be of interest for patients with postoperative complications and long hospital stays.

Effect of oral nutritional supplementation on weight loss and percutaneous endoscopic gastrostomy tube rates in patients treated with radiotherapy for oropharyngeal carcinoma

Malnutrition in the head and neck cancer population is a widely recognized factor contributing to negative outcomes. The goal of this study was to determine if providing complimentary oral nutritional supplementation for patients undergoing definitive radiation therapy for oropharyngeal carcinoma reduced weight loss and the need for percutaneous endoscopic gastrostomy (PEG) tube placement. The data from 79 patients undergoing radiotherapy for oropharyngeal cancer were extracted and analyzed retrospectively from an institutional Human Investigation Committee approved database for the study of advanced radiation therapy techniques for head and neck cancer. Forty patients were treated before the initiation of a nutritional supplementation program, and 39 patients received supplementation. Patients were stratified by type of treatment (radiation alone or chemoradiation) and whether or not they had a PEG tube. All patient groups receiving supplementation manifested a significant decrease in weight loss compared to those who did not receive it. Nutritional supplementation was associated with a 40% relative reduction in weight loss in patients treated with radiotherapy alone (6.1 vs 10.1%, p = 0.008) and a 37% reduction in weight loss in patients treated with chemoradiotherapy (6.7 vs 10.7%, p = 0.007). When patients were stratified by the presence or absence of a PEG tube, both groups experienced a 39% relative reduction in weight loss (with PEG, 5.7 vs 9.3%, p = 0.028; without PEG, 6.9 vs 11.2%, p = 0.002). Supplementation was associated with a decreased need for PEG tube placement (31% decreased to 6%) in patients treated with radiotherapy alone. Providing complimentary oral nutritional supplementation significantly decreases weight loss and the need for PEG tube placement in patients undergoing radiation therapy for oropharyngeal cancer.

Guidelines for the treatment of venous ulcers

1. Co-chaired this panel2. University of South Florida, Tampa, FL3. Healthpoint Ltd., Fort Worth, TX4. University of California, San Francisco, CA5. University of Texas Medical Branch, Galveston, TX6. University of Cardiff, Cardiff, Wales, UK7. University of Pennsylvania, Philadelphia, PA8. Private practice, Warren, PA9. Private practice, Tamarac, FL10. University of Pittsburgh, Pittsburgh, PA11. St. Louis University, St. Louis, MO, and12. Washington University, St. Louis, MO

Use of oral nutritional supplements in patients with Huntington’s disease

Objective This study assessed the effect of oral nutritional supplements on the nutritional status of patients with Huntington’s disease. Methods This was an experimental, longitudinal, prospective study of 30 patients with Huntington’s disease. We performed neurologic evaluation and dietary assessment and measured anthropometric indexes and biochemical indicators; in addition, patients were questioned about their weight, appetite, chewing difficulty, and dysphagia. Patients consumed two cans daily of a nutritional supplement that contributed an extra 473 kcal to their diet for a 90-d period. At the study’s end, the supplement was suspended and the same variables were reassessed. Results After 90 d, 68.7% of patients had increased body weight, 68.7% had ideal body weight percentages and body mass indexes, 53.3% had increased midarm circumferences, and 60.0% had increased arm muscle circumferences and body fat percentages; these changes were statistically significant ( P < 0.05). The neurologic evaluation subscales and the biochemical indicators did not change significantly. With regard to subjective variables, patients who reported losing weight during the 3 mo before the study did not lose more weight and patients who reported having an increased appetite before the study remained stable during the study. Conclusions The nutritional intervention stabilized or slightly improved the anthropometric variables assessed; however, no significant change in body mass index occurred in 87% of patients. For the purpose of maintaining an acceptable nutritional status in patients who have Huntington’s disease and normal nutritional status, we suggest oral nutritional supplements that contribute an average of 473 kcal/d in addition to a normal diet.

