Oral Nutritional Supplements (ONS)
to Tackle Malnutrition
A summary of the evidence base
Medical Nutrition International Industry (MNI)
Content
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What is malnutrition?
Identifying malnutrition
Prevalence of malnutrition
Causes and consequences of malnutrition
Economic consequences of malnutrition
Benefits of oral nutritional supplements (ONS)
•
Nutritional
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Functional
•
Clinical
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Economic benefits
• Benefits of screening for malnutrition
• Recommendations for action
The ‘hidden’ problem of malnutrition
“Malnutrition does not show up in the streets in Europe. Instead malnutrition
is a hidden health problem residing at home or in care homes”1
Management of malnutrition
Oral Nutritional Supplements (ONS) are an important strategy in nutritional care but there
is often poor awareness of the value of nutritional care, especially ONS
1. Ljungqvist O & de Man F. Nutr Hosp 2009; 24(3):368-370.
What is malnutrition?
• No universally accepted definition of malnutrition, but
following definition widely acknowledged (also by ESPEN)1-2:
“A state of nutrition in which a deficiency, excess or imbalance of energy,
protein, and other nutrients causes measurable adverse effects on tissue/body
form (body shape, size, and composition) and function, and clinical outcome.”
• ‘Malnutrition’ includes both over-nutrition
(overweight and obesity) as well as under-nutrition
• Here ‘malnutrition’ is used synonymously
with under-nutrition and nutritional risk
1. Elia M. Maidenhead, BAPEN. 2000
2. Lochs H et al. Clin Nutr 2006; 25(2):180-186.
Identifying malnutrition risk
• Nutritional screening identifies individuals who:
•
are ‘at-risk’ across the spectrum of nutritional status
•
are at risk of adverse outcome and who
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may benefit clinically from nutritional support
Patients will only benefit from nutritional screening
if it results in action* to improve their nutritional care
*Unless detrimental or no benefit expected from nutritional support e.g. imminent death.
Tools to identify malnutrition risk
• Practical, validated tools available to screen for risk
of malnutrition
• Specifically designed for different patient groups
and care settings
Examples include:
For hospital and
community patients
For older people
For adult hospital
patients
For children
NRS 2002
‘MUST’
Strongkids
However, they are not routinely used, meaning that malnutrition is often missed
Malnutrition goes undetected and untreated
• Lack of routine screening for malnutrition and its
risk factors has meant that the opportunity for
early intervention, and prevention, is often missed
• Even when found, malnutrition is not always appropriately
treated :
Often less than 50% of patients identified as malnourished
receive nutritional intervention1-4
Diagnosed malnutrition
No nutritional intervention
Nutritional intervention
1. Lamb CA et al. Br J Nutr 2009; 102(4):571-575
2. Meijers JM et al. Nutrition 2009; 25(5):512-519
3. van Nie-Visser NC et al. Clin Nutr 2009; 4 Supplement 2:45.
4. Meijers JM et al. Nutr 2009; 25(5): 512-519.
Mandatory screening shown to lower
malnutrition (NL)
Decreased prevalence of malnutrition in hospitals and home
following introduction of mandatory screening 1
• Increasing awareness and actively working toward
improvement could lower the rate of malnutrition1
• Screening allows early identification and management with an appropriate
care plan
Malnutrition prevalence rates in hospitals, nursing homes and home care institutions (NL)
1. Meijers JM et al. J Nutr 2009; 139(7):1381-1386.
Screening for malnutrition risk - Conclusions
• Reliable and validated tools for screening are available
BUT
screening is still not routinely used
Malnutrition continues to go unidentified
The opportunity for early intervention is often missed
Screening must result in action if patients are to benefit
Prevalence of malnutrition
Malnutrition is a major public
health concern that frequently
goes unrecognised and
untreated
An estimated 33 million
people in Europe are at risk
of malnutrition1
Population of Europe:
