Impact Of Oral Nutritional Supplements Research Articles

Exploring the Possible Impact of Oral Nutritional Supplements on Children's Oral Health: An In Vitro Investigation.

Eight pediatric oral nutritional supplements (ONSs) and 0.5% fat bovine milk were examined in vitro regarding their effect on the adhesion of three caries-related bacteria, Streptococcus mutans (strain CCUG 11877T), Lactobacillus gasseri (strain CCUG 31451), and Scardovia wiggsiae (strain CCUG 58090), to saliva-coated hydroxyapatite, as well as their pH and capacity to withstand pH changes. Bacteria were cultivated and radiolabeled. The adhesion assays used synthetic hydroxyapatite coated with whole or parotid saliva. Measurements of pH and titration of the products with HCl and NaOH were conducted in triplicate. Three ONSs promoted the S. mutans adhesion to saliva-coated hydroxyapatite (increase from 35% to >200%), supporting caries risk enhancement. S. wigssiae and L. gasseri adhered only to one and no ONS, respectively. Most supplements had limited buffering capacity to counteract acidification changes, suggesting their low capacity to neutralize acids, and one ONS showed a significant capacity to counteract basic changes, suggesting a high erosive potential. S. mutans adhesion was influenced by the ONS pH and volume NaOH added to reach pH 10. L. gasseri and S. wiggsiae adhesion was influenced by the ONSs' carbohydrate and fat content. Interdisciplinary efforts are needed to increase awareness and prevent the possible negative impact of ONSs on children's oral health.

PCR238 Oral Nutritional Supplementation in Pediatric Patients Diagnosed With Leukaemia Undergoing Chemotherapy: A Review of the Literature

This review aimed to find a high level of evidence on the impact of oral nutritional supplementation on the nutritional status of the pediatric population with leukaemia undergoing chemotherapy.

MO936: Oral Nutritional Supplementation Support in HAEmodialysis Patients: Impact on Nutritional Rehabilitation

Abstract BACKGROUND AND AIMS Nutritional status management and rehabilitation are significant concern treating maintenance haemodialysis (HD) patients. Oral nutritional supplements are essential to complement insufficient dietary intake, namely of energy and protein, and to rehabilitate a patient's nutritional status. Therefore, the objective of this preliminary study was to assess the impact of oral nutritional supplementation (ONS) prescription patterns on patients’ nutritional status. METHOD We did a cross-sectional analysis of HD patients’ first oral nutritional supplementation with commercial formulas between October 2018 and March 2020 in 25 outpatient HD clinics. The registered nutritionist dietitian decided to initiate, choosing the type of supplement and dose as part of a routine protocol of a comprehensive nutritional intervention and assessment. We assessed albumin, normalized protein catabolic rate, potassium and phosphate at the beginning (t = 0) and end (t = 1) of the supplementation period to understand the nutritional impact. We also estimated the daily proportion of energy, and protein contribution of each oral nutritional supplementation implemented, categorizing in cut-offs of 100 kcal and 5 g of protein. RESULTS We analyzed 398 patients, 217 (54.5%) males, 165 (41.5%) diabetic, with a median age of 79 years. Concerning feeding support status, 24.6% were autonomous, 54.8% had family care and 20.6% were institutionalized. Globally, the ONS impact was significant in the increment of albumin (P < 0.001) and nPCR (P = 0.002), although nPCR was not significant in the categorized group providing <5 g of protein/day (Table 2). The increment of K was also significant (P < 0.001) but not clinically relevant in increasing the risk of hyperkalaemia. There was no significant difference in P (P = 0.086). CONCLUSION ONS significantly impacted nutritional rehabilitation, with an albumin and nPCR increase (except for the categorized group of < 5 g protein/day). Although the increment of potassium was statistically significant, it was not clinically relevant in increasing the risk of hyperkalaemia. Further analyses are needed to understand the best targets for the energy and protein contribution of ONS.

