Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-11T11:46:02.716Z Has data issue: false hasContentIssue false

Summary of a systematic review on oral nutritional supplement use in the community

Published online by Cambridge University Press:  28 February 2007

Rebecca J. Stratton
Affiliation:
Wolfson College, University of Cambridge, Cambridge CB3 9BB, UK
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Despite a marked increase in the prescription of oral nutritional supplements (ONS) in the community (Department of Health, 1991–7), there is still uncertainty about the value of their use in patients with different diseases. To answer questions about the effects on ONS on body weight and structure, spontaneous food intake and body function, a critical systematic review was undertaken (Stratton & Elia, 1999a). Eighty-four trials were reviewed (forty-five randomized, thirty-nine non-randomized; 2570 patients; diagnoses including chronic obstructive pulmonary disease, Crohn’s disease, cystic fibrosis, human immunodeficiency virus and acquired immune deficiency syndrome and cancer). Most studies (83 %) were conducted in patients living at home. The supplements were typically mixed macronutrients in liquid form, providing < 0.42–10.5 MJ/d for 1 week–2 years. The studies reviewed in patients with predominantly chronic conditions living in the community suggested that: (1) ONS produce demonstrable clinical (including functional) benefits, but the nature and extent of these benefits varies with the underlying chronic condition; (2) ONS increase total energy intake with > 50 % of the energy from ONS typically additional to that from habitual food intake; (3) improvements in body weight, total energy intake and body function following ONS appear to occur more frequently in individuals with a BMI < 20 kg/m2 than in those with a BMI > 20 kg/m2.

Type
Meeting Report
Copyright
Copyright © The Nutrition Society 2000

References

Allan, JD, Mason, A & Moss, AD (1973) Nutritional supplementation in treatment of cystic fibrosis of the pancreas. American Journal of Diseases of Children 126, 2226.Google Scholar
Altman, DG (1991) Practical Statistics for Medical Research. London: Chapman and Hall.Google Scholar
Arnold, C & Richter, M (1989) The effect of oral nutritional supplements on head and neck cancer. International Journal of Radiation Oncology 16, 15951599.Google Scholar
Berry, HK, Kellogg, FW, Hunt, MM, Ingberg, RL, Richter, L & Gutjahr, C (1975) Dietary supplement and nutrition in children with cystic fibrosis. American Journal of Diseases of Children 129, 165171.Google Scholar
Breslow, RA, Hallfrisch, J, Guy, DG, Crawley, B & Goldberg, AP (1993) The importance of dietary protein in healing pressure ulcers. Journal of the American Geriatrics Society 41, 357362.Google Scholar
Cederholm, TE & Hellstrom, KH (1995) Reversibility of protein-energy malnutrition in a group of chronically-ill elderly outpatients. Clinical Nutrition 14, 8187.CrossRefGoogle Scholar
Chlebowski, RT, Beall, G, Grosvenor, M, Lillington, L, Weintraub, N, Ambler, C, Richards, EW, Abbruzzese, BC, McCamish, MA & Cope, FO (1993) Long-term effects of early nutritional support with new enterotropic peptide-based formula vs. standard enteral formula in HIV-infected patients: Randomized, prospective trial. Nutrition 9, 507512.Google Scholar
Department, of Health (1991–7) Prescription Cost Analysis, England .London: Government Statistical Service, Department of Health.Google Scholar
Dickersin, K, Scherer, R & Lefebvre, C (1994) Identifying relevant studies for systematic reviews. British Medical Journal 309, 12861291.Google Scholar
Donahoe, M, Rogers, RM, Openbrier, DR & Wilson, DO (1989) Effect of calorie intake on muscle strength and walking distance in malnourished COPD. American Review of Respiratory Disease 139, A334.Google Scholar
Douglass, HO, Milliron, S, Nava, H, Eriksson, B, Thomas, P, Novick, A & Holyoke, ED (1978) Elemental diet as an adjuvant for patients with locally advanced gastrointestinal cancer receiving radiation therapy: a prospectively randomized study. Journal of Parenteral and Enteral Nutrition 2, 682686.Google Scholar