> 800 million
1. Ljungqvist O, de Man F. Nutr Hosp 2009; 24:368-70.
Prevalence of malnutrition in older people
Malnutrition is significantly more common in older people1-4; an ageing
population will only exacerbate the problem in years to come
About 1 in 3 older people in More than 1 in 3 people in Around 1 in 3 older people
hospital at risk1-7
care homes at
living independently at risk6
risk1,6,8-10
An estimated 93% of malnourished people live in the community11
1. Russell C & Elia M. Redditch, BAPEN. 2008. 2. Russell C & Elia M. Redditch, BAPEN. 2009.
3. Russell C & Elia M. Redditch, BAPEN. 2011.
4. Russell C & Elia M. Redditch, BAPEN. 2012.
5. Imoberdorf R et al. Clin Nutr 2010; 29(1):38-41. 6. Kaiser MJ et al. J Am Geriatr Soc 2010; 58(9):1734-1738. 7. Vanderweek et al. J Adv Nurs 2011; 67(4):736-746. 8. Suominen MH et al. Eur J Clin Nutr 2009; 63(2):292-296.
9. Lelovics Z et al. Arch Gerontol Geriatr 2009; 49(1):190-196. 10. Parsons EL et al. Proc Nutr Soc 2010; 69:E197. 11. Elia M. & Russell C. Redditch: BAPEN, 2009.
Malnutrition is prevalent in hospitals
worldwide
About 1 in 4 patients in hospital are at risk of malnutrition1-7
1. Russell C & Elia M. Redditch, BAPEN. 2008.
2. Russell C & Elia M. Redditch, BAPEN. 2009.
5. Meijers JM et al. Br J Nutr 2009; 101(3):417-423. 6. Imoberdorf R et al. Clin Nutr 2010; 29(1):38-41.
3. Russell C & Elia M. Redditch, BAPEN. 2011.
7. Schindler K et al. Clin Nutr 2010; 29(5):552-559.
4. Russell C & Elia M. Redditch, BAPEN. 2012.
Prevalence of malnutrition in hospital patients
Malnutrition affects people of all ages
Almost 1 in 5 children admitted to
hospital at risk1
1. Joosten KF et al. Arch Dis Child 2010; 95(2):141-145.
Malnutrition is prevalent across a wide
variety of diseases
Prevalence of malnutrition risk in hospital by diagnosis
Republic of Ireland n = 1102 (‘MUST’ medium + high risk), UK n = 7521 (‘MUST’ medium + high risk)1,
The Netherlands n = 8028 (defined by BMI, undesired weight loss, nutritional intake)2.
1. Russell C & Elia M. Redditch, BAPEN. 2012.
2. Meijers JM et al. Br J Nutr 2009; 101(3):417-423.
Prevalence of malnutrition - Conclusions
• Studies across the developed world show that malnutrition is
common in patients
• in hospital
• in care homes and
• in people who live at home
• Malnutrition affects all age groups, including children
• Malnutrition is particularly common in older people
Causes of malnutrition
• Insufficient dietary intake
• disability and disease are at the heart of the problem
• Effects of disease and its treatment
• leading to low food intake e.g. poor appetite,
swallowing problems and side effects of drugs1
• Lack of clear responsibilities for health authorities and healthcare staff
• inadequate training and equipment for screening exacerbates the
problem of malnutrition2-3
More than 50% of patients in hospital don’t eat the full meal they are
given4, and 30% of nursing home residents eat less than half their
lunch5, often failing to meet their nutritional needs
1. Stratton RJ et al. Wallingford: CABI Publishing; 2003.
5. Valentini L et al. Clin Nutr 2009; 28(2):109-116.
2. Elia M & Russell C. Redditch, BAPEN. 2009.
3. Elia M. Redditch, BAPEN. 2003.
4. Hiesmayr M et al. Clin Nutr 2009; 28(5):484-491.
Factors causing poor food and nutrient intake1
Individuals
• Physical e.g. chewing or swallowing problems, difficulty self-feeding
• Physiological e.g. anorexia, feeling full rapidly, nausea, taste changes, pain
• Psychological e.g. confusion, low mood, anxiety
Health care workers
Institutions
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• Lack of recognition of importance of
nutrition
• Lack of knowledge and skills
• Poor documentation of nutrition
information
• Lack of screening, action and monitoring
Lack of nutrition policy or guidance
Poor organisation of nutrition services
Limitations in catering provision
Lack of specialist posts
Insufficient
energy and
nutrient intake*
Disease Related Malnutrition
1. Adapted from Stratton RJ et al. Wallingford: CABI Publishing; 2003.
*Requirements for some nutrients may be increased due to malabsorption, altered metabolism and excess losses.
