Effects Of Oral Nutritional Supplements Research Articles

Long-Term Effects of Oral Nutritional Supplements After Gastrectomy for Gastric Cancer: A Survival Analysis from a Multicenter, Open-Label, Randomized Controlled Trial.

Weight loss (WL) after gastrectomy for gastric cancer is associated with both decreased compliance with adjuvant chemotherapy and impaired survival. This study examined the effects of administering oral nutritional supplements (ONS) for 3months after gastrectomy in terms of compliance with adjuvant chemotherapy and survival outcomes. This large-scale, multicenter, open-label, randomized controlled trial enrolled 1,003 gastric cancer patients undergoing curative gastrectomy. Patients were assigned to the control group (n = 503) or ONS group (n = 500). In the ONS group, 400kcal/day of ONS was recommended in addition to a regular diet for 3months after gastrectomy. Compliance with adjuvant chemotherapy and survival outcomes were compared between the two groups. Compared with the control group, the ONS group showed significantly decreased WL at 3months after gastrectomy (8.6 ± 6.1 vs. 7.2 ± 5.7%, respectively, P = 0.0004). The control and ONS groups did not differ regarding the induction rate of adjuvant chemotherapy (84.9 vs. 82.8%, respectively, P = 0.614) or the continuation rate at 3months postoperatively (75.3 vs. 76.6%, respectively, P = 0.809). Oral nutritional supplements for 3months showed no survival benefit; the 3- and 5-year overall survival (OS) rates were 91.3% and 87.6% in the control group and 89.6% and 86.4% in the ONS group, respectively, indicating no significant difference (P = 0.548). Subgroup analysis could not detect a population in which ONS administration increased OS. Administration of ONS for 3months after gastrectomy was not associated with increased compliance with adjuvant chemotherapy or with improved prognosis.

Long-Term Effects of Oral Nutritional Supplements After Gastrectomy for Gastric Cancer: A Survival Analysis from a Multicenter, Open-Label, Randomized Controlled Trial.

Weight loss (WL) after gastrectomy for gastric cancer is associated with both decreased compliance with adjuvant chemotherapy and impaired survival. This study examined the effects of administering oral nutritional supplements (ONS) for 3months after gastrectomy in terms of compliance with adjuvant chemotherapy and survival outcomes. This large-scale, multicenter, open-label, randomized controlled trial enrolled 1,003 gastric cancer patients undergoing curative gastrectomy. Patients were assigned to the control group (n = 503) or ONS group (n = 500). In the ONS group, 400kcal/day of ONS was recommended in addition to a regular diet for 3months after gastrectomy. Compliance with adjuvant chemotherapy and survival outcomes were compared between the two groups. Compared with the control group, the ONS group showed significantly decreased WL at 3months after gastrectomy (8.6 ± 6.1 vs. 7.2 ± 5.7%, respectively, P = 0.0004). The control and ONS groups did not differ regarding the induction rate of adjuvant chemotherapy (84.9 vs. 82.8%, respectively, P = 0.614) or the continuation rate at 3months postoperatively (75.3 vs. 76.6%, respectively, P = 0.809). Oral nutritional supplements for 3months showed no survival benefit; the 3- and 5-year overall survival (OS) rates were 91.3% and 87.6% in the control group and 89.6% and 86.4% in the ONS group, respectively, indicating no significant difference (P = 0.548). Subgroup analysis could not detect a population in which ONS administration increased OS. Administration of ONS for 3months after gastrectomy was not associated with increased compliance with adjuvant chemotherapy or with improved prognosis.

The effects of oral nutritional supplements on functional outcomes and body composition in patients with solid cancer undergoing systemic chemotherapy: A pilot study.

