Ready-Made Oral Nutritional Supplements Improve Nutritional Outcomes and Reduce Health Care Use—A Randomised Trial in Older Malnourished People in Primary Care

Abstract

Large trials assessing oral nutritional supplements (ONS) and dietary advice (DA) in primary care are lacking. This study examined effects of ONS + DA versus DA on intake, weight, QoL, healthcare use and satisfaction in malnourished free-living older people. Three hundred and eight people (71.5 ± 10.7y) were randomised to receive ONS + DA (n154) or DA (n154) for 12 weeks. At baseline, 4, 8, 12 weeks, intake, weight, QoL, healthcare use and satisfaction were measured. ONS + DA group (mean daily intake ONS 480 kcal; 21 g protein; 80% compliance) had significantly greater total energy and protein intakes (+401 kcal/d, p < 0.001; +15 g/d, p < 0.001) and weight gain (+0.8 kg; p < 0.001) compared to DA. QoL improved in both groups over time with a significant improvement in index with ONS + DA (p = 0.009). Significantly more participants found ONS + DA made a difference for them (p = 0.011), but no differences were found between groups using Euroqol. Compared to DA, healthcare use reduced with ONS + DA, (HCP visits by 34%, emergency admissions 50%, LOS 62%). Acceptability of both interventions was high (ONS 96%, DA 95%), with significantly more participants satisfied with ONS (89%) than DA (73%) (p = 0.009). This trial in primary care indicates that ONS are acceptable, make a difference to patients, significantly improve intake and weight, and reduce health care use with potential savings.

Nutrition Care for Poorly Nourished Outpatients Reduces Resource Use and Lowers Costs

“… 38 In support, a randomized, controlled trial in the UK specifically examined use of ONS plus dietary advice to treat older undernourished people living in the community. 39 Results showed that nutrition care reduced visits to healthcare providers, lowered the frequency of ED visits, and shortened length of stay when hospitalization was needed. 39 Use of ONS as part of nutrition care has been shown to improve health outcomes and cut costs in the hospital, 40 in home-care services, 23 and in the community.…”

Prelevance and Feasibility of a Personalized Dietary Intervention in Older People With Meals-on-Wheels: A Randomized Controlled Pilot Trial

“…adding a slice of ham; adding cheese to soup). Fortification was combined with ONS to achieve higher enrichment levels in some older people, particularly in very small eaters (23,24). However, for very small eaters (calorie and/or protein ratios < 66%), meal enrichment was not sufficient to compensate for their nutritional deficit.…”

Adherence to Oral Nutritional Supplements After Being Discharged from the Hospital is Low but Improves Outcome in Patients with Advanced Chronic Liver Disease

“…49 In another study among 308 primary care malnourished patients, ONS for 12 weeks and dietary advice were superior to dietary advice alone in decreasing health care use (visits, emergency admissions, and length of stay) and improving the quality of life. 50 Moreover, 3-months therapy with ONS in 80 malnourished patients with benign digestive diseases has improved muscle function and the quality of life. 51 In ACLD patients, Iwasa et al have reported that nutritional counseling compared with no counseling improved the long-term survival of ACLD patients.…”