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      Adherence to Oral Nutritional Supplements: A Review of Trends in Intervention Characteristics and Terminology Use Since the Year 2000

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          ABSTRACT

          Research on disease‐related malnutrition and adherence to oral nutritional supplements (ONS) has increased in recent years. To guide future studies, it is important to identify trends in terminology use and intervention characteristics. This review aimed to map characteristics of research investigating adherence to ONS in patients with disease‐related malnutrition and explore changes over time. This review is a secondary analysis of quantitative studies from a systematic mixed‐studies review. Online databases, including PubMed, Cinahl, Cochrane Central Register of Controlled Trials, and APA PsycInfo, were searched to identify studies published from 2000 to March 2022. A quantitative content analysis of extracted data was performed, and the Mixed Methods Appraisal Tool (MMAT) was used to assess methodological risk of bias. This review includes 137 articles, over half of which are randomized controlled trials (52%). The term “oral nutritional supplements” was used in 40% of the studies. Adherence to ONS was mainly described by the term “compliance” (69%). It was most common to offer ready‐made milk‐based ONS (56%) and ONS as a sole intervention (51%). The prescribed dose of ONS was fixed in 64% of studies and individualized in 22% of studies. There was variation in the methods used to assess adherence to ONS, and adherence was not reported in nearly a fifth of studies. There was an increase in methodological quality over time ( p = 0.024). To ensure better understanding and increase the rigor and reproducibility of ONS intervention research, it is crucial to standardize the terminology used and to describe the interventions clearly.

          Abstract

          This review, encompassing 137 articles, mapped the characteristics of research on adherence to oral nutritional supplements (ONS) in patients with disease‐related malnutrition and explored changes over time. Key findings reveal a diverse range of terms used to describe ONS and adherence to this nutrition therapy. The ONS interventions frequently deviated from appropriate prescribing descriptions in nutrition guidelines, and there was a modest improvement in methodological quality over time.

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          Most cited references182

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          Rayyan—a web and mobile app for systematic reviews

          Background Synthesis of multiple randomized controlled trials (RCTs) in a systematic review can summarize the effects of individual outcomes and provide numerical answers about the effectiveness of interventions. Filtering of searches is time consuming, and no single method fulfills the principal requirements of speed with accuracy. Automation of systematic reviews is driven by a necessity to expedite the availability of current best evidence for policy and clinical decision-making. We developed Rayyan (http://rayyan.qcri.org), a free web and mobile app, that helps expedite the initial screening of abstracts and titles using a process of semi-automation while incorporating a high level of usability. For the beta testing phase, we used two published Cochrane reviews in which included studies had been selected manually. Their searches, with 1030 records and 273 records, were uploaded to Rayyan. Different features of Rayyan were tested using these two reviews. We also conducted a survey of Rayyan’s users and collected feedback through a built-in feature. Results Pilot testing of Rayyan focused on usability, accuracy against manual methods, and the added value of the prediction feature. The “taster” review (273 records) allowed a quick overview of Rayyan for early comments on usability. The second review (1030 records) required several iterations to identify the previously identified 11 trials. The “suggestions” and “hints,” based on the “prediction model,” appeared as testing progressed beyond five included studies. Post rollout user experiences and a reflexive response by the developers enabled real-time modifications and improvements. The survey respondents reported 40% average time savings when using Rayyan compared to others tools, with 34% of the respondents reporting more than 50% time savings. In addition, around 75% of the respondents mentioned that screening and labeling studies as well as collaborating on reviews to be the two most important features of Rayyan. As of November 2016, Rayyan users exceed 2000 from over 60 countries conducting hundreds of reviews totaling more than 1.6M citations. Feedback from users, obtained mostly through the app web site and a recent survey, has highlighted the ease in exploration of searches, the time saved, and simplicity in sharing and comparing include-exclude decisions. The strongest features of the app, identified and reported in user feedback, were its ability to help in screening and collaboration as well as the time savings it affords to users. Conclusions Rayyan is responsive and intuitive in use with significant potential to lighten the load of reviewers.
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            Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide

            Without a complete published description of interventions, clinicians and patients cannot reliably implement interventions that are shown to be useful, and other researchers cannot replicate or build on research findings. The quality of description of interventions in publications, however, is remarkably poor. To improve the completeness of reporting, and ultimately the replicability, of interventions, an international group of experts and stakeholders developed the Template for Intervention Description and Replication (TIDieR) checklist and guide. The process involved a literature review for relevant checklists and research, a Delphi survey of an international panel of experts to guide item selection, and a face to face panel meeting. The resultant 12 item TIDieR checklist (brief name, why, what (materials), what (procedure), who provided, how, where, when and how much, tailoring, modifications, how well (planned), how well (actual)) is an extension of the CONSORT 2010 statement (item 5) and the SPIRIT 2013 statement (item 11). While the emphasis of the checklist is on trials, the guidance is intended to apply across all evaluative study designs. This paper presents the TIDieR checklist and guide, with an explanation and elaboration for each item, and examples of good reporting. The TIDieR checklist and guide should improve the reporting of interventions and make it easier for authors to structure accounts of their interventions, reviewers and editors to assess the descriptions, and readers to use the information.
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              ESPEN guidelines on nutrition in cancer patients

