Specialized High-Protein Oral Nutrition Supplement Improves Home Nutrient Intake of Malnourished Older Adults Without Decreasing Usual Food Intake

Abstract

Background: Reduced nutrient intake is common in patients after hospitalization, contributing to increased risk for readmission and mortality. Oral nutrition supplements can improve nutrition status and clinical outcomes, but intake of food is prioritized by clinicians. This study examines the impact of a high-protein oral nutrition supplement (S-ONS) on nutrient intake post discharge.

Methods: In a subset of patients (14 S-ONS and 16 placebo) from the NOURISH (Nutrition effect On Unplanned ReadmIssions and Survival in Hospitalized patients) trial, 24-hour dietary recalls were conducted on 3 randomly selected days during the weeks of 30, 60, and 90 days post discharge. Nutrient intake was estimated using Nutrition Data System for Research software. Adequate energy and protein intake were defined as 30 kcal/kg/d and 1.2 g/kg/d, respectively. Dietary Reference Intakes (DRIs) were used for other nutrients.

Results: Less than half of patients met the requirements for energy, protein, and 12 micronutrients from food intake alone during the study. Energy and protein intakes from food were not diminished relative to placebo. Considering nutrient intake from both food and S-ONS, 50% and 71% of patients receiving S-ONSs met energy and protein goals respectively at 90 days (compared with 29% and 36%, in the placebo group), and 100% met the DRI for total carbohydrate, iron, phosphorus, copper, selenium, thiamin, and riboflavin at all time points, all of which were consumed at higher amounts vs placebo.

Conclusion: Three months of S-ONS consumption increases intake of numerous nutrients without decreasing nutrient intake from food in older malnourished adults post discharge.

Keywords: malnutrition; minerals/trace element intake; nutrient intake; oral nutrition supplement; vitamin intake.

© 2018 American Society for Parenteral and Enteral Nutrition.

Figures

Figure 1

Specialized oral nutrition supplement (S‐ONS) improves overall macronutrient consumption profile. Boxes represent interquartile range with median as the middle (horizontal line). Recommended intake is represented by dashed lines. Macronutrients included (A) total kilocalories, (B) protein, (C) total fat, (D) saturated fat, (E) linoleic acid, (F) linolenic acid, (G) total carbohydrate, (H) added sugars, and (I) dietary fiber. Significant difference between placebo and S‐ONS (food + S‐ONS): *P < .05; **P < .01. RDA, recommended dietary allowance.

Figure 2

Increased compliance to specialized oral nutrition supplement (S‐ONS) consumption, but not placebo, is associated with meeting more Dietary Reference Intakes (DRIs), regardless of time point. Time points were pooled within treatment groups after no significant differences in regression slopes were found. Relationships were tested via repeated‐measures analysis. S‐ONS group: P = .0002, β = 4.46; placebo group: P = .41, β = 1.21. Black triangles indicate day 30; squares indicate day 60; circles indicate day 90; gray‐filled shapes represent S‐ONS; white‐filled shapes represent placebo.