Enteral supplements: Dietary supplements or substitutes?

Objective: to assess the use of oral nutritional supplements analyzing the reason for prescription and its implication in caloric-protein intake. Setting: study performed at a university hospital of 350 beds with medical and surgical specialties. Subjects, patients: Patients inclusion was done by selecting all starting oral nutritional supplement prescription. Exclusion criteria were being younger than 18 years, being admitted to the Intensive Care Unit, having cognition or communication impairments, being on concomitant parenteral nutrition or requiring complete enteral diet, and/or using nasogastric tube for feeding. We also excluded special enteral diets, specifically designed for certain conditions. Interventions: One-year long prospective study on prescription of oral nutritional supplements. Through clinical chart review and personal interview, we recorded demographic data, nutritional parameters, characteristics of the diet and supplement, and caloricprotein intake prescribed and ingested. The data were introduced in an Access97 database and processed by means of SPSS software for Windows (R). We performed a descriptive study of quantitative and qualitative variables, a chi 2 analysis between qualitative variables, and a comparative analysis between means of all paired data by means of the student's t test, and variance analysis between quantitative variables. The significance level was set at p < 0.05. Results: we were only able to analyze 77 out of 130 prescriptions for nutritional supplements since we could not adequately interview the remaining patients, mainly due to neurological impairments. Mean age was 74.8 years (SD = 12) and 50.6% were women. The departments prescribing the highest number of supplements were hematology (22.1%) and internal medicine (20.8%). GI neoplasm was the most frequent diagnosis at admission (27.3%). The most frequent indication was kwashiorkor (45.5%), with 15.6% of patients being well nourished. Mean therapy duration was 11 days (SD = 11.1), and the main reason for termination was hospital discharge (70.1%). The supplement was concomitantly prescribed with the meals in 70.6% of the cases, and more than half of the patients (70.1%) liked it, the most frequently prescribed was as a cream (61%) and the best accepted being as a liquid (78%). The average daily caloric load ingested with the foods of the hospital diet was similar between the first an third days of supplement prescription (p = 0.879) and the first and seventh days (p = 0.499). So happened when analyzing protein intake. With the supplement administration, there was a significant increase in patients' caloric intake from 310 Kcal at the third day to 337 Kcal at the seventh day (p < 0.0005) in both cases. Similar results were obtained when assessing total protein load ingested (p < 0.0005). Conclusions: Nutritional supplements are correctly used in most of the cases. They allow for a significant increase in the protein-caloric intake with no modification of hospital diet, becoming an appropriate nutritional source when the diet is insufficient.