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Should food or supplements be used in the community for the treatment of disease-related malnutrition?

Published online by Cambridge University Press:  07 March 2007

Rebecca J. Stratton
Rebecca J. Stratton
Affiliation:
Institute of Human Nutrition, School of Medicine, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
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Abstract

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Strategies are needed for community-based treatment of disease-related malnutrition (DRM), which is a common debilitating condition that in the UK is estimated to cost >£7×109 annually. Whilst dietary fortification and counselling are often used as a first-line treatment for malnutrition, the numbers of dietitians available to undertake and oversee such practices are currently insufficient to address the extent of DRM in primary care. Although dietary fortification and counselling can improve nutritional (primarily energy) intake, the evidence base for this practice is weak and it needs addressing with well-designed trials that assess clinically-relevant outcome measures and costs. Liquid oral nutritional supplements (ONS) are increasingly used in the community, often in combination with dietary counselling. The larger evidence base of trials that have assessed ONS suggests that nutritional intake and some functional outcomes can be improved in some patient groups in the community. Although meta-analysis indicates significant reductions in mortality (odds ratio 0.59 (95% CI 0.48, 0.72), n 3258) and complication rates (odds ratio 0.41 (95% CI 0.31, 0.53), n 1710) with ONS v. routine care, few of these studies are community based. Thus, the impact of ONS on clinical outcome, healthcare use and costs requires further assessment. Similarly, the clinical and cost efficacy of other strategies (e.g. sensory enhancement, music, behavioural therapy), alone or in combination with other treatments, requires greater investigation in order to meet the challenge of treating DRM more effectively and cheaply in the future.

Keywords

MalnutritionSupplementsDietetic counsellingFood fortificationPrimary care
Type
BAPEN Symposium 4 on ‘Challenges of enteral feeding from the acute to the community setting’
Information
Proceedings of the Nutrition Society , Volume 64 , Issue 3 , August 2005 , pp. 325 - 333
Copyright
Copyright © The Nutrition Society 2005

References

American Society, for Parenteral and, Enteral Nutrition (2002) Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. Journal of Parenteral and Enteral Nutrition 26, 1SA–138SA Google Scholar
Arnaud-Battandier, F, Malvy, D, Jeandel, C, Schmitt, C, Aussage, P, Beaufrere, B & Cynober, L (2004) Use of oral supplements in malnourished elderly patients living in the community: a pharmaco-economic study. Clinical Nutrition 23, 1096–1103 CrossRefGoogle ScholarPubMed
Baldwin, C & Parsons, TJ (2004) Dietary advice and nutritional supplements in the management of illness-related malnutrition: systematic review. Clinical Nutrition 23, 1253–1510 CrossRefGoogle ScholarPubMed
Barton, AD, Beigg, CL, Macdonald, IA & Allison, SP (2000) A recipe for improving food intakes in elderly hospitalized patients. Clinical Nutrition 19, 451–454 CrossRefGoogle ScholarPubMed
Bonnefoy, M, Cornu, C, Normand, S, Boutitie, F, Bugnard, F, Rahmani, A, Lacour, JR & Laville, M (2003) The effects of exercise and protein-energy supplements on body composition and muscle function in frail elderly individuals: a long-term controlled randomised study. British Journal of Nutrition 89, 731–738 CrossRefGoogle ScholarPubMed
Bray, GA (2004) The epidemic of obesity and changes in food intake: the fluoride hypothesis. Physiology and Behavior 82, 115–121 CrossRefGoogle ScholarPubMed
Breslow, RA, Hallfrisch, J, Guy, DG, Crawley, B & Goldberg, AP (1993) The importance of dietary protein in healing pressure ulcers. Journal of American Geriatric Society 41, 357–362 CrossRefGoogle ScholarPubMed