10074 Background: Cancer cachexia is a complex syndrome characterized by significant weight loss and depletion of skeletal muscle mass. Despite its profound impact on the well-being of cancer patients, the effective management of cancer cachexia remains a challenging and underexplored aspect of oncology. This study aims to investigate the potential benefits of oral nutritional supplements (ONS) to cancer patients undergoing chemotherapy. Methods: This is single-arm, prospective pilot study. Patients with cancer cachexia undergoing chemotherapy were included. Patients received ONS twice a day for 8 weeks. The ONS contained 200 kcal, 22.5 gram of carbohydrates, 7.5 gram of fat, and 12.5 gram of protein per 200 mL. Primary endpoints were improvements of lean body mass and physical performance. The secondary endpoints were changes of health-care related quality-of-life (HRQoL), nutritional status, and gut microbiomes profiles. EORTC-QLQ-C30 questionnaire, body composition analysis, 4-meter-walk test, hand grip strength test, and fecal microbiome analysis were conducted at baseline and after 8 weeks. The bacterial 16S rRNA gene (V3 and V4 region) was amplified using PCR and sequenced on the Illumina MiSeq platform. The QIIME 2 pipelines were used to analyze the raw data. Results: From January 2023 to October 2023, total of 10 patients were included. There were no significant differences of the mean daily energy intake (p=0.62) and calf-circumferences (p=0.2) between baseline and after 8 weeks. However, participants exhibited a statistically significant improvement in hand-grip strength (p=0.002) and 4-meter walk test (p=0.021) after 8 weeks. In the body composition analysis using dual-energy X-ray absorptiometry, no differences were observed in body weight (p=0.43), fat mass (p=0.62), fat-free mass (p=0.27), and fat-free mass index (p=0.38). Also, no significant differences were detected in the results of HRQoL survey (p=0.85). In the microbiome analysis, no differences of microbiome composition at phylum and genus levels, α-diversity, and β-diversity were observed between baseline and after 8 weeks. Conclusions: While ONS have shown potential in enhancing physical functions of patients with cancer cachexia undergoing chemotherapy, this did not correlate with the anticipated microbiome changes or improvements in body composition. The absence of expected microbiome alterations, despite enriched protein and dietary fiber, underscores the complexity of cachexia and indicates that its management may extend beyond nutritional supplementation alone. Further research should explore the broader context of cachexia, including nutrition, metabolic processes, and the impact of chemotherapy.

Oral Nutritional Supplement Prescription and Patient-Reported Symptom Burden Among Patients With Late-Stage Non-Dialysis Chronic Kidney Disease.

Malnutrition and protein-energy wasting (PEW) are nutritional complications of advanced chronic kidney disease (CKD) that contribute to morbidity, mortality, and decreased quality of life. No previous studies have assessed the effect of oral nutritional supplements (ONSs) on patient-reported symptom burden among patients with non-dialysis CKD (CKD-ND) who have or are at risk of malnutrition/PEW. The objective of this study was (1) to quantify the associations between baseline nutritional parameters and patient-reported symptom scores for wellbeing, tiredness, nausea, and appetite and (2) to compare the change in symptom scores among patients prescribed ONS with patients who did not receive ONS in a propensity-score-matched analysis. This study conducted observational cohort analysis using provincial registry data. This study was done in multidisciplinary CKD clinics in British Columbia. Adult patients >18 years of age with CKD-ND entering multidisciplinary CKD clinics between January 1, 2010-July 31, 2019 who had at least 2 Edmonton Symptom Assessment System Revised: Renal (ESASr:Renal) assessments. The measurements include nutrition-related parameters such as body mass index (BMI), serum albumin, serum phosphate, serum bicarbonate, neutrophil-to-lymphocyte ratio (NLR), and ESASr:Renal scores (overall and subscores for wellbeing, tiredness, nausea, and appetite). Multivariable linear regression was applied to assess associations between nutritional parameters and ESASr:Renal scores. Propensity-score matching using the greedy method was used to match patients prescribed ONS with those not prescribed ONS using multiple demographic, comorbidity, health care utilization, and temporal factors. Linear regression was used to assess the association between first ONS prescription and change in ESASr:Renal overall score and subscores for wellbeing, tiredness, nausea, and appetite. Of total, 2076 patients were included. Higher baseline serum albumin was associated with lower overall ESASr:Renal score (-0.20, 95% confidence interval [CI] = -0.40 to -0.01 per 1 g/L increase in albumin), lower subscores for tiredness (-0.04, 95% CI = -0.07 to -0.01), nausea (-0.03, 95% CI = -0.04 to -0.01), and appetite (-0.03, 95% CI = -0.06 to -0.01). Higher BMI was associated with higher overall ESASr:Renal score (0.32, 95% CI = 0.16 to 0.48 per 1 kg/m2 increase in BMI), higher symptom subscores for wellbeing (0.02, 95% CI = 0.00 to 0.04) and tiredness (0.05, 95% CI = 0.02 to 0.07). Higher baseline NLR was associated with higher overall score (0.21, 95% CI = 0.03 to 0.39 per 1 unit increase in NLR), higher symptom subscores for wellbeing (0.03, 95% CI = 0.01 to 0.05) and nausea (0.03, 95% CI = 0.02 to 0.05). In the propensity-score-matched analysis, there were no statistically significant associations between ONS prescription and change in overall ESASr:Renal (beta coefficient for change in ESASr:Renal = 0.17, 95% CI = -2.64 to 2.99) or for subscores for appetite, tiredness, nausea, and wellbeing. Possible residual confounding. The ESASr:Renal assessments were obtained routinely only in patients with G5 CKD-ND and/or experiencing significant CKD-related symptoms. This exploratory observational analysis of patients with advanced non-dialysis CKD demonstrated BMI, serum albumin, and NLR were modestly associated with patient-reported symptoms, but we did not observe an association between ONS use and change in ESASr:Renal scores.