Results of High-Protein, High-Calorie Oral Nutritional Supplementation in Malnourished Older People in Nursing Homes: An Observational, Multicenter, Prospective, Pragmatic Study (PROT-e-GER)

ObjectivesTo assess if the impact of oral nutritional supplements (ONS) on nutritional and functional status in malnourished older persons living in nursing homes shown by clinical trials are also found outside a trial setting. DesignObservational, multicenter, prospective, pragmatic study. Setting and ParticipantsThis study was carried out in 38 nursing homes throughout Spain. Nursing home physicians recruited consecutive residents, older than 65 years, with a diagnosis of malnutrition, when a clinical decision to start ONS had been taken after unsuccessful initial management with dietary interventions. InterventionThe participants received daily 2 bottles of an energy-rich, high-protein commercial ONS for 3 months. MeasuresPrimary outcomes were changes in nutritional status [body weight, body mass index (BMI), and Mini Nutritional Assessment-Short Form (MNA-SF)]; secondary outcomes were functional changes [Functional Ambulation Classification, Barthel index, handgrip strength, and Short Physical Performance Battery (SPPB)], as well as safety and adherence after 12 weeks of follow-up. ResultsA total of 282 residents (median age 86 years, 67% women) were included, and 244 (86.5%) completed the follow-up. At baseline, 77.3% of the participants were malnourished (BMI 19.7 kg/m2, interquartile range 18.3–21.8). After 12 weeks of follow-up, participants experienced significant increases in body weight (2.6 ± 3.1 kg, 5.2 ± 5.9%), BMI (1.0 ± 1.2 kg/m2) and MNA-SF (4.0 ± 2.5 points). There were also significant improvements in functional status measured by the Barthel index, handgrip strength, SPPB, and gait speed. Good adherence was registered in 94.6% of the participants. No relevant side effects were found. Conclusions and ImplicationsImprovements in nutritional and functional status can be found when using a high-protein, high-calorie ONS in older undernourished people living in nursing homes.

The impact of oral nutritional supplementation in children treated for cancer

Background/Aim: Malnutrition is a dangerous comorbidity in children with cancer that can affect tolerance to treatment modalities such as chemotherapy and radiotherapy. It also adversely affects the treatment outcome and overall survival. It has been known that low Z score of body mass index (BMI) indicates malnutrition. This study aims to underline the effects of oral nutritional supplementation (ONS) on pediatric oncology patients. Methods: All records were collected from Kocaeli University Hospital, Department of Pediatric Oncology, Kocaeli, Turkey, and analyzed. Weight, height, and BMI status of sixty patients who received ONS with cancer treatment were recorded during visits up to 8 months after the start of ONS. Statistical analyses were maintained on the whole cohort as well as on following tumor sub-groups: CNS tumors (13.3%), lymphoma (18.3%), other tumors (68.3%). Results: Sixty malnourished pediatric oncology patients (64.6% male, 35.4% female) were included in the study cohort. BMI values of the majority (60%, P<0.05) of patients increased after ONS treatment while those of 40% decreased. BMI values also increased in the case of other tumors and lymphoma sub-groups (P<0.001 and P=0.012, respectively). Conclusion: This study underlined the benefits of ONS treatment in terms of BMI status among pediatric oncology patients. The recovery rate of nutritional status depends on malignancy, cancer type and location.

Impact of oral nutritional supplements (ONS) on growth outcomes and IGF-1 level in underweight older children and young adolescents (5-14 years) with short stature and no systemic disease: High versus normal calories density formula.

Objectives:This controlled trial investigated the effects of energy-dense pediatric oral nutritional supplements ONS versus standard ONS in pediatric patients requiring oral nutritional support for low body mass index (BMI) or weight gain per day (WGD) below the average for age and sex.Patients and Methods:34 children and adolescents (mean age 10.2 years) with faltering growth requiring ONS were randomized to cONS (n =22) or sONS (n = 12) for a year. We recorded their weight (WT), height (HT) and calculated height growth velocity (GV), Ht-SDS, BMI, WGD, every 3 months for a year.Results:The WGD, height growth velocity (GV: cm/year), and Ht-SDS increased significantly, in both groups, during the year of ONS. The use of the cONS resulted in significantly greater mean total WGD and BMI-SDS after 6 months and 1 year, compared to the sONS group. The increase in IGF1-SDS was significantly higher in the cONS groups versus the sONS group. Moreover, the WGD was correlated significantly with the height GV during the year of ONS intake.Conclusions:ONS improved the growth of underweight old children and adolescents who had no systemic illness. There was a significantly higher WGD and BMI-SDS in the group on cONS compared to those on sONS. In both groups, long-term use of ONS significantly improved Ht-SDS. (www.actabiomedica.it)

