Treating and Preventing Malnutrition with Oral Nutrition Supplements

Oral Nutrition Supplements and Malnutrition

At least one-third of patents entering a hospital are already malnourished. Another one-third of previously well-fed patients are leaving the hospital malnourished. Malnutrition can prolong and worsen disease, damaging quality of life and increasing healthcare costs. Oral nutrition supplements may be helpful in preventing and treating malnutrition and should be part of the medical treatment plan.

Poor nutrition status increases risk of complications, infection and mortality, slows wound healing, and decreases physical/cognitive function.

The United States spends up to $157 billion per year on treating disease-associated malnutrition. This includes morbidity, mortality and healthcare costs across eight diseases: Chronic Obstructive Pulmonary Disease, Coronary Artery Disease, Breast Cancer, Colorectal Cancer, Stroke, Musculoskeletal Disorders, Depression and Dementia. 

What is Malnutrition?

The World Health Organization defines malnutrition as deficiency, excess or imbalance in a person’s intake of energy and/or nutrients. Almost 11% of the world’s population is considered undernourished, meaning they lack adequate nutrients needed to thrive. Malnutrition can be the primary reason for illness or disease-associated malnutrition (DAM).

Indicators of Malnutrition:

• Unplanned weight-loss
• Children with slow weight-gain or who are not growing
• Weakness and/or fatigue
• Loss of appetite

While primary malnutrition is typically caused by food insecurity and poverty, DAM is caused by a preexisting condition. With disease, energy needs increase. When those needs are not met, nutrient deficiencies may occur and can have a negative effect on overall health.

Preventing and Treating Malnutrition with Oral Nutrition Supplelments

Oral nutrition supplements (ONS) provide calories, protein, vitamins and minerals to supplement food intake. You may find them in ready-to-drink/liquid or powder forms.  People who may benefit from ONS may not be able to consume adequate nutrients from food, putting them at risk for nutrition. This would include:

• Eldery
• Low birth weight
• Injury
• Food allergies
• Cardiac, renal and respiratory disease
• Cancer
• Dysphagia
• Food insecurity
• Organ failure
• Intestinal inflammatory disorders
• Other infectious causes

Once malnourished, immune response is lowered and healing slows. This can lead to longer hospital stays, higher risk of hospital readmission and overall higher healthcare costs. With oral nutrition supplements, this at-risk population has a better chance of thriving.

Benefits of Oral Nutrition Supplements:

Oral nutrition supplements have positive effects on indicators of malnutrition.

1. Improved body weight, physical and cognitive function, hand grip strength and social function
2. Increased protein intake, physical activity and improved scores on the Karnofsky Performance Scale
3. Reduced risk of post-surgical complications
4. Decreased length of hospital stay, readmission rates and healthcare costs

Malnutrition Awareness

Mid-September is Malnutrition Awareness Week, created by the American Society for Parenteral and Enteral Nutrition. With the goal to improve health and prevent the complications that malnutrition can cause, A.S.P.E.N. strives to educate the public and healthcare providers on signs, symptoms and treatment.

For more information, see related articles and nutrition resources here:

• Tube Feeding A Child: The G-Tube That Saved My Son’s Life & My Sanity
• Nutrition Over 70: A Guide To Senior Dietary Needs
• Top 5 Nutrients for Wound Healing
• Nutrition Management for Children with Developmental Disabilities Webinar Video
• Medical Nutrition Therapy: More Powerful Than You Think

References:

1. Abbott Nutrition

2. American Society for Parenteral and Enteral Nutrition

3. Caro MMM, Laviano A, Pichard C. Nutritional intervention and quality of life in adult oncology patients. Clinical Nutrition. 2007;26(3), 289-301. http://www.sciencedirect.com/science/article/pii/S0261561407000301.

4. Cawood AL, Elia M, Parsons EL, Smith TR, Stratton RJ. Cost-effectiveness of oral nutritional supplements in older malnourished care home residents. Clinical Nutrition. 2017; 1-8. http://www.sciencedirect.com/science/article/pii/S0261561417300584

5. Cawood AL, Elia M, Stratton RJ. Systematic review and meta-analysis of the effects of high protein oral nutritional supplements. Ageing Research Reviews. 2012;11(2), 278-296.  http://www.sciencedirect.com/science/article/pii/S1568163711000900

6. Elia M, Hébuterne X, Stratton RJ. A systematic review and meta-analysis of the impact of oral nutritional supplements on hospital readmissions. Ageing Research Reviews. 2013;12(4), 884-897. http://www.sciencedirect.com/science/article/pii/S1568163713000627

7. Elia M, Laviano A, Norman K, Normand C. A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in community and care home settings. Clinical Nutrition. 2016; 35 (125-137). http://www.clinicalnutritionjournal.com/article/S0261-5614(15)00191-0/fulltext

8. Hegazi R, Lakdawalla DN, LaVallee C, Linthicum MT, Matarese L, Snider JT, Wu Y. Economic Burden of Community-Bases Disease-Associated Malnutrition in the United States. Journal of Parenteral and Enteral Nutrition. 2014; 38 (2):77S-85S. http://journals.sagepub.com.proxy.library.cpp.edu/doi/pdf/10.1177/0148607114550000

9. Hill, SM. Oral nutritional supplementation: a user’s guide – ScienceDirect. Sciencedirect.com. http://www.sciencedirect.com/science/article/pii/S1751722217301440

10. Russell, CA. The impact of malnutrition on healthcare costs and economic considerations for the use of oral nutritional supplements. Clinical Nutrition Supplements. 2007;2(1), 25-32. http://www.sciencedirect.com/science/article/pii/S1744116107000038

11. Van der Meij BS, Langius JAE, Spreeuwenberg MD, et al. Oral nutritional supplements containing n-3 polyunsaturated fatty acids affect quality of life and functional status in lung cancer patients during multimodality treatment: an RCT. European Journal of Clinical Nutrition. 2012;66(3):399-404. doi:10.1038/ejcn.2011.214.

12. Zhong Y, Cohen JT, Goates S, Luo M, Nelson J, Neumann PJ. The Cost-Effectiveness of Oral Nutrition Supplementation for Malnourished Older Hospital Patients. Applied Health Economics and Health Policy. 2017;15(1):75-83. doi:10.1007/s40258-016-0269-7.