Knowing when to order supplements and when to refrain can be a challenge. Supplements may be a helpful intervention for inadequate intake and weight loss, but can also be costly, ineffective, and potentially harmful if used improperly. Keep the following guidelines in mind when considering the use of a supplement.
When to Order:
According to the Academy of Nutrition and Dietetics (AND) Evidence Analysis Library, medical food supplements (defined as “commercial or prepared foods or beverages that supplement energy, protein, carbohydrate, fiber, fat intake;” also known as oral nutrition supplements or (ONS) should be recommended for older adults that are undernourished or at risk for undernutrition. This may include those who are frail, those who have infection, impaired wound healing, pressure ulcers, depression, early to moderate dementia, recent hip fracture, or orthopedic surgery. The use of ONS to provide energy and nutrient intake, promote weight gain and maintain or improve nutritional status or prevent undernutrition is supported by research.1
When to Reconsider:
- Food Allergies & Intolerances. If the supplement in question contains an allergen or ingredient that is not tolerated by the resident, consider using another supplement, diet liberalization, between meal snacks or fortified foods. Remember to check the ingredient label to ensure the product formulation has not changed.
- Palliative or Hospice Care. Weight loss and nutritional decline may be unavoidable due to natural disease progression at end of life. An appropriate nutrition goal may be to provide adequate nutrition and hydration in accordance with the individual’s condition and wishes. Favorite foods and beverages, small and/or frequent meals, finger foods, altered textures, snacks, and food available 24/7 as desired may be appropriate interventions, depending on the individual and disease state. Supplements may be considered on a case-by-case basis.
- Incompatible with resident preferences. Individual taste preferences may vary and can change over time. Repeatedly providing supplements that will only be thrown in the trash is ineffective and costly. Consider offering a sample to taste before ordering a supplement and have measures in place to monitor acceptance and tolerance. Encourage staff to inform nursing or the dietitian of repeated supplement refusal or intolerance and adjust supplements accordingly. Fortified foods may be more palatable to some people and may be an appropriate alternative.
- Planned Weight Loss. If weight loss is related to use of diuretics, reduced edema, fluid removed at dialysis, removal of an external fixture (i.e. removal of a cast), or as a result of desired weight loss through reasonable changes in diet and physical activity for an overweight or obese individual, supplements may not be indicated.
- Gastrointestinal abnormalities. High fat supplements may not be well tolerated by those with GERD or after a cholecystectomy (gallbladder removal). Supplements with high sugar content (including Ensure and Boost) may not be tolerated well by those with dumping syndrome, recent history of gastric surgery or esophagectomy, short bowel syndrome, or diarrhea. Liquid protein supplements (including Promod and Prostat) or beverages with sugar alcohols may exacerbate diarrhea and cause upset stomach.
- If the recipient of a supplement is required to have thickened liquids, check to make sure that the supplement is the required consistency or thicker. A reference chart of supplement viscosity (thickness) can be found on RD411 (http://www.nutrition411.com/content/viscosity-levels-oral-and-enteral-feedings). If unsure if a supplement is thick enough, refer to a speech therapist for evaluation.
The registered dietitian should be consulted when considering the implementation of any supplement.