Impact of Oral Nutritional Supplement on Growth, Nutrient Intake and Frequency of Illness in Children aged 4-6 Years: A Randomised Controlled Study

Introduction: Protein-Energy Malnutrition (PEM) and prevalence of under-weight children in India, is an important health concern. Aim: To evaluate the effect of Oral Nutritional Supplement (ONS) on growth, overall nutrient intake and frequency of illness in nutritionally at-risk Indian children. Materials and Methods: In this prospective, randomised, gender-stratified, controlled, parallel group, open label study, 216 children (aged 4-6 years with weight-for-age z-score between -2 and -1) were randomised (1:1) to receive either 45 g of ONS {Test product+Dietary advice (T+D)} or control group {Dietary advice only (D-only)} for three months. Primary endpoints included weight-for-age z-score and weight gain in terms of g/kg/day from baseline to three months. Secondary endpoints included change in height-for-age z-scores; frequency of illness, change in dietary nutrient intake and Protein/Energy (P/E) ratio from baseline through three months. Safety endpoint included Adverse Events (AEs). PROC MIXED was used to perform Repeated Measures Analysis Of Variance (RMANOVA) based on the changes in z-scores. The z-scores changes within the group from baseline to the end of three months End-of- Study (EOS) were compared using paired t-test. Results: At baseline, the mean (SD) weight-for-age z-scores were similar in both the groups {1.50 (0.309) and -1.49 (0.312) in T+D and D-only groups, respectively}. At the EOS, only T+D group showed significant mean (SD) change from baseline in weight-for-age z-score compared to the D-only group {0.59 (0.296), p&lt;0.001 vs. 0.04 (0.267), p=0.0974}. Mean rate of weight gain (g/kg/day) was significantly higher in T+D group vs. D-only group (1.12 vs. 0.26, p&lt;0.0001). At baseline, height-for-age z-scores were similar in both the groups {-1.36 (0.668) vs -1.37 (0.638) in T+D and D-only groups, respectively}. At EOS, the mean (SD) change from baseline in height-for-age z-score was -0.02 (0.198), p=0.2389 in T+D group and -0.15 (0.171), p&lt;0.001 in the D-only group. However, the change was not proportionate to weight-for-age z-score. Total absolute number of illness episodes was less in T+D group vs. D-only group (9 vs. 13). Improvement in dietary nutrient intake (carbohydrate, fat, protein and energy) and P/E ratio was significantly higher (p&lt;0.001) in T+D group vs. D-only group. Overall, 8.3% children in T+D group experienced at least one treatment-emergent AE. Conclusion: The ONS helps to improve growth, nutrient intake and reduces frequency of illness in nutritionally at-risk children.

Impact of oral nutritional supplements in post-discharge patients at nutritional risk following colorectal cancer surgery: a randomised clinical trial

Rationale: Guidelines on clinical nutrition recommend the use of appropriate nutritional support therapy for surgical cancer patients at risk of malnutrition both during hospital care and following discharge from the hospital. However, previous studies regarding nutritional interventions have mainly focused on patients during their hospital stay; there is limited evidence supporting the recommendation of nutritional interventions for post-discharge patients after cancer surgery, particularly those who underwent colorectal cancer surgery and at high risk of malnutrition. The present study aimed to assess the impact of oral nutritional supplements (ONS) in post-discharge patients at nutritional risk following colorectal cancer surgery.

Effects of oral nutritional supplement with HMB on clinical outcomes and anthropometry in community-dwelling older adults at risk of malnutrition: A randomized, placebo-controlled trial

Rationale: There is limited data on the impact of oral nutritional supplement (ONS) containing beta-hydroxy-beta-methylbutyrate (HMB) in community-dwelling older adults at risk of malnutrition. The objective of this study was to determine the effects of ONS with HMB on clinical outcomes and anthropometry in this cohort.

Impact of oral nutritional supplements in post-discharge patients at nutritional risk following colorectal cancer surgery: A randomised clinical trial.

