Oral Nutritional Supplements (ONS)

Discuss ONS?

  • Multinutrient liquid supplements that are energy dense and contain both macronutrients (protein, carbohydrate and fat) and micronutrients (vitamins, minerals and trace elements).
  • ONS could be nutritionally complete, nutritionally incomplete (e.g. fat free or lacking some essential micronutrients) and modular (e.g. usually containing one or two energy sources only) varieties.
  • A range of specialized ‘disease- specific’ supplements is also available (e.g. for patients with malabsorption, diabetes, renal and hepatic disease).

How much should be prescribed?
The number of supplements required will vary according to the patient’s nutritional needs and food intake.

What products can be prescribed on NHS?
Not all supplements are available on the NHS. Those that can be prescribed on FP10 are listed in the BNF (Appendix 7)

What are the different types of ONS available?

  • Polymeric or elemental
  • With or without fibre
  • Nutritionally complete or disease specific
  • Energy dense or standard


How do you select ONS?

Enteral formulas should be selected according the clinical needs of the patient. Most standard formulae contain whole protein, lipid in the form of long-chain triglycerides
(LCT) and fiber. Most standard formulae contain neither gluten nor lactose in clinically relevant amounts.

  • Normal Gut function- Select nutritionally complete polymeric ONS (intact carbohydrates, protein and fat) like ensure (250ml, 1Kcal/ml) or ensure plus (220ml, 1.5Kcal/ml).
  • Volume restriction (calorie dense) – scandishake mix (1 satchet powder- 240ml/588Kcal), calogen (4.5Kcal/ml, usual dose 30ml tds).
  • Increased protein needs- fortisip extra. High protein formulae contain 20% or more of total energy from protein.
  • Impaired gut function- Elemental ONS like Elemental O28Xtra, peptamen.
  • Liver failure/ CRF on HD or CAPD- high energy, low fluid, low electrolyte ONS like nepro (2kcal/ml), Ensure plus, Enrich plus

NB

  • hyperosmolar feeds should be avoided if the short bowel ends in a stoma or the short bowel is anastomosed to the colon
  • Nutilis- for thickening of foods in pts at risk of aspiration

Ref

  1. Stratton RJ, Elia M. Who benefits from nutritional support: what is the evidence? Eur J Gastroenterol Hepatol. 2007 May; 19(5):353-8. Review.

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