Oral Nutritional Supplements Research Articles

Effect of Diagnosis, Complications, and Nutrition for Using Nasogastric Tube to Body Weight of Child Patients with Feeding Difficulty at Dr. M. Djamil General Hospital, Padang, Indonesia

Background: Several conditions in children can cause nutritional intake via the oral route to be inadequate. Providing enteral nutrition via a nasogastric tube (NGT) is an alternative option. Research on the use of NGTs in Indonesia is still limited, so this research aims to determine the effect of NGT use on the weight of pediatric patients with feeding difficulties at Dr. M. Djamil General Hospital, Padang.
 Methods: Experimental research with a pre and post-test-only design was conducted on 96 children aged 1 month - 18 years in the children's inpatient room at Dr. M. Djamil General Hospital, Padang. Body weight measurements were carried out before and after using NGT for 4 weeks (January 2022 – January 2023) at the pediatric nutrition and metabolic diseases polyclinic. Data were analyzed using paired t-test and ANOVA.
 Results: Most subjects (40.9%) were in the 1-12 month age group. The most common type of nutrition was ONS (oral nutritional supplements) (84.4%), the most common diagnosis was pulmonology (33.3%), and the majority were without complications (72.9%). There is an influence on the child's weight before and after using NGT (p-value <0.01). Significant differences were also found in changes in children's weight with diagnosis and complications (p<0.01).
 Conclusion: The use of NGT can increase the weight of pediatric patients who have feeding difficulties at Dr. M. Djamil General Hospital, Padang. Significant differences were found in changes in children's weight by diagnosis and complications.

Should handgrip strength be considered when choosing the administration mode of oral nutritional supplements in geriatric patients? A secondary analysis of the MEDPass Trial

ObjectiveIt is important to individualize nutrition therapy and to identify whether certain patient groups benefit from a specific intervention such as oral nutritional supplements (ONS). This study investigated whether patients with weak handgrip strength (HGS) benefit better from ONS administration in the Medication Pass Nutritional Supplement Program (MEDPass) mode regarding the individual coverage of energy and protein requirements throughout their hospitalization. MethodsA secondary analysis of the intention-to-treat data set of the randomized controlled MEDPass trial was conducted. Weak HGS was defined as <27 kg for men and <16 kg for women. Linear mixed-effect models adjusted for the stratification factors energy density of ONS and nutritional risk screening 2002 score were used to address the aim of the study. ResultsWe included 188 participants. Energy and protein coverage did not differ between the patients with weak or normal HGS depending on ONS administration mode (P = 0.084, P = 0.108). Patients with weak HGS and MEDPass administration mode tended to have the lowest energy and protein coverage (estimated mean, 77.2%; 95% confidence interval [CI], 69.3%–85% and estimated mean, 95.1%; 95% CI, 85.3%–105%, respectively). Patients with weak HGS and conventional ONS administration had the highest energy and protein coverage (estimated mean, 90%; 95% CI, 82.8%–97.2% and estimated mean, 110.2%; 95% CI, 101.3%–119%, respectively). ConclusionNo clear recommendations regarding the mode of ONS administration depending on HGS can be made. In clinical practice, appetite and satiety in patients with weak HGS should be monitored, and the ONS administration mode should be adjusted accordingly.

Effectiveness of Preoperative Immunonutrition in Improving Surgical Outcomes after Radical Cystectomy for Bladder Cancer: Study Protocol for a Multicentre, Open-Label, Randomised Trial (INu-RC).

Radical cystectomy (RC) with pelvic lymph node dissection is the standard treatment for patients with limited-stage muscle-invasive bladder cancer. RC is associated with a complication rate of approximately 50-88%. Immunonutrition (IMN) refers to the administration of substrates, such as omega-3 fatty acids, arginine, glutamine, and nucleotides, that modulate the immune response. IMN has been associated with improved outcomes following surgery for esophagogastric, colorectal and pancreatic cancer. In this paper, we describe a study protocol for a multicentre, randomised, open-label clinical trial to evaluate the effect of IMN in patients undergoing RC for bladder cancer. A 7-day preoperative course of IMN is compared with a standard high-calorie high-protein oral nutritional supplement. The primary outcome of this study is the rate of complications (infectious, wound-related, gastrointestinal, and urinary complications) in the first 30 days after RC. Secondary outcomes include time to recovery of bowel function and postoperative mobilisation, changes in muscle strength and body weight, biochemical modifications, need for blood transfusion, length of stay, readmission rate, and mortality. The results of this study may provide new insights into the impact of IMN on postoperative outcomes after RC and may help improve IMN prescribing based on patient nutritional status parameters.

