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      Adherences to oral nutritional supplementation among hospital outpatients: An online cross-sectional survey in Japan

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          Abstract

          Oral nutritional supplements (ONS) are multi-nutrient products used to increase the energy and nutrient intakes of patients. The aim of this study was to examine whether or not the adherence of patients varies according to their receiving prescription or over-the-counter ONS. Data were obtained from an online cross-sectional survey conducted with patients in Japan. A total of 107 patients who matched the inclusion criteria for the prescription ONS group and 148 who matched the criteria for the over-the-counter ONS group were further analyzed. In the prescription and over-the-counter ONS groups, the main medical reason for ONS consumption were “malnutrition” (48 patients [44.9%] vs. 63 patients [42.6%] p = 0.798], “frailty” (29 patients [27.1%] vs. 36 patients [24.3%] p = 0.663) and “aging” (25 patients [23.4%] vs. 30 patients [20.3%] p = 0.644). The proportion of “No particular disease” for prescription ONS consumption was significantly lower than that for over-the-counter ONS (6 patients [5.6%] vs. 24 patients [16.2%] p = 0.001). The body mass index of the prescription ONS group was significantly higher than that of the over-the-counter ONS group (21.1±4.38 kg/m 2 vs. 19.9±3.75 kg/m 2, p = 0.0161). In the prescription ONS group, all patients were given medical advice by doctors or registered dietitians. In contrast, in the over-the-counter ONS group, only 46 patients (31.1%) were given advice by doctors or registered dietitians (p<0.001). In the prescription ONS group, ONS was taken significantly more times and for a longer duration than in the over-the-counter ONS group (p<0.0001). However, among patients given advice by doctors or registered dietitians, there were no significant differences between the groups. Greater support by the medical team is still needed in order to maximize adherence to supplementation, especially concerning the calories, timing and period, so that benefits can be achieved and sustained.

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          Oral nutritional interventions in malnourished patients with cancer: a systematic review and meta-analysis.

          International guidelines on the nutritional management of patients with cancer recommend intervention with dietary advice and/or oral nutritional supplements in patients who are malnourished or those judged to be at nutritional risk, but the evidence base for these recommendations is lacking. We examined the effect of oral nutritional interventions in this population on nutritional and clinical outcomes and quality of life (QOL). Electronic searches of several databases including MEDLINE, EMBASE, and CINAHL (from the first record to February 2010) were searched to identify randomized controlled trials of patients with cancer who were malnourished or considered to be at risk of malnutrition and receiving oral nutritional support compared with routine care. We performed a meta-analysis using a fixed effect model, or random effects models when statistically significant heterogeneity was present, to calculate relative risk (mortality) or mean difference (weight, energy intake, and QOL) with 95% confidence intervals (CIs). Heterogeneity was determined by using the χ(2) test and the I(2) statistic. All statistical tests were two-sided. Thirteen studies were identified and included 1414 participants. The quality of the studies varied, and there was considerable clinical and statistical heterogeneity. Nutritional intervention was associated with statistically significant improvements in weight and energy intake compared with routine care (mean difference in weight = 1.86 kg, 95% CI = 0.25 to 3.47, P = .02; and mean difference in energy intake = 432 kcal/d, 95% CI = 172 to 693, P = .001). However, after removing the main sources of heterogeneity, there was no statistically significant difference in weight gain or energy intake. Nutritional intervention had a beneficial effect on some aspects of QOL (emotional functioning, dyspnea, loss of appetite, and global QOL) but had no effect on mortality (relative risk = 1.06, 95% CI = 0.92 to 1.22, P = .43; I(2) = 0%; P(heterogeneity) = .56). Oral nutritional interventions are effective at increasing nutritional intake and improving some aspects of QOL in patients with cancer who are malnourished or are at nutritional risk but do not appear to improve mortality.
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            Older adults and patients in need of nutritional support: review of current treatment options and factors influencing nutritional intake.

            Many older adults and patients do not achieve sufficient nutritional intake to support their minimal needs and are at risk of, or are suffering from, (protein-energy) malnutrition. Better understanding of current treatment options and factors determining nutritional intake, may help design new strategies to solve this multifactorial problem. Medline, Science Citation Index, ScienceDirect and Google databases (until December 2008) were searched with the keywords malnutrition, elderly, older adults, food intake, energy density, variety, taste, satiety, and appetite. 37 Factors affecting nutritional intake were identified and divided in three categories; those related to the environment, the person, and the food. For older adults in nursing homes, encouragement by carers and an appropriate ambiance seem particularly important. Meal fortification, offering variety, providing frequent small meals, snacks and particularly Oral Nutritional Supplements (ONS) between meals are other possibilities for this group. Product factors that stimulate intake include palatability, high energy density, low volume, and liquid format. The current review gives a comprehensive overview of factors affecting nutritional intake and may help carers to improve nutritional intake in their patients. The product factors identified here suggest that especially small volume, energy and nutrient dense ONS can be effective to improve nutritional intake. Copyright 2009 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
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              ESPEN guidelines on nutritional support for polymorbid internal medicine patients

              Polymorbidity (also known as multimorbidity) - defined as the co-occurrence of at least two chronic health conditions - is highly prevalent, particularly in the hospitalized population. Nonetheless, clinical guidelines largely address individual diseases and rarely account for polymorbidity. The aim of this project was to develop guidelines on nutritional support for polymorbid patients hospitalized in medical wards.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Writing – original draft
                Role: Writing – review & editing
                Role: Investigation
                Role: Investigation
                Role: Investigation
                Role: Investigation
                Role: Investigation
                Role: Project administration
                Role: Visualization
                Role: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                26 September 2019
                2019
                : 14
                : 9
                : e0222972
                Affiliations
                [1 ] Department of Pediatric Surgery, Kurume University School of Medicine, Kurume, Fukuoka Japan
                [2 ] Division of Medical Safety Management, Kurume University Hospital, Kurume, Fukuoka, Japan
                University of Mississippi Medical Center, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0001-9366-361X
                Article
                PONE-D-19-19397
                10.1371/journal.pone.0222972
                6762170
                31557201
                e9bc94a7-df5e-47b3-96cf-237d36b1b5e8
                © 2019 Hashizume et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 10 July 2019
                : 11 September 2019
                Page count
                Figures: 8, Tables: 8, Pages: 19
                Funding
                The authors received no specific funding for this work.
                Categories
                Research Article
                People and Places
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                Professions
                Medical Personnel
                Medical Doctors
                Medicine and Health Sciences
                Health Care
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                Medical Doctors
                People and Places
                Geographical Locations
                Asia
                Japan
                Biology and Life Sciences
                Nutrition
                Medicine and Health Sciences
                Nutrition
                Biology and Life Sciences
                Nutrition
                Malnutrition
                Medicine and Health Sciences
                Nutrition
                Malnutrition
                Medicine and Health Sciences
                Health Care
                Quality of Life
                Research and Analysis Methods
                Research Design
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                Medicine and Health Sciences
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