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Tackling malnutrition with better compliance to oral nutritional supplements Malnutrition is a major public health issue in Australia which leads to poor quality of life and health outcomes.1 Oral nutritional supplements (ONS) can provide an evidence-based solution. Defining malnutrition Increasingly, malnutrition is recognised as a health risk to patients and an economic burden.1 The prevalence is high, with up to 1 in 2 hospitalised adults and 2 in 3 adults in residential care facilities.2 Malnutrition can be caused by reduced food intake, nutrient malabsorption and/or losses and disease-associated inflammation.4,5 It effects a person’s risk of infections, falls, pressure injuries and hospitalistion, but also adversely effects quality of life and function.4,5 Identification is key to prevent and treat malnutrition and routine screening is recommended across community and clinical settings with the use of a validated screening tool.2
Best practice in managing malnutrition A comprehensive plan for treatment is recommended addressing problems contributing to malnutrition. Oral Nutritional
The five diagnostic criteria for malnutrition according to the Global Leadership Initiative on Malnutrition (GLIM):4 • • • • •
Weight loss Low body mass index (BMI) Reduced muscle mass Reduced food intake or assimilation Disease burden/inflammation
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Groups and disease states with an increased risk of malnutrition2 Older adults Critical illness Orthopaedic injury Gastrointestinal and liver disease Renal disease
Cancer Neurological disease Respiratory disease
Delical Concentrate Fast Facts Supplements (ONS) can provide an evidence-based strategy to help improve patient outcomes.3 When ONS are required, ESPEN guidelines recommend:3 • Tailor the type and flavor of ONS to the patient’s taste and eating capacities • Offer a variety of ONS options to avoid taste fatigue • Assess ONS monthly to help aid optimal compliance When offered, ONS should provide a minimum of 400kcal and 30 grams of protein per day and be continued for a minimum of 1 month.3
Introducing Delical Delical offers a variety of great tasting oral nutritional supplements for individuals who are unable to meet their nutritional needs through diet alone. Combining nutrition, great taste and a variety of flavours can mean better compliance and less wastage.
• • • •
High-Protein, High-Energy 2.3kcal/mL 29 grams of protein per 200mL serve Specifically formulated for maximum flavour
per 200ml serving
per ml
“We have used Delical Fruity and the Delical Concentrate over the past month as a trial and were very impressed with the product. It has a reduced amount for the concentrate compared to other brands, the range of flavours was well liked, and feedback said that the taste was great. Will definitely be using Delical for
How can we enhance compliance? Compliance with oral nutrition supplements is key to good malnutrition management. Several factors influence whether the patient consumes their prescribed supplements, and this can present a challenge to dietitians.6 A systematic review which investigated the factors influencing compliance of ONS highlighted some key areas which may help improve patient compliance in practice.6 Compliance was improved with:6 • Higher energy density ONS (>2Kcal/mL) vs lower energy density ONS (Figure 1). • Offering different flavours of the same type of supplement • Consuming the ONS in smaller volumes (compliance up to 93%).
Figure 1. Improved Compliance with higher energy density ONS
Percentage compliance between groups of studies with different energy densities. Compliance is significantly greater for ONS with energy density >2kcal/mL (n=8, *p<0.05, SD 4) vs 1-1.3 kcal/mL (N=21, SD 14) or 1.5kcal/mL ONS (N=12 SD 14).
