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Volume 9.11 12th Sep 2019
ORAL NUTRITIONAL SUPPLEMENTS: THE RANGE AVAILABLE AND HOW TO USE THEM As dietitians, we follow the mantra of 'food first', aiming to meet our patients’ nutritional requirements using real, easily accessible, affordable and appetising food. However, while we have many tools in our box to elevate the nutritional density of our patients’ food (for example, high energy/high protein snacks, food fortification and optimised menu planning), unfortunately, this is not always sufficient, and there is still a shortfall between nutritional intake and requirements. This puts patients at risk of developing malnutrition. Malnutrition (a dirty word to a dietitian) instantly pricks our ears up and sets the wheels in motion to get to work to rectify the situation! But what is ‘malnutrition’? NICE defines it as, ‘a state in which a deficiency of nutrients such as energy, protein, vitamins and minerals causes measurable adverse effects on body composition, function or clinical outcome”.1 Unfortunately, malnutrition is a prevalent problem in the UK with approximately 1 in 10 people over the age of 65 either malnourished or at risk of malnutrition.2 However, it is suggested that the majority of people at risk of malnutrition are actually younger than this, with more than three million UK citizens suffering from malnutrition at any one time.3 This
places a huge financial burden on our already stretched health and social care system, with malnourished patients costing two to three times more to treat than a comparable well-nourished patient.4 More importantly, and aside from the financial burden, malnutrition causes further health complications in an already vulnerable patient; for example, impaired immune response, compromised muscle strength, delayed wound healing, longer hospital stays and an escalation of medical care.
Evelyn Toner RD Freelance Dietitian Evelyn’s specialist areas include sports nutrition and gastroenterology, especially IBS and health and wellbeing. She enjoys media work and running her social media persona ‘The Active Dietitian’ (on Instagram as @the_active_ dietitian).
THE NEXT STEP FROM FOOD FIRST
Oral nutrition support is the first tool in the dietitian’s repertoire for tackling malnutrition and when the food-first approach fails to achieve the desired results, we will opt for oral nutrition supplements (ONS) as the next step. If possible oral nutrition support, using such supplements, is preferential to enteral or parenteral feeding, as it has less risk of complications or side effects, is less invasive and is more cost effective.5 ONS are generally calorie dense preparations that come in the form
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