              Cancers are among the leading causes of morbidity and mortality worldwide, and the number of new cases is expected to rise significantly over the next decades. At the same time, all types of cancer treatment, such as surgery, radiation therapy, and pharmacological therapies are improving in sophistication, precision and in the power to target specific characteristics of individual cancers. Thus, while many cancers may still not be cured they may be converted to chronic diseases. All of these treatments, however, are impeded or precluded by the frequent development of malnutrition and metabolic derangements in cancer patients, induced by the tumor or by its treatment. These evidence-based guidelines were developed to translate current best evidence and expert opinion into recommendations for multi-disciplinary teams responsible for identification, prevention, and treatment of reversible elements of malnutrition in adult cancer patients. The guidelines were commissioned and financially supported by ESPEN and by the European Partnership for Action Against Cancer (EPAAC), an EU level initiative. Members of the guideline group were selected by ESPEN to include a range of professions and fields of expertise. We searched for meta-analyses, systematic reviews and comparative studies based on clinical questions according to the PICO format. The evidence was evaluated and merged to develop clinical recommendations using the GRADE method. Due to the deficits in the available evidence, relevant still open questions were listed and should be addressed by future studies. Malnutrition and a loss of muscle mass are frequent in cancer patients and have a negative effect on clinical outcome. They may be driven by inadequate food intake, decreased physical activity and catabolic metabolic derangements. To screen for, prevent, assess in detail, monitor and treat malnutrition standard operating procedures, responsibilities and a quality control process should be established at each institution involved in treating cancer patients. All cancer patients should be screened regularly for the risk or the presence of malnutrition. In all patients - with the exception of end of life care - energy and substrate requirements should be met by offering in a step-wise manner nutritional interventions from counseling to parenteral nutrition. However, benefits and risks of nutritional interventions have to be balanced with special consideration in patients with advanced disease. Nutritional care should always be accompanied by exercise training. To counter malnutrition in patients with advanced cancer there are few pharmacological agents and pharmaconutrients with only limited effects. Cancer survivors should engage in regular physical activity and adopt a prudent diet.
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                Author and article information

                Contributors
                evelina.liljeberg@ikv.uu.se
                Journal
                Food Sci Nutr
                Food Sci Nutr
                10.1002/(ISSN)2048-7177
                FSN3
                Food Science & Nutrition
                John Wiley and Sons Inc. (Hoboken )
                2048-7177
                09 January 2025
                January 2025
                : 13
                : 1 ( doiID: 10.1002/fsn3.v13.1 )
                : e4722
                Affiliations
                [ 1 ] Department of Food Studies, Nutrition and Dietetics Uppsala University Uppsala Sweden
                [ 2 ] Department of Food, Nutrition and Culinary Science Umeå University Umeå Sweden
                [ 3 ] Pediatric Clinic at Umeå University Hospital Region Västerbotten Sweden
                [ 4 ] School of Psychology University of Southampton Southampton UK
                [ 5 ] Centre for Clinical Research Västerås Uppsala University Västerås Sweden
                [ 6 ] Geriatrics, Rehabilitation Medicine and Pain Centre Uppsala University Hospital Uppsala Sweden
                [ 7 ] Department of Women's and Children's Health Uppsala University Uppsala Sweden
                Author notes
                [*] [* ] Correspondence:

                Evelina Liljeberg ( evelina.liljeberg@ 123456ikv.uu.se )

                Author information
                https://orcid.org/0000-0002-5423-4262
                https://orcid.org/0000-0003-4770-3726
                https://orcid.org/0000-0002-6594-5668
                https://orcid.org/0000-0002-8367-1189
                https://orcid.org/0000-0002-2605-7457
                Article
                FSN34722 FSN3-2024-04-0938.R2
                10.1002/fsn3.4722
                11717485
                e4107796-77c0-4318-8482-b06217986381
                © 2025 The Author(s). Food Science & Nutrition published by Wiley Periodicals LLC.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 15 December 2024
                : 06 April 2024
                : 16 December 2024
                Page count
                Figures: 7, Tables: 3, Pages: 22, Words: 16000
                Categories
                Review
                Review
                Custom metadata
                2.0
                January 2025
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.5.2 mode:remove_FC converted:09.01.2025

                adherence,adherence assessment,compliance,nutrition intervention,oral nutritional supplement

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