Oral nutrition support (ONS) is a proactive strategy to improve or maintain a person's nutritional intake, particularly for those at risk of malnutrition due to illness, aging, or other health conditions. Unlike relying solely on a normal diet, ONS utilizes a range of products and strategies to boost consumption of essential macronutrients (protein, carbohydrates, fats) and micronutrients (vitamins and minerals). The goal is to address nutritional deficiencies, improve overall health, and support recovery without needing more invasive feeding methods like tubes.
Who Benefits from Oral Nutrition Support?
ONS is beneficial for a wide range of individuals, especially those with conditions that impair appetite, increase energy demands, or interfere with nutrient absorption. These groups often include:
- Elderly individuals: Age-related changes in taste, smell, and appetite, alongside chronic diseases, can lead to unintentional weight loss and frailty. ONS helps counteract these issues, leading to improved anthropometric and functional parameters.
- Cancer patients: Cancer and its treatments often cause side effects like nausea, taste changes, and appetite loss, making it difficult to consume adequate nutrients. ONS helps manage these treatment-related side effects and maintain weight.
- Individuals with Chronic Obstructive Pulmonary Disease (COPD): Malnourished COPD patients may experience improvements in energy and protein intake, body weight, and functional outcomes with ONS.
- Post-operative patients: To aid wound healing and recovery, patients following surgery may require extra protein and energy, which high-protein ONS can provide.
- Patients with dysphagia (swallowing difficulties): For these individuals, pre-thickened supplements or puddings are available to ensure safe and adequate nutritional intake.
The Components of Oral Nutrition Support
An effective ONS plan is typically devised by a dietitian and can involve several different approaches:
- Fortified foods: Standard foods are enriched with additional nutrients, such as adding skimmed milk powder to sauces or extra cheese to dishes, to increase their energy and protein content without a large increase in volume.
- Nourishing drinks: These are high-calorie and high-protein beverages that are palatable and easy to consume, such as milkshakes or soups.
- Oral nutritional supplements (ONS): These are commercially prepared products designed to deliver a concentrated source of nutrients in a small volume. They are often used to supplement, not replace, a normal diet.
Types of Oral Nutritional Supplements (ONS)
ONS comes in various formats and compositions to suit different patient needs and preferences:
- Standard supplements: These offer a balanced mix of nutrients and are suitable for many patients, including the elderly and those with conditions like dementia or COPD.
- High-protein supplements: Geared towards individuals recovering from surgery, with wounds, or certain types of cancer, they support tissue repair and muscle maintenance.
- High-energy, small-volume supplements: Ideal for patients who find it difficult to tolerate larger liquid volumes due to a poor appetite.
- Fibre-containing supplements: Helpful for patients experiencing constipation.
- Texture-modified supplements: Pre-thickened liquids and puddings are crucial for patients with swallowing difficulties (dysphagia) to reduce aspiration risk.
| Feature | Oral Nutrition Support (ONS) | Standard Diet |
|---|---|---|
| Composition | Concentrated nutrients (energy, protein, vitamins, minerals) in supplements, fortified foods | Varied nutrients from whole foods; composition depends on food choices |
| Purpose | To supplement a diet that is insufficient to meet nutritional needs, often in medically compromised states | To provide all necessary nutrients for healthy individuals |
| Prescription | Often recommended or prescribed by a healthcare professional (dietitian or doctor) | Generally based on personal preferences and nutritional guidelines |
| Volume | Can be low volume, high density for easy consumption, especially with poor appetite | Normal food portions, can be difficult to consume if appetite is poor |
| Efficacy | Shown to improve nutritional status, weight, and functional outcomes, and reduce complications | May not be adequate for individuals with high nutritional needs or poor intake |
| Flavor Variety | Available in many flavors (sweet, savory) and types (milk, juice, pudding) | Wide variety of flavors based on food options |
The Benefits of Using ONS
Clinical studies and meta-analyses have consistently demonstrated the positive impact of ONS on patient health outcomes. These benefits include:
- Increased energy and protein intake: By providing concentrated nutrients, ONS helps reverse malnutrition and prevent further weight loss.
- Improved weight and body composition: Especially in malnourished individuals, ONS can lead to weight gain and improved body mass index (BMI).
- Enhanced functional benefits: Improvements have been noted in physical performance indicators like hand grip strength and gait speed.
- Reduced complications: Malnourished patients are more prone to complications such as infections and pressure ulcers. ONS can lower the risk of these issues.
- Decreased hospital readmissions and length of stay: For acutely ill older people, ONS has been associated with a reduction in both hospital admissions and readmissions.
How Oral Nutrition Support is Managed
The provision of ONS is a structured process led by healthcare professionals, most notably registered dietitians. The key steps include:
- Nutritional Assessment: A dietitian evaluates the patient's nutritional status, medical history, dietary intake, and potential risk factors for malnutrition using validated screening tools.
- Developing a Plan: Based on the assessment, a personalized nutrition care plan is created. This plan specifies the type, quantity, frequency, and delivery method of ONS. Taste preferences and potential intolerances are also considered to maximize adherence.
- Monitoring and Evaluation: The patient's progress, including weight, body composition, and tolerance to the supplements, is regularly monitored. Adjustments are made to the plan as needed.
- Education and Counseling: Dietitians educate patients and their caregivers on proper usage, potential side effects, and the importance of nutritional compliance.
- Discontinuation: When adequate nutritional intake is achieved and the patient is stable, the dietitian may oversee the gradual discontinuation of ONS.
Oral vs. Other Nutrition Support Methods
While ONS is the least invasive option, it is not suitable for all situations. There are other methods for providing nutrition support for patients who cannot swallow or have a non-functional gastrointestinal (GI) tract.
- Enteral Tube Feeding: This involves delivering a nutritionally complete feed directly into the stomach or small intestine via a tube. It is used when a person has a functional GI tract but cannot meet their needs orally due to issues like dysphagia, severe appetite loss, or facial trauma.
- Parenteral Nutrition: This method involves the intravenous administration of nutrients, bypassing the GI tract entirely. It is reserved for patients who cannot absorb nutrients through their digestive system, such as those with severe inflammatory bowel disease, short bowel syndrome, or other GI failures.
The choice of nutrition support method is determined by a comprehensive clinical assessment of the patient's condition, GI function, and overall needs. The hierarchy of support typically starts with ONS, moving to enteral or parenteral feeding only when necessary, as outlined by the Healthcare Nutrition Council.
Conclusion
Oral nutrition support is a vital, evidence-based intervention for managing or preventing malnutrition in individuals who cannot meet their nutritional requirements through diet alone. By using supplements, fortified foods, and personalized dietary strategies, ONS can significantly improve weight, functional status, and overall clinical outcomes, especially for vulnerable populations like the elderly and those with chronic illnesses. Successful implementation requires careful assessment and ongoing monitoring by a healthcare professional, with a dietitian playing a central role throughout the process.
Note: For more detailed guidelines on nutrition support, the National Institute for Health and Care Excellence (NICE) offers comprehensive resources for healthcare professionals. You can find more information on their website.
