Recommending ultra‐processed oral nutrition supplements for unintentional weight loss: Are there risks?

Abstract

Oral nutrition supplements (ONS) are widely recommended for the management of unintentional weight loss in patient populations, long-term care residents, and community-dwelling older adults. Most marketed ONS are ultra-processed, with precision nutrition and aseptic composition, as well as convenience and availability, driving their selection. However, therapeutic effectiveness is mixed and the potential health risks of consuming ultraprocessed ONS long-term in lieu of less-processed foods have received little attention. A diverse and balanced microbiota supporting immunity and wellness is maintained by a diet rich in plant-sourced foods. The implications of ultra-processed ONS displacing plant-sourced foods, and specifically the potential for undesirable impacts on the gut microbiota, require consideration.Most ONS are either devoid of fiber or are supplemented with isolated or purified fibers that may contribute to adverse gastrointestinal symptoms and appetite suppression. In contrast, the diversity of microbial-available, nondigestible carbohydrates, together with the array of phytochemicals found in plant-sourced foods, support microbial diversity and its resiliency. This review outlines the clinical dilemma of recommending commercial ultraprocessed ONS vs nutritionally adequate (eg, high-energy/high-protein) foods and beverages that contribute to diet quality, maintenance of a diverse and stable gut microbiota composition, and support nutrition status and health. Ultra-processed ONS may fall short of expected health benefits, and overreliance may potentially contribute to the risk for patient and older adult populations because of the displacement of a variety of healthful foods.

Impact of Dietary Fiber on Inflammation and Insulin Resistance in Older Patients: A Narrative Review

“…SCFA exert a pivotal role in maintaining intestinal barrier integrity and in promoting growth and diversity of gut microbiota. While a variety of intact fibers characterize plant-sourced foods, fiber in functional foods and nutritional supplements may differ for origin (natural-extracted or purified, or synthetic) and most importantly diversity, as usually only one or a limited number of selected types of fibers are included [ 78 ]. As a result, comparing the effects of nutritional interventions based on different fiber supplementation to those of high-fiber diets is challenging, as well as assuming that the benefits of dietary fiber in natural plant-based foods documented by several studies apply also to supplemental fibers.…”

“…In addition to potential interactions with drug absorption, early satiety as a result of the effect of the SCFA acetate, which can cross the blood brain barrier and suppress appetite, should be considered, particularly in malnourished older patients [ 104 ]. Gastrointestinal discomfort and bloating as results of intestinal fermentation may reduce the tolerability of high-fiber diets, while when fiber is included in dietary supplements, dislike of flavor or texture may limit compliance [ 78 ].…”