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Lester S, Kleijn M, Cornacchia L, Hewson L, Taylor MA, Fisk I. Factors Affecting Adherence, Intake, and Perceived Palatability of Oral Nutritional Supplements: A Literature Review. J Nutr Health Aging 2022; 26:663-674. [PMID: 35842756 DOI: 10.1007/s12603-022-1819-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Oral nutritional supplements (ONS) are a clinically effective and relatively inexpensive way to supplement the diet of patients with, or at risk of, undernutrition. Good adherence is a primary determinant of the effectiveness of ONS. However adherence can be problematic for those with the greatest clinical need, such as undernourished older adults. This review aimed to appraise the available literature for the factors (contextual, personal and product related) affecting patient adherence and perceived palatability of ONS, identify areas requiring improvement and uncover gaps in the evidence to guide the focus of future research. Contextual factors identified were healthcare staff and the timing of administration. Personal factors included sensory changes and motivation which alter experience of and desire to consume ONS. The product's sensory characteristics determined palatability and intake, but undesirable attributes, such as off-flavours, can stem from nutritional ingredients. The contribution made by aroma to older adults' experience of ONS was a comparatively under-researched area. Further research should address this evidence gap to optimise the flavour, aroma profile and palatability for undernourished older consumers, thereby optimising intake. A combined multidisciplinary effort involving strategic expansion of research, industry development and clinical practice should simultaneously address the factors identified, to provide the best approach to improve adherence.
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Affiliation(s)
- S Lester
- Ian Fisk, University of Nottingham, Nottingham, Nottinghamshire, United Kingdom,
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Consumption of oral hospital diets and percent adequacy of minerals in oncology patients as an indicative for the use of oral supplements. Clin Nutr 2014; 33:655-61. [DOI: 10.1016/j.clnu.2013.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/15/2013] [Accepted: 09/08/2013] [Indexed: 01/31/2023]
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Roberts S, Chaboyer W, Desbrow B. Nutrition care-related practices and factors affecting nutritional intakes in hospital patients at risk of pressure ulcers. J Hum Nutr Diet 2014; 28:357-65. [PMID: 24974729 DOI: 10.1111/jhn.12258] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Malnutrition is common in hospitals and is a risk factor for pressure ulcers. Nutrition care practices relating to the identification and treatment of malnutrition have not been assessed in patients at risk of pressure ulcers. The present study describes nutrition care practices and factors affecting nutritional intakes in this patient group. METHODS The study was conducted in four wards at two hospitals in Queensland, Australia. Adult patients at risk of pressure ulcers as a result of restricted mobility were observed for 24 h to determine their daily oral intake and practices such as nutrition screening, documentation and intervention. Independent samples t-tests and chi-squared tests were used to analyse dietary intake and nutrition care-related data. Predictors of receiving a dietitian referral were identified using logistic regression analyses. RESULTS Two hundred and forty-one patients participated in the present study. The observed nutritional screening rate was 59% (142 patients). Weight and height were documented in 71% and 34% of cases. Sixty-nine patients (29%) received a dietitian referral. Predictors of receiving a dietitian referral included lower body mass index and longer length of stay. On average, patients consumed 73% and 72% of the energy and protein provided, respectively. Between 22% and 38% of patients consumed <50% of food provided at main meals. CONCLUSIONS Nutrition care practices including malnutrition risk screening and documentation of nutritional parameters appear to be inadequate in patients at risk of pressure ulcers. A significant proportion of these patients eat inadequately at main meals, further increasing their risk of malnutrition and pressure ulcers.
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Affiliation(s)
- S Roberts
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Centre for Health Practice Innovation, Griffith University, Gold Coast, QLD, Australia.,Griffith Health Institute, Griffith University, Gold Coast, QLD, Australia
| | - W Chaboyer
- Centre for Health Practice Innovation, Griffith University, Gold Coast, QLD, Australia.,Griffith Health Institute, Griffith University, Gold Coast, QLD, Australia.,NHMRC Centre of Research Excellence in Nursing, Griffith University, Gold Coast, QLD, Australia
| | - B Desbrow
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Centre for Health Practice Innovation, Griffith University, Gold Coast, QLD, Australia.,Griffith Health Institute, Griffith University, Gold Coast, QLD, Australia
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Thibault R, Chikhi M, Clerc A, Darmon P, Chopard P, Genton L, Kossovsky MP, Pichard C. Assessment of food intake in hospitalised patients: a 10-year comparative study of a prospective hospital survey. Clin Nutr 2010; 30:289-96. [PMID: 21067850 DOI: 10.1016/j.clnu.2010.10.002] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 09/24/2010] [Accepted: 10/03/2010] [Indexed: 01/12/2023]
Abstract
BACKGROUND & AIMS A food quality control and improvement permanent process was initiated in 1999. To evaluate the food service evolution, protein-energy needs coverage were compared in 1999 and 2008 with the same structure survey in all hospitalized patients receiving 3 meals/day. METHODS Nutritional values of food provided, consumed and wasted over 24h including non-exclusive nutritional support were calculated individually. Nutritional needs were estimated as 110% of Harris-Benedict formula for energy and 1.2 or 1.0 g protein/kg/day for patients <65 or ≥65 years old, respectively. Multivariate analysis identified factors associated with low nutritional intake in both populations standardized to body mass index (BMI) of 1999's patients. RESULTS Out of 1677 patients, 1291 were included. Mean BMI was higher in 2008 than 1999 (P<0.001). The proportion of underfed patients was unchanged (69 vs. 70%, NS). The consumption of ≥1 oral nutritional supplements (ONS) daily increased the protein needs coverage from 80% to 115% (P<0.001). The year 1999, high BMI, 1st week of hospital stay, specific diet, ONS absence and low meal quality were associated with low nutritional intakes. CONCLUSION The nutritional needs coverage could have improved in 2008 if BMI was similar to 1999's. ONS consumption is associated with a lower risk of underfeeding in hospitalized patients.