Bunout, B, Barrera, G, de la, Maza, P, Avendano, M, Gattas, V, Peterman, M Hirsch, S (2004) Effects of nutritional supplementation and resistance training on muscle strength in free living elders. Results of one year follow. Journal of Nutritional Health and Aging 8, 68–75 Google ScholarPubMed
Case, T & Gilbert, L (1997) Dietary and dining expectations of residents of long term care facilities. Nutrition 13, 703–704 CrossRefGoogle ScholarPubMed
Chandra, RK & Puri, S (1985) Nutritional support improves antibody response to influenza virus vaccine in the elderly. British Medical Journal 291, 705–706 CrossRefGoogle ScholarPubMed
Cuppari, L, Medeiros, FAM, Papini, HF, Neto, MC, Canziani, MEF, Martini, L, Ajzen, H & Draibe, SA (1994) Effectiveness of oral energy-protein supplementation in severely malnourished hemodialysis patients. Journal of Renal Nutrition 4, 127–135 CrossRefGoogle Scholar
de Jong, N, Chin, MJM, de Groot, LC, de Graaf, C, Kok, FJ, van Staveren, WA (1999) Functional biochemical and nutrient indices in frail elderly people are partly affected by dietary supplements but not by exercise. Journal of Nutrition 129, 2028–2036 CrossRefGoogle Scholar
Department of Health Department of Health (2000) National Minimum Standards for Care Homes for Older People London: Department of HealthGoogle Scholar
Department of Health Department of Health (2001a) Essence of Care – Patient Focused Benchmarking for Healthcare Practitioners London: Department of HealthGoogle Scholar
Department of Health Department of Health (2001b) National Service Framework for Older People London: Department of HealthGoogle Scholar
Department of Health Department of Health (2003) Single assessment process for older people: the accreditation process for off-the-shelf assessment tools (updated). http://www.dh.gov.uk/assetRoot/04/07/03/23/04070323.pdf Google Scholar
Donahoe, M, Rogers, RM, Openbrier, DR & Wilson, DO (1989) Effect of calorie intake on muscle strength and walking distance in malnourished COPD. American Review of Respiratory Disease 139 A334 Google Scholar
Douglass, HO, Milliron, S, Nava, H, Eriksson, B, Thomas, P, Novick, A & Holyoke, ED (1978) Elemental diet as an adjuvant for patients with locally advanced gastrointestinal cancer receiving radiation therapy: a prospectively randomized study. Journal of Parenteral and Enteral Nutrition 2, 682–686 CrossRefGoogle ScholarPubMed
Edington, J, Barnes, R, Bryan, F, Dupress, E, Frost, G, Hickson, M et al. . (2004) A prospective randomised controlled trial of nutritional supplementation in malnourished elderly in the community: clinical and health economic outcomes. Clinical Nutrition 23, 195–204 CrossRefGoogle ScholarPubMed
Efthimiou, J, Fleming, J, Gomes, C & Spiro, SG (1988) The effect of supplementary oral nutrition in poorly nourished patients with chronic obstructive pulmonary disease. American Review of Respiratory Disease 137, 1075–1082 CrossRefGoogle ScholarPubMed
Elia, M (2000) Guidelines for Detection and Management of Malnutrition Maidenhead, Berks BAPENGoogle Scholar
Elia, M (2003) Screening for Malnutrition: A Multidisciplinary Responsibility. Development and Use of the ‘Malnutrition Universal Screening Tool’ (‘MUST’) for Adults Redditch, Worcs BAPENGoogle Scholar
Elia, M, Pang, F, Russell, C, Green, C & Stratton, RJ (2005) The Cost of Malnutrition in the UK and the Economic Case for Oral Nutritional Supplementation (ONS) in Adults Redditch, Worcs BAPENGoogle Scholar
Elia, M, Ritz, P & Stubbs, RJ (2000) Total energy expenditure in the elderly. European Journal of Clinical Nutrition 54, S92–S103 CrossRefGoogle ScholarPubMed
Elia, M & Stratton, RJ (2004) Poorer vitamin status in the elderly at risk of malnutrition using the ‘Malnutrition Universal Screening Tool’?. Proceedings of the Nutrition Society 64 15AGoogle Scholar
Elia, M & Stratton, RJ (2005) Geographical inequalities in nutrient status and risk of malnutrition among English people aged 65 years and over Nutrition CrossRefGoogle Scholar