Hemodialysis Complications

Hemodialysis Complications

Nutritional Supplementation of Very Old People at Hospital Discharge Increases Muscle Strength: A Randomised Controlled Trial

Background: Undernutrition is common in older people admitted to hospital, but little is known about how nutritional state changes after discharge. Objective: This randomised controlled trial was designed to examine the effect of oral nutritional supplementation of undernourished very old people prepared to take supplements after hospital discharge following acute illness. Methods: Participants aged ≧75 years with a BMI ≤24 kg/m² and triceps skin fold thickness or mid-arm muscle circumference below the 10th centile and/or weight loss ≧5% during an acute hospital stay were allocated at random to either oral nutritional supplementation for 8 weeks from hospital discharge or to usual care. Primary outcome was change in weight, secondary outcomes were handgrip strength and anthropometry. Results: Of 198 patients eligible to participate, 136 patients (mean age 85 years) were randomised and 76/136 (56%) completed the study. Twenty percent (13/66) of the intervention group withdrew after only 2 weeks, citing intolerance of the supplements. Using intention-to-treat analysis, body weight increased by a mean of 1.6 and 2.2% in the control and intervention groups, respectively, but this between-group difference was not significant (p = 0.188). However, handgrip strength increased more (p = 0.055) in the intervention group (13.9%) than in the control group (7.2%). Conclusions: Oral nutritional supplementation was associated with a greater increase in handgrip strength than in non-supplemented controls and this observation merits further study.

Effects of Oral Nutritional Supplementation on Nutritional Status in Chronic Hemodialysis Patients

Protein-calorie malnutrition is common in chronic hemodialysis (CHD) patients and is associated with poor outcome. Very few studies of oral nutritional supplementation have been conducted and these have shown mixed results. Objective : To evaluate nutritional status in our CHD patients receiving oral nutritional supplementation over a period of 6 months. Methods : 22 CHD patients with evidence of malnutrition were included in this prospective study. The inclusion criteria were serum albumin of ≤ 3.5 g/dL or serum prealbumin of ≤ 30 mg/dL and a decrease of dry weight ≥ 5% in the last 3 months or ≥ 10% in the last 6 months. Patients received nutrition intervention by various oral nutritional supplements providing 450 calories and 15.4 grams of protein per day. Compliance was assessed by questioning patients at each HD session. Nutritional parameters were recorded and results were analyzed using paired t test to examine the difference between compliant and non-compliant patients for each nutritional parameter at baselines and 6-month follow-up. Results : 10 patients were considered as non-compliant because ingesting < 75% of prescribed nutritional supplementation. In compliant patients, there were significant increases in concentrations of serum albumin (3.14 ± 0.72 vs 3.57 ± 0.95 g/dL, p < 0.01), serum prealbumin (24.7 ± 6.3 vs 29.5 ± 4.7 mg/dL, p < 0.01) and of the estimated dry weight (64.2 ± 8.5 vs 67.9 ± 6.1 kg, p < 0.05). There was not any significant modification of nutritional markers in non-compliant patients. Dietary intake estimated by dietary recall was unchanged during the study in all patients. Conclusions : When observed, oral nutritional supplementation is effective to improve nutritional markers in malnourished CHD patients. Limits of this intervention are weariness and non-compliance over time.

Therapeutic effects of oral nutritional supplementation during hemodialysis

Protein-calorie malnutrition is common in chronic hemodialysis (CHD) patients and correlates with morbidity and mortality in these patients. There are limited trials evaluating the efficacy of oral nutritional supplementation in malnourished CHD patients. Eighty-five CHD patients with evidence of malnutrition were included in this prospective study. Patients were followed for a 3-month baseline period during which they received conventional nutrition counseling. This was followed by an intervention period, during which an oral nutritional supplement specifically formulated for CHD patients was given over a period of 6 months. An important element of this study was that the nutritional supplement was provided during dialysis to ensure compliance. Serial measurements of nutritional parameters including concentrations of serum albumin, prealbumin, transferrin as well as body mass index (BMI) and subjective global assessment (SGA) were obtained during the 9-month period. The nutritional parameters did not change during the 3-month baseline period. Following administration of oral supplementation during hemodialysis, there were significant increases in concentrations of serum albumin (from 3.33 +/- 0.32 g/dL at baseline, to 3.65 +/- 0.26 g/dL at month 6, P < 0.0001) and serum prealbumin (from 26.1 +/- 8.6 mg/dL at baseline, to 30.7 +/- 7.4 mg/dL at month 6, P = 0.002). Mean SGA score increased 14% by the end of the study (P = 0.023). Although BMI and estimated dry weight increased also, these changes were not statistically significant. Serum transferrin did not change during the study period. Oral nutritional supplementation given during hemodialysis improves nutritional markers in malnourished CHD patients.