Ready-made oral nutritional supplements improve nutritional outcomes and reduce health care use—A randomised trial in older malnourished people in primary care

Large trials assessing oral nutritional supplements (ONS) and dietary advice (DA) in primary care are lacking. This study examined effects of ONS + DA versus DA on intake, weight, QoL, healthcare use and satisfaction in malnourished free‐living older people. Three hundred and eight people (71.5 ± 10.7y) were randomised to receive ONS + DA (n154) or DA (n154) for 12 weeks. At baseline, 4, 8, 12 weeks, intake, weight, QoL, healthcare use and satisfaction were measured. ONS + DA group (mean daily intake ONS 480 kcal; 21 g protein; 80% compliance) had significantly greater total energy and protein intakes (+401 kcal/d, p < 0.001; +15 g/d, p < 0.001) and weight gain (+0.8 kg; p < 0.001) compared to DA. QoL improved in both groups over time with a significant improvement in index with ONS + DA (p = 0.009). Significantly more participants found ONS + DA made a difference for them (p = 0.011), but no differences were found between groups using Euroqol. Compared to DA, healthcare use reduced with ONS + DA, (HCP visits by 34%, emergency admissions 50%, LOS 62%). Acceptability of both interventions was high (ONS 96%, DA 95%), with significantly more participants satisfied with ONS (89%) than DA (73%) (p = 0.009). This trial in primary care indicates that ONS are acceptable, make a difference to patients, significantly improve intake and weight, and reduce health care use with potential savings.

Dietary advice, Free living elderly, Health care use, Malnutrition, Oral nutritional supplement

10.3390/nu12020517

2072-6643

Smith, Trevor R.

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Cawood, Abbie L.

4067d429-6ce8-4e50-b5f5-d8bf62aada79

Walters, Emily R.

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Guildford, Natasha

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Stratton, Rebecca J.

bf841e43-a4e2-44f0-9f25-bf67564a8d74

18 February 2020

Smith, Trevor R.

53e6838c-2e95-4c8f-9325-53163ab6255d

Cawood, Abbie L.

4067d429-6ce8-4e50-b5f5-d8bf62aada79

Walters, Emily R.

129e9486-7b19-4ced-943f-dc144f873fd9

Guildford, Natasha

7eb16a5a-aea2-4d03-ba1d-9d85169d6680

Stratton, Rebecca J.

bf841e43-a4e2-44f0-9f25-bf67564a8d74

Smith, Trevor R., Cawood, Abbie L., Walters, Emily R., Guildford, Natasha and Stratton, Rebecca J. (2020) Ready-made oral nutritional supplements improve nutritional outcomes and reduce health care use—A randomised trial in older malnourished people in primary care. Nutrients, 12 (2), [517]. (doi:10.3390/nu12020517).

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Accepted/In Press date: 14 February 2020

e-pub ahead of print date: 18 February 2020

Published date: 18 February 2020

Additional Information: Funding Information: Ethical approval from the Southampton Central Southampton Research Ethics Committee A was granted in September 2012 and the trial was conducted in accordance with their ethical standards and the Declaration of Helsinki. The trial was registered with ISRCTN database on 3rd October 2012; registration number ISRCTN26004104. The trial was sponsored by University Hospital Southampton NHS Foundation trust and was adopted by the National Institute of Health Funding Information: Funding: This work was supported by the National Institute of Health Research (NIHR), providing funding for service support costs for GP practices; and an unrestricted educational grant from Nutricia Advanced Medical Nutrition, Global Organisation, The Netherlands, who had no role in the design, analysis or writing of this article. Nutricia provided the nutritional supplements free of charge. Funding Information: Conflicts of Interest: T.R.S. on behalf of the trial sponsor University Hospital Southampton NHS Foundation Trust received funding from NIHR and an unrestricted educational grant from Nutricia to support the study. E.R.W. is a voluntary member of the Department of Health Advisory Board for Borderline Substances. A.L.C. and R.J.S. both of whom hold honorary research posts with the University of Southampton, are also employed part time by Nutricia. N.G. declared no conflicts of interest. Publisher Copyright: © 2020 by the authors. Licensee MDPI, Basel, Switzerland.

Keywords: Dietary advice, Free living elderly, Health care use, Malnutrition, Oral nutritional supplement

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