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Affiliation(s)
- Ronan Thibault
- Unité de Nutrition, Hôpitaux Universitaires de Genève, Genève, Switzerland
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Johnson S, Nasser R, Banow T, Cockburn T, Voegeli L, Wilson O, Coleman J. Use of Oral Nutrition Supplements In Long-term Care Facilities. CAN J DIET PRACT RES 2009; 70:194-8. [PMID: 19958575 DOI: 10.3148/70.4.2009.194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: Practices related to oral nutrition supplement (ONS) use were examined in elderly people living in longterm care (LTC) facilities. Methods: Thirteen LTC facilities within a large regional health authority participated, and 17 people responsible for prescribing ONS in their facilities were interviewed, using a key informant telephone survey. A survey on ONS practice wasmodified, pilot tested, and used. Results:Oral nutrition supplements were primarily prescribed by nursing staff (59%), followed by physicians, registered dietitians, or other staff; ONS use was prescribed for decreased intake, unintentional weight loss, or wound healing. Various ONS products (e.g., Ensure, Boost, or Resource 2.0) were prescribed. Only 18% of respondents reported using alternative food options first to supplement nutritional intake, before introducing ONS. In terms of follow-up and evaluation, the measures of improvement included weight gain, wound healing, or improved well-being; reasons for discontinuation included weight gain, increased intake, or death. Conclusions: Within LTC settings, the prescription and monitoring of ONS vary considerably. Evidence-based guidelines for the prescription and monitoring of ONS and for the use of a food-first strategy should be developed, implemented, and evaluated to optimize the nutritional health of the elderly in LTC facilities.
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Affiliation(s)
- Shanthi Johnson
- Faculty of Kinesiology and Health Studies, Saskatchewan Population Health and Evaluation Research Unit, University of Regina, Regina, SK
| | - Roseann Nasser
- Dietetic Internship Programme and Clinical Nutrition Services, Department of Nutrition and Food Services, Regina Qu’Appelle Health Region, Regina, SK
| | - Tiffany Banow
- Dietetic Internship Programme and Clinical Nutrition Services, Department of Nutrition and Food Services, Regina Qu’Appelle Health Region, Regina, SK
| | - Tanya Cockburn
- Dietetic Internship Programme and Clinical Nutrition Services, Department of Nutrition and Food Services, Regina Qu’Appelle Health Region, Regina, SK
| | - Leah Voegeli
- Dietetic Internship Programme and Clinical Nutrition Services, Department of Nutrition and Food Services, Regina Qu’Appelle Health Region, Regina, SK
| | - Orina Wilson
- Dietetic Internship Programme and Clinical Nutrition Services, Department of Nutrition and Food Services, Regina Qu’Appelle Health Region, Regina, SK
| | - Jean Coleman
- Dietetic Internship Programme and Clinical Nutrition Services, Department of Nutrition and Food Services, Regina Qu’Appelle Health Region, Regina, SK
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Mowe M, Bosaeus I, Rasmussen HH, Kondrup J, Unosson M, Irtun Ø. Nutritional routines and attitudes among doctors and nurses in Scandinavia: A questionnaire based survey. Clin Nutr 2006; 25:524-32. [PMID: 16701921 DOI: 10.1016/j.clnu.2005.11.011] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Accepted: 11/20/2005] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIMS Hospital malnutrition is prevalent, but nutritional practice in hospitals has a low priority. To improve the quality in nutritional routine, ESPEN has developed standards to improve the inadequate and insufficient nutritional treatments seen today. However, there is a discrepancy between the standards and clinical practice. This study was conducted to investigate nutritional practice in different hospital settings in relation to these standards (e.g.: screening of all patients, assessment of at-risk patients) among Scandinavian doctors and nurses. METHODS A questionnaire about nutritional attitudes and routine was mailed to doctors and nurses in Denmark, Sweden and Norway. RESULTS Altogether, 4512 (1753 doctors, 2759 nurses) answered the questionnaire. Both screening and assessment of at-risk patients differ between the countries. Nutritional screening was more common in Denmark (40%), compared to Sweden (21%) and Norway (16%). Measuring dietary intake in nutritional at-risk patients was more common in Denmark (46%), compared to Sweden (37%) and Norway (22%). However, all countries agreed that nutritional screening (92%, 88%, 88%) and measuring dietary intake (97%, 95%, 97%) were important, Denmark, Sweden and Norway, respectively. CONCLUSION There is a large discrepancy between nutritional attitudes and practice. The standards suggested from the ESPEN are not fulfilled.
