# Randomised Trial Shows Readymade Oral Nutritional Supplements in Older Malnourished People in the Community Improve Total Nutrient Intakes and Meet More Dietary Reference Values Without Reducing Intake from the Diet

## TL;DR

This study shows that adding ready-made nutritional supplements to dietary advice improves nutrient intake in older people at risk of malnutrition without reducing their regular food intake.

## Contribution

The study demonstrates that low-volume oral nutritional supplements significantly improve nutrient intake in older malnourished individuals without displacing dietary intake.

## Key findings

- ONS + DA significantly increased total energy and 25 out of 29 nutrients compared to dietary advice alone.
- Over 90% of energy and nutrients from ONS were additive to the diet, with little displacement.
- ONS + DA more than halved the number of people with nutrient intakes below dietary reference values.

## Abstract

Background: There is little information about the effectiveness of oral nutritional supplements (ONS) in combatting nutrient inadequacies in primary care, where most malnutrition exists. Aim: To examine the extent to which readymade ONS add or displace the nutrients consumed in the diet and their impact on combatting dietary inadequacies. Methods: 308 free-living people >50 years with medium + high risk of malnutrition (Malnutrition Universal Screening Tool) were randomised to receive readymade low volume (2.4 kcal/mL), liquid ONS plus dietary advice (ONS + DA) or dietary advice alone (DA). Intake was assessed at baseline (24 h recall) and 4-weekly for 12 weeks (3-day diet record). Total nutrient intake was benchmarked against UK and European dietary reference values (DRVs). The proportion of energy and nutrients from the ONS that added or displaced those from the diet (net addition/displacement) was calculated. Results: ONS + DA led to significantly greater total energy and nutritional intakes, with 25/29 nutrient intakes significantly higher than with DA alone. There were no significant differences in dietary energy and nutrient intakes from food between the groups. There was little or no displacement of nutrients from the diet, with over 90% of the energy and nutrients consumed in the ONS additive to the diet. ONS + DA more than halved the number of people with nutrient intakes that failed to meet DRVs and the number of nutrients per person that did not meet DRVs compared to DA alone. Conclusions: Supplementation with readymade, low volume (2.4 kcal/mL) liquid ONS overcomes most nutrient intake inadequacies in malnourished older people in primary care without significantly reducing intake from the diet. This makes ONS an effective way to improve nutritional intakes above dietary advice alone to improve the outcomes for the management of older people at risk of malnutrition.