Elmstahl, S, Blabolil, V, Fex, G, Kuller, R & Steen, B (1987) Hospital nutrition in geriatric long-term care medicine. I: Effects of a changed meal environment. Comprehensive Gerontology 1, 29–33 Google ScholarPubMed
Fiatarone, MA, O'Neill, EF, Ryan, ND, Clements, KM, Solares, GR, Nelson, ME, Roberts, SB, Kehayias, JJ, Lipsitz, LA & Evans, WJ (1994) Exercise training and nutritional supplementation for physical frailty in very elderly people. New England Journal of Medicine 330, 1769–1775 CrossRefGoogle ScholarPubMed
Fiatarone, Singh, MA, Bernstein, MA, Ryan, ND, O'Neill, EF, Clements, KM Evans, WJ (2000) The effect of oral nutritional supplements on habitual dietary quality and quantity in frail elders. Journal of Nutrition Health and Aging 4, 5–12 Google Scholar
Finch, S, Doyle, W, Lowe, C, Bates, CJ, Prentice, A, Smithers, G & Clarke, PC (1998) The National Diet and Nutrition Survey: People Aged 65 Years and Over London: The Stationery OfficeGoogle Scholar
Fuenzalida, CE, Petty, TL, Jones, ML, Jarrett, S, Harbeck, RJ, Terry, RW & Hambidge, KM (1990) The immune response to short-term nutritional intervention in advanced chronic obstructive pulmonary disease. American Review of Respiratory Disease 142, 49–56 CrossRefGoogle ScholarPubMed
Gibert, CL, Wheeler, DA, Collins, G, Madans, M, Muurahainen, N, Raghavan, SS & Bartsch, G (1999) Randomized, controlled trial of caloric supplements in HIV infection. Journal of Acquired Immune Deficiency Syndromes 22, 253–259 CrossRefGoogle ScholarPubMed
Gray-Donald, K, Payette, H & Boutier, V (1995) Randomized clinical trial of nutritional supplementation shows little effect on functional status among free-living elderly. Journal of Nutrition 125, 2965–2971 Google Scholar
Hanning, RM, Blinkie, CJ., R, Bar-Or, O, Lands, LC, Moss, LA, Wilson WM (1993) Relationships among nutritional status and skeletal and respiratory muscle function in cystic fibrosis: does early dietary supplementation make a difference. American Journal of Clinical Nutrition 57, 580–587 CrossRefGoogle Scholar
Harries, AD, Jones, LA, Danis, V, Fifield, R, Heatley, RV, Newcombe, RG & Rhodes, J (1983) Controlled trial of supplemented oral nutrition in Crohn's disease. Lancet i, 887–890 CrossRefGoogle Scholar
Hoh, R, Pelfini, A, Neese, RA, Chan, M, Cello, JP, Cope, FO, Abbruzese, BC, Richards, EW, Courtney, K & Hellerstein, MK (1998) De novo lipogenesis predicts short-term body composition response by bioelectrical impedance analysis to oral nutritional supplements in HIV-associated wasting. American Journal of Clinical Nutrition 68, 154–163 CrossRefGoogle ScholarPubMed
Jensen, MB & Hessov, IB (1997) Dietary supplementation at home improves the regain of lean body mass after surgery. Nutrition 13, 422–430 CrossRefGoogle ScholarPubMed
Jones, BM, Stratton, RJ, Holden, C, Russell, C & & Micklewright, A (2005) Trends in Artificial Nutritional Support in the UK 2000–2003. Annual Report of the British Artificial Nutrition Survey (BANS). Redditch, Worcs.: BAPEN.Google Scholar
King, CL, Blaikley, S, Hackston, A, Stroud, MA, Elia, M & Stratton, RJ (2004) Prevalence of malnutrition risk using the Malnutrition Universal Screening Tool ‘MUST’ within a district nurse referred population. Proceedings of the Nutrition Society 63, 27A.Google Scholar
Knowles, JB, Fairbarn, MS, Wiggs, BJ, Chan-Yan, C & Pardy, RL (1988) Dietary supplementation and respiratory muscle performance in patients with COPD. Chest 93, 977–983 CrossRefGoogle ScholarPubMed
Kondrup, J, Allison, SP, Elia, M, Vellas, B & Plauth, M (2003) ESPEN guidelines for nutrition screening 2002. Clinical Nutrition 22, 415–421 CrossRefGoogle ScholarPubMed
Lauque, S, Arnaud-Battandier, F, Mansourian, R, Guigoz, Y, Paintin, M, Nourhashemi, F & Vellas, B (2000) Protein-energy oral supplementation in malnourished nursing-home residents. A controlled trial. Age and Ageing 29, 51–56 CrossRefGoogle ScholarPubMed
Lennard-Jones, JE (1992) A Positive Approach to Nutrition as Treatment London King's Fund CentreGoogle Scholar
Lewis, MI, Belman, MJ, Dorr-Uyemura, L (1987) Nutritional supplementation in ambulatory patients with chronic obstructive pulmonary disease. American Review of Respiratory Disease 135, 1062–1068 Google ScholarPubMed