Causes of malnutrition - Conclusions
• The causes of malnutrition are multi-factorial
• Patient-related factors resulting from disease and disability
contribute to low food intake
• Organisational and institutional factors are also involved
• A multi-stakeholder approach is needed to
identify and implement effective solutions
Consequences of malnutrition for individuals
• Markedly increased morbidity and mortality rates1-2
• Malnourished patients experience more complications than
well nourished patients; the risk of infection is more than
three times greater in hospitalised malnourished patients2-3
• Associated with poorer quality of life1
• Malnutrition has a particularly high adverse impact in the
older person4 impairing function, mobility and
independence5
• Malnutrition has an adverse impact on growth and
development in children 1,5
1. Stratton RJ et al. Wallingford: CABI Publishing; 2003.
5. Elia M & Russell C. Redditch, BAPEN. 2009.
2. Sorensen J et al. Clin Nutr 2008; 27(3):340-349.
3. Schneider SM et al. Br J Nutr 2004; 92(1):105-111.
4. Stratton RJ et al. Br J Nutr 2006; 95(2):325-330.
Malnutrition is associated with increased
morbidity
• Malnutrition is associated with increased morbidity in acute
and chronic disease including:
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•
•
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Development of pressure ulcers1
Poor wound healing1
Post-operative complications such as acute renal failure,
pneumonia and respiratory failure1
Increased risk of infection2
1. Norman K et al. Clin Nutr 2008; 27(1):5-15.
2. Schneider SM et al. Br J Nutr 2004; 92(1):105-111.
Economic consequences of malnutrition
Malnutrition increases use of healthcare resources
Hospital patients
Community patients
• Increase in length of hospital stay1-5
• Increase in readmission rates4,6
• Delays in returning home7
• Increased number of visits to family
doctors8,9
• Increases in hospital admissions and
readmissions10,11
• Increases in length of hospital
stay8,9,11
Also in children malnutrition is associated with an increased
length of hospital stay12-14
Leandro-Merhi VA et al. J Parenter Enteral Nutr 2011; 35(2):241-248. 2. Pressoir Met al. Br J Cancer 2010; 102(6):966-971. 3. Pirlich M et al. Clin Nutr 2006; 25(4):563-572. 4. Lim SL et al.Clin Nutr 2011; 31(3):345-350. 5. Marco J et al. Clin Nutr 2011; 30(4):450-454. 6. Planas M etal. Clin
Nutr 2004; 23(5):1016-1024. 7. Nitenberg GM et al. Clin Nutr 2011; 6(Suppl 1):149. 8. Feldblum I et al. Nutrition 2009; 25(4):415-420. 9. Guest JF et al. Clin Nutr 2011; 30(4):422-429. 10. Collins PF et al. Proc Nutr Soc 2010; 69:E148. 11. Cawood AL et al.Proc Nutr Soc 2010; 69:E149.
12. Secker DJ & Jeejeebhoy KN. Am J Clin Nutr 2007; 85(4):1083-1089. 13. Hulst JM et al. Clin Nutr 2010; 29(1):106-111. 14. Joosten KF et al. Arch Dis Child 2010; 95(2):141-145.
