Summary of a systematic review on oral nutritional supplement use in the community

The influence of patients' nutritional risk, nutritional status, and energy density in MEDPass versus conventional administration of oral nutritional supplements - A secondary analysis of a randomized controlled trial

OBJECTIVES

The clinical influence of nutritional risk, nutritional status, and energy density of oral nutritional supplements (ONS) in MEDPass versus conventional administration of ONS is currently unknown. The aim of this analysis was to examine whether these variables have an impact on clinical outcomes.

METHODS

Secondary analysis of the intention to treat dataset of the randomized controlled MEDPass Trial in geriatric and medical inpatients. Patients in the intervention group received 4 × 50 ml ONS during the medication rounds (MEDPass mode), while those in the control group received ONS in a non-standardized manner. The examined endpoints included energy and protein coverage, ONS intake, handgrip strength (HGS), weight, appetite nausea and 30-day mortality. Three subgroup analyses for NRS 2002 total score (3, 4 or 5-7 points), NRS 2002 impaired nutritional status score (0, 1, 2 or 3 points) and energy density of the ONS (1.5 kcal/mL or 2 kcal/mL) were performed using linear and logistic regression with interaction and mixed effect models.

RESULTS

The data of 202 patients (103 women and 99 men) at nutritional risk (NRS total 2002 score ≥3), mean (SD) age 82.2 (6.5) years were included. There was no significant difference between the groups in the primary endpoint energy coverage in all three subgroup analyses. There were also no significant differences between the groups in the secondary endpoints of protein coverage, ONS intake, HGS, weight, appetite, nausea, and 30-day mortality.

CONCLUSION

The MEDPass mode of ONS administration was not superior to the conventional mode of administration in this study. ONS with high energy density (≥2 kcal/mL) should be offered since current evidence shows a tendency towards improved appetite, increased ONS and increased energy intake.

A multi-center prospective study of plant-based nutritional support in adult community-based patients at risk of disease-related malnutrition

Introduction

There is an emerging need for plant-based, vegan options for patients requiring nutritional support.

Methods

Twenty-four adults at risk of malnutrition (age: 59 years (SD 18); Sex: 18 female, 6 male; BMI: 19.0 kg/m2 (SD 3.3); multiple diagnoses) requiring plant-based nutritional support participated in a multi-center, prospective study of a (vegan suitable) multi-nutrient, ready-to-drink, oral nutritional supplement (ONS) [1.5 kcal/mL; 300 kcal, 12 g protein/200 mL bottle, mean prescription 275 mL/day (SD 115)] alongside dietary advice for 28 days. Compliance, anthropometry, malnutrition risk, dietary intake, appetite, acceptability, gastrointestinal (GI) tolerance, nutritional goal(s), and safety were assessed.

Results

Patients required a plant-based ONS due to personal preference/variety (33%), religious/cultural reasons (28%), veganism/reduce animal-derived consumption (17%), environmental/sustainability reasons (17%), and health reasons (5%). Compliance was 94% (SD 16). High risk of malnutrition ('MUST' score ≥ 2) reduced from 20 to 16 patients (p = 0.046). Body weight (+0.6 kg (SD 1.2), p = 0.02), BMI (+0.2 kg/m2 (SD 0.5), p = 0.03), total mean energy (+387 kcal/day (SD 416), p < 0.0001) and protein intake (+14 g/day (SD 39), p = 0.03), and the number of micronutrients meeting the UK reference nutrient intake (RNI) (7 vs. 14, p = 0.008) significantly increased. Appetite (Simplified Nutritional Appetite Questionnaire (SNAQ) score; p = 0.13) was maintained. Most GI symptoms were stable throughout the study (p > 0.06) with no serious adverse events related.

Discussion

This study highlights that plant-based nutrition support using a vegan-suitable plant-based ONS is highly complied with, improving the nutritional outcomes of patients at risk of malnutrition.

Nutrition education with or without oral nutrition supplements has contrasting effects on nutrition status in older adults: A randomized controlled study

BACKGROUND

Oral nutrition supplements (ONSs) play an important role in the management of malnutrition. This aim of study was to examine whether a comprehensive intervention, combining ONSs, family-centered health education, and nutrition and medical consultations, could improve the nutrition and health status of malnourished older adults living in community dwellings.