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.

Impact of malnutrition and nutritional support after gastrectomy in patients with gastric cancer.

Malnutrition, characterized by altered body composition and impaired function, is particularly prevalent among gastric cancer patients, affecting up to 60% of them. Malnutrition in these patients can manifest both before and after surgery, due to factors such as gastric outlet obstruction, cancer cachexia, and anatomical changes. Notably, total gastrectomy (TG) presents the most significant nutritional challenges. However, function-preserving gastrectomy, such as pylorus-preserving gastrectomy (PPG) and proximal gastrectomy (PG), have shown promise in improving nutritional outcomes. Effective nutritional risk screening and assessment are vital for identifying patients at risk. Nutritional support not only improves nutritional parameters but also reduces complications, enhances quality of life (QoL) and survival rates. Those unable to maintain more than 50% of the recommended intake for over 7 days are recommended for nutritional support. Common methods of nutritional support include oral nutrition supplements (ONS), enteral nutrition (EN), or parenteral nutrition (PN) depending on the patient's status. Effect of perioperative nutritional support remains controversial. Preoperative interventions including ONS and PN have shown mixed results, with selective benefits in patients with sarcopenia or hypoalbuminaemia, while impact of EN in gastric outlet obstruction patients have been positive. In contrast postoperative support appears to be consistent. Tube feeding after TG has shown improvements, and ONS have been effective in reducing weight loss and improving nutritional biomarkers. PN was also associated with benefits such as weight maintenance and QoL. This review explores the mechanisms, assessment, and clinical impact of malnutrition, emphasizing the importance of nutritional support in gastric cancer patients undergoing gastrectomy.

Efficacy of a High Protein Oral Nutritional Supplement in Maintenance Hemodialysis Patients

Efficacy of a High Protein Oral Nutritional Supplement in Maintenance Hemodialysis Patients

Prospective observational study of nutritional status and oral supplement utilization in users of an elderly daycare service, employing a web-based Mini Nutritional Assessment Form (MNA plus).

Seniors are vulnerable to frailty, a condition linked to falls, fractures, hospitalizations, and sarcopenia. Even with regular meals, senior daycare users are at risk for malnutrition. This study assessed malnutrition risk in daycare users, using the web-based Mini Nutritional Assessment Form (MNA®-SF). Individuals identified as malnourished or at risk were examined for changes in nutritional status with and without oral nutritional supplementation (ONS). Of 507 subjects, 138 (27.2%) were malnourished or at risk. Discontinuation rates were 20.0% (7/35) for the ONS group and 40.0% (10/25) for the regular care (RC) group. Among 29 patients with measurable weight change after six months, 19 (ONS group) and 10 (RC group) participated. The ONS group exhibited significant increases in body weight (+1.4 ± 2.9 kg, p < 0.01), body mass index (BMI) (+0.6 ± 0.9 kg/m2, p < 0.01), calf circumference (+3.2 ± 0.2 cm, p < 0.01), and grip strength (+1.2 ± 1.9 kg, p = 0.069). Conversely, the RC group showed no significant increases in body weight (+1.0 ± 1.9 kg, p = 0.146), BMI (+0.4 ± 0.8 kg/m2, p = 0.176), or grip strength (-0.7 ± 1.7 kg, p = 0.327), with decreased grip strength and calf circumference (-0.8 ± 0.9 cm, p < 0.05). In the ONS group, 52.6% (10/19) consumed over 400 kcal/day of ONS, and 84.2% maintained this intake for three months. Malnutrition is prevalent among daycare users. ONS influences weight, BMI, and calf circumference, potentially reducing discontinuation rates. https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000049767, UMIN000043580.