Economic consequences of malnutrition
Costs of malnutrition
Country
Costs of malnutrition
Note
UK1
€15 billion
Public expenditure on malnutrition in 2007
Germany3
€9 billion
Additional costs due to malnutrition across all care sectors
in 2003
The Netherlands4
€1.9 billion
Additional costs due to malnutrition in 2011
Republic of Ireland5
€1.4 billion
Public expenditure on malnutrition in 2007
1. Elia M & Russell C. Redditch, BAPEN. 2009
4. Freyer K et al. Clin Nutr 2012..
2. House of Commons Health Committee. 2004. 3. Cepton. Munich. 2007.
5. Rice N & Normand C. Pub Health Nur. 2011.
Malnutrition and associated diseases
increase healthcare costs in the UK
•
In 2003, the estimated UK annual healthcare cost of malnutrition and
any associated disease was over €8.4 billion (£7.3 billion*)1
•
These costs can be further broken down:
• €4.5 billion (£3.8 billion*) due to the treatment of malnourished patients in
hospital
• €3.1 billion (£2.6 billion*) due to the treatment of malnourished patients in
long-term care facilities
• €0.58 billion (£0.49 billion*) from GP visits
• €0.21 billion (£0.18 billion*) from outpatient visits and
• €0.18 billion (£0.15 billion*) from nutrition support in the community
1. Elia M & Russell C. Redditch, BAPEN. 2005.
* Calculated based on an exchange rate of £ to € of 1.17993 Source: Interbank 29.02.12).
Malnutrition and associated diseases
increase healthcare costs in the UK
•
A further estimated incremental cost of over €6.3 billion
(£5.3 billion*), is largely due to1†:
•
More frequent and expensive hospital stays
•
Greater need for long term care
The UK alone spends in excess of €15 billion annually on
managing malnourished patients,
corresponding to more than 10% of the total spend on
health and social care1
1. Elia M & Russell C. Redditch, BAPEN. 2005.
* Calculated based on an exchange rate of £ to € of 1.17993 Source: Interbank 29.02.12).
† The extra cost of treating all patients in the general population with medium and high risk of
malnutrition and associated disease compared with treating the same number of patients with
low risk of malnutrition and associated disease.
Estimated cost of malnutrition across the EU
Malnutrition in Europe costs healthcare systems
an estimated €170 billion per year1
1. Ljungqvist O, de Man F. Nutr Hosp 2009; 24:368-70.
Costs of malnutrition vs. obesity in the UK
Estimated UK public expenditure (health and social care):
Annual Cost in 2007
Disease-related malnutrition
€ 15 billion (£13 billion)
Obesity
€3.8-4.3 billion (£3.3-3.7 billion)
Overweight and obesity
€ 7.7-8.7 billion (£6.6-7.4 billion)
The economic costs of malnutrition are double the
economic costs of overweight and obesity1-2
*Public expenditure includes social and health care costs. Calculated based on an exchange rate of £ to € of 1.17993 Source: Interbank 29.02.12)
1. Elia M & Russell C. Redditch, BAPEN. 2009.
2. House of Commons Health Committee. London, The Stationery Office. 2004.
Consequences of malnutrition - Conclusions
• The adverse consequences of malnutrition are far-reaching
• Malnutrition is associated with:
• Increased complications
• Greater risk of infections
• Poor quality of life
• Increased mortality
• Suboptimal growth and development in children
Malnutrition is associated with increased healthcare resource use
and higher costs
Management of malnutrition
• Early identification is key to effective management of malnutrition
• Screening using validated tools should be routine practice
• A range of strategies can be used to manage malnutrition,
e.g. dietary advice, oral nutritional supplements, tube feeding or
parenteral nutrition (intravenous nutrition)
*Based on the ESPEN definition.
1. Lochs H et al. Clin Nutr 2006; 25(2):180-186.
Benefits of Oral Nutritional Supplements (ONS)
• ONS are an effective and non-invasive solution
to tackling malnutrition
• National and international reviews of the evidence,
for example NICE, cite ONS as having significant clinical
benefits for malnourished patients when compared to
standard care1-5
1. National Institute for Health and Clinical Excellence (NICE). London. 2006.
4. Milne AC et al. Ann Intern Med 2006; 144(1):37-48.
2. Milne AC et al. Cochrane Database Syst Rev 2009;(2):CD003288. 3. Milne AC et al. Cochrane Database Syst Rev 2005;(2):CD003288.