Efthimiou, J, Fleming, J, Gomes, C & Spiro, SG (1988) The effect of supplementary oral nutrition in poorly nourished patients with chronic obstructive pulmonary disease. American Review of Respiratory Disease 137, 10751082.CrossRefGoogle ScholarPubMed
Elia, M & Lunn, PG (1996) Biological markers of protein-energy malnutrition. Clinical Nutrition 16, Suppl. 1, 146.Google Scholar
Elkort, RJ, Baker, FL, Vitale, JJ & Cordano, A (1981) Long-term nutritional support as an adjunct to chemotherapy for breast cancer. Journal of Parenteral and Enteral Nutrition 5, 385390.Google Scholar
Evans, WK, Nixon, DW, Daly, JM, Ellenberg, SS, Gardner, L, Wolfe, E, Shepherd, FA, Feld, R, Gralla, R, Fine, S, Kemeny, N, Jeejeebhoy, KN, Heymsfield, S & Hoffman, FA (1987) A randomized study of oral nutritional support versus ad lib nutritional intake during chemotherapy for advanced colorectal and non-small cell lung cancer. Journal of Clinical Oncology 5, 113124.Google Scholar
Fiatarone, MA, O'Neill, EF, Ryan, ND, Clements, KM, Solares, GR, Nelson, ME, Roberts, SB, Kehayias, JJ, Lipsitz, LA & Evans, WJ (1994) Exercise training and nutritional supplementation for physical frailty in very elderly people. New England Journal of Medicine 330, 17691775.Google Scholar
Foster, KJ, Brown, MS, Alberti, KGMM, Buchanan, RB, Dewar, P, Karran, SJ, Price, CP & Wood, PJ (1980) The metabolic effects of abdominal irradiation in man with and without dietary therapy with an elemental diet. Clinical Radiology 31, 1317.Google Scholar
Fuenzalida, CE, Petty, TL, Jones, ML, Jarrett, S, Harbeck, RJ, Terry, RW & Hambidge, KM (1990) The immune response to short-term nutritional intervention in advanced chronic obstructive pulmonary disease. American Review of Respiratory Disease 142, 4956.Google Scholar
Gray-Donald, K, Payette, H & Boutier, V (1995) Randomized clinical trial of nutritional supplementation shows little effect on functional status among free-living elderly. Journal of Nutrition 125, 29652971.Google Scholar
Gray-Donald, K, Payette, H, Boutier, V & Page, S (1994) Evaluation of the dietary intake of homebound elderly and the feasibility of dietary supplementation. Journal of the American College of Nutrition 13, 277284.CrossRefGoogle ScholarPubMed
Harries, AD, Jones, LA, Danis, V, Fifield, R, Heatley, RV, Newcombe, RG & Rhodes, J (1983) Controlled trial of supplemented oral nutrition in Crohn's disease. Lancet i, 887890.Google Scholar
Hellerstein, MK, Pelfini, A, Hoa, R, Clinton, R, Faix, R, Richards, EW, Abbruzzese, BC, McCamish, MA & Cope, FO (1994) A fully randomised, prospective, double-blind short-term trial contrasting the use of a novel enterotropic peptide-based formula and the current standard of practice enteral formula in HIV and AIDS patients: evaluation of multiple clinical parameters. Journal of Parenteral and Enteral Nutrition 18, 25S.Google Scholar
Hirsch, S, Bunout, D, De, La Maza P, Iturriaga, H, Petermann, M, Icazar, G, Gattas, V & Ugarte, G (1993) Controlled trial on nutrition supplementation in outpatients with symptomatic alcoholic cirrhosis. Journal of Parenteral and Enteral Nutrition 17, 119124.Google Scholar
James, WPT & Ralph, A (eds) (1992) The Functional Significance of Low Body Mass Index. Proceedings of an I/D/E/C/G Workshop. Rome, Italy: Nestlé Foundation.Google Scholar
Jensen, MB & Hessov, IB (1997) Dietary supplementation at home improves the regain of lean body mass after surgery. Nutrition 13, 422430.CrossRefGoogle ScholarPubMed
Keele, AM, Bray, MJ, Emery, PW, Duncan, HD & Silk, DBA (1997) Two phase randomised controlled clinical trial of postoperative oral dietary supplements in surgical patients. Gut 40, 393399.Google Scholar
Kirschner, BS, Klich, JR, Kalman, SS, DeFavaro, MV & Rosenberg, IH (1981) Reversal of growth retardation in Crohn's disease with therapy emphasizing oral nutritional restitution. Gastroenterology 80, 1015.Google Scholar