Effect of oral nutritional supplementation on outcomes in older adults with hip fractures and factors influencing compliance.

Hip fractures are a major cause of morbidity and mortality, and malnutrition is a crucial determinant of these outcomes. This meta-analysis aims to determine whether oral nutritional supplementation (ONS) improves postoperative outcomes in older patients with a hip fracture. A systematic literature search was conducted in August 2022. ONS was defined as high protein-based diet strategies containing (or not containing) carbohydrates, fat, vitamins, and minerals. Randomized trials documenting ONS in older patients with hip fracture (aged ≥ 50 years) were included. Two reviewers evaluated study eligibility, conducted data extraction, and assessed study quality. There were 812 studies identified, of which 18 studies involving 1,522 patients met the inclusion criteria. The overall meta-analysis demonstrated that ONS was associated with significantly elevated albumin levels (weighted mean difference (WMD) 1.24 (95% confidence interval (CI) 0.95 to 1.53)), as well as a significant risk reduction in infective complications (odds ratio (OR) 0.54 (95% CI 0.39 to 0.76)), pressure ulcers (OR 0.54 (95% CI 0.33 to 0.88)), and total complications (OR 0.57 (95% CI 0.42 to 0.79)). Length of hospital stay (LOS) was also significantly reduced (WMD -2.36 (95% CI -4.14 to -0.58)), particularly in rehabilitation LOS (WMD -4.17 (95% CI -7.08 to -1.26)). There was a tendency towards a lower mortality risk (OR 0.93 (95% CI 0.62 to 1.4)) and readmission (OR 0.52 (95% CI 0.16 to 1.73)), although statistical significance was not achieved (p = 0.741 and p = 0.285, respectively). The overall compliance with ONS ranged from 64.7% to 100%, but no factors influencing compliance were identified. This meta-analysis is the first to quantitatively demonstrate that ONS could nearly halve the risk of infective complications, pressure ulcers, total complications, as well as improve serum albumin and reduce LOS. ONS should be a regular and integrated part of the perioperative care of these patients, especially given that the compliance with ONS is acceptable.

Oral Nutritional Supplements Reduce Body Weight Loss after Gastrectomy in Patients with Gastric Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

This systematic review and meta-analysis aimed to summarize the effects of oral nutritional supplements (ONSs) on body weight loss (BWL) after gastrectomy. A systematic search was conducted across the PubMed, Cochrane, and Embase databases through May 2023. The study inclusion criteria were as follows: (1) studies on interventions including ONSs after gastrectomy in patients with gastric cancer; (2) studies in which comparisons were specified according to standard, regular, or usual postoperative diets; and (3) randomized controlled trial studies including outcomes measured as mean differences in BWL. The data were pooled using the random-effects model and expressed as mean differences with 95% confidence intervals (CI). Based on data from seven studies including 1743 patients (891 for ONSs and 852 for the control), the overall pooled mean difference was 0.848 (95% CI: 0.466 to 1.230) and the Higgins I2 value was 86.0%. This systematic review and meta-analysis is the first study to show that ONSs are significantly associated with reducing BWL, compared with standard diets, after gastrectomy in patients with gastric cancer. Furthermore, we found that ONSs were more effective in patients with lower nutritional kilocalorie intake after gastrectomy.

Effect of Oral Nutrition Supplementation (ONS) contains phosphatidylserine, choline, and uridine on cognitive function and quantitative electroencephalography in elderly patients with mild and moderate dementia

