Improved compliance and increased intake of energy and protein with a high energy density, low volume multi-nutrient supplement

Abstract

Although it is often hypothesised that higher energy density liquid supplements will have a greater effect on total nutritional intake than standard supplements, there have been few comparative studies in clinical settings (1) . This study aimed to compare the effects of a low volume, high energy density (2.4 kcal/ml) liquid oral nutritional supplement (ONS) versus standard ONS (1.5-2.0 kcal/ml) on food and total energy and protein intakes and patients' compliance with supplementation.A longitudinal study was carried out in patients at risk of malnutrition requiring an oral nutritional supplement in three care homes and four hospitals in the UK and the Netherlands. Thirty eight patients (mean age 80 years (SD 15), 68 % female, mean BMI 17.9 kg/m 2 (SD 4.3), 55 % in care homes, 45 % in hospitals) completed the study and were eligible for analysis. Patients were offered a range of standard 200 ml ONS (1.5-2.0 kcal/ml, 300-400 kcal and 11-20 g protein per 200 ml bottle) ad libitum, daily in addition to the diet for 3 days. Patients were then offered a higher energy density, low volume ONS (2.4 kcal/ml, 300 kcal, 12 g protein per 125 ml bottle, Fortisip Compact, Nutricia 1 ) ad libitum daily in addition to the diet for a mean of 4 days (range 3-5 days). During the two periods of supplementation, dietary intake, including the intake of all foods, drinks and supplements were recorded on one day using 24 h food record charts (analysed using WISP version 3.0 dietary analysis package; Tinuviel, Anglesey, UK). Patients' compliance with ONS consumption (mean % bottle consumed) was recorded on a daily basis throughout the study.Total energy intake (diet plus ONS) was significantly greater when consuming the higher energy density (2.4 kcal/ml) ONS compared to standard ONS ( + 200 kcal/d, P = 0.01, see table). The mean intake of energy from 2.4 kcal/ml ONS was significantly greater (30%) than the intake from standard ONS (P = 0.002, see table). Total protein intake (diet plus ONS) was significantly higher with the 2.4 kcal/ml ONS compared to standard ONS (+ 11 g/d, P = 0.005, see table). The mean intake of protein from the 2.4 kcal/ml ONS was significantly greater (24 %) than the intake from standard ONS (P = 0.004, see Table). Voluntary dietary intakes (diet only) were similar during both periods of supplementation (see Table). Overall mean percentage compliance throughout the study period was significantly higher with the 2.4 kcal/ml ONS (91 %) than with standard ONS (77%) (P = 0.0001, paired samples t-test).This longitudinal study suggests that compliance is significantly greater with a more energy dense (2.4 kcal/ml), low volume liquid ONS than standard energy density supplements, resulting in patients consuming significantly greater total energy and protein intakes. Further well-designed, randomised trials are warranted to examine the clinical benefits of higher energy density low volume supplements.Thanks to the staff and patients involved in this study at

Encouraging appropriate, evidence-based use of oral nutritional supplements

“…The energy density, volume and macronutrient profile of the supplement, the time and way in which it is administered and the duration of supplementation are factors that may affect compliance (12,52) . Recently, studies have suggested that increasing the energy density of liquid feeds improves both nutritional intake and compliance with supplementation, over the use of standard energy dense feeds in hospital and community patients (53)(54)(55) . Increasing the energy density of ONS minimises the volume needed to be consumed by a malnourished patient, and so encourages compliance and nutritional intake (53)(54)(55) .…”

“…Recently, studies have suggested that increasing the energy density of liquid feeds improves both nutritional intake and compliance with supplementation, over the use of standard energy dense feeds in hospital and community patients (53)(54)(55) . Increasing the energy density of ONS minimises the volume needed to be consumed by a malnourished patient, and so encourages compliance and nutritional intake (53)(54)(55) . It is also likely that encouragement and education about the reasons for taking supplements would be beneficial.…”

Adherencia a la Nutrición Enteral Domiciliaria

“…A esto, se le suma que en los últimos trabajos sobre adherencia terapéutica, únicamente se encontraron herramientas estandarizadas para el tratamiento farmacológico, mientras que para el estudio del cumplimiento en la ingesta de suplementos nutricionales y nutrición enteral se siguen utilizando métodos indirectos no estandarizados (16); encontrando algunos trabajos que utilizan el conteo del número de envases consumidos, medir la cantidad de producto restante para determinar las calorías ingeridas al día y otros como es el uso de registros o diarios dietéticos de cinco días, métodos útiles pero no libres de sesgos importantes como es introducir en los resultados la propia sobreestimación del paciente (16)(17)(18).…”

That's why I take my ONS. Means-end chain as a novel approach to elucidate the personally relevant factors driving ONS consumption in nutritionally frail elderly users

“…Small volume, high energy density, and high nutrient density were shown to improve ONS compliance (Hubbard, Buchan, Sanders, Brothers, & Stratton, 2010;Hubbard et al, 2012;Nieuwenhuizen, Weenen, Rigby, & Hetherington, 2010). In addition, Nieuwenhuizen et al (2010) reported a positive influence of liquid format and general palatability on ONS compliance in a group of care home living ONS users.…”