Efficacy of oral nutritional supplement in cancer patients receiving chemotherapy: a systematic review and meta-analysis of randomized controlled trials.

The use of oral nutritional supplement (ONS) is one of the modalities employed to manage cancer-associated malnutrition. However, evidence of its efficacy is limited. In 2018, a meta-analysis reported the statistical benefits of increased body weight from ONS. This study aimed to evaluate the efficacy of ONS in cancer patients receiving chemotherapy in more recent trials. All randomized controlled trials (RCTs) of adult cancer patients receiving chemotherapy, which compared ONS with standard of care and reported on body weight, nutritional status, or quality of life (QoL), were included. Eligible RCTs were identified from PubMed, OVID, and the references of previous systematic reviews up until February 2023. The risk of bias was assessed using the Revised Cochrane risk-of-bias tool. The outcomes of interest were pooled and analyzed using the mean difference (MD) with a corresponding 95% confidence interval (CI). This study was registered in PROSPERO, number CRD42023400471. Ten RCTs comprising 1,101 patients were included. ONS did not show a significant impact on final body weight (MD -0.07 kg, 95% CI: -0.99 to 0.84, P=0.88). It tended to increase body weight (MD 0.90 kg, 95% CI: -0.48 to 2.28, P=0.20), and this benefit was particularly noticeable in elderly patients, those with low baseline body weight, females, and non-Asian patients. After adjusting for risk of bias, ONS was found to significantly increase body weight (MD 1.32 kg, 95% CI: 0.12 to 2.52, P=0.03), and it also tended to enhance Patient-Generated Subjective Global Assessment (PG-SGA) score of -2.13 (95% CI: -5.07 to 0.82, P=0.16), global domain QoL score of 4.01 (95% CI: 0.08 to 7.94, P=0.05) and fatigue domain QoL score of -7.63 (95% CI: -13.87 to -1.39, P=0.02). ONS could help to increase body weight in cancer patients receiving chemotherapy. This benefit was especially notable in those at high risk of malnutrition, including elderly patients, those with low baseline body weight, females, and non-Asian patients. It also resulted in improved PG-SGA scores and significantly improved patients' QoL during chemotherapy treatment. Future studies should explore the potential benefit of ONS on oncological outcomes or improvements of chemotherapy-related toxicity.

Prevention of Postoperative Malnutrition with Oral Nutritional Supplements in Patients Undergoing Gastrointestinal Surgery.

Oral nutritional supplements (ONSs) offer support for the nutritional needs of surgical patients. However, their efficacy is contingent upon the nutrient composition, absorption efficiency, and postingestion tolerance. Our study included a cohort of 84 patients who underwent elective open surgery involving at least one intestine anastomosis. To mitigate the risk of malnutrition, 2 groups of 28 patients each received either a high-protein low-osmotic ONS (Group I) or a high-calorie high-osmotic ONS (Group II). A standard diet was used in the control group (Group III). The metabolic effects were evaluated by measuring body weight and relative change in body weight (Δkg) from 24 h (-1 day) presurgery to 28 days postprocedure. Subjective tolerance following ONS consumption on the second postoperative day was also assessed. Our findings showed that, across all groups, the average body weight decreased during the initial 2 weeks postsurgery, subsequently stabilizing or returning to baseline levels by the third and fourth week of observation. Patients receiving ONS demonstrated greater weight gain between days 14 and 28, with Group I exhibiting the highest rate of gain. Low-osmotic ONS displayed superior tolerance and elicited fewer patient complaints postconsumption. Postoperative hospitalization duration did not differ significantly among the nutritional strategies. In conclusion, early administration of ONS supplies essential nutrients and facilitates refeeding, thereby reducing the risk of malnutrition. Low-osmotic preparations are better tolerated and contribute more effectively to the restoration of preoperative body weight, despite their lower caloric content.

Prevalence of the use of oral nutritional supplements among acute inpatients at risk of malnutrition and associated patient characteristics.