Objectives: Cognitive function gradually deteriorating over time is a symptom of dementia. Increased delta and theta slow wave activity is associated with decreased cognitive function. The study aimed to determine the effect of oral nutritional supplementation containing phosphatidylserine, choline, and uridine on improving cognitive function and quantitative electroencephalographic features in older people with mild-moderate dementia. Method: A pre-experimental study with the design of one groups pretest-posttest at Dr. Radjiman Wediodiningrat Malang's psychogeriatric clinic from January to March 2020. A total research subjects were 19. Oral nutritional supplementation containing phosphatidylserine, choline, and uridine in milk is given for four weeks. Laboratory and cognitive function tests using MMSE and MoCA-Ina scores and QEEG examinations were performed before and after supplementation. Results: The MMSE and MoCA-Ina scores showed improved cognitive function after four weeks of supplementation with p<0.000 and p<0.000, respectively. The QEEG picture before supplementation showed that from 19 subjects, hyperactivity was obtained from the slow wave type, namely Delta waves (0.1-4 Hz) and theta (4-8 Hz), namely 63.16% and 89.47% of subjects. After supplementation, there was a decrease in hyperactivity to 31.58% and 47.37% with a significance of 0.006 and 0.003 (p<0.05), so it was concluded that there was a significant difference in the appearance of delta and theta waves on QEEG examination. Conclusion: Oral nutritional supplementation containing phosphatidylserine, choline, and uridine showed improvement in cognitive function, and quantitative electroencephalograph showed a significant difference in changes in delta and theta wave hyperactivity that affected attention improvement in cognitive domains of dementia subjects.

Effect of oral nutritional supplements on outcomes in children presenting with, or at risk of, faltering growth in clinical settings: A systematic review and meta-analysis.

This systematic review summarises evidence regarding oral nutritional supplement (ONS) use in children with, or at risk of, faltering growth (FG). Ten randomised controlled trials (RCTs), compared changes in outcomes amongst children receiving ONS versus control were included. Overall, 1116 children (weighted mean (WM) age 5years; n658 (59%) male) were recruited, of which 585 (52%) received ONS (WM intake contribution 412kcal, 16.3g protein, 395ml) for 116days (WM). ONS use was associated with significantly greater gains in weight (mean difference (MD) 0.4kg, 95% CI [0.36, 0.44]) and height (MD 0.3cm, 95% CI [0.03, 0.57]), likely related to improvements in nutritional intake. Mean compliance to prescribed dose was 98%. Data suggested an association between ONS use and reduced infections. Further research is warranted to establish ONS dosage and effects upon other outcomes. This review provides evidence to support use of ONS in the management of children with, or at risk of, FG.

Effect of Oral Nutritional Supplements (ONS) on Weight of Malnourished Children in Developing Countries

Malnutrition during childhood is the condition which is at the high priority of world health concerning management and control. Malnutrition is the significant contributor of children death in several areas around the world. The factors that causes malnutrition in children are varied and multifaceted ranging from the political flux, cultural and social values, sluggish economic progress and various communicable diseases. The struggle to avoid and control malnutrition in childhood therefore need demands comprehensive investigation. The primary attribute of these investigations and measure could include a complete policy agenda regarding mother and child health to ensure maximum nutrition program along with regular monitoring in the growing children. RUSFs are the best to meet their nutritional requirements. It is obtained from and contains vegetable oil inter alia the dry skimmed milk. RUSF contains 513 Kcal. The reference weight increase is 5g/kg/day. RUSF is used for 3 to 4 months. The brands used in study are acha mum, wawa mum. Based on the results obtained it is recommended that Oral Nutritional Supplement RUSF should be provided to the mal- nourished children for their healthy growth.

Effects of oral nutritional supplements on the nutritional status and inflammatory markers in patients on maintenance dialysis: a systematic review and meta-analysis of randomized clinical trials.

Patients on hemodialysis (HD) or peritoneal dialysis (PD) often have insufficient energy and protein intake, resulting in poor nutritional status and adverse outcomes. Oral nutritional supplements (ONSs) are the most commonly used to increase such patients' energy and protein intakes. In this systematic review and meta-analysis, we analyzed studies on nutritional status, inflammatory markers, and electrolyte levels in patients on dialysis receiving ONSs. We searched four electronic databases from inception until 31 December 2022, for randomized controlled trials comparing ONS treatment versus placebo or routine care. 22 studies with 1185 patients on dialysis were included in our meta-analysis. Compared with the control group, the ONS group exhibited significantly increased serum albumin levels [1.26g/l (95%CI, 0.50-2.02, P<0.0001; I2=80.4%)], body mass indexes (BMIs) [0.30kg/m2 (95%CI, 0.09-0.52, P=0.005; I2=41.4%)], and handgrip strength (HGS) [0.96kg (95%CI, 0.07-1.84, P=0.034; I2=41.4%)] from baseline to the end of intervention. No significant differences were observed between the groups in lean body mass, phase angle, C-reactive protein, and serum phosphorus and potassium levels. In terms of improving albumin, the subgroup analyses show that ONS use seems to be more inclined to three variations: HD patients, short-term use, and non-intradialytic supplementation. In conclusion, ONS use can improve the nutritional status of patients on dialysis in terms of their serum albumin, BMI, and HGS without significant effects on serum phosphorus, potassium, and C-reactive protein levels. However, it remains uncertain whether these results translate to improvement in clinically relevant outcomes. Large-scale high-quality studies are still required in this population.