METHODS

A randomized controlled trial was conducted from October 2017 to May 2018 in Shanghai. All participants were screened using the Mini Nutritional Assessment-Short Form (MNA-SF). Participants with MNA-SF scores ≤11 and age ≥65 were selected. Participants with potential nutrition risk were randomized into two groups: intervention group (n = 101) were prescribed ONSs (400 kcal/day) and family-centered nutrition education (once every 2 weeks) and control group (n = 100) received only family-centered nutrition education. Anthropometric measurements, including weight and height, and nutrition and functional scales, including MNA-SF, grip strength, and activities of daily living scores, were collected at the beginning of the study and 12 weeks later.

RESULTS

Of the 201 study participants, 182 completed the study (mean age, 75.48 ± 7.47 years). After 12 weeks, nutrient intake improvements in the intervention group (+370.6 ± 432.6 kcal/day, +17.6 ± 24.1 g/day) exceeded that of the control group (-67.5 ± 378.2 kcal/day, -0.9 ± 16.7 g/day). In addition, improvements in weight, body mass index, and handgrip strength were significantly higher in the intervention vs control group (P < .05).

CONCLUSION

Comprehensive nutrition interventions improved nutrition status in malnourished older people living in community dwellings. Use of ONSs may be a good strategy to improve nutrition status and strength in community-dwelling older adults.

Characterizing the Dynamic Taste and Retro-Nasal Aroma Properties of Oral Nutritional Supplements Using Temporal Dominance of Sensation and Temporal Check-All-That-Apply Methods

Orally Disintegrating Tablets (ODTs) are used to restore the nutritional status of people suffering from swallowing pathologies such as dysphagia. ODTs are consumed without water intake and are easily swallowed. The main active compounds of ODTs are vitamins and minerals. These nutrients can have a bad taste or aftertaste, which can be masked by sweetening or flavoring. To ensure the effectiveness of masking strategies and to prescribe a product to patients with acceptable sensory qualities, it is essential to perform a precise and complete sensory characterization of these ODTs. Temporal dominance of sensations (TDS) and temporal check-all-that-apply (TCATA) methods were chosen to characterize the temporal sensory perceptions during the consumption of four ODTs varying in galenic forms and flavoring because of their particularly acute temporality in flavor perception. The ODTs presented common and individual sensory properties, mainly related to their galenic form and to the nature of the active ingredients. The use of a nose-clip to stop retro-nasal airflow showed that flavoring had a minimal impact on the sensory taste qualities of the ODTs. A comparison between the TDS and TCATA results indicates that these tests are capable of providing complementary information on the dynamic sensory qualities of the products studied. Although results were generally similar for both methods, TDS showed a greater number of differences in sensory taste attribute, whereas TCATA was more discriminating. These methods allowed for a better understanding of the evolution of sensory perceptions of these ODTs during their consumption, which could help to optimize masking strategies and develop new products with acceptable sensory properties.

Taste Perception of Nutrients Found in Nutritional Supplements: A Review

Nutritional supplements are prescribed when one’s nutritional status is not conducive to good health. These foodstuffs constitute concentrated sources of nutrients such as vitamins, minerals, amino acids, and fatty acids. For nutritional supplements to be effective, patients must consume the amount that has been prescribed for the recommended period of time. Therefore, special attention must be given to the sensory attributes of these products. Indeed, the presence of active compounds can cause an off-taste or aftertaste. These negative sensations can lead to a reduction in the consumption of nutritional supplements and reduce the effectiveness of the treatment. In this manuscript, we provide an overview of the sensory characteristics and the sensing receptor mechanism of the main compounds present in oral nutritional supplements, such as amino acids, minerals, fatty acids, and vitamins. Part of this article is devoted to the development of new masking strategies and the corresponding potential influence at the industrial level.

