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Should food or supplements be used in the community for the treatment of disease-related malnutrition?

Published online by Cambridge University Press:  07 March 2007

Rebecca J. Stratton
Rebecca J. Stratton
Affiliation:
Institute of Human Nutrition, School of Medicine, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
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Abstract

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Strategies are needed for community-based treatment of disease-related malnutrition (DRM), which is a common debilitating condition that in the UK is estimated to cost >£7×109 annually. Whilst dietary fortification and counselling are often used as a first-line treatment for malnutrition, the numbers of dietitians available to undertake and oversee such practices are currently insufficient to address the extent of DRM in primary care. Although dietary fortification and counselling can improve nutritional (primarily energy) intake, the evidence base for this practice is weak and it needs addressing with well-designed trials that assess clinically-relevant outcome measures and costs. Liquid oral nutritional supplements (ONS) are increasingly used in the community, often in combination with dietary counselling. The larger evidence base of trials that have assessed ONS suggests that nutritional intake and some functional outcomes can be improved in some patient groups in the community. Although meta-analysis indicates significant reductions in mortality (odds ratio 0.59 (95% CI 0.48, 0.72), n 3258) and complication rates (odds ratio 0.41 (95% CI 0.31, 0.53), n 1710) with ONS v. routine care, few of these studies are community based. Thus, the impact of ONS on clinical outcome, healthcare use and costs requires further assessment. Similarly, the clinical and cost efficacy of other strategies (e.g. sensory enhancement, music, behavioural therapy), alone or in combination with other treatments, requires greater investigation in order to meet the challenge of treating DRM more effectively and cheaply in the future.

Keywords

MalnutritionSupplementsDietetic counsellingFood fortificationPrimary care
Type
BAPEN Symposium 4 on ‘Challenges of enteral feeding from the acute to the community setting’
Information
Proceedings of the Nutrition Society , Volume 64 , Issue 3 , August 2005 , pp. 325 - 333
Copyright
Copyright © The Nutrition Society 2005

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