To provide a snapshot of the current use of oral nutritional supplements, its association with inpatient characteristics, and with a focus on the role of nursing monitoring of food intake and implementing nutritional interventions for patients with low intake. Retrospective cohort study. The study collected data from a hospital database regarding oral nutritional supplement initiation and variables of patients hospitalised in internal medicine departments, who did not receive enteral or parenteral nutrition. Of the 5155 admissions, 1087 fulfilled the inclusion criteria (47% female; mean age, 72.4 ± 14.6 years; mean length of stay, 14.6 ± 11.4 days). Sufficient food intake reporting was noted in 74.6% of the patients; of these 17% had decreased intake. Oral nutritional supplements and non-oral nutritional supplements groups did not differ in terms of sex, age, length of stay, Charlson Comorbidity Index, proportion of nursing reports, and absence of intake monitoring. Oral nutritional supplements were initiated in 31.9% of patients with a Malnutrition Universal Screening Tool score ≥2 and in 34.6% with decreased food intake. On multivariable analysis, hypoalbuminemia (adjusted odds ratio, 3.70), decreased food intake (adjusted odds ratio, 3.38), Malnutrition Universal Screening Tool score ≥2 (adjusted odds ratio, 2.10), and age <70 years (adjusted odds ratio, 1.56) were significantly associated with oral nutritional supplements use. The prevalence of oral nutritional intervention was suboptimal in patients at risk of malnutrition during acute hospitalisation, although decreased food intake and Malnutrition Universal Screening Tool score ≥2 independently increased the probability of oral nutritional supplements initiation. Understanding the clinical practice and nursing impact of care management in relation to nutritional intervention can assist in reviewing and improving patient care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE IMPACT (ADDRESSING): This study informs clinical management and influences nursing practice standards related to assessing, monitoring, and managing malnutrition risk. The study impacts the quality of care for patients at risk of malnutrition. We adhered to the STROBE Checklist for cohort studies. No Patient or Public Contribution.

Dietetic service provision and nutritional interventions provided to patients with head and neck sarcoma: Findings from a national United Kingdom centre five-year audit

ObjectivesHead and neck sarcomas (HNS) represent a subset of malignancies which may be treated with multiple-modalities including chemotherapy followed by surgery and/or radiotherapy. Malnutrition is common in head and neck cancer (HNC) but limited literature exists determining nutritional interventions required in HNS. This audit aimed to investigate the dietetic input and nutritional interventions in HNS at a London sarcoma centre according to evidence-based HNC nutritional guidelines. MethodsRetrospective review between January 2018 to January 2023. Adult patients (≥18 years) newly-diagnosed with HNS treated at the tertiary centre were included. Demographic data and information on nutritional interventions was collected and statistically analysed. Results337 patients were referred to the HNS multidisciplinary meeting; 154 met the inclusion criteria; 66 received dietetic intervention (age = 45 [30.5] years; 47% (n = 31) male; baseline weight = 70.3 ± 18.13 kg; BMI = 24.2 [8.47] kg/m2). 19.7% (n = 13) were malnourished at presentation. Nutritional interventions were as follows: dietary counselling 100% (n = 66); oral nutritional support 90.9% (n = 60); oral nutritional supplements 75.8% (n = 50); enteral tube-feeding 54.5% (n = 36). 15.2% (n = 10) had a prophylactic gastrostomy; n = 4 pre-surgery and n = 6 pre-radiotherapy/proton-beam therapy±chemotherapy with 100% and 33.3% using the tube for ≥4 weeks respectively. Average duration of dietetic intervention was significantly longer for patients with high grade sarcoma compared to low grade (411.5 days and 136.8 days respectively, p = 0.000039) and for those undergoing multi-modality treatment compared to single-modality (402.9 days and 187.7 days respectively, p = 0.000932). ConclusionA fifth of patients with HNS were malnourished at presentation and the majority receiving dietetic intervention required nutrition support, indicating the need for nutritional management in HNS.

Efficacy of intradialytic neuromuscular electrical stimulation and oral nutritional supplementation in hemodialysis patients: a multicenter, randomized controlled trial.