Kissileff, HR (1985) Effects of physical state (liquid-solid) of foods on food intake: procedural and substantive contributions. American Journal of Clinical Nutrition 42, 956965.Google Scholar
Knowles, JB, Fairbarn, MS, Wiggs, BJ, Chan-Yan, C & Pardy, RL (1988) Dietary supplementation and respiratory muscle performance in patients with COPD. Chest 93, 977983.Google Scholar
Kuhlmann, MK, Schmidt, F & Kohler, H (1997) Oral nutritional support in malnourished HD-patients. Preliminary results of a randomised controlled study. Journal of the American Society of Nephrology 8, 199A.Google Scholar
Lewis, MI, Belman, MJ & Dorr-Uyemura, L (1987) Nutritional supplementation in ambulatory patients with chronic obstructive pulmonary disease. American Review of Respiratory Disease 135, 10621068.Google ScholarPubMed
Lipschitz, DA, Mitchell, CO, Steele, RW & Milton, KY (1985) Nutritional evaluation and supplementation of elderly subjects participating in a ‘Meals on Wheels’ program. Journal of Parenteral and Enteral Nutrition 9, 343347.Google Scholar
Lynch, K, Henry, DA, Roberts, C & Coburn, JW (1983) Clinical trial with oral carbohydrate supplement in hemodialysis patients: A nutritional evaluation. Dialysis and Transplantation 12, 566568.Google Scholar
McManus, RJ, Wilson, S, Delaney, BC, Fitzmaurice, DA, Hyde, CJ, Tobias, RS, Jowett, S & Hobbs, FDR (1998) Review of the usefulness of contacting other experts when conducting a literature search for systematic reviews. British Medical Journal 317, 15621563.CrossRefGoogle ScholarPubMed
Malagelada, J-R, Go, VLW & Summerskill, WHJ (1979) Different gastric, pancreatic, and biliary responses to solid-liquid or homogenized meals. Digestive Disease and Sciences 24, 101110.Google Scholar
Meredith, CN, Frontera, WR, O'Reilly, KP & Evans, WJ (1992) Body composition in elderly men: effect of dietary modification during strength training. Journal of the American Geriatrics Society 40, 155162.Google Scholar
Nayel, H, El-Ghoneimy, E & El-Haddad, S (1992) Impact of nutritional supplementation on treatment delay and morbidity in patients with head and neck tumours treated with irradiation. Nutrition 8, 1318.Google Scholar
Norregaard, O, Tottrup, A, Saaek, A & Hessov, I (1987) Effects of oral nutritional supplements to adults with chronic obstructive pulmonary disease. Clinical Respiratory Physiology 23, Suppl. 12, 388S.Google Scholar
Otte, KE, Ahlburg, P, D'Amore, F & Stellfeld, M (1989) Nutritional repletion in malnourished patients with emphysema. Journal of Parenteral and Enteral Nutrition 13, 152156.Google Scholar
Ovesen, L & Allingstrup, L (1992) Different quantities of two commercial liquid diets consumed by weight-losing cancer patients. Journal of Parenteral and Enteral Nutrition 16, 275278.CrossRefGoogle ScholarPubMed
Parsons, HG, Beaudry, P, Dumas, A & Pencharz, PB (1983) Energy needs and growth in children with cystic fibrosis. Journal of Pediatric Gastroenterology and Nutrition 2, 4449.Google Scholar
Pichard, C, Sudre, P, Karsegard, V, Yerly, S, Slosman, DO, Delley, V, Perrin, L, Hirschel, B & Swiss HIV Cohort study (1998) A randomized double-blind controlled study of 6 months of oral nutritional supplementation with arginine, omega-3 fatty acids in HIV-infected patients. AIDS 12, 5363.Google Scholar
Plata-Salaman, C (1996) Anorexia during acute and chronic disease. Nutrition 12, 6978.Google Scholar
Pliner, PL (1973) Effect of liquid and solid preloads on eating behaviour of obese and normal persons. Physiology and Behavior 11, 285290.Google Scholar
Poppit, SD & Prentice, AM (1996) Energy density and its role in the control of food intake: evidence from metabolic and community studies. Appetite 26, 153174.CrossRefGoogle Scholar
Rabeneck, L, Palmer, A, Knowles, JB, Seidehamel, RJ, Harris, CL, Merkel, KL, Risser, JMH & Akrabawi, SS (1998) A randomized controlled trial evaluating nutrition counseling with or without oral supplementation in malnourished HIV-infected patients. Journal of the American Dietetic Association 98, 434438.Google Scholar