5. Avenell A & Handoll HH. Cochrane Database Syst Rev 2010;(1):CD001880.
Benefits of Oral Nutritional Supplements (ONS)
•
Proven nutritional benefits
•
•
ONS increase total energy intake without decreasing food intake and lead to
weight gain and prevention of weight loss in patients who are malnourished or
‘at-risk’ of malnutrition in hospital and in community settings1-4
Proven functional benefits
•
ONS have proven functional benefits such as improvements in activity, quality of
life and independence measures, particularly in older malnourished patients in
the community5-11
1. Stratton RJ et al. Wallingford: CABI Publishing; 2003. 2. National Institute for Health and Clinical Excellence (NICE). 2006. London, National Institute for Health and Clinical Excellence (NICE). 3. Milne AC et al. Cochrane Database Syst Rev 2009;(2):CD003288.
4. Cawood A et al.Ageing Res Rev 2012; 11(2):278-296 5. McMurdo ME et al.J Am Geriatr Soc 2009; 57(12):2239-2245. 6. Norman K et al.Clin Nutr 2008; 27(1):48-56. 7. Rabadi MH et al.Neurology 2008; 71(23):1856-1861. 8. Gariballa S et al. J Am Geriatr Soc 2007;
55(12):2030-2034. 9. Persson M et al. Clin Nutr 2007; 26(2):216-224. 10. Parsons EL et al. Clin Nutr 2011; 6(Suppl 1):31. 11. Stange I et al. Clin Nutr 2011; 6(Suppl 1):128.
Benefits of Oral Nutritional Supplements (ONS)
•
Proven clinical benefits
•
ONS have proven clinical benefits; ONS use is consistently linked to
lower mortality and complication rates for malnourished patients when
compared to standard care1-4, 5, 6
Lower complication rates in supplemented vs control patients in hospital1
1. Stratton RJ et al. Wallingford: CABI Publishing; 2003. 2. National Institute for Health and Clinical Excellence (NICE). 2006. London, National Institute for Health and Clinical Excellence (NICE). 3. Milne AC et al. Cochrane Database Syst Rev 2009;(2):CD003288.
4. Cawood A et al.Ageing Res Rev 2012; 11(2):278-296. 5. Avenell A & Handoll HH. Cochrane Database Syst Rev 2006;(4):CD001880. 6. Stratton RJ et al. Ageing Res Rev 2005; 4(3):422-450.
Benefits of Oral Nutritional Supplements (ONS)
• Data on the benefits of dietary counselling and food fortification in the
management of malnutrition are lacking;
ONS have been shown to be more effective1-5
• Greater nutrient intakes and fewer complications are seen in patients with
hip fractures given ONS compared with food snacks4-6
• Compliance to ONS is good. Compliance to other
methods of oral nutritional intervention need investigation7
1. National Institute for Health and Clinical Excellence (NICE). London. 2006. 2. Baldwin C & Weekes CE. Cochrane Database Syst Rev 2011;(9):CD002008. 3. Weekes CE et al. J Hum Nutr Diet 2009; 22:324-335. 4. Stratton RJ et al.
Proc Nutr Soc 2006;10A. 5. Stratton RJ et al. Proc Nutr Soc 2006; 65:4A. 6. Stratton RJ et al. Clin Nutr 2007; 2 Supplement 2:9. 7. Hubbard GP et al. Clin Nutr 2012; 31(3):293-312.
ONS reduce mortality in hospital patients
• Significantly lower mortality rates found in supplemented hospitalised liver
disease, orthopaedic, and surgical patients, and hospitalised older people1
• Represents a 24% reduction in mortality
Lower mortality in supplemented versus control patients
p < 0.001; odds ratio 0.61 (95% CI, 0.48 to 0.78), meta-analysis of 11 trials, n = 1965;
