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Recommendations Summary

UWL: Medical Food Supplements 2009

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    UWL: Indications for Medical Food Supplements

    The Registered Dietitian (RD) should recommend medical food supplements for older adults who are undernourished or at risk of undernutrition (i.e., those who are frail, those who have infection, impaired wound healing, pressure ulcers, depression, early to moderate dementia and/or after hip fracture and orthopedic surgery).  Studies support medical food supplementation as a method to provide energy and nutrient intake, promote weight gain and maintain or improve nutritional status or prevent undernutrition.

    Rating: Strong
    Imperative

    • Risks/Harms of Implementing This Recommendation

      None.

    • Conditions of Application

      Medical food supplements should be initiated as soon as possible for improved outcomes.

    • Potential Costs Associated with Application

      • Medical food supplements may be costly  

    • Recommendation Narrative

      • Two positive-quality systematic reviews were evaluated regarding nutritional supplementation in older adults.  Both concluded that oral protein and energy supplementation produces a small but consistent weight gain in older adults (Milne et al, 2005; Avenell and Handoll, 2006).  

      • Seven studies that were evaluated report an association between underweight, weight loss and/or poor nutrition status and prevalence of infection in adults over age 65 (Langmore et al, 2002; van der Steen et al, 2002; Barreto et al, 2003; Rothan-Tondeur et al, 2003; Dambach et al, 2005; Paillaud et al, 2005; Schmaltz et al, 2005).

      • ESPEN Recommendation 2.1:  "In patients who are undernourished or at risk of undernutrition use oral nutritional supplementation to increase energy, protein and micronutrient intake, maintain or improve nutritional status, and improve survival.  In frail elderly use oral nutritional supplements (ONS) to improve or maintain nutritional status."  (Grade A)
      • ESPEN Recommendation 2.1:  "In case of nutritional risk (e.g. insufficient nutritional intake, unintended weight loss >5% in 3 months or >10% in 6 months, body-mass index (BMI) < 20 kg/m2) initiate oral nutritional supplementation and/or tube feeding early."  (Grade B)
      • ESPEN Recommendation 2.7:  "In demented patients oral nutritional supplements or tube feeding may lead to an improvement of nutritional status.  In early to moderate dementia consider oral nutritional supplements -- and occasionally tube feeding -- to ensure adequate energy and nutrient supply and to prevent undernutrition."  (Grade C)

    • Recommendation Strength Rationale

      • Conclusion Statements in support of this recommendation received Grade I
      • ESPEN recommendations received Grades A, B and/or C

    • Minority Opinions

      Consensus reached.