Lipschitz, DA, Mitchell, CO, Steele, RW & Milton, KY (1985) Nutritional evaluation and supplementation of elderly subjects participating in a ‘Meals on Wheels’ program. Journal of Parenteral and Enteral Nutrition 9, 343–347 CrossRefGoogle Scholar
Norregaard, O, Tottrup, A, Saaek, A & Hessov, I (1987) Effects of oral nutritional supplements to adults with chronic obstructive pulmonary disease. Clinical Respiratory Physiology 23 388sGoogle Scholar
Odlund-Olin, A, Armyr, I, Soop, M, Ljungqvist, E, Jerstrom, S, Classon, I, Ljunggren, G & Ljungqvist, O (1998) Energy enriched meals improve energy intake in elderly residents in a nursing home. Clinical Nutrition 17 P09 CrossRefGoogle Scholar
Otte, KE, Ahlburg, P, D'Amore, F & Stellfeld, M (1989) Nutritional repletion in malnourished patients with emphysema. Journal of Parenteral and Enteral Nutrition 13, 152–156 CrossRefGoogle ScholarPubMed
Ovesen, L & Allingstrup, L (1992) Different quantities of two commercial liquid diets consumed by weight-losing cancer patients. Journal of Parenteral and Enteral Nutrition 16, 275–278 CrossRefGoogle ScholarPubMed
Parsons, HG, Beaudry, P, Dumas, A & Pencharz, PB (1983) Energy needs and growth in children with cystic fibrosis. Journal of Pediatric Gastroenterology and Nutrition 2, 44–49 Google ScholarPubMed
Patel, MG, Kitchen, S & Miligan, PJ (2000) The effect of dietary supplements on the nPCR in stable hemodialysis patients. Journal of Renal Nutrition 10, 69–75 CrossRefGoogle ScholarPubMed
Persson, MD, Hytter, A & Cederholm, T (2000) Effects of dietary counselling and liquid supplementation on weight, ADL function and serum lipids in malnourished geriatric outpatients. Clinical Nutrition 19, 9 Google Scholar
Pichard, C, Sudre, P, Karsegard, V, Yerly, S, Slosman, DO, Delley, V, Perrin, L, Hirschel, B & Study, SHC (1998) A randomized double-blind controlled study of 6 months of oral nutritional supplementation with arginine and omega-3 fatty acids in HIV-infected patients. AIDS 12, 53–63 CrossRefGoogle ScholarPubMed
Ragneskog, H, Brane, G, Karlsson, I & Kihlgren, M (1996) Influence of dinner music on food intake and symptoms common in dementia. Scandinavian Journal of Caring Sciences 10, 11–17 CrossRefGoogle ScholarPubMed
Ravasco, P, Monteiro, Grillo, I, Marques, Vidal, P & Camilo, M (2003) Nutrition and patient outcomes: prospective randomised controlled trial in head-neck cancer patients undergoing radiotherapy. Clinical Nutrition 22 S63 Suppl. 1 Google Scholar
Rogers, RM, Donahoe, M & Costantino, J (1992) Physiologic effects of oral supplemental feeding in malnourished patients with chronic obstructive pulmonary disease. American Review of Respiratory Disease 146, 1511–1517 CrossRefGoogle ScholarPubMed
Royal College & of Physicians (2002) Nutrition and Patients. A Doctor's Responsibility. Report of a Working Party of the Royal College of Physicians. London: Royal College of Physicians.Google Scholar
Schiffman, SS (1983) Taste and smell in disease. New England Journal of Medicine 308, 1275–1279 Google ScholarPubMed
Schiffman, SS & Warwick, ZS (1993) Effect of flavor enhancement of foods for the elderly on nutritional status: Food intake, biochemical indices, and anthropometric measures. Physiology and Behavior 53, 395–402 CrossRefGoogle ScholarPubMed
Sondel, SA, Parrell, SW, Becker, D & Mischler, EH (1987) Oral nutritional supplementation in cystic fibrosis. Nutritional Support Services 7, 20–22 Google Scholar
Stark, LJ, Bowen, AM, Tyc, VL, Evans, S & Passero, MA (1990) A behavioral approach to increasing calorie consumption in children with cystic fibrosis. Journal of Pediatric Psychology 15, 309–326 CrossRefGoogle ScholarPubMed
Stark, LJ, Mulvihill, MM, Powers, SW, Jelalian, E, Keating, K & Creveling, S (1996) Behavioral intervention to improve calorie intake of children with cystic fibrosis: Treatment versus wait list control. Journal of Pediatric Gastroenterology and Nutrition 22, 240–253 CrossRefGoogle ScholarPubMed