Role of Dietary Supplements in the Management of Parkinson's Disease

The use of food supplements or functional food has significantly increased in the past decades, especially to compensate both the modern lifestyle and the food shortages of the industrialized countries. Despite food supplements are habitually intended to correct nutritional deficiencies or to support specific physiological functions, they are often combined with common drug therapies to improve the patient's health and/or mitigate the symptoms of many chronic diseases such as cardiovascular diseases, cystic fibrosis, cancer, liver and gastrointestinal diseases. In recent years, increased attentions are given to the patient's diet, and the use of food supplements and functional food rich in vitamins and antioxidants plays a very important role in the treatment and prevention of neurodegenerative diseases such as Parkinson's disease (PD). Natural compounds, phytochemicals, vitamins, and minerals can prevent, delay, or alleviate the clinical symptoms of PD in contrast to some of the main physiopathological mechanisms involved in the development of the disease, like oxidative stress, free radical formation, and neuroinflammation. The purpose of this review is to collect scientific evidences which support the use of specific biomolecules and biogenic elements commonly found in food supplements or functional food to improve the clinical framework of patients with PD.

Intrauterine Programming of Diabetes and Adiposity

The prevalence of diabetes and adiposity has increased at an alarming rate and together they contribute to the rise in morbidity and mortality worldwide. Genetic studies till date have succeeded in explaining only a proportion of heritability, while a major component remains unexplained. Early life determinants of future risk of these diseases are likely contributors to the missing heritability and thus have a significant potential in disease prevention. Epidemiological and animal studies show the importance of intrauterine and early postnatal environment in programming of the fetus to adverse metabolic outcomes and support the notion of Developmental Origins of Health and Disease (DOHaD). Emerging evidence highlights the role of epigenetic mechanisms in mediating effects of environmental exposures, which in certain instances may exhibit intergenerational transmission even in the absence of exposure. In this article, we will discuss the complexity of diabetes and increased adiposity and mechanisms of programming of these adverse metabolic conditions.

The effect of chicken extract on ERK/CREB signaling is ApoE isoform-dependent

It is unclear how the nutritional supplement chicken extract (CE) enhances cognition. Human apolipoprotein E (ApoE) can regulate cognition and this isoform-dependent effect is associated with the N-methyl-d-aspartate receptor (NMDAR). To understand if CE utilizes this pathway, we compared the NMDAR signaling in neuronal cells expressing ApoE3 and ApoE4. We observed that CE increased S896 phosphorylation on NR1 in ApoE3 cells and this was linked to higher protein kinase C (PKC) activation. However, ApoE4 cells treated with CE have lowered S897 phosphorylation on NR1 and this was associated with reduced protein kinase A (PKA) phosphorylation. In ApoE3 cells, CE increased calmodulin kinase II (CaMKII) activation and AMPA GluR1 phosphorylation on S831. In contrast, CE reduced CaMKII phosphorylation and led to higher de-phosphorylation of S831 and S845 on GluR1 in ApoE4 cells. While CE enhanced ERK/CREB phosphorylation in ApoE3 cells, this pathway was down-regulated in both ApoE4 and mock cells after CE treatment. These results show that CE triggers ApoE isoform-specific changes on ERK/CREB signaling.

Nutritional interventions in community-dwelling Alzheimer patients with (risk of) undernutrition: a systematic review

ABSTRACT Background: Weight loss and undernutrition are common in patients with Alzheimer's disease (AD) and associated with negative health outcomes. In the current guidelines on diagnosis and treatment of AD, no recommendations for treatment of (risk of) undernutrition in community-dwelling AD patients are given. Methods: We conducted a systematic review on the effect of nutritional interventions in community-dwelling AD patients with (risk of) undernutrition, according to the methods outlined by the Cochrane Collaboration. Three electronic databases and three trial registers were searched from inception till April 2013. Results: Literature search in the electronic databases yielded 546 records of which one was relevant for this review. This study, with a high risk of bias, demonstrated that oral nutritional supplements improved nutritional outcomes without effect on clinical and biochemical outcomes. The search in the trial registers yielded 369 records of which two were relevant. One trial was terminated because of failing inclusion, the other is ongoing. Conclusions: This systematic review on the effect of nutritional interventions in community-dwelling AD patients with (risk of) undernutrition, reveals a serious lack of evidence. Therefore, it is not possible to state what the best approach is.

Dietary supplementation by Japanese patients with chronic obstructive pulmonary disease

OBJECTIVES

To investigate the prevalence and type of dietary supplements taken by Japanese patients with chronic obstructive pulmonary disease (COPD) and factors affecting their use.

