ONS

• Oral nutritional supplements (ONS)


  Specially formulated, intended for the dietary management of patients who are unable to meet their nutritional needs through diet alone, and should be used under medical supervision

  
• Malnutrition management is relevant in continuing professional education (CPE)

  
• Protein-energy malnutrition (PEM)


  1. Common causes

  2. Consequences
• Disease-related malnutrition


  1. Intake unable to meet nutritional needs

  2. Increased requirements e.g. trauma, surgery, sepsis, burns

  3. Impaired ability to absorb/utilise nutrients

  4. Other factors

  
• Consequences of malnutrition


  • Impaired immune function increasing susceptibility to infection and sepsis
  • Delayed wound healing and increased risk of pressure ulcers
  • Muscle wasting and weakness
  • Increased risk of mortality and complications during and after hospitalisation
  • Longer hospital stays
• Strategies to manage PEM

  1. Food-based approach

  2. Increase caloric and protein intake

  3. Individualised to allow more choices and honour personal preference

  4. Small frequent meals

  5. Nourishing drinks

  
• There is increasing evidence from randomized trials showing that nutritional support significantly reduces mortality in the population of medical inpatients at nutritional risk

  
• Dietary counseling


  1. Instruction or education in modifying food intake to improve nutrition or dietary quality

  2. Provided to the patient or caregiver during hospitalization and could continue subsequently in outpatient or community settings

  3. Any healthcare professional could provide counseling, including a dietitian, medical doctor, nurse, or other clinical staff

  
• Types of ONS


  • Liquid formula
  • Powdered formula
  • Modular
• Standard formula


  Polymeric enteral formula, contain intact macronutrients, lactose free, frequently used as an ONS and/or enteral feeding feed
• Nutritionally complete formula


  Contains sufficient micronutrients to meet the daily requirements
• Supplemental nutrition


  Does not contain sufficient micro-/macro-nutrients

  
• Standard formula examples


  • Powder
  • Liquid
• Higher nutrient density (1.5 to 2.4 kcal/ml) formulas


  • Useful when fluid restriction is required
• Specialised formula types


  • DM feed with lower CHO content
  • Renal feed with lower electrolytes (high vs low protein)
  • Juice-based formula

  
• Many EN formulas lack rigorous scientific evidence to support their specific composition, and marketing materials are not subject to the rigorous standards used for prescription drugs
• Hydroxymethylbutyrate (HMB)


  Its effects on skeletal muscle mass and strength have been investigated in athletes, and it is marketed to aid in the prevention of muscle loss reduction during aging
• Investigating the effects of HMB


  To investigate the effects of HMB alone, and supplements containing HMB, on skeletal muscle mass and physical function in a variety of clinical conditions characterized by loss of muscle mass and skeletal muscle weakness
• 15 eligible RCTs involved a total of 2137 adults, with all but 1 study providing a dose of 3 g/d HMB, and a considerable variability in the duration of the intervention, ranging from 7 d to 6 mo
• Findings on the effects of HMB

  • We found some evidence to support a positive effect of HMB on the change in muscle mass and strong evidence to support an increase in absolute muscle strength, but the effect size was small in both instances
  • Subgroup analysis indicated that participants receiving HMB and supplements containing HMB were significantly stronger compared to the control group, but with only a small to moderate effect size
• Prescribe suitable ONS according to patient's medical history, current condition, oral intake, preferences
• Critically evaluate the efficacy of ONS products and the statements made in marketing materials and by company representatives