our residents now.” Kym Farrell, Director of Nursing, Akooramak Aged Care The review also found that ONS consumption had little effect on food consumption and appetite resulting in an increase in total nutrient intake.6 In fact, another recent systematic review has also confirmed that in older adults, overall appetite may even be improved with the use of ONS.7
Do oral nutrition supplements impact appetite? A new systematic review and meta-analysis has examined the effectiveness of ONS on older adults with anorexia of aging (AA), which is a major contributor to malnutrition.7-9 This research demonstrated that ONS can help improve overall appetite in older adults with AA, which challenges the perception that ONS consumption leads to a reduction in food intake.7 Seventeen randomised controlled trials were identified for inclusion (n=1204), with a mean age of 81.9 years and ONS supplementation provided one to three times per day. The results showed that ONS had a positive effect on the overall appetite (p = 0.02) and consumption (p = 0.05). Importantly, these positive effects also led to a significance difference in body weight (p < 0.001), and body mass index (BMI) (p = 0.01).7
What does the research say about ONS efficacy? Various studies have looked at the efficacy of ONS in people at risk of malnutrition.10,11 A systemic review of 36 randomised
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Delical 2.3 kcal/mL Concentrate
Delical 1.8 kcal/mL Classic Milky
Delical 1.3 kcal/mL Fruity Drink
per 200ml serving
per 200ml serving
per 200ml serving
per ml
per ml
Delical Gelodiet Powder 225 g
per ml
*Chocolate 362 kcal
Flavours: • Coffee • Vanilla • Strawberry
IDDSI level:
Flavours: IDDSI level: • Coffee • Vanilla • Strawberry • Caramel • Chocolate • Red Berries • Peach Apricot • Neutral
Flavours: • Orange • Apple • Mixed Fruit
IDDSI level:
IDDSI level:
Key Summary • • • • •
alnutrition is preventable issue which impacts on patient health and wellbeing.4,5 M Oral nutritional supplements can form part of the solution.3 Patients are more likely to comply with energy dense supplements in smaller volumes.6 Appetite may be improved with ONS in older adults with anorexia of aging.7 Evidence suggests that ONS can help improve health and functional outcomes in those suffering from malnutrition.10,11
controlled trials and meta-analysis of high protein ONS (where >20% of the energy came from protein) found:10 • A reduction in complications (p<0.001) • A reduction in readmissions to hospital (p=0.004) • Improved grip strength (p<0.014) • Significant increased intake of protein and energy with little reduction in normal food intake (p<0.001) • Significant improvements in weight (p<0.001) But research has also shown that the use of nutrient dense low volume ONS can also help improve quality-of-life parameters in nursing home residents.11 References 1. Roberts, S.et al 2021 Nutrients, 13, 2316. 2. DAA Malnutrition Guideline Steering Committee, 2009, Nutrition & Dietetics, 66: S1-S34 3. Volkert D, et al 2019 Clin Nutr. Feb;38(1):10-47. 4. Cederholm T, et al 2019 Journal of Cachexia, Sarcopenia and Muscle; 10: 207–217 5. Saunders J, Smith T. 2010 Clinical Medicine Dec;10(6):624-7 6. Hubbard GP, 2012 et al. Clin Nutr 31(3):293-312. 7. Li M, et al 2021 Nutrients. Mar 3;13(3):835 8. Cox NJ, et al 2019 Nutrients. Jan 11;11(1):144. 9. Landi F,et al 2016 Nutrients. 2016;8(2):69 10. Cawood AL, Elia M and Stratton RJ, 2012 Ageing Res Rev 11(2):278-296. 11. Stange I, et al. 2013 J Am Med Dir Assoc 14(8):628
Scan the QR code or visit DELICAL.COM.AU for more information DELICAL CARELINE 1800 552 29 For healthcare professional use only
Food for special medical purposes. Use under medical supervison.
For healthcare professional use only
Delical. It’s French for “exploding with flavour”
Introducing Delical Concentrate – a high protein, high energy, vitamin and mineral enriched oral nutritional supplement. The Delical range offers a variety of great tasting oral nutritional supplements for individuals who are unable to meet their nutritional needs through diet alone, combining nutrition with great taste.
Does not contain fresh strawberries, just a delicious
strawberry flavour
Delical Concentrate gives you: • Ability to increase protein and energy intake with less volume •
Tastes like no other – with a range of flavours to suit different palates
•
Easy to pour, easy to store convenient bottles
•
IDDSI level:
(Mildly thick/moderately thick
when chilled)
2.32.3 kcal kcal
per 200ml serving
The NO.
per ml
1 brand in France , *
Delical is now available in Australia *ONS data accessed April 2021 https://www.openhealth.fr/
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Combining nutrition and great taste
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Sanulac Nutritionals Australia Pty Ltd. ABN 31 160 607 509. Level 1, 42-44 Chandos Street, St Leonards, NSW 2065. Food for Special Medical Purposes. Use under medical supervision
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While stocks last
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Visit delical.com.au for more information and to order your samples† DELICAL CARELINE 1800 552 229