Malnutrition affects 5 to 10% of elderly people who live at home. This figure is probably underestimated given the huge differences in health of the population not in care. Yet malnutrition increases the risk of hospitalisation. Can Oral Nutritional Supplements (ONS) make a difference? A recent French study (ENNIGME) explored the subject.
ONS are administered to the frailest malnourished patients
The survey covered 191 patients aged 70 and over, all malnourished according to French health authority criteria and living in their own homes: 133 patients were prescribed ONS by their GP and 58 were not.
The most frail patients were the ones who had been prescribed ONS. They had less appetite than the others, a significantly lower quality of life and a significantly lower ability to evaluate their health status.
To be effective, ONS must provide over 500 kcal per day
One month in, compliance was 83.5% and after 6 months appetite was significantly more improved in the ONS group compared to other patients.
Calorie and protein intake from ONS was a determining factor in the risk of hospitalisation:
- Where ONS provided more than 30g of protein per day, the risk of hospitalisation was reduced by 68% [OR = 0.320 (0.121–0.845), p = 0.02];
- Where ONS provided more than 500 kcal per day, the risk of hospitalisation was reduced by 81.5% [OR = 0.185 (0.121–0.845), p = 0.002];
Health costs were reduced by half when ONS when compliance was complete and when they provided over 500 kcal per day (€1389) compared to when compliance was less good and ONS provided fewer calories (€3502 – a significant difference). Altogether, there was no difference in cost between the groups with and without ONS (€2732 compared to €2345, p=0.48).
The type of ONS and compliance are determining factors
This survey shows that GPs prescribe ONS for malnourished patients who are dependent, anorexic and the most at risk of hospitalisation. Prescribing ONS does not increase cost. On the contrary, good compliance (with high rates of protein and calories) reduces the risk of hospitalisation and health costs.
La compliance à la complémentation nutritionnelle orale diminue le risque d’hospitalisation chez les patients âgés dénutris vivant à domicile, sans augmenter les coûts: étude ENNIGME D. Seguy, H. Hubert, J. Robert, J. -P. Meunier, O Guerin, A. Raynaud-Simon. Nutrition Clinique et Métabolisme, 33(1), 2019 https://doi.org/10.1016/j.nupar.2019.01.247