Nutrition Intervention With Oral Nutritional Supplements (ONS)

Good nutrition is a vital part of patient care and includes nutrition screening, assessment, and intervention. Nutrition intervention involves many strategies, including food, oral nutritional supplements, tube feeding, and parenteral nutrition.

ONS are supplementary oral intake of dietary food for special medical purposes in addition to the normal food.<sup>1</sup> ONS are one important nutrition intervention strategy for patients with poor food intake, low appetite, and those with or at risk of malnutrition. ONS are an effective and non-invasive solution to malnutrition. ONS have been demonstrated to be more effective than dietary advice and snacks; greater intakes of energy, protein, and micronutrients and significantly fewer complications have been shown in patients taking ONS.<sup>2</sup>

ONS have proven nutritional, functional, clinical, and economic benefits in both the hospital and community setting in a wide variety of patient populations. Studies show that ONS increase energy and protein intake in both hospital and community patients without reducing food/meal intake, and ONS might actually help to stimulate appetite in certain patient groups.<sup>2</sup> Research demonstrates that early nutrition intervention, including oral nutritional supplementation, improves outcomes in cancer patients including nutritional status, weight, treatment tolerance, and quality of life.

ONS may provide, maintain, or improve nutritional status in patients with or at risk for malnutrition. In addition to patients with malnutrition, those who are hospitalized for certain conditions and procedures and are prone to poor outcomes (e.g. complications, longer length of stay) may also benefit from oral nutritional supplementation. Additionally, certain populations in the community may benefit from ONS, particularly community-dwelling older adults.

Recent data from NutritionDay surveys showed that only 5-8% of patients eating half or less of their meals are provided nutrition intervention, including oral nutritional supplements.<sup>3</sup>

Nutrition intervention, including ONS, can improve outcomes and reduce health care costs. Many studies confirm the benefits of nutrition intervention for malnourished or at risk patients. Providing oral nutritional supplements to these patients helps decrease morbidity and mortality, decrease length of hospital stay, decrease readmission rates, improve quality of life, and decrease health care costs. <sup>4-6</sup>

A 2012 meta-analysis confirms these benefits and showed that high protein ONS demonstrated a range of benefits across settings and patient populations including reduced complications, reduced hospital readmissions, improved grip strength, increased protein and energy intake with little reduction in normal food intake, and improvements in body weight.<sup>4</sup>


  1. Lochs H, Allison SP, Meier R, et al. Clin Nutr. Apr 2006;25(2):180-86.
  2. Oral Nutritional Supplements to Tackle Malnutrition: A Summary of the Evidence Base. Brussels, Belgium: Medical Nutrition International Industry (MNI);2012.
  3. Hiesmayr M, Schindler K, Pernicka E, et al.Clin Nutr. 2009;28:484-91.
  4. Cawood AL, Elia M, Stratton RJ. Ageing Res Rev. 2012;11(2):278-96.
  5. Gariballa S, Forster S, Walters S, Powers H. Am J Med. Aug 2006;119(8):693-99.
  6. Philipson T, Snider T, Lakdawalla D, Stryckman B, Goldman D. Am J Manag Care. 2013;19(2):121-28.

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