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

Despite a marked increase in the prescription of oral nutritional supplemen ts (ONS) in the community (Department of Health, 1991-7), there is still un certainty about the value of their use in patients with different diseases. To answer questions about the effects on ONS on body weight and structure, spontaneous food intake and body function, a critical systematic review wa s undertaken (Stratton & Elia, 1999a). Eighty-four trials were reviewed (fo rty-five randomized, thirty-nine non-randomized; 2570 patients; diagnoses i ncluding chronic obstructive pulmonary disease, Crohn's disease, cystic fib rosis, human immunodeficiency virus and acquired immune deficiency syndrome and cancer). Most studies (83%) were conducted in patients living at home. The supplements were typically mixed macronutrients in liquid form, provid ing <0.42-10.5 MJ/d for 1 week-2 years. The studies reviewed in patients wi th predominantly chronic conditions living in the community suggested that: (1) ONS produce demonstrable clinical (including functional) benefits, but the nature and extent of these benefits varies with the underlying chronic condition; (2) ONS increase total energy intake with >50% of the energy fr om ONS typically additional to that from habitual food intake; (3) improvem ents in body weight, total energy intake and body function following ONS ap pear to occur more frequently in individuals with a BMI < 20 kg/m(2) than i n those with a BMI > 20 kg/m(2).