Guidelines on clinical nutrition recommend the use of appropriate nutritional support therapy for surgical cancer patients at risk of malnutrition both during hospital care and following discharge from the hospital. However, previous studies regarding nutritional interventions have mainly focused on patients during their hospital stay; there is limited evidence supporting the recommendation of nutritional interventions for post-discharge patients after cancer surgery, particularly those who underwent gastrointestinal cancer surgery and at high risk of malnutrition. To clearly address this issue, we designed and conducted two independent studies on two different groups of post-discharge patients at nutritional risk after gastrointestinal cancer surgery. The present study aimed to assess the impact of oral nutritional supplements (ONS) in post-discharge patients at nutritional risk following colorectal cancer surgery. Meanwhile, the sister study on the use of ONS in post-discharge patients following gastric cancer surgery will be reported separately. Between January 2017 and June 2019, post-discharge patients following colorectal cancer surgery in our institution were randomised to receive either dietary advice alone (control group) or dietary advice in combination with ONS (ONS group) for three months if they were at nutritional risk based on the tool of Nutritional Risk Screening 2002. The primary endpoints were nutritional outcomes and sarcopenia prevalence. The secondary endpoints were 90-day readmission rate, chemotherapy tolerance, and quality of life (QoL). Of the 232 eligible patients, 212 (107 in the control group and 105 in the ONS group) completed the trial. Their data were then analyzed. The mean ONS intake was 410mL every day. By the three-month intervention, the skeletal muscle index in the ONS group was significantly higher than that in the control group (39.75±5.83 vs 38.01±6.18cm2/m2, P=0.037), but no significant differences between the two groups were noted in weight, weight loss, body mass index, serum albumin and hemoglobin (P>0.05). In addition, the ONS group had a significantly lower sarcopenia prevalence (28.6% vs 42.1%, P=0.040). No significant difference between the two groups was found in the 90-day readmission rate (P>0.05). The number of patients undergoing postoperative chemotherapy in the two groups was similar, but chemotherapy modifications, such as delay, dose reduction, or termination, were significantly reduced in the ONS group (21.2% vs 36.8%, P=0.024). However, ONS had no significant effect on QoL (P>0.05). In post-discharge patients at nutritional risk following colorectal cancer surgery, the use of ONS may reduce skeletal muscle loss and sarcopenia prevalence, as well as improve chemotherapy tolerance, compared with dietary advice alone. These findings underline the importance of ONS treatment in post-discharge patients at nutritional risk following colorectal cancer surgery.

Effects of oral nutritional supplement on short-term nutritional status and treatment tolerance in locally advanced nasopharyngeal carcinoma patients receiving chemoradiotherapy

Objective To explore the impact of oral nutritional supplements in the local advanced nasopharyngeal carcinoma patients receiving chemoradiotherapy. Methods From 2016 to 2018, we prospectively collected 114 patients into our study, including intervention group (n=58) and control group (n=56). Patients in the intervention group were given oral nutritional supplements from the beginning of radiotherapy, while the control group patients were receiving usual diet care. We collected data of weight, hematological index and nutrition related information before, during and after treatments. Results All patients experienced weight loss during radiotherapy. The declining trend was more obvious in intervention group but with no statistical difference (P>0.05). Radiotherapy interruption was lower, completion rate of 2 cycles of concurrent chemotherapy was higher(78% vs 64%, P=0.02)and level of total serum protein and albumin was more stable (P=0.003, 0.001) in the intervention group. No difference was found in acute toxicities between the two groups (P>0.05). During the treatment period, the nutrition risk screening score declined, more patients with NRS 2002 ≥3 in the control group than the intervention group (P 0.05). Conclusions Oral nutritional supplements can improve treatment tolerance and keep the stability of serum protein level, nevertheless, it has no obvious advantage in maintenance of weight and short-term nutritional status Key words: Nasopharyngeal neoplasms/chemoradiotherapy; Nutrition supplement; Treatment tolerance

Impact of Nutritional Supplementation and a Psychomotor Program on Patients With Alzheimer's Disease.

