Adherences to oral nutritional supplementation among hospital outpatients: An online cross-sectional survey in Japan

Autoři: Naoki Hashizume aff001;  Yoshiaki Tanaka aff001;  Suguru Fukahori aff001;  Shinji Ishii aff001;  Nobuyuki Saikusa aff001;  Yoshinori Koga aff001;  Naruki Higashidate aff001;  Daisuke Masui aff001;  Saki Sakamoto aff001;  Minoru Yagi aff001
Působiště autorů: Department of Pediatric Surgery, Kurume University School of Medicine, Kurume, Fukuoka Japan aff001;  Division of Medical Safety Management, Kurume University Hospital, Kurume, Fukuoka, Japan aff002
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222972


Oral nutritional supplements (ONS) are multi-nutrient products used to increase the energy and nutrient intakes of patients. The aim of this study was to examine whether or not the adherence of patients varies according to their receiving prescription or over-the-counter ONS. Data were obtained from an online cross-sectional survey conducted with patients in Japan. A total of 107 patients who matched the inclusion criteria for the prescription ONS group and 148 who matched the criteria for the over-the-counter ONS group were further analyzed. In the prescription and over-the-counter ONS groups, the main medical reason for ONS consumption were “malnutrition” (48 patients [44.9%] vs. 63 patients [42.6%] p = 0.798], “frailty” (29 patients [27.1%] vs. 36 patients [24.3%] p = 0.663) and “aging” (25 patients [23.4%] vs. 30 patients [20.3%] p = 0.644). The proportion of “No particular disease” for prescription ONS consumption was significantly lower than that for over-the-counter ONS (6 patients [5.6%] vs. 24 patients [16.2%] p = 0.001). The body mass index of the prescription ONS group was significantly higher than that of the over-the-counter ONS group (21.1±4.38 kg/m2 vs. 19.9±3.75 kg/m2, p = 0.0161). In the prescription ONS group, all patients were given medical advice by doctors or registered dietitians. In contrast, in the over-the-counter ONS group, only 46 patients (31.1%) were given advice by doctors or registered dietitians (p<0.001). In the prescription ONS group, ONS was taken significantly more times and for a longer duration than in the over-the-counter ONS group (p<0.0001). However, among patients given advice by doctors or registered dietitians, there were no significant differences between the groups. Greater support by the medical team is still needed in order to maximize adherence to supplementation, especially concerning the calories, timing and period, so that benefits can be achieved and sustained.

Klíčová slova:

Japan – Malnutrition – Medical doctors – Outpatients – Quality of life – Questionnaires – Surveys


1. Stratton RJ, Elia M. Encouraging appropriate, evidence-based use of oral nutritional supplements. Proc Nutr Soc. 2010;69(4):477–87. Epub 2010/08/10. doi: 10.1017/S0029665110001977 20696091.

2. Gomes F, Schuetz P, Bounoure L, Austin P, Ballesteros-Pomar M, Cederholm T, et al. ESPEN guidelines on nutritional support for polymorbid internal medicine patients. Clin Nutr. 2018;37(1):336–53. Epub 2017/07/24. doi: 10.1016/j.clnu.2017.06.025 28802519.

3. Koretz RL, Avenell A, Lipman TO, Braunschweig CL, Milne AC. Does enteral nutrition affect clinical outcome? A systematic review of the randomized trials. Am J Gastroenterol. 2007;102(2):412–29; quiz 68. doi: 10.1111/j.1572-0241.2006.01024.x 17311654.

4. Ferreira IM, Brooks D, White J, Goldstein R. Nutritional supplementation for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2012;12:CD000998. Epub 2012/12/12. doi: 10.1002/14651858.CD000998.pub3 23235577.

5. National Institute for Health and Clinical Excellence (NICE). Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition (Clinical guideline 32). London, UnitedKingdom:National Collaborating Centre for Acute Care; 2006.

6. Stratton RJ, Green CJ, Elia M. Disease-Related Malnutrition: An Evidence-BasedApproach to Treatment.Cambridge,MA: Cabi Publishing; 2003.

7. Milne AC, Potter J, Vivanti A, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev. 2009;(2):CD003288. Epub 2009/04/15. doi: 10.1002/14651858.CD003288.pub3 19370584.