DESIGN

Cross-sectional study by face-to-face interviews.

SETTING

Six hospitals in central Japan.

PARTICIPANTS

Of the 300 referred COPD patients aged between 50 and 75 years, 278 eligible participants (244 men and 34 women) with complete data were available for analysis.

MAIN OUTCOME MEASURES

Prevalence of supplement use, dietary supplement categories (multivitamin, beta-carotene, vitamin C, vitamin E, and miscellaneous).

RESULTS

Overall, 42% of participants were dietary supplement users taking at least one category of supplements weekly; the prevalence being higher for female (47%) than male patients (41%). The most common supplements consumed were energy drink for men (11.1%), and multivitamin (11.8%) and vinegar (11.8%) for women. Dietary supplementation was found to be affected by age (p=0.04), COPD severity (p=0.03) and presence of co-morbidity (p=0.03). Older patients over 60 years were more likely to take dietary supplements (odds ratio (OR) 2.44, 95% CI 1.03-5.80), whereas severe COPD patients (OR 0.41, 95% CI 0.18-0.95) and those with a co-morbidity (OR 0.54, 95% CI 0.32-0.94) tended not to use.

CONCLUSIONS

Dietary supplements are popular for patients with COPD especially among older patients. The findings are important to clinical trials and experimental interventions advocating nutritional supplementation therapy for pulmonary rehabilitation.

Nutritional intervention and quality of life in adult oncology patients

The evaluation of quality of life (QoL) assesses patients' well-being by taking into account physical, psychological and social conditions. Cancer and its treatment result in severe biochemical and physiological alterations associated with a deterioration of QoL. These metabolic changes lead to decreased food intake and promote wasting. Cancer-related malnutrition can evolve to cancer cachexia due to complex interactions between pro-inflammatory cytokines and host metabolism. Beside and beyond the physical and the metabolic effects of cancer, patients often suffer as well from psychological distress, including depression. Depending on the type of cancer treatment (either curative or palliative) and on patients' clinical conditions and nutritional status, adequate and patient-tailored nutritional intervention should be prescribed (diet counselling, oral supplementation, enteral or total parenteral nutrition). Such an approach, which should be started as early as possible, can reduce or even reverse their poor nutritional status, improve their performance status and consequently their QoL. Nutritional intervention accompanying curative treatment has an additional and specific role, which is to increase the tolerance and response to the oncology treatment, decrease the rate of complications and possibly reduce morbidity by optimizing the balance between energy expenditure and food intake. In palliative care, nutritional support aims at improving patient's QoL by controlling symptoms such as nausea, vomiting and pain related to food intake and postponing loss of autonomy. The literature review supports that nutritional care should be integrated into the global oncology care because of its significant contribution to QoL. Furthermore, the assessment of QoL should be part of the evaluation of any nutritional support to optimize its adequacy to the patient's needs and expectations.

Appetite during consumption of enteral formula as a sole source of nutrition: the effect of supplementing pea-fibre and fructo-oligosaccharides

Liquid enteral formulas are commonly used as a sole source of nutritional support of patients in hospital and community settings. Their effect on appetite has important consequences for dietary management of such patients and is likely to be affected by the formula composition. The aim of the present study was to compare appetite within healthy subjects consuming both a standard formula and one supplemented with pea-fibre (10 g/l) and fructo-oligosaccharide (FOS; 5 g/l) as a sole source of nutrition. Eleven healthy subjects consumed a standard formula or a pea-fibre/FOS formula as a sole source of nutrition for 14 d in a double-blind, cross-over trial. Appetite was recorded using standard 100 mm lines anchored at each end by a phrase denoting the most extreme appetite sensation. Consumption of the pea-fibre/FOS formula resulted in higher mean fullness (46 v. 37 mm, P=0.035), minimum fullness (13 v. 9 mm, P=0.024) and minimum satiety (12 v. 8 mm, P=0.012) compared to the standard formula. As there were no differences in macronutrient intake between formulas, these differences are likely to be due to supplementation with pea-fibre and FOS. The effect on appetite of the composition of an enteral formula, both with respect to nutrient content and functional components such as pea-fibre and FOS, may be an important aspect to consider in the dietary management of patients consuming enteral formula as a sole source of nutrition.