This study aims to evaluate the impact of oral nutritional supplementation (ONS) and a psychomotor rehabilitation program on nutritional and functional status of community-dwelling patients with Alzheimer's disease (AD). A 21-day prospective randomized controlled trial was conducted and third intervention group performed a psychomotor rehabilitation program. Patients were followed up for 180 days. Mean (standard deviation) score of Mini Nutritional Assessment (MNA) increased both in the nutritional supplementation group (NSG; n = 25), 0.4 (0.8), and in the nutritional supplementation psychomotor rehabilitation program group (NSPRG; n = 11), 1.5 (1.0), versus -0.1 (1.1) in the control group (CG; n = 43), P < .05. Further improvements at 90-day follow-up for MNA in NSG: 1.3 (1.2) and NSPRG: 1.6 (1.0) versus 0.3 (1.7) in CG ( P < .05) were observed. General linear model analysis showed that the NSG and NSPRG ▵MNA score improved after intervention, at 21 days and 90 days, was independent of the MNA and Mini-Mental State Examination scores at baseline ( Ps > .05). The ONS and a psychomotor rehabilitation program have a positive impact on long-term nutritional and functional status of patients with AD.

SUN-PP103: Impact of Oral Nutritional Supplement and a Psychomotrocity Program on Community-Dwelling Patients with Mild Alzheimer‘s

SUN-PP103: Impact of Oral Nutritional Supplement and a Psychomotrocity Program on Community-Dwelling Patients with Mild Alzheimer‘s

Protein type and caloric density of protein supplements modulate postprandial amino acid profile through changes in gastrointestinal behaviour: A randomized trial

The requirement of leucine and essential amino acids (EAA) to stimulate muscle protein synthesis increases with age. To target muscle anabolism it is suggested that higher postprandial blood levels of leucine and EAA are needed in older people. The aim was to evaluate the impact of oral nutritional supplements with distinct protein source and energy density, resembling mixed meals, on serum amino acid profiles and on gastrointestinal behaviour. Four iso-nitrogenous protein (21 g) supplements were studied containing leucine-enriched whey protein with 150/320 kcal (W150/W320) or casein protein with 150/320 kcal (C150/C320); all products contained carbohydrates (10 or 32 g) and fat (3 or 12 g). Postprandial serum AA profiles were evaluated in twelve healthy, older subjects who participated in a randomized, controlled, single blind, cross-over study. Gastrointestinal behaviour was studied in vitro by looking at gastric coagulation and cumulative intestinal protein digestion over time. The peak serum leucine concentration was twofold higher for W150 vs. C150 (521 ± 15 vs. 260 ± 15 μmol/L, p < 0.001), higher for W320 vs. C320 (406 ± 15 vs. 228 ± 15 μmol/L, p < 0.001), and higher for low-caloric vs. high-caloric products (p < 0.001 for pooled analyses; p < 0.001 for interaction protein source*caloric density). Similar effects were observed for the peak concentrations of EAA and total AA (TAA). In vitro gastric coagulation was observed only for the casein protein supplements. Intestinal digestion for 90 min resulted in higher levels of free TAA, EAA, and leucine for W150 vs. C150, for W150 vs. W320, and for C150 vs. C320 (p < 0.0125). A low caloric leucine-enriched whey protein nutritional supplement provides a higher rise in serum levels of TAA, EAA and leucine compared to casein protein or high caloric products in healthy, elderly subjects. These differences appear to be mediated in part by the gastrointestinal behaviour of these products. ClinicalTrials.gov: NCT02013466.

P319: The impact of oral nutritional supplementation in patients aged 65+ with COPD

P319: The impact of oral nutritional supplementation in patients aged 65+ with COPD

PP128-SUN: The Impact of Oral Nutritional Supplementation in Medicare Patients with COPD

PP128-SUN: The Impact of Oral Nutritional Supplementation in Medicare Patients with COPD

The Health Economic Impact of Oral Nutritional Supplements (ONS) in Germany

<b>Purpose:</b> To assess the health economic impact of oral nutritional supplement (ONS), being a medical nutrition product in the community setting in Germany in 2007. <b>Methods: </b>This health economic analysis is based on a comparison of the use of ONS versus no use of ONS in patients, who are eligible for ONS due to (risk of) disease-related malnutrition (DRM). The costs of the two treatment strategies, “ONS” versus “no ONS” were assessed using a linear decision analytic model reflecting cost functions related with DRM. Data sources are based on the published literature, clinical trials, official national price/tariff lists and national population statistics. <b>Results:</b> This study shows that the extra costs for ONS (€ 534) are off-set by a reduction of hospitalisation costs (€ 768) leading to total cost savings of € 234 per patient. A scenario analysis based on length of hospital stays and per diem costing instead of DRG costs shows that the extra costs for ONS (€ 534) are also off-set by a reduction of hospitalisation costs (€ 791) leading to cost savings of € 257 per patient. Additional scenarios showed similar and consistent results. <b>Conclusions:</b> This health economic analysis shows that the use of ONS leads to cost savings for the cost of DRM in Germany in the community setting. In addition the use of ONS leads also to better clinical outcomes due to a reduction of hospitalisations. As a consequence the use of ONS might be considered cost-effective at a patient and also a population level, which could be shown also in extensive sensitivity analyses.