Sarcopenia is common in hemodialysis patients. This study aimed to evaluate the effect of simultaneous nutritional support and intradialytic neuromuscular electrical stimulation (NMES) in hemodialysis patients. We performed a 12-week, multicenter, randomized controlled trial. The participants were randomly assigned to the control group, the protein group (25 g of protein at every dialysis session), the NMES group (intradialytic NMES to quadriceps femoris muscles), and the NMES + P group (NMES with protein supplementation). The primary outcome was the difference in hand grip strength (HGS) and leg muscle strength (LMS) among groups. Secondary outcomes included body composition, physical performance (the 10-m walk test and the timed up and go test [TUG]), and questionnaires about quality of life (QoL), physical activity, and depression. In addition, subgroup analysis was performed by dividing NMES and NMES + P groups into high- and low-intensity NMES groups. Fifty-nine patients completed all the study outcomes. There was no difference in muscle strength (HGS and LMS) and muscle mass among groups. Gait speed improved in NMES and NMES + P groups. Subscale scores for QoL (kidney disease effect, role limitations due to physical or emotional problems, and overall health ratings) improved in the NMES + P group. In subgroup analysis, LMS and TUG improved only in the high-intensity NMES group. In this study, NMES and-/or- protein supplementation did not make a significant difference in HGS and LMS. However, NMES or NMES + P improved functional capacity and QoL. Furthermore, higher NMES was superior in improving LMS and functional capacity.

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

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

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

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

Nutritional status and nutritional intervention of older inpatients in China

BackgroundMalnutrition is a critical issue among older inpatients, yet limited large-scale research related to this issue has been conducted in China. This study aimed to examine the nutritional status and support of older inpatients in China, assess the associations between disease categories and malnutrition on admission, and explore effective nutritional intervention. MethodsA total of 24,139 older participants from the China Nutrition Fundamental Data 2020 Project were included. Malnutrition was measured by the Global Leadership Initiative on Malnutrition criteria. Adjusted odds ratios (aORs) were calculated using logistic analysis. ResultsThe overall frequency of malnutrition on admission was 18.9%. Participants with infections were more likely to have malnutrition (aOR = 1.929, 95% CI 1.486–2.504). Risks that were also noted for malnutrition included neoplasms (aOR = 1.822, 95% CI 1.697–1.957), hemic and lymphatic diseases (aOR = 1.671, 95% CI 1.361–2.051), nervous system diseases (aOR = 1.222, 95% CI 1.126–1.326), respiratory diseases (aOR = 1.613, 95% CI 1.490–1.746), and digestive system diseases (aOR = 1.462, 95% CI 1.357–1.577). Further, 32.26% inpatients with malnutrition during hospitalization didn’t receive nutritional support. Oral nutrition supplements, enteral tube feeding, and parenteral nutrition were associated with stable or improved nutritional status. ConclusionsOlder inpatients were at a high risk for malnutrition but did not receive adequate nutritional intervention. More resources and attention need to be devoted to the nutritional status of older inpatients and targeted nutritional support.

Nutritional Value and Physical Quality of Oral Nutritional Supplements Made from Purple Sweet Potatoes to Treat Malnutrition in Patients with Cancer

Background: Malnutrition often occurs in patients with cancer, which eventually leads to decreasing response to therapy and increased morbidity and mortality rate. Oral Nutrition Supplements (ONS) are necessary to provide additional nutritional intervention to prevent and treat malnutrition in cancer patients. Purple sweet potato is a local food that is abundantly available in Indonesia and can be utilized as a basic ingredient for producing a modified ONS formula that is not only high in nutritional value but also has good physical quality. Objective: This study aimed to evaluate the nutritional value and physical quality of purple sweet potato-based ONS. Methods: A new local food-based formula was formulated by using purple sweet potato as the main ingredient. This new formula, which was then mentioned as the treatment formula, was subsequently compared with the control formula. The control formula was made from ingredients commonly used for producing ONS in hospitals in Indonesia, such as milk powder, sugar, oil, and other additives such as maltodextrin and creamer. Meanwhile, the treatment formula was labelled into three treatment formulas based on the differences in the proportions of white egg flour and whey protein as a protein source in each treatment formula. The treatment formula was formulated by using local ingredients of purple sweet potato flour and egg white flour by adding whey protein, extra virgin olive oil, omega-3 powder, sugar, and creamer. A proximate analysis was conducted to analyze the nutrient content of the formula and the viscosity and osmolarity tests were conducted to evaluate the physical qualities of the formula. The laboratory analysis results were described as descriptive data, then analyzed by using One-Way ANOVA. The determination of the best treatment formula in the form of effectiveness (Nh). Results: The results of the proximate test and physical quality showed that the best formula based on the highest Nh value of 0.75 was P3 with 245 kcal energy, 8.8 g (14%) protein, 6.5 g (24%) fat, and 37.8 g (62%) carbohydrate, viscosity 28.1 cP, and osmolarity 492.3 mOsm (iso-osmolar) per serving size (200 ml). Conclusion: Formula P3 which contains more egg white flour than whey protein is the best formula that has the best nutritional value and good physical quality.