Role of nutritional supplements on oral health in adults - A systematic review.

Purpose: The word 'diet' usually encompasses the consumption of food that includes all the necessary nutrients required for the optimal functioning of the body. Nutritional supplements hold a supreme position due to the demanding lifestyles or medical conditions in this current era. Although medical literature has sufficient evidence exploring the effect of nutrients on general health, this systematic review aimed at specifically evaluating the role of nutritional supplements on oral health in adults. Methods: PRISMA guidelines were followed in conducting this systematic review where four electronic databases including Scopus, PubMed, EMBASE, and Web of Science were reviewed. Based on the inclusion criteria, four studies exploring the effect of oral nutritional supplements on oral health among the adult population were included in this systematic review. Results: This review generated evidence suggesting a positive effect of nutritional supplements on oral health. These findings were depicted in the form of a reduction in plaque scores, probing depths, gingival inflammation, and greater improvement in periodontal healing among individuals with higher intakes of nutritional supplements within recommended doses. Conclusions: The systematic review outlines the positive impact of consuming nutritional supplements in the recommended dosage on oral health.Additionally, this review stresses the necessity for interventional studies to further investigate the effects of nutritional supplements on oral health, particularly in regard to periodontal healing. PROSPERO registration: CRD42021287797 (27/11/2021).

Long-term effects of oral nutritional supplement with hmb on clinical and nutritional outcomes in community-dwelling older adults at risk of malnutrition: a randomized, placebo-controlled trial

Long-term effects of oral nutritional supplement with hmb on clinical and nutritional outcomes in community-dwelling older adults at risk of malnutrition: a randomized, placebo-controlled trial

Effect of oral nutritional supplementation combined with impedance vectors for dry weight adjustment on the nutritional status, hydration status and quality of life in patients on chronic hemodialysis: A pilot study

Protein energy wasting frequently affect hemodialysis patients and contribute to the development of overhydration. The objective of this study was to assess the effect of oral nutritional supplementation (ONS) combined with bioelectrical vector analysis (BIVA) on the nutritional and hydration status and the quality of life (QoL) in hemodialysis (HD) patients. Thirty-two chronic HD patients were included in a 6-month randomized pilot study. Patients in SUPL group received a simultaneous intervention consisting of a personalized diet, 245mL/d ONS and dry weight adjustment through BIVA. Patients in CON group received a personalized diet and dry weight adjustment by BIVA. Anthropometrical, biochemical, dietary, QoL, handgrip strength (HGS) and bioimpedance measurements were performed. Malnutrition Inflammation Score (MIS) was applied. At the end of the intervention, moderate undernutrition decreased by 43.8% in SUPL group while in CON group, severe undernutrition increased by 13% (p<0.04 between groups). In the adjusted covariance analysis, SUPL compared to CON group, increased HGS (Δ 2.8Kg vs Δ-1.8Kg, p=0.003), serum albumin (Δ 0.29g/dL vs Δ-0.03g/dL, p=0.04) and serum transferrin (Δ 4.7mg/dL vs Δ-0.7mg/dL, p=0.0007). The increase in QoL was significantly higher in SUPL group. Dry weight was achieved in 100% of patients in SUPL and 95% in CON group. ONS combined with BIVA for dry weight adjustment, improved nutritional status, QoL and achieved dry weight in HD patients.

Oral nutritional interventions in frail older people who are malnourished or at risk of malnutrition: a systematic review.