The budget impact of oral nutritional supplements for disease related malnutrition in elderly in the community setting.

A health economic analysis was performed to assess the economic impact on the national health care budget of using oral nutritional supplements (ONS), being a food for special medical purposes also known as medical nutrition, for the treatment of disease related malnutrition (DRM) in the community in the Netherlands. An economic model was developed to calculate the budget impact of using ONS in community dwelling elderly (>5 years) with DRM in the Netherlands. The model reflects the costs of DRM and the cost reductions resulting from improvement in DRM due to treatment with ONS. Using ONS for the treatment of DRM in community dwelling elderly, leads to a total annual cost savings of € 13 million (18.9% savings), when all eligible patients are treated. The additional costs of ONS (€ 57 million) are more than balanced by a reduction of other health care costs, e.g., re-/hospitalization (€ 70 million). Sensitivity analyses were performed on all parameters, including duration of treatment with ONS and the prevalence of DRM. This budget impact analysis shows that the use of ONS for treatment of DRM in elderly patients in the community may lead to cost savings in the Netherlands.

PP347 THE HEALTH ECONOMIC IMPACT OF ORAL NUTRITIONAL SUPPLEMENTS IN GERMANY

Rationale: To assess the health economic impact of oral nutritional supplement (ONS), being a medical nutrition product, in the community setting in Germany. Methods: This health economic analysis is based on a comparison of the use of ONS versus “no ONS” in patients, who are eligible for ONS due to (risk of) disease-related malnutrition (DRM). The costs of the two treatment strategies, ONS versus “no ONS” were assessed using a linear decision analytic model reflecting cost functions related with DRM. Data sources are published literature, clinical trials, official national price/tariff lists and national population statistics. Results: This study shows that the extra costs for ONS (€534) are off-set by a reduction of hospitalisation costs (€ 768) leading to total cost savings of € 234 per patient. A scenario analysis based on length of stay (LOS) and per diem instead of Disease Related Group (DRG) costs shows that the extra costs for ONS (€ 534) are also off-set by a reduction of hospitalisation costs (€791) leading to cost savings of €257 per patient. The national cost savings vary between €604 million and €662 million respectively in the base case and scenario analysis. Conclusion: This health economic analysis shows that the use of ONS leads to higher effectiveness because of a reduction of hospitalisation, thereby leading to cost savings for the cost of DRM in Germany at patient level in the community setting. As a consequence the use of ONS can be considered cost-effective at a patient and population level.

Lack of meal intake compensation following nutritional supplements in hospitalised elderly women

Undernutrition contributes to poor clinical outcomes in hospitalised elderly patients but the potential impact of oral nutritional supplements may be reduced by suppressing subsequent food intake. We investigated this possibility in elderly female patients recovering mainly from hip fracture by studying the effect of oral supplements on subsequent food intake during an ad libitum buffet luncheon meal. We tested the effect in seven women by giving the supplement 90 min before the meal and compared energy and macronutrient intake with a control water pre-load condition. A similar study was carried out in another seven women with the supplement or water drink given 30 min beforehand. Both self-rated appetite and energy intake were low in these women. The nutritional supplement did not alter ratings of hunger, fullness or prospective consumption or subsequent energy and macronutrient consumption whether given 90 or 30 min before the meal. There were significant independent correlations between the lack of adequate compensation of energy intake at meals and chronic undernutrition (as assessed by skinfold thickness) and energy intake during the control meal. We conclude that elderly women during the recovery phase after major fractures have low appetites and energy intakes and markedly impaired adjustment of energy intake following liquid oral nutritional supplements. The reasons for this are unknown but are related to anorexia and undernutrition. The consumption of liquid oral supplements given up to 30 min before a meal does not suppress subsequent energy intake from meals.