8. Baldwin C, Weekes CE. Dietary advice with or without oral nutritional supplements for disease-related malnutrition in adults. Cochrane Database Syst Rev. 2011;(9):CD002008. Epub 2011/09/07. doi: 10.1002/14651858.CD002008.pub4 21901680; PubMed Central PMCID: PMC6465043.

9. Chima CS, Barco K, Dewitt ML, Maeda M, Teran JC, Mullen KD. Relationship of nutritional status to length of stay, hospital costs, and discharge status of patients hospitalized in the medicine service. J Am Diet Assoc. 1997;97(9):975–8; quiz 9–80. doi: 10.1016/S0002-8223(97)00235-6 9284874.

10. Somanchi M, Tao X, Mullin GE. The facilitated early enteral and dietary management effectiveness trial in hospitalized patients with malnutrition. JPEN J Parenter Enteral Nutr. 2011;35(2):209–16. doi: 10.1177/0148607110392234 21378250.

11. Lawson RM, Doshi MK, Barton JR, Cobden I. The effect of unselected post-operative nutritional supplementation on nutritional status and clinical outcome of orthopaedic patients. Clin Nutr. 2003;22(1):39–46. 12553948.

12. Beattie AH, Prach AT, Baxter JP, Pennington CR. A randomised controlled trial evaluating the use of enteral nutritional supplements postoperatively in malnourished surgical patients. Gut. 2000;46(6):813–8. doi: 10.1136/gut.46.6.813 10807893; PubMed Central PMCID: PMC1756438.

13. Gariballa S, Forster S. Effects of dietary supplements on depressive symptoms in older patients: a randomised double-blind placebo-controlled trial. Clin Nutr. 2007;26(5):545–551. doi: 10.1016/j.clnu.2007.06.007 17662509

14. Gariballa S, Forster S, Walters S, Powers H. A randomized, double-blind, placebo-controlled trial of nutritional supplementation during acute illness. Am J Med. 2006;119(8):693–9. doi: 10.1016/j.amjmed.2005.12.006 16887416.

15. Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr. 2008;27(1):5–15. Epub 2007/12/03. doi: 10.1016/j.clnu.2007.10.007 18061312.

16. Jensen MB, Hessov I. Dietary supplementation at home improves the regain of lean body mass after surgery. Nutrition. 1997;13(5):422–30. doi: 10.1016/s0899-9007(97)91280-6 9225334.

17. Gosney M. Are we wasting our money on food supplements in elder care wards? J Adv Nurs. 2003;43(3):275–80. doi: 10.1046/j.1365-2648.2003.02710.x 12859786.

18. McMurdo ME, Price RJ, Shields M, Potter J, Stott DJ. Should oral nutritional supplementation be given to undernourished older people upon hospital discharge? A controlled trial. J Am Geriatr Soc. 2009;57(12):2239–45. Epub 2009/11/17. doi: 10.1111/j.1532-5415.2009.02568.x 19925613.

19. Gammack JK, Sanford AM. Caloric supplements for the elderly. Curr Opin Clin Nutr Metab Care. 2015;18(1):32–6. doi: 10.1097/MCO.0000000000000125 25474011.

20. Hubbard GP, Elia M, Holdoway A, Stratton RJ. A systematic review of compliance to oral nutritional supplements. Clin Nutr. 2012;31(3):293–312. Epub 2012/01/17. doi: 10.1016/j.clnu.2011.11.020 22257636.

21. Bauer J, Capra S, Battistutta D, Davidson W, Ash S, Group CCS. Compliance with nutrition prescription improves outcomes in patients with unresectable pancreatic cancer. Clin Nutr. 2005;24(6):998–1004. Epub 2005/09/06. doi: 10.1016/j.clnu.2005.07.002 16140426.

22. Ministry of Health, Labour and Welfare. 2nd NDB Open Data Japan 2017.

23. Cawood AL, Elia M, Stratton RJ. Systematic review and meta-analysis of the effects of high protein oral nutritional supplements. Ageing Res Rev. 2012;11(2):278–96. Epub 2011/12/22. doi: 10.1016/j.arr.2011.12.008 22212388.

24. Lis CG, Gupta D, Lammersfeld CA, Markman M, Vashi PG. Role of nutritional status in predicting quality of life outcomes in cancer—a systematic review of the epidemiological literature. Nutr J. 2012;11:27. Epub 2012/04/24. doi: 10.1186/1475-2891-11-27 22531478; PubMed Central PMCID: PMC3408376.