Malnutrition worsens the health of frail older adults. Current treatments for malnutrition may include prescribed oral nutritional supplements, which are multinutrient products containing macronutrients and micronutrients. To assess the effectiveness and cost-effectiveness of oral nutritional supplements (with or without other dietary interventions) in frail older people who are malnourished or at risk of malnutrition. MEDLINE, EMBASE, Cochrane Library, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and grey literature were searched from inception to 13 September 2021. A systematic review and meta-analysis was conducted to evaluate the effectiveness and cost-effectiveness of oral nutritional supplements in frail older people (aged ≥ 65 years) who are malnourished or at risk of malnutrition (defined as undernutrition as per National Institute for Health and Care Excellence guidelines). Meta-analysis and network meta-analysis were undertaken, where feasible, along with a narrative synthesis. A cost-effectiveness review was reported narratively. A de novo model was developed using effectiveness evidence identified in the systematic review to estimate the cost-effectiveness of oral nutritional supplements. Eleven studies (n = 822 participants) were included in the effectiveness review, six of which were fully or partly funded by industry. Meta-analyses suggested positive effects of oral nutritional supplements compared with standard care for energy intake (kcal) (standardised mean difference 1.02, 95% confidence interval 0.15 to 1.88; very low quality evidence) and poor mobility (mean difference 0.03, p < 0.00001, 95% confidence interval 0.02 to 0.04; very low quality evidence) but no evidence of an effect for body weight (mean difference 1.31, 95% confidence interval -0.05 to 2.66; very low quality evidence) and body mass index (mean difference 0.54, 95% confidence interval -0.03 to 1.11; very low quality evidence). Pooled results for other outcomes were statistically non-significant. There was mixed narrative evidence regarding the effect of oral nutritional supplements on quality of life. Network meta-analysis could be conducted only for body weight and grip strength; there was evidence of an effect for oral nutritional supplements compared with standard care for body weight only. Study quality was mixed; the randomisation method was typically poorly reported. One economic evaluation, in a care home setting, was included. This was a well-conducted study showing that oral nutritional supplements could be cost-effective. Cost-effectiveness analysis suggested that oral nutritional supplements may only be cost-effective for people with lower body mass index (< 21 kg/m2) using cheaper oral nutritional supplements products that require minimal staff time to administer. The review scope was narrow in focus as few primary studies used frailty measures (or our proxy criteria). This resulted in only 11 included studies. The small evidence base and varied quality of evidence meant that it was not possible to determine accurate estimates of the effectiveness or cost-effectiveness of oral nutritional supplements. Furthermore, only English-language publications were considered. Overall, the review found little evidence of oral nutritional supplements having significant effects on reducing malnutrition or its adverse outcomes in frail older adults. Future research should focus on independent, high-quality, adequately powered studies to investigate oral nutritional supplements alongside other nutritional interventions, with longer-term follow-up and detailed analysis of determinants, intervention components and cost-effectiveness. This study is registered as PROSPERO CRD42020170906. This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 51. See the NIHR Journals Library website for further project information.

Plasma Metabolomic Profiles Are Imbalanced in Adults Thalassemia Patients with Malnutrition and That Imbalance Is Alleviated By Oral Nutritional Supplements: A Prospective Randomized Controlled Trial

Background: Malnutrition is a common condition observed in children with thalassemia. However, the prevalence of malnutrition, alterations of plasma metabolomes, and the impact of nutritional supplements in adults with thalassemia were still unclear. Objectives: To evaluate the prevalence of malnutrition and plasma metabolomic profiles of adult thalassemia when compared with healthy control, as well as to evaluate the effects of oral nutritional supplements (ONS) on nutritional status and metabolomic profiles in those thalassemia patients with malnutrition Methods: Adult thalassemia (n=100) and healthy control (n=20) aged ≥ 18 years old were enrolled in the present study. This study was divided into 2 phases. Phase I of the study: All participants were assessed nutritional status by nutrition assessment 2013 (NT-2013), serum biomarkers (albumin, transferrin), and anthropometry. Plasma metabolomes including amino acids, long-chain free fatty acids, acylcarnitines (C0-18), and Krebs cycle metabolites were measured by liquid chromatography-quadrupole time-of-flight mass spectrometry (LC/Q-TOF-MS). All outcomes were compared among 3 groups including thalassemia with malnutrition, thalassemia without malnutrition, and healthy control. Phase II of the study, thalassemia patients with malnutrition, defined as NT-2013 score of 5 or more, were randomized into two subgroups. Each subgroup received either ONS or nutritional advice by a nutritionist for 3 months. ONS consisted of oral complete formula (Blendera-MF®) and/or whey protein based on the assessment by food questionnaire to achieve the target of individual total daily energy expenditure (Harris-Benedict equation multiplied with activity factor) and total protein of 1.3 g/kg/day. NT-2013, anthropometric parameters, serum biomarkers, and plasma metabolomes were re-evaluated after 12 weeks in each subgroup. ONS adherence was assessed every 2 weeks during the study period. Those with less than 80% ONS adherence were excluded from the final analysis. Results: A total of 100 patients were enrolled with a mean age of 34.9 years (range 18-60). Of which, 65.3% were females and 58.1% were transfusion-dependent thalassemia (TDT). The prevalence of malnutrition was 20% (15% mild, 85% moderate degree). Malnutrition was more common in TDT than non-TDT (30.9% vs 6.7%, p=0.003). Twenty age, sex, and body mass index-matched healthy controls were also enrolled. Regarding plasma amino acids, baseline alanine, proline, and tyrosine were significantly increased while arginine was significantly decreased in malnourished patients. Fatty acid-derived acylcarnitines (C12-18) were significantly increased in malnourished patients compared to the control group. Long-chain free fatty acids were not different between groups. Considering Krebs cycle, citrate was significantly decreased, but malate was significantly increased in malnourished patients compared to the control group (Table 1). Three participants had less than 80% ONS adherence. After 12 weeks, the mean NT-2013 score in overall malnourished patients significantly improved, when compared to their baseline (6.0±1.1 to 5.2±1.5, p=0.029). However, there was a trend of more improvement in ONS group than nutritional advice group (6.1±1.0 to 5.0±1.5, p=0.084 vs. 5.9±1.2 to 5.5±1.5, p=0.223). Fatty acid-derived acylcarnitines (C8-18) and malate were significantly decreased after ONS (Table 2). Anthropometric parameters, serum biomarkers, long-chain free fatty acids, and amino acids were not changed. Conclusions: The prevalence of malnutrition in adult thalassemia was 20%. Plasma metabolomic profiles suggested that the malnourished thalassemia had imbalanced protein turnover and incomplete fatty acid oxidation, resulting in the disruption of Krebs' cycle. Among thalassemia patients with malnutrition, both ONS and nutritional advice led to improve nutritional status. ONS for 12 weeks also promoted more complete fatty acid oxidation in malnourished thalassemia. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Effects of Oral Nutritional Supplementation on Patients with Venous Ulcers: A Clinical Trial.

