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

Abstract

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 · 10 9 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.

Recommended European Society of Parenteral and Enteral Nutrition protein and energy intakes and weight loss in patients with head and neck cancer

“…Our results reveal that patients consuming oral nutritional supplements do not maintain their weight, and lost twice the weight of patients consuming regular foods. 35 This difference in our results may be related to relatively high BMIs among the majority of patients at baseline. 34 The meta-analysis revealed that the increases in body weight were mainly observed in patients with BMI <20 kg/m 2 .…”

“…13 This recommendation aims to maintain adequate caloric and macronutrients and micronutrients, while minimizing weight loss. Similarly, a meta-analysis conducted by Stratton 35 concluded that oral nutritional supplements seem to be most effective in patients with a BMI <20 kg/m 2 (with 80% of the oral nutritional supplements energy being additive compared with 45% in those with a BMI >20 kg/m 2 ), or in patients who are malnourished at baseline. A metaanalysis by Paccagnella et al 34 evaluating the use of oral nutritional supplements in various cancer populations concluded that supplementation significantly increased total energy, protein, and micronutrient intakes, in addition to body weight.…”

“…34 The meta-analysis revealed that the increases in body weight were mainly observed in patients with BMI <20 kg/m 2 . Similarly, a meta-analysis conducted by Stratton 35 concluded that oral nutritional supplements seem to be most effective in patients with a BMI <20 kg/m 2 (with 80% of the oral nutritional supplements energy being additive compared with 45% in those with a BMI >20 kg/m 2 ), or in patients who are malnourished at baseline. 35 This difference in our results may be related to relatively high BMIs among the majority of patients at baseline.…”

A Cross-Sectional Survey on Dietary Supplements Consumption among Italian Teen-Agers

“…These characteristics seem to be in contrast with indications of nutritional supplementation, mainly addressed to the compensation of micronutrient deficiencies due to an inadequate diet, lack of appetite, or concomitant diseases [28].…”

To reform or be reformed: Can clinical dietitians survive without research as part of their everyday practice?

“…7 • Supplementation in community-based populations has shown mixed results. 8,9 • There is little evidence demonstrating dietitians can improve the problem. 10 The last fact is perhaps the most notable to the dietetic profession, but does this simply highlight the significant limitations when research is often driven by other professions?…”