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Affiliation(s)
- Morten Mowe
- Department of Geriatric Medicine, Aker University Hospital, Trondheimsveien 155, 0514 Oslo, Norway.
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Edwards JSA, Hartwell HJ. A comparison of energy intake between eating positions in a NHS hospital—a pilot study. Appetite 2004; 43:323-5. [PMID: 15527937 DOI: 10.1016/j.appet.2004.06.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2004] [Accepted: 06/10/2004] [Indexed: 11/28/2022]
Abstract
Malnutrition and the under-consumption of food in hospitals is prevalent and in UK hospitals, the consumption of meals is mainly a solitude event, despite evidence to show that eating in the presence of others can actually increase food intake. Dietary data were collected for three consecutive 24 h periods (n=13) from patients who consumed their meals either in bed, at the side of the bed or in the presence of others. Results show a significant increase (p<0.05) in the mean daily energy intake for those sitting around a table in the presence of others. Although a small pilot study, the results confirm the value of social facilitation in improving the under-consumption of food when in hospital.
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Affiliation(s)
- J S A Edwards
- Worshipful Company of Cooks Research Centre, Bournemouth University, Poole, Dorset BH12 5BB, England.
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Ryan M, Salle A, Favreau AM, Simard G, Dumas JF, Malthiery Y, Berrut G, Ritz P. Oral supplements differing in fat and carbohydrate content: effect on the appetite and food intake of undernourished elderly patients. Clin Nutr 2004; 23:683-9. [PMID: 15297106 DOI: 10.1016/j.clnu.2003.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2003] [Accepted: 11/07/2003] [Indexed: 11/25/2022]
Abstract
BACKGROUND & AIMS Since fat, relative to other macronutrients, has low satiety and high energy density, it may have therapeutic application for supplementing energy intake. This study compared the effect of isoenergetic (1050 kJ) high fat or high carbohydrate oral supplements, given at breakfast, on the short-term appetite and energy intake in undernourished elderly subjects. METHODS Sixteen hospitalised, undernourished (body mass index: 20 +/- 3 kg/m2), elderly (77 +/- 8 yr) people were randomly allocated to a control or 1 of 2 supplement groups [fat: carbohydrate: protein (% energy) was 70:25:5 or 25:70:5]. In each group, energy intake (24-h food consumption) and appetite (visual analogue scales) were assessed over 3 consecutive days. RESULTS Mean energy intake significantly (P = 0.0035) increased following supplementation: high fat 6973 kJ/d, high carbohydrate 6906 kJ/d vs. control 6079 kJ/d but mean voluntary 24-h energy intake remained unaffected. Compared to controls, supplemented subjects experienced reduced hunger (P = 0.07) between breakfast and lunch, but showed no difference over the whole day (P = 0.55). CONCLUSIONS Under these study conditions a 1050 kJ oral supplement, irrespective of macronutrient composition, does not cause voluntary short-term energy intake compensation in undernourished elderly people.
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Abstract
BACKGROUND It is reported that undernutrition in older hospitalized patients is commonly found, but estimates of its prevalence vary. It is also not clear which treatment approaches are best because poor methodology prevents comparison of outcomes between different studies. RATIONALE The rationale of this observational study was to look at typical elder care wards in order to determine what food supplements were being prescribed. We wished to determine whether serum albumin and/or body mass index (BMI) were appropriately related to the prescription of sip feeds and also to determine the palatability of supplements provided. METHOD We monitored the wastage of sip feeds over a 24-hour period and extrapolated an estimated cost. Ninety-six patients were studied, including 23 patients with a BMI of less than 20, of whom 30% were on supplementary feeds. RESULTS Seventy percentage of prescribed sip feeds were being given to people with a BMI of 20 or more. The mean wastage in this 24-hour period was 63% ( pound 79.56) in four wards containing 96 older patients. CONCLUSION We concluded that there was no relationship between the numbers of patients with a low albumin and BMI and the prescription of sip feeds. We found compliance to be low (37%) because of poor palatability, with a large number of patients who appeared to require sip feeds not being prescribed them and those who received them wasting more than they drank.
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Affiliation(s)
- Margot Gosney
- Department of Geriatric Medicine, University of Liverpool, Liverpool, UK.
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Pichard C, Genton L, Jolliet P. Delivering nutrients how and where they are needed: a lesson from the 17th century. Curr Opin Clin Nutr Metab Care 2002; 5:397-9. [PMID: 12107375 DOI: 10.1097/00075197-200207000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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