Background: The dosage and safety of nutritional supplements for patients with venous ulcers are still not well established. Aim: To evaluate the effects of a high calorie, high protein, arginine-, zinc-, and vitamins A, C, and E-enriched nutritional supplement on the biochemical profile, dietary intake, anthropometry, muscle strength, and characteristics of lesions of patients with venous ulcers. Methods: A controlled before–after clinical trial with a four-week follow-up involved 27 patients with venous ulcers under outpatient treatment in Brazil. It was administered in two to three doses per day (200 mL each) of a high-calorie and high-protein supplement enriched with arginine, zinc, and vitamins A, C, and E. Patients were assessed for anthropometric parameters, dietary intake, biochemical tests, and healing conditions according to the Pressure Ulcer Scale for Healing (PUSH). Results: It was observed that an increase in energy and protein supply led to an adequate intake of immunonutrients (zinc and vitamins A, C, and E), increased body weight, increased body mass index, and stronger handgrip strength. The injury area and the score on the PUSH notably decreased after the intervention (p < 0.001). Conclusions: The administered supplement, at the tested dosage, improved the nutritional status and characteristics of lesions in patients with venous ulcers.

Effect of Oral Nutritional Supplementation on National Institute of Health Stroke Scale in Acute Ischemic Stroke

BACKGROUND: Approximately, 6-31% of nutritional deficits are present before the stroke and worsen during hospitalization. Besides affecting the patient’s physical and mental abilities, stroke can also cause a decrease in nutritional status, which has a major influence on the rate of death and disability. One intervention to overcome stroke patients’ nutritional problems is giving oral nutritional supplementation. The role of oral nutritional supplementation in stroke severity in patients with acute ischemic stroke has not yet been extensively studied. AIM: This study aimed to evaluate the effect of oral nutritional supplementation on the National Institute of Health Stroke Scale (NIHSS) in patients with acute ischemic stroke. METHODS: This was an experimental study with a pre- and post-study group method. Twenty-eight patients with acute ischemic stroke were referred to Adam Malik General Hospital, Medan, Indonesia, and were allocated randomly into two groups. Fourteen patients as control group received the normal hospital diet and 14 patients as intervention group received normal hospital diet plus oral nutritional supplementation for 7 days. The NIHSS scores were assessed on the first day and the eighth day after intervention in each group. RESULTS: There were significant reductions in NIHSS scores between day 1 and day 8 in both groups (p &lt; 0.001). The mean delta NIHSS scores were −2.28 ± 1.63 and −2.57 ± 1.98 in the intervention and control groups, respectively. There was no significant difference in NIHSS scores between the intervention and control groups (p = 0.682). CONCLUSION: The effect of oral nutritional supplementation significantly reduced the NIHSS scores in acute ischemic stroke, but there was no significant difference compared to the normal hospital diet.