EFFECTS OF NUTRITION STATUS AND PERIOPERATIVE NUTRITION SUPPLEMENT COMPLETION ON POSTOPERATIVE OUTCOMES IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE UNDERGOING SURGERY

Abstract BACKGROUND Malnutrition is common in inflammatory bowel disease, (IBD) and is associated with poor disease activity, greater hospital length of stay (LOS), higher 30-day readmission rates, and increased risk of postoperative complications. Structured, multimodal prehabilitation including nutrition counseling improves various outcomes after elective cancer and orthopedic surgeries. We examined the effects of malnutrition and perioperative nutrition supplementation on surgical outcomes in IBD patients participating in a multimodal prehabilitation program. METHODS This was a retrospective study of patients aged 18-80 enrolled in a 10-week prehabilitation program undergoing surgery for IBD. Beginning 4 weeks prior to surgery, patients met with a multidisciplinary team including a nurse practitioner, physical therapist and registered dietitian. Patients were provided 3 preoperative carbohydrate loading oral nutrition supplements (ONS) 48 hours prior to surgery, and 20 perioperative immunonutrition ONS. Malnutrition was defined using the Global Leadership in Malnutrition criteria as moderate or severe. We used Fisher’s exact test to determine associations between malnutrition, ONS use, and postoperative complications (defined by the comprehensive complication index (CCI, with CCI scores &amp;gt;20 classified as severe)), and 30-day readmission. Logistic and linear regression were used to analyze length of stay (LOS), opioid use (defined as morphine milligram equivalents, MME), nutrition status, and ONS completion. RESULTS 25 patients (48% female, mean age 44, 18 (72%) with Crohn’s disease) completed the prehabilitation program between 05/2022 and 10/2023. 10 patients (40%) met criteria for malnutrition (of these, 50% were moderate and 50% severe). Malnutrition was not significantly associated with CCI severity (p=0.07), LOS (p =0.07), opioid use (p=0.07) or 30 day readmission rates (0.06). Higher ONS use for carbohydrate loading and immunonutrition were more likely to have a LOS&amp;lt;5 days (p=0.05 and p=0.03 respectively). CONCLUSION ONS for preoperative carbohydrate loading and perioperative immunonutrition may shorten LOS after surgery among patients with IBD. In our study, higher amounts of ONS consumption led to a shorter LOS. Larger, controlled studies will help to further clarify the effects of malnutrition, carbohydrate loading, and immunonutrition among patients with IBD preparing for surgery.

Effect of oral nutrition supplement on growth in preschool children – a systems physiology-based in silico analysis

Introduction: Optimum nutrition is the cornerstone of child growth and development. Childhood is a period of rapid growth and development. Children of preschool age have higher nutritional needs and are often at risk of nutrient deficiencies. Objective: The present study was designed to evaluate the effect of an oral nutritional supplement (ONS) on growth parameters in a representative population. Methods: We used the systems-biology-based mathematical model for child growth to analyze the effect of ONS on growth in a representative in silico population of preschool children. The analysis included changes in average growth velocities of weight, height, muscle mass, fat mass, fat-free mass, and bone mass. We used meta-data analysis for evaluating the absorption of micronutrients present in the ONS that affects growth in preschool children. Results: The results of the analysis showed one serving of ONS in milk/day improved the weight gain velocity by 1.7 times in preschool children. The linear growth was 1.04 times higher than the control. The absorption of micronutrients such as iron, vitamin K, calcium, and magnesium was higher in the ONS group. Conclusions: This study indicates that the ONS containing macro and micronutrients, docosahexaenoic acid (DHA), and prebiotics can potentiate growth and development in preschool children. It provides micronutrients that can be readily absorbed which are essential for other vital functions in the body.

