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Do oral nutrition supplements help malnutrition?

Yes, modestly, for older adults and hospital patients. Protein-and-calorie drinks (sip feeds, not pills) added about 2% to body weight across 42 trials of older people at risk (grade A), and deaths fell in trials of 2,461 people who were already undernourished. In 2,088 hospital patients, a dietitian-planned nutrition program lowered deaths at 30 days from 10% to 7%. For frail older people at home, the evidence is weak. Severe weight loss needs a clinician first.

Last reviewed

How we grade evidenceEditorial policy

What the studies found

  • Grade A. Drinks help older people gain a little weight. In a Cochrane review of oral protein-and-energy supplements, usually ready-made sip feeds, weight rose by 2.2% in the 42 trials that measured it. Deaths were not lower overall; they were lower in trials limited to undernourished people (2,461 of them), and 24 trials showed fewer complications. (Milne 2009)
  • Grade B. Planned nutrition in hospital lowers deaths. In 2,088 medical inpatients at nutritional risk, a plan set by dietitians to reach protein and calorie goals lowered the share with a bad outcome at 30 days to 23% (from 27%) and deaths to 7% (from 10%). A 2019 meta-analysis of oral or tube nutrition in such patients found deaths of 8.3% against 11.0%. (Schuetz 2019; Gomes 2019)
  • Grade C. After discharge, results were mixed. In 652 malnourished adults aged 65 or older leaving hospital, a high-protein drink with HMB (a leucine breakdown product) twice daily did not reduce the main outcome, death or readmission at 90 days, though deaths alone were 4.8% against 9.7% on placebo. (Deutz 2016)
  • Grade C. In frail older people, the benefit is unclear. A 2022 review of 11 trials with 822 people found little evidence that drinks reduced malnutrition or its harms, with very low certainty and frequent industry funding. (Thomson 2022)

Who should be careful

  • If you have lost a lot of weight or barely eaten for days, restarting food too fast can cause refeeding syndrome: dangerous drops in phosphorus, potassium or magnesium within 5 days. Start under a clinician's care. (da Silva 2020)
  • Nausea and diarrhea were the reported side effects of sip feeds. (Milne 2009)
  • If you have kidney disease, diabetes or a swallowing problem, ask your care team which drink and how much protein suits you.
  • See a clinician for weight loss you can't explain, trouble swallowing, ongoing vomiting or diarrhea, or eating very little for more than a few days.
  • If you are pregnant, breastfeeding or under 18, ask a clinician first.

Try first

  • Ask for nutrition screening and a dietitian. In the largest hospital trial, specialist dietitians set each patient's protein and calorie goals. (Schuetz 2019)
  • Enrich ordinary meals with extra protein and energy. In a review of food fortification for older people, the 4 studies that could be pooled showed higher calorie and protein intake, though the studies were small. (Morilla-Herrera 2016)

Sources

  1. Milne AC, et al. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev. 2009. PubMed 19370584 · doi:10.1002/14651858.CD003288.pub3
  2. Schuetz P, et al. Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial. Lancet. 2019. PubMed 31030981 · doi:10.1016/S0140-6736(18)32776-4
  3. Gomes F, et al. Association of Nutritional Support With Clinical Outcomes Among Medical Inpatients Who Are Malnourished or at Nutritional Risk: An Updated Systematic Review and Meta-analysis. JAMA Netw Open. 2019. PubMed 31747030 · doi:10.1001/jamanetworkopen.2019.15138
  4. Deutz NE, et al. Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: A randomized clinical trial. Clin Nutr. 2016. PubMed 26797412 · doi:10.1016/j.clnu.2015.12.010
  5. Thomson KH, et al. Effectiveness and cost-effectiveness of oral nutritional supplements in frail older people who are malnourished or at risk of malnutrition: a systematic review and meta-analysis. Lancet Healthy Longev. 2022. PubMed 36116457 · doi:10.1016/S2666-7568(22)00171-4
  6. da Silva JSV, et al. ASPEN Consensus Recommendations for Refeeding Syndrome. Nutr Clin Pract. 2020. PubMed 32115791 · doi:10.1002/ncp.10474
  7. Morilla-Herrera JC, et al. Effectiveness of Food-Based Fortification in Older People. A Systematic Review and Meta-Analysis. J Nutr Health Aging. 2016. PubMed 26812514 · doi:10.1007/s12603-015-0591-z