Stauffer, JL, Carbone, JE & Bendoski, MT (1986) Effects of diet supplementation on anthropometric and laboratory nutritional parameters in malnourished ambulatory patients with severe chronic obstructive pulmonary disease (COPD). American Review of Respiratory Disease 133, 204A Google Scholar
Steinkamp, G, Demmelmair, H, Ruhl-Bagheri, I, von der, Hardt, H Koletzko, B (2000) Energy supplements rich in linoleic acid improve body weight and essential fatty acid status of cystic fibrosis patients. Journal of Pediatric Gastroenterology and Nutrition 31, 418–423 Google Scholar
St-Onge, M-P, Keller, KL & Heymsfield, SB (2003) Changes in childhood food consumption patterns: a cause for concern in light of increasing body weights. American Journal of Clinical Nutrition 78, 1068–1073 CrossRefGoogle ScholarPubMed
Stratton, RJ & Elia, M (2005) Geographic inequalities in malnutrition prevalence in the elderly across England. Proceedings of the Nutrition Society 64, 12A.Google Scholar
Stratton, RJ, Green, CJ & Elia, M (2003) Disease-related Malnutrition: An Evidence Based Approach to Treatment Wallingford, Oxon Published on behalf of The Nutrition Society by CABI PublishingGoogle Scholar
Stratton, RJ, Hackston, A, Longmore, D, Dixon, R, Price, S, Stroud, M, King, C & Elia, M (2004) Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the ‘Malnutrition Universal Screening Tool’ (‘MUST’) for adults. British Journal of Nutrition 92, 799–808 CrossRefGoogle ScholarPubMed
Stratton, RJ, Thompson, RL, Margetts, BM, Stroud, M, Jackson, AA & Elia, M (2002) Health care utilisation according to malnutrition risk in the elderly: an analysis of data from the National Diet and Nutrition Survey. Proceedings of the Nutrition Society 61, 20A.Google Scholar
Stubbs, RJ, Johnstone, AM, O'Reilly, LM, Barton, K & Reid, C (1998) The effect of covertly manipulating the energy density of mixed diets on ad libitum food intake in ‘pseudo free-living’ humans. International Journal of Obesity 22, 980–987 CrossRefGoogle ScholarPubMed
Stubbs, RJ, Van Wyk, MCW, Johnstone, AM & Harbron, C (1996) Breakfasts high in protein, fat or carbohydrate: effect on within-day appetite and energy balance. European Journal of Clinical Nutrition 50, 409–417 Google ScholarPubMed
Süttmann, U, Ockenga, J, Schneider, H, Selberg, O, Schlesinger, A, Gallati, H, Wolfram, G, Deicher, H & Muller, MJ (1996) Weight gain and increased concentrations of receptor proteins for tumor necrosis factor after patients with symptomatic HIV infection received fortified nutrition support. Journal of the American Dietetic Association 96, 565–569 CrossRefGoogle ScholarPubMed
Thomas, B (2001) Manual of Dietetic Practice Oxford Blackwell Scientific PublicationsGoogle Scholar
Turic, A, Gordon, KL, Craig, LD, Ataya, DG & Voss, AC (1999) Nutrition supplementation enables elderly residents of long-term-care facilities to meet or exceed RDAs without displacing energy or nutrient intakes from meals. Journal of the American Dietetic Association 98, 1457–1459 CrossRefGoogle Scholar
UK Parliament (2000) Care Standards Act 2000 London The Stationery Office http://www.legislation.hmso.gov.uk/acts/acts2000/20000014.htm Google Scholar
Volkert, D, Hubsch, S, Oster, P & Schlierf, G (1996) Nutritional support and functional status in undernourished geriatric patients during hospitalization and 6-month follow-up. Aging Clinical and Experimental Research 8, 386–395 CrossRefGoogle ScholarPubMed
Walker, J & & Higginson, C (2001) The Nutrition of Elderly People and Nutritional Aspects of their Care in Long-term Care Settings. Final Audit Report 1997–2000. Edinburgh: Clinical Resource and Audit Group, Scottish Executive.Google Scholar
Weekes, CE, Elia, M & Emery, PW (2004) Tailored dietary advice and food fortification in patients with chronic obstructive pulmonary disease (COPD). Clinical Nutrition 23, 1493 Google Scholar
Wilson, NL, Wilson, RHL & Farber, SM (1964) Nutrition in pulmonary emphysema. Journal of the American Dietetic Association 45, 530–536 CrossRefGoogle ScholarPubMed