P069 Ultra-processed food intake and dietary insufficiencies are common in adults with Crohn’s Disease in remission. The INTICO 2 Study

Abstract Background Adults with Crohn’s Disease (CD) may have dietary restrictions and micronutrient inadequacies. Consumption of ultra processed foods (UPF) has been associated with an increased need for IBD-related surgery and is a growing area of research. This study aimed to investigate the habitual diet of adults with CD during disease remission to understand the nutritional adequacy, diet diversity and diet quality. Methods 196 adult CD outpatients in remission (Harvey Bradshaw Index &amp;lt;5 and calprotectin &amp;lt;250µg) were recruited from a single UK IBD centre outpatients as part of the INTICO 2 observational study. Seven-day food diaries were electronically recorded using Nutritics® (Libro) software. UPF intake was determined using NOVA Score . Data cleaning was undertaken by a dietitian prior to analysis to identify input errors. NOVA Score1 criteria was utilised to determine UPF intake. Product ingredient lists were examined using supermarket websites and ‘Open food Facts’ by two research dietitians to assign a NOVA score. Consensus on NOVA Scoring was achieved, and a data dictionary was prospectively updated to justify the assigned score. Results 97% (189/195) of those who underwent food diary analysis had at least one micronutrient below the LNRI. The intake was below the LNRI for a mean of 6 (SD 4.2) micronutrients per subject. The number of subjects who failed to meet the LNRI from diet (with and without inclusion of usual supplements) is listed for each micronutrient in table 1. Of note, 93% (181/195) of subjects failed to meet the SACN recommended 30g of fibre per day (median intake 17.7g). 33% of dietary intake was classified as UPF (Nova 4) and 13% processed (NOVA 3). Conclusion Both micronutrient insufficiencies and UPF intake are common in a CD remission population and should be considered alongside one another in studies of dietary intake. UPF intake should be interpreted with caution as NOVA does not account for nutritional content. Blanket recommendations to avoid UPFs need to be carefully considered within this already nutritionally vulnerable population as avoidance of UPF products such as fortified cereals or oral nutritional supplements could lead to increased dietary inadequacies.

2023 Oral nutritional supplement prescribing in care homes: The benefit of dietetic review

Abstract Introduction Prevalence of malnutrition in care homes is high and oral nutritional supplements (ONS) often prescribed. Prescription and monitoring of ONS use varies considerably within residential settings. Locally dietetics are not funded to visit care homes and input is limited. This project explored dietetic ONS prescribing within care homes in one primary care network within Devon, recording the potential impact on costs. Methods All patients prescribed ONS (n=50) across 16 care homes were reviewed, alongside referrals to dietetics (n=39) from November 2022-March 2023. Supplements were switched to first-line formulary supplements where possible, stopped where unnecessary according to dietetic assessment, and a “food first” approach encouraged within homes. Cost of supplements prescribed pre-dietetic assessment, cost of new prescriptions, dietetic staff time and mileage costs were recorded. Supplement cost was calculated from the local formulary and staff cost from NHS oncosts. Results Patients seen represented 20% of all residents 20% (89/436) within the 16 care homes, suggesting high suspected clinical need. Mean age was 90 years, ranging from 73-103 years. Female patients accounted for the majority (n=68). Addressing inappropriate prescribing saved £57.62 per day in prescriptions through stopping or changing ONS. Cost of dietetic staff time and milage totalled £3105.80 over the five-month period meaning that after 54 days the dietetic review service was saving money. Patients often preferred first line powder-based supplements, and these were either similar or more appropriate in nutrient content than initially prescribed ONS. For example, one patient affected by pressure ulcers was prescribed a fat emulsion supplement. It contained no protein or micronutrients to promote skin healing (cost £3.15) whilst first--line supplements provided macronutrient and micronutrient needs (cost 52p each and £1.04 total prescription). Discussion Dedicated dietetic input for care home residents appears to save costs on ONS prescribing whilst providing specialist nutritional expertise.