Ramsey, BW, Farrell, PM, Pencharz, P & Consensus, Committee (1992) Nutritional assessment and management in cystic fibrosis: a consensus report. American Journal of Clinical Nutrition 55, 108116.Google Scholar
Rogers, RM, Donahoe, M & Costantino, J (1992) Physiologic effects of oral supplemental feeding in malnourished patients with chronic obstructive pulmonary disease. American Review of Respiratory Disease 146, 15111517.CrossRefGoogle ScholarPubMed
Schurch, B & Scrimshaw, NS (eds) (1987) Chronic Energy Deficiency: Consequences and Related Issues .Background papers and working group reports presented at an I/D/E/C/G meeting of August 37, 1987. Rome, Italy: Nestlé Foundation.Google Scholar
Shepherd, RW, Thomas, BJ, Bennett, D, Cooksley, WGE & Ward, LC (1983) Changes in body composition and muscle protein degradation during nutritional supplementation in nutritionally growth-retarded children with cystic fibrosis. Journal of Pediatric Gastroenterology and Nutrition 2, 439446.Google Scholar
Simko, V (1983) Long-term tolerance of a special amino acid oral formula in patients with advanced liver disease. Nutrition Reports International 27, 765773.Google Scholar
Skypala, IJ, Ashworth, FA, Hodson, ME, Leonard, CH, Knox, A, Hiller, EJ, Wolfe, SP, Littlewood, JM, Morton, A, Conway, S, Patchell, C, Weller, P, McCarthy, H, Redmond, A & Dodge, J (1998) Oral nutritional supplements produce significant weight gain in cystic fibrosis patients. Journal of Human Nutrition and Dietetics 11, 95104.Google Scholar
Sondel, SA, Parrell, SW, Becker, D & Mischler, EH (1987) Oral nutritional supplementation in cystic fibrosis. Nutritional Support Services 7, 2022.Google Scholar
Stauffer, JL, Carbone, JE & Bendoski, MT (1986) Effects of diet supplementation on anthropometric and laboratory nutritional parameters in malnourished ambulatory patients with severe chronic obstructive pulmonary disease (COPD). American Review of Respiratory Disease 133, A204.Google Scholar
Stratton, RJ & Elia, M (1999a) A critical systematic analysis of the use of oral nutritional supplements in the community. Clinical Nutrition 18, Suppl. 2, 2984.Google Scholar
Stratton, RJ & Elia, M (1999b) The effects of enteral tube feeding and parenteral nutrition on appetite sensations and food intake in health and disease. Clinical Nutrition 18, 6370.Google Scholar
Stubbs, RJ (1992) Macronutrients, appetite and energy balance in humans. PhD Thesis, University of Cambridge.Google Scholar
Stubbs, RJ, Johnstone, AM, O'Reilly, LM, Barton, K & Reid, C (1998) The effect of covertly manipulating the energy density of mixed diets on ad libitum food intake in ‘pseudo free-living’ humans. International Journal of Obesity 22, 980987.Google Scholar
Tisdale, MJ (1997) Cancer cachexia: Metabolic alterations and clinical manifestations. Nutrition 13, 17.Google Scholar
Tolia, V (1995) Very early onset nonorganic failure to thrive in infants. Journal of Pediatric Gastroenterology and Nutrition 20, 7380.Google Scholar
Volkert, D, Hubsch, S, Oster, P & Schlierf, G (1996) Nutritional support and functional status in undernourished geriatric patients during hospitalization and 6-month follow-up. Aging Clinical and Experimental Research 8, 386395.Google Scholar
Welch, PK, Dowson, M & Endres, JM (1991) The effect of nutrient supplements on high risk long term care residents receiving pureed diets. Journal of Nutrition for the Elderly 10, 4962.Google Scholar
Wilson, DO, Rogers, RM, Sanders, MH, Pennock, BE & Reilly, JJ (1986) Nutritional intervention in malnourished patients with emphysema. American Review of Respiratory Disease 134, 672677.Google ScholarPubMed
Woo, J, Ho, SC, Mak, YT, Law, LK & Cheung, A (1994) Nutritional status of elderly patients during recovery from chest infection and the role of nutritional supplementation assessed by a prospective randomized single-blind trial. Age and Ageing 23, 4048.Google Scholar
Yassa, JG, Prosser, R & Dodge, JA (1978) Effects of an artificial diet on growth of patients with cystic fibrosis. Archives of Diseases in Childhood 53, 777783.Google Scholar