The Value Of Oral Nutritional Supplements
Combating diseaserelated malnutrition with oral nutritional supplements.
Oral nutritional supplements (ONS) are specialised foods designed to help meet the nutritional needs of patients living with a disease, disorder or medical condition who are temporarily or permanently unable to achieve an adequate nutritional intake from normal foods and are at risk of malnutrition.
ONS can partially supplement, or wholly replace, a normal diet to provide patients with the essential nutrients they need when food alone is insufficient to meet their daily nutritional requirements. ONS should be used under medical supervision across a wide range of settings such as hospitals, care homes, clinics and in patients’ homes.
Patients requiring ONS range from those who are critically ill, to those with inherited genetic disorders to those with chronic illnesses, including cancer, kidney failure, cystic fibrosis, diabetes, difficulties with swallowing, loss of muscle mass and respiratory disease.
ONS can be an essential part of medical management and may be required either for life or for short periods of time, for example in patients recovering from a stroke or surgery. In these cases, they help to manage malnutrition, or guard against it, until a normal diet can be resumed.
Prescribed when needed, ONS can prevent the complications associated with malnutrition and significantly improve patients’ health outcomes. They are evidence based nutritional solutions for disease-related malnutrition and are highly regulated.
What are ONS?
Most ONS are flavoured milkshakes that are sometimes called ‘sip feeds’. They are also available as: juice-, yoghurt-, soup- and savoury-style drinks; dessertstyle supplements that can be eaten with a spoon; and as powders that can be made up into drinks or added to drinks or foods such as tea, coffee, custard and cereal. They are uniquely placed to deliver high calorie content and balanced nutrition in a single, easy-to-use serving: they have been designed and formulated to provide additional calories, protein and micronutrients (such as vitamins and minerals) to the diets of people who are either malnourished or at risk of malnutrition. They do not reduce intake of normal food.4 ONS are available in a variety of styles, volumes, flavours, textures and consistencies so that under the advice of their healthcare professional, patients can access the most appropriate product for their needs.
A wide variety of ONS products is available, for example:
High protein ONS: usually for patients with wounds or fractures, post-operative patients, some types of cancer patients, renal patients on dialysis, patients with COPD and the elderly.
Fibre-containing ONS: usually for patients who need additional fibre in their diet.
Pre-thickened ONS: usually for patients with conditions that affect their ability to swallow (dysphagia), such as stroke and neurological conditions.
Small volume, high energy dense ONS: usually for patients who cannot tolerate large volumes of food or drink.
Use of ONS can help:
- Improve wound healing.
- Reduce risk of pressure sores.
- Maintain muscle strength.
- Support recovery from illness and surgery.
- Optimise immune response.
ONS can support positive health outcomes and reduce costs to the NHS
Malnutrition affects at least 3 million people in England at any one time and the health and social expenditure is estimated to be £19.6 billion in England alone. NICE has calculated that the delivery of optimal nutritional care would provide the fifth largest cost saving to the NHS. The NICE Quality Standard on Nutrition Support in Adults (QS 24) clearly states that people who are malnourished or at risk of malnutrition should have a management care plan that aims to meet their complete nutritional requirements. The NHS England Commissioning Guidance on Nutrition and Hydration also recognises that malnutrition and dehydration have a large impact on the health economy with increased demands on GP services, out-of-hours services and increased rates of transition across pathways of care.
The provision of dietary advice and ONS to malnourished patients reduces complications such as infections and wound breakdown by 70% and mortality by 40%. The use of ONS in the hospital setting is linked to reduced mortality, reduced complications and reduced length of hospital stay,10 which is the main driver of potential cost savings to the NHS. The reduced burden on healthcare services, due to use of ONS, amounts to a potential cost saving of £101.8 million per year in England alone. When ONS are used for 3 months or more amongst malnourished patients in care homes and in the community, the median cost saving is 5%, as well as improved clinical outcomes such as improved quality of life, reduced infections, reduced minor postoperative complications, reduced falls and functional limitations. Person-centred nutritional care leads to positive health outcomes and reduces health and social care costs.
ONS are a clinically and cost effective way to manage malnutrition
The health and social care cost of malnutrition is currently estimated to amount to £19.6 billion per year in England alone. Used when needed, ONS could save £101.8 million per year due to:
- Reduced clinical complications
- Fewer hospital admissions and readmissions
- Shorter length of stay in hospital
- Fewer healthcare needs in the community (such as GP visits and care at home)