no significant heterogeneity between individual studies
1. Stratton RJ et al. Wallingford: CABI Publishing; 2003.
ONS reduce complications in hospital
patients
• Significantly lower complication rates in supplemented surgical,
orthopaedic, elderly and neurology hospital patients1
• Represents a 56% reduction in complication rates
Lower complication rates in supplemented versus control patients in hospital
p < 0.001; odds ratio 0.31 (95% CI, 0.17 to 0.56), meta-analysis of 7 trials, n = 384;
no significant heterogeneity between studies
1. Stratton RJ et al. Wallingford: CABI Publishing; 2003.
ONS reduce length of hospital stay
• Reduced length of hospital stay found in patients who
received ONS compared with control patients
(meta-analysis of 9 trials)
• Average reductions ranged from 2 days (in surgical
patients) to 33 days (in orthopaedic patients)1
1. Stratton RJ et al. Wallingford: CABI Publishing; 2003.
ONS reduce hospital readmissions
• High protein ONS have been shown to
reduce hospital readmissions by 30%1
Significant reductions in readmissions with ONS
1. Cawood AL et al. Ageing Res Rev 2012; 11(2):278-296.
Financial Benefits of Oral Nutritional
Supplements (ONS) in hospital
COUNTRY
AUTHOR
(year)
PATIENT GROUP
COST-SAVING*
PER PATIENT
COST-SAVING*
PER ANNUM
HOSPITAL
Denmark
Lassen et al.
(2006) 1
Medical
-
€16.4 million
(USD 22 million)**
The Netherlands
Freijer & Nuijten
(2010) 2
Abdominal surgery patients
€252
€40.4 million
UK
Elia et al.
(2005) 3
Pooled results from analysis in
surgical, elderly and stroke
patients
€1002 (£849)
(bed day costs)
€352 (£298)
(complication costs)
-
UK
Elia & Stratton
(2005) 4
Older patients at risk of
developing pressure uclers (Stage
IV)
€543 (£460)
-
UK
Stratton et al.
(2003) 5
Surgical, orthopaedic, elderly and
cerebrovascular accident patients
€415-€9651
(£352-£8179)
-
* Calculated based on an exchange rate of £ to € of 1.17993 (Source: Interbank 29/02/2012. ** Calculated based on an exchange rate of USD to € of 0.74448
(Source: Interbank 29/02/2012); based on medical inpatient days.
1. Lassen KO et al. BMC Health Serv Res 2006; 6:7. 2. Freijer K, Nuijten MJ. Eur J Clin Nutr 2010; 64(10):1229-1234. 3. Elia M et al. Redditch, BAPEN. 2005.4. Elia M, Stratton RJ. Clin Nutr 2005; 24:640-641.
5. Stratton RJ et al. Wallingford: CABI Publishing; 2003
ONS can reduce medical care costs
in community patients - France
• Evaluation of the economic impact of using ONS among
malnourished older people in the community found that
intervention with ONS supported clinical and economic
advantages including1:
• Reduction in healthcare utilisation
• Fewer home nursing visits
• Less GP and physiotherapist visits
• Fewer hospital admissions
• Shorter length of hospital stay with admission
• After considering the investment required for ONS, the average reduction
in medical care costs was €195 per patient
1. Arnaud-Battandier F et al. Clin Nutr 2004; 23(5):1096-1103.
Financial Benefits of Oral Nutritional
Supplements (ONS) in the community
COUNTRY
AUTHOR
(year)
PATIENT GROUP
COST-SAVING*
PER PATIENT
COST-SAVING*
PER ANNUM
Community
France
ArnaudBattandier et al.
(2004) 1
Malnourished older people (>70
years of age)
€195
-
Germany
Nuijten (2010) 2
Eligible for ONS due to risk of
DRM
€234-€257
€604-€662 million
The Netherlands
Freijer & Nuijten
(2010) 3
Older people (>65 years of age)
eligible for ONS due ro DRM
€173
-
The Netherlands
Nuijten & Freyer
(2010) 4
Older people (>65 years of age)
eligible for ONS due ro DRM
-
€13.3 million
UK
Cawood et al.