A Systematic Review of Oral Nutritional Supplement and Wound Healing.

To explore the current literature for effects of oral nutritional supplement on wound healing rates in humans. A systematic review of the literature was performed using the Medline and PubMed database following PRISMA guidelines. The PubMed database was searched using terms relating to oral nutritional supplement and wound healing from 1837 to March 2020. Study inclusion criteria were: (i) design: randomized controlled trials, clinical studies, observational studies, clinical trials; (ii) population: adults; and (iii) intervention: oral nutritional supplement. The search yielded 2433 studies, 313 of which were clinical trials or clinical studies. After abstract review, 28 studies qualified to be included in the review evaluating the following supplementation categories on wound healing: protein and amino acids (10), mineral, vitamin and antioxidants (9), probiotics (1), and mixed nutrients (8). Arginine and omega-3 supplement were shown to improve wound healing in head and neck cancer patients with surgical wounds by decreasing incidence of postoperative complications and reducing length of hospital stay. Mineral, vitamins, and antioxidants enriched supplements were more beneficial in increasing wound healing than non-enriched protein supplement for diabetic foot and pressure ulcers. Supplementation of a variety of nutrients had variable effects on improving wound healing in different types of wounds. However, further research on the impact of nutritional supplements on surgical wound healing is necessary. The impact of multiple nutrient formulations may also need to be further evaluated for efficacy.

The effect of oral nutritional supplements on the nutritional status of community elderly people with malnutrition or risk of malnutrition.

To evaluate the effect of oral nutritional supplements (ONS) on community elderly people with malnutrition or risk of malnutrition. A single arm intervention trial for 3 months was conducted. Whole nutrient powder was given to all the participants. Dietary intakes were measured by 3-day diet record. Nutritional status was evaluated using body weight, body mass index (BMI), calf circumference (CC), and Mini Nutritional Assessment Short-Form (MNA-SF) scores. Muscle mass was measured by bioimpedance analysis (BIA). All these parameters as well as muscle strength, physical function, and quality of life were measured at both the baseline and the end. Compared with the baseline, ONS increased protein intake (58.32±16.67 vs 41.90±18.49 g/d, p<0.001), body weight (57.03±8.31 vs 56.68±8.23 kg, p<0.05), BMI (22.16±2.13 vs 22.02±2.08 kg/m2, p<0.05), CC (34.21±2.53 vs 33.80±2.53 cm, p<0.001), MNA-SF scores (12.61±1.43 vs 10.48±0.99, p<0.05), hand grip strength (24.54±8.05 vs 23.27±7.74 kg, p<0.001), and 6-m gait speed (1.11±0.33 vs 0.96±0.28 m/s, p<0.001). Moreover, SF-36 scores of the overall subjects have been improved in all dimensions (p<0.05). The study demonstrated that ONS can effectively increase protein intake and improve nutritional status, muscle strength, physical function and quality of life of the elderly with malnutrition or malnutrition risk in communities.

Effect of Oral Nutritional Supplementation on Growth in Children with Undernutrition: A Systematic Review and Meta-Analysis.

Oral nutritional supplements (ONS) are used to promote catch-up growth in children with undernutrition. We conducted a systematic review and meta-analysis to summarize the evidence of ONS intervention effects on growth for 9-month- to 12-year-old children who were undernourished or at nutritional risk. Eleven randomized controlled trials met the inclusion criteria; trials compared changes in anthropometric measures in children using ONS or ONS + DC (dietary counselling) to measures for those following usual diet or placebo or DC alone. The RCTs included 2287 children without chronic diseases (mean age 5.87 years [SD, 1.35]; 56% boys). At follow-up time points up to 6 months, results showed that children in the ONS intervention group had greater gains in weight (0.423 kg, [95% confidence interval 0.234, 0.613], p < 0.001) and height (0.417 cm [0.059, 0.776], p = 0.022) versus control; greater gains in weight (0.089 kg [0.049, 0.130], p < 0.001) were evident as early as 7–10 days. Longitudinal analyses with repeated measures at 30, 60, and 90 days showed greater gains in weight parameters from 30 days onwards (p < 0.001), a trend towards greater height gains at 90 days (p = 0.056), and significantly greater gains in height-for-age percentiles and Z-scores at 30 and 90 days, respectively (p < 0.05). Similar results were found in subgroup analyses of studies comparing ONS + DC to DC alone. For children with undernutrition, particularly those who were mildly and moderately undernourished, usage of ONS in a nutritional intervention resulted in significantly better growth outcomes when compared to control treatments (usual diet, placebo or DC alone).