25. Norman K, Kirchner H, Lochs H, Pirlich M. Malnutrition affects quality of life in gastroenterology patients. World J Gastroenterol. 2006;12(21):3380–5. doi: 10.3748/wjg.v12.i21.3385 16733855; PubMed Central PMCID: PMC4087869.

26. Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr. 2003;22(3):235–9. 12765661.

27. Freijer K, Tan SS, Koopmanschap MA, Meijers JM, Halfens RJ, Nuijten MJ. The economic costs of disease related malnutrition. Clin Nutr. 2013;32(1):136–41. Epub 2012/07/10. doi: 10.1016/j.clnu.2012.06.009 22789931.

28. Baldwin C, Spiro A, Ahern R, Emery PW. Oral nutritional interventions in malnourished patients with cancer: a systematic review and meta-analysis. J Natl Cancer Inst. 2012;104(5):371–85. Epub 2012/02/15. doi: 10.1093/jnci/djr556 22345712.

29. Gariballa S, Forster S, Walters S, Powers H. A randomized, double-blind, placebo-controlled trial of nutritional supplementation during acute illness. Am J Med. 2006;119(8):693–9. doi: 10.1016/j.amjmed.2005.12.006 16887416.

30. Nieuwenhuizen WF, Weenen H, Rigby P, Hetherington MM. Older adults and patients in need of nutritional support: review of current treatment options and factors influencing nutritional intake. Clin Nutr. 2010;29(2):160–9. Epub 2009/10/13. doi: 10.1016/j.clnu.2009.09.003 19828215.

31. Lee HO, Han SR, Choi SI, Lee JJ, Kim SH, Ahn HS, et al. Effects of intensive nutrition education on nutritional status and quality of life among postgastrectomy patients. Ann Surg Treat Res. 2016;90(2):79–88. Epub 2015/01/28. doi: 10.4174/astr.2016.90.2.79 26878015; PubMed Central PMCID: PMC4751149.

32. Hubbard GP, Elia M, Holdoway A, Stratton RJ. A systematic review of compliance to oral nutritional supplements. Clin Nutr. 2012;31(3):293–312. Epub 2012/01/17. doi: 10.1016/j.clnu.2011.11.020 22257636.

33. van den Berg GH, Lindeboom R, van der Zwet WC. The effects of the administration of oral nutritional supplementation with medication rounds on the achievement of nutritional goals: a randomized controlled trial. Clin Nutr. 2015;34(1):15–9. Epub 2014/04/30. doi: 10.1016/j.clnu.2014.04.011 24880907.

34. Stratton RJ, Hebuterne X, Elia M. A systematic review and meta-analysis of the impact of oral nutritional supplements on hospital readmissions. Ageing Res Rev. 2013;12(4):884–97. Epub 2013/07/24. doi: 10.1016/j.arr.2013.07.002 23891685.

35. Ministry of Health, Labour and Welfare. Health and Medical Services. Health Insurance (accessed on 15 July 2019)

36. Paccagnella A, Morassutti I, Rosti G. Nutritional intervention for improving treatment tolerance in cancer patients. Curr Opin Oncol. 2011;23(4):322–30. doi: 10.1097/CCO.0b013e3283479c66 21552123.

Článek vyšel v časopise


2019 Číslo 9

Nejčtenější v tomto čísle

Tomuto tématu se dále věnují…


Zvyšte si kvalifikaci online z pohodlí domova

Antiseptika a prevence ve stomatologii
nový kurz
Autoři: MUDr. Ladislav Korábek, CSc., MBA

Citikolin v neuroprotekci a neuroregeneraci: od výzkumu do klinické praxe nejen očních lékařů
Autoři: MUDr. Petr Výborný, CSc., FEBO

Zánětlivá bolest zad a axiální spondylartritida – Diagnostika a referenční strategie
Autoři: MUDr. Monika Gregová, Ph.D., MUDr. Kristýna Bubová

Diagnostika a léčba deprese pro ambulantní praxi
Autoři: MUDr. Jan Hubeňák, Ph.D

Význam nemocničního alert systému v době SARS-CoV-2
Autoři: doc. MUDr. Helena Lahoda Brodská, Ph.D., prim. MUDr. Václava Adámková

Všechny kurzy
Kurzy Doporučená témata