(2010) 5
Older people (>65 years of age)
at high risk of malnutrition
-
€19 million
(£16 million)
UK
Elia et al. (2005)
Pre-surgery (elective)*
€812 (£688) (hospital
bed-day costs)
€424 (£359) (excess
bed-day costs)
-
6
* Short-term ONS (about 2 weeks)
1. Arnaud-Battandier F et al. Clin Nutr 2004; 23(5):1096-1103. 2. Nuijten M, Mittendorf T. Aktuel Ernahrungsmed 2012; 37:126-133. 3. Freyer K, Nuijten M. Value in Health 2010; 13(3):A101 (PH106). 4. Freijer K et al. Front Pharmacol 2012; 3:78.
5. Cawood AL et al. Proc Nutr Soc 2010; 69:E544. 6. Elia M et al. Redditch, BAPEN. 2005.
ONS are cost-effective (UK)
• Cost per quality adjusted life year (QALY) of the use of ONS
within the context of a screening program undertaken in older
hospital patients: €8,024* (£6,800)
based on NICE economic modelling 1
• This is well below the NICE threshold of €23,599-35,398/QALY
(£20-30,000*/QALY) for treatments deemed to be good value for money
Cost/QALY
(€/year)
ONS
Threshold
0
10000 20000 30000 40000
*Public expenditure includes social and health care costs. Calculated based on an exchange rate of £ to € of 1.17993 Source: Interbank 29.02.12)
1. National Institute for Health and Clinical Excellence (NICE). London. 2006.
Recommendations for action
Fundamental prerequisites for success
• There must be multi-stakeholder involvement at all levels
• Awareness, training and education are central to success
• Audit and quality improvement activities should be included in any
initiative that strives to tackle malnutrition
• Good practice should be routinely shared
Recommendations for action
Identifying
Malnutrition
•
•
•
•
•
•
National nutrition policy addressing under-nutrition as well as obesity/overweight
Routine screening for vulnerable groups built into national nutrition policies
Validated screening tools routinely used
Appropriate equipment (weighing scales, stadiometers) available
Agreement about who is responsible for performing screening
Evidence-based guidance (including nutritional care plans) used to take action following
screening and for monitoring
Prevalence
•
•
Commitment made to systematically measure the prevalence of malnutrition
A common approach taken to measuring and documenting malnutrition and risk of
malnutrition, enabling comparisons to be made
Causes
•
Evidence based approaches for nutritional care plans should be used taking account of
causes
Consequences
•
Awareness raised about the negative consequences of malnutrition for patients, healthcare
providers and for society
Evidence based screening programmes used to ensure malnutrition is identified early and
appropriate action taken
•
Recommendations for action
Benefits of ONS
•
A wealth of evidence is available that demonstrates the benefits
of ONS. This should be translated into practice to ensure that
patients who need nutritional intervention receive it in a timely
and appropriate manner
Guidance
•
Guidance on managing malnourished patients or patients at risk
of malnutrition should reflect current evidence and should
provide clear and practical advice about how and when to use
different forms of nutritional intervention, including ONS
Good Practice
•
Examples of good practice should be shared widely to facilitate
the implementation of nutritional guidelines and ensure best use
of resources.
Note
•
This presentation is based on a report synthesising relevant information on the rationale for and value of
ONS to provide stakeholders with an up-to-date and practical summary of the evidence base:
http://www.medicalnutritionindustry.com/mni-publications/
•
This document is an updated version of previous reports prepared in 2009 and 2010. A pragmatic
approach was used to identify relevant publications and material for inclusion. This document draws on the
key elements of a comprehensive systematic review of the evidence base for the management of disease
related malnutrition published in 20031. It builds on it by adding recent data on the prevalence, causes and
consequences of malnutrition as well as the nutritional, functional, clinical and economic benefits of ONS. It
now includes new data from outside Europe, as well as data examining the paediatric area.
•
This document includes a unique collation of relevant guidelines relating to ONS, as well as examples of
implementation of guidelines and good practice. We recognize there are gaps - either real gaps or due to
difficult accessibility of documentation. We hope this will be the starting point to encourage further
documentation and sharing of information
•
Therefore, this report represents work in progress as unpublished data may not be included, trials are
ongoing and further guidelines and good practice may be in development
•
The full report is available to download at www.medicalnutritionindustry.com